Fall 2012

CAN SAN JOAQUIN GENERAL HOSPITAL BECOME OUR FIRST

PLUS: 2012 Decision Medicine

CENTER?

Office Manager’s Resources

Fall 2012 FALL 2012

SAN JOAQUIN PHYSICIAN 1

the prActice wAs just beginning to tAke off

now who knowS when you wiLL reTurn.

Learn more

About this vAluAble plAn todAy!

As A physiciAn you probably know better than anyone else how quickly a disability can strike and not only delay your dreams, but leave you unable to provide for your family. Whether it is a heart

—————————————————————————

attack, stroke or a car accident or a fall off a ladder, any of these

Call Marsh for free information, including features, costs, eligibility, renewability, limitations and exclusions at:

things can affect your ability to perform your medical specialty.

800.842.3761 —————————————————————————

That’s why the San Joaquin Medical Society sponsors a Group Long Term Disability program underwritten by New York Life Insurance Company, with monthly benefits up to $10,000. You are protected in your medical specialty for the first 10 years of your disability. With this critical protection, you’ll have one less thing to worry about until your return.

or SCan To Learn more!

SpoNSoreD bY:

UNDerWrITTeN bY:

New York Life Insurance Company New York, NY 10010 on Policy Form GMR

56429 (9/12) ©Seabury & Smith, Inc. 2012

Ar Ins. Lic. #245544 • CA Ins. Lic. #0633005 d/b/a in CA Seabury & Smith Insurance program Management 777 South Figueroa Street, Los Angeles, CA 90017 • 800-842-3761 CMACounty.Insurance@marsh.com • www.CountyCMAMemberInsurance.com

2

SAN JOAQUIN PHYSICIAN

FALL 2012

VOLUME 60, NUMBER 3 • SEPTEMBER 2012

Decision Medicine 2012 students

{FEATURES}

20 24 34 43 54 FALL 2012

CALPAC

Success in a new era: CALPAC continues to thrive

ATYPICAL

{DEPARTMENTS} 17 CMA FOUNDATION

CMA Foundation Helps Physicians COPD Awareness Month

Hand, Foot, and Mouth Disease

26 PRACTICE MANAGER RESOURCES

SAN JOAQUIN GENERAL HOSPITAL

28 IN THE NEWS

Will it be our first Trauma Center?

PRIVATE PRACTICE STRATEGIES PT. 1 Retaining Independence

Free to SJMS Members!

New Faces and Announcements

54 DAMERON HOSPITAL 100 Years of Caring

67 IN MEMORIAM

DECISION MEDICINE

28 Students Receive a Glimpse of a Life in Medicine

SAN JOAQUIN PHYSICIAN 3

PRESIDENT Raissa Hill, DO PRESIDENT-ELECT Thomas McKenzie, MD PAST-PRESIDENT George M. Khoury, MD SECRETARY-TREASURER Ramin Manshadi, MD BOARD MEMBERS Lawrence R. Frank, MD, Moses Elam, MD, Peter Drummond, DO, Dan Vongtama, MD, Susan McDonald, MD, James J. Scillian, MD, Karen Furst, MD, Kwabena Adubofour, MD, Kristin M. Bennett, MD

MEDICAL SOCIETY STAFF EXECUTIVE DIRECTOR Michael Steenburgh DEPUTY DIRECTOR Nikki West COMMUNITY PROJECT MANAGER Vanessa Armendariz MEMBERSHIP COORDINATOR Jessica Peluso

SAN JOAQUIN PHYSICIAN MAGAZINE EDITOR Moris Senegor, MD EDITORIAL COMMITTEE Moris Senegor, MD, Kwabena Adubofour, MD, Mike Steenburgh MANAGING EDITOR Michael Steenburgh CREATIVE DIRECTOR Sherry Roberts,

COMMITTEE CHAIRPERSONS MRAC F. Karl F. Karl Gregorius, MD DECISION MEDICINE Kwabena Adubofour, MD

sherrylavonedesign.com CONTRIBUTING WRITERS James Noonan, Elizabeth Zima, William West

ETHICS & PATIENT RELATIONS to be appointed COMMUNICATIONS Moris Senegor, MD LEGISLATIVE Jasbir Gill, MD

THE SAN JOAQUIN PHYSICIAN MAGAZINE is produced by the San Joaquin Medical Society

COMMUNITY RELATIONS Joseph Serra, MD AUDIT & FINANCE Marvin Primack, MD MEMBER BENEFITS Jasbir Gill, MD NOMINATING Hosahalli Padmesh, MD MEMBERSHIP Ramin Manshadi, MD

SUGGESTIONS, story ideas or completed stories written by current San Joaquin Medical Society members are welcome and will be reviewed by the Editorial Committee.

PUBLIC HEALTH Karen Furst, MD SCHOLARSHIP LOAN FUND Eric Chapa, MD

PLEASE DIRECT ALL INQUIRIES AND SUBMISSIONS TO:

NORCAP COUNCIL Thomas McKenzie, MD

San Joaquin Physician Magazine 3031 W. March Lane, Suite 222W

CMA HOUSE OF DELEGATES REPRESENTATIVES Robin Wong, MD, Lawrence R. Frank, MD, James R. Halderman, MD, Patricia Hatton, MD,

Stockton, CA 95219 Phone: 209-952-5299 Fax: 209-952-5298 Email Address: nikki@sjcms.org

James J. Scillian, MD, Peter Oliver, MD, Roland Hart, MD Kwabena Adubofour, MD, Gabriel K. Tanson, MD, Ramin Manshadi, MD

4

SAN JOAQUIN PHYSICIAN

MEDICAL SOCIETY OFFICE HOURS: Monday through Friday 9:00 AM to 5:00 PM

FALL 2012

Get More Support

Craig Bobson, M.D. Hill Physicians provider since 2004.

Uses Hill inSite, RelayHealth and Ascender for eligibility, eClaims processing, electronic health records, practice management, secure online communications, ePrescribing, eReferrals and preventive care reminders.

Practices affiliated with Hill Physicians Medical Group retain their independence while enjoying the support of a large, well-integrated network of providers. Hill’s advantages include: • Fast, accurate claims payments • Free eReferrals, ePrescribing and online doctor-patient communications • Experienced RN case management for complex, time-intensive cases • Deep discounts on EPM and EHR solutions to help you meet the federal mandate • Easy preventive care and disease management reminders for patients • Extensive health resources that boost patient engagement • High consumer awareness that builds practice volume That’s why 3,700 independent primary care physicians, specialists and healthcare professionals have made Hill Physicians one of the nation’s leading Independent Physician Associations. Get more for your practice and your patients by affiliating with Hill Physicians Medical Group.

Get more information at www.HillPhysicians.com/Providers or contact: San Joaquin and Stanislaus: Paula Friend, regional director, (209) 762-5002, Paula.Friend@hpmg.com Sacramento area: Doug Robertson, regional director, (916) 286-7048, Doug.Robertson@hpmg.com Bay Area: Jennifer Willson, regional director, (925) 327-6759, Jennifer.Willson@hpmg.com

FALL 2012

Hill Physicians’ 3,700 healthcare providers accept commercial HMOs from Aetna, Alliance CompleteCare (Alameda County), Anthem Blue Cross, Blue Shield, CIGNA, Health Administrators (San Joaquin), Health Net, United Healthcare WEST and SAN JOAQUIN 5 who optPHYSICIAN in.

Western Health Advantage. Medicare Advantage plans in all regions. Medi-Cal in some regions for physicians

Letter From The Executive Director

STAFF REPORT

GIVING BACK TO OUR COMMUNITY

I

MIKE STEENBURGH

{

was reminded of how fast time flies recently when I approved an ad for our 3rd Annual Golf Tournament which will take place on September 29th at The Reserve at Spanos Park. Hard to imagine this will be our 3rd fund-raising event for the very deserving First Tee of San Joaquin kids. Drs. George Khoury and Kwabena Adoubofour have championed this event since its inception and have likely already chased many of you down in the halls of our hospitals seeking your commitment to join them! Please take a moment to check out our ad promoting this wonderful social (and fund-raising) event on page 48 and call the society today with your reservation.

WE HAVE SECURED DR. ANNE PETERS, DIRECTOR OF THE USC CLINICAL DIABETES PROGRAM FROM THE USC KECK SCHOOL OF MEDICINE AS OUR KEY-NOTE SPEAKER. DR. PETERS IS WIDELY RESPECTED FOR HER WORK IN THIS FIELD AND IS A HIGHLY SOUGHT AFTER SPEAKER. A second important event that many of you will want to place on your calendars is our upcoming 12th Annual Diabetes Seminar on November 3rd which will be held at the University Plaza Waterfront Hotel in downtown Stockton. This popular event always draws a capacity crowd and includes complimentary breakfast and lunch and will now provide up to 5 hours of CME from St. Joseph’s Medical Center. We have secured Dr. Anne Peters, Director of the USC Clinical Diabetes Program from the USC Keck School of Medicine as our key-note speaker. Dr. Peters is widely respected for her work in this field and is a highly sought after speaker. We are delighted she will be joining us. You can learn more about the seminar on page 59.

Lastly, I want to welcome Vanessa Armendariz to our SJMS staff family as our Community Project Manager. Vanessa is heading up all of our community outreach efforts which encompass our new “Health Hub” website (launching in early November), our popular Decision Medicine program and several other grant-funded projects relating to Diabetes and other chronic diseases. Vanessa is a joy to work with and she looks forward to meeting each of you as we expand these projects further.

All the Best,

6

SAN JOAQUIN PHYSICIAN

FALL 2012

FALL 2012

SAN JOAQUIN PHYSICIAN 7

A message from our President – Raissa Hill, DO

Unite for Change We considered the hidden beauty of Stockton that is obviously not known to much of the United States.

Being an inland seaport and delta community, we enjoy water activities and delta breezes unlike many valley cities.

ABOUT THE AUTHOR Dr. Raissa Hill is President of the San Joaquin Medical Society and is a second-generation physician who practices family medicine in Stockton.

8

SAN JOAQUIN PHYSICIAN

W

e now find ourselves in our own 50 shades of gray. Or should we say 50 shades of change?

Is that such a bad way? With the state of California, our county, our city, and healthcare, it may not be that bad.

Being an election year, we watch the politicians, including our president “duke it out,” be it through debates, mudslinging campaigns, etc. We hear them discuss our future economy, healthcare, and the like seemingly so light and easy as if playing a traditional board game. Where can we get a Chance or Community Chest card?

There is no ‘Get out of this mess free’ card. What I know for certain is that we have ourselves, our community, and our ability to band together in this time of change.

Stockton, in particular, has been getting quite a bit of scrutiny emboldening itself once again on the map for being the largest city in the United States to file bankruptcy.

Rather than wallow in ourselves as the media seems to lead us to do, in

their attempts to bring sensational news to our homes, on the contrary, we need to take the opportunity to regroup and unite. As strong as the ‘fight or flight’ response occurs every time we hear of a burglary, shooting, gang issue, or other violent violation occurring close to our home, or our friends or family, we must resist lest we become as irrational as the goings on around us. What we have here in our community are roots. The choice to invest in these roots did not come lightly at one point in the past.

We considered the hidden beauty of Stockton that is obviously not known to much of the United States. Being an inland seaport and delta community, we enjoy water activities and delta breezes unlike many valley cities.

The diversity of our population allows us exposure to different cultures. The proximity to the ocean, mountains, and metropolitan cities such as San Francisco and our capital Sacramento make it an ideal location. We have a renowned symphony. I could go on,

FALL 2012

but the point is our investment in this town is still valuable despite the dismal sounding state of its economics.

Similar in many ways, healthcare and its continually debated “reform” may appear dismal in its own way.

Politicians use it more as a pawn moving it far to the left then to the right. Yes, a change of some sort has been a long time in the works with 50 million uninsured. And I have no misconceptions on how difficult a task it is to come up with a solution while still preserving the basic freedoms and rights of choice that comes with being an American.

In this process we need the combined input from who directly works with the patients and healthcare processes. We cannot leave decisions simply to lawyers, politicians, and the like and then complain about holes in the final product. Input from patients, healthcare providers, hospitals, and insurance companies would be ideal. It seems obvious but not actually, when coming from a capitalistic arena promoting competition and independence.

However, this is a new age of change. The patients are our utmost priority. We need to bring the focus locally and take care of our own people in our community, county, state, and country. This requires involvement and proactivity.

This can occur in many ways. It can even be as passive and easy as being an active member of our local San Joaquin Medical Society which translates to the state level, California Medical Association.

You can be as involved as desired but every bit counts.

FALL 2012

We are essentially in this ‘mess’ together. Change is on the horizon. We can choose to take part or not. Great outcomes do not come about by luck or on their own. Just as any success in life, to relate to Malcolm Gladwell’s “Outliers,” does not come without

hours put in, opportunities available, in addition to pure desire and ability. Let’s take advantage of what we have in our own community and ourselves. And we tell all those who oppose, “divided we stand, united we are.”

Sutter Community Connect The Epic-powered EHR solution for your independent practice

Comprehensive

EHR and practice management applications

Certified

CCHIT Certified; Compliant to meet Meaningful Use

Integrated

with Sutter Health’s clinical data repository

For a limited time, Sutter Health will make a donation to help offset the costs of implementing an EHR system for eligible physicians.

Request a demo www.suttercommunityconnect.org or call (855) 426-7117

Powered by

SAN JOAQUIN PHYSICIAN 9

A Message From The Editor - Moris Senegor, MD

Judging Errors Medicine Versus Sports

Back in the 1970’s a University of Chicago graduate student in anthropology named Charles Bosk studied the process of initiation among surgery trainees in that institution’s general surgery program.

ABOUT THE AUTHORMoris Senegor, MD serves as the Chairperson of the Publications Committee for the San Joaquin Medical Society and Editor of its flagship publication the San Joaquin Physician.

10

SAN JOAQUIN PHYSICIAN

T

o those familiar with the history of baseball, the name Bill Buckner conjures up an image of incompetence.

Buckner was a first baseman for the Boston Rex Sox who in the 1986 World Series, playing against the New York Mets, missed an easy ground ball which went through his legs. This error, committed in an exciting overtime game, 6th of the series, allowed the Mets to win the game and eventually the World Series. Frustrated Boston fans blamed the entire World Series debacle on this one error committed by Buckner, despite other shortcomings of the team.

They pilloried Buckner.

Prior to that fateful night in 1986, Bill Buckner had a respectable baseball career that dated back to 1969, with the LA Dodgers, Chicago Cubs and subsequently Boston Red Sox. With the latter team, he led the League in various statistics including a 25 year record in assists by a first baseman in a season, the category into which ironically, his World Series error fell. By all measures Buckner should have retired from the game with the respect afforded to veteran players who put up solid, reliable long term performances. Instead, in a split second, with a ball that went through his legs at the worst possible occasion, his reputation turned sour. That moment became a defining moment in his career.

The experience of Buckner is not

unique. Many others have had seemingly brief moments in their lives which have bludgeoned their image and reputation.

As I began to write this article way back in the autumn of 2011, another venerable sports figure was in the news with such an experience. The longstanding football coach of Penn State, Joe Paterno found himself paying for a moment of ill-judgment with forced retirement amidst disgrace. It was an ignominious ending to an otherwise storied career. His moment occurred in 2002 when he was informed that an assistant coach in his staff was molesting a child.

While treating the problem “by the book” and passing the information up the chain of command at the University, he failed to alert the police or do anything else to protect other children. The perpetrator continued to commit sexual offenses until his arrest in 2011. Had Paterno, a most revered and respected figure in the organization notified legal authorities then, many more years of sex abuse could have been prevented. His decision was viewed as part of a cover-up in order to protect Penn State from a scandal, and it became the object of indignation by the entire nation when a scandal did eventually erupt and was more horrific than anyone expected.

