August/September 2023 Coastal Physician

Christopher O'Grady, MD

Maximiliano Cuevas, MD MCMS President 2018-2021

Donaldo Hernandez, MD, FACP CMA President 2023

Lisa Hernandez, MD, MPH SC Public Health Officer

James Hlavacek, MD MCMS Treasurer 2021-Jun 2023

Clay Angel, MD

John Christensen, MD

Malcolm Kearns, MD

Brian Brunelli, MD

Dawn Motyka, MD Inemesit Newsome, MD

John Pestaner, MD

Jeannine Rodems, MD, FAAFP

Joyce Orndorff, MD

Eloy Romero, MD Jack Watson, MD

Co-President Anthony Sturzu, MD

President-Elect Daniel Greene, MD Treasurer Amy McEntee, DO

Co-President Steven Harrison, MD

Secretary Alfred Sadler, MD, FACP

Immed Past President Ciara Harraher, MD, MPH

For 123 years, the Medical Association in Santa Cruz and Monterey Counties has pursued the promotion of the science and art of medicine, protection of public health, and the betterment of the medical profession Together in partnership with the California Medical Association we improve and advocate for the health and well-being of physicians and the community; and the common goals of similar organizations

The Santa Cruz Monterey Medical Association Foundation is a collaborative physician and community-led subsidiary 501(c)(3) public benefit corporations dedicated to improving community health, supporting physicians throughout their career, and serving as a leader in fostering careers in medicine.

Treasurer Grant Hartzog, PhD

Secretary Donna Odryna

Chair of the Board Alfred Sadler, MD, FACP

Immed. Past President Christopher O'Grady

President Jack Watson, MD D

Violetta Barroso, MD

Anastasia Klick, MD Amy McEntee, DO

Valerie Berry, MD

Melissa Nothnagle, MD, MSc

Jeannine Rodems, MD, FAAFP

Presidents’ Letter

Dear Fellow Colleagues,

It is our honor to serve in leadership representing the Santa Cruz County and Monterey County region. The fall marks the final preparations for the 152nd House of Delegates which will convene on Saturday October 21st in Los Angeles with more than 500 physicians from around the State in attendance. In addition to specific and general business of the House, local Santa Cruz Hospitalist, Dr. Donaldo Hernandez, will be recognized by the House of Delegates and at the CMA Presidents Gala for his extraordinary leadership and exemplary service over this past year as the 2023 CMA President

The primary focus of the House of Delegates is dedicated to this year’s major issues which include Consumer Health Technology & Artificial Intelligence, the Office of Health Care Affordability, and Climate Change, (click here for the draft schedule). Among the regular business matters coming before the House include one of significance to our region -- the approval of the Charter that recognizes the consolidation and merger of the Santa Cruz County and Monterey County Medical Societies.

Now called the Santa Cruz Monterey Medical Association (SCMMA), we look toward the first meeting (Sept 28) of the newly consolidated Board of Directors, (see pages 2-3 for the list of Officers and Directors). Of immediate priority on the agenda are the setting of the annual calendar of board meetings and association activities for the coming year, nominations and elections for open board and delegate seats, preparation for the House of Delegates, appointments to committees, and the planning of the SCMMA Strategic Planning Meeting.

If you would like to get involved with the Medical Association or its Foundation, please reach out to us at 831479-7226 or email donnao@cruzmed org

Fall is also membership renewal time with early bird renewal discounts available. Be on the lookout for your membership renewal statement in October or click here to renew your membership today: https://www.cmadocs.org/renew. And if you are not yet a member, join today and get 15 months for the price of 12. Click here to become a member: https://www.cmadocs.org/join.

We want to express our sincerest appreciation to the members of the Board, past and present, who have generously served to give back to their communities and the profession by representing the voice of all physicians when it matters most.

Membership in the SCMMA and CMA acknowledges physicians’ commitment to the medical profession and to preserving its time-honored place in modern society. With more than 680 members, SCMMA is committed to keeping the practice of medicine in the hands of physicians, helping to champion health care initiatives, and advocating for patients

Sincerely,

Steven Harrison, M.D. Anthony Sturzu, M.D.

