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Official Publication of SDCMS JULY/AUGUST 2021

DR. SERGIO R. FLORES BECOMES 2021–2022 SDCMS PRESIDENT Dr. Holly B. Yang Becomes Immediate Past President After Tumultuous Year

2021 VIRTUAL GALA INSTALLS NEW OFFICERS


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Editor: James Santiago Grisolia, MD Editorial Board: James Santiago Grisolia, MD; David E.J. Bazzo, MD; Robert E. Peters, MD, PhD; William T-C Tseng, MD Marketing & Production Manager: Jennifer Rohr Art Director: Lisa Williams Copy Editor: Adam Elder OFFICERS President: Sergio R. Flores, MD President–Elect: Toluwalase (Lase) A. Ajayi, MD Secretary: Nicholas (Dr. Nick) J. Yphantides, MD, MPH Treasurer: Heidi M. Meyer, MD Immediate Past President: Holly B. Yang, MD, MSHPEd, HMDC, FACP, FAAHPM

Contents JULY/AUG

VOLUME 108, NUMBER 7

GEOGRAPHIC DIRECTORS East County #1: Catherine A. Uchino, MD East County #2: Rakesh R. Patel, MD Hillcrest #1: Kyle P. Edmonds, MD Hillcrest #2: Steve H. Koh, MD (Board Representative to the Executive Committee) Kearny Mesa #1: Anthony E. Magit, MD, MPH Kearny Mesa #2: Alexander K. Quick, MD La Jolla #1: Preeti S. Mehta, MD (Board Representative to the Executive Committee) La Jolla #2: David E.J. Bazzo, MD, FAAFP La Jolla #3: Sonia L. Ramamoorthy, MD, FACS, FASCRS North County #1: Arlene J. Morales, MD North County #2: Christopher M. Bergeron, MD, FACS North County #3: Nina Chaya, MD South Bay #1: Paul J. Manos, DO South Bay #2: Maria T. Carriedo-Ceniceros, MD AT–LARGE DIRECTORS #1: Thomas J. Savides, MD #2: Kelly C. Motadel, MD, MPH #3: Irineo (Reno) D. Tiangco, MD #4: Miranda R. Sonneborn, MD #5: Stephen R. Hayden, MD (Delegation Chair) #6: Marcella (Marci) M. Wilson, MD #7: Karl E. Steinberg, MD, FAAFP #8: Alejandra Postlethwaite, MD ADDITIONAL VOTING DIRECTORS Medical Student: Jimmy Yu Resident: Nicole L. Herrick, MD Young Physician: Brian J. Rebolledo, MD Retired Physician: Mitsuo Tomita, MD CMA OFFICERS AND TRUSTEES Robert E. Wailes, MD William T–C Tseng, MD, MPH Sergio R. Flores, MD Holly B. Yang, MD, MSHPEd, HMDC, FACP, FAAHPM AMA DELEGATES AND ALTERNATE DELEGATES District I: James T. Hay, MD District I Alternate: Mihir Y. Parikh, MD District I At–Large: Albert Ray, MD District I At–Large: Robert E. Hertzka, MD District I At–Large: Theodore M. Mazer, MD District I At–Large: Kyle P. Edmonds, MD District I At–Large Alternate: David E.J. Bazzo, MD, FAAFP District I At–Large Alternate: Holly B. Yang, MD, MSHPEd, HMDC, FACP, FAAHPM CMA DELEGATES District I: Karrar H. Ali, DO, MPH District I: Steven L.W. Chen, MD, FACS, MBA District I: Franklin M. Martin, MD, FACS District I: Vimal I. Nanavati, MD, FACC, FSCAI District I: Peter O. Raudaskoski, MD District I: Kosala Samarasinghe, MD District I: James H. Schultz, MD, MBA, FAAFP, FAWM, DiMM District I: Mark W. Sornson, MD District I: Wynnshang (Wayne) C. Sun, MD District I: Patrick A. Tellez, MD, MHSA, MPH RFS: Rachel Buehler Van Hollebeke, MD

Opinions expressed by authors are their own and not necessarily those of San Diego Physician or SDCMS. San Diego Physician reserves the right to edit all contributions for clarity and length as well as to reject any material submitted. Not responsible for unsolicited manuscripts. Advertising rates and information sent upon request. Acceptance of advertising in San Diego Physician in no way constitutes approval or endorsement by SDCMS of products or services advertised. San Diego Physician and SDCMS reserve the right to reject any advertising. Address all editorial communications to Editor@SDCMS.org. All advertising inquiries can be sent to DPebdani@SDCMS.org. San Diego Physician is published monthly on the first of the month. Subscription rates are $35.00 per year. For subscriptions, email Editor@SDCMS.org. [San Diego County Medical Society (SDCMS) Printed in the U.S.A.]

Features

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Sergio R. Flores, MD SDCMS President Virtual Gala 2021 Speech

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Holly B. Yang, MD, MSHPEd, HMDC, FACP, FAAHPM, SDCMS Immediate Past President Virtual Gala 2021 Speech

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2021 SDCMS Virtual Gala Awards Dr. Nick Yphantides: 2020 James T. Hay, MD Award Dr. Rodney Hood: 2021 James T. Hay, MD Award Dr. Jess Mandel: 2020 Presidential Citation Dr. Andres Smith: 2020 Presidential Citation Dr. Asha Devereaux: 2021 Presidential Citation Dr. James H. Schultz: 2021 Presidential Citation

Departments

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Briefly Noted: COVID-19 Vaccines • COVID-19 Regulations • SDCMS Members

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Malpractice Claims From the COVID-19 Pandemic By Robert E. White Jr.

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Champions for Health Soiree By Adama Dyoniziak, MPH, CPH

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Telehealth From the Field By Sue Boisvert, BSN, MHSA and Chad Anguilm, MBA

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Classifieds SanDiegoPhysician.org 1


BRIEFLY NOTED 2

July/August 2021

COVID-19 REGULATIONS

CA Lifts Most COVID-19 Restrictions; Masks Still Required in All Healthcare Settings COVID-19 VACCINES

CMS Increases Payments for At-Home COVID-19 Vaccinations By California Medical Association Staff THE CENTERS FOR MEDICARE AND MEDICAID Services (CMS) recently announced an additional payment amount for administering in-home COVID-19 vaccinations to Medicare beneficiaries who have difficulty leaving their homes or are otherwise hard to reach. While many Medicare beneficiaries can receive a COVID-19 vaccine at a retail pharmacy, their physician’s office, or a mass vaccination site, some beneficiaries have great difficulty leaving their homes or face a taxing effort getting around their communities easily to access vaccination in these settings. There are approximately 1.6 million adults 65 or older who may have trouble accessing COVID-19 vaccinations because they have difficulty leaving home. To better serve this group, Medicare is incentivizing providers and will pay an additional $35 per dose for COVID-19 vaccine administration in a beneficiary’s home, increasing the total payment amount for at-home vaccination from approximately $40 to approximately $75 per vaccine dose. For a two-dose vaccine, this results in a total payment of approximately $150 for the administration of both doses, or approximately $70 more than the current rate. Delivering COVID-19 vaccination to access-challenged and hard-to-reach individuals poses some unique challenges, such as ensuring appropriate vaccine storage temperatures, handling, and administration. The Centers for Disease Control and Prevention has outlined guidance to assist vaccinators in overcoming these challenges. The additional payment amount accounts for the clinical time needed to monitor a beneficiary after the vaccine is administered, as well as the upfront costs associated with administering the vaccine safely and appropriately in a beneficiary’s home. The payment rate for administering each dose of a COVID-19 vaccine, as well as the additional in-home payment amount, will be geographically adjusted based on where the service is furnished.

ON JUNE 15, THE STATE OF California officially lifted the majority of its COVID-19 restrictions, including most mask requirements for vaccinated people, and capacity limitations on businesses and venues. Under the new guidance from the California Department of Public Health, masks are not required for fully vaccinated individuals except in the following settings where masks are required for everyone, regardless of vaccination status: • Healthcare settings • On public transit and in transportation hubs • Indoors in K-12 schools, as well as in childcare and other youth settings • State and local correctional facilities and detention centers • Homeless shelters, emergency shelters, and cooling centers Masks continue to be required for unvaccinated individuals in indoor public settings and businesses. The continued requirement for masks in all healthcare settings aligns with the Centers for Disease Control’s Updated Health Care Infection Prevention and Control Recommendations in Response to COVID-19 Vaccinations. The following individuals are exempt from wearing masks at all times: • Persons younger than 2 years old • Persons with a medical condition, mental health condition, or disability that prevents wearing a mask • Persons who are hearing impaired, or communicating with a person who is hearing impaired, where the ability to see the mouth is essential for communication • Persons for whom wearing a mask would create a risk to the person related to their work, as determined by local, state, or federal regulators or workplace safety guidelines.