Bill Buckner’s mistake was a technical slip-up, an accident that could happen to any of us in our day to day lives as we engage

FALL 2012

Bosk then observed that technical errors were forgiven regardless of how egregious they may be, as long as the trainee did not keep repeating them.

with familiar activities. Paterno’s error on the other hand, pointed to a moral weakness which the man, 84 years old when the scandal broke, had not previously revealed. By all accounts he was solid as a rock, leading an exemplary football program, in a college football world rampant with dishonesty in player recruiting and maintenance. He was considered a bastion of morality in an otherwise contaminated milieu. It is always shocking when celebrities with well- established images reveal opposite sides of themselves (think Tiger Woods), and Paterno, despite being a side character in the child sex abuse scandal, ended up deflecting attention from the perpetrator, and shouldering most of the wrath displayed by a shocked nation.

Back in the 1970’s a University of Chicago graduate student in anthropology named Charles Bosk studied the process of initiation among surgery trainees in that institution’s general surgery program. The thesis that resulted from his project, published as a book labeled “Forgive and Remember”, became a classic in the field of sociology, and a popular read among surgeons. Bosk’s central thrust was an analysis of how surgery professors handled mistakes among their trainees.

Bosk identified three types of mistakes. The first were technical errors, such as a pneumothorax while tapping the chest. These he considered inherent in the education of inexperienced physicians, and regular, expected events in the delivery of medical care. The second category which he labeled “normative errors”, he defined as a doctor’s failure to discharge his or her role conscientiously. He included a diverse group of acts in this category including delay in notifying superiors of changes in patient conditions, inability

FALL 2012

to get along with fellow physicians or ancillary personnel, intellectual dishonesty, and cover-ups of any sort. Bosk indicated that while technical errors were mistakes in carrying out a role, normative ones related to how a role was assumed.

His last category which he labeled “quasi-normative errors” related to violations in attending specific, idiosyncratic protocols. Those familiar with high profile surgeons know how prevalent and capricious their quirks can be. Bosk pointed out that while residents who violated such rules often did not endanger patient care, frequent such breaches by an initiate indicated a potential personality problem, namely that of hubris.

Bosk then observed that technical errors were forgiven regardless of how egregious they may be, as long as the trainee did not keep repeating them. While such errors could lead to serious complications and increased cost of care, the teaching establishment considered them rectifiable via the existing educational process. The rule that applied to such mistakes was “forgive and remember”. The “remember” aspect of this dual norm had to do with those who for various reasons did not have the technical capacity to become surgeons, and who were eventually weeded out if observed to be committing too many technical mistakes.

Normative errors on the other hand fell into a moral arena. These were treated more harshly by the teaching establishment. Bosk indicated that “forgive and remember” did not apply to such mistakes, because unlike technical errors which were easy to correct, normative errors implied existence of character defects in the trainee and these would be much harder to fix. There was little tolerance for such mistakes, and these individuals were more promptly expelled.

SAN JOAQUIN PHYSICIAN 11

A Message From The Editor - Moris Senegor, MD

backstage at my word processor

Written by: Moris Senegor, MD

Over the years many readers have asked me questions about whether I write my editorials myself, and how I come up with my ideas. I have told more than one colleague that no, I do not have a ghost writer. I write them myself. The quest for subjects has

been a never ending one ever since I became editor of the magazine over a decade ago.

These usually come to me provoked by some newspaper headline or discussion at the hospital, especially in the operating room. Afterwards I retreat to my computer and the essays pour out of me, many complete in one or two writing sessions. I subsequently subject them to countless revisions before publication.

However, occasionally the process is painfully constipated. I embarked upon the present editorial in early September 2011 when, always searching for fresh subjects, I decided to do a sports theme, something I had not tackled previously for I am no longer a sports fan. I somehow hit upon the misfortune of Bill Buckner and decided to use this as a parable in showing how a split second can redefine a person’s life work. I printed out a lengthy Wikipedia essay on Buckner and intended to take it with me on a European trip. Just about then the Penn State scandal broke and was in the news.

I wrote the first page of the essay referring to Buckner and Paterno at the San Francisco Airport in one swift rush while awaiting a plane to Prague. I thought it looked good, but then while in Europe, when I decided to take the essay in the direction of an analogy with surgery morals and thought of Bosk’s “Forgive and Remember”, I realized that I would have to re-read this book before proceeding further. It had been decades since I had read it, and I no longer had the book in my possession. Upon return from Europe I ordered the book, and when it arrived it sat on a pile of pending reading material for weeks, then months. I decided the thesis of my essay was too difficult and abandoned it, turning instead to a book I wanted to write which now occupied almost all my free time.

Then in May 2012 I received deadline pressure from Mike Steenburgh for the next magazine editorial. It coincided with another European trip, this time to Istanbul. By now my book project was fairly advanced and I could turn back to my sports essay. I took Bosk with me to Istanbul and began extending the essay beyond the single page I had written months earlier. It was a tough and slow sludge through painfully written sentences, and murky concepts that I had difficulty clarifying for myself. The more I reread Bosk, the more I realized that surgery and sports could not be easily analogized in their moral underpinnings. Bosk himself, as I noticed, was very cautious not to extrapolate his thesis beyond surgery. It took another month of self-enforced return to the project when it finally came together as a cohesive essay. By now the project was nine months from the first page I had written about Buckner and Paterno in San Francisco.

I then submitted the editorial for our Spring issue only to discover that I had missed the print deadline by a few days and it would have to await the Autumn magazine. “No problem”, I thought. But then the Penn State scandal re-ignited with publication of the Freeh report in July 2012, and consequent events forced me into yet another revision.

“Oh no!”, I thought, “here we go again.” At first I was dismayed by how my essay was caught behind new developments, but these very same events actually strengthened my conclusions. I became happiest and most confident with the latest revision. It was nonetheless my most painful and laborious essay, and I surprised myself by completing it, because oftentimes when I hit a brick wall, I simply purge it out of my computer and look for other, easier subjects.

I hope that by giving you a glimpse into what it takes to write a relatively short, simple piece, I convey how challenging such writing can be. Oftentimes a large expansive project, say a novel, is in some ways easier to write, for it allows substantial room for the author to ramble. But rambling is an unforgivable sin in op-ed essays. In this format one has to be concise, and the concepts conveyed locked into each other coherently and unassailably. Whether my essay indeed appears so is up to you, the readers. Achieving this is at times, as you can surmise from my ordeal, an accomplishment much larger than the essay itself.

12

SAN JOAQUIN PHYSICIAN

The intermediate category of “quasinormative” also resulted in expulsion if observed frequently and against several different attendings, thus also in reaction to character defects.

Extrapolating from the surgery training milieu, Bosk concluded that, “moral failure is more often the subject of serious social control efforts than errors in technique.” He went on to state, “when a physician acts in good faith, the reasons for failure…are excusable.”, again implying that moral fortitude is a foundation upon which physicians are judged, regardless of results.

In today’s world, as opposed to the 1970’s when Bosk’s project occurred, rules of due process do not allow easy firing of residents. Nonetheless the basic guidelines defined by Bosk about acceptable versus unacceptable behavior remain unchanged. In my residency, also at the University of Chicago, there was a much mentioned case of a junior resident who accepted a patient on transfer from New York after a craniotomy which failed to address an unusual giant fusiform aneurysm of the brain. Unbeknownst to this resident the patient arrived on his watch with no bone flap under his scalp, and that’s where the aneurysm lay. When the resident encountered a large, soft, pulsatile swelling on the scalp he mistook it for a subgaleal fluid collection and attempted to tap it with a spinal needle.

The result was a neurological catastrophe as the aneurysm bled.

Dr. Mullan, the Chief of the service to whom this patient was transferred, was furious with this most egregious mistake but did not fire the resident, who eventually graduated and went on to a respectable career in academic neurosurgery. But neither Dr. Mullan nor this resident ever forgot the mistake, a technical blunder related to inexperience.

Decades later I heard this resident tell his story still obviously emotional and teary eyed as he re-lived the event. All future generations of residents that came along in my program also heard the story as an admonishment that one cannot blindly stick needles into neurosurgical spaces

FALL 2012

LODI MEMORIAL HOSPITAL ACUTE PHYSICAL REHABILITATION 21

YEARS OF SPECIALIZED, INPATIENT

REHABILITATION SERVICES FOR:     

Stroke patients Brain-injury patients Spinal-cord-injury patients Multiple-trauma patients Other neurological conditions

THE

COUNTY’S ONLY ACUTE, INPATIENT

PHYSICAL-REHABILITATION PROGRAM, FEATURING: 

State-of-the-art technology for neurologic training



Daily visits and medical care by rehabilitation specialist Ramnik Clair, MD



Dedicated 24-hour care by registered nurses with specialized training and experience in rehabilitation



Coordinated physical, occupational, speech and recreational-therapy sessions, three hours per day



Emphasis on regaining independence for safe transition back to home



Clean, spacious facility with private to semi-private rooms



Large dining area, outdoor patio/garden, functional therapy gyms and kitchen

INTAKE DEPARTMENT 209/712-7905 209/333-3082 (FAX) 975 S. FAIRMONT AVE. LODI, CA 95240 WWW.LODIHEALTH.ORG FACEBOOK.COM/LODIMEMORIAL TWITTER.COM/LODIMEMORIAL FALL 2012

SAN JOAQUIN PHYSICIAN 13

A Message From The Editor - Moris Senegor, MD

without precise knowledge of what lies beneath. This case was “forgive and remember” at its best.

In Boston, after the initial furor over the 1986 World Series died down, Bill Bucker was eventually forgiven

by Red Sox fans. After being traded away, he returned to the team as a free agent in 1990, and on his first game received a standing ovation from the fans. In a more poignant gesture, Buckner threw a ceremonial first pitch in the Red Sox 2008 season opener, the one which followed their 2007 World Series

The thesis that resulted from his project, published as a book labeled “Forgive and Remember”, became a classic in the field of sociology, and a popular read among surgeons. Bosk’s central thrust was an analysis of how surgery professors handled mistakes among their trainees.

Championship, and on this occasion Red Sox fans gave him a four minute standing ovation. Bygones were now bygones, and Buckner’s error was recognized for what it was, a freak accident for a veteran player who otherwise served the game well.

The forgiveness element of “forgive and remember” seemed to be at play with Buckner and his fans. While Charles Bosk never made a leap in his thesis from the milieu of surgery to carry his conclusions to society at large, common sense dictates that an occasional, accidental error, no matter how egregious, could be forgiven by those who stand in judgment, provided that the doer was well intentioned, and did not repeat such errors with unacceptable frequency. One can argue that Buckner’s otherwise solid career performance speaks for itself in providing an overwhelming counterbalance to that ball that went through his legs.

With moral errors, the ones Bosk called

14

SAN JOAQUIN PHYSICIAN

“normative”, professionals are strict in punishing their own and filtering them out. By comparison society at large is not as rigorous with such transgressions, frequent as they are, commonly seen in celebrities, politicians, and indeed sports figures. The difference lies in the nature of the professional-client relationship.

Vulnerable and helpless clients place themselves at the mercy of professionals who cannot guaranty success.

Clients have to nonetheless trust professionals, and the only way they can do so is if a professional guild maintains impeccable moral standards, and thereby exudes a reputation of reliability and trustworthiness.

Sports figures do not have the same relationship with their fans and are held to looser standards by society than are doctors.

Nonetheless, there are certain thresholds which if breached, do provoke swift and powerful repercussion, often energized by an outraged public and enforced by established organizations that oversee a sport, albeit accompanied by opposition and controversy. One example that pops into my mind is Pete Rose, another baseball star more famous than Bill Buckner, who was caught betting, including for games in which his team played, and was forever banned from the Hall of Fame. Another is the recent New Orleans Saints scandal where monetary bonuses were discovered for players to intentionally deliver serious bodily injuries to opponents. The perpetrators of this policy were swiftly and seriously punished.

Joe Paterno has now endured a worse fate. First the Penn State establishment, under immense pressure from fuming public opinion, delivered him a humiliating punishment in the form of forced retirement. Soon thereafter he passed away, and now it was his reputation and legacy that became the target of further castigation, especially after a recent publication of an investigative report which described his moral lapse with much clarity. Some think that the NCAA, the organization that oversees college football, and the new administration of Penn State have gone overboard in their assault of Paterno’s legacy with such acts as the removal of his statue from their stadium, and negation of all his past wins as though they did not really occur.

While this may be so, it should be remembered that the Penn State scandal is now less than a year old, and the fiery passions it has aroused are still raging. How Paterno will emerge from its ashes in the long term remains unclear. Many in the tightly knit Penn State community continue unwavering support towards him, their local hero for decades, while the rest of the country remains appalled. It is clear however that Paterno’s folly will not be forgiven and forgotten. If Bosk’s observation about societal attitude towards moral mistakes is correct, we can expect Paterno to do much worse than Buckner in the long run.

FALL 2012

FALL 2012

SAN JOAQUIN PHYSICIAN 15

Dameron Hospital accounts for over 90% of all orthopedic surgeries in San Joaquin County. In the past 10 years over 5,000 joint surgeries have been performed at Dameron. The Hospital is fully equipped with the highest level of medical technology in support of orthopedic procedures.

“In my job I do a lot of traveling.

Having experienced 10 operations in my life in 6 different hospitals, I will tell you, Dameron Hospital was absolutely the best experience I’ve ever had. Stockton should be proud of the job this hospital is doing.

I entered the Hospital early Friday, March 2 nd and from moment one the feeling was one of care and confidence a rare combination. I recommend it highly, I’m glad I chose Dameron.”

Morgan Mayfield Vice President of Sales,

Dorfman Pacific

Dameron Hospital Patient, Full Knee Replacement Surgery

16

SAN JOAQUIN PHYSICIAN

FALL 2012

cma foundation news

Chronic obstructive pulmonary disease COPD; Chronic obstructive

November is National

COPD Awareness Month!

Known by many names, COPD (chronic obstructive pulmonary disease) is a serious lung disease which is now the 3rd leading cause of death in the United States. It is one of the nation’s largest health care concerns and is severely underdiagnosed and undertreated, according to the COPD Foundation. More than 12 million people are currently diagnosed with COPD and it is estimated that another 12 million may have COPD but not realize it; and according to the Centers for Disease Control (CDC), in 2005, COPD caused an estimated 126,005 U.S. deaths in people older than 25 years Prevention of COPD begins with reducing or eliminating smoking initiation among teens and young adults and encouraging cessation among current smokers. Approximately 75% of COPD cases are attributed to cigarette smoking. You can take an active role in talking to your patients about smoking cessation and provide them with resources to help them. A referral to the California Smokers Helpline website at: http://www.nobutts.org/

FALL 2012

Information/p.shtml or call: 1-800-NO-BUTTS, where they will be provided with a live person to counsel them on cessation options.

Although tobacco use is a key factor in the development and progression of COPD, asthma, exposure to air pollutants in the home and workplace, as well as genetic factors and respiratory infections also play a role. Some of those occupational exposures are to chemical fumes, gases, vapors and dust.. If your patient works with this type of lung irritant, suggest they talk to their supervisor about the best ways to protect themselves, such as wearing a mask.

A simple Spirometry test can be used to measure pulmonary function and detect COPD in current and former smokers aged 45 years and older, and anyone with breathing problems due to environmental exposure to smoke or occupational pollutants.

By taking steps now and talking with your patient about smoking cessation, treatment options, and symptoms such as coughing or wheezing, many of these conditions can be treated with medications.

IF your patients have respiratory infections, they should be treated with antibiotics, if appropriate.

Antibiotics are not recommended except for use in the treatment of bacterial infections.

airways disease; Chronic obstructive lung disease; Chronic bronchitis; Emphysema; Bronchitis - chronic Last reviewed: May 1, 2011.

Chronic obstructive pulmonary disease (COPD) is one of the most common lung diseases. It makes it difficult to breathe. There are two main forms of COPD: Chronic bronchitis, which involves a long-term cough with mucus Emphysema, which involves destruction of the lungs over time Most people with COPD have a combination of both conditions.

