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Official Magazine of FRESNO COUNTY Fresno-Madera Medical Society KERN COUNTY Kern County Medical Society KINGS COUNTY Kings County Medical Society MADERA COUNTY Fresno-Madera Medical Society TULARE COUNTY Tulare County Medical Society

December 2010 • Vol. 32 No. 12

Vital Signs

See Inside: • CMA On Call Service • CMA Regulation Quick List • Registered Valley Motorists Set to Pay $29 Million “Dirty Air” Penalty


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Vital Signs Official Publication of Fresno-Madera Medical Society

Contents EDITORIAL..................................................................................................................................5 CMA NEWS ................................................................................................................................7

Kings County Medical Society Kern County Medical Society Tulare County Medical Society

NEWS PRACTICE MANAGEMENT: CMA On-Call ......................................................................................9 CMA REGULATIONS QUICK LIST ..............................................................................................10

December 2010 Vol. 32 – Number 12 Editor, Prahalad Jajodia, MD Managing Editor, Carol Rau Fresno-Madera Medical Society Editorial Committee Virgil M. Airola, MD John T. Bonner, MD Hemant Dhingra, MD David N. Hadden, MD Prahalad Jajodia, MD Roydon Steinke, MD Kings Representative Sheldon R. Minkin, MD Kern Representative John L. Digges, MD Tulare Representative Gail Locke

MEDICAL OUTREACH: Medical Relief to Haitians Follow 7.0 Earthquake ....................................12 AIR QUALITY: Valley Motorists Will Now Pay a $29 Million Dirty-Air Penalty .................................13 CLASSIFIEDS............................................................................................................................18 CME ACTIVITIES.......................................................................................................................18 FRESNO-MADERA MEDICAL SOCIETY .......................................................................................14 • ICE Your Cell Phone • Yosemite Postgradute Institute • Order Your 2011 Pictorial Directory KERN COUNTY MEDICAL SOCIETY ............................................................................................16 • Sentinel Provider Network • KCMS Installation of Officers TULARE COUNTY MEDICAL SOCIETY.........................................................................................17 • Arpan Global Charities: Mission Alexandria, September 20-26, 2010 • Congratulations Dr. Frederick Young

Vital Signs Subscriptions Subscriptions to Vital Signs are $24 per year. Payment is due in advance. Make checks payable to the Fresno-Madera Medical Society. To subscribe, mail your check and subscription request to: Vital Signs, Fresno-Madera Medical Society, PO Box 28337, Fresno, CA 93729-8337. Advertising Contact: Display: Annette Paxton, 559-454-9331 Classified: Carol Rau, 559-224-4224, ext. 118

Cover photography: Hearst Castle’s Great Room by David Slater, MD Calling all photographers: Please consider submitting one of your photographs for publication in Vital Signs. – Editorial Committee

Vital Signs is published monthly by Fresno-Madera Medical Society. Editorials and opinion pieces accepted for publication do not necessarily reflect the opinion of the Medical Society. All medical societies require authors to disclose any significant conflicts of interest in the text and/or footnotes of submitted materials. Questions regarding content should be directed to 559-224-4224, ext. 118. V I TA L S I G N S / D E C E M B E R 2 0 1 0


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EDITORIAL Regrettable Parallels Between the Canadian Health Care Act and Obama Care by Lyle B. Stillwater, MD, FACS, Otolaryngology Past President Tulare County Medical Society

In the original Obama health care plan, House Bill HR-3200, the Obama administration would have forced the American people to pay for health care for millions of illegal immigrants in the United States. The plan was to allow illegal immigrants the benefit of taxpayer funded benefits. The original legislation contained no verification mechanism to insure that illegal immigrants did not apply for benefits. The plan was for one citizen family member to be eligible for benefits, then the entire family including illegal immigrants would also be eligible, which was essentially a taxpayer funded benefit for law breakers. However, excluding illegal immigrants was the price Obama paid for bringing conservative democrats on-board for passing his health care plan. However, it became obvious that once they became legalized through Obama’s comprehensive immigration reform legislation, there would be no such barrier. Once they would become legal, this would provide a pathway to citizenship for them and then they would be eligible for the same benefits as everyone else. His immigration plan would lead to the legalization of 12 million illegal aliens, and they would all be eligible for the new health care plan. Fifty-nine percent of all illegal immigrant adults lack health insurance, in the last reported year 2007. This number is dramatically higher than the 14% uninsured rate for U.S. born adults. The children of illegal aliens are also uninsured at extremely high rates. At least 45% of foreign born children are uninsured. Health care for illegal aliens costs Americans at least 1 billion dollars each year, not including health costs for children and the elderly. The proposed amnesty for 11 million illegal aliens will have a disastrous impact on the American economy and amnesty only serves to encourage more illegal immigration. Having millions more of illegal aliens draining our limited resources will make these resources less available for citizens and legal immigrants. The Heritage Foundation has found that the net government costs for elderly immigrants with low skills amounts to $17,000 per person per year. Half of this cost is in medical expenditures, under the Medicare/Medicaid programs. Outright the repeal of the Obama health care reform plan is not within the power of the new Congress, while President Obama is in office. With the recent Republican victories both federally and in multiple state legislatures, various government entities can try to defund specific actual roll-outs of parts of the new law and state Attorneys General are challenging provisions of the new health care law in the courts, and will probably be successful, but full repeal and replacement will have to wait for a new president and an improved Senate, and that is probably in 2013 and before the law fully kicks into place in 2014. Another Republican strategy includes limiting money for the Internal Revenue Service so that it could not aggressively enforce the provisions of the law that requires people to obtain coverage and employers to help pay for it. That provision of the law depends heavily on the fact that those who do not comply would face tax penalties. The IRS will need $5-$10 billion over 10 years to determine who is eligible for tax credits and other health care subsidies and HHS needs an equal

amount to carry out other changes mandated by the law. Republican leaders plan to use spending bills to block other elements of the law for which they object, not withstanding progress on implementing Obama care or Republican efforts in the house, to repeal as much of it as possible. Over the next two years Obama himself will try to enact amnesty for 11 million illegal immigrants and shift funds from Medicare to Medicaid to help insure them. The Canadian Health Care Act allows legal immigrants to have full health care coverage upon arriving in Canada with permanent residency, within three months of their arrival. After three months in Canada they essentially benefit from the same universal health care system that exists for Canadian citizens, who have contributed to the cost of the system throughout their working lives. In Canada most provinces set a global yearly expenditure for health care, and even with increased enrollment in their system, the size of the health care pie remains the same, even if new legal immigrants are added. This has the effect of diluting available resources to long established legal citizens. The effect can be seen in longer waiting lists for needed diagnostic procedures and elective surgeries, as well as much longer waiting lists for available nursing home beds and other support services. Given the horrific deficit spending now occurring at the federal level, if Obama is successful in a blanket amnesty program, the same effect will be felt in the United States. At some point, there will have to be a cap on yearly costs for Medicaid and Medicare services, and by increasing the number of now illegal immigrants involved in the plan, current citizens dependent on these plans will be further displaced, finding it necessary to compete with those who have never contributed equally to the financial viability of federal and state health plans. Of note is the fact that members of Congress, both Senate and House, and members of the executive branch and the judicial branch federally have a separate health care system apart from the rest of the citizenry. They would not feel the effects of dilution of available resources, by the addition of 11 million illegal immigrants in an amnesty program. Also as far as the social security program, they again have a separate plan that would not be affected by the addition of an almost infinite number of new retirees. The Canadian system has only the burden of taking care of 26 million people total, for the whole country. Their social welfare system is also supported by a constant enrichment of the Canadian federal government by an almost infinite number and flow of natural resources, while the American HHS funded through the federal government is supported mainly by corporate and federal and state taxes. Both Medicare and social security are now essentially drained of any reserves. It seems unfair in both countries, that those who contribute to the cost of the plans for many years with a view to adequate health care in their later years, are now lumped together with recent immigrants, both legal and potentially illegal in the Untied States. This competition for limited resources, in both countries seems very unfair, whether Obama care is repealed or not. V I TA L S I G N S / D E C E M B E R 2 0 1 0


