Fall 2021

Fall 2021

Decision Medicine students enjoy an expert experience New Vaccination Rules for Healthcare Workers SJMS Installation of Officers New Resources to Combat Opiod Overdoses in san Joaquin County

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PRACTICE

CONFIDENCE Confidence in your coverage instills confidence in your practice.

Medical Professional Liability Insurance Risk Management Professional Wellness

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VOLUME 69, NUMBER 3 • SEPTEMBER 2021

PICTURED ABOVE: DECISION MEDICINE 2021 STUDENTS AT THEIR CELEBRATION BANQUET

9 PRESIDENT'S MESSAGE 12 IN THE NEWS 18 NEW VACCINATION RULES FOR WORKERS

20 SJMS INSTALLATION OF OFFICERS

24 PRACTICE NEWS AND

36 WE ARE FAMILY 46 SJGH GRADUATES MEDICAL SPECIALISTS

47 ST. JOSEPH'S GRADUATES STAY

50 PUBLIC HEALTH UPDATE 54 IN MEMORIAM

RESOURCES

28 THE RIGHT TYPE

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PRESIDENT Raghunath Reddy, MD PRESIDENT ELECT Cyrus Buhari, DO TREASURER Nguyen Vo, MD BOARD MEMBERS Hyma Jasti, MD, Shahin Foroutan, MD, Neelesh Bangalore, MD, Philip Cheng, MD, Maggie Park, MD, Sujeeth Punnam, MD, John Zeiter, MD, Alain Flores, MD, Manreet Basra, MD, Sanjeev Goswami, MD

MEDICAL SOCIETY STAFF EXECUTIVE DIRECTOR Lisa Richmond MEMBERSHIP COORDINATOR Jessica Peluso ADMINISTRATIVE ASSISTANT Maria Rodriguez-Cook

SAN JOAQUIN PHYSICIAN MAGAZINE EDITOR Lisa Richmond EDITORIAL COMMITTEE Lisa Richmond, Hyma Jasti, MD, Raghunath Reddy, MD MANAGING EDITOR Lisa Richmond

COMMITTEE CHAIRPERSONS CMA AFFAIRS COMMITTEE Larry Frank, MD DECISION MEDICINE Kwabena Adubofour, MD MEDICAL EDUCATION PROGRAMS R. Grant Mellor, MD

CREATIVE DIRECTOR Sherry Lavone Design CONTRIBUTING WRITERS Jo Ann Kirby, Jamie M. Bossuat, Esq, Raghunath Reddy, MD, Daniel Kim, MPH, Adam Kaye, PharmD

PUBLIC HEALTH COMMITTEE Maggie Park, MD SCHOLARSHIP LOAN FUND Gregg Jongeward, PhD

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

CMA HOUSE OF DELEGATES REPRESENTATIVES Robin Wong, MD, Lawrence R. Frank, MD James R. Halderman, MD, Raissa Hill, DO

SUGGESTIONS, story ideas are welcome and will be reviewed by the Editorial Committee.

Richelle Marasigan, DO, Ramin Manshadi, MD Kwabena Adubofour, MD, Philip Edington, MD Harpreet Singh, MD

PLEASE DIRECT ALL INQUIRIES AND SUBMISSIONS TO: San Joaquin Physician Magazine 3031 W. March Lane, Suite 222W Stockton, CA 95219 Phone: (209) 952-5299 Fax: (209) 952-5298 E-mail Address: lisa@sjcms.org MEDICAL SOCIETY OFFICE HOURS: Monday through Friday 9:00am to 5:00pm Closed for Lunch between 12pm-1pm

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EXECUTIVE DIRECTOR’S REPORT

THEN

NOW

WORTH THE WAIT It’s hard to believe it’s 20 years since Decision Medicine began as a small cohort of six freshman students from Edison High School. Since then, it has blossomed and grown to what it is today. After having to cancel last year due to COVID-19, we were thrilled to be able to offer an abbreviated version of DM with a hybrid of in person and interactive virtual activities. The 24 students represented 15 high schools from across San Joaquin County and had an average GPA of 4.36. We feel extremely grateful to our partners who went out of their way during a time when the healthcare system has been especially stressed to provide a wonderful experience for our students. Our community never lets us down!

LISA RICHMOND

It warms our hearts when we receive photos and updates from our students as they are accepted to medical school or beginning residency. I was sent these photos by Farwa Feroze, who shadowed Drs. San Tso and Raissa Hill during DM 2013 and was able to recreate the photo as she rotated through their clinic as a fourth-year medical student! In another email I received recently, Tejwinder Sandhu, Touro University, Class of 2025, told me “Decision Medicine is one of the main reasons why I choose to pursue a career in medicine, and I am truly grateful to SJMS for making this program possible.”

Messages like this fuel our fire and commitment to growing our own doctors. It’s a long road, but worth definitely the wait.

A couple of years ago, SJMS began the tradition of gifting stethoscopes to our program alumni as they enter their first year of medical school. It was so exciting to present 11 this year! We are certain you will enjoy the feature article for a glimpse in to both programs and the success of our wonderful students!

Finally, I had hoped to include a save the date for or Holiday Party, which will serve as a celebration to honor the 2020 Lifetime Achievement and Young Physician award recipients, Drs. Peter Garbeff and Philip Cheng. But alas we have hit a speed bump with the Delta variant and feel it is necessary to wait a bit longer to make the determination. Please feel free to “pencil it in” for Thursday, December 9 and we will communicate more information just as soon as we can.

Be well,

Lisa Richmond

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A message from our President > Raghunath Reddy, MD

COVID, COVID, COVID !!!

It is almost 18 months since WHO declared COVID -19 as a pandemic in March 2020 and we are still struggling with no end in sight. As we strive for effective vaccine or treatment our best bet is to hope for a medical or natural end and sooner the better, not preferred but we may be heading in the direction of social end.

· Medical End- Infection and death rates plummet. That’s how the flu pandemic of 1918 ended – those infected either died or developed immunity

· Social end - People simply get tired of living in fear and learn to live in a world with the disease, which is not an actual end since the disease itself doesn’t go away. In this situation the disease may continue to spread, which can delay the medical end.

· Most prior deadly pandemics ended naturally with significant loss of lives and survivors ending up with herd immunity perhaps.

