Coastal Physician - June/July 2023

Anthony Sturzu, MD, and Steven Harrison, MD, Co-Presidents of the

MEET YOUR 2023 LEADERSHIP TEAM

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

Clay Angel, MD

Brian Brunelli, MD

John Christensen, MD

Dawn Motyka, MD Inemesit Newsome, MD Christopher O'Grady, MD

Joyce Orndorff, MD John Pestaner, MD

Jeannine Rodems, MD, FAAFP Eloy Romero, MD

*Maximiliano Cuevas, MD

*James Hlavacek, MD

*Donaldo Hernandez, MD, FACP CMA President 2023

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

President Jack Watson, MD Treasurer Grant Hartzog, PhD

Secretary Donna Odryna

Chair of the Board Alfred Sadler, MD, FACP

Immed Past President Christopher O'Grady, MD

Violeta Barroso, MD

Anastasia Klick, MD

Melissa Nothnagle, MD, MSc

Valerie Berry, MD

Jeannine Rodems, MD, FAAFP

Amy McEntee, DO

Anthony Sturzu, M D President of the Board (Jan-June 2023) Santa Cruz County Medical Society

Dear Members and Supporters,

I am thrilled to address you as Co-President of the newly consolidated Santa Cruz Monterey Medical Association (SCMMA) and share with you some of my reflections from the past year. Through our unwavering commitment to our mission and the tireless efforts of our dedicated members, we have made significant strides in advancing healthcare, supporting physicians, and serving our community

One of our primary objectives has been to advocate for our physician members, ensuring their voices are heard and their needs are met In the past year, we have actively engaged with local and state policymakers to address pressing issues affecting the medical profession Through our advocacy efforts and with the support of CMA President, Dr. Donaldo Hernandez, we have influenced policy decisions, including bills impacting changes at the Medical Board of California, public service loan forgiveness, prior authorization reform, truth in advertising, provider protections for reproductive health, access to care, health equity, and Medi-Cal rate increases In fact, just this past month, the California Legislature passed a bill which renews the state’s Managed Care Organization tax and provides the largest Medi-Cal rate increase in California history – ensuring that millions of Californians have greater access to affordable, high-quality, life-saving health care

The strength of our association lies in the unity and camaraderie we cultivate among our members Emerging from the pandemic, we have been able to more frequently facilitate networking opportunities to foster collaboration among our physician community. Through regular meetings, educational webinars, and social events, we have created a platform for physicians to connect, share knowledge, and support one another At our Excellence in Health Care Awards Gala in December 2022, we were delighted to honor one of our esteemed clinicians, Dr Dean Kashino, for a career of dedicated service to our community, as well as recognize the incredible work of the Pajaro Valley Health Care Project in their work to secure the continuation of Watsonville Community Hospital

The well-being of our physicians has been a paramount concern throughout this challenging time in healthcare We recognize the toll that the pandemic has taken on the mental and emotional health of healthcare professionals To address this, the CMA has prioritized physician wellness and support. We have provided access to virtual wellness workshops, mental health seminars, and confidential counseling resources to provide physicians with the necessary tools and resources to navigate these difficult times Our commitment to promoting self-care, fostering work-life balance, and combating burnout has remained steadfast By prioritizing physician well-being, we seek to ensure that our members are equipped to deliver the highest quality of care to our community Nevertheless, we have much more to do in this area and welcome your input and suggestions.

Partnerships have been the cornerstone of our mission over the past year. We have forged collaborations with local hospitals, healthcare systems, and our public health departments to maximize our impact Our members have worked tirelessly to support the development of the Morehouse School of Medicine Dominican Hospital Family Medicine Residency Program which will begin training our first family physicians beginning in July 2024. Through mentorship and educational initiatives, we look forward to nurturing the next generation of physicians, fostering a culture of excellence, and ensuring the continued delivery of high-quality care on the Central Coast

Finally, a renewed partnership forged between the Monterey County Medical Society and the Santa Cruz County Medical Society led members of both societies to recognize that each could more effectively deliver upon our common missions if consolidated into a single, unified organization In keeping with our similar values, politics, patients, community, and overall structure, I am pleased to announce the consolation efforts between the societies are now complete With our added strength in numbers, I look forward to new collaborations and partnerships that will undoubtedly blossom in the years to come

As we reflect on our accomplishments, we recognize that our work is far from complete The challenges facing our healthcare system are ever-evolving, and there is much more to be done However, I am confident that our collective dedication, resilience, and collaborative spirit will guide us through the road ahead

I extend my deepest appreciation to each and every member of the SCMMA for your unwavering support, passion, and commitment to our shared mission Together, we have made a significant impact on healthcare for our providers, our patients, and communities in Santa Cruz and Monterey Counties, and I am excited about what we will achieve in the future

Sincerely,

Anthony Sturzu

Anthony Sturzu, M D

Co-President of the Board (July-Dec 2023) Santa Cruz Monterey Medical Association

etter:

Steven W Harrison MD President of the Board (2020 - Jun 2023) Monterey County Medical Society

y last formal address as president of the MONTEREY County Medical Society (MCMS) and I’d like to talk about several things important to our society and its members:

First - we have seen the end of Covid restrictions Second - we have seen the end of a threat to MICRA and a small compensatory increase in malpractice costs Third - we have proceeded with and have completed a merger with the Santa Cruz County Medical Society (SCCMS), which will benefit both societies tremendously and has been the subject of much debate over the last 2 plus years.

