Coastal Physician - June 2022

Coastal

Physician June 2022

Inside this Issue MEMBER SPOTLIGHTS — pp. Dr. Melissa Nothnagle of Monterey County Dr. Violeta Barroso of Santa Cruz County Combating the Workforce Crisis — pp.

Dr. Alfred Sadler

3

1

2

1

-

7

1

6

7

1

6

CMA PRESIDENT-ELECT — pp.

Dr Donaldo Hernandez

-

MCMS MEMBERSHIP SPOTLIGHT Melissa Nothnagle. MD

SCCMS MEMBERSHIP SPOTLIGHT Violetta Barroso, MD

NEW MEMBERS - SCCMS

MCMS BOARD OF DIRECTORS

NEW MEMBERS - MCMS

SCCMS BOARD OF GOVERNORS

EXECUTIVE NOTES Donna Odryna, Executive Director SCCMS & MCMS

5

8

7

1

0

4

2 6

0

0

0

1

1

0

0

TABLE OF CONTENTS

NEED PPE?

CMA PRESIDENT-ELECT Donaldo Hernandez, MD FACP | Hospitalist, Palo Alto Medical Foundation

RESILIENCE IN MEDICINE

WORKFORCE CRISIS

MICRA MODERNIZATION

Alfred Sadler. MD

CSUMB GRADUATION

NEWS & EVENTS

2

5

6

8

4

9

3 1

1

1

1

1

1

1

2

TABLE OF CONTENTS

2022 BOARD OF DIRECTORS

President Steven Harrison, MD

Treasurer James Hlavacek, MD*

Past President Secretary Maximiliano Cuevas, MD Alfred Sadler, MD**

Directors Alejandro Francisco Centurion, MD Gary Santiago Garcia, MD Walter W Mills II, MD** Eloy Romero, MD Erika Romero, MD Guadalupe Arreola, MD *Elected CMA Delegates | **Elected CMA Alternates The Cypress Foundation Board of Directors Chairman Alfred Sadler, MD Secretary Donna Odryna, Executive Director Directors: Valerie Berry, MD, Alexandra Klick MD, Melissa Nothnagle, MD Medical Doctors Political Action Committee (MDPAC)

Chairperson Maximiliano Cuevas, MD

The Monterey County Medical Society and Santa Cruz County Medical Society are non-profit professional associations led by and for physicians. In partnership with the California Medical Association, (CMA), The Societies are dedicated to promoting excellence in the provision of quality, ethical health care; the health of our community; physicians’ personal, social, and professional integrity and well-being; and the common goals of similar organizations.

Opinions expressed by authors are their own and not necessarily those of Coastal Physician, MCMS. SCCMS or CMA or any of their related organizations.

4

2022 BOARD OF GOVERNORS

President Ciara Harraher, MD

President-Elect Anthony Sturzu, MD

Treasurer Daniel Greene, MD

Secretary Amy McEntee, MD*

Past President Joyce Orndorff, MD**

Governors Clay Angel, MD Brian Brunelli, MD* John B Christensen, MD* Dawn Motyka, MD* Inemesit U. Newsome, MD Christopher O’Grady, MD** John C. Pestaner, MD** Jeannine M. Rodems, MD* Kuntal Thacker, MD** Jack Watson, MD** Board Advisors Gail Newel, MD, Public Health Officer Donaldo Hernandez, MD, CMA President-Elect *Elected CMA Delegates | **Elected CMA Alternates Physicians for a Healthy Central Coast Foundation Board of Directors President Jack Watson, MD Treasurer Grant Hartzog, PhD Secretary Donna Odryna, Executive Director Directors Violetta Barroso, MD, Amy McEntee MD, Jeanine Rodems, MD

The Cypress Foundation in Monterey and Physicians for a Healthy Central Coast in Santa Cruz are 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. It is a of the Monterey County Medical Society and the Santa Cruz County Medical Society.

Coastal Physician reserves the right to edit all contributions for clarity and length, and to reject any material submitted in whole or part.