Learning to live in a world with COVID-19 doesn’t mean permanent quarantine. We can live our lives with a few modifications. Masking, social distancing, hand washing and quarantine when appropriate can help protect us until we have a medical end – hopefully with a vaccine or an effective treatment.

ABOUT THE AUTHOR Raghunath Reddy, MD is the current president of the San Joaquin Medical Society and practices family medicine at Stockton Primary Care Medical Center

Quarantine, by the way, originated during the 14th century Plague pandemic called The Black Death, wiping out 200 million people in Europe over a period of four years. As for how to stop the disease, people had no scientific understanding of contagion, but they knew that it had something to do with proximity. That’s why forward-thinking officials in Venetian-controlled port city of Ragusa decided to keep newly arrived sailors in isolation until they could prove they weren’t sick. At first, sailors were held on their ships for 30 days, which became known in Venetian law as a trentino. As time went on, the Venetians increased the forced isolation to 40 days or a quarantino and became Quarantine as we know now.

Over the last few weeks, as I was contemplating writing about the Covid-19, I

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A message from our President > Raghunath Reddy, MD

was hoping and praying that it is “Swan Song” time for Covid, alas the Delta variant caused a serious dent in my wishes and prayers with rampant rise the world over and just making its presence felt here in the USA as we speak. The alarming rise in Delta cases is a recipe for concern with more contagious nature and rapid spread and according to CDC, the Delta variant is more transmissible than the viruses that cause MERS, SARS, Ebola, the common cold, the seasonal flu and smallpox, and it is as contagious as chickenpox. It is also known to affect vaccinated people, causing asymptomatic infection and cause for more transmission. 71,000 new cases per day on average in the United States, the new data suggest that vaccinated people are spreading the virus and contributing to those numbers — although probably to a far lesser degree than the unvaccinated.

Despite all this, it may be hopefully a godsend as we are seeing relatively low mortality and low case severity with delta variant as compared to the alpha variant- this is based on current published data and anecdotal evidence

Covid has left us with one too many a real-time story, some

gut-wrenching, some heartwarming, some with courage, valor and kindness and just to share a couple here…80 yr old gentleman in Italy, critically ill, survived after weeks of ICU care, ventilatory support and oxygen, came out with lifetime savings dwindled and was profusely thankful to the entire medical staff, hospital administration, then turned towards the sky and said,” Good lord, thank you for the free Oxygen for 80 years, never realized what it meant, took so much for granted all my life.”

Another 85-year-old in India, during the second wave, was critically ill at a time when there was a struggle for hospital beds, oxygen, and ventilators. Family somehow secured a spot for inpatient care and while at the registration desk, he saw a young woman sobbing and pleading for a bed for her young husband who was also critically ill with COVID. The elderly gentleman, despite objections from the family, volunteered his bed to the younger one, stating he lived his life and the young one has a family to take care of, went home, and passed away peacefully three days later.

Hoping and praying a medical end to Covid-19 soon…

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Finding and fixing from the inside out.

Interventional Radiology offers minimally invasive options.

Today, with minimally invasive techniques, the Interventional Radiology team at St. Joseph’s Medical Center can treat many conditions that once required surgery, using minimally invasive treatments, offering less risk, less pain, and less recovery time for our patients, when compared to open surgery. Whether your patients are suffering from back pain, chronic kidney disease, heart and vascular conditions, cancer or men’s and women’s health issues, interventional radiology treatments are available to address many health concerns.

St. Joseph’s Interventional Radiologists have a wealth of experience and expertise in minimally invasive treatments. Some of those treatments include pulmonary embolism and DVT, radioembolization for liver cancer, cryoablation for kidney cancer and balloon kypohoplasty for vertebral compression fractures. For more information visit, StJosephsCares.org/Interventional-Radiology or call IR scheduling at 209.467.6323.

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In The News

IN THE

NEWS Northern California Shriners Hospital Offers Live, Online CME According to Loren Davidson, M.D., medical director of the pediatric rehabilitation program at Shriners Hospitals for Children — Northern California, a physician need not have a definitive diagnosis for a child with suspected developmental delay to refer that child for state services. Children under 3 years of age may be eligible for assistance from the California Department of Developmental Services if they show signs of developmental delay or have documented risk factors, such as pre-term birth. In a recent continuing medical education session, Dr. Davidson stressed the importance of referring patients early to take advantage of neuroplasticity. To learn more, visit https://www. shrinerschildrens.org/continuing-education.

Kaiser Permanente’s New Lathrop Mental Health and Wellness Center Meets Growing Demand for Services in the Central Valley Kaiser Permanente Central Valley recently opened the Lathrop Mental Health and Wellness Center providing access to mental health and addiction services and helping to meet the growing demand in the Central Valley.

The 26,000-square-foot Lathrop facility, located off South Harlan Road, features 36 provider rooms, 14 group therapy rooms, and is the first in Kaiser Permanente’s Central Valley service area to offer addiction medicine along with child, adolescent and adult mental health services under one roof.

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

Kaiser Permanente’s Mental Health and Wellness Center as we continue our work to address the growing need for mental health services,” said Corwin Harper, senior vice president and area manager for Kaiser Permanente’s Central Valley service area. “As we emerge from the pandemic, many find themselves struggling to overcome the mental toll of the past year and a half. We are committed to increasing access, removing the stigma of seeking mental health care and providing pathways to recovery.”

To meet the mental health needs across a rapidly growing region, Kaiser Permanente has prioritized access to behavioral health services. Last November, Kaiser Permanente opened the Enterprise Mental Health and Wellness Center in Modesto and also recently expanded the behavioral health departments in Tracy and Stockton.

“This center is an important addition to our community

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In April, the Stockton Behavioral Health Department was remodeled and expanded, adding 14 more provider offices and two group therapy rooms. Last November, the Modesto-Enterprise Mental Health and Wellness Center opened its 27,000-square-foot facility adjacent to the Bangs Ave Medical Offices with 52 provider offices and seven group therapy rooms. In late 2019, the Tracy Medical Offices Behavioral Health Department expanded to include nine new provider offices.

“Kaiser Permanente’s investment in these facilities is an investment in the health of our community,” said Sanjay Marwaha, MD, physician-in-chief for Kaiser Permanente Central Valley. “These resources provide convenient access for the community, leverage the latest technologies and enable us to best meet the specific needs of our members.”