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At its annual House of Delegates conference earlier last month, the California Medical Association adopted principles for physicians to follow in evaluating accountable care organizations (ACOs) and medical foundations. One key element of health care reform involves establishing ACOs as a new model of care. Under the new law, groups of physicians who see Medicare patients and agree to work together – meeting certain government requirements to qualify as an ACO – would be eligible for bonuses if they meet spending benchmarks for caring for their patient population and other criteria. Many in the health care industry see ACOs as an opportunity to capitalize on health reform, realign and boost overall cost effectiveness, but exactly how ACOs will work remains unclear, as the federal government still must spell out regulations. Physicians need to make prudent decisions in the near future about their interest in participating, if they are to take advantage of the opportunities created by new health care reform laws and regulations. CMA’s adopted principles include: Guiding principle – The goal of an accountable care organization (ACO) is to increase access to care, improve the quality of care and ensure the efficient delivery of care. Within an ACO, a physician’s primary ethical and professional obligation is the well-being and safety of the patient. ACO governance – ACOs must be physician-led and encourage an environment of collaboration among physicians. ACOs must also be physician-led in order to ensure that a physician’s medical decisions are not based on commercial interests but rather on professional medical judgment that puts patients’ interests first. Voluntary participation – Patient participation in an ACO should be voluntary rather than a mandatory assignment by Medicare. Any physician organization (including an organization that bills on behalf of physicians under a single tax identification number) or any other entity that creates an ACO must obtain the written affirmative consent of each physician to participate in the ACO. Physicians should not be required to join an ACO as a condition of contracting with Medicare, MediCal or a private payor or being admitted to a hospital medical staff. Savings used for patient care – The savings and revenues of an ACO should be retained for patient care services and distributed to the ACO participants. An ACO’s savings and revenues should not go to insurers. Flexibility in patient referral and antitrust laws – The federal and state anti-kickback and self-referral laws and the federal Civil Monetary Penalties (CMP) statute (which prohibits payments by hospitals to physicians to reduce or limit care) should be sufficiently flexible to allow physicians to collaborate with hospitals in forming ACOs without being employed by the hospitals or ACOs. This is particularly important for physicians in small and medium size practices who may want to remain independent but otherwise integrate and collaborate with other physicians (i.e., so-called virtual integration) for purposes of participating in the ACO.

For more detailed information, please visit CMA’s website to read the full report from CMA’s Physician-Hospital Alignment Technical Advisory Committee. CMA will continue to keep members apprised of all significant developments concerning ACOs and federal health care reform, as they unfold. Contact: Francisco Silva, 916-444-5532 or


Medicare claims received on or after January 3, 2011, will not be paid if the ordering or referring provider is not enrolled in PECOS (Provider Enrollment, Chain and Ownership System). Physicians should also be aware that PECOS enrollment is required to receive federal EHR incentives under the Medicare program. Beginning in 2011, Medicare providers who demonstrate “meaningful use” of an EHR stand to receive up to $44,000 in incentive payments over five years. Palmetto GBA, California’s Medicare carrier, recently identified 3,500 California providers (physicians and other practitioners who order services) who still do not have a record in PECOS. Over the next several weeks, these providers will receive letters from Palmetto notifying them of the need to enroll. Physicians are urged to complete the application process as soon as possible. Applications are generally processed within 60 days, but can take longer if the application is incomplete or additional information is needed. Physicians who wish to take advantage of the incentive payments available for electronic prescribing, PQRI, and electronic health record program must be enrolled in PECOS. CMA has also developed a step-by-step guide to walk physicians through the process, from determining if they are already in PECOS to helping them navigate the Internet-based PECOS enrollment system. This guide is available at the members-only website. CMA also hosted a PECOS enrollment webinar with Palmetto. The previously recorded webinar is available for ondemand viewing at the members-only website. Physicians who need help with the enrollment process can contact CMA’s member service center, 800-786-4CMA (4262) or, for assistance. Contact: CMA’s member service center, 800-786-4CMA or



are reminded that before they sign a health plan contract, it is important to know what value that relationship will bring to their practice. Physicians do not have to accept contracts that are not mutually beneficial. To help physicians negotiate and manage complex third-party payor agreements, CMA has published a contracting tool kit, “Taking Charge: Steps to Contracting.” The tool kit is available free to members at the members only website: member (click on “Reimbursement Advocacy” under “Physician Advocacy” in the main menu.

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CMA ON-CALL: Medical Records The California Medical Association’s Information-On-Demand Service Online: DOCUMENT #1100 Medical Records: Most Commonly Asked Questions January 2010 DETERMINING HOW TO RESPOND TO REQUESTS FOR MEDICAL INFORMATION “I thought medical information was confidential. How should I respond to the numerous requests I get for copies of my patients’ medical records?” As a general rule, medical information is confidential. The reason for this principle is clear: without a reasonable guarantee of confidentiality, patients may not seek treatment or will fail to disclose the often very personal information the physician needs to provide necessary care. Consistent with the societal need to protect the confidentiality of medical information, physicians have both a legal and ethical duty to protect that confidentiality on behalf of their patients.1 Generally speaking, physicians will meet both their legal and ethical obligations by complying with one simple rule:


Don’t release medical information to anyone other than the patient without the patient’s signed authorization. Unfortunately, this is not a perfect rule. Sometimes the law demands that medical information be released despite the lack of authorization. Sometimes the law prohibits release even with the patient’s authorization. And sometimes the law gives physicians discretion to release information without authorization. Thus, physicians must establish a system for complying with a complex maze of confidentiality rules. Many attorneys believe the easiest way of keeping these rules straight is to consider first who is asking for the information, and then and only then, whether the type of information requested raises any special confidentiality concerns. To determine what laws may apply to the request you have received, you will need to determine who is asking for the information; once you have determined who is requesting the information, you should review the CMA ON-CALL document discussing access by the relevant party.