TRUST

SDCMS MEMBERS

Dr. William Stanton Passes WILLIAM STANTON, MD, DIED peacefully on June 16, 2021. Dr. Stanton was a distinguished oncologist who served as a member of the San Diego County Medical Society for more than 36 years and a member of Scripps Mercy Hospital medical staff for more than 40 years. During this time, he contributed significantly to improving cancer care, both as a medical director for Scripps Mercy Cancer Center and most recently as physician advisor for Scripps MD Anderson Cancer Center. Scripps Mercy Hospital Chief Executive Tom Gammiere declared, “Dr. Stanton was a brilliant medical oncologist and an intense advocate for his patients’ wellbeing. His devotion to his patients was matched by his love and dedication to his many friends and family. Bill was truly a renaissance man and a superb physician with finely honed clinical judgement; a visionary cancer community leader; and a talented musician and devotee of the arts. One can only imagine the profound peace and comfort Bill brought to each of his patients when he took the time to play his classical guitar for them. ‘Where words fail, music speaks’ was one of his favorite sayings.” Dr. Stanton served as a teacher and mentor to many of his colleagues. Dr. Carrie Constantini, a Scripps medical oncologist and graduate medical education director at Scripps Green Hospital noted: “Dr. Bill Stanton was one of the first Scripps Mercy physicians I met over 10 years ago, and I am so thankful he was part of my life. His support and encouragement of my medical education interest was a driving force in my ultimate career path. The way he connected with patients continues to amaze me to this day and is something I will always strive to achieve. My thoughts are with his family and all who knew him. I will miss my mentor and colleague.” Another fellow mentee and Scripps oncology leader, Dr. Marin Xavier, reflected: “When I think about what the right thing to do is, I think: What would Dr. Stanton do? He was always my role

model, guide, and mentor in work and life. He touched the lives of everyone he took care of and worked with. There was no man more honorable and just than Bill Stanton, and up until just this past Monday I sought his advice on any big programmatic decisions. He gave his heart to Mercy and his community of colleagues and patients. His life dream was to build a cancer center at Scripps Mercy, and he knew his dreams were coming true. He was a cornerstone of the cancer and palliative/hospice community in San Diego for nearly five decades and mentored most of our local oncology leaders and multiple others at UCSD and Scripps. He was also transformational, not just for Scripps Mercy, but for the San Diego Hospice, The Medical Oncology Association of Southern California, and the many years he spent as the Scripps systemwide oncology care line director.” Dr. Stanton was a member of the Scripps Mercy Hospital Advisory Council for more than 15 years. His tireless fundraising and advocacy were instrumental in making Prebys Cancer Center a reality. Gammiere concluded, “While Bill will not attend the cancer center opening in September, it will forever stand as his legacy; a lasting testimony to his indominable will, and his caring and gentle spirit.” Dr. Stanton is survived by Lois (Del Mar, Calif.), his wife of 56 years; daughter Lisl (Austin, Texas); grandchildren Gerald and Brayden Doherty; and sisters Ruth Stanton Hucke (San Diego) and Martha Stanton (Bedford, Mass.). A tribute will be held later this summer, and donations in his honor can be made to Prebys Cancer Center, which is part of Scripps MD Anderson Cancer Center. Prebys Cancer Center is located on the campus of Scripps Mercy Hospital.

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On May 25, the San Diego County Medical Society installed its 151st President, Dr. Sergio Flores. The 2020 Gala for President Holly B. Yang was cancelled due to the pandemic and this year’s Presidential Installation and Gala was held virtually for the same reason. Below are the remarks made by incoming President Flores during the virtual gala.

Sergio R. Flores, MD, SDCMS President 2021 Virtual Gala Speech 4

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THANK YOU, DR. HERTZKA. I first want to say what a great honor it is to become the 151st president of the San Diego County Medical Society: founded in 1870 with just a handful of physicians, now 4,600 members. I would also like to thank our distinguished guests, award recipients and all of our sponsors. I would especially like to thank Paul Durr and the physicians and staff of Sharp Community Medical Group, as well as Chris Howard and Sharp Healthcare for their very generous support — not only financially, but for allowing me the opportunity to learn and grow over the years, learning about the various aspects of healthcare we may not always see: Capitation, foundation models, contracts, MSO, PSO, ACO, CIN, finances, and Safety Net, of which they play a huge role. Bob, Paul, the entire staff of the San Diego County Medical Society, members and board: Thank you. A special shout-out to Holly Yang and Jim Schultz for their amazing work during this very difficult year. A little bit about myself: I was born and raised in San Diego except for a few years living in Tijuana, where I attended preschool and kindergarten. I grew up in Chula Vista and attended Chula Vista High School, where I met my beautiful wife. Not knowing my exact career path, I attended Southwestern College, where I met visiting medical students from UCSD during a career day who encouraged me to pursue my dream. I transferred to the pre-med program at San Diego State. I attended medical school at UCSF and completed all my training at UCI.


After being in private practice in Eureka, California, for three years, we eventually moved back home to San Diego. I have been a member of the medical society since 1998. Eventually I joined the board, and realized how little I knew about organized medicine in San Diego. On a state level, I also became a CMA delegate to the large group forum through my affiliation with SCMG. I was eventually elected to the board of trustees. This past year I was elected as vice-chair of the board. I’m in private practice as a gastroenterologist with San Diego Digestive Disease Consultants. We are seven partners with three offices in San Diego, Poway, and Coronado. I was elected to the board of Sharp Community Medical Group in 1999 and the executive committee in 2002, eventually becoming vice president. I got the opportunity to serve on the Sharp Healthcare board of directors as the SCMG representative between 2005 and 2012, and continue to serve on its finance committee. Completing a leadership academy there was very beneficial as well. I’m so lucky to have such a wonderful family. My beautiful wife, Christina, and I started dating in high school and we have been happily married for 35 years. She has been very supportive of me and my career, both emotionally and financially as we were married after my first year at UCSF. She has put up with the long hours during medical school and training, and is now dealing with long hours with multiple meetings from the various boards I belong to. We have three wonderful children. Alexandria attended the University of Arizona, then received her master’s in teaching. She has been teaching first grade in the classroom since August. It can be done and we need to get the kids back in school. Our son, Sergio, went to UCLA. He graduated medical school from UCSF last year and is currently an orthopedic surgery resident there.

Our daughter Erica went to the University of Oregon and is a public relations specialist. She got her dream job only to be let go during the pandemic. Eventually rehired, she has been working long hours from home. I’m sure she will one day own the company. Luckily all three of our kids are foodies and we promised them that if they graduated from college, we would take them to eat at the French Laundry, which we did. Like some of us here, I’m sure even they would also go back there during a pandemic. This past year has been difficult for all of us. Do we furlough our staff? Do we take out loans? We decided to keep all of our employees. Even as physicians we didn’t know the full extent of the severity of this new virus. Many of us had great concern of all the death and suffering we were seeing. We were certainly concerned for our patients, families, friends, and colleagues. We changed our practices and adapted to telemedicine, something most of us had no intention of ever doing. Being in the hospital and clinics, we wondered if we would get ill and bring it home to our families. Getting PPE from CMA and SDCMS really helped our practices. Eventually getting our vaccinations in December and then volunteering to give them made us feel like we were contributing to ending the pandemic. I volunteered many Saturdays with Dr. Asha Devereaux as well as many shifts with Sharp Healthcare, and remember being asked, “Why are you doing that?” I just said, “Because we have to.” A small dent in Sharp’s 600,000 vaccinations given to date, but we have to shift from

vaccinating at supersites to giving vaccines in our offices, where our patients can discuss their concerns with their trusted physician. We look forward to returning to a normal life, and practice. I’m sure telemedicine is here to stay in one form or another, depending on payment reforms. Our patients, however, also look forward to coming back to our offices. A few points: We need more physicians involved in organized medicine to have a seat at the table to direct our own future, or it will be directed for us. We must defend MICRA and defeat the November 2022 initiative or it will destroy malpractice as we know it. I would love to see more diversity in our medical schools and the physician workforce that resembles our population. We need to encourage more students to go into medicine, perhaps setting up booths at career days at local schools, colleges, and universities. That is how I went from wishing I could be a doctor to being guided in the right path and accomplishing my goal. I would also encourage you to support the medical society’s own Champions for Health Project Access by volunteering your medical services for those in greatest need. I ask this not only from the physicians, but also from all healthcare facilities to perhaps allow your physicians to do one case per month to start. I look forward to serving as your president and promise to do my best to represent all of our members’ concerns. If I do half of what Holly did, I would be proud. Thank you.