5

MEMBERSHIP SPOTLIGHT Dr. Melissa Nothnagle - Monterey County Medical Society Although I’m a native New Englander, I was happy to escape winter and move to the beautiful Central Coast; it’s been my home for the past four years. Outside of work, I enjoy CrossFit, paddle boarding, vegetarian cooking and exploring the Central Coast with my husband and our teenage son. I’m looking forward to more in-person socializing with my medical-society colleagues soon!

What drew you to a career in medicine, in particular becoming a physician?

I was drawn to a career in medicine—and family medicine, in particular—to advance social justice.

During my training, I gained: the practical skills to treat almost any illness; the ability to partner with patients, thereby, helping them improve their wellbeing; and the knowledge to advocate for healthcare equity for patients from historically- marginalized communities. Now as an educator teaching residents and students, I’m impacting the health of tomorrow’s patients and their communities.

As a clinician, I’m passionate about reproductive healthcare (especially contraception), infertility and abortion care. Access to these essential healthcare services is becoming more restricted, in particular, for low-income and rural communities and people of color. The result is stark national disparities in pregnancy outcomes that aren’t happening in other wealthy countries. I love providing reproductive healthcare to my patients. I love teaching these skills to future primary-care physicians; this improves access for our patients.

Tell us about the work you do now and how it inspires you As the Residency Director and Chief of Family Medicine at Natividad, my job’s fantastic. I’m practicing and teaching the full spectrum of family medicine. I see patients of all ages—from prenatal care and delivering babies to caring for older adults—in our residency clinic, a safety-net health center on the Natividad campus, and Natividad’s inpatient hospital including its labor and delivery services.

Working with our 30 wonderful Natividad residents is a privilege.These newly-graduated physicians choose to do their three years of family-medicine specialty training at Natividad for the high quality of our clinical education and to serve our communities (including the most marginalized in Monterey county like our migrant farmworkers). Many of our residents come from immigrant families.They’ve overcome tremendous challenges to become doctors—their , understanding, experience and their commitment to the care of their patients are unique.

6

MEMBERSHIP SPOTLIGHT Dr. Violetta Barroso - Santa Cruz County Medical Society I moved with my family from Mexico when I was a child to the small farming community of King City. This is where I grew up, went through the King City school system, before leaving to attend Stanford University. I graduated from Stanford in 2000 with a BS in Biological Sciences. I took a bioinformatics job in New York City after graduating Stanford.

Eventually, I returned to the Salinas Valley. I took a summer job in a winery lab and began working in the wine industry. During this time I decided being a doctor would be more fun.

I left the wine industry and entered the UCSF Post-Baccalaureate Program. In 2009, I returned to Stanford for medical-school training. While completing my studies at Stanford, I did a fellowship in “Leadership in Health Disparities.” I did my residency—specializing in Family Medicine—at Kaiser Vallejo.

For the past five years, I’ve been practicing full-spectrum family medicine at the Kaiser Watsonville clinic. My husband, our two huskies, and I live in the area. We enjoy early morning walks with our dogs on the beach before my work day begins.

What drew you to a career in medicine, in particular becoming a physician?

I was drawn to a career in medicine because I love to learn. I get bored easily: medicine challenges me constantly. The wonders of the human body are fascinating. The art and creativity of the diagnostic process are satisfying; they make me love every moment of my job.

Tell me about the volunteer work you do now and how it inspires you?

I serve on the Board of the Santa Cruz Medical Society’s foundation, Physicians for a Healthy Central Coast (PHCC). I’m working with fellow PHCC Board Member Grant Hartzog, PhD, on building the new UCSC Post-Baccalaureate Program. I’m also working with the Latino Education Advancement Foundation (LEAF), based out of San Jose CA. With LEAF, we’re creating pathways to medicine for a broader more diverse pool of applicants. Our goal is helping these students enter medical school and joining us as colleagues in the future. We’ll be a stronger industry for it.

7

Welcome new members!