As MCMS President, I have focused primarily on the merger and the discussions at the board level regarding the same It is peculiar that my claim to fame will be to merge the two societies back together after 123 year If you ’ ve been following the debate, you’ll understand that due to attrition, MCMS is down to approximately 100 members which is a third of what it was when I was president in 2005. Merging with Santa Cruz allows us to have strength in numbers, a more stable administrative staff, stabilize current membership throughout the region, and hopefully begin to significantly increase membership in Monterey County.

It has been an honor and a privilege to serve as president and to follow Dr Maximiliano Cuevas in that role I will be continuing in partnership with my co-president from Santa Cruz County, Dr Anthony Sturzu for the remainder of 2023 Together, we will set the stage for the future I thank you very much for the privilege of serving you and look forward to the progress that the next years will bring

Respectfully,

Steven Harrison

Steven W Harrison, M D Co-President of the Board (July-Dec 2023) Santa Cruz Monterey Medical Association

Jack Watson, M D President of the Board (2020-Jun 2023) Physicians for a Healthy Central Coast Foundation

As we near the long awaited consolidation of the Santa Cruz County and Monterey County Medical Societies, I’d like to take a moment to thank some of the friends who helped me find the silver lining and squeeze the lemonade during my time as President for the Physicians Foundation for a Healthy Central Coast

The long hours of the COVID pandemic tested local physicians in countless ways, including a shortage of PPE, a shortage of ICU beds, and the sudden need to learn how to navigate the societal impacts of stay at home and quarantine orders. Yet, on the bright side, the pandemic did show us who our friends are.

The Medical Societies and Foundations quickly shifted priorities and resources and partnered with local groups such as PPE4CC, Idea Fab labs, Santa Cruz Bicycle Shop, the Pajaro Valley Quilt Association, and many others to fabricate, source, and distribute masks and shields to physicians, medical practices, skilled nursing facilities, medical students, and community clinics and organizations throughout the Santa Cruz County and Monterey County region. Additionally, in partnership with CMA, we were able to organize drive-thru distribution events in Watsonville and Salinas where, together with the CMA, we provided PPE throughout the region including the residency program and CSUMBs students of the Master in Science Physician Assistants program These community connections and friendships during some of our darkest hours will not be forgotten.

Ironically, one of the upsides of the COVID pandemic was the democratizing of medical education Early in 2020, a retired public health physician clued me into a series of YouTube videos about the basic science of the disease that were being posted by a Southern California intensivist named, Dr Roger Seheult During those early days of COVID, this doctor helped make sense of a bewildering illness. With 161 videos to date, Dr. Seheult was prolific with his “Coronavirus Pandemic Updates”

I am also grateful to UCSF for their sterling role in CME during Covid As the pandemic matured, I shifted from viewing the “Clinical Problem Solvers” and their focus on improving diagnostic reasoning, to a case-based focus Creators Dr Rabih Geha and Dr. Reza Manesh then spawned the subscription RLR weekly podcasts which have been similarly excellent Finally, the UCSF Department of Medicine now posts their weekly Grand Rounds on YouTube which covers topical subjects of the day

The Covid pandemic has been a challenging time from which we are continuing to evolve Now with a regional approach, new partnerships, and a wider-range of resources for education, the next chapter begins.

Sincerely,

Jack Watson

Jack Watson, M D President of the Board (Jul - Dec 2023) Santa Cruz Monterey Medical Association Foundation

It helps when you ’ re given lemons to make lemonade!

& moving forward Looking back

Alfred M Sadler Jr , M D , F A C P Chairman of the Board (2021 - Jun 2023) Cypress Foundation

To The Cypress Foundation Community, Transitions in life have a way of inviting us to reflect back on the history of what was. As your Foundation’s Chairman, it brings me great pleasure to share with you a brief history of Monterey County Medical Society’s philanthropic arm - the Cypress Foundation

Founded in October, 1981, the Cypress Foundation spent its first 20 years devoted to providing continuing medical education (CME) conferences for physicians These were organized by Dr Donald Scanlon, who many of you may remember as the Director of Medical Education at the Community Hospital of the Monterey Peninsula For nearly two decades, the conferences attracted physicians from not only Monterey County, but also Santa Cruz, San Benito and other Northern California counties

Following this period of robust learning, CME transitioned to a specialty, online system As is common with many transitional phases, priorities for the Society shifted, and the Cypress Foundation lay dormant for about 15 years