SanDiegoPhysician.org 5


Holly B. Yang, MD, MSHPEd, HMDC, FACP, FAAHPM, Immediate Past President SDCMS 2021 Virtual Gala Speech On May 25, the San Diego County Medical Society installed its 151st president, Dr. Sergio Flores. The 2020 Gala for President Holly B. Yang was cancelled due to the pandemic, and this year’s Presidential Installation and Gala was held virtually for the same reason. Below are the remarks made by outgoing President Yang during the virtual gala.

T

hank you for that introduction, Dr. Hertzka. When I thought about my goals as president during our Board of Directors retreat in February of 2020, I thought it would be a year of honoring our 150th anniversary as a medical society, starting a committee on diversity and equity, preparing for organizational strategic planning, and carrying forward the good work of all those before me. While initially (and naively) optimistic about dealing with the new coronavirus, I realized as the pandemic began to unfold how SARS-CoV-2 was really so much worse than the flu, and that our physician community and organized medicine at the local, state, and national level would

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be called on in ways that we have never been called on before. I did not anticipate using my palliative care skills in my role as president, yet my tenure has been a year of dealing with uncertainty, of hoping for the best and planning for everything else, of listening with compassion while trying to elevate less-heard voices, and of bringing people together during crisis for the common goal of doing the most good possible. Despite the challenges, we as a physician community have come together and we not only showed up, but we have led during the most trying of times, and I am so proud of what SDCMS has accomplished. In the early months of 2020, during Jim Schultz’s presidency, through his leadership and that of Dr. Nick Yphantides and the assistance of then past-president Dr. David Bazzo, we partnered with San Diego County Health and Human Services and the Hospital Association of San Diego and Imperial Counties to provide virtual Clinical Town Halls to help physicians stay up to date on the newest information on the pandemic, hosting local experts as

well as physicians from New York and Italy to help us understand the crisis as it evolved. This filled an important role for all physicians — especially those in smaller practices who did not have a large health system emailing them updates. We continued the townhalls at varying frequencies into April of this year and will offer them in the future as needed. Also in the early days of the pandemic, we heard from physicians in the community that they urgently needed an online resource to figure out workflows and protocols on how to care for patients while keeping their staff safe, how to switch to telemedicine, and how to keep their doors open and get financial relief due to office closures during the early stay-at-home orders. We used our staff and expert physician community to crowdsource information and partnered with colleagues from Be There San Diego to get the information online rapidly, and the County later transitioned much of the information onto its physician resource pages. As the news showed hospital systems


in Italy becoming overwhelmed and cases in New York were surging, it was clear that we could face a situation where we would be unable to provide care for everyone who needed it and would be forced into a situation where scarce resources, like critical care services, ECMO, and dialysis, would need to be triaged. While terrible to even contemplate, physicians all over San Diego began to ask what would happen and how would we be able to make decisions in an ethical way. SDCMS stepped into that void and helped to convene more than 150 clinicians and experts to plan for a coordinated regional response, with the assistance of the Be There San Diego, HASDIC, and the San Diego County emergency operations center. In time, it became clear that there would be no national guidance for this possibility, and it was unknown if California would come out with statelevel recommendations. Time was of the essence with the pandemic accelerating daily, and many people in San Diego put in countless hours to discuss, review, ask hard questions, and plan, and I want to give a special thank-you to all who participated in lengthy Zoom meetings, and responded to our many emails, phone calls, and texts. Ultimately, the State of California later came out with its own plan so our local work was stopped. However, I firmly believe that our collaboration outside of institutional silos with goals to engage the community was unprecedented in San Diego and may bear fruit in happier times. As you well know, for a long time during this pandemic, we struggled to access adequate personal protective equipment and this created significant fear for our own wellbeing and that of our families. Indeed, some physicians and many of our interprofessional colleagues became sick, and some tragically died. In the face of this, SDCMS was thrilled to be able to distribute more than 800 boxes containing a two-month supply of PPE to small and medium physician practices in partnership with the California Medical Association, Governor Newsom, the California

Office of Emergency Services, and Altais. Loading boxes into people’s cars and seeing their relieved faces will stay with me as one of the most rewarding things I did this year. Sadly, while tirelessly working to combat this crisis, our public health officers came under attack, and SDCMS was proud to forcefully call for support of Dr. Wilma Wooten after she was doxxed in a County Board of Supervisors meeting. We also launched our first social media campaign with #ISupportMyPHO, which featured more than a hundred selfies of physicians and community members wearing their masks and publicly supporting Dr. Wooten. SDCMS staff and I continue to virtually attend Board of Supervisors meetings to be your voice in support of public health measures, despite often being outnumbered by callers opposed to them for a variety of reasons. Speaking for a community of more than 4,600 physicians, retired physicians, and medical students carries weight. Your membership matters. SDCMS also helped physicians volunteer to provide patient care in areas experiencing COVID surges, give vaccines, and fight medical disinformation. We helped to raise awareness of COVID-related clinical trials and free monoclonal antibody therapies, and are now working with CMA to get COVID vaccines into practices that care for children. We also partnered with other Southern California medical societies to discuss our regional response to the pandemic through the newly formed Southern California Medical Society Presidents’ Council, which I currently chair. We have much to be proud of and our work is not done. While it seems like it was “all COVID all the time” for most of my year, I distinctly remember the first time I was called upon to speak for our physician community as president. Having served in leadership roles for many years, it was the first time I needed to be the voice for an organization and its membership. Today is the one-year anniversary of the murder of George Floyd in Minneapolis,

where I trained for residency. I remember I couldn’t believe what I was seeing in the video, and that shock was a product of my own privilege. Mr. Floyd’s brutal death has catalyzed our nation to speak up and take concrete steps to eliminate bias and racism. SDCMS spoke out that Black Lives Matter, and while grieving the situation, I was proud to use our voice. We also spoke out against Anti-Asian hate with the increase in violence that has come with some people framing the pandemic in racist rhetoric. We made sure to incorporate speakers into our townhalls to address issues and inequities that our communities of color have faced during COVID. I am so pleased we are included as part of the COVID-19 Equity Taskforce in San Diego led by Dr. Hood, and I am incredibly proud of the work that our foundation, Champions for Health, has done to educate and increase access to COVID vaccines in communities that have been disproportionately impacted by this pandemic. In the midst of all this, we started our new committee on Health Equity and Justice. I will be the first to say that it has just gotten started and that we have much work to do to intentionally and explicitly incorporate equity work into our living organization, so that it is an integral part of who we are. As only the eighth woman who has served as president of SDCMS — and, I believe, the first Asian-American woman during our 150 years — I am pleased to have gotten this committee launched, and look forward to the future as we join CMA and the AMA in having these important conversations within the house of medicine, and strive to truly serve all our patients. My core message, as I finish up my term as president of the San Diego County Medical Society, is one of gratitude. I am grateful for all of our healthcare and frontline workers, without whom we would have not made it through 2020. I am especially grateful to our physician members whose membership and participation allow us to be a force for public health, a support for all San Diego physi-

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cians, and advocates for the healthcare community at large. I am indebted to our San Diego County Medical Society staff, who have done incredible work this year and helped us carry through. We would be nowhere without Paul, Jen, Brandon, Hanna, Sue, and Kevin. Thanks to our Board of Directors, our committees, and our Executive Committee for their countless hours of hard work. I am grateful to our Champions for Health staff and volunteers, and the many communitybased organizations here in San Diego working together for our health. I am

grateful for our elected officials who followed the science when it wasn’t popular. I am especially thankful to all the staff at the County of San Diego Health and Human Services, the Hospital Association of San Diego and Imperial Counties, and Be There San Diego for its partnership during this pandemic. Much gratitude also goes to the SDCMS Wellness Committee, whose work is critical to support our physician community now and as we deal with the trauma of the pandemic, and to the Ilan-Lael Foundation for its support in Healing the Healers. Maybe most notably, my gratitude goes out to our families and friends who were there for us when we were giving our all during this pandemic and didn’t have much left to give at home. I know I cannot thank my husband, Joe Runnion, enough

for all the patience, love, support, and his incredible cooking in the past year. I am lucky that his pandemic hobby was perfecting a wide variety of recipes to lift my spirits. Additionally, I am so thankful for my parents, my brother and his fiancé, my friends both old and those I forged over Zoom during this crisis, my SDCMS predecessors, mentors and friends, and those colleagues local and around the globe who have been a wonderful support to me. I want to give a special shout-out to my medical group, the Scripps Health Inpatient Providers Medical Group, and all of you for being here and listening to my long speech. We did a few things this year. Finally, I want to celebrate and welcome Dr. Sergio Flores. Sergio, I’m here to help. You’re going to do a fantastic job! Dr. Hertzka, back to you.

