Jan/Feb 2019 | Los Angeles Medicine Magazine

OFFICIAL PUBLICATION OF THE LOS ANGELES COUNTY MEDICAL ASSOCIATION

COMMUNITY IMPACT LA PHYSICIANS ARE JOINING THE CONVERSATIONS, SEEKING SOLUTIONS AND TAKING ACTION

JAN/FEB 2019

PLUS: Honoring Local Leaders at the Los Angeles Healthcare Awards

LACMA PRESIDENT

C . F R E E M A N , M D, M B A , FA PA

Patients, Practices, and Politics Paperwork and administrative burdens, difficulty using EHRs, government regulations, prior authorizations, Maintenance of Certification (MOC) requirements and costs are what some physician readers of Medical Economics identify as ruining medicine. Although there is no quick fix to any of these challenges, LACMA and CMA physicians have the ability to not only weigh in on the conversation but also identify and support representation that is sensitive to the needs of our patients and the ability to run our practices.

The tenure of Governor Gavin Newsom, who received endorsement from the California Medical Association, is heralded by his outlining comprehensive plans that seek to improve access to care and reduce healthcare costs for Californians. The new governor is visionary in the recognition of the need to address the social determinants of health by also creating a new surgeon general position to look at health disparities before they manifest. The governor shares the concerns of physicians and is actively working to increase our ability to provide care.

Just as Governor Newsom was identified to receive support, physicians must continue to organize efforts to identify other like-minded representation who can effect positive changes in our plagued healthcare system. Physicians must also seek and take opportunities to have our voices heard, which are more effectively heard as members of organized medicine.

If you feel that medicine is being ruined, consider getting involved, renewing your membership or encouraging your peers to join LACMA. Both LACMA and CMA provide resources and support for advocacy and practice management while physicians can focus on what is important, our patients.

[P]hysicians must continue to organize efforts to identify other like-minded representation who can effect positive changes in our plagued healthcare system.

Physicians must also seek and take opportunities to have our voices heard...

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EDITOR Sheri Carr | editor@physiciansnewsnetwork.com ADVERTISING SALES Dari Pebdani 858.231.1231 | dpebdani@gmail.com

VOLUME 150 ISSUE 1 | JAN/FEB 2019

EDITORIAL ADVISORY BOARD David H. Aizuss, MD Troy Elander, MD Thomas Horowitz, DO Robert J. Rogers, MD HEADQUARTERS LOS ANGELES COUNTY MEDICAL ASSOCIATION 1055 West 7th Street, Suite 2290 | Los Angeles, CA 90017 Tel 213.683.9900 | Fax 213.226.0350 www.losangelesmedicine.org LACMA OFFICERS PRESIDENT | C. Freeman, MD, MBA, FAPA PRESIDENT-ELECT | Sion Roy, MD TREASURER | Diana Shiba, MD SECRETARY | Jeffery Lee, MD IMMEDIATE PAST-PRESIDENT | William K. Averill, MD

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LACMA BOARD OF DIRECTORS COUNCILORS-AT-LARGE TRUSTEES & CHAIR DELEGATION Jerry Abraham, MD (1) Jack Chou, MD, CMA Trustee Samuel Fink, MD (6) Jerry P. Abraham, MD, MPH, Chair of the LACMA Delegation Kambiz Kosari, MD (6) Peter Richman, MD, CMA Trustee Maria Lymberis, MD (5) Nhat Tran, MD (9) COUNCILORS Robert Bitonte, MD, JD (D1) Stephanie Booth, MD (D3) Troy Elander, MD (D5) Marc Mendes, MD (D6) David Hopp, MD (D7) Omer Deen, MD (D9) Christine Phan, MD (D10) William Hale, MD (D14) Roxana Yoonessi, MD, JD (SCPMG) Heather Silverman, MD (SSGPF) Po-Yin Samuel Huang, MD (1, YP Councilor) Hector Flores, MD (1, EPC Chair) Laura Halpin, MD (Resident Councilor) Sameer Berry, MD (Alt. Resident Councilor) Ali Tafreshi (Student Councilor, USC)

LACMA’s Board of Directors consists of a group of 30 dedicated physicians who are working hard to uphold your rights and the rights of your patients. They always welcome hearing your comments and concerns. You can contact them by emailing or calling Lisa Le, Director of Governance, at lisa@lacmanet.org or 213-226-0304.

