January 2011 • Vol. 33 No. 1
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
See Inside: • Medicare SGR Cut Blocked • Bone Marrow Donations • Physician Community Service Honors
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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 MEDICARE UPDATE: Medicare SGR Cuts Blocked for 2011; Work Begins on Long-Term Solution ...8 BLOOD BANK: A Personal Account About Donating Marrow .........................................................9
January 2011 Vol. 33 – Number 1 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
CLASSIFIEDS............................................................................................................................18 CME ACTIVITIES.......................................................................................................................18 TULARE COUNTY MEDICAL SOCIETY.........................................................................................10 • The Life of a Remarkable Holilstic Healer • TCMS Holiday Event 2010 KERN COUNTY MEDICAL SOCIETY ............................................................................................12 • President’s Message: Who is Doctor Portia Choi? • KCMS 2011 Presidential Inauguration & Installation of Officers, January 29 • Membership Recap FRESNO-MADERA MEDICAL SOCIETY .......................................................................................14 • President’s Message: Sablan Medical Clinic • FMMS Welcomes It’s 128th President: Oscar Sablan, MD • The Three Phantoms in Concert • Physicians Honored and New Officers Installed at Annual Banquet • Medical Managers Network Forum, January 12
Vital Signs Subscriptions Subscriptions to Vital Signs are $24 per year. Payment is due in advance. Make checks payable to Medical the Fresno-Madera 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 email@example.com Classified: Carol Rau, 559-224-4224, ext. 118 firstname.lastname@example.org
Cover photography: Shaver Lake by Robert Bernstein, 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 / J A N U A R Y 2 0 1 1
The Fresno-Madera, Kern and Tulare County Medical Societies are pleased to announce a new 10-year and 20-year Term Life program for members. You now have a choice of locking in your premium rate for the first 10 or 20 years of your policy,* enabling you to achieve dramatic premium savings. And you can apply for limits of up to $1,000,000! Now is the time to take a good look at the sponsored plan if:
• You think you may be paying too much
• It has been more than one year since you last reviewed your life insurance protection
• The amount of coverage provided by your medical group isn’t enough and you can’t take it with you if you leave
• You had a change in lifestyle (e.g., married, had a child, adopted a child, taken out a mortgage or business loan or invested in a new practice) • The long-term assets that you once counted on for your financial planning no longer seem as secure as they once did Sponsored by:
Fresno-Madera Medical Society Kern County Medical Society Tulare County Medical Society
Call Marsh today at 800-842-3761 for information on this new program and to determine how you can save on your life insurance!
Insurance is provided by ReliaStar Life Insurance Company, a member of the ING family of companies.
*The initial premium will not change for the first 10 or 20 years unless the insurance company exercises its right to change premium rates for all insureds covered under the group policy with 60 days advance written notice. 51396 (1/11) ©Seabury & Smith Insurance Program Management 2011 • d/b/a in CA Seabury & Smith Insurance Program Management 777 South Figueroa Street, Los Angeles, CA 90017 • 800-842-3761 • CMACounty.Insurance@marsh.com • www.MarshAffinity.com
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“Live Long and Prosper!” by Prahalad B Jajodia, MD Editor, Vital Signs
sincerely, the iconic phrase “Live long and prosper” is both emotionally beautiful and intrinsically meaningful. Further, it provides an interesting framework through which to view our lives. Though we who toil in the medical field usually prosper financially, many times it’s at a cost of long sedentary hours in the office. And, too often, our overall health suffers from a combination of physical inactivity and overindulgence in the culinary bounty our financial prosperity has provided. Hmm… aren’t these the very things we caution our patients against? Thus, it seems the heartfelt words have only been half met. To live long and prosper means far more than simply accumulating money and years. It means living a quality life during these days and years, complete with a deep enjoyment and profound satisfaction. Now, that is not only living long, that’s living large! But, how to do it?
GET PHYSICAL There were things I had to do this morning, but I moved them down on my priority list and took a walk. It’s fun, I like doing it, it’s good exercise, and the world didn’t come to an end because I put something off to take care of myself. To prosper with a long, full and complete life, it’s important we stay physically active and healthy. Most of us won’t be signing up for the Iron Man Triathlon any time soon, but that doesn’t mean we shouldn’t enjoy a walk, run, swim, bike ride, play a sport or indulge in any other physical activity that attracts our interest. So, if you’re not already physically active, pick a time at random, and do something physical you enjoy. Stay physical for a long and prosperous life in the fullest sense.
EAT RIGHT Do you eat to live or live to eat? A patient recently told me that before fasting for a day prior to a procedure, he’d never realized how much food was around him every minute of every day! He also realized that very little of it was anything other than processed comfort food loaded with empty calories. He said it was a wake-up call to be more careful about what he puts in his body. Let’s all have this wakeup call and eat to live longer.
GET SOME SLEEP To be fully alert and alive during the day, we need adequate rest at night, at least six to eight hours. So, I urge you to do what you tell your children to do. No more excuses, just go to sleep. You’ll wake refreshed and ready to take on the world.
GET SPIRITUAL I won’t presume to lecture you on spiritual matters, but I am presumptuous enough to say that an understanding of one’s spiritual nature can greatly enhance life. Having a spiritual element to my life gives me an inner peace and keeps me in harmony with my loved ones, the world, my Creator and myself. For me, faith is both a sanctuary and an inspiration; it embellishes my life with a fullness and meaning beyond what it would have otherwise been. So, my friends, live long and prosper in the fullest sense. Take time to take care of yourself, and enjoy a long, fruitful and joyous life. Happy New Year to all, and may every dream come true for you and yours in the coming new year.