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“As a practicing physician, volunteering for Champions for Health is perfect.” “The process is simple. You receive medical information in advance to optimize the patient and physician time during consultations. You get to provide state-of-the-art care in top-notch hospitals. I still receive thank you cards from Champions for Health patients I had years ago. It is so rewarding to transform people’s lives.” — Dr Hernan Goldsztein, Otolaryngologist-Head and Neck Surgeon.

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2021

Virtual GALA AWARDS

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THE JAMES T. HAY, MD AWARD In late 2019, the SDCMS Executive Committee decided to rename the Atlas Award the James T. Hay, MD Award in honor of Dr. Jim Hay, who was retiring from his family medicine practice in early 2020 after caring for the San Diego community for more than 48 years. He is a past recipient of the Atlas Award, and a review of his contributions will explain why we chose to rename it in his honor. After undergrad at Duke and medical school at Jefferson Medical College in Philadelphia, Dr. Hay trained in family medicine through the U.S. Navy and cared for patients at Camp Pendleton. He started North Coast Family Medical Group in 1978 and served as president of the North County Physician Medical Group IPA. In addition to many leadership roles in clinical medicine, he is a past chief of staff at Scripps Memorial Hospital, Encinitas. He is well known in the San Diego community as a man of exemplary service and a mentor to so many of us at SDCMS. Dr. Hay is a past president of both the San Diego County Medical Society and the California Medical Association, past speaker of the house for CMA, and a delegate to the American Medical Association. He has served on committees too numerous to mention, including chairing the initial Governance Technical Advisory Committee for CMA. He served on the board of directors and executive committee for CALPAC and continues to serve on the board of directors for the CMA Foundation, now known as Physicians for a Healthy California. Dr. Hay helped to establish the SDCMS Foundation, now known as Champions for Health, including Project Access, which helps uninsured San Diegans get specialty medical care. This year Champions has become an important part of the COVID vaccination effort, which you will learn more about shortly. He also founded California Public Protection and Physician Health, Inc., whose mission is to identify and assist physicians with burnout, medical or emotional issues, or substance-abuse diagnoses. As you can see, Dr. Hay’s dedication to the wellbeing and health of patients and physicians is truly exceptional. So we happily rename this award in his honor, and designate it to be given to someone who has shown years of exemplary service to SDCMS, San Diego physicians, and the San Diego community. This year, Dr. Jim Schultz and I will both be giving awards as Dr. Schultz was unable to give out awards in 2020 as our gala was canceled due to the COVID pandemic. The physical awards will be delivered to recipients at a later time, given our virtual celebration tonight.

Dr. Nick Yphantides: 2020 James T. Hay, MD Award It is with great honor and pride that I present the 2020 — and inaugural — James T. Hay, MD Award to our colleague and my friend, Dr. Nick Yphantides. Dr. Nick went to APU at age 16 and was one of the youngest graduates of the UCSD School of Medicine. He has done medical missions in Africa (I remember seeing him as a Bwana), Eastern Europe and Central America. After residency at Ventura, and still a baby, he continued his mission orientation by becoming medical director at Escondido Community Clinic. There he helped elevate that whole organization and planted the seeds of organizational success. He served as the chair of the Physician Council of the 21-member Council of Community Clinics and started the quality improvement movement in our local CHCs.

In his spare time back then, Nick ran for and was elected to the board of directors of Palomar Health, where he ultimately served as chair during a difficult tumultuous time. In 2000 he took off on a round-the-county tour of all 50 states and all major league ballparks while managing to lose 270 pounds and save a life while simultaneously performing CPR and watching a baseball game. Nick has been a longtime board member of both the medical society and of the medical society foundation, now called Champions for Health. You’ll hear more about Champions later, but his role in the county and on the Champions board has helped Champions survive some tough times and has fostered patients at the UCSD Student Run Free Clinic and other free clinics getting free surgeries, imaging, and specialty care services from our wonderful volunteer physicians, surgery centers, and hospitals. Nick has a knack for being in important places at important times; he would tell you that God places key people who are willing and receptive in key positions at key times. He was across the river in New Jersey when 9-11

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happened and was able to assist rescuers and rescue efforts; if you spend any time with him you will find out he has been in the right place at the right time too many times to recount. Fortunately for all of us and all of San Diego County, Dr. Nick was in the position of chief medical officer of the county when COVID hit. He made the first state of emergency declaration on Feb. 14, 2020, well ahead of other counties, and was right to do so. I spent a lot of time behind the scenes with Nick via text and voice in the early phases of COVID and can tell you that he was the primary reason San Diego County had the quickest and most efficient COVID response in California. It was through a combination of medical expertise, networking with local, national, and international colleagues, political contact and savvy, and sheer persistence and determination that San Diego had an early and robust response to COVID. His actions, in my estimation, likely saved tens of thousands of lives in San Diego. Nick used these same qualities to get the heads of FEMA and Homeland security on the ground in San Diego and Imperial counties, resulting in federal aid stations being established in both counties. His concept of Monoclonal Antibody Regional Centers resulted in a combined federal, state, and local effort to stand these up in multiple sites in two counties despite inherent bureaucratic hurdles that can sometimes be beyond imagination. Nick was key in paving the way for the crossborder relief efforts led by Andres Smith, Jess Mandel, and the multisystem team that helped in Tijuana and Mexicali. He helped ensure that a cogent, usable Crisis Standards of Care document was developed to be used when called upon. When hospitals were overwhelmed in January he was able to help ensure adequate and timely response through the usual as well as the atypical channels. His powers of persuasion and international influence resulted in hundreds of San Diego physicians hearing directly from the front lines in Italy, Germany, and New York during our weekly COVID town halls. And because he is as multitalented as he is, he was able to create the town halls, marshal the county resources to coordinate, host, and produce them, and even emceed them in inimitable style until early this year. Thank you, Nick, for all you have done for the San Diego County Medical Society, for Champions for Health, for our colleagues in healthcare, and for our neighbors in San Diego and Imperial counties. We know this has sometimes been at great personal cost and sacrifice to you, but for the greater good — and we all have benefitted. Congratulations on being the recipient of the San Diego County Medical Society’s inaugural James T. Hay, MD Award!

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Dr. Rodney Hood: 2021 James T. Hay, MD Award This year the James T. Hay, MD Award goes to Dr. Rodney Hood. Dr. Hood is well known to the San Diego community for his many years of service, and I have had the great fortune to get to know him this year, working together on COVID and issues of health equity. Dr. Hood earned a BS in pharmacy from Northeastern University School of Pharmacy and was one of the first African-American students to graduate from UCSD medical school. He trained in internal medicine at UCSD and is a Fellow of the American College of Physicians. He founded and served as president of an independent physician association, the Multicultural Medical Group, and he is a board member of the Alliance Healthcare Foundation and president of the Multicultural Health Foundation. He was the 101st president of the National Medical Association in the year 2000, and is also pastpresident of the San Diego chapter of the NMA and the Golden State Medical Association. Additionally, he has served as past-chair of the W.

Montague Cobb/NMA Health Institute, and is a longtime member of SDCMS, CMA, and the AMA. Just since the start of the pandemic, Dr. Hood led the formation of the COVID-19 Equity Taskforce in San Diego and helped the NMA establish its COVID-19 Vaccine Task Force. He is one of San Diego County’s Vaccine Advisory Group Tri-chairs, attending many of our Clinical Townhalls to provide the most up to date information to San Diego physicians. He was also appointed by Governor Newsom as a member of the California Scientific Safety Review Workgroup that evaluates COVID vaccines. He serves as trusted messenger for Black and other underrepresented communities, including through his work at “Together Against COVID,” a collaboration between the Multicultural Health Foundation and the County through Live Well San Diego. He also cares for patients as part of San Ysidro Health Center. Dr. Hood has won numerous awards for his advocacy, leadership, and service, and I am grateful to add to these honors. Thank you is not enough, Dr. Hood, for your tireless work. Congratulations!


PRESIDENTIAL CITATIONS This year we are also starting a new award of Presidential Citations to recognize a small number of individuals who have gone above and beyond their normal roles in service to SDCMS and our community. They will be awarded annually by the president for unparalleled contributions during that president’s term as a special acknowledgement of gratitude.