SANTA CRUZ COUNTY Nareh Valerie Burgen, MD Palo Alto Medical Foundation Dermatology

Brook M Goddard, MD Vituity Healthcare Emergency Medicine

David Theodore Greenwald, MD Palo Alto Medical Foundation Urology

Daniel Martin Mecozzi, MD Palo Alto Medical Foundation Pediatrics

Brian Wallace Nevitt, MD Palo Alto Medical Foundation Anesthesiology

Rachel Lynn Rider, MD Palo Alto Medical Foundation Obstetrics and Gynecology

Patrick Worth Shepard Cary, DO Vituity Healthcare Emergency Medicine

Madhu Raghavan, MD, FAAP Private Practice Pediatrics

Alisa Maki, MD Palo Alto Medical Foundation Facility Medicine

Dena Marie Janigian, MD Palo Alto Medical Foundation Anesthesiology

Robert Jay Segal, MD Palo Alto Medical Foundation Dermatology

Heidi May Goddard, MD Vituity Healthcare Emergency Medicine

8

Welcome new members!

SANTA CRUZ COUNTY Thomas Robert Yarema, MD Center for Wellness & Integrative Medicine | Family/Internal Medicine

Punit Mayankkumar Patel, DO Santa Cruz Medical Group, Inc. Dignity | Physical Medicine & Rehab

Miguel Carlo Aragozo Amurao, MD Santa Cruz Medical Group, Inc. Dignity | Hospitalist

Thanh Ngoc Vu, MD Santa Cruz Medical Group, Inc. Dignity | Internal Medicine

Kimberly Smith Moreland, MD Santa Cruz Medical Group, Inc. Dignity | Obstetrics and Gynecology

Ian Glen Ferguson, DO Vituity Healthcare Emergency Medicine

Benjamin Robert Wagner, MD Santa Cruz Medical Group, Inc. Dignity | Nephrology

Wiktoria Zuzanna Zaleska, MD The Permanente Group Family Medicine

Kirtkumar Gopalji Desai, MD Palo Alto Medical Foundation

Adam Micheal Montagna, MD Palo Alto Medical Foundation

Anesthesiology

Anesthesiology

Dara Ennis Mendelsohn, MD Vituity Healthcare Emergency Medicine

9

Welcome new members!

MONTEREY COUNTY

Cole Patrick Klick, MD Vituity - Natividad Medical Center | Emergency Medicine

Nathaniel David Uchtmann Natividad Medical Center Internal Pediatric Medicine

Richard Garza, MD Monterey County Surgical Assoc. | General/Vascular Surgery

Heather D. Cunningham, MD Private Practice Hematology Oncology

Jill Joanne Reyes Tiongco, MD Montage Medical Group Internal Medicine

Eva Perusquia Frias, MD Clinica de Salud del Valle de Salinas | Internal Medicine

Nadia Arias, MD Clinica de Salud del Valle de Salinas | Pediatrics

Preston Carlisle Linson Gentry, MD Vituity Healthcare Psychiatry

Erardo Rodriguez Bautista, MD Clinica de Salud del Valle de Salinas | Family Medicine

Miguel Angel Acuna, MD Vituity Healthcare Psychiatry

10

EXECUTIVE NOTES Donna Odryna Executive Director Physicians continue to face many challenges as they transition into the post -pandemic era and in the changing practice of medicine in general. The work we continue to do in partnership with the California Medical Association (CMA) and other medical societies and specialty associations advocates for physicians, supporting their care for patients, and community health. While there are clearly wins associated with the modernization of MICRA (see pp.19-20), there is no doubt that there are real concerns that need to be discussed and addressed (such as H.R. 6087 see pp. 21).

We want you to know that we are keenly aware that the work we do collectively is paramount in helping to secure the practice of medicine and access to care throughout the communities of the Santa Cruz and Monterey counties. We strive to serve and support physicians in ways that are salient, relevant, and helpful. But that can only be done in partnership with you the members of these Societies. To help us better do that, we would greatly appreciate you sharing your thoughts with us. Please use the following link to let us know what type of information is most useful to you and, or, your practice.

Click here to take this brief 2-minute survey.

If you have questions, please email me by clicking on my name below or call me at 831-334-8484. From our family to yours, it is our honor to serve and work for you. We appreciate your countless contributions to organized medicine here at home, in Sacramento, and in Washington, DC. Sincerely,

Donna Odryna

11

COMBATTING THE WORKFORCE CRISIS Alfred Sadler, M.D. ScD (Hon) FACP Chairman of the Board, Cypress Foundation Board Secretary, Monterey County Medical Society

“Foster a dynamic and diverse physician workforce. Assist current and next generation physicians and advanced practice clinicians in efforts to address the physician shortage. Encourage youth interest in health sciences while fostering careers in medicine.”