Donna Odryna

Executive Director

~

Executive Notes

The transition from summer to autumn has always brought with it the invitation to slow down, reflect back on what was, and look forward to what’s ahead And just in time for the seasonal transition comes a significant transition of our own as four organizations consolidate into two -- the Santa Cruz Monterey Medical Association and the Santa Cruz Monterey Medical Association Foundation

In 1900, the passionate hearts and brilliant minds from the tri-county region came together to form the first physician-led organization for the benefit of patients in Monterey, San Benito, and Santa Cruz counties. Though the partnership between the county medical societies has looked different over the past 100+ years, the guiding star has remained consistent - the promotion of the science and art of medicine, protection of public health, and the betterment of the medical profession to improve and advocate for the health and well-being of physicians and the community

EXECUTIVE LETTER

Obviously I was not at the table in 1900, but I might imagine the founding physicians gathered were driven by questions like, “How do we provide access to quality of care for our patients?” and, “How can we advance medicine and save lives?”

Today, in the Autumn of 2023, we prepare for October’s House of Delegates where the final punctuation will be added to the page as we turn it and step into a new era of growth and unification During this season of transition, I want to acknowledge the countless contributions of our current and past leaders who were and are visionaries. And I am most grateful for the opportunity to have a seat at the table during this momentous season of transition

"Life, it seems, is nothing if not a series of initiations, transitions, and incorporations."

Alan Dundes

The Santa Cruz Monterey Medical Association Foundation (SCMMAF), in partnership with UCSC, is helping to support pre-med students with the opportunity to shadow with a physician for 2 half days during either the fall, winter, or spring quarter This program will allow students the unique opportunity to get a first hand glimpse of what their day-to-day life might look like as a physician while providing them with recommended clinical exposure prior to medical school application

You must be a practicing physician, M D or D O (you do not need to be a member)

You must have 2 half days during the span of a month available before the summer of 2024

You must work in an office or hospital that will allow a student to shadow you

Aaron Morse, MD Sleep Health MD Internal Medicine, Sleep Medicine

Victor Salazar Castillo, MD The Permanente Medical Group Family Medicine

Kim Albridge, MD California Skin Institute - Santa Cruz Dermatology

Lisa Hernandez, MD County of Santa Cruz Health Services Public Health and Preventative Medicine

Oscar Gantes, MD Salud Para La Gente Health Clinic Family Medicine

Steven Prager, MD Central Coast Allergy & Asthma Allergy and Immunology

Harvey Kryger, MD, DMD The Monterey Preventative Medical Clinic Family Medicine

6 reasons to become a member

Free legal help

Ever wish you could have a legal expert on speed dial? Well, as a member you can CMA's legal help line provides immediate assistance for questions on human resources, medical, regulatory or legal issues.

Get paid

A team of expert economic advocates with advanced training in physician reimbursement and medical business issues are available to provide free, one-on-one help to improve your bottom line

Head seat at the policy table

BENEFITS OF MEMBERSHIP - DONE

As a member, you'll have the opportunity to get involved with highly influential stakeholders shaping and implementing health policy Members are able to serve in CMA's House of Delegates or on councils and committees, join CMA's sections and forums, or run for a leadership position with SCMMA as well as CMA

CME & learning opportunities

Let's face it, change is a constant As a member, you're able to attend credited in-person seminars, secure free CME credits, or watch live webinars from the comfort of your own home or office

Personal and professional discounts

Not only do members get free or discounted access to all SCMMA and CMA events, but you also unlock an expansive menu of discounts for both your professional and personal needs (examples include auto & home insurance, magazine subscriptions, RxSecurity paper, and up to 80% off at Staples)

Collegial connection

SCMMA and CMA bring physicians from all parts of the medical community together through leadership, cooperation, and social events.

MEMBERSHIP OPENS DOORS FOR IMPACT

Santa Cruz Monterey Medical Association Foundation

Workforce Development: Provide leadership and feedback to local premed students involved in programs like UCSC’s Student Lecture Series.

Residency Program: Get involved with expanding local residency programs to help create more pathways for our future physicians

Young People in Medicine: Become a youth mentor through programs such as UCSC’s MESA Program

Join our board

Members are eligible to run for a seat on our board and become one of the voices shaping the Santa Cruz Monterey Medical Association’s mission, focus, and involvement.

Run for local office

Bring your expertise and background in medicine to your local office where you’ll have a direct hand in shaping both state and local health care policy As a member of SCMMA and CMA, you’ll have the support of CALPAC staff and physician leaders helping you run for office.