Dr. Jess Mandel: 2020 Presidential Citation Jess is a pulmonologist and critical care specialist who is the chief of the division of Pulmonary, Critical Care, and Sleep Medicine at UCSD. As the Kenneth M. Moser Professor of Medicine at the UC San Diego School of Medicine, Dr. Mandel trains medical students, residents, and fellows. He has authored two textbooks and a number of scholarly articles related to pulmonary and critical care medicine as well as medical education. Dr. Mandel completed a fellowship in pulmonary and critical care medicine at Brigham and Women’s Hospital in Boston. He did his residency in internal medicine at Beth Israel Hospital in Boston, where he served as chief resident. Dr. Mandel is board certified in internal medicine, pulmonary medicine, and critical care medicine.

He was voted a “Top Doc” by the San Diego County Medical Society/San Diego Magazine in 2019 and has won multiple teaching awards. Dr. Mandel is active in several leadership roles with the American Thoracic Society, including serving as chair of its international conference. I first met Jess when he volunteered to educate the San Diego physician community on the care of critically-ill COVID patients in one of our original Clinical Town Halls early in the COVID crisis. He was a frequent guest on and was consistently calm, reasoned, and relevant. He was very patient with us in tolerating questions about treatment fads of the day and reminding us to stick to the treatments that had solid evidence, while adapting new evidence quickly; he kept us all on track. As someone whose main role in the town halls has been to field questions from our colleagues and feed them to the panelists, I saw firsthand the fear and near-panic the physician community was experiencing — especially early on facing COVID. His scholarly, practical, calm presence was a balm to all of us. Jess was one of the first

people to recognize that we needed to help our colleagues to the south, as they were getting inundated with a true humanitarian disaster with little in the way of supplies, skills, personnel, or facilities needed to cope with the flood of extremely sick people. Where others were met with reluctance from local and state officials and health systems to help south of the border, Jess was able to marshal the will and resources to provide direct aid. With the help of heroes like Andres Smith, Tim Morris, Omar Mesarwi, Venktesh Ramnath, Lucy Horton, Stacey Holberg, Linda Hill, Kelley O’Connor, and Laura Chechel, Jess succeeded in providing boots-on-the-ground training and supplies over a several-month period to medical communities, physicians, hospitals, and trainees in both Tijuana and Mexicali. Jess and his crew met live or virtually twice a week with physicians in Tijuana and Mexicali for several months. His actions and those of his colleagues — physician and nursing — no doubt saved hundreds of lives, reduced the crossborder spread of COVID, and provided much needed mental and physical support to our southern counterparts. Jess also worked extensively behind the scenes with the County on the COVID response with little acknowledgement or publicity. And somehow he was able to do this while running his department, teaching, working with the UCSD response, getting permission (or not) to do all these things from UC, and more: There is a wild rumor that he may have even dabbled in simian viral pulmonology along the way … Jess is now in my personal pantheon of medical legends and I am proud and happy to present him with the Presidential Citation. Dr. Andres Smith: 2020 Presidential Citation Andres Smith is an ER physician working for Vituity, director of Emergency Services at Sharp Chula Vista and also serves as the president of Cruz Roja de Tijuana, helping direct a hospital there and the only EMS service in a city of over a million people. He has also been the

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medical director of Sharp’s Global Patient Services program. He has received many awards, including the Guardian Angel Award from grateful patients at Sharp. He has led many crossborder training programs over the years as well. Andres was so helpful on the San Diego County/Medical Society town halls explaining to a concerned physician audience what was really happening on the other side of the border and how it was affecting the situation here. But that was a small part of what he has done. His firsthand knowledge of the Tijuana environment and his integration into the medical community, as well as his in-depth knowledge of the political realities and players in Baja California and on our side of the border were the key to the relief efforts being effective and efficient. His humility and delicacy in navigating the political realities in a chaotic crisis opened the doors for so many to help and directly and indirectly saved hundreds or thousands of lives on both sides of the border and fostered improved relationships moving into the future that will help everyone. Andres also met twice weekly with our Mexican counterparts in Tijuana and Mexicali, virtually and frequently in person. His actions and those of his colleagues — physician and nursing — no doubt saved hundreds of lives, reduced the cross-border spread of COVID, and provided much needed mental and physical support to our southern counterparts. Andres spent many long days hauling us — people and essential supplies — across the border to provide training to physicians and nurses in Tijuana and Mexicali. He really served as a key coordinator in all those relief efforts, even convincing both Mexican and U.S. Customs agents to expedite border crossings VIP-style. He was able to enlist the EMS services in Tijuana when needed, and a simple thing such as stuffing his car full of PPE and ventilator humidification equipment had a direct tangible impact on medical and nursing staff and how they were able to care for patients. Andres also worked extensively behind the scenes with the County on the border COVID response. And somehow he was able to do this while running his department, teaching, and coping with the Tijuana pandemic and overwhelmed hospitals and EMS staff there. He is such a gentle and unassuming person you would be forgiven for underestimating his strength, passion and effectiveness; his wisdom and skill has been a privilege to witness. Andres is also now in my personal pantheon of medical legends, and I am proud and happy to present him with the President’s Commendation.

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Dr. Asha Devereaux: 2021 Presidential Citation Dr. Asha Devereaux is a pulmonary and critical care physician who has a pulmonology practice in Coronado. She has an MPH from Tulane and served in the U.S. Navy for 11 years, achieving the rank of commander. She serves as the senior medical officer of the San Diego CALMAT Unit, and has served as chair and co-chair of the Task Force for Mass Critical Care. She has provided expertise to the CDC, the Institute of Medicine/National Academy of Medicine, and the California Crisis Care Advisory Committee. She is a past-president of the California Thoracic Society, served as a chair of the Disaster Response Network of the American College of Chest Physicians, has served on the board of directors for the American Lung Association in California and the CHEST Foundation, and is currently an active volunteer with the national Disaster Medical Assistance Team. In her previous volunteer roles with the Medical Reserve Corps, Dr. Devereaux responded to the humanitarian needs of evacuees following the San Diego fires and Hurricane Katrina.

This year, when I started asking around about who could help us figure out how to best respond when planning for the worst case scenario during the pandemic, Dr. Devereaux’s name kept coming up. She took my unscheduled phone call and quickly joined with Dr. Jen Tuteur and me to begin work on a regional plan, spending countless hours of her personal time, lending her deep expertise to our work. She has boundless energy and I have no idea how many panels, working groups, and committees she has been on this year while running her practice, but she does it with humility, practicality, and good humor. She is the sole reason I am published in a disaster medicine journal, as she also cares deeply about learning from each experience and sharing that knowledge for the benefit of others around the globe. Through her role at CALMAT, Dr. Devereaux deployed more than once to Imperial County during the pandemic, caring for patients in the alternative care site in a gymnasium. She rapidly got vaccines and volunteers into her already busy practice, and helped to immunize healthcare workers who did not have access to them through a large healthcare system when the vaccines first became available. I cannot express how important this was and how palpable the fear was in our medical community. Her actions provided such relief to solo and small-


practice physicians, their staff, as well as other healthcare professionals. She later expanded her vaccine efforts to highrisk adults as they became eligible. She kindly agreed to give me even more of her time when she generously presented in one of our Clinical Townhalls and participated in a panel for UCSD medical students about leadership during the pandemic. Based on our many late-night calls, I don’t think Dr. Devereaux sleeps. I am grateful for her immense service to our community and I am pleased to award her a Presidential Citation. Dr. James H. Schultz: 2021 Presidential Citation Dr. Jim Schultz is a family medicine physician and, as you know, the outgoing immediate past president of SDCMS. He has an MBA and is a fellow of the American Academy of Family Physicians. While it may be unusual to honor someone who is currently in office, it has been an unusual year to say the least, and his significant contributions to our community merit this recognition. In his day job, Dr. Schultz is the chief medical officer for Neighborhood Healthcare. He also serves as a consultant for Integrated Health Partners and Health Center Partners, and is medical director for Project Access San Diego through Champions for Health. He is a volunteer clinical professor for the UCSD department of Family Medicine and Public Health and the lead faculty for the UCSD Family Medicine Residency Outpatient Gynecology Rotation. He also is a hospitalist at Palomar Medical Center and does a medical trip for a month

each year to Nepal, where he puts his diploma in mountain medicine and fellowship in the Academy of Wilderness Medicine to good use. So … that’s all just normal for Jim. During this year, I cannot tell you how much I relied on Jim for his time, expertise, practical wisdom, professional network, and his good humor. He was a very busy past-president, serving as the Question Wrangler for almost all of our virtual Clinical Townhalls with patience and grace. He was an active and thoughtful member in our work to develop San Diego’s crisis standard of care. He deployed with CAL-MAT to provide support at a nursing home in Orange County

when they had a critical need for staff during the pandemic. When COVID was deeply impacting the Tijuana region of our binational community, he jumped in to assist in figuring out what resources and education we could provide to our colleagues in Mexico, along with Drs. Smith and Mandel as you have heard. So, for his service above and beyond his normal work, and for his role in keeping me sane this past year, I am pleased to award a Presidential Citation to Dr. Jim Schultz.