For more information about Kaiser Permanente mental health services, including how to access care and make appointments, please visit kp.org/mentalhealth.

St. Joseph's Appoints Dr. Jennifer Oakes, MD, as Designated Institutional Officer St. Joseph’s Medical Center is proud to announce the appointment of Dr. Jennifer Oakes, MD, FACEP, FACMT to the position of Director of Academic Affairs and Designated Institutional Official for Graduate Medical Education at St. Joseph's. In this role, Dr. Oakes will be the senior leader responsible for both graduate and undergraduate medical education programs at St. Joseph’s, and will be responsible for the reporting relationship between St. Joseph’s and the Accreditation Council for Graduate Medical Education , the organization that provides accreditation of our residency programs.

Dr. Oakes attended medical school at the State University of New York - Upstate Medical University and completed her residency in Emergency Medicine at the Harvardaffiliated Beth Israel Deaconess Medical Center. She subsequently completed a fellowship in Medical Toxicology at the Emory University/Centers for Disease Control & Prevention Joint Fellowship, and served in a variety of clinical and academic leadership roles prior to coming to St. Joseph's Medical Center in 2017. Currently she is an adjunct Professor of Emergency Medicine at Touro University Osteopathic College of Medicine - California,

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Dr. Jennifer Oakes, MD and for the past four years has done an outstanding job in serving as the founding Program Director for St. Joseph’s Emergency Medicine Residency Program.

St. Joseph’s Celebrates TAVR Milestones St. Joseph's Heart & Vascular Institute recently celebrated the fifth anniversary of the start of its Transcatheter Aortic Valve Replacement (TAVR) Program. TAVR is a minimally invasive procedure that treats aortic stenosis without requiring open heart surgery, resulting in faster recovery times and an improved quality of life. The fiveyeaanniversary of the program also coincided with the hospital performing it’s 300th TAVR procedure.

As a newly named CommonSpirit Health TAVR Center of Excellence, St. Joseph’s is proud to be home to one of the largest and most recognized cardiovascular care teams in the state, including the facility’s multidisciplinary TAVR team.

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In The News

IN THE

NEWS

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

HOPE Program

TAVR Milestones

Physician Education & Resources At Your Fingertips St. Joseph’s has launched a one-stop webpage for physicians looking to find the latest information. Physicians can find information about free CME opportunities, Quarterly Provider Wellness Mixers and community updates. To learn more and access all of the great information, please visit StJosephsCares.org/PhysicianEducation.

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HOPE Program Graduates First Cohort of Nursing Students After years of facing barriers to pursuing a career in nursing, 12 local incumbent healthcare workers have graduated as the first cohort of HOPE Program nursing students at St. Joseph’s Medical Center.

The HOPE Program, which stands for Helping Our People Elevate, was developed both to help meet the local workforce demand and to help remove barriers for high school students and hospital workers pursuing careers in nursing. The programs’ incumbent worker pathway enables current employees at local healthcare facilities to make the transition into San Joaquin Delta College’s Associate Degree in Nursing (ADN) program.

“Building up the next generation of nurses in our community is close to my heart, which is what inspired me

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to name this program HOPE,” said Anitra Williams, DNP, Director of Nursing Operations at St. Joseph’s. “The Hope Program truly is what its name stands for, an opportunity for us to elevate our own gifted employees, as well as our community’s youth.”

Ten employees from St. Joseph’s Medical Center graduated the program as part of the first cohort, in addition to one employee from St. Joseph’s Behavioral Health Center and one from San Joaquin General Hospital.

Health Plan of San Joaquin Earns Reaccreditation as a Health Plan NCQA (National Committee for Quality Assurance) – Thanks to hard work and collaboration throughout their provider network and plan staff, HPSJ in June successfully completed the process for three-year accreditation by NCQA. HPSJ has been accredited since 2015.

Tools You Can Use – From the Provider Services Team at Health Plan of San Joaquin • N EW Provider Checklist: VBP Payments & Prop 56 Reimbursement Guide – This is a reminder that visits for HPSJ patients should include the Checklist services – and practices may qualify for additional VBP/ Prop 56 reimbursement. Note: Encounters occurring at Federally Qualified Health Centers, Rural Health Clinics, American Indian Health Clinics and Cost Based Reimbursement Clinics will be excluded from VBP payment. Find this two-pager at http://www.hpsj. com/wp-content/uploads/2021/07/provider-VBPreimbursement-guide-letter-1.pdf.

• C linical Practice Guidelines (2021). Now Online – Find the Health Plan of San Joaquin PDF at https:// www.hpsj.com/wp-content/uploads/2021/06/ClinicalPractice-Guidelines-2021.pdf.

• For Outpatient Care – Current Medications for Outpatient Treatments of COVID-19 – Management of COVID-19 is rapidly evolving. There are only a few medications that have obtained Emergency Use Authorization (EUA) from the FDA to treat this disease in the ambulatory population. To assist providers, as they appropriately advocate for and treat patients, Health Plan of San Joaquin’s Pharmacy Department

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has brought together in this single piece all the current FDA-authorized treatment options for outpatient management for COVID-19. See it – and updates – at www.hpsj.com/pharmacy-announcements/.

• Mental Health Experts – Easily Accessed via Health Plan of San Joaquin – As so many have lived with the fear and restrictions of COVID-19 – especially teens and others who may still struggle, HPSJ’s Online Provider Directory is your link to vetted, daily updated help for HPSJ members. Find behavioral health professionals and facilities at www.hpsj.com/find-aprovider.

Improved Payment Experience for Health Plan of San Joaquin providers – To ensure no delays in payments, many providers have already acted In the fall, HPSJ will transition to a new payment system.

To ensure a smooth transition for providers’ electronic payments – or to transition from paper – providers who have not already done so are asked to supply the name and email address of the person authorized to make decisions on claims and payments. This information can be entered at www.hpsj.com/paycontact. For questions, see www. hpsj.com/pay, or call HPSJ Provider Services at 1.888.936.

PLAN (7526).