SUBSCRIPTIONS Members of the Los Angeles County Medical Association: Los Angeles Medicine is a benefit of your membership. Additional copies and back issues: $3 each. Nonmember subscriptions: $39 per year. Single copies: $5. To order or renew a subscription, make your check payable to Los Angeles Medicine, 10755 Scripps Poway Parkway, Suite 615 | San Diego, CA 92131. To inform us of a delivery problem, email editors@physiciansnewsnetwork.com.

Acceptance of advertising in Los Angeles Medicine in no way constitutes approval or endorsement by LACMA Services Inc. The Los Angeles County Medical Association reserves the right to reject any advertising. Opinions expressed by authors are their own and not necessarily those of Los Angeles Medicine, LACMA Services Inc. or the Los Angeles County Medical Association. Los Angeles Medicine reserves the right to edit all contributions for clarity and length, as well as to reject any material submitted. Los Angeles Medicine is not responsible for unsolicited manuscripts.

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PRESIDENT’S LETTER

C. Freeman, MD, MBA, FAPA A MESSAGE FROM LACMA CEO

Gustavo Friederichsen CONTRIBUTING TO THE CONVERSATION, SEEKING SOLUTIONS AND TAKING ACTION

COMMUNITY IMPACT

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New California Laws of Interest to Physicians for 2019

Honoring Local Leaders at the 7th Annual Los Angeles Healthcare Awards

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LACMA CEO

G U S TAV O F R I E D E R I C H S E N

A Strong Finish, a New Year and a Fresh Perspective LACMA finished last year with historic growth in terms of membership and revenue as we welcomed several new group members such as UCLAHealth and Acuity Eye Group, and expanded our already strong partnership with Southern California Permanente Medical Group. Our staff continues to reach out to independent physician practices and deploy various methods for engaging providers as we plan for the 2019 Saving Private Practice Consortium, which promises to be bigger, better and more useful than ever before.

In this issue, members learn about new healthcare laws as we continue to monitor key legislation that impacts your ability to practice medicine. One example of policy run amock is the new California law that requires all security prescription forms to have a uniquely serialized number. It requires California physicians who prescribe controlled substances to use updated controlled substance prescription forms. Although, technically, this requirement went into effect January 1, the California Department of Justice (DOJ) only very recently issued any guidance as to the manner in which the serialized number is going to go on the prescription forms.

As California’s new governor, Gavin Newsom, enacts his vision for healthcare reform in the state, LACMA’s president, Dr. C. Freeman, weighs in: “The state and Los Angeles County have long needed a leader committed to healthcare, who understands the fragile relationship between patient, medical provider and community-centered care.

While former Governor Jerry Brown said his state would not ‘turn back’ on advances it’s made in health coverage, he didn’t instill confidence in protecting the most vulnerable and those who provide care every day.

Social determinants of health must be addressed by Governor Newsom and his new administration to solve poor access to essential services, the rising cost of care, preventable illness and disease, resulting in healthier, more vibrant communities.”

Now, speaking of glass half full, kudos to all who were recognized, attended and supported the Los Angeles Healthcare Awards fantastic gala this past November. The event was sold out and raised dollars for the Charles R. Drew University School of Medicine and Science. This transformational night brought the medical community together to share, inspire and recognize achievement.

LACMA continues to change as the needs of members change, and one thing remains a certainty: We will, as a community partner, look for ways to impact the lives of providers, patients and communities alike. We won’t shy away from speaking out on behalf of members when it comes to issues like access to care, healthcare reform, physician wellness, social determinants of health and communities in crisis.

Gun violence, as a public health issue, continues to destroy lives and impact medical providers in many ways. We need rigorous research to better understand the crisis, test solutions, and learn how best to implement and sustain work that is being done. Physicians have the knowledge and responsibility to seek the answers to questions related to health and safety of the communities they serve every day. “Perhaps one step is to follow the lead of the American College of Surgeons,” says Dr. Freeman, “as they have enlisted gun owners to help them dissect the dilemma and help develop workable solutions. In fact, the best solution may be respectful dialogue between gun owners and physicians to seek solutions and get away from ideology and painful rhetoric -- a compromise based on facts, not ideology or raw emotion.”

A new day, a new year, a fresh perspective on how to move medicine forward in the wake of chaos. That’s today’s LACMA.

LACMA continues to change as the needs of members change, and one thing remains a certainty: We will, as a community partner, look for ways to impact the lives of providers, patients and communities alike.

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YOU’RE A DOCTOR, NOT A COLLECTION AGENCY CAP’s FREE New Guide Helps You Focus More on Medicine and Less on Billing The Cooperative of American Physicians (CAP) published The Physician’s Action Guide to Smarter Billing to help physicians and medical staff develop sound billing practices that can help you get paid in a timely and fair manner.