Thank you TO OUR SPONSORS Scripps Health Inpatient Providers Medical Group

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COVID-19: PRACTICE MANAGEMENT

Malpractice Claims From the COVID-19 Pandemic More Questions Than Answers BY ROBERT E. WHITE JR.

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HE PANDEMIC HAS RAISED

pressing questions around preventive measures, vaccines, and safe treatment, but it has also obscured one key lingering uncertainty for medical professionals: Where are all the medical malpractice claims? A variety of factors create a cloud of uncertainty around when, if ever, we will see the claims we expected from care provided just before the pandemic, much less claims deriving from care during the pandemic of both COVID-19 patients and non–COVID-19 patients. Malpractice Claims Take Time to Surface We won’t know until 2022 or later whether there will be an increase in claims related to the pandemic. When a medical error occurs, it’s not like an automobile accident. Everybody nearby knows when there’s been an automobile accident because they hear screeching tires, a loud crash, and then sirens. But when a medical error occurs, generally speaking, neither the doctor nor the patient immediately knows that something is amiss. It can take months or years for people to realize that something untoward has occurred. Claims from medical errors that occurred before the pandemic bring additional uncertainties. In 2020, we saw fewer than expected overall claims filed from events occurring 18 to 24 months before the pandemic. In total, 20 percent fewer claims were filed than in 2019. This may have had to do with courts shutting 16

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down, people being reluctant to meet with attorneys to discuss a claim, and/or lawyers working from home. We may see these claims filed later than expected, or maybe we won’t see them at all. But without a doubt, pandemic-related claims will be filed. The pandemic’s impact on physicians increases the risk of claims. Burnout is a major cause of medical errors, and a recent study found that out of 60 countries, U.S. healthcare providers showed the highest rates of burnout. We’re concerned about the stress affecting physicians’ performance — not just the physical stress of the demands put on them while treating COVID-19 patients, but all of the worry. For instance, a lot of doctors at the start of this pandemic stayed at hotels because they didn’t want to bring the virus home to their families if they got exposed. Those sorts of stressors from life disruptions, on top of the stress of treating COVID-19 patients and the stress of treating non–COVID-19 patients within overtaxed healthcare systems, contribute to the possibilities for error. Immunity Protections Are Not Fail-Safe And while healthcare providers have medical liability protections during the pandemic, these protections may not prevent claims. Healthcare provider pandemic-related liability laws vary from state to state, and they will be tested in the courts as to whether they’re constitutional. For example, there is pending legislation in New York State that would repeal the provider protections created there at the start

of the pandemic. Further, some expert witnesses will couch their statements in terms of what it takes to get around one of these statutes. Therefore, physicians do have reason for concern, even in states with strong liability protections. The following case example, which is one of about 40 COVID-19–related claims made against our members so far, is a poster child for why these protections are necessary: A quadriplegic patient with COVID-19 had reached the point of organ failure before he reached the emergency room. There was really nothing medical science could do for him at that point, in terms of a chance at recovery. Therefore, the patient’s physician and conservator placed him in assisted living for palliative care. This was a sad but reasonable decision during a pandemic, with hospital beds needed for patients with a shot at surviving. Following that patient’s death, the physician is being sued. Defending Claims Regarding Treatment vs. Regarding Infection Control We are very confident in our ability to protect our members against claims where they are being sued over the treatment of the disease. Claims arising out of treatment are not concerning to us because there is no cure for COVID-19 — one can only treat the symptoms as the virus runs its course. On the other hand, suits harder to defend would be those that revolve around transmitting the disease because providers didn’t follow guidelines from the Centers for Disease Control and Prevention (CDC) or there wasn’t enough personal protective equipment (PPE). That’s why we stress the importance of following CDC guidelines, and why we’ve taken proactive steps to communicate with the entire medical community throughout the pandemic as part of our commitment to serve those who provide care. Robert E. White Jr. is chief operating officer of The Doctors Company.


CHAMPIONS FOR HEALTH

Champions for Health Board of Directors: Stony Anderson, MD, Renee Wailes, Jim Hay, MD, Adama Dyoniziak, Paul Hegyi, Al Ray, MD, Liliana Osorio, Jim Schultz, MD, Jeffrey Willmann

Awardees: Miguel Gonzalez & Teresa Blanco, Michelle Gonzalez, Kristin Gaspar, Christopher Hajnik, MD, Dhruvil Gandhi, MD

Champions for Health Soiree Waves of Wellness 2021 BY ADAMA DYONIZIAK, MPH, CPH

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he Second Annual Champions Soiree on July 10 at the Birch Aquarium was a celebration of the synergy between the physician volunteers and partners who support Champions for Health’s program, Project Access San Diego. These heroes were honored during the awards ceremony for transforming the lives of patients. Project Access patients are grateful to their healers for bringing each one to better health and reinvigorating their life with their family, at work, in worship, and at play. Holly Araya received the Project Access Medical Interpreter of the Year award. Medical interpreting removes language as a barrier to health and is a free service for Project Access patients. Since 2017, Araya has volunteered as a medical interpreter because she wants to ensure that the interaction between the provider and patient goes smoothly, and that the patient’s concerns have been given a voice. Core Orthopaedic received the Project Access Facility of the Year award. This

volunteer team of three physicians, Dr. Christopher Hajnik, Dr. Luke Bremner, and Dr. Nathan Hammel, have provided reconstructive joint surgeries to two dozen patients since 2012. This team helped the patients by getting them back up and running, walking, working, and moving — something that many of the patients have not been able to do for years. Kristin Gaspar received the Civic Health Leader of the Year award. Gaspar was an elected official for a decade as a supervisor for the County of San Diego. Her leadership focused on key areas of behavioral health, human trafficking, the opioid epidemic, justice involving youth, and transformative solutions for homelessness. Gaspar was and continues to be a major supporter of the Champions for Health mission and Project Access patients. Dr. Varuna Raizada received the Project Access Physician of the Year award. Since 2017, she has provided consultations and procedures to 11 patients. As a urogynecologist, Dr. Raizada believes gynecologic and

urinary issues drastically impact quality of life for women of all ages. She works with patients to educate them about treatment options and to find the best possible treatment plan, through collaboration with various specialties. TrueCare received the Project Access Partner of the Year award. TrueCare staff are dedicated to meeting the needs of their community so that families can achieve lifelong health and wellbeing, which aligns with Champions for Health’s mission and vision. This 10year legacy started by former President Barbara Kennedy and CMO Dr. Patrick Tellez, and continues today with the current President, Michelle Gonzalez, and CMO Dr. Marie Russell. Dr. Dhruvil Gandhi received the Champion of the Year award. Since 2015, Dr. Gandhi has volunteered his gastroenterologist skills in providing consultations and procedures that turn his patients’ lives around. He has helped 24 Project Access patients with colonoscopies and hernia repairs at both Tri-City Medical Center and Carlsbad Surgery Center. Northgate Gonzalez Market received the President’s Award. As a major community partner for Champions for Health immunizations and health screening programs for almost a decade, it serves as a community hub in San Diego’s health equity zones. As a Live Well San Diego partner, it is actively involved in Love Your Heart blood pressure screenings. Northgate Gonzalez Market gives back to its community to ensure a vibrant and healthy populace. SanDiegoPhysician.org 17


TELEHEALTH

Telehealth From the Field Case Study Involving Remote Monitoring Problems BY SUE BOISVERT, BSN, MHSA AND CHAD ANGUILM, MBA

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VEN BEFORE THE COVID-19

pandemic, the use of remote patient monitoring was expanding. The technologies offer many benefits, but they may also create potential malpractice risks. Consider the following case example and strategies that can help mitigate risks. Case Example During an annual physical, the physician recommended ambulatory 18

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electrocardiography for a patient with a history of prior cardiac arrhythmia. The physician told the patient he would receive the ambulatory monitor by mail and that the package would contain everything he needed. About a week later, the monitoring package arrived. The patient was in the process of moving and set the package aside. Several weeks later, after completing the move, the patient found the box. He opened it, read the instructions, and

applied the device. After a few hours, the device fell off. He reapplied it multiple times, but the device continued to fall off. After several calls with the device manufacturer, the patient gave up, tucked the device in the box, and mailed it back to the manufacturer. A week later, the patient received a letter from the physician, stating that his monitoring results were normal. The patient—who was surprised to receive these results—followed up. During the discussion, the physician told him that the device manufacturer downloaded and evaluated the results and provided a report that the physician then shared with the patient. The physician was surprised to learn that the patient had not completed the monitoring period and the device had not performed as expected, but the results were still reported as normal. The patient lost confidence in both the physician and remote monitoring technology, and did not return to the practice.