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Mark Your Calendar
Yosemite Postgraduate Institute April 1-3, 2011 Brochure to follow in January 2011 For further information, call the Fresno-Madera Medical Society, (559) 224-4224 x118 e-mail: email@example.com â€˘ website: fmms.org
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CMA NEWS CMA FILES BRIEF IN CITY OF HOPE CASE
The California Medical Association (CMA) has filed an amicus letter brief in support of physicians’ lawsuit against the City of Hope National Medical Center Corporation. In the letter, CMA argues the corporation’s attempt to set up a foundation is merely a scheme to circumvent the ban on the corporate practice of medicine, which prohibits hospitals from directly hiring physicians and influencing their treatment decisions. The physicians from the City of Hope Medical Group filed suit last spring against the City of Hope National Medical Center Corporation. The hospital is located in Duarte, Calif., a suburb of Los Angeles. The physicians allege the corporation’s move to a foundation is an attempt to take over physician oversight of care, end important research and establish a model of care allowing it to charge the government and their patients more for outpatient services. They also allege it violates the corporate practice of medicine bar. In its amicus letter filed Nov. 19, CMA asked the California Court of Appeal to determine whether a “physician friendly” professional corporation complies with the corporate practice of medicine bar. The central issue in this case is the enforcement and interpretation of Business and Professions Code section 2400, commonly referred to as the “corporate practice of medicine bar” or the “corporate bar.” This law prohibits lay entities from controlling, directly or indirectly, the practice of medicine to safeguard patient care. Changing economics in the health care delivery system combined with incentives offered by health care reform have spurred hospitals, such as the City of Hope National Medical Center, to pursue new governing structures and models of care. Many of these new arrangements involve greater control of physicians that violate, or potentially can violate, the corporate bar. One such scheme circumventing the corporate practice of medicine bar is the physician friendly professional corporation, in which a lay entity, such as the City of Hope, sponsors the creation of a professional corporation that employs physicians. Under this model, the degree of “control” the lay entities exercise over physicians and their medical practices can vary. CMA’s letter argues that the corporate practice of medicine bar must be enforced by not allowing models to flourish that violate, or get around, this critical public health protection. CMA urges the court to explain the proper boundaries of control a lay entity may have over a physician friendly professional corporation and provide a check against unlawful attempts to control physicians and their treatment decisions. Contact: Lisa Matsubara, 916-444-5532 or firstname.lastname@example.org.
CONGRESS PASSES ‘RED FLAGS’ EXEMPTION FOR DOCTORS
Accurate Credit Transactions Act. The rule designates physician offices and certain other businesses as creditors, thus requiring them to submit written identity theft mitigation and prevention strategies. Physicians have said the rule is time-consuming, awkward and could delay care if patients do not bring proper identification to appointments. Earlier this year, the American Medical Association, the American Osteopathic Association, the Medical Society of the District of Columbia and the Council of Medical Specialty Societies filed a lawsuit seeking to exempt physicians from the rule. The Red Flag Program Clarification Act of 2010 states that small businesses, such as physician offices, should not be classified as creditors because they do not provide or maintain accounts that pose identity theft risks. AMA President Cecil Wilson said the legislation will “help eliminate the current confusion about the rule’s application to physicians.”
NEW TIMELY ACCESS REGULATIONS TO TAKE EFFECT JANUARY 17
California Department of Managed Health Care’s new “timely access” regulations take effect on Jan. 17. The regulations require health plans regulated by the Department of Managed Health Care (DMHC) to ensure that patients can see a provider within certain timeframes and that plans have adequate provider networks to meet these requirements. (DMHC regulates all HMOs and Blue Shield and Blue Cross PPOs, as well as their contracting medical groups/IPAs.) The California Medical Association (CMA) was instrumental in obtaining several concessions from DMHC, that included provisions providing flexibility on appointment waiting times, ensuring liability protections, extending contractual safeguards, and monitoring a health plan’s network adequacy. Although the burden for complying with the regulation falls on health plans, not physicians, it is possible that some health plans or medical groups may pass on these requirements contractually to physicians and other providers. Most major health plans – including Aetna, Anthem Blue Cross, Blue Shield of California, CIGNA, Health Net and PacifiCare – have indicated to CMA that they will retain responsibility for compliance with the regulation, including the triage and screening requirements. Physicians should, however, keep an eye out for contract amendments from other health plans. The regulation requires plans to provide physicians with advance notice of any contractual changes and the right to negotiate those changes. For more information on the timely access regulation, see CMA’s “Physician Guide to DMHC’s New Timely Access Regulation.” The guide is free to members at the members-only webiste. Contact: Armand Feliciano, 916-551-2552 or email@example.com.
Both the Senate and the House passed by voice vote a bill (S 3987) that would exempt physicians and other health care providers from the “Red Flags” rule outlining anti-identity theft requirements and safeguards required for creditors. The bill would amend the Red Flags rule under the Fair and V I TA L S I G N S / J A N U A R Y 2 0 1 1
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In December, 2010, Congress passed a measure blocking the 25 percent Medicare cuts scheduled to take effect on Jan. 1 for a year, through Dec. 31, 2011. The one-year patch, however, freezes Medicare reimbursements and does not include an update. Furthermore, it does not include the Medicare Geographic Cost Price Index (GPCI) payment locality update the California Medical Association (CMA) has been advocating. CMA, AARP and the American Medical Association (AMA) joined in thanking Congress for acting but said it is crucial for lawmakers to take the next step and repeal the Sustainable Growth Rate (SGR) formula once and for all. “We have bought some time,” CMA President James Hinsdale, M.D., said in a press release. “Now it’s crucial A $20 BILLION that we roll up our sleeves and work with Congress to fix BILL IS A the problem for good by eliminating the flawed Sustainable Growth Rate (SGR) formula and replacing it SIGNIFICANT with stable, rational funding seniors and doctors can INVESTMENT IN count on.” PATIENT CARE IN CMA joined with AMA and AARP to mount an aggressive grassroots campaign to stop the Medicare cuts. THIS POLITICAL CMA mobilized California physicians and their AND ECONOMIC Medicare patients to contact their elected representatives, and posted a six-minute video on ENVIRONMENT. YouTube showing how poor reimbursements are hurting doctors and patients. CMA is working with a very small group of state medical associations and specialty societies through the AMA to develop an alternative to the SGR to present to Congress. The one-year reprieve does not provide a payment update in Medicare rates to cover inflation. The Medicare economic index rose half a percent, but Congress did not add that into the bill, unfortunately. However, physicians received a 2.2 percent update during 2010 that was above the Medicare economic index increase. The other payment reforms included in the health care reform bill, such as the primary care and general surgery bonuses, will still take effect. Please be sure to thank your congressional representatives and our U.S. senators who voted to stop the cuts and who also voted to repeal the SGR earlier this year. The total cost of the legislation was nearly $20 billion and it was the first time in more than five years that Congress paid to stop the SGR cuts rather than funding it by increaing the cuts in future years. The GPCI fix was under discussion as part of the bill, but the day before the vote, Sen. Mitch McConnell, the ranking Republican leader, ruled out making any Medicare policy changes in the legislation. Reps. Sam Farr, D-Carmel, and Darrell Issa, R-Vista, made herculean efforts to include the California GPCI fix in the final bill and deserve physicians’ thanks. Thank you for all your support and advocacy with the California congressional delegation. No other delegation has a better voting record on the Medicare issues than California’s. This was an organized effort that demonstrates the strength of physicians truly working together. A $20 billion bill is a significant investment in patient care in this political and economic environment. Contact: Elizabeth McNeil, 415-882-3376 or firstname.lastname@example.org.