DHM Providing Free Breast Cancer Support Groups Join Doctors Hospital of Manteca for Breast Cancer Support Groups on the third Tuesday of every month at 5 p.m. in our Conference Center (off the cafeteria) at 1205 E. North Street in Manteca. We provide these free support groups for breast cancer patients and survivors. While we focus mainly on breast cancer, individuals with other types of cancers are welcome.

Upcoming dates: September 21 October 19 November 16 December 21 For those with questions, please call (209) 239-8382.

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Physician Education & Resources St. Joseph’s Medical Center offers a variety of updates and education just for physicians.

We have created one central page where you can get updates on everything from upcoming physician events and news, to CME presentations. To learn more and access session links please visit:

StJosephsCares.org/PhysicianEducation Free CME Opportunities for Physicians

Continuing Medical Education (CME) presentations, including Tuesday Noon Conferences, are listed on the web page with the appropriate meeting links.

CME

CREDITS

Quarterly Provider Wellness Mixers

Join with your colleagues for a time to connect and decompress.

Our next mixer will be held on September 21, 5:30 - 7pm, at Stockton Golf & Country Club.

Community Updates

Find information on upcoming community updates and other hospital events and presentations.

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New Vaccination Rules for Healthcare Workers

BY JAMIE M. BOSSUAT, ESQ. ON AUGUST 5, 2021, THE CALIFORNIA STATE PUBLIC HE ALTH OFFICER ISSUED AN ORDER REQUIRING THAT ALL WORKERS PROVIDING NE W REQUIREMENTS FOR VACCINATIONS AND TESTING OF HE ALTH CARE WORKERS.

Who is Covered?

The Order applies to the following health care facilities: • General Acute Care Hospitals • Skilled Nursing Facilities (including Subacute Facilities) • Intermediate Care Facilities • Acute Psychiatric Hospitals • Adult Day Health Care Centers • Program of All-Inclusive Care for the Elderly (PACE) and PACE Centers • Ambulatory Surgery Centers • Chemical Dependency Recovery Hospitals • Clinics & Doctor Offices (including behavioral health, surgical)

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• Congregate Living Health Facilities • Dialysis Centers • Hospice Facilities • Pediatric Day health and Respite Care Facilities • Residential Substance Use Treatment and Mental Health Treatment Facilities All workers in these facilities are covered, including both paid and unpaid individuals who work in indoor settings where care is provided to patients or patients have access for any purpose.

Workers include, but are not limited to: • Nurses, nursing assistants, and physicians • Technicians, therapists, phlebotomists, and pharmacists • Students and trainees

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• Contract staff not directly employed by the healthcare facility • Persons not directly involved in patient care, but who could be exposed to infectious agents such as clerical, dietary, environmental services, laundry, security, engineering, billing, and other personnel or volunteers.

What is Required?

All workers must have their first dose of a one-dose regimen or their second dose of a two-dose regimen by September 30, 2021. All COVID-19 vaccines authorized for emergency use by either the U.S. Food and Drug Administration or the World Health Organization meet the requirements.

What Are the Exceptions?

Employees who decline the vaccination due to Religious Beliefs or due to a Qualifying Medical Reason may provide the healthcare facility with a declination form stating the basis for their declination.

Employees with a Qualified Medical Reasons exemption must provide their employer a written statement signed by a physician, nurse practitioner, or other licensed medical professional practicing under the license of a physician, stating that the worker qualifies for the exemption and the probable duration of the worker’s inability to receive the vaccine.

All healthcare workers who are exempt due to a properly documented Religious Belief or Qualifying Medical Reason

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must meet the following requirements when entering a healthcare facility: • Testing – Workers must receive twice weekly testing for acute health care and long-term care settings and once weekly testing for workers in other healthcare settings.

Testing must be done with either Polymerase Chain Reaction (PCR) or antigen tests that have an Emergency Use Authorization (EUA) by the FDA. • Masks – Workers must wear a surgical mask or higher-level respirator such as an N95 filtering facepiece or respirator at all times while in the facility.

Are There Recordkeeping Requirements?

Healthcare facilities must maintain a record of workers’ vaccination status or exemption status. (These must be maintained pursuant to the CDCPH Guidance for Vaccine Records Guidelines and Standards.) For workers who are exempt, the healthcare facility must maintain records of the workers’ testing results.

How Does This Alter the July 26th Order?

The July 26th Order remains in effect. However, based upon the August 5th Order, it appears that after September 30th, testing as an alternative to vaccination is no longer available for workers who do not meet the criteria for a religious or medical exemption.

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S J M S I N S TA L L AT I O N OF OFFICERS In late June, the San Joaquin Medical Society board of directors met in person for the first time in over a year to celebrate outgoing President Hyma Jasti, M.D., and officially pass the gavel to incoming President Raghunath Reddy, M.D. Additionally, Cyrus Buhari, D.O., and Nguyen Vo, M.D., were installed as president elect and treasurer, respectively.

The Board is grateful to Drs. Sanjay Marwaha, Ben Morrison and Richelle Marasigan for their years of service and welcomed new members, Drs. Alain Flores, Manreet Basra and Sanjeev Goswami.

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We Help You Get Paid CMA’s reimbursement experts have recouped $33 million from payors on behalf of member physicians in the past 12 years.

COVID-19 We know that many physician practices are struggling financially in the wake of the COVID-19 pandemic. That’s why CMA continues to work closely with state and federal leaders to ensure that physicians are included in COVID-19 relief programs. CMA has also ensured that there is payment parity between in-person and telehealth services, including telephonic visits, and will continue to fight for physicians’ ability to use telehealth services while not being undercut by out-of-state teledoc companies. Telehealth services have proven to be a critical tool for physicians so they can safely provide care to those who need it during the COVID-19 public health emergency.

PRACTICE MANAGEMENT ASSISTANCE CMA’s practice management experts provide free assistance to members and their staff on reimbursement, contracting and practice management related issues.

DIRECT PAYOR INTERVENTION CMA has recouped $33 million from payors on behalf of CMA member physicians in the past 12 years. These monies represent actual physician reimbursements that would have likely gone unpaid without CMA intervention.

EDUCATION CMA offers timely, high-quality education programs for physicians and their staff. From interactive in-person seminars to live and on-demand webinars, CMA provides the information needed to help run a successful medical practice.