This is one of the four Strategic Themes of the Foundations affiliated with the Monterey County and Santa Cruz County Medical Societies (MCMS and SCCMS). I would go so far as to say that this may be of greatest importance as our North Central Coast communities deal with the growing shortfall in the number of Physicians and other advanced health care professionals, nurses, etc. This growing shortage is causing challenges around access to care and delays in treatment and is only projected to get worse as physicians retire. Based on the average physician age, as much as 37% of the physicians practicing in Monterey and Santa Cruz counties will be retiring over the next decade. In hard numbers, that’s approximately 680 physicians. So, what are we doing?

Though I am retired from my practice, I continue to be actively involved in local efforts that are helping to address these challenges. As the Chairman of the Board for the Cypress Foundation and Secretary of the MCMS Board, I am committed to helping support our next generation physicians who come through the Family Medical Residency Program at Natividad Medical Center. Under the leadership of Melissa Nothnagle, MD, MSc, Residency Director, and Chief of Service Family Medicine, ten residents graduate annually and many remain in the central coast to practice medicine. On the horizon, expanding opportunities are emerging as a new family residency program is under development at Dignity Dominican Hospital in Santa Cruz County, thus expanding the residency slots in our region.

12

I believe supporting interdisciplinary teams in healthcare is critical to the future of care delivery. I am proud to serve as Associate Medical Director for the Physician Assistant Program at California State University Monterey Bay, a program I cofounded in 2015. The MSPA program at CSUMB began in 2019. The fourth class of 30 MSPA candidates began at CSUMB began in January 2022. The first class of 29 graduates are thriving with more than half of them working in a variety of settings right here in the North Central Coast. We expect this to be an ongoing trend for the second cohort upon the successful completion of the national PA certification examination (PANCE) in June.

More than 200 physicians in our tri county region volunteer their time and expertise as preceptors supporting the 240 required clinical rotations for each MSPA cohort. In addition, many physicians contribute to the MSPA teaching program by serving as guest lecturers.

Studies and our experience demonstrate that Physicians and Physician Assistants are more likely to remain in the community where they completed their training. For more information about our philanthropic work or how you can help support the next generation of physicians and advanced healthcare professionals in our community, reach out to Donna Odryna at (831) 479-7226.

”(P)LUCK re ects the moxie and grit needed to tackle a career in healthcare and its focus is fully consonant with the Medical Societies and Foundations workforce priorities”, said Fred.

The Sadler’s discuss the healthcare manpower shortage and share 15 lessons for catalyzing change. To learn more, go to pluckthebook.com.

Coauthored with Fred’s identical twin brother Blair, the book is available June 28th at Amazon and other locations,

fl

13

Cypress Foundation Awards Grant The Cypress Foundation cheered on the 2022 graduates of the CSUMB Master of Science Physician Assistant Program on graduation day with a $5000 donation for an on-campus evening party. The graduates, their friends and families, CSUMB faculty, and members of the Monterey County and Santa Cruz County Medical Societies and Foundation attended.

Graduate John Villerreal (R) made sure his fellow graduate “Layla” was included in the big day. He made a huge portrait of Layla, (who missed out due to illness) and kept her front-and-center all day. The two friends belong to the 30-student cohort who began the program in 2020.

This year’s graduation events are the first inperson since the MSPA program began in 2019.

(Due to Covid-19, the inaugural class of 30 students couldn’t meet in person for graduation.)

(L-R) CSUMB MSPA Program Director Christopher Forest, DMS & PA-C, MSPA Medical Director Leonard Caputo, MD, MCMS-SCCMS Executive Director Donna Odryna, MCMS President Steve Harrison, MD, TCF Board Chairman Fred Sadler, MD, and TCF Director & MSPA Clinical Coord for Didactic Programs Valerie Berry, MD - May 20, 2022

14

NEED PPE? If you practice in Santa Cruz County or Monterey County, you're in luck!

The Santa Cruz County and Monterey County Medical Societies have PPE supplies for physicians, medical practices, and clinics…and it’s free when you pick it up.

There are a variety of materials available locally, (supplies may be delivered for the cost of shipping).