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A Personal Account About Donating Marrow by Alfonso A. Castillo
One of my first assignments when I joined Newsday as a reporter in 1999 was to cover a bone marrow drive for Nelson Campos – a 15-month-old Hempstead, New York boy who was suffering from a rare form of cancer. After learning that people with similar nationalities are more likely to be matches and that Nelson’s family was from Central America, like mine, I decided to join the registry. I gave a blood sample that day with the knowledge that the odds of Nelson, or anyone in need, finding a donor match was around 1 in 20,000. Sadly, Nelson died just a week later, and from then on, I gave little thought to the vial of blood I left behind at Nassau University Medical Center. But about a year later, I was told I was a “potential match” for a person in need of a bone-marrow transplant. The recipient did not live in the United States, and her country’s laws prohibited us from knowing each other’s identity or having any contact. I visited a lab to take another blood test, and was notified shortly afterward that I was just about a perfect match. I agreed to go ahead with the donation despite some concerns from my family about the risks – most of them associated with receiving general anesthesia. Over the next several weeks, I went for a few more tests and consultations. Then, on one June morning in 2001, I went to North Shore University Hospital in Manhasset, changed into a hospital gown, was quickly knocked out, and woke up what felt like seconds later with a bit of a backache and a big bandage on my lower back. As it was explained to me, a hollow needle was injected into the rear of my pelvic bone and drew out marrow, which was then quickly shipped. It cost me and my insurance plan nothing. The pain was minimal: the kind you might feel if you fell hard on your backside. I was up and about within hours and home before dark, but I did need a pillow to sit that first day. I was back to work a day later, where some of my colleagues were nice enough to give me a hero’s welcome, complete with a Costco cake. I encouraged my co-workers to join the registry. For several years, I wondered what became of the recipient. Then, during a stressful holiday season in 2006, I received another call from the New York Blood Center. My recipient had written me a letter. I did a little reporting and learned that she was a woman in her 30s who lived in Italy. In broken English, she wrote about her family’s pain and despair as leukemia brought her to the brink of death. After receiving my marrow, she almost completely recovered, and was happily married and living on a farm. She was not able to have children because of her illness, so she and her husband decided to adopt an orphan. She said I should feel good about saving not only one life, but two. Quite the Christmas gift.
MARROW DONOR RECRUITMENT 2006-2010
Offsite Marrow Blood Drives
(For Drives Only) Ethnicity
Walk # of -Ins Donors
C–172 H–550 O–199
C–237 H–311 O–145
C–294 H–109 O–700
C–277 H–335 O–430
C–111 H–101 O–250
2007 2008 2009 2010 Grand Total from 2006-2010
CCBC contributes to marrow and hematopoietic stem cell donor recruitment efforts locally through the National Marrow Donor (‘Be The Match’) Program (NMDP) offices in Sacramento. As shown in the table, almost 3200 such potential marrow donors from our area have been added to the NMDP marrow registry over the past 5 years. There is a fee for adding potential donors to the registry, to cover certain required costs for initial tissue typing and administrative costs; the current fee is $52.00. However, funding is currently available through NMDP to cover the entire registration fee for all potential donors. Contact the marrow donation/recruitment coordinator at CCBC (559389-5433 ext. 5464) with any questions about local opportunities to join the marrow registry. Ethnicity Key: C - Caucasian; H - Hispanic; O - Other
(Source: Newsday, 10/17/08)
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Tulare The Life of a Remarkable Holilstic Healer by Luis H. Velosa MD, MBA
On the second of December 2010 at the Tulare County Medical Society Annual Christmas event, I 3333 S. Fairway Visalia, CA 93277 559-627-2262 Fax 559-734-0431 website: www.tcmsonline.org
TCMS Officers Steve Carstens, DO President Gaurang Pandya, MD President-Elect Mark Reader, DO Secretary/Treasurer Ralph Kingsford, MD Immediate Past President Board of Directors Steve Cantrell, MD Karen Haught, MD Thomas Gray, MD Parul Gupta, MD Monica Manga, MD H. Charles Wolf, 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
had the honor of presenting the George Tiss, MD Memorial Award which was awarded to Frank Clarke, MD, MPH. It was a memorable evening. Dr. Clarke, I felt, is the kind of person I wish I could have known him many, many years before. Therefore, I will try to illustrate some of many highlights of his professional life. To start, Dr. Clarke has been working, every Wednesday, during the past six years at the Samaritan Center in Visalia, a free clinic operated by the Visalia Ecumenical Charities that treats a very vulnerable population deprived of any health coverage. The clinical team has always been impressed with his passion, his energy and enjoyment for his clinical work to the point that nurses related a “logistic problem in the Clinic”: Dr. Clarke spends a lot of time in the examination room, explaining, educating and reassuring his Dr. and Mrs. Frank Clarke patients “he does care very deeply for his patients, and he does not leave the examination room until he is totally satisfied that the patient gets his message.” Dr. Clarke is also a teacher of the art of Medicine – par excellence. During the summer, medical students joined him to observe and learn from him, and after the first meeting, Dr. Clarke delivered his first lesson, “when we are with patients do not come in t-shirts and jeans.” His influence is so strong, that by the end of the summer, medical students have a totally different self concept and a better awareness of a doctor-patient relationship. To continue, Dr. Frank Clarke is a Native American Indian, descendent from the Hualapai Tribe and an initiated Hopi. Hualapai means people of the tall pine. The Hualapai live on a Reservation about a million acres in