PRACTICE MANAGEMENT NEWSLETTER CMA Practice Resources—known as CPR—is a monthly email bulletin that includes tips and tools to help physicians and their office staff improve practice efficiency and viability.

PAYOR CONTRACT ANALYSIS CMA members have free access to objective written analyses of major health plan contracts designed to help physicians understand their rights and options when contracting with a third-party payor, as well as which contract provisions are prohibited by California law.

“The value that CMA brings to physician practices cannot be understated. Membership is not a cost to my practice – it is an investment. I couldn’t run my practice without it.”

–Tom McKenzie, M.D., member since 1991

NEED HELP? Contact CMA’s Reimbursement Help Line at (888) 401-5911 or economicservices@cmadocs.org

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Rev. 12.1.2020

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Preeti Srivatsa, M.D.

Radhika Hombalegowda, M.D.

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Maya Nambisan, M.D.

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Practice News and Resources Free to SJMS/CMA Members!

The Office Managers Forum empowers physicians and their medical staff with valuable tools via expert led educations sessions from industry professionals who are committed to delivering quality healthcare.

For the time being, we will be offering Zoom Meetings until we can get back to meeting in person.

This monthly forum is normally held on the second Wednesday of each month. Registration is required!

If you don’t receive a monthly invitation via E-Mail, please email Jessica@sjcms.org for the Zoom call info!

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October 13th, 2021:

TBD

November 10th , 2021: 11:30AM-1PM

The Modern Workforce Revisited – 5 Ways to Attract and Retain the Next Generation of Workers Presented by: Jeff Gilbert and Chad Sublet – Verve IT In our previous presentation, Jeff and Chad advocated for a new way of thinking about the Workplace in order to attract and retain the growing Millennial demographic. Now, here in 2021, more than 50% of the workforce is comprised of Millennials - and not only will this number continue to increase, but Generation Z is hot their heels.

With the impact of COVID, and businesses globally rethinking their work-from-home policies, the Modern Workplace is now no longer a luxury - it is an essential business strategy to compete for the best talent in this new, moder n era.

Join us as we revisit our original presentation and update you on the latest trends that will help you continue to attract and retain the next generation of workers.

Jeff Gilbert, CEO– Jeff has been in the Information Technolog y industr y for 20 years, and has served in virtually all aspects of the IT world, getting his start in basic IT work, progressing through software development and architecture, and finally to IT Management. Jeff ’s career has led him to provide services for some of the world’s largest firms, including global project management

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firms, and top 5 national defense firms. Jeff lives in Stockton with his wife Christina and their 4 sons.

Chad Sublet, Partner – Chad’s background includes 20+ years of customer service and sales.

Starting his technical career with electronics re pair in the USAF Minute Man program and transitioning those skills to satellite and weapons re pair in the civilian world. Eventually growing his skillset to sales, and becoming a partner at Verve in 2008. Chad now has responsibility for the Verve Sales & Account Management team. Chad lives in Stockton with his wife Madeline and their 2 children.

December 8th, 2021: 11:00AM to 1:00PM

“Medicare Changes: 2022 and Beyond” This 60-minute virtual (online) training provides your practice with updates on Policy, Payment and Quality Provisions for Medicare under the Physician Fee Schedule (PFS) for CY 2022 and beyond.

Subjects highlighted in this workshop: • Telehealth during COVID- PHE • Evaluation and Management (E/M) Visits • Quality Payment Program (MACRA) Year 6 • Compliance with the MAC • Other Medicare Part B issues Your billing staff will walk away with the resources to decrease denials and maximize reimbursement.

Cheryl Bradley is an Associate Director in CMA’s Center for Economic Services. She has over 25 years’ experience in the Medicare Program and has held a variety of responsibilities including

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Education and Training Specialist, Medical Review Analyst, and has worked with providers in virtually all specialties across all the CA Medicare contractors. Cher yl is a known educator speaking at conferences, state associations, and for numerous organizations. She provides problem solving assistance to CMA member physicians on a number of Medicare issues. She is great at using humor to help providers navigate this difficult healthcare program.

CMA PRACTICE RESOURCES UHC DELAYS DESIGNATED DIAGNOSTIC PROVIDER PROGRAM IN CA UNTIL JAN. 1, 2022

United Healthcare (UHC) has delayed implementation of its Designated Diagnostic Provider (DDP) program for laboratory services in Califor nia. Previously scheduled to begin July 1, 2021, the DDP program is now tentatively scheduled to be implemented on January 1, 2022, pending regulatory approval. The program will create a tiered network for laboratory services for its fully insured commercial lines of business and will limit outpatient laboratory service coverage to only Designated Diagnostic Provider labs, which are freestanding or hospital outpatient labs that have met certain quality and efficiency requirements.

The delay follows questions raised by the Califor nia Medical Association (CMA) and other stakeholders regarding implementation of the DDP program, including concerns with how physicians and patients will identify DDP

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labs in the UHC provider directory, confusion identifying patients with coverage limited to DDP laboratories, potential concer ns with timely access to lab services for UHC enrollees and increased patient out-of-pocket costs when they mistakenly receive services from an out-ofnetwork lab provider.

Citing the need to reduce outpatient diagnostic laboratory costs, UHC had planned to implement DDP as part of its new patient benefit designs for 2021, pending state regulatory approval. Originally, the DDP program would have required patients under these new benefit designs to only access DDPs for outpatient diagnostic lab services. Patients who utilized any other provider would have had services denied as non-covered and could be held financially liable for the charges. UHC has, however, recently altered the program to now cover patients for outpatient diagnostic lab services at a lower cost share when delivered by a DDP with patients paying a greater cost share for care rendered by non-DDPs. Once implemented, the DDP benefit designs will not apply to lab services rendered as part of inpatient admissions, emergency room visits or outpatient surgery pre-operation testing that is billed as part of a global surgical package.

UHC plans to expand the DDP benefit designs and limited provider network to major radiology services (MR, CT, PET/Nuclear Medicine) beginning January 1, 2022. However, UHC has advised that the delay for laboratory services will likely impact the implementation timeline for radiology services as well.

Providers with questions or concer ns regarding the DDP program can email United Healthcare at ddp_lab@uhc.com. For more information on the DDP program, see UHC’s Frequency Asked Questions or visit uhcprovider.com .