In 2019, the Foundation was reborn with a lens focused on supporting practicing physicians Part of the Foundation's focus was on efforts to enhance physician well-being, including offering free, confidential counseling services to physicians Additionally, the Foundation’s original commitment to education in medicine was reignited directed toward the next generation The Cypress Foundation continues to support both individuals interested in pursuing medicine as a career, as well as the institutions which train them, like the Natividad Family Practice Residency Program and CSUMB’s Master of Science Physician Assistant Program

As the Medical County Societies of Monterey and Santa Cruz are consolidated, so will their nonprofit Foundations Under this newly consolidated foundation, we will be able to expand our important work supporting the next generation of healers Our work will include a partnership with UCSC, including their mentorship program and the new post baccalaureate program in support of recently graduated pre-med students who need to fill one or two gaps in the coursework We are also excited to collaborate with the new Morehouse School of Medicine Dominican Hospital Family Medicine Residency Program launching in July 2024

Thank you to the Cypress Foundation Board of Directors for their dedication and leadership toward making a lasting impact on the community Without them and the countless physicians and other members of the community who have supported the Cypress throughout the years, the Foundation would not have had the resources to make a difference in community Continuing committed leadership and financial support will allow us to expand our impact and achieve our goals

Sincerely,

Alfred Sadler

Alfred M Sadler Jr , M D , F A C P Chairman of the Board (July-Dec 2023) Santa Cruz Monterey Medical Association Foundation

Donna Odryna

Executive Director

Executive Notes

From gathering for the member socials, to finalizing the consolidation of the two medical societies and foundations, the sense of unity has been palpable.

The Member Socials this year marked the first, in-person, organized social events for the county medical societies since COVID. Seeing everyone share updates, stories, and time reminded me of the true gift being a part of this community has been and continues to be for me.

When picturing a community, there’s a tendency to see only the collective Yet, it is the selfless contributions of the individual members in the community that often determine the strength of the whole - and the medical society is not short on strong leaders Leaders play pivotal roles in the functioning of a community Community leaders can show up with a vision for what could be and a drive to make it happen like all those who spent countless hours paving the path to expand their respective societies into one consolidated community. They can show up as passionate communicators like the physicians who contributed to this issue of the magazine. Or, they can take on an advisory position to help influence and guide the group like Dr Newel who has spent the past 5 years as an advisor to the medical society before heading into her well deserved retirement. While her leadership will be missed, she will remain a cherished member of our community

It is this robust and inspiring community that transforms the work I do from being just a job to being a part of who I am Thank you for all that you do to serve our community and cultivate the community of your Medical Society.

"There is immense power when a group of people with similar interests gets together to work toward the same goals "

~ Idowu Koyenikan

W E L C O M E O U R N E W M E M B E R S

Natividad Medical Center Program

Marie Schow, DO

Maura Becerra, MD

Jason Chen, MD

Christopher Gunther, MD

Georgina Aguilar-Portillo, MD

Miguel Lopez, DO

Joel Marshall, MD

Francis Ventura, MD

Saul Tapia, MD

Alejandra Beristain-Barajas, MD

Victor Carrasco, MD

Helen Colliton, DO

Andrea De La Torre, MD

Chun Ning Hu, DO

Stephanie Morales, MD

Henry Sanchez, MD

Marie Schilling, MD

Alejandro Anaya-Rocha, MD

Alexandra Arnold, MD

Eleanor Battino, MD

Touro University College of Osteopathic Medicine

Roberst Albertian

Jadzia Nguyen-Khoa

Erin Scheftz

Caitlin Smith

Tessa Smith

Michael Baule, DO

The Permanente Medical Group Family Medicine

A budget trailer bill has been introduced that will renew the state's Managed Care Organization (MCO) Tax to provide the largest Medi-Cal rate increase in California history, ensuring that millions of Californians will have greater access to life-saving health care The proposal represents a generational opportunity to fulfill the promise of Medi-Cal and provide meaningful access to health care for millions of Californians

Specifically, the legislation would increase provider rates to at least 87 5% of Medicare for certain primary care, maternity care and non-specialty mental health services in 2024 and provide $75 million annually for graduate medical education Starting in 2025, the bill provides for an annual appropriation of $1 38 billion in primary care rate increases, $1.15 billion in specialty care rate increases, over $500 million for family planning and reproductive health care, and $600 million for behavioral health facilities including increasing inpatient psychiatric beds

Once the legislation passes, the work to implement these monumental changes will continue over the next few months and into next year Throughout the process, CMA will continue to advocate on behalf of physicians to ensure the funding flows efficiently to providers

Click here to view our and

MCO Fact Sheet FAQ

This is truly a historic moment, and CMA appreciates the Governor and the legislature for their work to achieve justice and equity in access to care for Medi-Cal patients. We are urging swift passage of the budget trailer bill and look forward to working with policy makers on implementation of this important investment that provide millions of California patients with increased access to life-saving health care