Source: www.ncbi.nlm.nih.gov

SAN JOAQUIN PHYSICIAN 17

A FREE Member Benefit:

Sponsored by

18

SAN JOAQUIN PHYSICIAN

FALL 2012

FALL 2012

SAN JOAQUIN PHYSICIAN 19

C

20

SAN JOAQUIN PHYSICIAN

FALL 2012

CALPAC Success in a new era: CALPAC continues to thrive under state’s new election policies

CALPAC THANKS TO PROPOSITION 11 (2008), district boundaries for the state Assembly and Senate were, for the first time in California history, drawn by a 14-member Citizens Redistricting Commission, rather than members of the Legislature themselves. This historic shift meant that lawmakers were no longer able to protect one another through the creation of gerrymandered districts and so-called “safe seats” for their fellow incumbents.

HAS STRONG SHOWING IN JUNE PRIMARY Adding to the chaos was the fact that the June primary was also the first to implement the top-two system as a result of Proposition 14 (2010). The new rule calls for the top two candidates with the most votes to move on to the November general election, regardless of party affiliation.

Together, these myriad of outcomes that have been California’s Junechanges primarycreated electiona was a landmark event, onewould that brought several unheard of under thechanges previoustorules.

For the first time in state history, it was the way the Golden State chooses its leadership. imaginable that two Democrats could be facing off in a November contest to represent a district that, historically, had belonged to Republicans. >>

By: Richard Thorp, M.D. Chair, CALPAC Richard Thorp, M.D.

FALL 2012

Chair, CALPAC

SAN JOAQUIN PHYSICIAN 21

Despite the shake ups, one constant from previous years remained intact –the California Medical Association’s Political Action Committee (CALPAC), was incredibly successful in supporting candidates that will go on to uphold the efforts of organized medicine.

In all, CALPAC engaged in a total of 32 contests.

Of those, 30 races, or 94 percent of the contests we participated in, have CALPAC-

supported candidates moving on to the November elections.

Additionally, 14 CALPAC-supported candidates are moving on to the November general election as a prohibitive favorite in a safe seat. In short, these candidates are all strong favorites to be in the Capitol in 2013.

Of the remaining CALPAC-backed candidates, 12 will be moving into a November contest against a member of their own party, while a remaining four will be

Prognostication is not a science, …comfort care is.

Your option for patients with life limiting illnesses experts in pain & symptom management comfort care at your patient’s residence emotional and spiritual support for both patients and their families We provide medications durable medical equipment 24-hour on call service & more… additional information at

www.hospicesj.org

Quality You can trust Joint commission accredited

22

SAN JOAQUIN PHYSICIAN

(209) 957-3888 caring support guidance choices

facing a competitive race against a member of the opposing party.

One interesting race to look for in November will be held in Los Angeles County’s Assembly District (AD) 49, where Dr. Matthew Lin (R), a past president of the Los Angeles County Medical Association and current CMA member, will be working to win over a district that tends to lean Democrat.

Dr. Lin managed to pick up an impressive 52.1 percent of the vote in a three-way contest that featured two Democrats, but will need further support from CALPAC members to help translate this performance into a November victory.

Further north, in Los Angeles’ AD 39, CALPAC-backed candidate Raul Bocanegra (D) put up an impressive performance, finishing first in a six-way contest with 36.1 percent of the total vote.

Bocanegra, the current chief of staff for Assemblymember Felipe Fuentes (D- Los Angeles), has never run for public office, but will be facing off against former Assemblymember and current Los Angeles City Council member Richard Alarcon (D), who pulled in roughly 26 percent of the June vote.

To say that these two differ in their stance toward organized medicine would be a severe understatement.

Bocanegra is part of an Assembly office that has historically supported the efforts of CMA, while Alarcon is backed by trial attorneys and is staunchly opposes MICRA. In short, CALPAC will continue to involve itself in this contest and help ensure that Bocanegra is successful this November.

Successes such as these are certainly a cause for celebration, but it’s also important to remember that they don’t come easy.

In order to make sure that our candidates are successful in November, CALPAC members must stay active and continue to support our efforts. Contributions can range in both size and frequency, but every dollar goes on to help bolster the voice of organized medicine in Sacramento.

In a year of many changes, CALPAC candidates continue to look strong on their own.

But together, we are stronger.

FALL 2012

Expanding your expertise with ours.

When you refer your patients to John Muir Health, you can be confident they will receive exceptional care from a dedicated team of experts.

Our highly experienced medical specialists provide a comprehensive, multidisciplinary approach that offers a continuum of clinical expertise across a full range of services.

• Behavioral Health Center • Cancer Institute • Cardiovascular Institute • High-Risk OB • Inpatient Rehabilitation Services • Level III NICU

John Muir Medical Centers, Concord and Walnut Creek, California

FALL 2012

• Level II Trauma Center • Neurosciences Institute • Orthopedics Institute • Pediatrics • Surgical Services • Weight-Loss Surgery

johnmuirhealth.com

SAN JOAQUIN PHYSICIAN 23

Atypical

Hand, Foot, and Mouth Disease:

24

SAN JOAQUIN PHYSICIAN

FALL 2012

SJC Public Health Update > Atypical Hand, Foot and Mouth Disease

Be on the

By Cora Hoover, MD, MPH, Assistant Health Officer, San Joaquin County Public Health Services

Lookout

STARTING IN LATE 2011 AND 2012, atypical hand, foot, and mouth disease (HFMD) caused by coxsackievirus A6 has been seen in California and throughout the United States. HFMD is usually caused by enteroviruses, and usually affects children less than 5 years of age. The most common cause of HFMD is coxsackievirus A16. Although A6 is not a new strain of coxsackievirus, it did not circulate widely in the United States until recently. Coxsackievirus A6 can cause atypical clinical features, and about a quarter of those affected are adults, likely due to lack of prior exposure.

While persons infected with coxsackievirus A6 can have typical HFMD manifestations, some may have a more severe presentation. This includes a higher fever and a more extensive rash. The rash may involve a large body surface area (not just the hands, feet, and mouth) including limbs, buttocks, and trunk. The rash may affect sites of prior skin damage or irritation such as prior sunburn or atopic dermatitis, and may involve widespread papules, blisters, and/or hemorrhagic areas. Skin desquamation and nail shedding may follow the rash. Cases of atypical HFMD have been initially diagnosed as impetigo, eczema herpeticum, and Kawasaki disease. No deaths or serious long-term sequelae have been reported as a result of these infections.

Diagnosis of atypical HFMD, like the diagnosis of typical HFMD, is generally made on the basis of clinical symptoms. Coxsackievirus A6 does not grow in viral culture, and so the specific viral etiology can only be determined by PCR testing. Please contact San Joaquin County Public Health’s Communicable Disease Program

FALL 2012

(209-468-3822) for further guidance concerning testing.

In general, testing is reserved for outbreak situations and seriously ill or hospitalized cases.

Enteroviruses are generally spread from person to person via contact with saliva, sputum, blister fluid, and stool from an infected individual. Persons can also become infected after touching objects and surfaces contaminated by infectious individuals. Sick children should be excluded from school or daycare until they have been afebrile and free of diarrhea and vomiting for at least 24 hours. If an atypical rash with extensive blistering is present, the child may be excluded until blisters are healed or scabbed and no longer draining or oozing.

HFMD is not generally a reportable disease. However, providers are requested to notify San Joaquin County Public Health of any suspected outbreaks or seriously ill or hospitalized cases. Phone 209-468-3822. Fax 209-4688222. For further information and for photos of skin rashes, please go to http://www.cdph.ca.gov/programs/cder/ Pages/CVA6.aspx.

SAN JOAQUIN PHYSICIAN 25

practice manager Free to SJMS/CMA Members!

resources

The Office Manager’s Forum empowers physicians and their medical staff with valuable tools via expert led educational sessions from industry professionals who are committed to delivering quality health care.

For more than 130 years, the San Joaquin Medical Society (SJMS) has been at the forefront of current medicine, providing its physician’s and their staff with assistance and valuable practice resources. SJMS is proud to offer the Office Manager’s Forum, a monthly educational seminar designed to enhance the healthcare environment with professional development opportunities while providing solutions to some of the challenges that come from managing a practice.

Attendees gain knowledge on a broad array of topics related to the field of medical staff services, office management, billing and coding, human resources, accounting and back office support.

The Office Manager’s Forum is held on the second Wednesday of each month from 11:00AM – 1:30PM at Papapavlo’s in Stockton and includes a complimentary lunch. Attendance is always FREE to our members. Non-members are welcome and may attend for one month at no cost to experience one of the quality benefits that comes with Society Membership ($35.00 thereafter).

Registration required.

For more information or to be added to the mailing list email Jessica Peluso, SJMS Membership coordinator, at Jessica@SJCMS.org or call (209) 952-5299.

26

SAN JOAQUIN PHYSICIAN

FALL 2012

SEPTEMBER 12TH, 2012:

“MANAGING UP! MASTERFUL MANAGEMENT FOR YOUR PHYSICIANS” 11:00AM to 1:30PM Part 1 of 4 Office Managers Educational Series is designed to help Physicians and Office Managers set expectations, manage change, and design a practice culture that helps everyone and the practice thrive.

Debra Pharias, President of Practice Liability Consultants comes to you with 20 years of experience and is here to assist you by providing superior practice management and customer service.

ARE YOU READING CPR? CPR contains the latest in Practice Management Resources, Updates and Information.

OCTOBER 10TH, 2012:

STAY CURRENT & COMPLIANT WITH THE LATEST E&M GUIDELINES! 11:00AM TO 1:30PM Learn how to apply the Evaluation & Management (E&M) guidelines in daily practice to optimize reimbursement, ensure compliance and save time by streamlining the documentation process. ~Amy Wolf, founder of Valley Medical Management, concentrates on the development and optimization of billing and coding practices.

Her wealth of knowledge will prove to be very beneficial to you and your Physician.

NOVEMBER 14TH, 2012:

MANAGING DIFFICULT EMPLOYEES AND REDUCING CONFLICT IN THE PRACTICE 11:00AM TO 1:30PM Part 2 of the Office Managers Educational Series is a packed workshop that will teach you the secrets of how to lead, coach and manage difficult employees; set practice values and create teamwork and morale needed for harmony in the medical office.

Debra Pharias, President of Practice Liability Consultants, assists physicians in hiring and evaluating practice managers and helps practices establish and maintain processes and procedures.

May 2012

In this issue:

Aetna to require addition al accreditation requirements in order to be paid for certain surgical pathology services ue: on two Anthemeditation require1 Update In this iss Cross issues tional accr Blue with addi Departm irethe in surgical 1 pending ent of Managed Health Care Aetna to requ r to be paid for certa 1 Meet Your CMA Center ments in orde ices for Economic ing serv : Mark Lane s issue Advocate s pend Services pathology Cros 2 Anthem Blue two Advocac CMA y at Work Update on

May 2012

2 Urgent survey respons e requested 3 Aetna erroneously terminat es providers from California network 3 Document, Docume nt, Document 3 United Healthcare announc es extension of HIPAA 5010 enforcement 4 What’s a COHS? 4 Save the Date

4 Act now to avoid the 2013 e-prescribing penalty 5

Payor Updates Health plan provider

newsletters

CMA resources

5 5

the etin from etin is monthly bull Services. This bull ic tice R) is a free urces (CP Center for Econom e staff improve prac CMA ResoPractice tice on’s es (CPR)thei offic ciatiResourc CMA Prac Californ and is ar free monthly bulletin from ia Medica sicians ion’s Medical Asso l Associat help phy Center for Econom to date, signthe California full tool s toand and of tips stay up ic Services. This bulletin is : To their . tools to help physicia full of tips efficienc ns ility and TERS viab SLET office y and viabilityCMA staff improve practice and NEW R. efficiency agues. /newsletters.

ANY OTHE .org colle OR SUBSCR anet and CPR IBE rs TO TO CPR OR ANY .cmOTHER orke CMA NEWSLE SUBSCRIBEup forcriptions at www your cow TTERS: To stay up subs free subscriptionsthis bulletin to to date, sign at www.cm up for free anet.org/newsletters. se forward Plea SPREAD THE WORD: WORD: Please forward SPREAD THE this bulletin to your uiremrsents itation reqcoworkeser and red acc nal ogy - colleagues.

gical pathol Aetna uire addeitio certain Aetna to reqto requir onalsuraccreditation requir perd foradditi in to betopai ticesemen be paid for certain surgic 1, 2012, prac Labora- ts in orderorder tive August al patho Clinical vices logy serthat, effec ired to be both the Colphysicians

be requ Aetna notified edited with recently notified testing will a recently fied and accr ologyphysicia Aetnforming ns that, certi effective August 1, 2012, practice ffice pathpatholo the ents (CLIA) ing in-oin-office form istent with s pert Amendm gy testing tory Improve is cons P). will be required ge be both Clinical Amendm as an Improvemenment the chanto ents (CLIA) torylege ologists (CA certified ion ofedCAP y Laboraof America andgnit rican Path a claims that accredit testn Patholo Aetn(CAP). with S) reco olog the lege ofInAme r to phy Colsicians,gists Services (CM pital anatomic path a letter to physicia icaid In a lette ns, Aetna claims -hosthe icare & Med Centersfor for nonthat change is consistentimplemenMedicar nization en& ters forMed Medicai with orga Cen the the d Services atio with (CMS) conc approved accr edit ation ernsion recognit ficaofdual oved accredit CAPcerti organization for non-hos as an appr voiced ing. pitalthe needicforpatholo ciation has anatom ngyorganiza Medical Asso d Aetna to explain accreditatio testThe CaliforniaiaMedical oved ety aske TheCaliforn appr soci has an has as a specialty voiced tationnofofthis policy and Associat e CAP concern thispolicy gnizion ion ands with reco and the CMAenficat has implem tatio may asked her, certi S Aetna A Furt tion. Althoug a CLIto explainng ices.for dual theserv ough CMmay recogniz need accredit- ation. Alth h CMS require bothe CAP y testi CAPcertifica not olog as the tion, an path approve in does CMS aS d accreditation not require to obta accredittion, CMdoes to bothffice orm in-o sicians a CLIA CAP, theorganizainin certifica accredit g tion andgatospecialty ty of phy ation n perf in-office of obta accreditatioto perform a. Accordin with the abili patholo Aetn processsociety expresse testing bygy concserns services. dessed concern ally, the Further, CMA with the imposed ition of 90 physicia days.nsAdd the deadlineability tion expr to obtaintices. CAP prior to the r todeadline closeoximately imposed tion prio ly for prac the, CM is working aby Aetna.

Aaccredit s appr tion process Accordi ess take ng to be very cost issue takes CAP, the accredit approxiatio this n can r state and tion proc 90 days. editmately Aetna on a seconda several othe ay accr nally, with Additio ry ndar the accredit and act process A) ation cont of r a seco can obtainin (AM g or costly to thei be veryAsso ciati foronpractice In addition ils. totion In addi their contact Medical Aetna on furthers.deta Tammy Gaul, seni d for ly with the America American with this issue, CMA act is working . Stay tune lette Medical ly with the nical r can cont closeAssociat societies iont (AMA) the specialty medical and several other state manet.org societies. ques tions abou specialty med 4. and e@c for further-660 with Stay tuned PracticesPrac 1 or mlan details. withtices a at (215)775 (888 questionsatabout ) 401-591 ager Aetn thet letter can contact Tammy network manage help line, at Aetna atburs Gaul, senior emen5-6604. networkr man (215)77 reim A Contact: CMAtact: CMsement Con reimbur help line, (888) 401-591 ding with pen 1 or mlane@ cmanet. issues org

When you see this icon, that means there are addition al resources available free to Californ ia Medical Association (CMA) membe rs at the, CMA means To access any of . icon that website thisresourc these see es, s availyou n http://w Whe ww.cmanet.org/ al resourcevisit Assoadditionces. ia Medical CMA website. there are to Californ able free A) members at the s, visit urce (CM reso on e ciati any of thes To access cmanet.org/ces. http://www.