CAP provides California’s finest physicians with superior medical malpractice coverage and supplemental benefits. The Physician’s Action Guide to Smarter Billing is just one of the many benefits.

Request your free copy: 800-356-5672 CAPphysicians.com/LABG1 Medical professional liability coverage is provided to CAP members by the Mutual Protection Trust (MPT), an unincorporated interindemnity arrangement organized under Section 1280.7 of the California Insurance Code.

As practitioners, physicians have the ability to impact the health of hundreds of people. As community members, physicians have the potential to influence thousands, even millions. As demonstrated on the following pages, Los Angeles physicians are uniting and leading by example, addressing issues that challenge the welfare of our community by contributing to the conversation, seeking solutions and taking action.

C. FREEMAN, MD, MBA, FAPA, PRESIDENT, LOS ANGELES COUNTY MEDICAL ASSOCIATION, ADULT AND GERIATRIC PSYCHIATRIST

Hours after a gunman opened fire in the Borderline Bar One physician member had a different view: & Grill in Thousand Oaks, killing 12 people before turning “I feel safer in my house knowing that many doctors have the gun on himself, the NRA told “anti-gun” doctors to “stay guns in their house, deterring break-in robberies. There isn’t in their lane” after a series of research papers about firearm research that says keeping guns away from law-abiding docinjuries and deaths was published tors deters criminals.” in the Annals of Internal Medicine, Perhaps one step is to follow the “The best solution may including new recommendations to lead of the American College of Surreduce gun violence. geons as they have enlisted gun ownbe a respectful dialogue The NRA wrote in the tweet, ers to help them dissect the dilemma between gun owners “Someone should tell self-important and help develop workable solutions. and physicians to seek anti-gun doctors to stay in their In fact, the best solution may be a resolutions and get away lane.” Half of the articles in Annals of spectful dialogue between gun owners Internal Medicine are pushing for gun and physicians to seek solutions and from ideology and painful control. Most upsetting, however, the get away from ideology and painful rhetoric — a compromise medical community seems to have rhetoric — a compromise based on based on facts, not ideolconsulted NO ONE but themselves.” facts, not ideology or raw emotion. This ogy or raw emotion.”

As president of the Los Angeles year LACMA will be hosting a “converCounty Medical Association (LACMA), sation” with local stakeholders includa 147-year-old organization dedicating emergency room, trauma and ed to serving the medical profession, and as a mental health mental health experts along with law enforcement and, yes, advocate, I agree with my colleagues that we indeed need gun advocates to seek dialogue, and perhaps, just perhaps, rigorous research to better understand the crisis, test soluthe lane could be expanded to many, not some. tions, and learn how best to implement and sustain work that is being done. As physicians we have a responsibility to seek the answers to questions related to health and safety of the communities we serve every day.

At LACMA, we surveyed our members (approximately 6,000), and the feedback has been both consistent and sobering: Some believe that organized medicine should treat violence, including gun violence, as an epidemiological health issue. Firearm ownership should include getting an operator’s license and requirements for safe storage and safe use.

Requiring every gun owner to complete a training course at first purchase and a recertification every year or two would also be useful. The training should include gun safety, depression warning signs, and instruction about how to get help for those in need. This is similar to what is done with motor vehicles. A sales tax on all gun purchases and ammunition purchases could be used to fund shelters, mental health facilities, free gun lock programs, and sponsor gun buybacks. All of this is similar to what was done with tobacco.

COMMUNITY IMPACT

Physicians and the NRA

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COMMUNITY IMPACT

Taking Action on Climate Change: Steps for Health Care Providers Emily Audet, BA, Civic Spark Fellow Susan Lesser, MPH, Program Manager Sarah Huang, BA, Civic Spark Fellow Elizabeth Rhoades, PhD, Director Los Angeles County Department of Public Health, Climate Change and Sustainability Program, Environmental Health Division

For additional information, please visit http://rx.ph.lacounty.gov/RxClimate1118

You may have seen recent news stories about climate change. For instance, in October the Intergovernmental Panel on Climate Change warned of the dire consequences of 2°C of warming1 (the planet is currently on track for more than that), and in November the National Climate Assessment enumerated the serious health, economic and security consequences of climate change for our country.2 In addition, the Lancet Commission on Health and Climate Change asserted that the health impacts of climate change are already occurring.3 The message is unanimous: Climate change is already negatively impacting people, and aggressive action must be taken to slow it.