Dear CMA Member,

An Ephemeral Healthcare Camelot Early COVID 2020 in Santa Cruz County

By Wells Shoemaker, MD

In the minds of many doctors, Medical Leadership means playing defense...against nuisances and perceived threats to the traditional practice of medicine It’s a long list—bad laws, perverse payers, hostile lawyers, greedy pharma, smug regulators, cold auditors, corporate muggers, some administrators and government in general

This delegated defensive mandate has rarely involved high speed, open handed, simultaneous collaboration with people from virtually all of the disciplines in this list of adversaries However, true defense on a community wide scale against a lethal plague required exactly that

We saw this phenomenon unfold “live” in the Spring of 2020 in Santa Cruz County I call it our Healthcare Camelot It didn’t last long, but it left an impression and a glimpse of our potential

COVID crashed onto the shores of North America in early 2020 By March, urban mayhem filled the news In those early days, the science was sketchy, and the therapy

was anecdotal but the pace was ferocious

People bumped elbows, and masks made headlines Hospitals ran out of gowns, and commerce shut down Elders died Poor people died Nurses died Doctors died

A few naïve folks thought the scourge wouldn’t creep over the Hill into our County, but that wishful thinking did not afflict our Health Department

Dr David Ghilarducci, Deputy Director of the Santa Cruz County Department of Public Health, was a former firefighter and then an ER physician before choosing a career path in population health That unique background blended two disciplines famous for crisis mentality: “Find it, fix it fast ” We got lucky

In mid-March, David, working with Dr Larry deGhetaldi of PAMF, looked at all the myriad, essential gears all moving on separate shafts and decided we needed a multidisciplinary Clinical Task Force (CTF) immediately With their invitation, I had the privilege of serving as CTF lead for a month

We realized immediately that this challenge was not merely "difficult medical care," but rather something vastly larger

We assembled a group of unprecedented inclusivity in a matter of days and dove in The CTF met by Zoom twice a week, and in between, many of the members put in consecutive 14-16 hour days making connections, opening doors, taking down barricades and, yes, providing care

Obviously, intensive care of the sickest individuals was going to be essential, but an effective response required more than the grueling technicalities of the ICU Frontline physicians in our community were not alone under fire

We had a lot of questions and not many answers but we needed those answers right away To share a glimpse of our experience, while simultaneously naming some of the many unsung heroes, I will elaborate on these questions as we saw them in the present tense

***

Santa Cruz County has 3 hospitals and 3 high-performing, multi-specialty medical groups They compete ardently for market

share. Each of those entities has sophisticated administration, expert medical directorship, superb hospitalists, and integrated medical staff They also all have a long history of friction both internally and externally In addition, unaffiliated solo and small group practices are scattered throughout the county. There’s simply no way to have divergent standards of care without inviting chaos Which begs the first question: Can they tuck in the tensions of yesterday and work together as one?

It's only a matter of time before doctors, nurses, lab & imaging technicians, central supply personnel, pharmacist, janitorial workers, security personnel, and supervisors get sick and quarantined Or worse Will unions pitch in?

- Medical staff leaders from Dominican, Sutter, and Watsonville, you paved the way.

Historically, Public Health has served communities in non-partisan ways that complemented the delivery of acute care. Can Public Health leverage its know-how and connections to solve problems when the acute care providers are crushed, exhausted, and depleted for months or maybe years?

- Dr. George Wolfe, your legacy lives. Thank you, Dr Ghilarducci & Dr Newel

We have multiple, mature Federally Qualified Health Centers (FQHC) which serve some of the county’s most threatened individuals...even more now. Historically FQHC’s don’t do much inpatient and specialty work, and they have distinctive cultures. How can we integrate the FQHC’s crucial access and communications avenues with the other delivery systems of different structures?

- Dr Birkhart, Dr Peeler, Dr McEntee, and Dr. Gabriel-Cox found the answers.

Both our emergency rooms are swamped, and each one has its own unique set of admission and transfer protocols How do we figure out the coordination between the two? Is it even possible for our existing ambulance services to serve both incoming and transfers of severely ill patients in this volume? And what about patients with traditional emergencies?

- Thank you for your supreme navigation Dr Whitley, Dr Yellin, and Dr Walther

The chaos we ’ re seeing in the emergency

rooms is only a reflection of the crisis flooding our streets and neighborhoods With the healthcare demands descending upon us, is the administrative Byzantium of the county capable of coordinating the actions of the Fire Protection agencies and the various tiers of Law Enforcement? And how does the County government interact with incorporated city governments for isolation, quarantine, mandates, and enforcement?

- The rock star, Mimi Hall, led the way. Pharmacies and DME providers, including their expert staff will likely be swamped What if there is no oxygen available? What if we run out of drugs? What happens when pharmacists get sick?

- Jennifer Gavin PharmD and Glenn Robbins R.Ph had us covered.

It's well known how nursing homes and extended care facilities are vortices of contagion Those same facilities are also the traditional destinations for patients recovering from severe illness and injury Where do step down patients go, and what if they bring in COVID to vulnerable residents? Can the local and corporate chains work together?