In this publication, you will “medical-legal” docume find references to Medical Association’s nts. The California (CMA) online medical library contains over -legalences to 4,500 pages of medical refer legal, regulatory, and you will find - California Health reimburs lication,ement pub Managed with nts. Theion. medical-legal Medical-legal In this documeinformat artment of s, docume al”are nts l-leg A) onlinrse free to membe ider claim 2 the Dep audit and can be found “medica on’s (CM of medical- DMHC claims in HC claims rted, on Jan. 12, 201Cross to reprocess prov audit Associati online resource DM 0 pages icalCMA’s library, http://wMed information. ly repo over 4,50 As ww.cma ains hem Blue th plans net.org/ resource bursement members previously reported As previous , on Jan.) orde ry cont red Ant Nonmembers can librapurchas n largest heal threshthe y, and reim-library.

HC 12, 2012 Care (DMHC) ordered 7. Departmentaudi e medical (DM are free to of thedseve of Manage the l, regulator e 200 nts ts -legal Care to ments for $2 per Anthem doculega Health ume abov urce Blue Cross to DMHC page.ical-legal doc interest, dating backrest, dating back payments ’s online reso s provide Med r claims, inte to 2007.r is based on 2008reprocestion s of claim d in CMA rg/resource-library. with foun s. viola be d orde u-The order is based th plan s to pay The ts foun and can on 2008The ww.cmanet.o medical-legal doc se audiaudits seven heal ired the plan rate CMA Center for at all ia. DMHC in California. These Californ requ ry, http://w of hase law s, the ia seven libra fine purc Econo largest e onst forn in audits found violation miccan es Cali s of plans inistrativ health plans dem 1201 J Street, #200, members Servic old allowed under Californ ed under NonSacram sed adm paymenman page. assesclaim ts dated that perCA old allowia 1 of 5 ento, law DM for $2 95814 allHC economicservices@cman d and above the threshseven were 2012 • Page ments et.org healthowe a result, at plans.

CPR • May s As a result, DMHCAsassessed • 916/551-2061 ey they viceprovide adminis mon trative Ser the s ic fines, required the plans to ider they were owed and mandat for Economento, CA 95814 1 rs the moneyprov pay ed that plans demons CMA Center Sacram -206 trate et, #200, • 916/551 1201 J Stre ices@cmanet.org CPR • May 2012 • Page serv 1 of 5 economic

ces CMA resour

Medical-Legal Librar y (Formerly CMA On-Ca ll) al Library Medical-Leg A On-Call) CM (Formerly

Cross them Blue e Update on on two An Health Car dateAnthe naged Uptwo of Ma Cross entBlue issue tmm the Departhe Depar tment of Managed Health Cares pending with

CMA Practice Resources (CPR) is a free monthly e-mail bulletin from CMA’s Center for Economic Services. This bulletin is full of tips and tools to help physicians

DECEMBER 12TH, 2012:

MEDICARE UPDATE 2013 11:00AM TO 2:00PM Join us for our annual Medicare Update workshop for physicians and office staff. This 3 hour seminar will cover relevant information about current, future and proposed changes for the coming year. ~Michele Kelly, Associate Director, CMA’s Center for Economic Services, provides one-on-one assistance to physician members and their staff on reimbursement and practice operations issues.

Assistance ranges from coaching and education, to direct intervention with payors or regulators.

FALL 2012

and their office staff improve practice efficiency and viability.

SUBSCRIBE NOW

Sign up now for a free subscription to our e-mail bulletin, at www.cmanet.org/news/cpr

SAN JOAQUIN PHYSICIAN 27

In The News

IN THE

NEWS

Dr. Rahman Dr. Rahman Joins Millsbridge Clinic in Lodi The Lodi Memorial Community Clinic - Millsbridge welcomes family-practice physician Fareen Rahman, MD. Dr. Rahman graduated from the Fiji School of Medicine University of the South Pacific. She completed a residency program in internal medicine and pediatrics at Hurley Medical Center, Michigan State University.

She is certified by the American Board of Internal Medicine and the American Board of Pediatrics.

Dr. Rahman sees patients at the Lodi Memorial Community Clinic - Millsbridge, located at 1901 W. Kettleman Ln., Ste. 200, in Lodi. New patients and most insurances are accepted. Dr. Rahman can be reached at 334-8540.

Providing staff, physicians and patients with relevant & up to date information

hospitals, have been honored with an “A” Hospital Safety Score by The Leapfrog Group, an independent national nonprofit run by employers and other large purchasers of health benefits.

The Hospital Safety Score was calculated under the guidance of The Leapfrog Group’s Blue Ribbon Expert Panel using publicly available data on patient injuries, medical and medication errors, and infections. U.S. hospitals were assigned an A, B, C, D, or F for their safety.

“This ‘A’ score and recognition from the Leapfrog Group is very important,” said David Benn, President of Sutter Health’s Central Valley Region. “It is valuable feedback, and keeps us focused on our efforts to continually improve our processes to provide patient care in a safe, professional manner.”

“It’s The Leapfrog Group’s goal to give patients the information they need and deserve before even entering a hospital,” said Leah Binder, president and CEO of The Leapfrog Group. “We congratulate the hospitals that earned an ‘A’ and we look forward to the day when all hospitals in the U.S. will earn the highest scores for putting patient safety first.”

CMA Launches new publication on ACA Reform Launched in conjunction with the two-year anniversary of the Patient Protection and Affordable Care Act, CMA Reform Essentials is a regular publication designed to provide readers with the latest developments of California’s ongoing implementation of federal health care reform.

If there are aspects of the ACA that you would like to see discussed in later issues of Reform Essentials, please contact us at (916) 551-2552 or bjohnson@cmanet.org ials ornia Medical Association Essentbers of the Calif Reform mem newsletter for

California

ation Medical Associ

e readers with

28

SAN JOAQUIN PHYSICIAN

opments of

the latest devel

California’s

imple-

ange plans ract with exch icians cont Could phys ing? cting noted, contra without know Reform Essentials have Exchange

Benefit issues of As previous state’s Health and whether d through the physicians, with plans offere obligations for that a host of new is a decision likely brings exchange plans business with or not to do nia . many Califor taken lightly to learn that ling rk shouldn’t be unsett nge plan netwo it may be onto an excha Knowing this, their y be signed ured alread struct nce plans have physicians could that major insura due to the way opportuments. provider the provider agree opt ments give the ively agree er select or provid ct networks Many plans’ plan’s produ in. to all of the not take part nity to opt in would rather networks they can get tricky. out of those ct on the contracting will have a produ This is where whether they are being don’t know products, they Because plans will call those e all names. or what they uous nge es need to ensur ambig excha the da under reasons, practic that all t B – Blue Shield contract adden many other reviewed and – titled Exhibi identified in For this and dum eradden nia are thoroughly Comm in an d contracts networks as stood. The Califor For instance, 90 nge provider new and revise ble, are fully under intended excha signed onto tively reimbursing resources availa identifies its in Blue products being B and C, respec contract review set forward Networks A, iation also has cts. of the rates Assoc contra nt al cial PPO/EPO plan perce Medic 70 percent and es of most major percent, 80 ct. as well as analys contra al. the in manu re er Shield’s provid er, appears nowhe in the nge,” howev s what is seen reflect racts ach The word “excha exr cont ursement appro d under the d your payo r for (QHPs) offere The tiered reimb Understan ct

by CMA’s Cente health plans es conducted ions of the contra for qualified ers at Contract analys “metal tiers” to amend provis le free to memb ers s are availab with plans’ ability ease, it’s likely that provid Economic Sevice change, and relative themselves manual with .org/ces. will soon find www.cmanet and provider e the cts” clause the “all produ network, despit who opt in to nge provider excha ct. an of contra as part rks in the represented of such netwo ts, the plan emen any discussion of requir ce absen dexchange uate any new mandated amen ersation!

To later effect along as a state60 days of Join the conv to send them ans writing within would only need /cmaphysici ers object in l contract. twitter.com ans ally, unless provid of the origina /cmaphysici ment. Gener becomes part facebook.com , much less object amendment thoroughly review release, the physicians don’t es will be bound Given that many that many practic it. likely it’s know , Page 1 of 3 even ments not cmanet.org. s in 2014 and to, routine amend or bjohnson@ nge requirement 552 excha 551-2 new by the on at (916)

Questions

Two Sutter Health Hospitals in the Central Valley Awarded an “A” for Patient Safety by Hospital Safety Score Memorial Medical Center and Sutter Tracy Community Hospital, both part of the Sutter Health network of Northern California

A biweekly

to provid 2012 ation designed August 13, a regular public Essentials is . care reform CMA Reform federal health mentation of

? Contact Brett

m Essentials

about Refor

Johns

FALL 2012

Keep it personal. How would policies and laws affect you and your practice?

Keep it going! Follow legislative leaders as well as your local elected officials and mention them in your tweets to ensure they hear what CMA is working on.

Not sure who to follow? @ CASenateDems, @JerryBrownGov and @SpeakerPerez will send your messages directly to Senate Leadership, Governor Brown and Assembly Speaker Perez, respectively.

Not sure about Twitter or don’t have an account yet? Here’s the skinny:

Dr. Parra Dr. Parra Joins LMH’s Family Practice Clinic Lodi Memorial Hospital’s Primary Care Family Practice Clinic welcomes physician Jose Parra, MD. Dr. Parra attended Autonomous University of Guadalajara and completed his residency at Bella Vista Hospital in Mayagüez, Puerto Rico. He is bilingual, English and Spanish.

Dr. Parra sees patients at the Lodi Memorial Hospital Primary Care Clinic, located at 2415 W. Vine St., Ste. 105, in Lodi. New patients and most insurances are accepted. Dr. Parra can be reached at 333-3121.

Join the Conversation!

The California Medical Association is using Twitter, one of the latest social media tools, to share information and opinions with legislators and other influential policymakers.

Familiar with Twitter? Great! Follow us at @cmaphysicians and @doclobby for the latest news and action alerts.

TWITTER TIPS

Keep it informative. Report on the facts without hyperbole.

FALL 2012

Twitter is a rich source of instantly updated information. You can customize Twitter by choosing who to follow. Then you can see tweets from those folks as soon as they’re posted.

How does it work? Twitter lets you write and read messages of up to 140 characters, including all punctuation and spaces. The messages are public, and you can even send and receive Twitter messages—or tweets—from your desktop or your mobile phone.

Want in on the fun? Go to http://twitter.com, then sign up, and follow @cmaphysicians and @doclobby.

Anthony Tsappis, M.A., PH.D.

Says Thank You This communication is to inform you that as of April 30, 2012, I have retired from, and sold my Audiological Practice to Carissa La More, Au. D. I want you all to know that I thank and appreciate the medical community for the support that you have demonstrated during my past thirty-five years of practice in Stockton.

That support has been exemplified by your consistent diagnostic treatment referrals to STOCKTON HEARING & SPEECH CENTER. With Dr. Carissa La More’s purchase of my practice, I have retired with the confidence that you and the patients that you serve are in capable professional hands regarding continuing Hearing, Speech, and Language evaluation and care.

Thank you again, and Godspeed.

STOCKTON HEARING & SPEECH CENTER Carissa La More, Au.D 4623 Quail Lakes Drive Stockton, CA 95207 209-951-6491

Have questions? Contact Brooke Byrd, bbyrd@cmanet.org or Nikki Ragsac, nragsac@cmanet.org for more information.

SAN JOAQUIN PHYSICIAN 29

In The News

IN THE

NEWS Robin Clark named Director of Philanthropy for Sutter Gould Medical Foundation Sutter Gould Medical Foundation (SGMF) is pleased to announce that Robin Clark has accepted the position as Director of Philanthropy. In her new role, Clark will be responsible for developing and managing charitable support for SGMF health initiatives, as well as continuing SGMF’s long history of supporting community health organizations.

According to Paul DeChant, M.D., CEO of SGMF, “In this pivotal time in the future of health care in this country, it is more important than ever to elicit philanthropic support to ensure that we continue to serve our patients with the highest quality of care and provide valuable health education resources to our communities.

Philanthropy will play an important role in our vision for the future of SGMF.” “I am delighted to be a part of the Sutter organization and contribute to furthering its mission. I will be focused on efforts to create funding opportunities in support of new initiatives that help meet the health care needs of our communities,” said Clark.

“Additionally, I look forward to maintaining and building strong partnerships with organizations in the communities we serve.”

Prior to joining SGMF, Clark spent most of her career with the Scripps organization in La Jolla, CA, most recently as Vice President of Communications at The Scripps Research Institute.

For more information on SGMF’s philanthropic initiatives, please call Robin Clark at (209) 530-3696.

30

SAN JOAQUIN PHYSICIAN

St. Joseph’s Symposiums Offer Health Care Professionals New Perspectives In Cancer And Heart Care St. Joseph’s Medical Center is proud to feature nationally recognized and accredited medical centers of excellence. As part of its dedication to clinical excellence, St. Joseph’s will host two educational symposiums for health care professionals in February.

First, St. Joseph’s Heart Center will host its Cardiovascular Symposium on February 9 at the Stockton Golf & Country Club. The symposium, running 7:30 a.m.-3:30 p.m., will focus on new advancements, treatment options, and the latest technologies in cardiovascular care. This year’s program has been designed for physicians, nurses and other clinical practitioners involved in the diagnosis, treatment and care of individuals with cardiac disease. All attendees will receive five contact hours of continuing education credit.

Additionally, St. Joseph’s Regional Cancer Center will host its 15th Annual Cancer Care Symposium on Saturday, February 23 at O’Connor Woods in Stockton. This oneday symposium will feature leading clinical experts from across the nation presenting new perspectives and insights in cancer care.

Featured speakers include UCSF professor and melanoma specialist Dr. Adil Daud, and Board Certified Music Therapist and Clinical Psychologist Eric Walden, PhD. Six contact hours of continuing education credit for pharmacists, physicians, clinical laboratory scientists, social workers, nurses, and radiation therapists will be awarded to attendees.

For more information or to register for either of these CME opportunities, call 467-6331.

Dr. Adil Daud Health Volunteers Overseas I recently completed my third volunteer mission with Health Volunteers Overseas, (the other two were in Siem Reap, Cambodia). This was my first volunteer experience in Costa Rica. I have also done volunteer work with other organizations in Honduras, Vietnam, and Africa. On this trip I was the first pediatric orthopaedic surgeon to volunteer in Costa Rica. As with any volunteer experience, I did not know what to expect.

For those who have been on missions with Health Volunteer Overseas or with other volunteer organizations, Costa Rica was a very different experience. Costa Rica has a relatively modern health care system.

The level of care is comparable to many western countries. The pediatric orthopaedic attending surgeons with whom I worked (8 at the Hospital Nacional de Ninos( the one and only children’s hospital in Costa Rica)) do a wonderful job of providing care for their patients. They have some limitations due to

FALL 2012

lack of equipment.

I stayed at the Crowne Plaza Corobici.

The hotel was comfortable and conveniently located. Each morning I was picked up at the hotel and driven to the hospital.

The entire staff of the hospital including attending surgeons, fellows and residents as well as other staff were very welcoming and made me feel at home.

The major negative for me was my inability to speak Spanish. Most of the younger physicians, residents and fellows did speak English. Each morning there was a conference attended by all of the residents, fellows and attending surgeons. The emergency patients for the past 24 hours were presented and discussed; this was

followed by a presentation of those patients scheduled for surgery that day. Although I was always asked my thoughts, I was unable to understand the discussion and therefore this made my participation limited.

Since I was the first volunteer to work at this hospital, my role at the hospital was not well-defined. Most of the surgery that was done while I was there had been scheduled as long as two to three years in advance. The surgery was done by attending surgeons.

The only participation I had in surgery was to help the residents and fellows with emergency cases and teach them how I dealt with particular problems in the operating room.

I spent a good deal of my time in the

Health Volunteers Overseas HVO is a network of health care professionals, organizations, corporations and donors united in a common commitment to improving global health through education.

Mission Statement Health Volunteers Overseas is a private non-profit organization dedicated to improving the availability and quality of health care in developing countries through the training and education of local health care providers.

Vision HVO will be recognized as a global leader in the development and implementation of educational programs designed to empower health care providers in developing countries.