CMA ON-CALL Document

Attorneys a. Pre-litigation requests for records (Evidence Code §1158 or Civil Code §56.105 requests) b. Subpoenas c. Subpoenas for sensitive information

CMA ON-CALL document #1127, “Attorney Pre-Litigation Request for Medical Information”CMA ON-CALL document #1180, “Subpoenas: Guide for Responding ”CMA ON-CALL document #1110, “Confidentiality of Sensitive Medical Information”


CMA ON-CALL document #1145, “Employer Access to Medical Records/ Employment Physicals”

Health Plans

CMA ON-CALL document #1147, “Requests by Law Enforcement/Search Warrants”

Local Health Officers

CMA ON-CALL document #1170, “Health Plan Access to Medical Records”

Medical Board of California Investigators

CMA ON-CALL document #1187, “Disclosure of Immunization Information”

Medi-Cal or Medicare Investigators

CMA ON-CALL document #0705, “Medical Board Investigations”


CMA ON-CALL document #1148, “Medi-Cal and Medicare Investigators’ Access to Medical Records”

QIOs (Lumetra)

CMA ON-CALL document #1150, “Patient Access to Medical Records”

Requests by Other Third Parties (not covered above)

CMA ON-CALL document #1155, “QIO Access to Physician Office Charts”

Requests by Other Third Parties for Sensitive Medical Information

CMA ON-CALL document #1110, “Confidentiality of Sensitive Medical Information”

This ON-CALL document has been reviewed and updated by the American Medical Association. V I TA L S I G N S / D E C E M B E R 2 0 1 0


C M A R E G U L AT I O N S Q U I C K L I S T CMA's Regulations Quick List provides a summary and current status of significant regulations followed by CMA's Center for Medical & Regulatory Policy. The Quick List is circulated regularly on a monthly basis or more frequently, as needed. For more information on a specific regulatory package, please contact the appropriate staff member identified at the end of each regulation summary by e-mail or by calling 916-444-5532.

STATUS SCOPE OF PRACTICE IN LICENSED HEALTH FACILITIES (California Department of Public Health, CDPH) This regulatory package dramatically increases the scope of practice for a variety of licensed health care providers in hospital settings. These regulations allow non-physician practitioners to admit patients, perform medical examinations, place patients in restraints, complete medical records, coordinate care, and order transfers. In an earlier iteration, these regulations also contained provisions that would have defeated the right of medical staff self-governance, but which were removed after strong opposition from CMA. On October 14, 2009, the Office of Administrative Law (OAL) disapproved the regulations, thus beginning the 120 day period for CDPH to submit a revised package. The revised language was then approved by the OAL on March 3, 2010. CMA remains strongly opposed to these regulations.

Noticed: 7/11/08. Disapproved by OAL 10/9/09, Second 15-day comment period: 11/20/09-12/7/09, CMA comments submitted 12/7/09. Revisions sent to OAL 2/11/10. Approved by OAL: 3/3/10. EFFECTIVE: 4/2/10.

MANIPULATION UNDER ANESTHESIA (Board of Chiropractic Examiners) These regulations allow chiropractors to perform manipulation on a patient who is under anesthesia administered by a physician, surgeon or other authorized health care provider. CMA repeatedly urged the Board to withdraw this regulatory proposal and remains concerned that Manipulation Under Anesthesia is outside the lawful scope of chiropractic practice.

Noticed: 1/12/09. Fourth 15-day comment period: 10/28/09-11/12/09, CMA comments submitted 11/12/09. Approved by OAL: 2/16/10. EFFECTIVE: 3/18/10.

LETHAL INJECTIONS PROCESS (California Department of Corrections and Rehabilitation) These regulations require physician participation in lethal injections. Although the regulations do not require a physician to administer the lethal injection chemicals, they do require a number of execution-related tasks to be performed by a physician. The adopted language requires a psychiatrist to certify that an inmate is mentally competent for execution – a direct violation of AMA and CMA policy. CMA remains opposed to these standards.

Noticed: 5/1/09. 2nd 15-day notice: 6/11/10-6/25/10, CMA comments submitted 6/25/10. Revisions sent to OAL 7/6/10. Approved by OAL: 7/30/10. EFFECTIVE: 8/29/10.

RESCISSION AND UNDERWRITING (Department of Insurance, DOI) These regulations provide protections for consumers in the event a health insurer attempts to rescind their individual health coverage. These regulations establish standards for patient health history questions on insurer applications, broaden medical underwriting requirements for insurers, and set new agent attestation and notification requirements when applications are submitted to insurers. CMA attempted to establish an independent third party review on all proposed rescissions before they get finalized and urged DOI to require insurers to prove that the consumer intentionally misrepresented facts prior to rescission (consistent with new federal reform law) in the regulation. However, DOI declined both suggestions because they lack statutory authority to include them in the regulations. CMA will continue to push these two issues legislatively.

Noticed: 6/5/09. CMA comments submitted 7/14/09. First 15-day comment period: 4/19/10-5/4/10, CMA comments submitted 5/4/10. Approved by OAL 7/19/10. EFFECTIVE 8/18/10.

TIMELY ACCESS REGULATION (Department of Managed Health Care, DMHC) These regulations require health plans and physicians to abide by specific time standards when setting up appointment for patients (e.g., urgent care appointments within 48 hours of the requested appointment). CMA submitted comments to give physicians more flexibility in abiding by the specific time standards, and to prohibit health plans from passing on administrative costs to physicians associated with the implementation of the regulation. CMA continues to work with DMHC’s implementation team to ensure that the regulations are implemented in a reasonable manner.

Noticed: 9/25/09. CMA comments submitted 10/7/09. Approved by OAL 12/21/09. EFFECTIVE: 1/17/10. HMOs must demonstrate compliance plans to DMHC: 10/17/10. Full implementation by HMOs required: 1/17/2011

At the urging of CMA, DMHC conducted a survey of the number of health plans that were intending to delegate requirements under Timely Access Regulations. DMHC indicated that major health plans, including Aetna, Anthem Blue Cross, Blue Shield of California, CIGNA, Health Net and PacifiCare indicated that they will retain responsibilities under the Timely Access Regulations. However, the following smaller health plans are going to delegate timely access requirements to their contracting medical groups and providers: CalOptima; Care 1st Health Plan; Central Health Medicare Plan; Chinese Community Health Plan; Community Health Group; PrimeCare; Golden State Medicare Health Plan; Health Plan of San Mateo; Inland Empire Health Plan; Monarch Health Plan, Inc.; Santa Clara Family Health Plan; and Universal Care. CMA updated its Timely Access Guide to identify delegating and non-delegating health plans for our members and has shared the updated guide with local medical societies and members. GLAUCOMA CERTIFICATION REQUIREMENTS (Board of Optometry) These regulations were issued as a result of SB 1406 (Correa), which was chaptered in 2008. These regulations would establish requirements that optometrists must meet in order to be issued a certificate to treat glaucoma. The regulations would allow optometrists to treat glaucoma without requiring any hands-on training, to which CMA has continually testified in strong opposition. After continual prodding from CMA and the California Academy of Eye Physicians and Surgeons (CAEPS), the Board of Optometry amended the regulations to require glaucoma-certified optometrists to complete 10 hours of glaucoma specific optometric continuing education every license renewal period. CMA remains concerned that these regulations fail to meet the legislative intent of SB 1406 by not adequately protecting patient safety and filed a petition on June 7, 2010 along with CAEPS and the American Glaucoma Society asking the Director of the Department of Consumer Affairs (DCA) to disapprove the proposed regulations. These regulations were approved by the DCA Director and sent to the Office ofAdministrative Law for decision. Due to CMA opposition, the Board of Optometry withdrew the proposed regulations on September 24, 2010. The amended proposal was noticed and public comments will be considered at a public meeting on October 22, 2010.