the Norwest part of Arizona along 108 miles of the Colorado River and the Grand Canyon. On November 11, 1921, 89 years ago, Dr. Clarke was born, just three years before the United States government declared that Native Americans were entitled for citizenship. When he was a boy, his widowed father placed him in an Indian school in Southern California. Half of the school days were devoted to crafts and the other half to basic learning. In 1933 when he was 12-years-old, he attended the Sherman Institute in Riverside, CA. He served as a student body president and graduated in 1939. Dr. Clarke then enrolled at Los Angeles City College, and while in his second year, the government of Japan bombed Pearl Harbor. The following day, December 8, 1941, Dr. Clarke enlisted in the Navy. During his duty in the armed forces, he was selected as a Hospital Corpsman in Combat, and later he was in active combat in the grim battle of the Salomon Islands. The Navy decided to place him as officer in training and asked him to pick an area of interest. He chose pre-medical studies at the University of California and later with savings, GI Bill support and part-time work, he was able to enroll at St. Louis University obtaining his medical degree in 1950. Dr. Clarke completed his internship at the Oak Knoll Naval Hospital, and received his post-graduate training at the Naval Medical Center in Bethesda Maryland. He attempted a career in the Navy, but after he was assigned a “desk job” in Denver, Colorado, he left the service. He wanted to be a “real doctor” and start practicing Family Practice. But there is much more. From 1954 through 1975, Dr. Clarke had his family practice in Woodlake, Please see Dr. Clarke on page 11
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Tulare TCMS Holiday Event 2010 The Tulare County Medical Society (TCMS) proudly hosted the annual membership holiday dinner on December 2, 2010 at the Visalia Convention Center. The event provided everyone who attended an occasion to mingle, while enjoying a delightful selection of holiday and jazz compositions performed by Chris Hewitt and four other very talented members of the Exeter Union High School jazz band. The Vintage Press prepared and served an extraordinary dinner for the 180 guests in attendance at this year’s TCMS holiday event. Recognition and praise were also in order as Dr. Frank Clarke was very deservingly awarded the 2010 Dr. George Tiss Memorial Award. In addition, many generous donors provided an array of items for the silent auction in which all monies raised will be donated to the Samaritan Center of Tulare County. Thank you to everyone who attended. Please mark your calendar for next year’s TCMS holiday event on Thursday, December 1, 2011.
Dr. Clarke Continued from page 10 Tulare County, and in 1975 turned his private practice over to another physician. He and his family agreed that it was time to accept his responsibilities and the commitment to Indian Service. “MEDICINE He earned a Master of Public REQUIRES MORE Health Degree (MPH) at UC Berkeley in 1981, becoming then a THAN A regional Director of the Indian TECHNOLOGICAL Health Service in Albuquerque, New Mexico. He found and VIRTUOSITY. directed 11 health-clinics and SUCCESSFUL became quite active making preTREATMENT sentations and workshops throughout the country. Dr. Clarke was ALSO DEPENDS one of the founding fathers of the ON PATIENTS Association of American Indian Physicians and due to his WHO CAN BE leadership role he received a ENCOURAGED TO Commendation of this AssociaEXTRACT THE tion with its highest honor, the Distinguished Service Award. Dr. BEST OF Clarke also received a CommendaTHEMSELVES.” tion of the United States Public Health Service because his pioneer – DR. CLARKE and hard work with the Indian Service. In 1986 Dr. Clarke came back and resumed his practice in Woodlake. After his retirement he has been the most terrific and essential healer with the undocumented migrants at the Samaritan Center. Regarding academia: Dr. Clarke formally held the position of Assistant Clinical Professor in the Department of Family and Community Service at Georgetown University and Adjunct Professor in the College of Allied Health Professions at Idaho State University.
Regarding professional Certifications: Dr. Clarke is a Charter Fellow at the American Academy of Family Physicians and Certified by the American Board of Family Practice. I researched some of his lectures Dr. Clarke delivered in the 80s and surprisingly those ideas still hold significant value. At the Alberta Indian Health Care Commission Conference: “The Western World,” according to Dr. Clarke, “has divided up the universe and people into comfortable little pieces, and has forgotten how to put it back together. When Western medicine thinks about sickness (which Indians called lack of harmony or unbalance) they send the body to the hospital, send the mind back to school or to a mental institution with bars, and send the soul to church on Sunday.” Speaking to an audience of 250 health professionals, Dr. Clarke said that modern medicine is now looking at traditional medicine men from all over the world, trying to learn lessons long forgotten in Western history. Native medicine, in all tribal societies, is based on the unity of body, mind and spirit. At UC Irvine College of Medicine Dr. Clarke addressed the group of about 75 medical students: “Having a high grade in medical school is no indication of how good of a doctor you are going to be,” Dr. Clarke told the group. “Make you feel better?” “Listen to the patient and he/she will give you the diagnosis.” “Smile, put out your hand, establish a rapport, extend compliments – give the patient a sense of belonging, a sense of knowledge and self-esteem.” “Medicine requires more than a technological virtuosity,” he said. “Successful treatment also depends on patients who can be encouraged to extract the best of themselves.” Finally, Mrs. Tiss gave to Dr. Clarke the George Tiss Memorial Award, and the entire membership was impressed observing Dr. Clarke’s vitality and energy and were moved when he stated, “Sixty years ago I received my medical degree, I was so taken that I went someplace private and I cried. Today I am very thankful of such a recognition I am very impressed but I will not cry,” concluded the wise man.