Guiding Principles HVO programs will be staffed by highly qualified health care professionals who will demonstrate the highest standards of professional and personal conduct. Sensitivity and respect for the cultural and social beliefs and practices of the host country

Peter Soloman, MD with Health Volunteers Overseas FALL 2012

should guide professional and personal behavior.

SAN JOAQUIN PHYSICIAN 31

In The News

IN THE

NEWS and to a much lesser extent, teach hands-on in the operating room.

It was my impression that Costa Rican fellows and residents are in need of didactic teaching which is lacking and this is something a volunteer can provide by both lecturing and going over cases in the Clinic. I did not have the opportunity to see much of the country and I look forward on my return to the Hospital Nacional de Ninos in San Jose Costa Rica to having more opportunity to tour the country.

Rae Charos

Ginger Manss

out-patient clinic and had the opportunity to provide input related to the patients that were seen each day. My input was always welcomed.

I gave a number of talks/lectures while I was in San Jose, Costa Rica; this was done both during the day and in the evening; some were scheduled and some were

extemporaneous. The talks were often attended by attending orthopaedic surgeons, fellows and residents and this was an opportunity to interact and teach.

I would summarize my visit by stating that I see the best role for the pediatric surgical HVO volunteer in Costa Rica is to teach in the clinics and give lectures to the residents

St. Joseph’s Administrators Appointed To Positions For Association Of California Nurse Leaders Ginger Manss, MSN, RN, AOCN, Director of Cancer Services, ICU and Oncology/ Telemetry at St. Joseph’s Medical Center has been elected the 2012 President of the Association of California Nurse Leaders (ACNL). As ACNL president, Manss will guide the organization as it strives to improve patient care delivery and advance the professional practice of nursing in California.

HAVE SOMETHING TO SHARE? We welcome submissions to our In-the-News Section from our community healthcare partners. We prefer Word files and .jpg images and may edit for space restrictions. Send your files to nikki@sjcms.org one month prior to publication (Aug 1 for the Fall issue, Nov 1 for the Winter issue, Feb 1 for our 2013 Spring issue and May 1 for our 2013 Summer issue).

32

SAN JOAQUIN PHYSICIAN

FALL 2012

Manss completed her Associate degree in nursing at New Mexico State University, then earned both Bachelor’s and Master’s degrees in nursing at CSU, Fresno. A long time ACNL member, she was recognized in 2008 with the organization’s Contributions to ACNL award. For several years, Manss was an advisor for the California Nursing Students’ Association. Her enthusiasm and commitment to the nursing profession is a source of motivation and inspiration for nursing students. Following in her mother’s footsteps, Manss’ daughter, Jennifer, is also a nurse.

Rae Charos, MSN, FNP, RN, Vice President of Nurse Services at St. Joseph’s Medical Center in Stockton, was elected to the 2012-14 Board of Directors of the Association of California Nurse Leaders (ACNL). In this position, Charos will represent central California nurse leaders on the statewide ACNL board.

Born in Stockton at St. Joseph’s, Charos earned a Bachelor’s degree in nursing at the University of San Francisco. She relocated to San Diego where she worked in cardiac care. Charos then completed her family nurse practitioner certificate at Long Beach State University, and later earned her MSN from CSU, Dominguez Hills.

Charos has served in various community efforts, including the American Diabetes Assn, the San Joaquin County Medical Society Alliance, and the Child Abuse Prevention Council, and is the Chair of the Advisory Board for the California State University, Stanislaus, School of Nursing.

Ginger Manss, Director of Cancer Services Rae Charos, Vice President of Nurse Services The Association of California Nurse Leaders is a nonprofit professional organization representing nurse leaders in hospitals, health systems, academia, research and business. For more than 30 years, ACNL has affected positive change for nursing and health care by developing nurse leaders, advancing the professional practice of nursing and improving the health of California’s communities.

FALL 2012

Dorene Tomei ST. JOSEPH’S Oncology Clinical Nurse Specialist designated CERTIFIED BREAST PATIENT NAVIGATOR

Dorene Tomei earns distinction from the National Consortium of Breast Centers STOCKTON, CA, August 28, 2012 – The National Consortium of Breast Centers (NCBC) has designated Dorene Tomei, St. Joseph’s Medical Center Oncology Clinical Nurse Specialist, a Certified Breast Patient Navigator in Imaging and Cancer. This certification program validates Tomei’s knowledge and skills in navigating a breast patient through their breast care/cancer continuum of care. This achievement is a testament to her personal and professional commitment to providing quality care for her patients at St. Joseph’s.

The National Consortium of Breast Centers promotes excellence in breast health care for the general public through a network of diverse professionals dedicated to the active exchange of ideas and resources. It serves as an informational resource and provides support services to those rendering care to people with breast diseases through educational programs, newsletters, a national directory and patient forums. It encourages professionals to concentrate and specialize in activities related to breast disease and encourages the development of programs and centers that address breast disease and promote breast health.

Private retirement and estate planning for physicians and affluent entrepreneurs STULL FINANCIAL GROUP provides: Specialized Knowledge Extensive Resources Focused Experience Customized Analysis Extraordinary Customer Care A Substantial Network of Seasoned Professionals STULL FINANCIAL GROUP 5637 N. Pershing Avenue Stockton, CA 95207 (209) 957-1673 dstull@htk.com www.stullfinancial.com

SAN JOAQUIN PHYSICIAN 33

TRAU

SAN JOAQUIN GENERAL HOSPITAL WILL IT BE OUR FIRST

By William West

CENTER? 34

SAN JOAQUIN PHYSICIAN

FALL 2012

UMA IF YOU ARE INJURED IN A VEHICLE ACCIDENT, LIKE 25 PERCENT OF

LOCAL HOSPITAL AS A LEVEL III TRAUMA CENTER EARLY NEXT YEAR. THE

TRAUMA CASES IN SAN JOAQUIN COUNTY, YOU MAY BE TRANSPORTED

NEED IS CRYSTAL CLEAR. EXPECTATIONS ARE THAT 600-PLUS TRAUMA

TO AN OUT-OF–COUNTY TRAUMA CENTER. TIME SPENT IN TRANSPORT IS A

CASES WILL OCCUR IN THE COUNTY ANNUALLY, ACCORDING TO DAN

RISK FACTOR FOR YOUR SURVIVAL AND RECOVERY.

BURCH, S.J. COUNTY EMERGENCY MEDICAL SERVICES ADMINISTRATOR.

TRAUMA VICTIMS NEED SPECIALIZED CARE WITHIN THE ‘GOLDEN HOUR’

“DESIGNATION OF A LEVEL III TRAUMA CENTER HERE IS A VERY BIG

AFTER SUFFERING THEIR INJURIES. UNFORTUNATELY, THAT IS NOT ALWAYS

DEAL FOR PATIENTS,” BURCH SAID. “THERE IS A LOT OF TRAUMA IN

THE CASE IN SAN JOAQUIN COUNTY, BUT HEALTHCARE LEADERS ARE

SAN JOAQUIN COUNTY. THOSE PATIENTS AREN’T GETTING OPTIMAL

CONFIDENT THAT THIS IS ABOUT TO CHANGE.

CARE TODAY. WE COULD LOWER MORTALITY AND MORBIDITY WITH A

SAN JOAQUIN COUNTY’S BOARD OF SUPERVISORS WILL DESIGNATE ONE

FALL 2012

DESIGNATED TRAUMA CENTER ANCHORING A TRAUMA SYSTEM.”

SAN JOAQUIN PHYSICIAN 35

SJGH > First Trauma Center?

nominal capital investment for “It will take a

SJGH to comply with Level III standards and it will result in somewhere around

$2.7 million revenue increase.” a

Steve Bestolarides, S.J. County Supervisor

36

SAN JOAQUIN PHYSICIAN

A Level III trauma center is a hospital that has expertise in the acute care of traumas and can react quickly to an incoming patient.

Trauma centers range from Level I (highest) to Level IV (lowest). The American College of Surgeons Committee on Trauma (ACSCOT) is the generally accepted authority on trauma center levels. (Specifics on Level III capabilities later in this article.)

Mr. Burch, who was an EMT and also served as a hospital corpsman in the Navy, is the principal author of the proposed trauma system plan. He was advised by Dr. Richard Buys, EMS Medical Director, and followed guidelines from the American College of Surgeons. Mr. Burch also adhered to the standards set forth by the State of California’s EMS Authority and various state regulations.

“It is the job of the EMS to blend state law and American College of Surgeons guidelines into a functional policy,” Mr. Burch said.

Under California law, counties create local EMS agencies. It is the local agency’s responsibility to design a local trauma care system, including trauma centers. Once designated, EMS is charged with reviewing a hospital’s performance according to the standards for a particular trauma center level.

Mr. Burch looked at counties with the same kind of urban and rural balance as San Joaquin County in order to discover best practices. Among others, he examined the systems in Santa Barbara County, Fresno County, and Ventura County, which, according to Burch, is the most up-to-date plan. San Joaquin County is one of the last to establish a trauma center. There were attempts to create a trauma system with a trauma center in the early 1990s and in 2004, but the efforts didn’t bear fruit.

San Joaquin General Hospital is the only hospital that has publicly indicated their goal to become a trauma center. SJGH is adding staff and gearing up to satisfy Level III designation.

San Joaquin General Hospital’s CEO, Dave Culbertson, indicated in a recent interview that he is confident about their chances for the designation. He cautions that the process is open to any local hospital and that he holds all the local hospitals in high regard. He is hopeful but not certain of the

FALL 2012

DR. HOSAHALLI PADMESH AND CEO DAVID CULBERTSON SHARE THE FALL 2012 VISION FOR THE NEW TRAUMA CENTER

SAN JOAQUIN GENERAL HOSPITAL SAN JOAQUIN PHYSICIAN 37

SJGH > First Trauma Center?

outcome of the process.

“We are very excited about the opportunity to apply to be designated a Level III trauma center,” Mr. Culbertson said. “We see this as an opportunity to shine and take care of patients who would otherwise have to leave the county.”

Some in the medical community seem a bit more confident in the outcome.

“The hope is that we finally get a trauma system in San Joaquin County,” said Joe Harrington, CEO of Lodi Memorial Hospital, “and that San

experience.”

“The designation, if obtained, will also help to improve the financial viability of the hospital. We can provide a service that no one else can do and do it cost effectively,” Mr. Culbertson said.

Mr. Culbertson’s reference to improving the financial viability of the hospital is based on an analysis of increased revenues that SJGH could generate as a trauma center. Patients who might otherwise be sent out of the county would create revenue as

“Clinically we are probably at a level III now but we don’t have policies and procedures in place.”

“We are positioned right now to provide physician services around the clock,” Mr. Culbertson said. “We will need to enhance some sub-specialties.

Add neurosurgery, interventional radiology, orthopedics, but we are going to have to do a number of those things already under our business plan to serve the community. We are training some of the nursing team to get the appropriate credentials. Dr. Padmesh’s surgical team is well-credentialed and some Designation of a emergency room doctors need a course or two.”

Dr. Hosahalli Padmesh is here is a very big deal for patients Administrator Dan Burch the Chairman of the Surgery Department at San Joaquin Joaquin General will be able to be the patients in SJGH. Trauma centers can General Hospital.

Level II trauma center for the County bill for services at a higher rate than non“We are establishing a registry and with support from the other hospitals in designated hospitals. They incur more a registrar to track and evaluate,” Dr. the county.” costs to hire staff and equipment, but Padmesh said. “We want to know what Mr. Harrington is a member of an analysis shows that revenues more than we did every step of the way. A trauma interim advisory board for SJGH. exceed the cost. center is much more introspective and it Timeline The proposed plan has been through the “We are about the public comment period and now the EMS will opportunity to apply to be designated a Level III craft a Request for Proposal that is open to .” , all local hospitals. After applications are received, CEO of San Joaquin General Hospital and the EMS agency evaluates them, the Board of Supervisors will vote to approve one “What will happen is that SJGH will is a requirement that we evaluate every hospital as the designated trauma center. get better reimbursements because the case very thoroughly, learn from what we The RFP will occur in December, government code says that all traumas aren’t doing well. That really enhances 2012, and site inspections would take must go to a trauma center,” said San the skill set and cooperation of the teams place in January, 2013.The projected Joaquin County Supervisor Steve here.” selection date is in February, 2013.

Bestolarides. “It doesn’t mean patients Other hospitals in the area have not Implementation of the trauma system won’t go to another local hospital first, indicated that they will apply for the plan is slated for July, 2013. if medically necessary, but they will be designation, but they are all aware of the “We’re getting ready, and we transported to SJGH instead of out of the benefits of a trauma system anchored by are excited and looking forward to county in some percentage of cases.” a trauma center. The benefits to patients hopefully receiving the designation,” “It will take a nominal capital are primary but there are operational Mr. Culbertson said. “We are bringing investment for SJGH to comply with benefits for the other local hospitals as resources to the table and buying Level III standards and it will result well. equipment. We are hiring a nurse in somewhere around a $2.7 million “Having an organized trauma system manager with lots of trauma center revenue increase,” Mr. Bestolarides said. can only help local hospitals by better

Level III trauma center

“

.” EMS

very excited

trauma center

38

SAN JOAQUIN PHYSICIAN

Dave Culbertson

FALL 2012

CMA Center for Economic Services

GILL OBSTETRICS & GYNECOLOGY MEDICAL GROUP, INC.

DIPLOMATS OF THE AMERICAN BOARD OF OBSTETRICS & GYNECOLOGY

75,000 HEALTHY BABIES DELIVERED Experience Matters

With 50 years of experience and roots dating back to 1953, Gill Obstetrics has a rich history of serving generations of women throughout San Joaquin County. We offer clinical expertise and compassionate care in a welcoming environment where women can feel comfortable and secure, knowing that we put our patients’ needs first.

After all… each woman's needs are unique and you deserve special care!

PRENATAL & POSTPARTUM CARE · HIGH RISK PREGNANCY · INFERTILITY · INVITRO FERTILIZATION · GYNECOLOGY ENDOMETRIOSIS · URINARY INCONTINENCE · OVARIAN CYSTIC DISORDER · LAPAROSCOPY · HYSTEROSCOPY DIAGNOSIS & TREATMENT OF CERVICAL, UTERINE & OVARIAN CANCERS

Param K. Gill, M.D.

Vincent P. Pennisi, M.D.

Jennifer Phung, M.D.

David L. Eibling M.D.

Jasbir S. Gill, M.D.

Harjit Sud, M.D.

Patricia A. Hatton, M.D

Thomas Streeter, M.D.

Kimberly McLaughlin, M.D.

Darrell R. Burns, M.D.

Tonja Harris-Stansil, M.D.

John Kim, M.D.

Meena Shankar, M.D.

R. Afiba Arthur, M.D.

Catherine Mathis, M.D.

Lynette Bird, R.N., B.S.N.

Kevin E. Rine, M.D.

Linda Bouchard, M.D.

Vicki Patterson-Lambert, R.N.P.C. Denise Morgan, M.S.N. - N.P.

Stockton: 1617 N. California St., Ste. 2-A (209) 466-8546 (Evening hours available) • 435 E. Harding Way (209) 464-4796 2509 W. March Ln., Ste. 250 (209) 957-1000

Lodi: 999 S. Fairmont Ave., Ste. 225 &230 – Ph. (209) 334-4924 • Manteca: 1234 E. North St., Ste. 102 – Ph. (209) 824-2202 visit our website at www.gillobgyn.com FALL 2012

SAN JOAQUIN PHYSICIAN 39

SJGH > First Trauma Center?

Plane crash spurred trauma care pioneer Trauma care adopted by American College of Surgeons-Committee on Trauma On February 17, 1976, orthopaedic surgeon James Styner was flying a 6-seat Beach Barron twin-engine plane from Los Angeles to Lincoln, Nebraska. In Nebraska he ran into a cloud layer and flew beneath it until after several hours he became disoriented and lost altitude. He flew into a row of trees at 168 miles per hour.