Noticed: 11/12/09. CMA comments submitted 12/21/09, 4/7/10. Board approval 5/11/10. Department of Consumer Affairs Approval 6/16/10. Withdrawn by Optometry Board 9/24/10. Amended regulations Noticed: 10/5/10. Comment period 10/5/10-10/19/10. CMA comments submitted 10/19/10. Expected Decision: 11/6/10.

LIMITED LICENSE PRACTICE (Medical Board of California) This proposed regulation sets forth requirements and criteria for the limited practice license. Legislation, AB 501, effective January 1, 2010 authorizes the Medical Board to issue a limited practice license to an applicant for licensure who is otherwise eligible for a medical license in California but is unable to practice all aspects of medicine safely due to a disability.

Noticed: 9/8/10. Comment period: 9/8/10-10/25/10. Public Hearing: 11/5/10.


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STATUS DISCOUNT HEALTH PLANS (Department of Managed Health Care) The Department of Managed Health Care (DMHC) is currently considering regulations that would allow them to regulate “discount health plans.” The discount health plan business model generally market discount health services to employers and individual consumers. Services can include dental, chiropractic, pharmacy, acupuncture, physician, hospital or basic medical care. The programs typically charge a monthly or annual fee in exchange for a list of participating providers whose services will be provided at a "discount." Marketing of these programs has increased through the use of the Internet and fax machines. CMA has submitted written and oral comments in opposition to the regulations.

Noticed: 1/8/10. CMA comments submitted 2/22/10. Second 45-day comment period: 8/6/10-10/6/10. CMA comments submitted 10/6/10. Expected Decision: 1/8/11.

DMHC recently unveiled an amended version of this regulation. CMA is preparing to challenge these regulations via a public hearing and will be working to mobilize its membership in advocating against these regulations. At the request of CMA, Senate and Assembly Republican leaders sent a letter to DMHC questioning its authority to promulgate the proposed discount regulations. On October 5, 2010, at the request of CMA, DMHC held a public hearing on the discount health plans regulations in Sacramento. On behalf of CMA, Dr. Paul Phinney testified to express our concerns with legalizing discount health plans in California. DMHC’s comment period ended on October 6, 2010. ELECTRONIC AND STANDARDIZED MEDICAL TREATMENT BILLING (Division of Workers’ Compensation) These regulations would encourage both Workers’ Compensation insurers and providers to transition to electronic billing. They would implement standard claims forms to be used in workers’ compensation cases, clarify that workers’ compensation insurers are subject to HIPAA rules, and increase penalties on insurers that fail to pay physicians in a timely manner. In addition, these regulations would clarify rules and procedures to be used in electronic billing. CMA supported this regulation as electronic billing is often a more efficient means of submitting claims to payers.

Noticed: 3/5/10. CMA comments submitted 4/23/10. Expected Decision: 3/5/11.

Resource-Based Relative Value Scale (RBRVS) FEE SCHEDULE (Division of Workers’ Compensation) This proposed regulation would transition physician payment in workers’ compensation from the current Official Medical Fee Schedule (OMFS) to an RBRVS system. CMA has long opposed using RBRVS for workers’ compensation, as we believe it does not adequately reimburse physicians for the extra time and administrative burdens involved in treating workers’ compensation patients. The formal regulation process will begin sometime later this year.

Noticed: 3/22/10. Informal comment period: 3/22/104/5/10. CMA comments submitted 4/5/10.

HIT/MEDICAID FEDERAL REGULATIONS MEANINGFUL USE OF ELECTRONIC HEALTH RECORDS (Center for Medicare and Medicaid Services) Under the American Recovery and Reinvestment Act (ARRA, also known as the “Stimulus Bill”), most Medicare and Medi-Cal provider physicians are eligible to receive up to roughly $44,000 through Medicare and $65,000 through Medi-Cal for demonstrating “meaningful use” of an electronic health record (EHR) system. This Federal rulemaking institutes the first stage of the definition of meaningful use. CMA is pleased that the final version of this rule provides physicians more flexibility in demonstrating meaningful use than the earlier proposal.

Language released: 12/30/09. CMA comments submitted 3/12/10. Final Rule released 7/13/10. Official Notice 7/28/10. Effective 9/26/10.

CERTIFICATION OF ELECTRONIC HEALTH RECORDS (Center for Medicare and Medicaid Services) In order to qualify for Federal electronic health record (EHR) provider incentives, physicians must use a certified EHR system. These regulations would lay out two processes through which systems would be certified. The first process has already begun, but is only temporary. The second process will take longer to begin, but will be permanent. CMA submitted comments urging this process to be as inclusive and straightforward as possible, grandfathering in legacy systems.

Noticed in Federal Register: 3/10/10. 30-day comment period on temporary program 3/10/2010-4/9/2010, CMA comments submitted 4/5/10. The Temporary Certification Program is already in effect. The regulations for the Permanent Certification Rule are expected in 2011.

ELECTRONIC PRESCRIBING OF CONTROLLED SUBSTANCES (Department of Justice) This interim final rule (IFR) would, for the first time, allow physicians to transmit prescriptions for controlled substances electronically. The regulations will also allow pharmacies to receive, dispense, and archive these prescriptions. Recent CMA policy (HOD 109-09) supports the establishment of requirements enabling the use of e-prescribing for controlled substances. However, we objected to restrictions placed on physicians via these regulations as being too onerous for physician practices.

Noticed in Federal Register: 3/31/10. CMA comments submitted 5/31/10. The Final Rule is expected in late 2010 or early 2011.

MEDICAID PROGRAM; PREMIUMS AND COST SHARING; FINAL RULE (Center for Medicare and Medicaid Services) This Federal regulation lays out rules that states must comply with prior to implementing copayments or other cost-sharing in their Medicaid programs. For example, it requires that states have processes in place to guarantee that Medicaid patients do not spend more than 5 percent of their income on co-payments or cost-sharing. These regulations are important in light of the Governor’s proposed Budget, which would implement co-payments in the Medi-Cal program, which physicians would be expected to collect in lieu of a portion of their payments.

Noticed in Federal Register: 5/28/10. EFFECTIVE: 7/1/10.

MODIFICATIONS TO THE HIPAA PRIVACY, SECURITY, and ENFORCEMENT RULES (Department of Health and Human Services) This proposed rule implements changes to HIPAA which were enacted as part of the Stimulus Act. Specifically, the rule expands individuals’ rights to access their information, requires business associates of HIPAA-covered entities to be under most of the same rules as the covered entities, and prohibits the sale of protected health information without patient authorization. The rule also enhances enforcement of HIPAA.