Become a delegate or alternate

Are you a member with something to say about the practice of medicine? Well, we might have just the stage for you CMA’s House of Delegates (HOD) consists of more than 500 elected member delegates that convene annually to debate on the most important issues affecting members, the association, and the practice of medicine.

Join a counsel or subcommittee

here here here here here

CMA’s Council and Subcommittee structure addresses the entire range of health care issues impacting the practice of medicine in California. Nominate yourself or a colleague to serve on one of CMA’s standing Councils and Subcommittees such as the Council on Ethical, Legal and Judicial Affairs, or the Council on Science and Public Health

For questions, comments, or if you’d like to get involved, reach out to Tira Hepker at sccms@cruzmed org

LEADING VOICE IN HEALTH CARE: Through expert political and regulatory advocacy, CMA has positioned itself as one of the most infuential stakeholders in the development and implementation of health policy. CMA also gives members direct access to our state’s and nation’s legislative leaders so they can shape the practice of medicine in California.

ADMINISTRATIVE BURDENS: CMA works hard to reduce administrative burdens in physician practices, so physicians can spend more time caring for patients. CMA is fghting to streamline prior authorization at both the state and federal level, prevent unfair payment practices, stop duplicative reporting requirements and more.

LEGAL EXPERTS: CMA’s Center for Legal Affairs provides members with information about laws and regulations that impact the practice of medicine. Our health law information specialists—with the help of CMA legal counsel—will help you fnd information on a multitude of health-law related issues.

PHYSICIAN WORKFORCE: CMA is committed to ensuring California is training enough physicians to meet current and future demand. Our CalMedForce GME grant program to date has allocated over $189 million to 143 GME programs across California to retain and expand residency programs in primary and emergency medicine.

REIMBURSEMENT ASSISTANCE: Members receive one-on-one assistance from CMA’s reimbursement experts, who have recouped $40 million from payors on behalf of CMA physicians since 2008.

LOAN FORGIVENESS: CMA’s CalHealthCares program provides loan repayment on educational debt for California physicians and dentists. Eligible physicians can receive up to $300,000 in exchange for a fveyear service obligation. To date, 1,077 California providers have received a combined total of $256 million to pay down student debt.

TELEHEALTH: Through CMA’s advocacy, both public and private payors were pushed to expand their coverage of and reimbursement for services provided via telehealth. CMA in 2022 also successfully pushed to extend the COVID-19 telehealth waivers into 2023 and to permanently extend key Medi-Cal telehealth payment parity.

“Membership in CMA allows me to make a long-lasting diference in the lives of my patients and protect and enhance the practice of medicine in California.”

Bradford Anderson, M.D. Physical Medicine/Rehabilitation Member since 1991

careers.cmadocs.org

CALIFORNIA PHYSICIANS CAREER CENTER

opportunity"

FIND A JOB

QUICK FACTS

Members post for FREE

Members get access to free 90 day job postings. Check out the pricing brackets here.

Wondering if the grass is greener on the other side? Well, go ahead and take a peak! See who’s hiring, what they’re offering, and if it’s your shade of green

Step 1: Setup your FREE account

The first step is to setup your free account as a Job Seeker or Employer Get started here

Step 2: Validate your account

Before you may start browsing Candidate Profiles, you need to validate your account Instructions on how are shared once you create your Employer account

FIND A CANDIDATE

Browse and contact the candidates you are interested in You only pay when the candidate expresses interest back If they’re not interested you pay nothing Get started here

POST A JOB

Have an opening you need filled? Head on over to the “Post a Job” page, select the type of posting you’d like, and simply fill out the form with the criteria you’re looking for

POST A RESUME

Are you ready to launch your career in the medical industry? Check out the free resume review tool, or use the resume builder on the website Upload your resume here.