FALL 2021

DID YOU KNOW? PHYSICIANS CAN HELP PATIENTS APPEAL MEDICAL NECESSITY DENIALS

Both the California Department of Managed Health Care (DMHC) and the California Department of Insurance (CDI) have independent medical review (IMR) processes through which patients can request an exter nal medical review of any health plan or insurer decision to deny, modify or delay treatment based on a lack of medical necessity or investigational or experimental denials.

Under Califor nia law, all patients enrolled in fully insured commercial products regulated

by DMHC or CDI have the right to appeal these denials through the regulator’s IMR process.

The goal of the legislature in mandating the availability of this formal IMR process was to ensure that appropriate and equitable medical necessity decisions are made and to increase public confidence in the managed care system.

Both the DMHC and CDI have established IMR processes that are accessible on the regulator websites.

According to the 2020 DMHC Annual Report, 68% of consumers who submitted an IMR request received the service or treatment they requested. CDI’s Interactive Independent Medical Review Statistics also show that 53% of IMRs filed through CDI were decided in favor of the patient.

During an IMR, independent physicians that do not work for the health plan will examine the case to see if the denial was appropriate or if the enrollee should receive the requested service or treatment. If it is determined that the health plan/insurer’s denial was not appropriate, the plan/insurer must cover the requested service or treatment.

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Before filing for an IMR, patients must first file a grievance with their plan/insurer.

However, if the patient does not agree with the health plan/insurer's response or the payor takes more than 30 days to fix the problem, the patient can file for an IMR through the DMHC Help Center or through CDI, depending on which entity regulates the patient’s insurer. Typically, DMHC regulates all HMOs as well as the Blue Shield and Anthem Blue Cross PPOs, while CDI regulates the remaining PPO products.

It’s also important to know that physicians can assist their patients in filing for IMR or can file on the patient’s behalf. Patients who wish to designate a physician or another person to file on their behalf must complete and sign the required DMHC Authorized Assistant Form or for CDI regulated products must sign the Designation of IMR Agent (last page of the IMR form).

IMR requests must be made within six months unless the regulator approves an extension due to special circumstances. Applying for an IMR is free.

For more information about how physicians can assist patients in seeking an IMR, see Califor nia Medical Association health law library document #7155, “Independent External Medical Review.”

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Decision Medicine students enjoy an expert experience

BY JO ANN KIRBY

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FALL 2021

2021 Decision Medicine Aderinsola Akintade Health Careers Academy Paulina Barrera-Garcia Tokay High School Harmandeep Batth Tokay High School Priscilla Casique Cesar Chavez High School Saniya Dhanoa Mountain House High School Mariana Diggs Aspire Langston Hughes Academy Stacy Du John C. Kimball High School

What do you want to be when you grow up?

The two dozen high school juniors learning to type blood on a recent summer day at Dameron Hospital already know the answer.

They are all interested in medical careers and were accepted out of more than 100 applicants to take part in Decision Medicine, a San Joaquin Medical Society summer program that provides a mix of interactive virtual and hand-on learning opportunities. Besides getting a glimpse at a day in the life of a doctor, they were able to ask physicians questions about the journey that led them to their careers, they gained insights about the pathway to medical school and witnessed the healthcare needs of the local community.

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Arshdeep Gill Stockton Early College Academy Ahmad Karabala Stockton Collegiate International School Harleen Kaur Aspire Ben Holt College Academy Imaan Khan Aspire Ben Holt College Academy

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The goal is to inspire local students to pursue a career in medicine and come back to serve their community. It is designed for students from high achieving, underprivileged and under-represented students, who would not otherwise have the opportunity to interact with medical professionals for pathway advice. The thriving program is the brainchild of Dr. George Khoury, a radiologist, and Dr. Kwabena Adubofour, who practices internal medicine.

“We wanted to get kids interested in becoming doctors. If we grow our own, they would want to come home to practice,” Dr. Adubofour said.

Dr. Khoury and Dr. Adubofour said they realized if their own children expressed an interest in medicine, they had many contacts to reach out to for guidance and shadowing opportunities by virtue of being doctor’s kids. But what about students who don’t have a parent or relative in the field?

“As physicians, we can’t continue to complain that there aren’t enough of us if we don’t employ the strategies and programs to ensure students are interested in medicine and that our county is attractive with enough carrots that they want to practice here,” Dr. Adubofour said.

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Dr. Khoury said that Decision Medicine has enjoyed great fortune. “The support of the hospitals, medical groups and universities are key for our success,” he said, also praising efforts to grow the program from its original half dozen students to two dozen today.

The 2021 Decision Medicine program also featured a visit to various departments and interactions with medical students, residents, and physicians at San Joaquin General Hospital. At St. Mary’s Dining Hall students learned about the outreach to the less fortunate in our community and were excited to become CPR certified at St. Joseph’s Medical Center, among other fun activities. The cohort had a college prep session and took part in Zoom sessions with other program partners including UC Davis School of Medicine. One Zoom session featured renown pathologist Dr. Bennet Omalu.

“ We are now getting data on how many have entered medical school and it’s really exciting,”

FALL 2021

Alma Limon Health Careers Academy Victoria Luna Weston Ranch High School Kathy Ly Stockton Early College Academy Giselle Murillo Franklin High School Alynna Nguyen Health Careers Academy Colleen Nguyen Bear Creek High School Morgan Peters Ripon High School “We are starting to see the fruits of our labor in that we have students graduating from medical schools, finishing residencies and returning to their home communities to start their practice,” Dr. Khoury said.

Liliana Ramirez Lincoln High School

Dr. Adubofour said the results are fantastic. “We are now getting data on how many have entered medical school and it’s really exciting,” Dr. Adubofour said.

Myriam Ramirez Stockton Collegiate International School

The statistics show that students who took part in San Joaquin Medical Society programs for young people include 25 now in medical school, five working in residency programs, and one practicing physician plus more than 210 students are studying STEM majors in undergraduate school.

Arshdeep Gill, a student at Stockton Early College Academy, applied to take part in Decision Medicine after hearing about the program from a neighbor.

“I always wanted to be in the medical field because my mom is a nurse but I’m thinking about being a physician,” he said. “This has been inspirational and motivational to me. Reading about being a radiologist on a blog and meeting one in person and watching them work is a lot different. It was so informative.”