Noticed in Federal Register: 7/14/10. CMA comments submitted 9/13/10.

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Medical Relief to Haitians Follow 7.0 Earthquake Submitted by Lieutenant Joe Martin, Reserve Medical Programs Recruiter

When a 7.0 magnitude earthquake shook the island nation of Haiti on January 12, 2010, the US Navy responded with 17 ships, 48 helicopters and 12 fixed-wing aircraft, staffed by 10,000 Sailors and Marines. The Navy’s contribution to Operation Unified Response was part of a larger US response to a request from the government of Haiti for urgent humanitarian aid. “This is why we train,” said Commander Melanie Merrick, senior medical officer aboard USS Bataan (LHA 5). “We are equipped for these types of injuries to provide resuscitation and stabilization. We will continue to assess the individuals and go from there.” The Bataan arrived off the coast of Haiti Jan. 18, 2010, and immediately began providing assistance. A multipurpose amphibious assault ship that normally carries almost 2,000 Marines, Bataan has an 800-bed hospital, an afloat capacity second only to the Navy’s hospital ships. Also contributing the on-scene medical support was the aircraft carrier USS Carl Vinson (CVN 70), with its 200-bed hospital. The capstone of the United State Navy’s medical relief efforts arrived with the hospital ship USNS Comfort, a floating 1,000 bed hospital, representing all the capacity of Portsmouth Naval Hospital. Comfort alone treated 871 patients and performed 843 surgeries. Soon after arriving on station, Comfort was receiving patients every six to nine minutes during its first four days and had more than 540 critically-injured patients on board within the first 10 days. During this initial phase of its mission, the Navy hospital ship ran 10 operating rooms at full capacity to care for injured Haitian, American and other foreign national earthquake victims requiring surgical care. This deployment marked the first time the ship reached full operational capacity, utilizing all operating rooms and beds, since it was delivered to the Navy in 1987. By March, US Military support of the relief efforts included: • US Government Medical Personnel in Haiti (peak level) . . . . . . . . . . . . . . . . . . . . . . . . . . 1,100 • Hospital Beds Provided (peak level) . . . . . . . . . . . . . 1,400 • Patients aboard all ships (peak level) . . . . . . . . . . . . . . 543 • Pounds of medical supplies developed . . . . . . . . . . 149,045 • Number of surgeries performed by US Military . . . . 1, 025 • Number of medical evaluations. . . . . . . . . . . . . . . . . . . 343 • Number of patients treated by US Military . . . . . . . . 9,758

AFTERWORD: The Navy relies heavily on Navy Reserve doctors, dentists, nurses and a host of other health care providers to provide the needed surge capacity to bring these floating hospitals to life. Working for the Navy only two days a month, and training two weeks each year, these part time health care providers are the human element of the Navy’s ability to provide humanitarian assistance and disaster relief around the world. The Navy is actively seeking Reserve (part time) health care professionals. Basic eligibility requirements are US Citizenship,


D E C E M B E R 2 0 1 0 / V I TA L S I G N S

ability to complete 20 years of service prior to 62nd birthday (68 for physicians – waivers are routinely considered for certain specialties and for those are willing to waive retirement eligibility). Graduation from a US accredited school granting a MD, DO, DDS, or DMD, and current licensure. Navy nurses must have a BSN or higher nursing degree from a US accredited school, RN license, and three months experience. All other health care specialties have specific professional requirements, most requiring a masters or doctoral degree. In addition to their part-time salaries, Navy Reserve health care professionals enjoy affiliation bonuses ranging up to $25,000 for three years for certain specialties, earned retirement benefits, inexpensive health care insurance, educational benefits for spouses and children, access to officers’ clubs and military recreational facilities worldwide, space available travel on military aircraft, and the camaraderie of serving not only as a medical professional, but as a commissioned officer in the United States Navy. Anyone interested in being part of such operations is invited to contact Lieutenant Joe Martin, Reserve Medical Programs Recruiter, via email, or his cell phone 559-217-0781.


Registered Valley Motorists Set to Pay $29 Million Dirty-Air Penalty by Michelle Garcia, Air Quality Director


Air officials indicate October the San Joaquin Valley Air Pollution Control PAYING THE PRICE that if businesses are District (SJVAPCD) made a ruling to have registered San Only vehicles registered in charged with the fee, the Joaquin Valley motorists pay most of a $29 million penalty fee San Joaquin Valley counties dollars would go into the incurred for failing to meet the federal standard. This will pay the $12 fee. DIRTY ozone AIR DIP U.S. Treasury and not ruling is the first of its kind in the nation. Onlyhave two reduced air districts Businesses Pollution sources smog-forming oxides nitrogen into Valley air cleanup have even discussed the option of charging motorists for of missing by 75% since 1980, projects. State law allows an ozone deadline – the SJVAPCD and the South Coast Air Cars/trucks Managed burns, officials say. this vehicle fee to remain Quality Management District in Southern California. motorcycles fireplaces 3.4% with the district. The SJVAPCD board members Tonsvoted per dayunanimously to 9% Air district officials institute a $12 annual fee to be paid by Valley motorists even Off-road 300 fear that this approach though they are reported to create less than a tenth of the tractors, construction 24.6% makes sense and that it Valley’s ozone problem. If the district’s action is approved by 47.8% equipment 250 up in court, 2.8 million would be unfair to state and federal agencies and holds 15.1% burden Valley businesses, Valley owners of registered vehicles will begin paying the 200 which have paid $40 additional fee late next year. The US Environmental Protection Business, billion in the last three Agency must approve the idea by next summer or the Valley will industrial, Heavy-duty petroleum decades to reduce their face sanctions, including increased150 costs for new businesses and trucks/buses operations pollution by 75% and temporary loss of road-building funds of about $250 million a 100 who are being driven out year. Who pays, who doesn’t of the area. Air board According to the California Air Resource Board (CARB) members seem interested passenger vehicles (cars, pickups and 50SUV’s) make up only 9% Exempt Subject to penalty in discussing a rebate for THE PRICE of the ozone problem, but they also report that all vehicles, PAYING Most of the $29 million penalty vehicles in or whoregistered own hybrid 0 which include diesel Onlythose will be paid by drivers whose San Joaquin Valley counties ’80 ’85 ’90 ’95 ’00 ’05 ’10 electric vehicles. trucks, buses and off road vehicles create 9% of the will pay the $12 fee. DIRTY AIR DIP Source: San Joaquin Valley Air The goal of the $12 vehicles are responsible problem. While heavy-duty Businesses have reduced Pollution Control District surcharge is to collect for the largest source of Pollution truck and bus traffic passing sources smog-forming oxides of nitrogen THE FRESNO through the Valley creates pollution at 81.4%. Most BEEroughly $30 million by 75% since 1980, Cars/trucks Managed burns, 47.8% of pollution, up to half officials say. annually, which would registered vehicles in the motorcycles of these polluters escape the fireplaces 3.4% be used by the air district Central Valley are fee because these vehicles Tons per day 9% at via programs aimed passenger cars, pickups are registered elsewhere. Off-road 300 helping to buy new and SUV’s. Diesel trucks tractors, Source: California Air Resources 24.6%help diesel school buses, that travel through the construction Board, San Joaquin Valley Air 47.8% equipment 250 truck owners buy new Valley, tractors, conPollution Control District 15.1% equipment and invest in struction equipment, THE FRESNO BEE mass transit. and trains would be 200 Business, “As a matter of principle, I oppose fees and penalties because exempt because they industrial, they're form of tax,” said Kern County Supervisor Ray aren’t registered locally petroleum another Heavy-duty 150 trucks/buses operations Watson, who also serves on the San Joaquin Valley Air Pollution with the Department of Control District board. "I don't think we have a choice,” he said. Motor Vehicles. 100 Who pays, who doesn’t “I think we need to adopt the surcharge.” Clean air advocates The counties within the SJVAPCD include San Joaquin, will likely challenge the Exempt 50 Subject to penalty Stanislaus, Merced, Madera, Fresno, Kings, Tulare and Kern. decision citing the adFor more information on this and other clean air topics and to vice of the EPA, which Most of the $29 million penalty 0 will be paid by drivers whose learn how you can get involved contact: Michelle Garcia, Fresnoindicates that the ’80 ’85 ’90 ’95 ’00 ’05 ’10 vehicles create 9% of the Madera Medical Society Air Quality Director at 559-224-4224 highest-polluting busiSource: San Joaquin Valley Air problem. While heavy-duty Pollution Control District ext. 119 or nesses should incur the truck and bus traffic passing penalty. THE FRESNO BEE through the Valley creates 47.8% of pollution, up to half of these polluters escape the fee because these vehicles are registered elsewhere. Source: California Air Resources Board, San Joaquin Valley Air V I TA L S I G N S / D E C E M B E R 2 0 1 0 Pollution Control District THE FRESNO BEE