When patient information will be extracted, analyzed, and reported by a third party, it is incumbent on providers to ensure that the process is rigorous.

Patient Safety Strategies Whether you have already implemented remote patient monitoring or are thinking about it, consider the following strategies: • Use a deliberate process to evaluate potential monitoring devices. » Determine if the equipment is classified as a medical device by the U.S. Food and Drug Administration (FDA). Often, FDA classification as a medical device is required for billing, and it is a sign that the device has been objectively evaluated. » Ask the device manufacturer for a list of current clients and contact them to review their experiences with the company and the device. » Schedule an in-person product demonstration and consider ease of use from the patient’s perspective. Make sure that patient instructions are clear. Evaluate whether the device is manageable in terms of size, portability, and application.

In the case scenario, the device did not adhere properly to the patient’s skin. • Determine how the data will be collected, transmitted, and stored. » Use a secure (encrypted) method for data collection, transmission, and storage. Data from remote patient monitoring devices are subject to privacy and security regulations. » Use caution with applications that transmit data directly into the electronic health record (EHR). Determine the frequency and volume of data transmission. Test the process to confirm that the information populates appropriately and does not negatively affect EHR function. » Determine who will review the data and how frequently, and verify what data will be incorporated into the patient’s medical record. When patient information will be extracted, analyzed, and reported by a third party, it is incumbent on providers to ensure that the process is rigorous. How is the information parsed and interpreted? Is there a process for identifying and rapidly communicating critical or highly concerning results? Is there an internal quality review process? In the case example, the data were stored in the device, which was returned to the manufacturer for extraction and reporting. When the physician followed up with the device manufacturer about the report, the manufacturer was unable to provide a satisfactory answer as to why the result was reported as normal

when the entire reporting period had not been completed. • Ensure the patient is ready to participate. » Check with the patient periodically during the monitoring process to determine if the device was received and is in use. This also provides an opportunity to assess the patient’s level of comfort and answer any questions. » Advise patients to call the office about any device problems or concerns. In the case example, the patient was planning to move. Since the patient’s condition was stable, it may have been more convenient for him to delay the monitoring until after the move. Instead, the patient forgot about the monitor, delayed application for several weeks, and then experienced problems using the device. Plan and Prepare This case study highlights the importance of careful planning and preparation when incorporating remote technologies into the patient care services offered by a medical practice. Providers who recommend products and services to their patients have a responsibility to apply due diligence in confirming that the device manufacturer is reputable, the device is safe, and the information it produces is accurate and reliable. Once a decision is made to use remote technology, the next steps should be to develop appropriate use guidelines that include preparing patients, managing device concerns/troubleshooting, tracking results, and following up with patients. For more information on remote patient monitoring, see our articles “Remote Patient Monitoring” and “Wearables Offer Wealth of Data During COVID-19, but Liability Risks Remain,” or contact the Department of Patient Safety and Risk Management at (800) 421-2368 or patientsafety@thedoctors.com. Sue Boisvert is patient safety risk manager II for The Doctors Company. Chad Anguilm is vice president, In-Practice Technology Services, Medical Advantage, part of the TDC Group. SanDiegoPhysician.org 19


CLASSIFIEDS VOLUNTEER OPPORTUNITIES

PHYSICIANS: HELP US HELP IMPROVE THE HEALTH LITERACY OF OUR SAN DIEGO COUNTY COMMUNITIES by giving a brief presentation (30–45 minutes) to area children, adults, seniors, or employees on a topic that impassions you. Be a part of Champions for Health’s Live Well San Diego Speakers Bureau and help improve the health literacy of those with limited access to care. For further details on how you can get involved, please email Andrew.Gonzalez@ChampionsFH.org. CHAMPIONS FOR HEALTH PROJECT ACCESS: Volunteer physicians are needed for the following specialties: endocrinology, ENT or head and neck, general surgery, GI, gynecology, neurology, ophthalmology, orthopedics, pulmonology, rheumatology, and urology. We are seeking these specialists throughout all regions of San Diego to support those that are uninsured and not eligible for Medi-Cal receive short term specialty care. Commitment can vary by practice. The mission of the Champions for Health’s Project Access is to improve community health, access to care for all, and wellness for patients and physicians through engaged volunteerism. Will you be a health CHAMPION today? For more information, contact Andrew Gonzalez at (858) 300-2787 or at Andrew.Gonzalez@ ChampionsFH.org, or visit www.ChampionsforHealth.org. PHYSICIAN OPPORTUNITIES

Kaiser Permanente San Diego Per Diem Physiatrist Opportunity Southern California Permanente Medical Group is an organization with strong values, which provides our physicians with the resources and support systems to ensure they can focus on practicing medicine, connecting with one another, and providing the best possible care to their patients. For consideration or to apply, visit https://scpmgphysiciancareers. com/specialty/physical-medicinerehabilitation/. For questions or additional information, please contact Michelle Johnson at 866-503-1860 or Michelle.S1.Johnson@kp.org. We are an AAP/EEO employer Please call 858-281-1588

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July/August 2021

CHULA VISTA VETERANS HOME SEEKS A STAFF PSYCHIATRIST: The Veterans Home of California - Chula Vista seeks a 30 hour/week Staff Psychiatrist. This facility contains three level of care for our 300 resident veterans: independent living, assisted living and skilled nursing. A Geropsychiatry background is recommended but not mandatory. More information may be reviewed at the following URL https://www. jobs.ca.gov/CalHrPublic/Jobs/JobPosting. aspx?JobControlId=221636 or you may email Paul D. Wagner, MD, FACP, Chief Medical Officer at paul.wagner@calvet.ca.gov. PRIMARY CARE PHYSICIAN POSITION: San Diego Family Care is seeking a Primary Care Physician (MD/DO) at its Linda Vista location to provide direct outpatient care for acute and chronic conditions to a diverse adult population. San Diego Family Care is a federally qualified, culturally competent and affordable health center in San Diego, CA. Job duties include providing complete, high quality primary care, and participation in supporting quality assurance programs. Benefits include flexible schedules, no call requirements, a robust benefits package, and competitive salary. If interested, please email CV to sdfcinfo@sdfamilycare.org or call us at (858) 810- 8700. FAMILY MEDICINE OR INTERNAL MEDICINE PHYSICIAN: TrueCare is more than just a place to work; it feels like home. Sound like a fit? We’d love to hear from you! Visit our website at www.truecare.org. Under the direction of the Chief Medical Officer and the Lead Physician, ensure the provision of effective quality medical service to the patients of the Health center. The physician is responsible for assuring clinical procedures are continually and systematically followed, patient flow is enhanced, and customer service is extended to all patients at all times. PUBLIC HEALTH LABORATORY DIRECTOR: The County of San Diego is seeking a dynamic leader with a passion for building healthy communities. This is a unique opportunity for a qualified individual to work for a Level 3 Public Health Laboratory. The Public Health Services department, part of the County’s Health and Human Services Agency, is a local health department nationally accredited by the Public Health Accreditation Board and first of the urban health departments to be accredited. Public Health Laboratory Director-21226701UPH NEIGHBORHOOD HEALTHCARE MD, FAMILY PRACTICE AND INTERNISTS/ HOSPITALISTS: Physicians wanted, beautiful Riverside County and San Diego County- High Quality Family Practice for a private-nonprofit outpatient clinic serving the communities of Riverside County and San Diego County. Work Full time schedule