Don’t miss the

CAREER PLANNING PORTAL

If you’re looking for career advice, industry insights, or career coaching, look no further. The Career Planning Portal is a one-stop resource center designed to prepare you for your next opportunity

"Connecting talent with

YEAR-ROUND RESOLUTIONS

Board Actions on Q3 Council Reports

The Board took the following actions on the Recommendations in the report from the Council on Science and Public Health:

RECOMMENDATION 1: 103-23 Front of Package Labeling for Food High in

Calories, Sugar, Fats or Sodium

RESOLVED: That CMA supports front-of-package labeling for foods high in calories, sugar, unhealthy fats, or sodium; and be it further

RESOLVED: That CMA supports front-of-package labeling that allows for relative ease of comparisons between different foods; and be it further

RESOLVED: That CMA encourages the development of a nutritional food grading system that meets a minimum standard of providing a) a simple, highly visible (i e front-of-package), and b) easy-to-understand rating scale that is usable by consumers to compare foods at point-of-purchase; and be it further

RESOLVED: That CMA supports developing a process for nutritional food labeling that prioritizes scientific rigor to ensure the nutritional food grading system is evidence-based.

Board action: Approved Council's recommendation to adopt amended Resolution 103-23.

RECOMMENDATION 2: The Council on Science and Public Health recommends disapproval of Resolution 109-23.

Board action: Approved Council's recommendation to disapprove resolution.

Board Actions on Q3 Council Reports

Email Title: Board Actions on Q3 Council Reports - DONE

The Board took the following actions on the Recommendations in the report from the Council on Membership, Governance and Bylaws:

RECOMMENDATION 3: 302-23 Merger of Santa Cruz County Medical Society and Monterey County Medical Society

RESOLVED: That pursuant to Chapter 4, Section 4 04 of the CMA Bylaws that the charters of both the Monterey County Medical Society (MCMS) and Santa Cruz County Medical Association (SCCMS) be rescinded, and that a new charter be issued to the merged entity now named the Santa Cruz Monterey Medical Association, and be it further

RESOLVED: That the CMA officially recognize this consolidation and make appropriate changes in all official publications, documents, and policies, and be it further

RESOLVED: That the CMA notify the American Medical Association of the consolidation and the new name and request that the appropriate changes be made in the organization’s official publications, documents, and policies

Board action: Approved Council's recommendation to adopt amended resolution.

The Board took the following actions on the Recommendations in the report from the Council on Ethical, Legal and Judicial Affairs:

RECOMMENDATION 4: The Council on Ethical, Legal and Judicial Affairs recommends approval of a substitute in lieu of Resolutions 501-22 and 501-23.

RESOLVED: That CMA recognizes that it is imperative to establish a framework for healthcare providers to appropriately but temporarily hold and care for those adult patients who: 1) lack capacity to make healthcare decisions for themselves, 2) are seriously ill, gravely disabled or at other risk of harm to themselves or others, and 3) who wish to leave the healthcare facility despite the existence of these conditions and/or risk of harm, until such time that 1) the individual recovers decision-making capacity, 2) a surrogate decision-maker can be appointed, or 3) the patient can be safeguarded by family or friends, whichever comes first; and be it further

RESOLVED: That CMA supports the development, with the collaboration of appropriate stakeholders, of a model policy and an action plan to promote the implementation of a framework for healthcare providers to determine how to temporarily hold and care for those adult patients who 1) lack the capacity to make healthcare decisions, 2) are seriously ill, gravely disabled or at other risk of harm to themselves and or others, and 3) who wish to leave the healthcare facility despite such conditions and/or risk of harm, until such time that 1) they recover decision-making capacity, 2) a surrogate decisionmaker can be appointed, or 3) the patient can be safeguarded by family or friends, whichever comes first.

Board action: Approved Council's recommendation to approve amended resolution.

NEW PUBLIC SERVICE LOAN FORGIVENESS

As a result of CMA's victory in expanding the Federal Public Service Loan Forgiveness (PSLF) program, California physicians who work in nonprofit hospitals, foundations, clinics, or other healthcare establishments full time (30 hours/week) for 10 years may now be eligible for the program. "Physicians who are in for-profit sole proprietorships or partnerships or are employed by forprofit medical groups or other professional corporations still qualify under the new rules as long as 30 hours of services per week are provided in a non-profit facility through a written agreement with the facility or health care entity." Read CMA's full article highlighting the most recent changes here!

Stress, anxiety, depression, and grief are common, but they’re manageable. The Santa Cruz Monterey Medical Association is working collaboratively to support Central Coast physicians who are experiencing stress and burnout. Our resiliency sessions provide relief, an increased ability to cope, healing, and an opportunity for personal fulfillment.

Through the Resilience in Medicine Program (RIM), physicians can access up to two (2) annual resiliency sessions with approved and vetted RIM providers. We pay for RIM directly, discreetly, and anonymously to ensure the highest level of confidentiality. Your insurance will never be asked for, nor billed.