• Gowns • Gloves (Size L) • Face Shields • Googles • Coveralls • Hand Sanitizer (70% Alcohol) • Procedural/Surgical Masks

• N95 Masks • Pre-packaged boxes of PPE (limited!) containing: • Face Shields • Procedural Masks • N95 Masks • Gloves (a variety of sizings)

To make a request, email DonnaO@cruzmed.org, or call (831) 479-7226 or (831) 455-1008.

In Partnership with

15

First Santa Cruz Physician Elected as CMA President-Elect Donaldo Hernandez, MD, FACP As a physician, past-President of the Santa Cruz County Medical Society, and three-term Trustee for District VII*, Dr Donaldo Hernandez has worked in organized medicine for most of his career. Many of you know Dr Hernandez from his work in Santa Cruz County during the height of the Covid-19 pandemic: he was medical director of both the Alternate Care Sites and the CZU-Fire evacuation with shelters. Others have worked along side him as a leader in addressing the inequities and lack of representation in medicine and the formation of the Justice, Equity, Diversity, and Inclusion (JEDI) Committee at the California Medical Association. Now, he’s President-Elect of the CMA. What’s changed since becoming CMA President-Elect Dr Donaldo Hernandez?

I’m much more in the crosshairs of decision-making; particularly, the larger overarching policy perspective. I’m thinking about how the House [of Delegates] and the Board of Trustees dictate the CMA’s direction—especially, operationalizing policies which make things happen. It’s an interesting conversation, look at the MICRA fight, its intensity, that back-and-forth, continuing the conversation, and making decisions. We must be nimble in approaching issues as they arise. It’s fun but the work is serious. We want innovative thinking and collaborative problem-solving.

What was the moment like when they released the results and declared you winner?

It was a rush of feelings. One that went from, ‘Oh, that just happened to Oh! THAT just happened!’ I was flooded with humility, gratitude, and a mild bit of exhaustion . . . There was also a great sense of meeting expectations: a lot of people imbued me with their hope. People trusted me as their spokes[person] who’ll speak for them when they can’t. I felt that sense of responsibility. And then just excitement from thinking about the cool things we can do like maybe moving the needle again with respect to healthcare equity; with respect to opportunities for physicians; and, with respect to giving hope to underrepresented communities by allowing them a seat at the table and responding to their voiced needs.

What are the current issues facing CMA and physicians today?

Medical Injury Compensation Reform Act (MICRA) has been front and center. On May 23, Governor Gavin Newsom signed Assembly Bill 35 (MICRA Modernization) into law, and in doing so finalized an achievement few thought was possible.

16

Californians Allied for Patient Protection (CAPP), the Consumer Attorneys of California, Nick Rowley (trail attorney, author and primary funder of the November ballot measure), and both sides of the looming ballot measure worked together with the Legislature and Gov. Newsom to end a decadeslong political battle and usher in a new era of stability around malpractice liability. (See pp. 19-20.)

Also, providing and maintaining equitable, affordable access to stable physician practices.

This might be more important, but it dovetails with MICRA. We need stability within the medical marketplace as we’re emerging from the [worst of the] pandemic. Several medical practices are struggling to reestablish themselves in our post-pandemic world. More-so when many of them couldn’t operate normally during the heat of the pandemic. Ensuring financial stability and continued viability in these practices is incredibly important. This highlights why advocating for improving reimbursements, particularly with Medicare and MediCal, and pushing back against insurance companies while helping them and us care for their subscribers, our patients, matters greatly.

I also think workforce issues are prominent right now. With so many physicians and nurses leaving practice, we must help physicians’ offices remain fully staffed. Providing a high level of care in an understaffed practice is exhausting; it’s causing burnout. Let’s help each other get to place where we’re replenished. This means reducing the administrative workload on everybody in a medical office. Not only physicians, but medical-practice staff, too. Those are some of CMA’s priorities in the next five-to-eighteen months.

As the Incoming President of the largest statewide medical association, is there anything else you’d like to say to your fellow physicians?