This article, which discusses steps that clinicians can take on a clinical, institutional, policy and personal level to slow climate change, was adapted from the November issue of Rx for Prevention, the Los Angeles County Department of Public Health’s (LAC DPH) publication for clinicians. A companion article describes how clinicians can address the health impacts of climate change on their patients.

ACTIONS TO MITIGATE CLIMATE CHANGE There are many opportunities for clinicians to use their expert knowledge and professional influence to slow climate change and protect their patients’ health.

Examples of recommended clinical, institutional, policy, and personal actions are described below. See the “Further Engagement” section in the full-length Rx for Prevention article for resources for getting involved.

INTERACTIONS WITH PATIENTS | Many health-promoting behaviors, such as encouraging patients to walk or bike and eat more plant-based food, mitigate climate change.4 Clinicians can post, in waiting rooms, information such as the Center for Climate Change & Health’s Climate and Health posters and the LAC DPH fact sheet on reducing one’s carbon footprint.

INSTITUTIONAL ACTION | The healthcare sector in the United States contributes significantly to greenhouse gas (GHG) emissions, the primary contributor to climate change. Clinicians can advocate for climate action within their affiliated hospitals, clinic or professional associations. The American Medical Association provides short- and long-term steps clinicians can take to improve the sustainability of their practice, and the American Hospital Association’s Sustainability Roadmap provides instructions on how to improve sustainability in hospital operations..

Promoting Sustainable Transportation • Propose commuter and transportation assistance programs that incentivize use of vanpools or mass transit, such as discounts, rebates, vouchers and shuttles to nearby transit stops.

• Work with the facilities/operations department to include: o Facilities that support active transportation, like lockers, showers and bike parking. o Electric vehicle parking and charging stations.

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Reducing Energy Use • Work with the facilities/operations department to: o Install renewable energy and energy efficiency measures, like solar panels or energy-efficient lighting. o Implement energy efficiency campaigns that encourage using stairs or turning off lights. o Adopt green procurement policies, including preferences for local supplies and local food. o Install cool and green roofs and landscape with shade trees to reduce the urban heat island effect.

Reducing Waste • Propose that the facilities/operations department adopt landfill waste reduction strategies, such as composting in cafeterias, reducing bottled water use, and recycling paper and other waste.

Education • Encourage professional associations to host educational opportunities related to climate change and health.

• Include information on the health impacts of climate change in employee orientation and training.

POLICY ACTIVITIES | Framing climate change in the context of health has been shown to be the most effective way to elicit support for climate policies and programs.5 Clinicians can use their expertise, stature and a health lens to advocate for climate change policy. Examples may include the following: • Support measures that benefit both climate change mitigation and health, such as active transportation funding and infrastructure. Track proposed California legislation through the Southern California Association of Governments and Health Officer Association of California’s reports.

• Propose policies that address climate change and promote health equity at urban planning agency public meetings, such as improving public transit accessibility or increasing green space.6 • Advocate for programs and policies that make personal mitigation actions more accessible to people with low incomes, for example, accepting SNAP EBT (Supplemental Nutrition Assistance Program Electronic Benefits Transfer) at farmers’ markets.

• Join an organization that promotes health care sector action on climate change.

PERSONAL | Clinicians can reduce their own contributions to climate change through simple actions at home and work.

• Buy more locally grown food, such as from farmers’ markets, community-supported agriculture programs, and the local food section of grocery stores.

• Decrease water usage by taking showers instead of baths or adding indoor and outdoor water-efficient fixtures.

• Use CFL (compact fluorescent light) or LED (light-emitting diode) bulbs in the home and office.

See LAC DPH’s 10 Things You Can Do to Reduce Climate Change fact sheet. 7 CONSIDERING THE NEEDS OF VULNERABLE GROUPS Climate change disproportionately harms low-income communities and communities of color. They are, for example, disproportionately vulnerable to negative health impacts of extreme heat because they often live in urban heat islands and are less likely to have access to coping tools, like home air conditioning or a vehicle to travel to cooling centers.8 When acting to mitigate and adapt to climate change, clinicians should consider impacts on these groups, prioritize actions that benefit them, and value their voices in the planning process.

For instance, clinicians can use geomedicine, which provides environmental health information related to a patient’s place of residence, to get a fuller picture of potential health concerns9 and develop care plans that address unique vulnerabilities and risks.

At institutional or policy levels, clinicians can ensure that those most impacted by climate change are centered in planning and decision-making.