- Dr Morris and Dr Quinn indefatigable!

There seems to be no consensus when it comes to labor and delivery What do we do with babies delivered to a mom with COVID? What about bonding and breast feeding? Are the NICU’s prepared for what’s coming?

- Brilliant work in this department, Dr. Titen

The inchoate science is confusing, and the epidemiology is frightening Do we have full time, elite infectious disease expertise to sort out the daily, often contradictory, information to avoid chaos in our approach to treatment and protection?

- Much gratitude to you, Dr. Deetz.

It's only a matter of time before acute beds are all filled like they are in New York How do we handle the ethical challenges of who gets into the ICU when we ’ re out of beds and ventilators?

- Dr. McNamara was no stranger to discernment under stress.

Eventually, we will need to find space to create a “MASH” unit for patients of moderate severity and step down care How do we equip it? How do we staff it? Can retired physicians and nurses work in such facilities without being throttled by regulatory agencies? But first and foremost, where will we create this space?

- 1440 Administration stepped up early.

Crops are ripening in the field, and workers are toiling shoulder to shoulder Agricultural workers often go home to extended families with vulnerable elders. South County was ground zero What can be done to avoid a catastrophic impact on those families?

- Nishan Moutafian and South County Growers stood tall

As time passes, so too does the cresting wave of emotional turmoil grow Who is going to respond to the behavioral needs of those coping with grief, aggravated stress, fear, and isolation?

- Thank you for your navigating that wave, Dr. Bacos.

We can’t fly blind We need to know who’s ill, where, and how it’s changing But HIPAA restrictions, firewalls, and security paranoia can take years to overcome, even for the simplest data sharing How are we going to coordinate the scattered information systems from all these diverse facilities?

- Lots of IT pros, Public Health, and the California Healthcare Foundation rose to help.

The Alliance will be involved with access, care coordination, and pharmaceuticals for a disproportionate percentage of COVID patients To what degree can locally governed Medi-Cal (the Alliance) contribute to timely access, post-illness recovery, family support, and data sharing? With such daunting regulatory restrictions, will they even help?

- Thank you for pitching in, Dr Bishop

There will be a day when the smoke will clear, and the countless unsung heroes who have risked their lives to stanch the predation of the virus will remain in the aftermath Are malpractice lawyers going to feast on the suffering and trample the

careers of these heroes? Can honorable lawyers protect the staff and facilities offering lifesaving care now? If that requires legislative action or executive decrees, who’s going to make that happen?

- Santa Cruz’s corporate lawyer, Bill Richter, rolled up his sleeves.

Urgent care centers, freestanding surgery centers, and infusion centers have facilities possibly adaptable to care for patients who might ordinarily be hospitalized They have separate administrations, staff, and experience Can we find a way to coordinate and prepare them for expanded roles? We'll need to find a way Easiest to start with the hospital-affiliated facilities

People living with cancer, renal failure, and technology-dependent conditions depend upon specialized facilities and staff Interruptions in care, along with COVID in these vulnerable patients, could be synergistically lethal How can we protect them? We can't allow this to happen We need to touch every one of these ASAP

People are shut in and frightened Can mainstream and Spanish language TV, along with radio, and print media help to reach them? It's Santa Cruz... Yes, of course they will!

Medi-Cal, Medicare, all the commercial insurors, and the County are unprepared for a crisis this pervasive and long lasting Who's going to pay for all this? Nobody

About the author

knows yet, but that will have to wait We will take care of the patients first That cannot wait.

And what happens when COVID goes to jail? When in doubt, ask Public Health!

Any one of the above questions would take months, often years to resolve in the molasses of the status quo Draw a line between any two of these entities and you’ll find historical tension Draw a line between all of them yikes!

And yet, there is no time for gridlocks Collaborative interventions need to be rolled out in a matter of weeks not years We need these individuals and their siloed organizations to immediately commit to acting like a single, intelligently coordinated, health system whose only purpose is to keep our county’s residents alive

Which brings me back to the overarching question I started with: Can they can we take this leap?

***

I had the privilege of watching the answer unfurl And the answer was a resounding, "Yes "

During COVID, 'they' became ' we ' and we did take that leap together It was magnificent

By the middle of April, 2020, the direst fears had softened New cases emerged as a daily trickle, not a deluge. The ICUs were impacted but not crushed Elderly and handicapped patients were not denied ventilators, and the morgues did not overflow into refrigerated trailers Our FQHC’s rose to the front line challenge with zeal and inspiration Skilled Nursing Facilities struggled, but it wasn’t apocalyptic We didn’t need a MASH hospital after all As the curve “flattened,” the Clinical Task Force closed down The ordeal shifted to a chronic phase...but COVID has not disappeared

Santa Cruz County did have “training wheels” for this exercise. The Health Improvement Partnership and the Santa Cruz County Medical Society had created “safe harbor” for competitors and disciplines to work together although not at the scale nor velocity required in March, 2020