Through grants and private donations, we're able to offer the first two visits free of charge for physicians living and practicing in Monterey or Santa Cruz Counties. Physicians may extend their participation at their expense after the second visit.

Please ask for help. Sessions are not only confidential, they are also convenient, and FREE. Visit RIM to learn more about how to take advantage of these free and confidential resiliency sessions.

Fri. 10/20 Sat. 10/21

Sat. 10/21

New Delegate Orientation

CALPAC Reception

Presidential Gala

Future of Medicine Event

Session 1 - Sat 10/28: 8-11:30am

Session 2 - Sat 10/21: 1-5:00pm

Session 3 - Sun. 10/22: 8-11:30am

Session 4 - Sun 10/22: 1-4:00pm

Detailed schedule for the full weekend can be downloaded here (subject to change)

The 152nd annual session of the CMA House of Delegates at JW Marriott LA LIVE

Learn more on the HOD event page cmadocs.org/hod-2023

Donaldo Hernandez, M D CMA President 2023, Santa Cruz

Tanya Spirtos, M D CMA President 2024, Redwood City

CALPAC, the California Medical Association Political Action Committee, works to elect candidates who share our vision for the future of health care in California, as well as to maintain relationships with these legislators in offce.

Please donate today by scanning the code with your smartphone or visiting: calpac.org/donate.

CALPAC is a voluntary political organization that contributes to candidates for state and federal offce who share our philosophy and vision of the future of medicine. Contributions are not deductible for state or federal income tax purposes. More information available at CALPAC.org

CMA and AMA urge court to portect patient safety and uphold long-standing prohibition against non-physicians' use of 'doctor' (Source: CMA) - 9/6

“The California Medical Association (CMA) and the American Medical Association (AMA) have filed a joint amicus curiae brief defending California’s long-standing law that prohibits the use of the term “doctor” or the prefix “Dr.” by anyone other than Californialicensed allopathic and osteopathic physicians.”

GAO upholds award of TRICARE contract to TriWest Healthcare Alliance (Source: CMA) -8/16

“The Government Accountability Office (GAO) has upheld the U.S. Defense Health Agency (DHA) decision to award the TRICARE West region managed care support contract to TriWest Healthcare Alliance, rejecting Health Net Federal Services' (HNFS) second protest over the decision.”

Federal court strikes down steep fee hike and batching rules in latest NSA case (source: CMA) - 8/22

“The most recent lawsuit — the fourth filed by TMA challenging provisions of the rule — objects to a 600% hike in administrative fees for those seeking dispute resolutions.”

Speaker's Message: August 14, 2023 (source: CMA)

“The Medical Board of California recently published a long-awaited update to its opioid prescribing guidelines, which will make it easier for patients to get the care they need while maintaining appropriate safeguards. Importantly, the medical board has clarified that the guidelines are not intended to replace a physician’s clinical judgment and individualized, patient-centered decision-making.

Watsonville Community Hosptial hosts town hall on agency's future (source: Santa Cruz Sentinel) -7/21

“The last time Matko Vranjes, the interim CEO of Watsonville Community Hospital, was in the cafeteria at Watsonville High School in late 2021, the mood was a lot more somber. […] But what a difference a year and a half can make.”

Major donation marks a new chapter for the Dignity Health mobile wellness clinic, enhancing vital care to communities in need (source: Dignity Health) - 8/23

“In collaboration with the Dominican Hospital Foundation, Dignity Health Dominican Hospital announced that it received a transformative donation of $1 million towards a $2.145 million philanthropy-funded campaign. The new Wellness on Wheels campaign will significantly expand the availability of vital medical care in underserved communities in Santa Cruz County. ”

Judge invalidates federal regs that allow insurers to artivicially deflate payments in surprise-billing disputes (source: CMA) - 8/22

“‘These provisions unfairly disadvantaged physicians in payment disputes with health insurers, ultimately robbing our patients of access to physicians’ care,’ said TMA President Rick Snyder, M.D. “

Court lifts injunction on retroactive enforcement of CMA law requiring reimbursement for COVID-19 services (source: CMA) - 9/5

“A Los Angeles County Superior Court lifted a preliminary injunction on the retroactive enforcement of Senate Bill 510’s requirement that health plans and insurers reimburse health care providers for certain COVID-19 claims that predated the effective date of the law.”