Yes! We need to get back to a place where we realize the joy of what we do—how what we do is so special. We’re in it together. Some of us affiliate ourselves along specialty lines. This is cool, I get it, but we’re physicians first, always. We share that in common. We must understand, deeply, how special this bond is while caring for ourselves. As physicians, we focus on caring for others but let’s really re-examine how and why self-care matters especially now. It’s crazy out there.

The last two years were hard. Being a leader during the outbreak was difficult for all of us. I think taking stock, celebrating our resiliencies and our professionalism may help us better recognize how special we are. Taking care of our patients is important. But it’s imperative we’re caring for ourselves, too.

*There are eleven CMA Districts in California: “Each CMA district shall be entitled to elect one (1) trustee plus one (1) additional trustee for each full two thousand (2,000) fully paid regular active members, according to its membership as verified by CMA as of the 31st day of December of the preceding year.” District VII includes the counties of Monterey, San Benito, Santa Cruz, Santa Clara, and San Mateo.

17

Support is just a click away!

The Medical Societies of Santa Cruz County and Monterey County are working collaboratively to support Central Coast physicians who are experiencing stress and burnout.

Stress, anxiety, depression, and grief are common, but they’re manageable. 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. Sessions are confidential, convenient, and FREE to physicians living and practicing in Monterey or Santa Cruz Counties.

Participation in RIM is confidential.

We pay for RIM directly, discreetly, and anonymously.

Insurance will never be asked for nor billed.

Physicians may extend their participation at their expense after the second visit.

The first two visits are made available through grants and private donations.

Please ask for help. Visit the RIM to learn more about how to take advantage of these free, confidential resiliency sessions.

A Physician Wellness Program of the Physicians for a Healthy Central Coast & the Cypress foundations.

18

MICRA Modernization 2022 Historic agreement brings new and sustained era of stability around malpractice liability.

In a historic agreement, Californians Allied for Patient Protection (CAPP) and the Consumer Attorneys of California have announced a consensus on legislation to modernize the Medical Injury Compensation Reform Act (MICRA). The modernized approach to MICRA— introduced as Assembly Bill 35 in the legislature and jointly authored by Assembly Majority Leader Eloise Reyes and Senator Tom Umberg—will extend the longterm predictability and affordability of medical liability insurance premiums, while keeping MICRA’s essential guardrails solidly in place for patients and providers alike.

For decades, California’s landmark medical malpractice laws have successfully struck a balance between compensatory justice for injured patients and maintaining an overall health care system that is accessible and affordable for Californians.

Over the years, California’s physician and provider communities have repeatedly defended MICRA through expensive battles at the ballot, in the courtroom and in the legislature. This year, with the so-called Fairness for Injured Patients Act (FIPA) slated for the November 2022 ballot, we were again facing another costly initiative battle that could obliterate existing safeguards for out-of-control medical lawsuits and result in skyrocketing health care costs.

“For the first time in a generation, we were met with an opportunity to achieve a meaningful consensus between competing interests through a modernized MICRA framework that could protect both the rights of injured patients while keeping MICRA’s essential guardrails solidly in place for patients and providers alike,” says Robert E. Wailes, M.D., president of the California Medical Association (CMA). “At times like these, we have an obligation to protect patient care and to seize a historic opportunity for a brighter future for California’s health delivery system.”

The Threat If approved by voters, the FIPA initiative would have effectively eliminated MICRA’s cap on non-economic damages by creating a new, broadly-defined category of injuries not subject to the cap. This would have resulted in a significant increase in litigation with unpredictably high verdicts and no less than an immediate doubling of malpractice insurance premiums.

The non-partisan state legislative analyst predicted FIPA would have resulted in more than $11 billion a year in increased health care costs. This would have had a chilling effect on the entire health care system, with the trickledown effect borne primarily by low-income patients, who would face higher costs and restricted access to care.

The initiative also directly targeted physicians, putting personal assets at risk.

A Modernized Framework A new consensus has been reached between health care, legal and consumer advocates on legislation to modernize MICRA. This agreement unifies stakeholders and puts the interests and wellbeing of Californians ahead of historic conflicts. The compromise reflected in this legislation will ensure that health care is accessible and affordable, while balancing compensation for Californians who have experienced health care related injury or death.