REFERENCES 1. Robin Matthews JB. Intergovernmental Panel on Climate Change. Global Warming of 1.5°C: Special Report. 2018. https://www.ipcc.ch/sr15/. Accessed January 7, 2019.

2. Reidmiller DR, Avery CW, Easterling DR, et al. U.S. Global Change Research Program. Fourth National Climate Assessment: Impacts, Risks, and Adaptation in the United States, Volume II. 2018. doi:http://dx.doi. org/10.7930/NCA4.2018.

3. Watts N, Amann M, Ayeb-Karlsson S, et al. The Lancet Countdown on health and climate change: from 25 years of inaction to a global transformation for public health. The Lancet. 2018;391(10120):581-630. doi:http://dx.doi.org/10.1016/S0140-6736(17)32464-9.

4. Luber G, Knowlton K, Balbus J, et al. U.S. Global Change Research Program. National Climate Assessment. 2014. https://nca2014.globalchange.gov/report/sectors/human-health. Accessed April 30, 2018.

5. Myers, TA, Nisbet MC, Maibach EW, Leiserowitz AA. A public health frame arouses hopeful emotions about climate change: A letter. Climatic Change. 2012;113(3-4):1105–1112. doi:http://dx.doi.org/10.1007/ s10584-012-0513-6.

6. ChangeLab Solutions and TransForm. Getting Involved in Transportation Planning: An Overview for Public Health Advocates. 2013. https:/www.changelabsolutions.org/sites/default/files/Health_ Transport_Factsheet_FINAL_20110713_%28rebrand_20130409%29.pdf. Accessed October 11, 2017.

7. Los Angeles County Department of Public Health. 10 Things You Can Do to Reduce Climate Change. 2014. www.publichealth.lacounty.gov/eh/docs/ climatechangeThingYouCanDotoReduceClimateChange.pdf. Accessed October 18, 2017.

8. Morello-Frosch R, Pastor M, Sadd J, Shonkoff, SB. The Climate Gap: Inequalities in How Climate Change Hurts Americans & How to Close the Gap. University of Southern California Program for Environmental and Regional Equity (PERE). 2009. https://dornsife.usc.edu/pere/climategap/. Accessed April 30, 2018.

9. Davenhall, B. Geomedicine: Geography and Personal Health. Esri. 2012. http:/www.esri.com/library ebooks/geomedicine.pdf. Accessed June 4, 2018.

FURTHER ENGAGEMENT To learn more and access a variety of climate change resources for clinicians, including patient education materials, reports and partnership opportunities, see the LAC DPH Climate Change website and the “Further Engagement” section in the complete Rx for Prevention article.

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New California Laws of Interest to Physicians for 2019 The California Legislature had an active year, passing many new laws affecting health care. In particular, there was a strong focus on health care coverage, drug prescribing, public health, and mental health issues. On the following pages you will find highlights of the most significant health laws of interest to physicians.

ALLIED HEALTH PROFESSIONALS SB 762: Optometry: administration of immunizations | Requires training programs for certification of optometrists to administer immunizations to be endorsed by the Accreditation Council for Pharmacy Education in addition to the federal Centers for Disease Control and Prevention.

AB 2086: Controlled substances: CURES database | CMA POSITION: SUPPORT | Allows prescribers to access the Controlled Substance Utilization Review and Evaluation System (CURES) database for a list of patients for whom that prescriber is listed as a prescriber in the CURES database.

CONSENT AB 3189: Consent by minors to treatment for intimate partner violence | Authorizes a minor who is 12 years of age or older and who states he or she is injured as a result of intimate partner violence, as defined, to consent to medical care related to the diagnosis or treatment of the injury and the collection of medical evidence with regard to the alleged intimate partner violence.

AB 2487: Physicians and surgeons: continuing education: opiate-dependent patient treatment and management | CMA POSITION: NEUTRAL | Authorizes a physician and surgeon to complete a one-time continuing education course of 12 credit hours on opiate-dependent patient treatment and management, including eight hours of training in buprenorphine treatment as an alternative to the mandatory continuing education course on pain management and the treatment of terminally ill and dying patients.

DRUG PRESCRIBING AND DISPENSING AB 1751: CURES database: Interstate data sharing | CMA POSITION: OPPOSE UNLESS AMENDED | Requires the Department of Justice, no later than July 1, 2020, to adopt regulations regarding the access and use of the information within CURES by consulting with stakeholders, and addressing certain processes, purposes, and conditions in the regulations. Authorizes the department, once final regulations have been issued, to enter into an agreement with any entity operating an interstate data sharing hub, or any agency operating a prescription drug monitoring program in another state, for purposes of interstate data sharing of prescription drug monitoring program information, as specified.