Mrs. Styner was killed instantly. Three of Dr. Styner’s children were unconscious from head injuries. Dr. Styner had fractured ribs, wounds to his head and face and a zygomatic fracture.

A fourth child had a fractured right forearm and a lacerated right hand. Dr. Styner made it to an adjacent road and flagged down help. He and his kids were taken to a local hospital a few miles away.

The hospital was closed. It took a bit of time to find personnel to open the hospital. Dr. Styner discovered that the doctors had little training in the treatment of serious trauma. He worried that they did not protect the injured children’s cervical spines.

“When I can provide better care in the field with limited resources than my children and I received at the primary facility, there is something wrong with the system and the system has to be changed,” Dr. Styner said.

He collaborated with colleagues and in 1978 in Auburn, Nebraska, the prototype Advanced Trauma Life Support course was held. The course was eventually adopted by the American College of Surgeons Committee on Trauma (ACS-COT).

40

SAN JOAQUIN PHYSICIAN

identifying the capabilities of each hospital and reducing the time from injury to definitive care,” Mr. Harrington said.

Dr. Padmesh concurs with Mr. Harrington’s assessment.

“A trauma center will take some of the strain out of their systems,” Dr. Padmesh said. “By taking patients they can’t handle and sending them to the trauma center, they will be happy ultimately.”

“It is important to add that the people of the county need this trauma center,” Dr. Padmesh said. “Studies show that 50 percent survival in a trauma system is pretty good. When you look in San Joaquin County, preventable death percentages are much higher than other counties.”

Level III Trauma Center The American College of Surgeons was established in 1913 to improve the care of surgical patients and the education of surgeons. The ACS Committee on Trauma was created in 1922 by Charles Scudder, MD, FACS. According to their resource book, “the committee focuses on improving the care of injured patients believing that trauma is a surgical disease demanding surgical leadership.”

The ACS-COT delineates the traits of the various levels of trauma centers, ranging from Level I (highest) to Level IV. San Joaquin County’s plan calls for a Level III, initially, which the ACS-COT describes as having “the capability to initially manage the majority of injured patients and have transfer agreements with a Level I or Level II trauma center for patients whose needs exceed their resources.”

Part of the draft plan by Mr. Burch is the formal negotiation of written agreements with UC Davis Medical Center in Sacramento, Kaiser Hospital in south Sacramento, Doctors Hospital in Modesto, and Memorial Hospital also located in Modesto. These hospitals are either Level I or Level II centers.

Further, Level III centers must have constant general surgical coverage. Surgeons, according to ACS-COT, must be in the emergency department on patient arrival, with adequate notification from the field.

The maximum acceptable response time is 30 minutes. In addition, ongoing education programs for nurses and doctors, and allied health workers involved with trauma are all functions of a Level III trauma center.

Injury prevention education for the community is part of being a Level III center.

A Level II trauma center has increased surgical sub-specialty expertise in orthopedics, neurosurgery, urology, ophthalmology, plastic surgery, and obstetrics, among others. It also requires surgical availability of no more than 15 minutes for on call physicians. This is half the time of Level III centers. Both levels need to have a traumatic injury registry and a registrar to record and evaluate each case. The draft plan by Mr. Burch indicates that Level II should be reached soon by the yet-to-be determined trauma center. No firm date for reaching Level II is in the plan.

The ACS-COT believes that an ideal trauma system incorporates all the essentials to provide optimal trauma care: prevention, access, acute hospital care, rehabilitation and research activities. They use the phrase “inclusive trauma system” to emphasize the need for various levels of trauma centers to cooperate in the care of injured patients and thus to leverage precious medical resources.

FALL 2012

We help you succeed. \sək-sēd\ v. to accomplish or achieve something desired.

In today’s challenging business climate it’s more important than ever to have a bank and a team of bankers you can count on to stand by you. At the Bank of Agriculture & Commerce our Relationship Management Teams are committed to helping your business succeed.

They do this by getting to know you, understanding your business and offering the right solutions.

If you’re looking for a long term partnership and not just a bank – we’re the right Bank for you.

Established 1965

A Unique Community Banking Experience

STOCKTON Claudia Cozad

claudia.cozad@bankbac.com 209-473-6834

LODI Phil Felde

phil.felde@bankbac.com 209-333-9648

STOCKTON Eddie Lira

eddie.lira@bankbac.com 209-444-3356

Internet Banking | Remote Deposit | Cash Management | Positive Pay FALL 2012

Member FDIC

www.bankbac.com

SAN JOAQUIN PHYSICIAN 41

42

SAN JOAQUIN PHYSICIAN

FALL 2012

Private Practice Strategies > Part 1

Retaining independence while embracing accountability: care coordination and integration strategies for small physician practices (Part I)

PHYSICIANS THROUGHOUT THE COUNTRY ARE TRYING TO FIGURE OUT HOW TO BEST ACHIEVE THEIR PROFESSIONAL GOALS IN THE CHANGING HEALTH CARE delivery environment. Physician payments are increasingly being structured in a way that incentivizes quality and cost effectiveness over volume, and many place physicians at financial risk. In addition, public reporting of physicians’ performance will now be the norm, rather than the exception, with Medicare’s expansion of its Physician Compare website in 2013.

Will physicians need to be employed by a hospital or a large medical group or health system in order to provide the quality and manage the costs that these payment and reporting systems require and take advantage of the emerging opportunities resulting from health system reform?

Not necessarily. While some physicians may ultimately decide that formal alignment with a large medical group or hospital system is their best option, others are actively working to integrate new care coordination and accountability capabilities into their smaller

FALL 2012

practices. Indeed, there are a number of avenues that physicians in smaller practices can take that will allow them to retain their independence while also achieving the new capabilities they will need to succeed in this new environment.

Developing new capabilities to coordinate care and improve results AMA has published a new resource to assist physicians in small and solo practice in taking advantage of the opportunities presented by the changing health care delivery environment, entitled “Retaining independence while embracing accountability: care coordination and integration strategies for small physician practices,” available at www.ama-assn.org/go/ACO. This resource identifies the core capabilities physician practices will likely need to enhance to be successful in the future and describes how small physician practices can attain these capabilities, which are summarized briefly below.

The resource also discusses options small practices may have to collaborate with other physicians and to obtain financing for practice enhancement, which will be covered in a subsequent article.

SAN JOAQUIN PHYSICIAN 43

SEPT - NOV

2012

Education Series

SEPT 5

Sept. 5: A Guide to Reviewing Payor Contracts Kris Marck • 12:15 – 1:15 p.m.

Kris Marck from CMA’s Center for Economic Resources will offer you tips to maximize success in negotiating with a high-level review on contract terms and provisions. She will identify top provisions practices should be aware of prior to signing or renewing an agreement, because a contract is so much more than just reimbursement rates.

SEPT 6

Sept. 6: California Workers’ Comp eBill Part 4: Effective eBilling Jopari Solutions & CA Division of Workers Comp • 12:15 – 1:30 p.m.

Part 4 of an extended 4-part California eBill Webinar Educational Series. Find out how your physician practice can minimize payment delays by learning to submit workers’ compensation eBills and attachments correctly the first time. This webinar is free to all attendees.

SEPT 19

OCT 3

OCT 17 NOV 7

Sept. 19: Creating and Implementing Financial and Office Policies Debra Phairas • 12:15 – 1:15 p.m.

In the medical office, office policies and procedures are handed down verbally from one staff person to another. Inevitably, important elements of policies are lost in translation. Creating written financial and office policies and procedures help staff learn their jobs faster, with greater accuracy, and relieves physician and manager frustration!

Oct. 3: Protect Your Practice From Payor Abuse Mark Lane • 12:15 – 1:15 p.m.

CMA sponsored legislation (AB 1455 - The Health Care Provider Bill of Rights) includes many protections against unfair payment practices by health plans and insurers. Mark Lane from CMA’s Center for Economic Resources will discuss important California laws that protect physicians and their practices from payor abuse.

Oct. 17: Establishing Expectations for High Performance from Medical Staff Debra Phairas • 12:15 – 1:15 p.m.

Superstar staff members are made, not born. Staff usually rise to the owner or manager’s level of expectations. This webinar will teach physicians/managers how to set high expectations for performance, create monitoring tools to evaluate and reward staff who achieve stellar performance.

Nov. 7: Understanding ARC and CARC Revenue Codes David Ginsberg • 12:15 – 1:15 p.m.

The use of remark codes and claims adjustment reason codes became standardized under HIPAA. The recent introduction of the 5010 standards further emphasizes use of these codes on remittance advices and payments made to medical offices by health insurers.

Understanding the codes can assist medical practices in more effective payment posting and follow up on denials or payment reductions.

The above webinars are being hosted by the California Medical Association. Please register at www.cmanet.org/events. Once your registration has been approved, you will be sent an email confirmation with details on how to join the webinar. Questions? Call the CMA Member Help Line at (800)786-4262.

44

SAN JOAQUIN PHYSICIAN Please note that this calendar does not include CMA’s ICD-10 training courses to be offered in 2012.

FALL 2012

Private Practice Strategies > Part 1

Three steps to improve quality There are at least three things

• Lowered the number of emergency room referrals for its patients;

that even the smallest of practices can do to improve care:

• Reduced hospital admissions for its patients;

• Standardize care through the use of accepted guidelines, policies and procedures;

• Increased the number of patients seen within 24 hours of a telephone call five-fold.

• Facilitate better coordination and interaction among all the parties involved with the care, including the patient; • Develop and analyze data to change behavior, produce better outcomes, and provide care more efficiently.

One practice’s success story For example,

in “Achieving Clinical Integration with Highly Engaged Physicians,”1 the authors point to Consultants in Medical Oncology and Hematology (CMOH), a ten-physician independent hematology practice in Delaware County outside of Philadelphia.

These physicians were dissatisfied with their inability to contract on acceptable terms with managed care plans, and therefore began collecting their own data that would demonstrate the practice’s value by measuring performance on issues such as keeping their patients out of the hospital, and producing high satisfaction scores.

They implemented an electronic health record to track their patients’ utilization of services and provided standardized approaches to care. With collaboration among its clinical support teams, the practice adhered to evidence-based guidelines, provided enhanced patient access to care through same day/next day visits, and educated patients to improve medication, evaluation, and treatment compliance, etc. According to the study, the results of these efforts were impressive, as the practice: • Increased its financial margin by lowering its full-time employee staffing requirements by 10%;

FALL 2012

• By 2010, the group’s clinical integration program resulted in it receiving the first oncology patient-centered medical home designation by the National Committee for Quality Assurance. (Id. at 10-11.)

Tools for small practices Tools are available for

physicians to help them make changes to their practices and manage patient referrals and transitions necessary to support coordinated care. For example, the Institute for Healthcare Innovation, funded by the Commonwealth Fund, has provided a toolkit entitled “Reducing Care Fragmentation” that introduces four key concepts for enabling change, and offers activities, model documents, and other tools to support their implementation. This toolkit is available at www. improvingchroniccare.org.

Similarly, there are a number of tools that small physician practices can use to aggregate and evaluate their data efficiently:

FLOW SHEETS. The American Medical Association-convened Physician Consortium for Performance Improvement (PCPI) has developed prospective data collection flow sheets for a number of clinical conditions that incorporate evidence-based performance measures. See

www.ama-assn.org/ama/pub/physicianresources/clinical-practice-improvement/ clinical-quality.page. These prospective data sheets can serve as a reminder checklist to ensure that all care team members know what needs to be done when the patient is in the office.

REGISTRIES. The ability to generate and use registries, that is, lists of patients with specific conditions, medications, or test results, is also considered a proxy for high quality health care.2 Such registries help office staff identify patients who are overdue for recommended services and facilitate contacting them and arranging for office visits, lab monitoring, referrals and other needed care. Some registries can even be developed using free software. The AMA has provided guidance on patient registries, including information on how to create them. See “Optimizing Outcomes and Pay for Performance: Can Patient

Registries Help?” a copy of which can be found at www.ama-assn.org/ama1/x-ama/ upload/mm/368/pt_registries_102005. pdf. In addition, the California Health Care Foundation’s resource “Chronic Disease Registries: A Product Review,” available at www.chcf.org may also be helpful.

ELECTRONIC HEALTH RECORDS. Electronic health records (EHR) can also assist with care coordination. Physicians in smaller practices may be particularly interested in investigating some of the newer, cheaper cloud-based EHR systems.

SAN JOAQUIN PHYSICIAN 45

Private Practice Strategies > Part 1

care services. For example, in 2000, “U.S. patients were much more likely—three or four times the benchmark rate—than patients in other countries to report having had duplicate tests or that medical records or test results were not available at the time of their appointment.”4

attention, and (3) better branding opportunities.

Increased financial benefits. The National

“CLOUD COMPUTING” refers to a Priority Partnership, convened by number of technology solutions that: (1) the National Quality Forum, has operate over the Internet; (2) use shared identified four activities which require resources such as storage, processing, physician involvement that reduce costs memory and network bandwidth with (and more patients). Private third-party substantially and improve quality. The other users; and (3) are “on-demand,” payers have ranked physicians for years. opportunity for estimated savings can be meaning capabilities such as network And now, Medicare has gone into the summarized as follows: storage can be adjusted virtually, “quality reporting” business by launching See www.nationalprioritiespartnership.org. eliminating the need for on-site IT staff. a Medicare Physician Compare site which, For more information on health information technology, including the Medicare/Medicaid EHR OPPORTUNITY SAVINGS incentive programs, go to the AMA’s website at Preventing hospital readmissions . . . . . . . . . . . $25 billion www.ama-assn.org/go/ HIT.

Improved “profiles”

Improving patient medication adherence . . . . . $100 billion Reducing emergency department overuse . . . . . $38 billion Preventing medication errors. . . . . . . . . . . . . . . $21 billion

CLAIMS DATA. Another potentially valuable source of information is claims data.

AMA has published a toolkit to help physicians use these data for practice improvement activities, whether they are received from health insurers associated with their physician profiling reports or directly from a physician’s practice management system or clearinghouse.

This helpful resource, “Taking Charge of your Data,” is available at www.ama-assn. org/go/physiciandata.

Potential benefits

Finally, this resource outlines the benefits which accrue from engaging in quality measurement programs and using practice data to monitor, report, and improve:

Increased quality.

Measurement drives behavior.3 Measurement can result in both improved outcomes for patients and lower health care costs generally due to the avoidance of duplicative and/or unnecessary health

46

SAN JOAQUIN PHYSICIAN

starting in 2013, will include Physician Quality Reporting System (PQRS) results based first on the 2012 reporting year.5 Increasingly, anyone who has access to a website can find out information about his or her physician, and how that physician “compares” to other physicians.

While many physicians have been concerned about such public ranking, physicians who are acknowledged as recognized providers in these programs have gotten more patients to treat than non-recognized physicians and often get the opportunity to participate in more networks.6 Consequently, despite their drawbacks, performance measures can mean that those who score well will be in a better position to obtain: (1) higher payment; (2) increased consumer

Thus, not only is performance measurement likely to improve patient care, it may also serve as a foundation for financial incentive and reward programs in value-based purchasing strategies. In California alone, since 2004 approximately $400 million dollars have been distributed to physicians by certain health plans participating in a pay for performance initiative.7 See Results of Integrated Healthcare Association Pay for Performance Program, at www.iha.org.

In the end, physician practices that enhance their competency with respect to the three core areas outlined above, (1) standardization, (2) care coordination, and (3) data evaluation, will likely perform better, both clinically and financially.

FALL 2012

Third Annual

Golf Tournament Join fellow San Joaquin Medical Society members and friends at

The Reserve at Spanos Park on Saturday, September 29th, 2012

for a relaxing round of golf, lunch and an opportunity to benefit our local First Tee of San Joaquin program.

Drs. Kwabena Adubofour and George Khoury will be your host for this fun event and all golfers of every level are invited to play. To enhance our interactions with our community each physician is mandated to bring a non-physician partner to the game. The day begins with Registration at 12:00PM and Shotgun start at 1:00PM. Multiple prizes awarded for Longest Drive, Closest-to-the-Hole, Lowest Score and many others!