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Kern PORTIA CHOI, MD, MPH
2229 Q Street Bakersfield, CA 93301-2900 661-325-9025 Fax 661-328-9372 website: www.kms.org
President’s Message WHO IS DOCTOR PORTIA CHOI?
KCMS Officers Portia S. Choi, MD President Joel R. Cohen, MD President-elect Calvin J. Kubo, MD Secretary Ronald L. Morton, MD Treasurer Mark L. Nystrom, MD Immediate Past President Board of Directors Alpha Anders, MD Noel Del Mundo, MD John Digges, MD J. Michael Hewitt, MD Peter McCauley, MD Wilbur Suesberry, MD Tonny Tanus, MD Edward Taylor, MD CMA Delegates: Jennifer Abraham, MD Eric Boren, MD John Digges, MD Ronald Morton, MD CMA Alternate Delegates: Lawrence Cosner, Jr., MD Patrick Leung, MD Michelle Quiogue, MD Staff: Sandi Palumbo, Executive Director Kathy L. Hughes Membership Secretary
new President of the Medical Society was born in Wonju, Korea two years before the commencement of the Korean War. During the war, she was a refugee repeatedly escaping the Communist soldiers by walking, and sometimes by riding the train. Her mother, an older sister and she all survived the war and arrived in Los Angeles when Portia was eight-years-old, joining her father who had been in the USA to study for the ministry. Growing up in a minister’s home, she remembered how her parents had revered doctors. She remembered how their family doctor, John Fowler, MD, visited them at their home. This kind man would even bring the family a whole box of apples during Christmas. Although she was not considered the smartest in the family, she made good grades at UCLA, and this encouraged her to apply to medical school. She also attended UCLA for both medical school and later to obtain her Masters in Public Health (1975). A few experiences during medical school influenced her choice of a specialty. The summer after the first year, she had a choice to perform surgical procedures on dogs, or to go to Alaska for an apprenticeship in Public Health. She chose to spend the summer in the tundra of Alaska. The only doctors in the remote town were doing a two year assignment for the federal government’s Indian Health Service. They provided care to the natives, many of whom lived in scattered villages. The main modes of transportation from the villages to the hospital were by boat or bush plane. The doctors made daily rounds by using a two way radio. They had trained local natives to take a medical history and vital signs; and the doctors advised the natives through the radio. Portia Choi, the medical student, found it fascinating the way medical care was delivered in the Alaskan tundra. During her fourth year, she took an elective in South Korea to study the health care delivery system. She found that there were many doctors in the large cities. However, in the countryside, there were many areas lacking doctors. She experienced going to one of the villages. A hospital in the city run by an American medical missionary formed a team of doctors and nurses to deliver medical care to outlying villages. They walked and climbed small hills to get to the village. The group converted a church into a clinic. The patients came in wearing their best native clothing and were very respectful, even to the medical student Portia, whom they knew only as a doctor. These two experiences influenced doctor Portia Choi to specialize in Preventive Medicine/Public Health, in which she is board-certified. She has served as the Deputy Health Officer of the Kern County Department of Public Health Services since 1996.
SAVE THIS DATE KCMS 2011 PRESIDENTIAL INAUGURATION OF PORTIA S. CHOI, MD & INSTALLATION OF OFFICERS Saturday, January 29, 2011 The Padre Hotel, Bakersfield, CA 6 pm Hosted Reception • 7 pm Dinner 8pm Installation of Officers Watch for your Invitation RSVP with more information.
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MEMBERSHIP NEWS Membership Recap NOVEMBER 2010 Active . . . . . . . . . . . . . . . . . . . . . . . . . 259 Resident Active Members . . . . . . . . . . . 0 Active/65+/1-20hr . . . . . . . . . . . . . . . . . 4 Active/Hship/1/2 Hship . . . . . . . . . . . . . 0 Government Employed. . . . . . . . . . . . . 10 Multiple memberships . . . . . . . . . . . . . . 2 Retired. . . . . . . . . . . . . . . . . . . . . . . . . . 62 Total . . . . . . . . . . . . . . . . . . . . . . . . . . 337 New members, pending dues . . . . . . . . . 0 New members, pending application. . . . 0 Total Members . . . . . . . . . . . . . . . . . . 337
Fresno-Madera OSCAR SABLAN MD
PO Box 1029 Hanford, CA 93230 559-582-0310 Fax 559-582-3581
Post Office Box 28337 Fresno, CA 93729-8337
1382 E. Alluvial Avenue #106 Fresno, CA 93720
KCMS Officers Mario Deguchi, MD President
TAKING A LOOK AT HEALTH REFORM
Daria Majzoubi MD President elect
How was your Christmas and New Year? Hope you had a great time
Theresa P. Poindexter, MD Secretary Treasurer Jeffrey W. Csiszar, MD Past President
Board of Directors Bradley Beard, MD Bhupinder Chatrath, MD James E. Dean, MD Laura Howard, MD H. James Jones, MD Ying-Chien Lee, MD Bo Lundy, MD Kenny Mai, MD Sheldon R. Minkin, DO
CMA Delegates: James E. Dean, MD Jeffrey W. Csiszar, MD CMA Alternate Delegates: Sheldon R. Minkin, DO Mario Deguchi, MD Staff: Marilyn Rush Executive Secretary
with your family and loved ones. Things are about to change drastically as we head into the new year. How do you feel about the new health care reform? Disaster or opportunity? Like it or not, the avalanche of changes will be upon us before you know it. As we start the new year, individually and collectively, we have many challenges. For the first time in decades, I hear many physicians worried about their future financial security. First let us look at the positives of the new health care law. It prohibits denials of coverage based on pre-existing conditions. It requires insurers to allow dependents to remain on their parent’s plan until age 26. It invests in preventive care. It clamps down on insurance company abuses. It recognizes the need for more primary care providers. And lastly, it creats a regulated marketplace where affordable health care coverage can be purchased. On December 13, 2010, the health reform act had its first significant push back when a Federal judge in Virginia agreed with the plaintiffs that