My hope for the future is that we keep alive the cross cultural respect, ingenuity, communication, and collaboration that pulled us through We will need it again Physicians’ contributions to a pervasive threat are precious and necessary but not sufficient Sharing leadership and ingenuity, we can play traditional defense and share community wide success

Dr. Wells Shoemaker practiced pediatrics in Watsonville and Natividad for 25 years, during which time he opened the NICU and The Lactation Center at WCH He entered population healthcare as the first medical director of the Alliance and subsequently served as medical director of PMG He shaded into senior statewide positions in quality improvement with CAPG, the California Quality Collaborative, and Governor Brown’s expert advisory panel He was a founding co-chair of our HIP Council, PI for a county wide AHRQ diabetes grant, and co-initiator of the tri-county Regional Diabetes Collaborative.His central interests included primary care revitalization, health disparities, targeted infrastructure, creative workers’ health strategies, end of life care, data supports for complex care, & novel community partnerships

n 2005, he received a career perinatology award from Stanford and was also named by Santa Cruz United Way as Community Health Hero

In 2021 he was recognized as the first recipient of the Phil Rather Award for career healthcare service in the Pajaro Valley Now retired, Dr Shoemaker has been a member of the Santa Cruz Medical Society since 1976

Wells Shoemaker, MD with four cords of chainsawed and hand split oak from the winter windfalls

Author:

Marc B Yellin, MD, FACEP EMCC Commissioner

EMCC Update Report

A Brief Background

Board of Supervisors (BOS)

County Office of Emergency Services (OES)

It all started in 1975 when Santa Cruz County established the Emergency Medical Care Commission (EMCC) under the California Health & Safety Code Sections 1797.270 et seq. Today, the commission is comprised of 13 County residents from various health and emergency services entities - all of whom have been appointed by the The primary purpose of this commission is to act in an advisory capacity to the BOS and the on all matters related to Emergency Medical Services, often in the form of submitting letters in support of (or against) planned measures or actions.

To learn more about the EMCC, use to be redirected. As your representative to this body, I would like to summarize for you some of the different areas of focus for the commission over the past several months.

The Pandemic... and a little more

The Pandemic has been a major topic over the past few years and Dr. D. Ghilarducci (Santa Cruz EMS Medical Director & Deputy Health Officer) has made regular reports detailing the relevant statistics within the community as well as within the hospitals including vaccination status, antiviral availability, testing and monitoring programs, masking and social gathering updates, and all else related to the Covid 19 pandemic

More recently, we’ve had discussions around Monkey Pox incidences and vaccination availability and now an increase in Syphilis detection

The CZU Fire

The months following the CZU fire resulted in much discussion on how to establish enhanced communication with the public on evacuation routes, resource centers and shelters We have had similar discussions on other storm related outcomes and mitigation measures

One outcome from these events has been the general acceptance that our county’s Fire/Law Enforcement communication system is outdated

this link

and in need of serious upgrade This has led to the formation of a multi-agency committee that will establish the criteria for the project's RFP, which is anticipated to be a costly upgrade

The County contract for 911 services - currently held by American Medical Response (AMR) - was up for renewal The EMCC reviewed and supported the decision for a two-year extension of the current contract with AMR. The Commission anticipates at the end of this twoyear cycle, there will be an RFP for the subsequent contract.

Medication Shortage and Excess

The topics discussed as of late have also included the challenges faced by shortages in critical medications (ie Albuterol and epinephrine) and management options

The opioid/fentanyl crisis is frequently discussed as well As of June 2023, the County will roll out the paramedic Suboxone program This drug will be carried by the paramedic units and available, per written protocols, for field administration Our county is part of a regional trial program with Monterey and San Benito Counties

The Big One: 5150 Services

The status of the County’s emergency (5150) Behavioral Health services has been a frequent topic In brief, the Santa Cruz County Behavioral Health Center manages the Crisis Stabilization Program(CSP) which is responsible for evaluating individuals on the 5150 They determine whether the 5150 is “lifted” or if the the patient needs a transfer and admission to an out of county inpatient psychiatric facility.

Over the last several years, multiple reasons given from lack of staffing to capacity challenges and Covid restrictions, has resulted in the facility being on “Diversion”. During this state, the CSP refuses all 5150 patient transfers from the Emergency Department (ED), as well as most brought in by law. This leads to the patient occupying an ED bed (often with an officer at the bedside) for extended periods of time The County has been unable to successfully increase capacity at the facility and most recently, Telecare (which holds the contract with the County to run the CSP) announced their intention to withdraw from their contract as of June 2023 The County has since re-negotiated with them, and under the new structure Telecare will be an adult only facility as of July 1, 2023

County Behavioral Health is working on setting up an interim 5150 center for minors on the Watsonville Hospital campus, but this is not expected to open until the Fall of 2023 The County has also purchased land near the Sheriff’s location on Frontage Rd along Hwy 1 to build a permanent pediatric crisis and in-patient facility but, again, this won’t open until late 2024 (at the earliest) In the meantime, a minor 5150 will have to stay in one of the two ED’s until they can be transferred out of county, or have the 5150 released by the Mobile Emergency Response Team for Youth (MERTY) These are Licensed social/ psychiatric workers that can come into the ED’s and have the authority to release a 5150