Cost is only $120 per golfer (includes Green Fees, Golf Cart, Lunch , Hors d’oeuvres & Drinks) $50 of every entry fee goes to The First Tee of San Joaquin program.

To sign up, please call the San Joaquin Medical Society office at 952-5299.

FALL 2012

Sometimes You Just Need a Little Help.

SAN JOAQUIN PHYSICIAN 47

2012 Lifetime Achievement Award

Access AMA resources online “Retaining independence while embracing accountability: care coordination and integration strategies for small physician practices,” is available as part of the AMA resource, ACOs, CO-OPs and other options: A how-to manual for

48

SAN JOAQUIN PHYSICIAN

physician’s navigating a post-health reform world, at www.ama-assn.org/go/ACO. Stay up to date with all of the new resources from the AMA, by signing up to receive the free AMA Practice Management Alerts emails at www.ama-assn.org/go/pmalerts.

The AMA Private Sector Advocacy Unit created “A Physician’s Guide to Evaluating

Incentive Plans” that physicians can use to evaluate such plans for their financial and patient care implications http://www. ama-assn.org/resources/doc/psa/x-ama/ pfp_brochure.pdf.

(1) See Alice G. Gosfield, JD, and James L. Reinertsen, MD, “Achieving Clinical Integration with Highly Engaged Physicians,” a copy of which can be found at http:// www.wsma.org/files/Downloads/ PracticeResourceCenter/Achieving_ Clinical_Integration_GR.pdf.

(2) See Fleurant, et al., “Massachusetts e-Health Project Increased Physicians’ Ability to Use Registries, and Signals Progress Towards Better Care,” Health Affairs, July 2011, 30:7.

(3) Asch, McGlynn, et al., “Comparison of Quality of Care in the Veterans’ Health Administration and Patients in a National Sample,” Ann.of Int.Med. Vol. 141, No. 12, December 21, 2004, pp. 938-345.

(4) The Commonwealth Fund Commission on a High Performance Health System, Why Not the Best? Results from the National Scorecard on U.S. Health System Performance, 2008, The Commonwealth Fund, July 2008. http://www. commonwealthfund.org/Publications/FundReports/2008/Jul/Why-Not-the-Best-Results-from-the-National-Scorecard-on-US--Health-System-Performance--2008.aspx.

(5) See 42 U.S.C. §280j-2. Further, although the PQRS was once voluntary, if eligible professionals do not satisfactorily submit data on quality measures for covered professional services for the quality reporting year beginning in 2015, the Medicare Fee Schedule amount for such services will be reduced. (42 U.S.C. §1395w-4.)

(6) See Berry, Emily, “Narrow Networks: Will You Be In or Out?” AMedNews, Oct. 4, 2010.

FALL 2012

The

REMEDY for all your

Financial

NEEDS

As a member of the San Joaquin Medical Association, you’re privy to an exclusive benefit—Financial Center Credit Union membership for you and your staff !

In a time when the safety and soundness of funds is at the forefront of everyone’s minds, Financial Center membership is the perfect prescription for peace-of-mind. Voted Best Of San Joaquin, Financial Center is the most trusted credit union in the Valley. Time and time again, we offer our members the lowest rates on their loans as well as the safest place to save their money.

Follow the doctor’s orders and call us today. And don’t forget to pass this message onto your staff – they (and their wallets!) will thank you.

209-948-6024

•

www.fccuburt.org Federally insured by the NCUA.

FALL 2012

SAN JOAQUIN PHYSICIAN 49

We have something in common...

...your patients are our residents.

ON THORNTON

Independent, Assisted Living and Memory Care Communities

A Premiera Care Community Valley Owned and Managed

Stockton 209-476-1500

RCFE License # 397002881

A state-of-the-art housing and health care alternative combining independence AT UNION RANCH with personal care in a warm, dignified Manteca community setting.

209-463-9100 RCFE License # 397004045 *Chef Prepared Meals Daily *Laundry/Linen Services Visit the community of your choice at *Barber/Beauty Services www.premieracare.com *Transportation DALE COMMONS *Activities Programs Modesto *Library 209-526-2053 *Medication Supervision RCFE License # 507001611 *Security/Emergency Systems AT DALLAS RANCH AT ELK GROVE *Hydrotherapy Bath Antioch Elk Grove *Pets Welcome 925-754-7772 916-683-6833 *Special Personal Care Services RCFE License # 075601279 RCFE License # 347004302 Provided as Needed *Spa Services Where Quality Of Life Matters Every Day!

S E RV I N G C E N T R A L VA L L E Y FA M I L I E S S I N C E 1996

50

SAN JOAQUIN PHYSICIAN

I

CONN EC

MMUNITY CO

Serving San Joaquin, Stanislaus and Merced Counties

15

R

Nearly 125,000 members in San Joaquin, Stanislaus and Merced Counties experience improved access to health care through Health Plan of San Joaquin.

WITH O U NG TI

1-888-936-PLAN hpsj.com

FALL 2012

MIEC Belongs to Our Policyholders!

Lamont D. Paxton, MD Vice Chairman of the Board of Governors

And So Does its Profit — $30,000,000 Dividend Declared in 2011

Consistently Lower Rates + Higher Dividends.

Ask an MIEC Insured!

Lower rates for CaLifornia in 2012

For more information or to apply contact: n n n

www.miec.com

Call 800.227.4527

Email questions to underwriting@miec.com

* (On premiums at $1/3 million limits. Future dividends cannot be guaranteed.)

MIEC 6250 Claremont Avenue, Oakland, California 94618 • 800-227-4527 • www.miec.com SJMS_06.28.12 FALL 2012

MIEC Owned by policyholders SANthe JOAQUIN PHYSICIAN we 51 protect.

2012 Lifetime Achievement Award

52

SAN JOAQUIN PHYSICIAN

FALL 2012

Dameron Hospital > 100 Years

CELEBRATES 100 YEARS OF COMMUNITY SERVICE In 1912, a physician named Dr. John Dameron, with the help of a few local businessmen, established Dameron Hospital.

The endeavor was to offer an independent alternative to local health care even back in their time.

Dameron Hospital nurses with the Hospital’s ambulance in the early 1930’s

This photo from the late 1920’s shows when Dameron Hospital’s main entrance was on Lincoln Street

FALL 2012

Dameron Hospital remains in the same location where it was originally founded in Central Stockton. From a humble beginning, Dameron Hospital has grown to become a 202 bed full service community owned medical facility. Over the years Dameron Hospital has continued an aggressive path to rebuild and upgrade medical services from the inside out. During the past 10 years, almost every area of the Hospital has seen renovation and modernization. While government and corporate involvement in medical care is common these days, it’s comforting to know that Dameron Hospital has always remained community owned, solely dedicated to medically serving this community. Through independence, Dameron Hospital can assure physicians, patients, nurses and clinical staff that excellence in patient care and patient services will never be compromised by an out of town corporate entity or directive.

Founding physician Dr. Dameron was succeeded by Dr. Herbert Chapman who transferred Dameron Hospital to non-profit status in 1942. Succeeding Dr. Chapman in 1957, Dr. Luis Arismendi assumed leadership and then transferred the position to his son, Dr. Christopher Arismendi in 2000. Through the years the Hospital’s community minded mission, vision and values have always been maintained. The Hospital’s strong community values are something the Hospital wishes to carry over to future generations of local residents. Dameron Hospital is proud of its place within this community and is dedicated to continue serving the medical needs of a growing San Joaquin County for another 100 years.

Dr. Dameron would be pleased to see that the hospital he founded in 1912 would grow to become Stockton’s third largest private employer and a vital community asset serving thousands of residents each year. Over the next few months, the public is invited to join Dameron Hospital in celebrating its centennial through local events and recreational activities. Dameron is proud of its past and dedicated to provide independent medical services to this community for the next 100 years.

SAN JOAQUIN PHYSICIAN 53

Decision Medicine > 2012

2012

DECISION MEDICINE 28 Students Receive a Glimpse of a Life in Medicine

A

STORY AND PHOTOS BY VANESSA ARMENDARIZ

CCORDING TO THE 2006 CENTRAL VALLEY HEALTH POLICY INSTITUTE REPORT, there are only 87 primary care physicians and 43 specialists per 100,000 people that serve in the San Joaquin Valley. The valley is disproportionately affected by the shortage of physician’s and one way to change that is to inspire our youth. In 2001, what had only been a dream to Dr. Kwabena Adubofour finally became a reality. With the financial support of Kaiser Permanente and the Health Plan of San Joaquin, the Decision Medicine Program was initiated. Although the program has changed drastically over the past 11 years, one thing has remained constant; the goal. The goal of the program is to expose high-achieving high school students to the world of medicine in hopes that they come back and serve in the Valley. The communities within the Valley are extremely diverse and by having home-grown physicians come back to serve them, we could foster a better relationship between the community and physicians. Patients put their trust in physicians and if they are able to relate with them in being raised in the same community, the doctorpatient relationship could flourish.

In its inception, the Decision Medicine Program only consisted of 6 students from one local high school. It then grew to 12 students representing high schools throughout Stockton. For the past few years, 24

54

SAN JOAQUIN PHYSICIAN

FALL 2012

FALL 2012

SAN JOAQUIN PHYSICIAN 55

Decision Medicine > 2012

California Medical Association Political Action Committee CALPAC needs your help to support candidates and legislators who understand and embrace medicine’s agenda.

Fighting for you!

Our top priorities are: 1. Protect MICRA 2. Preserve the ban on the corporate practice of medicine 3. Provide solutions to our physician shortage crisis!

Please visit www.calpac.org for more information

56

SAN JOAQUIN PHYSICIAN

FALL 2012

students from high schools throughout the San Joaquin County have been accepted.

At 24 students, we thought we had reached capacity. As with every year, the application pool grows larger and stronger. With over 100 applications, only 45 applicants are granted an interview and only 24 are selected. This year, however, the applications were so impressive that we increased the size of the program to accommodate for 28 students, the largest group thus far. The students represented 13 different high schools and 5 different cities.

Some of the students have parents who are physicians or in the medical field, which is where they get their motivation from. Some of the other students get the drive to pursue medicine because they will be the first in their family to go to college. Although the students were of different ethnicities, backgrounds, and socioeconomic status, they all became one team.

Although the program is only two weeks long, the students are exposed to a wide range of fields within the medical profession. The students began their first day of the program at the San Joaquin County Office of Education’s

FALL 2012

Ropes Course. The students were challenged both mentally and physically as they got to know each other. Coming in, the students were unfamiliar with one another and the only thing that they knew they had in common was having the same goal of yearning to become a physician.

As the day progressed, the students found themselves in situations that forced them to work together as a team. Many of the students expressed their fear of heights, but none of them let the fear overcome them.

With the moral support of the group, all of the students successfully climbed and jumped from a 50-foot pole in the trapeze jump. When asked how the ropes course was relevant to medicine, Yanxin Madrid, a student in this year’s program, said, “Today’s activities have represented exactly what my journey to become a physician will require- creative thinking, problem solving skills, and determination.”

The second day of the program was held at St. Joseph’s Medical Center where the students toured the Emergency Department, Cardiac Catheter Lab, Surgical Suite, the Maternity/Neonatal Intensive Care Unit, Cancer Care Center, and attended a presentation on infection prevention. While in the surgical suite, the students were thrilled to go through a mock surgery, where they wore “bunny suits” complete with the head and foot gear, scrubbed in and had gloves and a coat placed on them by the nurse, and interacted with the simulation dummy. A highlight of the day was when the students were greeted at lunch by Dr. Susan McDonald, Dr. Richard Waters, and Dr. Prasad Dighe. They all talked about their individual paths to a career in medicine, showing the students that there are many routes you can take to reach the same goal.

Day three of the program was spent

decision medicine What is It? DECISION Medicine is a 2 week program designed to introduce students to the field of medicine through personal mentoring opportunities and site visits with behind-the-scenes access to some of our regional hospitals, clinics and public health centers.

Participants will be challenged with real world decisions as they explore the many facets of a career as a physician. The program is limited to a small group of 24 participants each year for maximum impact.

Throughout the program you will work in various team configurations, including a one-on-one mentoring opportunity with a local physician in their personal practice.

Additionally, you’ll visit several local hospitals and surgery centers, the famous UC Davis Medical School in Sacramento, the new Kaiser Permanente Hospital in Modesto, and several specialized hospitals in San Francisco to meet and interact with physicians conducting fascinating research in the areas of organ transplantation, brain surgery and other cuttingedge facets of medicine.

at the San Joaquin County’s General Hospital.

The students were greeted in the morning

by Dr. Jerry Royer and soon after, they were

SAN JOAQUIN PHYSICIAN 57

Decision Medicine > 2012

separated into groups to go on rounds with the medical teams in the Internal Medicine and Family Medicine wards. Jazzmin Williams commented, “I felt like I was watching the early seasons of Grey’s Anatomy live: there was the attending, the reporting resident, the interns, and the medical students.” The students were then inspired by Dr.Mohsen Saadat during lunch and there was a question and answer session between the students and residents. After lunch, the students were able to tour the neonatal intensive care unit, the emergency room, and the diagnostic imaging department. The students were given the opportunity to answer incoming ambulance calls in the ER, see a 1.14 ounce premature baby in the NICU, and analyze a variety of fascinating X-Rays and CT scans that have been witnessed over many years from Radiology technician Rick Halligan.

On the fourth day of the program, the students gave back to their community by volunteering at St. Mary’s Dining Hall. The students helped by sorting shoes for the annual shoe drive, prepared napkins and utensils, organized clothes in the warehouse, and helped serve drinks. Not only did they volunteer their time, they also personally donated shoes, socks, toiletries, and money. The students were truly humbled by the experience, as Anthony Phan claims, “these homeless people are in fact a part of our community. Not all of us are fortunate and it’s important to remember that some people need help and it’s even more important that we help those people.” After lunch the students were excited to be trained for CPR certification. They were challenged by having to respond to different medical emergencies as if a person were choking, had fainted, or stopped breathing.

Day five began at UC Davis School of Medicine. The students

engaged in medical role-play where they were able to re-enact a routine checkup in a prepared exam room. They learned how to take a patient’s history and basic vital signs. The students then had lunch with seven medical students who talked about their individual journeys to medical school. They also provided the students with great advice about college and medical school. After lunch, the students went to Shriner’s Hospital and received a tour of the facility. They were able to see the orthotics and prosthetics lab, which specializes in making personalized prosthetic limbs and burn suits. The students were then able to engage in medical play with some of the patients, making dolls, putting on finger casts, drawing, and having fun. Jaslyn Valenicia commented, “I can only imagine what these young kids have been through and to see them all play and momentarily forget about whatever problems they may have was amazing.”

Day six of the program was spent at Dameron Hospital, where the

students started the day by getting their blood drawn. They learned about “Basic Hematology” from Mark Koenig in preparation for the students typing their own blood, making a blood smear, and analyzing their smear under a microscope. Before lunch, the students were engrossed in a presentation by forensic pathologist, Dr. Robert Lawrence. The students worked together to analyze and solve real-life crime scene investigations. After lunch, the students toured the Pathology department, Core Laboratory, and Health Information

58

SAN JOAQUIN PHYSICIAN

FALL 2012

SAVE THE DATE! SAN JOAQUIN MEDICAL SOCIETY presents

The 12th Annual Stockton Diabetes Seminar

FOSTERING EXCELLENCE IN THE PRIMARY CARE OF

Diabetes Saturday

November 3, 2012 9:00 am to 2:00 pm

UNIVERSITY PLAZA WATERFRONT HOTEL 110 West Fremont Street • Stockton

REGISTRATION IS REQUIRED

Please call the San Joaquin Medical Society at 209.952.5299 or register online at www.SJCMS.org

This NO FEE SEMINAR for licensed professionals includes: •

Free continental breakfast and lunch

•

Networking opportunities with healthcare providers engaged in innovative diabetes care

•

Updates on recent and important advances in diabetes care

In lieu of a conference fee, we kindly ask that you donate at least one new book for a child up to 5 years of age. Stockton ranks last in a study of literacy in the nation’s largest 70 cities showing that there is a growing need for literacy resources. Your book will be donated to Reach Out and Read San Joaquin®.