requiring all Americans to have health insurance is unconstitutional. While not an overwhelming victory, it is an eye opener for many decision makers, and eventually, the Supreme Court will weigh in with a final decision in about a year or so. One thing is clear though, both Republicans and Democrats agree, that there is no way the health reform act will be completely repealed. The status quo was not working, and change was inevitable regardless of party politics. As we watch and hopefully participate with the health reform rollout, I can’t help but agree that not only is medicine set to take a great leap of faith into the unknown, but our patients are also along for the ride and just as unsure and insecure about this adventure. For many people, insurance rates have gone through the roof. Ask any school district how much their rates have gone up over the last two years, especially over the last three months in the Central Valley. This uncontrolled growth has caused financial disaster for many school districts. Qualified teachers are let go and class sizes have gone up. Indirectly, you and I are affected as well, as more school districts and large corporations modify their fee for service insurance plans in favor of lower cost options. This means less payouts to you, the service provider. Let us review some statistics to get a perspective on the new health care reform. Insurance rates have risen 30 percent and personal income growth only three percent from 2001 to 2005 (Robert Wood Johnson Foundation). The total annual premium for a typical family health insurance plan offered by employers was $ 12,680 in 2008. (Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2008). Expenditures on Healthcare in the U.S. exceed $ 2 trillion a year! (Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group). In comparison, the federal budget is $ 3 trillion a year! Please see President’s Message on page 17
559-224-4224 Fax 559-224-0276 website: www.fmms.org FMMS Officers Oscar Sablan, MD President Robb Smith, MD President-elect Krista Kaups, MD Vice President Prahalad Jojodia, MD Secretary/Treasurer Harcharn Chann, MD Past President Board of Governors A.M. Aminian, MD Hemant Dhingra, MD Ujagger-Singh Dhillon, MD David Hadden, MD Sergio Ilic, MD S. Nam Kim, MD Stuart Mason, MD Ranjit Rajpal, MD Rohit Sundrani, MD Mohammad Sheikh, MD Phillip Tran, MD CMA Delegates FMMS President John Bonner, MD Adam Brant, MD Michael Gen, MD Sergio Ilic, MD Brent Kane, MD Kevin Luu, MD Andre Minuth, MD Roydon Steinke, MD Toussaint Streat, MD CMA Alternate Delegates FMMS President-elect Prahalad Jajodia, MD Toby Johnson, MD Peter T. Nassar, MD Trilok Puniani, MD Dalpinder Sandu, MD Salma Simjee, MD Steven Stoltz, 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
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Fresno-Madera FMMS Welcomes It’s 128th President: Oscar Sablan, MD Oscar M. Sablan, MD, an internist in Firebaugh, became the Fresno-Madera Medical Society’s 128th president January 1, 2011. Dr. Sablan was born on the island of Saipan, US Commonwealth, Northern Marianas Islands, in 1951. Following his maternal family’s custom, at one year of age, he was taken by his grandmother and raised on the island of Ponape for the next 8 years, thousands of miles from his birthplace. “My grandmother AS TWO OF THE was a native healer and treated everyone – including all my FEW PHYSICIANS various cuts and bruises,” said Dr. PRACTICING Sablan. “I never saw a doctor during my first eight years of life.” IN THE It was his grandmother’s influence that led Dr. Sablan to a career in SURROUNDING medicine. After attending a college prep RURAL school on Guam, he moved on to St. Louis University for his COMMUNITIES bachelor’s degree, after spending a year in Hawaii. “My first winter in UNTIL RECENTLY, St. Louis was pretty much a THE SABLANS weather shock,” said Dr. Sablan. “I bought winter gear like I was STAY VERY BUSY moving to Alaska. ” It was at St. Louis University WITH THEIR that Dr. Sablan met his future wife, Marcia Sablan, MD, whom MEDICAL he practices with in Firebaugh. “She had served in the Peace PRACTICE. Corps in El Salvador, and had just started medical school at the U of Missouri School of Medicine in Columbia, Missouri.” They were married in Columbia, Missouri, during Marcia’s first year in medical school. Their oldest son was born later during Oscar’s last year at St. Louis University. Both of the Sablans received their medical degrees from the University of Hawaii (after Marcia transferred there). Oscar and Marcia had their other three children in Hawaii while going through medical school. Oscar completed one year of Internal Medicine internship at the University of Hawaii Queen’s Hospital in Honolulu, before transferring to Fresno and completing his residency training at Valley Medical Center. Marcia completed her Family Practice training at Honolulu’s Kaiser Hospital prior to their move to Firebaugh, California. Both the Sablans entered the National Health Service Corp and elected to serve and practice in Firebaugh. Oscar was still completing his residency when they moved to Firebaugh. “Driving home nights after being on call, was brutal,” said Dr. Oscar Sablan. 14
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An intended three-year stay, has turned into a 29 year commitment to the medically underserved community of Firebaugh. “We could have moved back to Hawaii, but our children had friends and wanted to stay. We were busy from the start and felt at home here,” said Dr. Sablan. “Firebaugh has been good to us and our family. We are grateful for the kindness of the people in Firebaugh/Mendota, and the surrounding small communities on the Westside.” As two of the few physicians practicing in the surrounding rural communities until recently, the Sablans stay very busy with their medical practice. In addition, they serve their community in many other philanthropic ways. This past Christmas marked the 20th anniversary of a Christmas Day dinner they have organized along with like-minded community members for everyone in Firebaugh and the surrounding area to attend. “The food, cooking and all the help are all volunteered,” said Dr. Sablan. “Over the years, we have served many families who might have not been