Currently, these teams have limited hours The County has been trying to expand the hours and augment the MERTY/MERT (youth) roster but is having difficulty in hiring The challenges to appropriately manage our 5150 population in a timely manner have direct, and often negative consequences to both EDs, their staff, and patients, including those on the 5150

Watsonville Hospital

The status of Watsonville Community Hospitaland most recently, Hazel Hawkins Hospitalcontinues to be on the monthly agenda with reports shared from a variety of local agencies and groups

New Program Monitoring

This past year, the EMCC reviewed the County’s Health Information Exchange (HIE) project designed to electronically link the paramedics reports with the Electronic Medical Record database so it's readily available to all providers

We monitor other new programs such as the ET3 (Triage, Treat & Transport ), a state pilot study for for alternate destination care Current State regulations mandate a 911 activated paramedic unit can only transport to an ED with a Paramedic Base Station The ET3 project will be looking at transporting to "alternate sites" such as an Urgent Care

Additionally, Dr. Ghilarducci provides a report from the Pre-Hospital Advisory Committee, which is yet another group that formulates paramedic policies and develops protocols and best practices (e.g. the “Red Lights & Sirens” study looking at reducing the number of emergency vehicles dispatched to an event, and determining if lights and sirens are necessary)

Another metric being required by State Emergency Medical Service (EMS) is the Ambulance Patient Offload Time (APOT) This is the amount of time it takes for a paramedic to offload a patient onto an ED bed and return to service Elsewhere in the state, there have been excessively long waits The measure includes penalties (such as losing specialty center statusie STEMI, Stroke) for failure to engage in corrective measures where needed.

Contact Me

Look for updates in the months to come as new developments and issues of concern arise If you have questions or wish to provide further commentary, please feel free to email me at Marc54@cruzio.com.

Congratulations

C L A S S O F 2 0 2 3

On May 20th, the Cypress Foundation had the honor of sponsoring the Hooding Ceremony for the third cohort of CSUMB's rigorous 28 month Master of Science Physician Assistant program. It was held at the National Steinbeck Center in Salinas. In attendance to celebrate this auspicious occasion were the foundation's Chairman, Dr Fred Sadler, Director, Dr Valerie Berry, and Secretary/Treasurer, Donna Odryna.

The delivery of excellent medical care usually

in highly functioning teams. Physicians rely on these teams, which often include Physician Assistants, to deliver the high quality care their patients need. The event was led by CSUMB President Vanya Quinones, Provost, Katherine Kantardjieff, Deans, Harald Barkhoff and John Binkley, Dr. Sadler, Dr. Berry, medical director, Dr. Leonard Caputo, and program director, Dr Christopher Forest to

PURPOSE

The aim of the AMA Physician Practice Information Survey is to better understand the costs faced by today’s physician practices to support physician payment advocacy.

QUICK INFO FOR YOU

Surveys sent out

July 2023 - April 2024

ICIPATION NEEDED

ngly urges all physicians who d for the surveys to respond as ssible. We recognize that it is a time-consuming survey, but it is very important that we get enough responses to have accurate and statistically valid physician cost data."

ABOUT

THE SURVEY

SAMPLING UNIT

Mathematica will identify group practices using Taxpayer Identification Numbers (TINs); the TIN is their sampling unit

SCOPE OF DATA

Practice Survey: 10,800 practices (3,400 complexownership practices and 7,400 individual-ownership practices)

Physician Survey: Starting sample ~90,000 physicians from the 3,243 practices that complete the practice survey

CALCULATING ESTIMATE

To calculate estimates of practice expenses per patient care hour, Mathematica will divide estimates from the practice survey (expenses) by the physician survey (patient care hours) for sampled practices

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.

If you have any input on the direction of the topic, please offer your testimony by Monday, July 17.

Major Issues topics are now available for comment CLICK HERE

Consumer Health Technology/Artificial Intelligence (Actionable Report and Presentation)

Office of Health Care Affordability (Actionable Report and Presentation)

Climate Change (Actionable Report and Presentation)

Book your Room today!

FOR MORE INFO ON THE EVENT, INCLUDING: Registration and rosters Meeting materials and wifi

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

Medi-Cal provider rates to increase under Governor’s budget (source: CMA)

“‘The provider reimbursement rate cuts from 2011 have had a detrimental impact on patient access to care for more than a decade and I am very happy to see the Governor’s May revised budget today, which will help us achieve justice and equity in access to care for Medi-Cal patients,” said CMA President Donaldo Hernandez, M.D.”

Dominican Hospital Receives $2 Million Grant from California Department of Health Care Access and Information to Support New Primary Care Residency Program (source: Dignity Health - back in March)

“The first class of 8 family medicine residents will begin their training in Santa Cruz beginning in July 2024. With Morehouse School of Medicine as the program’s academic sponsor, post-graduate residents and fellows will benefit from training focused on addressing health inequities and underserved patients.