Medi-Cal Rx to reimplement prior auth for some therapeutic classes, including enteral nutrition products (source: CMA) - 8/31

“The California Department of Health Care Services (DHCS) recently initiated Phase IV, Lift 2 (P4/L2) of the Medi-Cal Rx transition, which will reinstate prior authorization requirements for new start therapies for standard therapeutic classes 68, 86, and 87, which includes enteral nutrition products, effective September 22, 2023.”

Appeals court preserves FDA approval of abortion drug, but subject to restrictions; sets up Supreme Court review (source: CMA) - 8/22

“In the latest ruling in an ongoing legal battle on the future of abortion medications, a panel of the U.S. 5th Circuit Court of Appeals in New Orleans recently upheld parts of a Texas District Court ruling that would restrict the use of mifepristone, while still allowing the drug to remain on the market.”

SAVE THE DATE

Webinar: New Federal Loan Forgiveness for CA and TX Physicians - Everything Physicians and Hospitals

Need to Know

Hosted by CMA

When: September 28, 2023…12:15pm - 1:15pm

Where: Online

Webinar: Elevating Physician Practices - Grant Opportunities for Advancing Population Health and Data Sharing Capabilities

Hosted by CMA

When: October 5, 2023 … 12:15pm - 1:15pm

Where: Online

Webinar: Virtual Grand Rounds: Opioid Treatment

Hosted by CMA

When: October 10, 2023…12:00pm - 1:00pm

Where: Online

Conference: 2023 American Conference on Physician

Health: Building the Workplace of the Future

Hosted by Stanford University School of Medicine

When: October 11-13, 2023…12:15pm - 1:15pm

Where: Palm Desert

Webinar: CMA Data Exchange Explainer Series #5How to Optimize Your Practice’s Workflows for Data Exchange

Hosted by CMA

When: October 12, 2023…12:15pm - 1:15pm

Where: Online

SAVE THE DATE

Orientation: House of Delegates: New Delegate Orientation

Hosted by CMA

When: October 17, 2023… 6:30pm - 7:30

Where: Online

Assembly: 2023 Organized Medical Staff Section (OMSS) Assembly

Hosted by CMA

When: October 20, 2023… 10:00am - 3:00pm

Where: Los Angeles, CA - JW Marriott LA Live

Webinar: Virtual Grand Rounds: Silicosis

Hosted by CMA

When: November 14, 2023…12:00pm - 1:00pm

Where: Online

Webinar: CMA Data Exchange Explainer Series #6 - Incentives and Other Funding Opportunities for Data

Hosted by CMA

When: December 14, 2023… 12:15pm - 1:15pm

Where: Online

The California Medical Association has partnered with Lockton Affnity to administer the CMA Insurance Program. Whether you operate independently or as part of a group practice, are beginning your career or considering retirement, this program offers key benefts to help protect you through all stages:

Available policies

To meet your exact needs, Lockton Affnity offers extensive policy options.

C O A S T A L P H Y S I C I A N

* * * S C M M A a n d C M A m e m b e r s r e c e i v e a 2 5 % d i s c o u n t

D E A D L I N E S F O R S U B M I T T I N G :

1 0 / 7 / 2 3 ( f o r N o v e m b e r ' s p u b l i c a t i o n ) 1 2 / 7 / 2 3 ( f o r J a n u a r y ' s p u b l i c a t i o n )

2 / 7 / 2 4 ( f o r M a r c h ' s p u b l i c a t i o n )

/ 7 / 2 4 ( F o r M a y ' s p u b l i c a t i o n )

6 / 7 / 2 4 ( f o r J u l y ' s p u b l i c a t i o n ) 8 / 7 / 2 4 ( F o r S e p t e m b e r ' s p u b l i c a t i o n )

I f p a y m e n t i s n o t r e c e i v e d b y t h e f i n a l d a y o f t h e m o n t h p r i o r t o t h e p u b l i c a t i o n m o n t h , t h e a d v e r t i s e m e n t i s s u b j e c t t o c a n c e l l a t i o n r a t e a d j u s t m e n t s a c c o r d i n g l y .

E m a i l s c c m s @ c r u z m e d . o r g f o r a l l i n q u i r i e s a n d s u b m i s s i o n s