AB 2760: Prescription drugs: prescribers: naloxone hydrochloride and other FDA-approved drugs | CMA POSITION: NEUTRAL | Requires a prescriber, as defined, to offer a prescription for naloxone hydrochloride or another drug approved by the United States Food and Drug Administration for the complete or partial reversal of opioid depression to a patient when certain conditions are present and to provide education on overdose prevention and the use of naloxone hydrochloride or another drug to the patient and specified others, except as specified. Subjects a prescriber to referral to the licensing board charged with regulating his or her license for the imposition of administrative sanctions, as that board deems appropriate, for violations of these provisions.

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AB 2783: Controlled substances: hydrocodone combination products | Reclassifies specified hydrocodone combination products as Schedule II controlled substances under the California Uniform Controlled Substances Act. AB 2789 – Prescriptions: electronic data transmission | CMA POSITION: OPPOSE | Requires, on and after January 1, 2022, health care practitioners authorized to issue prescriptions to have the capability to transmit electronic data transmission prescriptions and would require pharmacies to have the capability to receive those transmissions. Mandates electronic prescribing, unless specified exceptions are met.

EMERGENCY SERVICES AB 2576: Emergencies: health care | CMA POSITION: SUPPORT IF AMENDED | Authorizes a pharmacist or a community clinic to furnish a dangerous drug or device in reasonable quantities without a prescription during a declared emergency. Requires the Pharmacy Board to allow for the use of a mobile pharmacy or clinic during an emergency if certain conditions are met. Authorizes the Governor, during a state of emergency, to direct all state agencies to utilize, employ, and direct state personnel, equipment, and facilities for the performance of any and all activities that are designed to allow community clinics and health centers to provide and receive reimbursement for services provided during or immediately following the emergency, including directing DHCS to seek federal approvals to allow community clinics and health centers to provide and be reimbursed for Medi-Cal or other services that are provided either telephonically, or to patients at a shelter or other location within the geographical boundaries of the emergency as stated in the proclamation declaring the state of emergency.

END-OF-LIFE AB 282: Aiding, advising or encouraging suicide: exemption from prosecution | Prohibits a person whose actions are compliant with the End of Life Option Act from being prosecuted for deliberately aiding, advising, or encouraging suicide.

AB 3211: Advance health care directives | Revises the language of the form for written advance health care directives created under the Health Care Decisions Law to allow a person to authorize an agent to consent to any temporary medical procedures necessary to maintain organs, tissues, and/or parts for the purpose of donation.

HEALTH CARE COVERAGE AB 2941: Health care coverage: state of emergency | Requires a health care service plan or health insurer to provide its enrollees or insureds who have been displaced by a state of emergency, as defined, access to medically necessary health care services. Requires a health care service plan or health insurer, within 48 hours of a declaration of emergency by the Governor that displaces or has the immediate potential to displace enrollees or insureds, to file a notification with the regulator containing specified information regarding how the plan or insurer is communicating with and addressing the needs of its enrollees or insureds during the state of emergency.

SB 997: Health care service plans: physician to enrollee ratios | Deletes the repeal date of existing law that would have sunset on January 1, 2019, and requires a health care service plan to ensure that there is at least one full-time equivalent primary care physician for every 2,000 enrollees and authorizes the assignment of up to an additional 1,000 enrollees, as specified, to a primary care physician for each full-time equivalent non-physician medical practitioner, as defined, supervised by that physician. These provisions will operate indefinitely.

HEALTH CARE FACILITIES AB 2983: Health care facilities: voluntary psychiatric care | CMA POS: SUPPORT | Prohibits a general acute care hospital or an acute psychi-

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atric hospital from requiring a person who voluntarily seeks care to be in custody as a danger to himself or herself or others or gravely disabled as a condition of accepting a transfer of that person after his or her written consent for treatment and transfer is documented or in the absence of evidence of probable cause for detention.

SB 1152: Hospital patient discharge process: homeless patients | CMA POSITION: OPPOSE UNLESS AMENDED | Requires each hospital to include a written homeless patient discharge planning policy and process within the hospital discharge

Did you know CMA’s online health law library is free to members?