and receive paid family medical benefits. Malpractice coverage provided. Be part of a dynamic team voted ‘San Diego Top Docs’ by their peers. Please click the link to be directed to our website to learn more about our organization and view our careers page at www.Nhcare.org. PHYSICIAN WANTED: Samahan Health Centers is seeking a physician for their federally qualified community health centers that emerged over forty years ago. The agency serves low-income families and individuals in the County of San Diego in two (2) strategic areas with a high density population of Filipinos/Asian and other lowincome, uninsured individuals — National City (Southern San Diego County) and Mira Mesa (North Central San Diego). The physician will report to the Medical Director and provide the full scope of primary care services, including but not limited to diagnosis, treatment, coordination of care, preventive care and health maintenance to patients. For more information and to apply, please contact Clara Rubio at (844) 200-2426 EXT 1046 or at crubio@samahanhealth.org. FULL-TIME CARDIOLOGIST POSITION AVAILABLE: Seeking full time cardiologist in North County San Diego in busy established general cardiology practice. EP or Interventional also welcome if willing to hold general cardiology outpatient clinic also at least 50% of time while building practice. Please email resume to jhelmuth1220@ gmail.com. Immediate opening. INTERVENTIONAL PHYSIATRY/PHYSICAL MEDICINE SPECIALIST POSITION AVAILABLE: Practice opportunity for part time interventional physiatry/physical medicine specialist with well-established orthopaedic practice. Position includes providing direct patient evaluation/care of spine and musculoskeletal cases, coordinating PMR services with all referring providers. Must have excellent interpersonal and communication skills. Office located near Alvarado Hospital. Onsite digital x-ray and emr. Interested parties, please email lisas@ sdsm.net. CARDIOLOGIST WANTED: San Marcos cardiology office looking for a part-time cardiologist. If interested, send CV to evelynochoa2013@yahoo.com or via fax to (760) 510-1811. GENERAL FAMILY MEDICINE PHYSICIAN: to provide quality patient care to all ages of patient in a full-time traditional practice. The Physician will conduct medical diagnosis and treatment of patients using medical office procedures consistent with training including surgical assist, flexible sigmoidoscopy, and basic dermatology. The incumbent


must hold a current California license and be board eligible. Bilingual Spanish/English preferred. Founded as a small family practice in Escondido 1932 by Dr. Martin B. Graybill, today we’re the region’s largest Independent Multi-specialty Medical Group. Our location is 277 Rancheros Dr., Suite 100, San Marcos, CA 92069. We are an equal opportunity employer and value diversity. Please contact Natalie Shields at (760) 291-6637/nshields@ graybill.org. You may view our open positions at: https://jobs.graybill.org/. BOARD CERTIFIED OR BOARD-ELIGIBLE PHYSICIAN DERMATOLOGIST: Needed for busy, well-established East County San Diego (La Mesa) private Practice. We currently have an immediate part-time opening for a CA licensed Dermatologist to work 2-3 days per week with the potential for full-time covering for existing physicians, whenever needed. We are a full-service Dermatology office providing general, cosmetic and surgical services, including Mohs surgery and are seeking a candidate with a desire to provide general dermatology care to our patients, but willing to learn laser and cosmetics as well. If interested, please forward CV with salary expectation to patricia@grossmontdermatology.com.

or long term lease. Please call Melissa at (310) 471-2700 for more information. TURNKEY OFFICE SPACE FOR RENT NEAR ALVARADO HOSPITAL: Turnkey office space for rent. Modern, remodeled and clean. We have a little space available or a lot, depending on your needs. We are located near Alvarado hospital. Conference room, nurses station and many exam rooms, along with Doctors and Admin spaces. To inquire or to schedule a showing, please contact Jo Turner (619) 733-4068. OFFICE SPACE IN POWAY: Office in Poway. Centrally located. Close to Pomerado hospital. Radiology, pharmacy next door. Fully furnished, WiFi included. Three exam rooms, reception area, waiting room. Half days to full time available. Ideal for specialist who wants to expand. Call Dr. Luna if interested: (619) 472-1914. KEARNY MESA OFFICE FOR SUBLEASE: Kearny Mesa area sublease in our orthopedic office which includes: onsite x-ray available, storage space, space for 1-2 employees and free parking. Can discuss internet, phones, fax line, access to printer/copier, and more. Please contact Kaye Spotz at kspotz@synergysmg.com for more information.

OFFICE SPACE / REAL ESTATE AVAILABLE

MEDICAL OFFICE SPACE FOR LEASE: 2095 West Vista Way, Vista, CA in the Tri City Medical Plaza adjacent to the Tri-City Hospital. The space is 1650 sq ft and has a built in reception center for two or more intake staff. The suite has six separate examination rooms each with sink and cabinetry built in, three private offices, extra storage and a staff lounge. The suite also has two private restrooms, and the building common area has public restrooms as well. This space is move-in ready. Call Agent for a tour: Jonathan Peacher (760) 310-3919 DRE# 01746179 OFFICE SPACE FOR MENTAL HEALTH PRACTITIONER: Available June 1st, 2021, Mercy Medical Building, one large consultation room facing eastern mountains, large windows, recently remodeled. Includes waiting room, plenty of storage, BR, parking for patients. Walking distance to UCSD medical center and Mercy Hospital and lots of restaurants. Freeway close. Contact Randall Hicks MD, at (619) 298-7135. TURNKEY MEDICAL OFFICE FOR LEASE IN BRAWLEY, CA: 6,504 SF medical office space available at 283 Main Street Brawley, CA. Office includes a large reception area, 10 exam rooms, 5 offices, 5 restrooms, X-ray room, lounge, lab space and nurses station. Located on the main road with easy access and abundant parking. Available for a short

SAN DIEGO OFFICE NEAR SHARP FOR SUBLEASE OR TO SHARE: Rady Children’s Hospital medical office building at 7910 Frost Street. Central location near to both Rady Children’s Hospital and Sharp Memorial Hospital, between HWY 163 and I-805. Available to any specialty. The space available includes access to one office, two exam rooms and a nurse’s station / common area desk. Be close to excellent referral sources in the building and from the hospital campus. If you have an interest or would like more information, please call (858) 278-8300 x. 2210 or email nhughes@synergysmg.com OFFICE SPACE / REAL ESTATE WANTED MEDICAL OFFICE SUBLET DESIRED: Solo endocrinologist looking for updated bright office space in Encinitas or Carlsbad to share with another solo practitioner. Primary care, ENT, ob/gyn would be compatible fields. I would ideally have one consultation room and one small exam room but I am flexible. If the consultation room was large enough I could have an exam table in the same room and forgo the separate exam room. I have two staff members that will need a small space to answer phones and complete tasks. Please contact (858) 633-6959. MEDICAL EQUIPMENT / FURNITURE FOR SALE

utilize our medical exam tables which are in great condition. Our practice is going in a different direction, thus the need for us to provide these tables, which were barely used. The tables are approximately 70 x 30 inches and have black padding on top of a natural pine wood frame. Each table adjusts up and has a headrest with a pillow included. We are interested in moving these out of our office as soon as possible, since we are remodeling and need the space to complete the project. We can provide a picture and schedule time to see the tables between 9am - 5pm M-Th, or 9am - 2:00pm Friday. Price is negotiable and we are just looking for a reasonable donation for the tables. We can sell individually as well, but will provide a greater incentive for taking both. Please contact Rick at 619-795-6700 or email rick@ manageyourage.com. OBGYN RETIRING WITH OFFICE EQUIPMENT FOR DONATION: Retiring from practice and have the following office equipment for donation: speculums, biopsy equipment, lights, exam tables with electric outlets, etc. Please contact kristi.eisenhauermd@yahoo. com or (760) 753-8413. MEDICAL EQUIPMENT FOR SALE: 2 Electric tables one midmark, 3 Ultrasounds including high resolution Samsung UG-HE60 with endovag and linear probes, STORTZ hysteroscopy equipment, 2 NOVASURE GENERATORS, ENDOSEE OFFICE HYSTEROSCOPY EQUIPMENT: NEW MODEL, OLDER MODEL, Cynosure laser equipment: MONALISATOUCH (menopausal atrophy), TEMPSURE Vitalia RF (300 watts!) for incontinence, ENVI for face, Cynosure SculpSure with neck attachment for body contouring by warm sculpting. Please contact kristi.eisenhauermd@yahoo.com or (760) 753-8413. FOR SALE: Nuclear medicine equipment including Ge Millennium MG system, hot lab, and sources Cs-137. Rod Std 2. Cs-137. DCRS 3. Cs-137. Spot 4. Co-57. Flood sheet. Please contact us at (760) 730-3536 if interested in purchasing, pricing or have any questions. Thank you. NON-PHYSICIAN POSITIONS WANTED

MEDICAL OFFICE MANAGER/CONTRACTS/BILLING PERSON: MD specialist leaving group practice, looking to reestablish solo private practice. Need assistance reactivating payer contracts, including Medicare. If you have that skill, contact ljmedoffice@ yahoo.com. I’m looking for a project bid. Be prepared to discuss prior experience, your hourly charge, estimated hours involved. May lead to additional work.

MEDICAL EXAM TABLES FOR SALE: Unfortunately for us, we are unable to

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