ICE Your Cell Phone!

Post Office Box 28337 Fresno, CA 93729-8337 1382 E. Alluvial Avenue #106 Fresno, CA 93720

IN CASE OF EMERGENCY Programming ICE into your mobile phone allows emergency responders to contact a designated person if you are incapacitated in an emergency situation.

559-224-4224 Fax 559-224-0276 website:

FMMS Officers Harcharn Chann, MD President Oscar Sablan, MD President-elect Robb Smith, MD Vice President Krista Kaups, MD Secretary/Treasurer Cynthia Bergmann, MD Past President

HOW TO ICE YOUR PHONE: • Choose a responsible person to be your ICE contact; one who knows your medical history. The person must agree to be your ICE contact. • Type in ICE, then the full contact name (ICE John Smith). Add phone may list more than one ICE contact (ICE 1 John Jones; ICE 2 Mary Smith). • For security purposes, do not list titles to names (i.e. “mother”, “father”, “boss”). • Cell phone or address book cannot be password-protected.


Board of Governors Ujagger Singh Dhillon, MD David Hadden, MD Sergio Ilic, MD Prahalad Jajodia, MD Yuk-Yuen Leung, MD Stewart Mason, MD Ranjit Rajpal, MD Krishnakumar Rajani, MD Bonna Rogers-Neufeld, MD Rohit Sundrani, MD Muhammad Sheikh, MD Philip Tran, MD

Mark Your Calendar April 1-3, 2011

Yosemite Postgraduate Institute

CMA Delegates FMMS President John Bonner, MD Adam Brant, MD Denise Greene, MD Brent Kane, MD Kevin Luu, MD Andre Minuth, MD Robb Smith, MD Roydon Steinke, MD Toussaint Streat, MD CMA Alternate Delegates FMMS President-elect Sergio Ilic, MD Prahalad Jajodia, MD Toby Johnson, MD Peter T. Nassar, MD Trilok Puniani, MD Rajeev Verma, MD CMA YPS Delegate Paul J. Grewall, MD CMA YPS Alternate Yuk-Yuen Leung, MD CMA Trustee District VI Virgil Airola, MD Staff: Sandi Palumbo Executive Director 14

Brochure to follow in January 2011 For further information, call the Fresno-Madera Medical Society, (559) 224-4224 x118 e-mail: • website:

D E C E M B E R 2 0 1 0 / V I TA L S I G N S

Fresno-Madera ORDER YOUR 2011 PHYSICIAN PICTORIAL DIRECTORY Orders are now being taken for the 2011 edition of the Fresno-Madera Medical Society (FMMS) Pictorial Directory, due for delivery in January, 2011. This directory also includes listings of hospitals, pharmacies, and other health-related resources.

, Alex O. HABIBE S , Harold GRO OM


*OB G arstow #10 8 347 E . B 10 00 9 937 Fresno 0 / F AX: 2 24-9 224-090 Sch Med ’75 U Pittsburg

athan D. AN, Jon GROSSM PM . Herndon 1630 E 06 93720 Fresno 3 / F AX: 261-19 256-595 e’s U niv St. G eorg ’03 Med S ch of

en M . AN, S teph GRO SSM M-G ER IM-CC e #10 1 87 E . Oliv 28 937 Fresno 8 299-282 Med Sc h ’86 Chicago

SER GULES H. Dickran


Grp IM-C D Multi-Specialty S pruce S pruce # 101 1275 E. 03 937 20 Fresno 7 / F AX: 24 3-13 ’85 of Med 439-575 Univ S ch Tulane

#105 *IM H erndon 1383 E. 136 937 20 Fresno 1 / FA X: 2 33-8 ’02 233-469 Univ Sch of Med St. Lo uis

T. T , Leonard HAC KETM-*ON 0

*IM-*HE Millbrook #10 7130 N. 93720 : 4 47-4 925 Fresno / FAX 447-4949 r Univ ’77 McMaste

Physician members of FMMS will automatically receive a complimentary copy of the directory. Additional directories can be purchased at the member rate of $20 each. They will be delivered or mailed directly to the physician’s address as shown on FMMS’ membership data base.

t Margare CK , M. HAD COast S urgery

*GS-Bre Fresn o #102 6167 N. 343 93710 Fresno 0 / F AX: 3 20-4 320-430 Stritch ’7 9 U Loyola


K, William


#10 1 *VS . Alluvial 1247 E 93720 : 44 0-9005 Fresno / FAX 431-6 226Stritch ’77 U Loyola


M. , David

*PTH-C Palm #20 0 5151 N. 43 2 9370 4 Fresno 0 / F AX: 2 26-8 Med ’67 226-120 land S ch U Mary

orah L. A, Deb GU MIN alists

S peci *GS urgical Valley S S pruce #1 01 1125 E. 9372 0 : 4 50-39 03 Fresno 01 / FAX 450-39 la ’90 U of Loyo

J. , Steven HAG ER M-IM

s *ON-*HEC are Asso ciate Cancer Fir . 1791 E 937 20 3 26-12 25 X: Fresno 22 / FA 326-12 of Osteo ’84 NY C ol

, Steven ESON GUSTAV *IM 4thS t. 1111 W. 93637 Madera 0 673-300 Univ ’90 Tulane

gshik HAN , Hon

*PS-*HS Maple #108 7005 N. 937 20 603 Fresno 32 / FA X: 3 25-2 325-38 Chicago ’96 Univ of

, Brian GUTH RIE *PD don 2071 Hern 11 Clovis 936 0 324-551is ’85 UC Dav Fres

ty 2010 ical S ocie era Med no–Mad

y Director


FMMS non-members may purchase directories for $30 each. Hospitals, governmental agencies, businesses and individuals do NOT qualify for the member rate. Sales tax and shipping are included in the price.