The California Medical Association (CMA) online health law library contains nearly 5,000 pages of up-to-date legal information on a variety of subjects of everyday importance to practicing physicians. One of CMA’s most valuable member benefits, the searchable online library contains all the information available in the California Physician’s Legal Handbook (CPLH), an annual publication from CMA’s Center for Legal Affairs.

CMA members can access the library documents free at cmadocs.org/health-law-library. Nonmembers can purchase documents for $2 per page. CPLH, the complete health law library, is also available for purchase in a multi-volume print set or annual online subscription service.

To order a copy, visit cplh.org or call (800) 882-1262. policy. Among other requirements, the policy shall require a hospital to inquire about a patient’s housing status; to connect the patient with available community resources and supportive services; and to identify a post discharge destination for the patient. Requires a hospital to document specified information before discharging a homeless patient, including that the patient has been offered a meal and weather-appropriate clothing.

Requires, commencing on July 1, 2019, a hospital to develop a written plan for coordinating services and referrals for homeless patients with the county behavioral health agency, health care and 1 0 L O S A N G E L E S M E D I C I N E | J A N U A R Y/ F E B R U A R Y 2 0 1 9

social service agencies in the region, health care providers, and nonprofit social service providers, as available, to assist with ensuring appropriate homeless patient discharge.

INSURANCE SB 910: Short-term limited duration health insurance | Prohibits a health insurer from issuing, selling, renewing, or offering a short-term limited duration health insurance policy, as defined, for health care coverage in California. Makes conforming changes.

MEDI-CAL AB 2861: Medi-Cal: telehealth: alcohol and drug use treatment | CMA POSITION: SUPPORT | Requires, to the extent federal financial participation is available and any necessary federal approvals have been obtained, that a Drug Medi-Cal certified provider receive reimbursement for individual counseling services provided through telehealth by a licensed practitioner of the healing arts or a registered or certified alcohol or other drug counselor, when medically necessary and in accordance with the Medicaid state plan.

SB 849: Medi-Cal | Establishes, until January 1, 2026, the Proposition 56 Medi-Cal Physicians and Dentists Loan Repayment Act Program, to be developed by the State Department of Health Care Services to provide loan assistance payments to qualifying, recent graduate physicians and dentists that serve beneficiaries of Medi-Cal and other specified health care programs as specified. Allows the department to authorize a dental integration pilot program in San Mateo County as a component of the Medi-Cal 2020 demonstration project.

SB 1287: Medi-Cal: medically necessary services | Revises the Medi-Cal definition of “medically necessary” for purposes of an individual under 21 years of age to incorporate federal standards related to Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services and requires the department and its contractors to update any specified materials to ensure the new medical necessity standard for coverage for individuals under 21 years of age is accurately reflected in all materials.

MEDICAL RECORDS AB 2088: Patient records: addenda | Requires a health care provider to allow a patient, regardless of their age, who inspects their patient records to

provide to the health care provider a written addendum with respect to any item or statement in their records that the patient believes to be incomplete or incorrect.

These are just a sampling of the new laws impacting health care in 2019 and beyond. For a comprehensive list, see “Significant New California Laws of Interest to Physicians for 2019,” at

health conditions including, but not limited to, postpartum depression.

PROFESSIONAL LICENSING AND DISCIPLINE cmadocs.org/new-laws-2019.

MENTAL HEALTH SB 1448: Healing arts licensees: probation AB 1968: Mental health: firearms | CMA status: disclosure | CMA POSITION: OPPOSE POSITION: NEUTRAL | Prohibits a person who | Requires, on or after July 2, 2019, the has been taken into custody, assessed, and admitted to a designated licensing boards for podiatrists, naturopathic doctors, chiropractors, facility because he or she is a danger to himself, herself, or others, as acupuncturists, physicians and surgeons, and osteopaths to provide, a result of a mental health disorder and who was previously taken before the patient’s first visit, a specified disclosure to a patient or into custody, assessed, and admitted one or more times within a the patient’s representative if the licensee is on probation pursuant period of one year preceding the most recent admittance from to a probationary order made on and after July 1, 2019. Also requires owning a firearm for the remainder of his or her life, subject to existthe licensing boards to post specified information related to licensing notice and hearing procedures. ees on probation on their website.

AB 2193: Maternal mental health | CMA POSITION: NEUTRAL | Requires,

by July 1, 2019, health care service plans and health insurers to develop a maternal mental health program, as specified. Requires a licensed health care practitioner who provides prenatal or postpartum care for a patient to offer to screen or to appropriately screen a mother for maternal mental health conditions, subject to specified exceptions.