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Jasleen Sohal Aspire Ben Holt College Academy Veronica Sotelo Weston Ranch High School Angel de Jesus Tovar Edison High School Emily Villa Edison High School

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HPSJ Health Careers Scholarships Decision Medicine Students Honored During the 2021 Decision Medicine Celebration

a long-time supporter of the Decision Medicine

Banquet, at Stockton Golf and Country Club,

(DM) program. Years ago, they began to offer

Health Plan of San Joaquin leaders were on hand

a scholarship to alumni of the program, which

to present HPSJ Health Careers Scholarships

later grew to two recipients. This year, with their

to this year’s DM alumni. Pictured, from left

unwavering commitment to the program, HPSJ

to right, are DM graduate Andrea Ramos who

leadership elected to award three scholarships

will attend San Joaquin Delta College and

totaling $9,000.

major in biology with her ultimate goal to be a

HPSJ Chief Medical Officer Lakshmi

family practice doctor, HPSJ Director of Quality

Dhanvanthari, MD, said: “We believe that during

Management Andrea Swann, HPSJ Director

this pandemic and the ongoing shortage of

of Community, Marketplace and Member

local healthcare professionals, it is even more

Engagement Vena Ford, HPSJ Director of

essential that HPSJ maintains our tangible

HEDIS and Accreditation Kathleen Dalziel, HPSJ

support and encouragement to nurture this next

Director of Provider Services Heather West, and

generation. Beyond these important financial

DM graduate Heather Bastiansen who will attend

resources, the three awardees receiving

UC Berkeley and major in microbial biology.

the $3,000 HPSJ Health Careers Program

Not pictured is Danish Khan who will attend UC

scholarships will also have the benefit of a

Davis and major in microbiology, psychology and

personal mentor from our professional HPSJ

behavior with the ultimate goal of becoming a

staff. The HPSJ mentors are eager for this

physician.

opportunity to continue the mentor program we

Health Plan of San Joaquin (HPSJ) has been

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started several years ago.”

FALL 2021

Gill said it was exciting to be able to speak with residents.

“Most of the residents told us that when you go into residency you are exposed to a lot of different fields,” he said, adding that he thinks that is helpful to realize that he doesn’t have to know exactly what kind of medicine he wants to practice at his age.

In addition to learning that his blood type is the rare O negative that day, he also made a new friend. That’s something that Lisa Richmond, executive director of the San Joaquin Medical Society, said has been a surprising bonus of the program that brings like-minded students together.

Gill met Ahmad Karabala, who is a student at Stockton Collegiate International School. As the two worked on their blood typing assignment, Karabala explained how meaningful the entire experience has been.

Thank You for Your Support!

Premier Financial Sponsors Health Plan of San Joaquin Community Health Fund

Community Partners Adventist Health Dameron Hospital Kaiser Permanente San Joaquin General Hospital St. Joseph’s Medical Center

“Honestly, I think it reinforced what I was leaning towards.

I now have a general vision of what I want to do now and look forward to accelerating my education in that direction.”

St. Mary’s Dining Hall

Of the applicants vying for a spot, 45 were interviewed. Dr. Khoury said he looks for students who have commitment to achieving goals in their junior high and high school years, the resourcefulness to get back on the path when plans are derailed, and true empathy for others.

Physician Volunteers

Dr. Khoury echoed the need for more physicians to get involved with the program and provide that one-on-one interaction with the students that is a hallmark of the program.

Hyma Jasti, MD

Dr. Adubofour and Dr. Khoury both said they were excited to see the students be able to visit the participating hospitals since last year’s program was cancelled due to the pandemic.

Linda A Asante-Ackuayi, MD

“I’ve learned so much,” Victoria Luna, a Weston Ranch High School student, said. “It was really great to be able to ask the doctors questions.”

UC Davis School of Medicine

Alain Flores, MD Bennet Omalu, MD George Khoury, MD Khaleedah Young, DO Kwabena Adubofour, MD Marina Castillo, MD Nguyen Vo, MD Philip Cheng, MD Sachidanand Prabhu, MD Sanjay Marwaha, MD Shahin Foroutan, MD Sujeeth Punnan, MD

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FALL 2021

We are Family BRIDGE TO MEDICINE MENTOR PROGRAM IS LIKE HAVING A DOCTOR ON CALL

BY JO ANN KIRBY The San Joaquin Valley has the lowest supply of doctors in the state, at a ratio of about 39 physicians per 100,000 residents, 22% lower than the state average, according to the California Health Care Foundation. It’s a grim challenge felt by the medical community countywide but one that the San Joaquin

medicine and return home to practice in their underserved communities. Bridge to Medicine provides invaluable one on one mentoring as well as guidance into applying to medical school and finding research and volunteer opportunities.

For Natalie Pearlman, being part of the program has already had a life-changing impact. The Tracy native is an ideal candidate for the program. “I think especially “ I applied and wasn’t accepted. It was a really being from the Central Valley, I saw big blow. There’s not a lot of people talking so many people important to me like, about that. What does this mean in terms of family members, friends or neighbors, who struggled to find medical care, reapplying? I had to think about whether this especially to find a specialist because was something I still wanted to pursue.” we have such a high turnover of specialists in our area,” she said. “I did Medical Society is committed to helping solve through the health pathways at John C. Kimball High School, which is Decision Medicine and Bridge to Medicine, two successful how I got connected to Decision Medicine in 2012. I went to and selective programs for students that aim to help our area the University of Washington and graduated in 2018.” grow its own doctors.

Armed with an undergraduate degree in molecular biology While Decision Medicine provides high school students and experience working with nonprofits in Seattle, she took with a behind-the-scenes look at the medical field, the Bridge the next step. “I struggled with applying to medical school,” to Medicine program pairs physicians with local academically she said. “I applied and wasn’t accepted. It was a really big blow. talented high school or college students who want to study There’s not a lot of people talking about that. What does this

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mean in terms of reapplying? I had to think about whether this was something I still wanted to pursue.”

Thanks to Bridge to Medicine, she was paired with a mentor, Dr. Grant Mellor, a Kaiser Permanente pediatrician. “We want it to be like having a doctor in the family,” Dr. Mellor said.