Natividad "Best Hosptial in the Salinas Valley" (source: Natividad)

”Natividad, a hospital and Level II Trauma Center dedicated to improving and inspiring healthy lives, has received first place as Best Hospital in the Salinas Valley by the Salinas Valley Readers’ Choice Awards 2022.”

United Healthcare pauses controversial GI prior auth policy (source: CMA)

“In place of the prior authorization policy, UHC will instead implement an optional advance notification process where physicians voluntarily submit patient data for clinical review, prior to performing certain gastroenterology endoscopy services.”

CMA president issues statement in response to Gov. Newsom's proposal to address gun violene crisis (source: CMA)

“Gun violence is a public health crisis that impacts all Americans. Guns have become the leading cause of death for U.S. children and teens1, and in 2021 –the most recent year for which data is available –more Americans died of gun-related injuries than any other year on record.”

U.S. Supreme Court preserves right to sue to enforce state compliance with Medicaid requirements (Source: CMA)

”With the fundamental threat to Section 1983 private enforcement of Medicaid requirements averted, CMA can continue to serve physicians and their Medicaid patients using all available advocacy tools, including litigation against state agencies when needed.”

$47 million grant program launched to support health data exchange in California (Source: CMA) ”California entities that have signed the DSA can apply to receive direct support for DxF implementation, with financial assistance ranging from $15,000 to $50,000, or more via enhanced funding to entities serving underserved communities.”

Physicians who had temporary Medicare provider access during PHE must complete CMS-855 application (source: CMA)

“Physicians and other providers will have 90 days from the date of the letter to submit their CMS-855 enrollment application. The temporary PTANs will remain in effect for the duration of the 90 days.”

Lawmakers urge FDA to address adverse effects of drug shortages on cancer patients (source: CMA) “Out of the 136 drugs currently in shortage, as reported by the FDA, 15 of them are oncology medications that are widely used in the treatment of common cancers, including lung, breast, ovarian, testicular, head and neck cancer, endometrial cancer, and many types of cancers impacting children.”

Federal bill would expand access to critical health services for the unhoused (source: CMA)

“The most recent federal estimates indicate that more than 580,000 individuals experience homelessness on any given night, and approximately one-third of unhoused people suffer from a substance use disorder or mental health issues.”

SAVE THE DATE

Retreat: The Mindful Healers Connect In Nature Retreat

Hosted by Pause & Presence with Jessie Mahoney, MD

When: July 14-16, 2023 (Friday-Sunday)

Where: Green Gulch Farm & Zen Center

Webinar: Virtual Grand Rounds: TBD

Hosted by CMA

When: August 8, 2023… 12:00pm - 1:00pm

Where: Online

Webinar: Medi-Cal Managed Care Plan Transition in January 2024 - What Physicians Should Know

Hosted by CMA

When: August 10, 2023…12:!5pm - 1:15pm

Where: Sacramento - Kimpton Sawyer Hotel

Webinar: CMA Data Exchange Explainer Series #4How to Optimize Your Practice’s Current EMR for Data Exchange

Hosted by CMA

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

Where: Online

SAVE THE DATE

Webinar: Demystifying the Medical Staff

Hosted by CMA

When: August 22, 2023…. 12:15pm - 1:15pm

Where: Online

Summit: Health Equity Leadership Summit

Hosted by Physicians for a Healthy California (PHC)

When: September 14-15

Where: San Jose - Marriott Hotel

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:!5pm - 1:15pm

Where: Palm Desert

Continuing Education for Physicians, Dentists, and Other Health Professionals

O R A L H E A L T H & D I A B E T E S

A Two-way Relationship with Clinical Relevance

Monday, July 31, 2023, 2-5 PM

$75 per person

Kathleen King Community Room

85 Nielson St. Watsonville, CA

LOCAL PANELISTS

Oscar Gantes, MD, Sung H. Sohn, DDS, Sepi Taghvaei, DDS,

Family Medicine Physician, Salud Para La Gente, and Medical Director, Diabetes Health Center Dental Director, Salud Para La Gente Chief Dental Officer, Dientes Community Dental

CEs units available through Cabrillo College Dental Hygiene and American Academy of Family Physicians

Proceeds benefit the Kathleen King Oral Health Endowment at the Community Health Trust of Pajaro Valley

To register, scan the QR code or visit www.pvhealthtrust.org/annual-health-forum-2023

Sponsored By

WENCHE S MPH, PHD Senior Research Associate in Health Sciences & Adjunct Clinical Assistant Professor in the Department of Periodontics and Oral Medicine at University of Michigan's School of Dentistry

GEORGE W. TAYLOR, DMD, MPH, DRPH Associate Dean for Diversity and Inclusion and Professor in the Department of Preventive and Restorative Dental Sciences in the Division of Oral Epidemiology and Dental Public Health at University of San Francisco's School of Dentistry