WORKFORCE & OFFICE SAFETY ISSUES AB 2311: Medicine: trainees: international medical graduates | CMA POSITION: SUPPORT | Eliminates the reference to the specific courses in clinical instruction authorized to be offered to the international medical graduate participants in the pre-residency training program at the David Geffen School of Medicine of the University of California, Los Angeles.

AB 2315: Pupil health: mental and behavioral health services: telehealth technology: guidelines | CMA POSITION: SUPPORT IF AMENDED | Requires the State Department of Education, in consultation with the State Department of Health Care Services and stakeholders, to, on or before July 1, 2020, develop and post guidelines, as specified, for the use of telehealth technology in public schools, to provide mental health and behavioral health services to pupils on school campuses.

How do you imagine your retirement?

If you’re dreaming about retirement, you’re probably not thinking about all of the complexities of closing down your primary care practice. Continuity of care. Patient notifications. Recordkeeping responsibilities.

AB 2325: County mental health services: veterans | CMA POSITION: SUPPORT | Prevents a county from denying an eligible veteran county mental or behavioral health services while the veteran is waiting for a determination of eligibility for, and availability of, mental or behavioral health services provided by the United States Department of Veterans Affairs. Makes specific findings and declarations about the county’s duty to provide mental and behavioral health services to veterans.

We can help. MDVIP has an experienced team dedicated to assisting primary care physicians retire. Our services are complimentary, and we have already facilitated more than 60 successful retirements. Our team can: • Aid with retirement planning and continuity-of-care options • Send state-required communications • Host a retirement event for you and your patients Stop dreaming. Start retiring.

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AB 3032: Maternal mental health conditions | Requires a general acute care hospital or special hospital that has a perinatal unit to develop and implement, a program as specified, relating to maternal mental Los-Angeles-medical-ad.indd 1

8/27/18 2:29 PM J A N U A R Y/ F E B R U A R Y 2 0 1 9 | L O S A N G E L E S M E D I C I N E . O R G 1 1

On November 30, the Los Angeles County Medical Association and its Patient Care Foundation hosted the 7th Annual Los Angeles Healthcare Awards, celebrating the achievements of healthcare innovation in Los Angeles County.

Over 200 physicians and healthcare leaders gathered at the Four Seasons Los Angeles at Beverly Hills to honor LA County’s top physicians, healthcare leaders and institutions for their work to improve healthcare delivery in LA County.

Proceeds from the 2018 Los Angeles Healthcare Awards benefitted medical student scholarship programs at the Charles R. Drew University of Medicine and Science (CDU).

Troy Elander, MD, chair of the Patient Care Foundation, in his opening remarks, praised the honorees for their commitment and stressed the importance of the Foundation’s mission: “In recent times, the practice of medicine has grown ever more complex and, in far-too many cases, out of the reach of people who need it most. That is why we are here tonight to celebrate the individuals and institutions who are aligned with the mission of the Foundation and are helping the cause of health and well-being in Southern California.”

Among the honorees were Toni Chavis, MD, MPH, FAAP, honored with the Independent Physician Leadership Award, followed by Don W. Larsen, MD, MBA, MHA, FACHE, who received the Hospital Physician Leadership Award. The Cedars-Sinai Medical Network was honored with the Innovation Award for Healthcare Delivery, and Southern California Permanente Medical Group-Kaiser Permanente received the Quality in Medicine Award. The last two awards of the evening were presented to L.A. Care Health Plan, which received the Innovation Award for Community Service, followed by Barbara Ferrer, PhD, MPH, MEd, who received the Healthcare Champion of the Year Award.

The evening closed with a check presentation to Charles R. Drew University of Medicine and Science (CDU), followed by remarks from the university’s president and CEO, David M. Carlisle, MD, PhD, and two third-year medical students. Through outstanding education, clinical service and community engagement, CDU is one of the leading medical education institutions in LA County driving innovative initiatives that help to increase the pool of health professional leaders who are dedicated to social justice and health equity for underserved populations.

The Patient Care Foundation was founded in 2008 as the charitable arm of LACMA to improve the quality of life of all patients in LA County by nurturing the next generation of physicians.

Each year the Foundation carefully selects the honorees of the Los Angeles Healthcare Awards to recognize the achievements of LA County’s outstanding healthcare leaders and raise funds to benefit medical education institutions and medical students, with the goal of improving patient access to care, treatment, and health education.

1 2 L O S A N G E L E S M E D I C I N E | J A N U A R Y/ F E B R U A R Y 2 0 1 9

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