“This balanced proposal modernizes and updates MICRA while preserving its essential guardrails, strengthening provider protections and providing for fair compensation for injured patients,” said Dustin Corcoran, CMA CEO and Chair of the Campaign to Protect Access and Contain Costs. “This framework is essential to our shared goal of health access for all Californians. We look forward to working with the Legislature and the Newsom Administration to enact this historic proposal.”

19

The modernized framework preserves MICRA’s protections while providing a fair and reasonable increase to MICRA’s established limit on non-economic damages for medical negligence starting on January 1, 2023 – with gradual increases over the next 10 years and a 2.0% annual inflationary adjustment thereafter.

Other important guardrails of MICRA will continue unchanged, including advance notice of a claim, the one-year statute of limitations to file a case, the option of binding arbitration, early offers of proof for making punitive damages allegations and allowing other sources of compensation to be considered in award determinations. Critical MICRA guardrails that will remain in place with modest updates include the ability to pay awards of future damages over time and limits on plaintiff’s attorney’s contingency fees.

“This compromise will help to ensure that community health centers across California that serve some of our state’s most vulnerable patients will have continued access to safe, affordable health care,” said Jodi Hicks, Planned Parenthood Affiliates of California President and CEO. “It was important for Planned Parenthood to have a voice in this process because the proposed initiative would have caused significant harm to California’s safety net. We’re pleased to see a solution that creates long-term stability and protects access to care for those who need it most.”

CAPP reached the agreement with the initiative’s proponent, Nick Rowley, and the Consumer Attorneys of California, the state’s largest organization representing plaintiffs’ attorneys.

Changes to the MICRA Cap Current law limits recovery of non-economic damages to $250,000, regardless of the number of defendants.

The modernized framework would increase the existing limit to $350,000 for non-death cases and $500,000 for wrongful death cases on the effective date of January 1, 2023, followed by incremental increases over 10 years to $750,000 for non-death cases and $1,000,000 for wrongful death cases, after which a 2.0% annual inflationary adjustment will apply.

The proposal will also create three separate categories of caps, which could apply depending on the facts of each case: + One cap for health care providers (regardless of the number of providers or causes of action)

New Protections for Benevolent Gestures and Statements of Fault Often, a patient’s decision to file a medical malpractice lawsuit is triggered by a failure in communication, not negligence. The modernized framework establishes new evidentiary protection for all pre-litigation expressions of sympathy, regret or benevolence, including statements of fault, by a health care provider. Allowing physicians and patients to have full and open conversations about adverse events and unexpected health care outcomes will foster greater trust and accountability, while facilitating improved patient safety.

Next Steps The proposal reflected in this legislation strikes a prudent and patient-focused balance between fair compensation to injured patients and the need for universal, high-quality and cost-effective health care. More significantly, in the shadow of the most sweeping public health crisis in a century, it demonstrates a unifying willingness to put the interests of California patients ahead of divisive political positions.

Our broad and diverse coalition of physicians, community health centers, dentists, hospitals, nurses and hundreds of other organizations dedicated to affordable, accessible health care will be working closely with the Newsom Administration and the California Legislature to ensure this updated approach to medical negligence cases is enacted and signed into law.

CMA and the provider community remain united and committed to the principle of high-quality health care that is accessible and affordable to all Californians.

Californians Allied for Patient Protection (CAPP) is the large and diverse coalition working to protect access to health care through the Medical Injury Compensation Reform Act (MICRA). Its membership includes the California Medical Association (CMA), California Hospital Association, California Dental Association, CMA’s component medical societies, medical malpractice insurance carriers, community

+ One cap for health care institutions (regardless of the number of providers or causes of action)

California and many more. (You can see the full membership at micra.org.)

+ One cap for unaffiliated health care institutions or providers at that institution that commit a separate and independent negligent act

CAPP and its members also made up the core of Californians to Protect Patients and Contain Health Care Costs, the campaign CMA has been leading to defeat this dangerous ballot measure.

A health care provider or health care institution can only be held liable for damages under one category, regardless of how the categories are applied or combined.

CAPP reached the agreement with the initiative’s proponent, Nick Rowley, and the Consumer Attorneys of California, the state’s largest organization representing plaintiffs’ attorneys.