able to provide for themselves. We served about 650+ people Christmas Day. We also delivered food to the elderly who are not able to attend the dinner personally.” The dinner provides the community with a sense of family and provides an opportunity for those who want to help others. The Sablans also acknowledge City Hall and the school district – FLDUSD – for their help in making the event succesful. They are also especially very grateful to a local club who provides over 300 turkeys to be distributed every Christmas – including 35 turkeys for the annual Firebaugh Christmas Day Dinner. The Sablans also provided toys for over 300 kids through the Toys for Tots program. In addition, Oscar has served on the Firebaugh School Board for over 12 years with another four years to go. He is proud of the progress that the children in the district have achieved during his term – and hopes one day to have a local Doctor’s Academy modeled after the very succesful program in Fresno. Marcia has served as Firebaugh’s Mayor for over 10 years and has been on the City Council for over 20 years. Two of their sons have followed their parents’ footsteps and became physicians (one an orthopedic surgeon in Merced and the other as an orthopedic sports medicine fellow at the Kerlin Jobe Clinic in Los Angeles). Another son is an attorney in Firebaugh and their daughter is a teacher in Oakland. When not working or seeing to the needs of his community, Dr. Sablan can be found visiting his six grandchildren, traveling with his wife or on a golf course. “I don’t get a chance to play as often as I’d like, but I still manage to play 2-3 times a month,” said Dr. Sablan. One of Dr. Sablan’s goals as president this year is to encourage better member participation in the FMMS by establishing more personal communication lines with staff and officers. (See his President’s article on page 13) Dr. Sablan encourages physicians to reach him at 559-2893737 or at email@example.com or firstname.lastname@example.org with any suggestions and concerns.
presents... an evening with the Philharmonic Pops
The Three Phantoms in Concert
SATURDAY, FEBRUARY 5, 2011 The William Saroyan Theatre 6:00 p.m. Reception 8:00 p.m. Performance
Hear it, feel it. Let the music secretly possess you. Featuring trios and duets from three extraordinary performers who have played the Phantom on Broadway. Begin your evening enjoying hors d’oeuvers and beverages while socializing at an exclusive pre-performance reception for Fresno-Madera Medical Society members and guests. For further information, call 224-4224, ext. 118.
With appreciation to our reception sponsor : Premier Valley Bank
The Three Phantoms in Concert™ February 5, 2011 RECEPTION CONCERT ________FMMS MEMBER AT NO COST ________Upper Balcony Seats at $42 each ________FMMS guest(s) at $10 each TOTAL PAYMENT ENCLOSED:_______________ Payment method:
Check, payable to FMMS
Card #________/________/________/________ Verification #_______ Expiration Date:_________________ Cardholder’s Name:___________________________________________ Billing Zipcode________________ Cardholder’s Signature:_________________________________________ Phone_______________________ Preferred mailing address for tickets:__________________________________________________________ __________________________________________________________ Mail payment and form to: FMMS, P.O. Box 28337, Fresno, CA 93729-8337
FAX to: 559-224-0276
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Fresno-Madera Physicians Honored With Service Awards and FMMS President-Elect Installed at Banquet The
Fresno-Madera Medical Society held its Installation and Awards Banquet on November 10 at Roger Rocka’s Music Hall. A grand time was felt by all who attended the festivities, which included honoring the 2010 Community Service Award recipients, recognizing FMMS’ out-going president, Harchann Chann, MD and installing President-Elect Oscar Sablan, MD. Doctors Theodore Steinberg and Mohammad Arain were both honored with the Lifetime Achievement Award.
THEODORE STEINBERG, MD, RETIRED OPHTHALMOLOGIST A great many of Dr. Steinberg’s medical contributions were made in legislative chambers, meeting rooms and congressional offices, where he was a persuasive representative of his medical specialty – ophthalmology, all the while being a respected practitioner, medical ethicist, medico-legal expert and teacher - volunteering his professional expertise to residents at Valley Medical Center, international exchange physicians, nursing students and public school nurses. Dr. Steinberg was born in the Ukraine in 1910 and immigrated to the United States via Palestine in 1924 at the age of 14. He received his BS degree in three years from MIT and obtained his medical degree from Tufts Medical School in 1938. He completed an ophthalmology fellowship at Green’s Eye Hospital in San Francisco before enlisting the army in 1942. After practicing in San Francisco, Dr. Steinberg moved to Fresno in 1948 to begin his private practice. He retired in 1994. Among the many offices he held in organized medicine are: • President – and the force behind the formations of – the California and American Associations of Ophthalmology • Chair, AMA Ophthalmology Section Council • Judicial Council Member; Chairman, Scientific Board and FMMS Delegate to the California Medical Association • Chairman: Section of Ophthalmology at Fresno General Hospital • Writer: guidelines for vision screening in California schools His life and his professional career exemplify a core motivation to provide service for fellow mankind, including treating numerous patients who lacked the ability to pay. He has distinguished himself academically and has provided high level medical care in a selfless manner, while serving his profession. For several years, and for a salary of $1 a year from the State of California, Dr. Steinberg taught at Fresno State College, giving ophthalmology lectures to student nurses. And lastly, one of Dr. Steinberg’s great achievements include his 100th birthday – which he celebrated in July, 2010. Congratulations Dr. Steinberg! 16
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President-elect Dr. Oscar Sablan, (left) was installed as the 2011 FMMS president by out-going President Harcharn Chann, MD.