All orders are payable in advance. To purchase, please complete this order form, and return it with your check or credit card payment. To assist us in ordering sufficient copies and to assure your reservation, please order by Dec. 15, 2010. Credit card purchases may be faxed to 559-224-0276. For additional ordering information, please contact FMMS at 559-224-4224 ext. 118 or

2011 FMMS


NOTE: Physician members receive one complimentary copy. NOTE: Physician members receive one complimentary copy

I am a member physician.

Send______ copy(ies) @ $20 each = $__________

I am not a member physician. Send______ copy(ies) @ $30 each = $__________ Check enclosed (payable to FMMS) Name:__________________________________________________Phone_____________________________ Organization:_______________________________________________________________________________ Delivery address:___________________________________________________________________________ City, State, Zip code:________________________________________________________________________ Credit card payment:



Card #:_________-_________-_________-_________ verification #_________ Expiration Date:___________ Cardholder’s Name:________________________________________________ Billing zip code:___________ Signature:__________________________________________________ Order Date:_____________________ Please return this form by December 15, 2010

Fresno-Madera Medical Society P.O. Box 28337 - Fresno, CA 93729-8337 Fax: 559-224-0276

V I TA L S I G N S / D E C E M B E R 2 0 1 0



Kings Sentinel Provider Network by Portia S. Choi, MD, MPH KCMS 2011 President-Elect

2229 Q Street Bakersfield, CA 93301-2900 661-325-9025 Fax 661-328-9372 website:

KCMS Officers Mark L. Nystrom, MD President Portia S. Choi, MD President-elect Philipp Melendez, MD Secretary Ronald L. Morton, MD Treasurer Bradford A. Anderson, MD Immediate Past President Board of Directors Joel Cohen, MD Lawrence Cosner, Jr., MD Noel Del Mundo, MD John Digges, MD Mathilda Klupsteen, MD Hemmal Kothary, MD Calvin Kubo, MD Peter McCauley, MD Anil Mehta, MD Tonny Tanus, MD CMA Delegates: Jennifer Abraham, MD Eric Boren, MD John Digges, MD Ronald L. Morton, MD CMA Alternate Delegates: Lawrence Cosner, Jr., MD Philipp Melendez, MD Michelle Quiogue, MD Staff: Sandi Palumbo, Executive Director Kathy L. Hughes Membership Secretary

With the 2010/2011 influenza season upon us, the Kern County Public Health Services Department is hoping to recruit eight or nine local doctors to participate in the sentinel provider network. The sentinel provider network is a joint effort between providers, local health departments, the California Department of Public Health (CDPH), and the Centers for Disease Control and Prevention (CDC). Sentinel provider surveillance is a critical component of California’s influenza surveillance program along with laboratory and hospital data. At this time, Kern County does not have a provider participating in the sentinel provider network. CDC has set a goal of one sentinel provider per 250,000 population. California, with a population of approximately 39,000,000, requires 156 sentinel providers to meet the CDC goal. Although there are currently 230 sentinel providers enrolled, only 123 report more than 50% of the time. CDPH proposes a more aggressive goal of 1 sentinel provider per 100,000 population in order to better represent the population and make sentinel providers a more integral piece of seasonal influenza surveillance. This year, the state plans to recruit sentinel providers evenly across the state according to county populations as well as expand our pool of OB/GYN physicians. Sentinel providers are physicians, nurse practitioners, and physician assistants from a variety of specialties – family practice, internal medicine, pediatrics, infectious diseases – working in a variety of outpatient settings – private practice, public health clinics, urgent care centers, large HMO clinics, emergency rooms, Indian Health Service clinics, and student health centers. Sentinel providers report the total number of patient visits each week and the number of patient visits for influenza-like illness by four age groups (0-4 years, 5-24 years, 25-64 years, >65 years). By survey, most participants reported that being in the network enhanced their clinical practice and that it took less than 30 minutes to complete the weekly report. If you would be interested in participating in the sentinel provider network, please call Kirt Emery, M.P.H. at 661-868-0303. Kirt Emery is the Epidemiologist and Director of the Health Assessment and Epidemiology Program of Kern County Public Health Services Department.

SAVE THIS DATE KCMS INSTALLATION OF OFFICERS Saturday, January 29, 2011 • Location: Padre Hotel 6:00pm No-Host Cocktails 6:45pm Dinner • 7:30pm Installation of Officers Meeting Notice Being Emailed/faxed with RSVP form attached.


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PO Box 1029 Hanford, CA 93230 559-582-0310 Fax 559-582-3581 KCMS Officers Jeffrey W. Csiszar, MD President Mario Deguchi, MD President elect Theresa P. Poindexter, MD Secretary Treasurer John E. Weisenberger, MD Past President

Board of Directors Bradley Beard, MD Frank T. Buchanan, MD James E. Dean, MD H. James Jones, MD Ying-Chien Lee, MD Kenny Mai, MD Sheldon R. Minkin, DO Daniel Urrutia, MD

CMA Delegates: James E. Dean, MD Thomas S. Enloe, Jr., MD CMA Alternate Delegates: Sheldon R. Minkin, DO Staff: Marilyn Rush Executive Secretary

Tulare Arpan Global Charities Mission Alexandria, September 20-26, 2010 by Dr. Onsy Said

Arpan Global Charities (AGC) embarked on its ninth volunteer medical mission from September 20-26 to the University Hospital in Alexandria, Egypt. This mission had 48 team members with a large contingency of physicians which included: two anesthesiologist, a colorectal surgeon, a pediatric general surgeon, two pediatric cardiologists, an ophthalmologist, an internist, three neonatologist, two general pediatricians and a radiologist. In addition there were five pharmacists, a physician assistant, two cardiac sonographers, two occupational therapists, eight nurses, seven non-medical volunteers and five medical residents from different disciplines, who each contributed to the overall success of the mission. While in Alexandria the team members examined and treated about 800 patients. There were 78 surgical procedures performed which included complex pediatric general and orthopedic surgeries, gynecological surgeries, gastrointestinal surgeries on the colon, Colonoscopy, heart surgeries, eye surgeries as well as 35 echocardiograms. Approximately $100,000 worth of equipment, supplies and material donated by different organizations in US, including Boston Scientific, was used to perform above stated surgeries. The AGC team doctors accompanied the University of Alexandria faculty doctors and their residents on daily bedside rounds and participated in discussions on difficult and complex patients. Since education is another important part of Arpan Global Charities goals, this trip was replete with didactic lectures and hands-on training for the doctors and other medical personnel in Alexandria. A scientific session was arranged by the Alexandria University department of anesthesia where two of the AGC team anesthesiologists, Drs. Michael Gropper and Errol Lobo from UCSF, gave four presentations. The nursing team members were equally involved in hands on teaching and training of the local NICU nurses. This gift of knowledge and training will serve the people of Alexandria for generations to come. This mission also included daily visits to different orphanages where every orphan was examined by team pediatricians. The team members distributed clothes, toys and food to children in these orphanages. The president of Alexandria University, Professor Hind Mamdouh Hanafy, and the dean of the Faculty of Medicine at Alexandria University, Professor Mahmoud Elzalabany, have expressed their desire to establish a formal educational affiliation between CHOC and Children/UCI and Alexandria University Faculty of Medicine. The dialogue has already been initiated to work towards this affiliation. Once again Arpan Global Charities lived up to its goal of providing free medical care to those who are medically underserved of providing continuing education in the field of medicine to help promote self-sufficiency and providing compassionate charity for the less fortunate.