20

NEWS & EVENTS U.S. House fast tracks reckless scope of practice legislation Congress is rushing to push through a bill that recklessly expands scope of practice at the federal level. Through a parliamentary procedure typically reserved for non-controversial legislation, H.R. 6087, the “Improving Access to Workers’ Compensation for Injured Federal Workers Act,” was rushed to the oor of the U.S. House of Representatives, and approved by unanimous consent. This bill now moves to the U.S. Senate.

If passed, this bill would allow nurse practitioners (NPs) and physician assistants (PAs) to diagnose, prescribe, treat, and certify an injury and extent of disability for purposes of compensating federal workers under the Federal Employees’ Compensation Act. To take this function away from physicians who have the proper education, training, and expertise to make these evaluations is a threat to patients and the practice of medicine and is quite simply, unacceptable.

Not only does H.R. 6087 threaten patients’ health and safety, but its dangerous approach has also been shown to lead to increased health care costs while doing little to expand access, particularly in rural and underserved areas. The American Medical Association (AMA) send a letter to democratic and republican Congressional leaders detailing these and other pitfalls associated with this legislation.

This bill was pushed through on consent based in part on the argument that it would not preempt state laws that prohibit NPs and PAs from practicing without physician supervision. The argument that this bill does not preempt state laws is illusory. Enactment of a federal law that expands NP and PA practice sends a strong message to state legislatures and sets a powerful precedent that will be dif cult to overcome at the state level.

It is critical that as physicians, we stand together and send a powerful message to Congress: Don’t support legislation that prevents physicians from being at the center of critical health care decisions: VOTE NO on H.R. 6087. AMA, the California Medical Association and all of organized medicine will work to stop this reckless legislation.

CMA welcomes new Chief Legal Of cer and General Counsel.

Read more…

Join our Virtual Grand Rounds: Clinical Updates in COVID-19 & Monkeypox Tues., Jul 12, 2022 from 12:00 p.m. PT to 1:00 p.m. PT. Register Now…

On Demand Webinars GME Leadership Summit 2022 (Complete) Virtual Grand Rounds: Updates in COVID-19 and Novel Surveillance Methods

fl

fi

fi

21

NEWS & EVENTS 2022-2023 STATE BUDGET On June 15th the legislature sent Governor Gavin Newsom Senate Bill 154, the primary state budget bill for scal year 2022-2023. This memo summarizes some of the highlights that would be of particular interest to our members.

The Governor will need to sign a state budget bill into law no later than July 1st for the budget year that begins on that day. However, since the legislature and the Governor are still negotiating on some key budget priorities and on budget trailer bills, the expectation is that there will be an additional budget bill sent to the Governor before SB 154 is signed.

CMA president issues statement in response to recent acts of violence against physicians!

"The latest acts of violence in Tulsa, Oklahoma, and Encino, California, that have targeted physicians underscores the escalating threat of violence that health care workers have faced in recent years. We are heartbroken and resolved to stand in solidarity with our colleagues who have dedicated their lives to saving the lives of others. We send not just our deepest condolences, but our outrage that such senseless acts of violence continue to plague our nation.”

CMA calls for immediate action to address epidemic of gun violence. Read more…

Aledade value-based care ACO applications are due June 28!

In 2019, the California Medical Association (CMA) Physician Services Organization (PSO) partnered with Aledade to help primary care practices and community health centers succeed in value-based care. For the most recent reporting year (2020), practices in Aledade's Medicare Shared Savings Program ACOs earned an average of $198,000 each in shared savings revenue.

Learn how your practice can maintain independence, improve work ows, increase revenue and provide better care for your patients!

Request a consultation from Aledade or connect with CMA PSO to lean more at physicianservices@cmadocs.org.

You can also download two recent webinars discussing value-based care with Aledade:

fi

fl

Thriving in Practice Through Value Based Care Thrive, Not Survive: Why Committing to an ACO Helps Your Primary Care Organization Thrive

Thank you to all our readers

Santa Cruz County Medical Society 1975 Soquel Dr. Suite 215 Santa Cruz, CA, 95060 831-455-1008 SCCMS@cruzmed.org www.cruzmed.org

Monterey County Medical Society 419 Webster Street, Suite 202 Monterey CA 93940 831-455-1008 MCMS@cruzmed.org www.cruzmed.org