MOHAMMAD ARAIN, MD, GENERAL SURGEON Since 1981, when Dr. Arain began his private general surgery practice in Madera, he has provided surgical and medical assistance to indigent and welfare patients from various clinics and physicians around Madera and internationally for disaster victims. Among some of his humanitarian services: • Arranged transportation for injured civilians from Bosnia to California for medical care and raised over $70,000 for Bosnia Relief Fund, along with donated medical supplies • Raised funds and medical supplies for hospitals and clinics in Mexico, Pakistan, Afghanistan, Kosovo, Honduras, Ecuador, Peru and Burma. • Provided medical relief to victims of Indonesia’s tsunami and earthquake, New Orleans’ Katrina and Pakistan’s earthquake • Provides free medical care to nonpaying patients at Madera Community Hospital’s Clinic on Saturdays for the past 30 years In 2007, Dr. Arain served as president of the Fresno-Madera Medical Society and in 2009, he was honored with the Jefferson Award and the California Medical Association’s Ethnic Physician Leadership Award. As recently as this past August, Dr. Arain worked with WHO and UNICEF to provide medical care and vaccination to the victims of Pakistan’s flood relief. Dr. Arain was born in India in 1944. He received his medical Please see Annual Banquet on page 17
Fresno-Madera President’s Message Continued from page 10 How about Medi-Cal and Medicare? Are you prepared for the upcoming changes? Are you willing to help with access to care for the poor and uninsured? What changes need to happen in order for you to see a share of patients without adequate medical coverage? If you do not know what ACOs are, you should educate yourself on this concept for it is the future. You might ask, why should I join the Fresno Madera Medical Society (FMMS)? What is it doing for me? Let me propose that instead of asking these questions on what the FMMS can do for you, ask what you can do for the FMMS – to borrow a phrase from President John F. Kennedy. It is organized medicine that can bring some sanity to this chaotic debate, not because they have the magical answer but because they have a seat at the table where hard decisions are being made. These debates will affect how we practice medicine for the next two decades. It is being a part of the FMMS or the ACP, or the AAFP, the AAP, the CMA and the AMA that the collective voice for what works in the medical world will be heard. Congress will listen when the consumer (AARP) and organized medicine (AMA) step to the plate asking the right questions, questioning the validity of the policy statements put forth by someone far removed from the daily practice you and I see every day. Medicine is and will always be the career choice for me, and I think the same goes for you. We do the only thing no one else in the world is able to do: practice the best medicine while being well compensated. We can also enjoy the rewards of patient care – be it a child’s infectious smile or the warm handshake of a grateful elderly patient. I would like to welcome new members to the FMMS. I also welcome back those of you who have endured the changes that medicine has brought us over the last half century. When all is said and done, I know that you all feel that there is no other country that treats the poor and the underinsured with more compassion, integrity and equality. Let us share in the care of patients, rich or poor, for one day, we maybe on the receiving end of that care. I welcome your comments at: email@example.com. You can call me anytime at 559-289-3737 or oscarsablan@ me.com.
m u r o f k r o netw
2011 MEDICARE CHANGES! an overview of what to expect and how to prepare Wed., January 12, 2011 9:45am - 3:00pm • $30 FMMS BOARD ROOM 1382 E Alluvial Avenue #106 - Fresno, CA 93720 9:45am – Registration 10:00am - 12noon Kathy Montoya, RMC, Ombudsman, Palmetto GBA
2011 Medicare Part B Updates Fee Schedule Update Preventive Services, New Covered Services and Updates ESRD Consolidated Billing • Provider Incentives Physical Therapy Updates Preparing for Changes to ASC5010 and ICD-10-CM
12 noon - Lunch Break 12:30 - 2:00pm Sandra Siddall, RN, MSN, Provider Educator, Palmetto GBA
Denial Rates are UP... CMS is Cracking DOWN! Evaluating Management Services How to Avoid Denial and Choose the Right Code Utilizing CMS’ Tools and Resources
Continued from page 16 degree from Liaquat Medical College in Pakistan , completed his internship and residency training at Liaquat Medical College Hospital and Atlantic City Medical Center in Jew Jersey. Before moving to Madera, he served as a Major, United States Air Force and Chief of Surgical Services at Castle Air Force Base in Merced. Dr. Arain has shown his commitment to community service both locally and internationally, while exhibiting the highest ethical and moral standard and love for fellow human beings. Congratulations Dr. Arain!
2:00 - 3:00pm – Q&A
RESERVATIONS MUST BE PREPAID with VISA, M/C, CHECK or CASH
Contact Sheryl Tatarian at 559-224-4224 x112 Limited to first 50 people Attendees must be FMMS member
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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.
FRESNO / MADERA ANNOUNCEMENT
PHYSICIAN / PROVIDER WANTED
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 3200580.
Large OB-GYN group seeking mid-level provider for busy office. F/T great benefits, compensation and other rewards. Email CV to Mandid@omniwomenshealth.com.
FREE FREE: 2, 4-panel GE X-ray view boxes. Desk or wall mount. Call 559-431-5428.
SERVICES OFFERED Disability Income Protection with Guardian, Standard & Principle. Contact Scott Karl at 559307-6103.
Calif. Association of Neurological Surgeons, The Future of Your Neurosurgical Practice after Health Care Reform – Januaary 14-16, 2011 Location: San Francisco; Contact: 916-457-2267 or firstname.lastname@example.org. Skeptics Guide to the Medical Literature – January 19, 2011 Location: Kaweah Delta; 6-8 pm; Credit: 2; Fee: N/C; Contact: 559624-2595 or email@example.com. Diabetes and Acute Kidney Injury – January 25, 2011 Location: Kaweah Delta; 6-8 pm; Credit: 2; Fee: N/C; Contact: 559624-2595 or firstname.lastname@example.org. Cardiometabolic Risk Symposium: Focus on Women – March 19, 2011 Location: Saint Agnes Medical Center; 8am-2:30 pm; Credit: 5; Fee: N/C; Contact: 559-450-7566.
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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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