Reach Out and Read San Joaquin® makes literacy promotion a standard part of pediatric primary care, so that children grow up with books and a love of reading. Reach Out and Read San Joaquin® trains doctors and nurses to advise parents about the importance of reading aloud and provides physicians with books to give to children at pediatric checkups.

By building on the unique relationship between parents and medical providers, Reach Out and Read® helps families and communities encourage early literacy skills so children enter school prepared for success in reading.

KEYNOTE SPEAKER Anne Peters, MD

Director, USC Clinical Diabetes Program Professor, Keck School of Medicine of USC

FALL 2012

SAN JOAQUIN PHYSICIAN 59

Decision Medicine > 2012

St. Teresa Comprehensive Cancer Center ...every life is a gift

Technology. They were also able to interact with paramedics on their ambulance and some of them had the opportunity to have an EKG ran on them.

The seventh day of the program was

spent at the University of the Pacific. The students went on a tour of the campus, visited the Pacific Fatigue Laboratory, and heard from the Vice President of Student Life, Dr.Elizabeth Griego and the Provost, Dr.Maria Pallavicini. As a fun activity for the students, Joni Bauer from the Community Center for the Blind and Visually Impaired demonstrated to the students how to orient themselves and become mobile when visually impaired. The students learned how to be a guide to the blind and were then blindfolded and asked to walk around with their partner guide as if they were blind. Parnoor Khinda commented, “I found this experience to be very enlightening because it was something that I had not experienced before and I did not realize that being blind can be detrimental, but it can be resuscitated through various types of activities that the Community Center has to offer.” The students ended their day by being trained and First-Aid certified.

On the eight day of the program, the At St. Teresa Comprehensive Cancer Center, we believe that in order to treat the disease, you must begin by caring for the entire patient. As a result, our staff is equipped to offer many services designed to care for the patient and their friends and family.

Our compassionate team provides customized and highly specialized patient-centered care.

students were able to spend the day with a mentor physician. The students enjoy this day because they are able to spend one-on-one time with the doctors and witness first-hand the doctor-patient interaction.

Natalie Pearlman shadowed Dr. George Khoury and said, “The most fascinating thing about Dr. Khoury, to me, was his outlook on life. He told us that in order to be a great doctor or a great anything, you need to enrich your entire mind. You need to spend your life studying math, science, history, art, everything in order to use your mind to its full capability. He had so many interesting outlooks on life about giving back to your community and living a happy life. He really gave me a lot to think about!”

The ninth day of the program was spent Dr. Vitune Vongtama

Dr. Dan Vongtama

St. Teresa Comprehensive Cancer Center 4722 Quail Lakes Dr., Suite B Stockton, CA 95207 Phone: (209) 472-1848

www.stteresascancercenter.com

60

SAN JOAQUIN PHYSICIAN

at the Kaiser Permanente Hospital in Modesto. The students toured t­­ he Emergency Department, learned about infection control, practiced patient safety measures such as the lifts that transport patients, and they witnessed a simulated baby delivery. The students were thrilled to have the opportunity of watching the state of the art simulation dummy that was able to talk, move, and give birth. In the simulation, the delivery team was challenged on multiple occasions, showing the students the importance of team work

FALL 2012

Combined with advanced medical and a quick response emergency staff, the San Joaquin County Emergency Medical Services Agency has named Dameron Hospital as a designated STEMI (heart attack) receiving center in San Joaquin County.

A STEMI or (ST segment elevation myocardial infarction) is a common type of heart attack caused by a blocked coronary artery that can be treated through cardiac catheterization or clot busting drugs to restore blood flow to the heart. The longer it takes for a patient to get treatment generally the worse the outcome. Because of Dameron’s LifeLine Technology and its cardiac prepared ER staff, emergency response teams will automatically take patients suffering a STEMI to Dameron Hospital.

Dameron Hospital cardiac education and preparedness results in better lives for the residents of San Joaquin County.

Pictured Above: AMR Cardiac Response Team Members;Greg Garcia - EMT, FTO and Brent Tindle - Paramedic, FTO

FALL 2012

SAN JOAQUIN PHYSICIAN 61

Decision Medicine > 2012

and communication. After lunch, many different health professionals, including physicians, nurses, pharmacists, and the President and Area Manager of the hospital, spoke to the students about their career paths. This was an enlightening experience for the students.

On the final day of the program, the students traveled to San Francisco’s California Pacific Medical Center. The students learned about limb reattachment from Dr.Bunke, leech therapy, and current advancements in heart and vascular catheterization. The

A Professional Law Corporation

MICHAEL R. MORDAUNT PETER J. KELLY CORINNE K. REYNOLDS STEPHANIE ROUNDY LORI A. REIHL

Our firm devotes its practice to civil litigation with decades of experience representing healthcare professionals in: • MEDICAL MALPRACTICE ACTIONS • MEDICAL BOARD INVESTIGATIONS • HOSPITAL CREDENTIALING PROCEEDINGS • PERSONAL INJURY LITIGATION

2509 West March Lane, Suite 200 Stockton, California 95207 Phone (209) 473-8732 Fax (209) 957-9165

62

SAN JOAQUIN PHYSICIAN

students also had the opportunity to use a robot that allows surgeons to operate on a patient while not actually having to be near the patient or handling any medical instruments. At the Medtronic Center, the students were able to dissect pig hearts under the instruction of Dr. Steven Hao and they also learned how to insert catheters from the leg to the heart. They ended their day at Pier 39, where they were treated to a thrilling boat ride and dinner at Bubba Gump’s.

Through the duration of the program, there was a common theme that was reiterated by multiple healthcare professionals.

Many of the professionals that the students interacted with stressed the importance of coming back to serve in the Valley. Since the physicians, nurses, and medical students work here in the local hospitals, they witness the growing need for physician’s first-hand.

Many of the students in the program admitted that they had no idea about the physician shortage and now that they know about it, they feel an obligation to come back here to the Valley to make a difference. With the growing violence and economic downturn in Stockton, the youth need something to keep them focused and to show them that despite challenges, they can accomplish anything if they put their minds to it. All of our sponsors, partners, and physicians invest quality time into the program and they truly make a lasting impression on these students. All it takes is one person to tell a student that they believe in them and this program offers more than just that.

FALL 2012

We Celebrate Excellence – Corey S. Maas, MD, FACS CAP member and founder of “Books for Botox®” community outreach program, benefitting the libraries of underfunded public schools

800-252-7706 www.CAPphysicians.com

San Diego orange LoS angeLeS PaLo aLTo SacramenTo

For over 30 years, the Cooperative of American Physicians, Inc. (CAP) has provided California’s finest physicians, like San Francisco facial plastic surgeon Corey Maas, MD, with superior medical professional liability protection through its Mutual Protection Trust (MPT).

Physician owned and physician governed, CAP rewards excellence with remarkably low rates on medical professional liability coverage – up to 40 percent less than our competitors.

CAP members also enjoy a number of other valuable benefits, including comprehensive risk management programs, best-in-class legal defense, and a 24-hour CAP Cares physician hotline. And MPT is the nation’s only physician-owned medical professional liability provider rated A+ (Superior) by A.M. Best.

We invite you to join the more than 11,000 preferred California physicians already enjoying the benefits of CAP membership.

Superior Physicians. Superior Protection.

FALL 2012

SAN JOAQUIN PHYSICIAN 63

San Joaquin Medical Society’s website …get the resources & help

64

SAN JOAQUIN PHYSICIAN

FALL 2012

just got an upgrade‌ you need at SJCMS.org.

The all new website offers a

SJCMS.org provides a member physician finder. Search by name, specialty, zip code, and more.

member only physician finder, member resources, association programs, up-to-date CMA news, upcoming events, patient resources and more. Make sure to stop by and take a look around.

Physician finder results provide you with info such as contact info, mapped locations, and even photos.

www.sjcms.org

Get info on all of your SJCMS member benefits plus your CMA benefits at SJCMS.org.

Physician Magazine and archived issues are available online with the SJCMS.org bookshelf.

FALL 2012

SAN JOAQUIN PHYSICIAN 65

eMR implementation can be hard.

let us make it easy.

CROWN ENTERPRISES IS A LOCAL FULL SERVICE INFORMATION TECHNOLOGY COMPANY SPECIALIZING IN PROVIDING MEDICAL PRACTICES:

• Certified EMR/PM software selection • Reaching Meaningful Use for Federal Stimulus Money Funding • Hardware Installation and Repair • Business Continuity & Disaster Recovery • HIPPA/HiTech Regulatory Compliance • Network and Systems Security • Local Affordable Flat Fee IT Support

We guide our clients through every critical step and our process ensures improved operational efficiencies, quality of care, and increased practice profits.

Call us today for a complimentary consultation at (209) 390-4670

In Memoriam

In Memoriam John Fisk Sheldon, MD • Walter E. Reiss, MD

JOHN FISK SHELDON, MD April 10, 1916 - May 16, 2012

Returning to Stockton, Dr. Sheldon established a medical practice in 1956 which spanned 53 years.

FALL 2012

John F. Sheldon, MD, peacefully passed away on May 16, 2012 in Stockton at the age of 96. Born in Vermillion, Kansas, John was raised mainly in Stockton and Fresno, CA. He graduated from the University of Southern California School of Medicine, Class of 1943. Upon his graduation, he served his country in the US Navy during WWII attached to the 4th Marine Division of the Pacific Fleet. After seeing action in Saipan and Okinawa, he was honorably discharged in 1946 with the rank of Lt (MC). He married Marielta Huron in 1946, enjoying 39 years together until she passed away in 1985. With Marielta, he served the Board of Foreign Missions of the Methodist Church as a missionary. While serving at the Nyadiri Mission in Zimbabwe for 5 years, he established the precursor of the Washburn Memorial Hospital.

Returning to Stockton, Dr. Sheldon established a medical practice in 1956 which spanned 53 years. He was a member of many professional organizations including: San Joaquin Medical Society, California Medical Society, American Medical Association, American Society of Clinical Hypnosis, American Academy of Family Practice, Institute of Logo Therapy and was a life-long member of Central United Methodist Church of Stockton. Throughout his life he supported missionaries around the world.

Dr. Sheldon is survived by his sister Inez Sheldon Holt, his children: Frank Huron Sheldon of Stockton, and Joan Sheldon Wong of Danville, grandchildren: John Frank Sheldon, Steven Andrew Wong and Michelle Christine Wong. Longtime Lodi physician.

SAN JOAQUIN PHYSICIAN 67

In Memoriam

WALTER E. REISS, MD November 27, 1933 -

Dr. Reiss is survived by his wife, Carol, to whom he was married for 55 years.

68

SAN JOAQUIN PHYSICIAN

June 24, 2012 Walter E. Reiss, 78, passed away this past June. He was a muchloved family doctor and a true character. He loved his family, his patients, his friends, his music, his work, his flying, golf and University of Nebraska football. Dr. Reiss loved life.

Dr. Reiss had been a family physician in Lodi since 1962 and delivered hundreds of Lodi’s babies. He also provided flight physicals to pilots.

But perhaps his most significant medical legacy was providing medical care to the homeless in Lodi. He couldn’t stand that among them were many veterans who had been cast aside after losing their footing in this world. He went so far as to cajole the Salvation Army into giving him a room in their old headquarters on Sacramento Street in order to provide care to the homeless. He was a doctor to

whom you couldn’t say “no.” He lassoed area physicians to assist him in his noble cause. Many of their patients had alcohol and serious medical problems that had long been unattended. Dr. Reiss did all this because he knew he could, and he knew it was the right thing to do.

When the Salvation Army moved their headquarters to Lockeford Street, Dr. Reiss roped the hospital in and had LMH build, fund and staff a medical clinic for the indigent in the Salvation Army space. And when, after a decade, patients and doctors outgrew that space and moved to a vacant corner of the San Joaquin County Public Health Clinic on Oak Street in Lodi, LMH was thrilled to be able to name the clinic the LMH Walter E. Reiss Outreach Clinic (WE-ROC) in his honor. He was most deserving and continued to work there along with his volunteer physician colleagues and LMH staff. Never was, or is, a homeless or uninsured patient charged for care.

In combining his pilot and physician skills, Dr. Reiss was a frequent traveler to San Quentin in Baja California,

FALL 2012

Mexico. There he and his colleagues in the Good Samaritans founded Hospital de San Quentin. There they provided pro bono medical care.

Dr. Reiss was a dapper guy. In his last 10 years, some of the LMH staff took to calling him “Cary Grant.” Once a Lodi NewsSentinel reporter had been visiting LMH to

Dr. Reiss was a dapper guy.

In his last 10 years, some of the LMH staff took to calling him “Cary Grant.” do a story on the kitchen’s terrific Mexican food. She happened upon Dr. Reiss with a mouthful of taco, and he raved about LMH’s Mexican food. The reporter noted he was a Cary Grant lookalike. He got a kick out of that and offered to buy her glasses.

Dr. Reiss is survived by his wife, Carol, to whom he was married for 55 years. They have three daughters and four grandchildren.

Walter E. Reiss Outreach Clinic memorials may be directed to the LMH Foundation.

Services were last Friday.

LMH is grateful for everything he did for the hospital, patients and the community. He will be remembered fondly and with much love.

Submitted by Joe Harrington

FALL 2012

SAN JOAQUIN PHYSICIAN 69

• • • •

Business Records Storage Media/Vital Records Vault Certified Document Destruction Document Imaging Services

Mike Long, Director of Marketing

209-320-6618

email: mlong@pacificstorage.com www.pacific-records.com

70

SAN JOAQUIN PHYSICIAN

FALL 2012

STOCKTON MRI & Molecular Imaging Medical Center, Inc. 2320 N. California Street • Stockton, CA 95204 PHONE 209-466-2000 • Fax 209-466-2600 w w w. stockton m ri . com

The Most Advanced and Comprehensive Medical Imaging Center in San Joaquin County Just Got Better with the Addition of the Central Valley’s only 128 Multislice CT Scanner with Lowest Radiation Dose Imaging Services Include: • • • • •

The first PET-CT since 2003 Full service of Nuclear Medicine Most advanced G. E. High Field MRI (1.5 Tesla) Full service of Digital Radiography and Fluoroscopy New GE Logic 9e 3D & 4D Ultrasound Unit

All Board Certified Radiologists with fellowship: Javad Jamshidi, MD Jack L. Funamura, MD Benjamin Covington, Jr., MD Francis Isidoro, MD Brij J. Kapadia, MD

The Fastest 128 Multislice High Resolution CT in community practice:

Siemens Somatom Definition AS+ (128) FALL 2012

SAN JOAQUIN PHYSICIAN 71

San Joaquin Medical Society 3031 W. March Lane, Suite 222W Stockton, California 95219-6568

PRSRT STD. U.S. POSTAGE

PAID

Permit No. 60 Stockton, CA

RETURN SERVICE REQUESTED

NO INDEMNITY REGIONAL CLAIMS OFFICES

29 Years “a” raTeD BY a.M. BesT

86

TRIALS

88

At NORCAL Mutual, our numbers testify to great claims support for you. Of the claims we closed in 2011, 88% were closed without settlements or jury awards, compared to an industry average of 71%.* We won 86% of our trials, compared to 80% industry-wide.** You’re prepared for each stage of litigation and kept fully informed — and we don’t settle without your consent. We help you manage events so they don’t become claims, and, to back up our promise to stand by you, we remain financially stable, as evidenced by 29 consecutive years of “A” ratings by A.M. Best.

Our numbers add up to great claims support for your practice. * Physicians Insurers Association of America Risk Management Review: 2011 Edition. **Jena et al. Research Letter, Online First: Outcomes of Medical Malpractice Litigation Against U.S. Physicians. Archives of Internal Medicine. May 14, 2012.

Call 1-800-652-1051 or visit norCalmutual.Com Proud to be endorsed by the San Joaquin County Medical Society

Our passion protects your practice