3333 S. Fairway Visalia, CA 93277 559-627-2262 Fax 559-734-0431 website:

TCMS Officers Ralph Kingsford, MD President Steve Carstens, DO President-Elect Mark Reader, DO Secretary/Treasurer Mark Tetz, MD Immediate Past President Board of Directors Thomas Daglish, MD Karen Haught, MD Gaurang Pandya, MD H. Charles Wolf, MD Parul Gupta, MD Thomas Gray, MD CMA Delegates: Thomas Daglish, MD Roger Haley, MD John Hipskind, MD CMA Alternate Delegates: Robert Allen, MD Ralph Kingsford, MD Mark Tetz, MD Sixth District CMA Trustee James Foxe, MD Staff: Steve M. Beargeon, Executive Director Francine Hipskind Provider Relations Gail Locke Physician Advocate Maui Thatcher Executive Assistant


Dr. Young was recently selected to participate on the CMA Council on Information Technology. This council is charged with continuously evaluating and making recommendations regarding the strategic use of information technology within both CMA and the health care system. On behalf of TCMS and the entire membership, thank you Dr. Young for your time and support of this extremely important initiative.

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CME Activities

MEMBERS: 3 months/3 lines* free; thereafter $20 for 30 words. NON-MEMBERS: First month/3 lines* $50; Second month/3 lines* $40; Third month/3 lines* $30. *Three lines are approximately 40 to 45 characters per line. Additional words are $1 per word. Contact the Society’s Public Affairs Department, 559-224-4224, Ext. 118.



Dr. Naeem M. Aktar, Ambreen Khurshid and Mikhail Alper, PA-C at California Gastroenterology Associates have moved to 7121 N. Whitney Ave. Fresno; north of Maple/Herndon avenues. University Psychiatry Clinic: A sliding fee scale clinic operated by the UCSF Fresno Dept. of Psychiatry at CRMC M-F 8am-5 pm. Call 320-0580. Nassar Women’s Care and Drs. Theodore and Peter Nassar are proud to welcome Dr. Oscar N. Young to their practice. He is seeing new patients in Obstetrics, Gynecology and Minimally Invasive Surgery at 363 E. Almond Ave. #101, Madera.

Medical records shelves, $100/ea/OBO. 18 available. Call Sierra Endocrine Associates, 559431-6197. Ask for Gerry or Charles. FREE: 2, 4-panel GE X-ray view boxes. Desk or wall mount. Call 559-431-5428.

FOR LEASE / RENT Medical office space, 1,500-6,500 sf, $1.20psf plus. Near Fresno Surgery Ctr at 6137 N. Thesta. Call Bill Brar at 559-681-6390. Professional office building at 7045 N. Maple Ave. (Maple & Herndon) near SAMC. 2,5004,500 sf, $1.40 psf. Will build to suit. Call Scott Buchanon at 559-256-2430. Medical office space, 1,500-6,500 sf., $1.20 psf, plus. New Fresno Surgery Center at 6137 N. Thesta. Call Bill Brar at 559-681-6390.

Gar McIndoe (661) 631-3808 David Williams (661) 631-3816 Jason Alexander (661) 631-3818

MEDICAL OFFICES FOR LEASE 1902 B Street – 1,695 sf. 2501 H Street – 1,234 rsf. 2204 Q Street – 1,238 rsf. 2701 16th St. – 2,400 - 4,800 - 10,000 rsf. 608 34th St. – 1,935 rsf. Crown Pointe Phase II – 2,000-9,277 rsf. Meridian Professional Center – 1,740-9,260 rsf. 3941 San Dimas – 3,959 rsf. 4040 San Dimas St. – 2,035 rsf. 9330 Stockdale Hwy. – 7,376 rsf. 3115 Latte Lane – 5,637 rsf. 2731 H Street – 1,400 sf. SUB-LEASE 1401 Commerce, Suite 210 – 1,098 sf. 6001 Truxtun Ave #120 – 1,200 sf. 3850 River Lakes Dr. – 2,859 rsf. 4100 Truxtun Ave. – 11,424 rsf. Medical Admin and Chart Storage DENTAL OFFICE FOR LEASE OR SALE 3115 Latte Lane – 2,850-5,697 rsf. FOR SALE 2633 16th Street – 4,800 rsf. 2701 16th Street – 10,000 sf. Crown Pointe Phase II – 2,000-9,277 rsf. 3311 Latte Lane – 5,637 rsf. Meridian Professional Center – 1,740-9,260 rsf. 2000 Physicians Plaza – 17,939 sf. gross 9900 Stockdale Hwy. – 2,000-6,000 rsf.


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PHYSICIAN / PROVIDER WANTED Large OB-GYN group seeking mid-level provider for busy office. F/T great benefits, compensation and other rewards. Email CV to Physician for PT or more, upscale Occupational Medicine facility for injured workers, new-hire physicals and visiting large local employers for increasing work place safety. Contact Su Rosenthal, Clinic Manager. or 559-222-9200 x 228 or 559-287-0172.

SERVICES OFFERED Disability Income Protection with Guardian, Standard & Principle. Contact Scott Karl at 559307-6103.

Cardiac Care Update – December 8, 2010 Location: Kaweah Delta; 6-8 pm; Credit: 2; Fee: N/C; contact: 559-6242595 or Calif. Association of Neurological Surgeons: The Future of Your Neurosurgical Practice after Health Care Reform – January 14-16, 2011 Location: San Francisco; contact: 916457-2267 or

V I TA L S I G N S / D E C E M B E R 2 0 1 0


PRSRT STD U.S. Postage PAID Fresno, CA Permit No. 30

VITAL SIGNS Post Office Box 28337 Fresno, California 93729-8337 HAVE YOU MOVED? Please notify your medical society of your new address and phone number.

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from NORCAL Mutual Register and complete CME courses at your convenience. Submit Attestation Forms online. Print transcripts and CME certificates. All from one easy-to-use Web site.

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2010 December  
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