“Through this program, everyone can have a doctor in the family with the advice we give.”

Dr. Mellor’s own daughter is in medical school at Case Western Reserve University and the advice he’s been sharing with Pearlman is the same advice he gives her.

Due to the Covid-19 pandemic, Dr. Mellor and Pearlman only met in person recently. They would interact by phone, checking in with each other by calling or texting. “Having the phone number of a physician was a huge thing. We would talk about experiences I was having and how that would translate.

If I had a barrier, he would say, let me check into that for you. When I practiced for my interviews, he would read my personal statement,” she said. “He wrote one of my letters of recommendation.”

Together, the duo created a strategy for Pearlman to become an ideal medical school candidate. “She is very dedicated in a gutsy way,” Dr. Mellor said of his advice that she become an EMT. “I think she got some real hands-on medical experience.”

Working as an EMT during the high risk Covid-19 pandemic showed bravery, Dr. Mellor said, and it demonstrated that she likes helping people. The passionate and innately curious young woman also looked for opportunities to get involved with teaching, another helping profession.

With an open mind, a caring heart and a willingness to do the hard work, Pearlman followed Dr. Mellor’s advice and was rewarded with acceptance to the UC Davis Medical School.

She’s thankful to the San Joaquin Medical Society’s for both their Decision Medicine and Bridge to Medicine programs. “I think Decision Medicine was really paramount to me realizing that being a doctor was a possibility,” she said. “When I came back to the Valley, Bridge to Medicine was a network for me that was already there as an alumnus of Decision Medicine.”

Dr. Mellor said the need for Bridge to Medicine evolved as another way to continue to support aspiring doctors who could come back and serve locally. “We realized we couldn’t expand Decision Medicine because logistics just prevent that,” he said.

“So, we conceived of a mentoring program that became Bridge to Medicine.”

Mentors include physicians, alliance members, nurse practitioners and even a professor at San Joaquin Delta College who has authored a book on how to get into medical school.

The mentoring effort is a low-capital endeavor that can be expanded with the addition of more mentors or existing mentors who are willing to take on extra students. Dr. Mellor said he would encourage his peers to become involved, adding that he’s thoroughly enjoyed his own experience as a mentor and knows that ultimately it’s going to pay off richly by helping bring more doctors to the area.

Forging a relationship with aspiring doctors gives them much-needed support and hopefully makes it even more likely that they will return to their roots to serve. “Like a lot of doctors in our area, especially those who’ve had leadership positions where they’ve had to hire, know that recruiting for our local area is a challenge,” Dr. Mellor said. “The Central Valley is a great place to practice medicine. The sort of people we take care of in the Central Valley are good common-sense folks and it’s a good place to live in so many ways.”

As Pearlman starts medical school, she thinks about the future. “I can’t wait to go home and help my community, which my parents thought was ironic, because I couldn’t wait to leave when I graduated from high school,” she said.

And she won’t be alone at UC Davis where she’s found five other medical students in her cohort who are Decision Medicine alumni.

“I can’t say enough about the work the society is doing,” she said. “To be the first one in my family to go into medicine and to know I have the support from Bridge to Medicine is a unique experience for anyone who has the opportunity to be involved.”

HOW TO GET INVOLVED?

SJMS is currently recruiting volunteer mentors to join our Bridge to Medicine (BTM) committee.

The committee meets every other month (virtually via Zoom) and consists of physicians (working & retired), alliance members, nurse practitioner and even a local college professor. Most importantly, you don’t need to be an expert! We have committee members with a wide array of skill sets and resources, so you are never alone. For more information, please contact Lisa Richmond at 9525299 or Lisa@sjcms.org.

Bridge to Medicine accepts new applicants as mentor availability allows, please find more information at www.sjcms.org>programs>bridgetomedicine.

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FALL 2021

World-class technology The art of a confident diagnosis Advanced Imaging Center 1031 S. Fairmont Ave., Lodi 209-334-8580

Imaging services with a personal touch The Advanced Imaging Center at Adventist Health recently renovated the entire facility to ensure that your patient’s diagnostic imaging experience is as welcoming and enjoyable as possible. We provide an unrivaled level of service by combining state-of-the-art equipment with well-trained, innovative, knowledgeable and caring imaging clinicians.

Exceptional radiologists The radiologists at Adventist Health bring years of training and clinical expertise to our imaging services, assuring you a level of expertise that allows for a precise reading and interpretation of diagnostic tests.

We’ve invested in the latest technology so your patients can get advanced imaging services they need, without leaving our community.

• 128-slice CT Scanner • MRI • 3D Mammography

FALL 2021

• Digital Radiography • DEXA (bone densitometry) • Ultrasound

To schedule imaging procedures for your patients, please call 209-339-7505 or fax an order to 209-339-7412.

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Medical School Admissions

AARON SACKSCHEWSKY Stritch School of Medicine, Loyola University Chicago Bridge to Medicine • Mentor: Hyma Jasti, MD

ANGELA COLBACK University of California, Davis School of Medicine Decision Medicine 2011

ABIRATH NAKKA Debusk College of Osteopathic Medicine, Lincoln Memorial University Decision Medicine 2016

CATHERINE ZHANG Cooper Medical School, Rowan University Decision Medicine 2015

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FALL 2021

JESSICA TANG University of California, Davis School of Medicine Decision Medicine 2014 • Bridge to Medicine Mentor: Pinki Goswami, MSN, CPNP

KARTIK GOSWAMI California Northstate University College of Medicine Decision Medicine 2016

JORDAN LARSSON University of California, Davis School of Medicine Bridge to Medicine Mentor: John Zeiter, MD

MONIFA SAWYERR University of California, Davis School of Medicine Decision Medicine 2014

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Medical School Admissions

NATALIE PEARLMAN University of California, Davis School of Medicine Decision Medicine 2012 • Scholarship Loan Fund • Bridge to Medicine • Mentor: R. Grant Mellor, MD

UYEN TU HOANG NGUYEN University of California, Davis School of Medicine Scholarship Loan Fund Decision Medicine 2014

TEJWINDER SANDHU Touro University California College of Osteopathic Medicine Decision Medicine 2014 42

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FALL 2021

Residency Match

SHIVANI NAIDU, MD Internal Medicine Program, San Joaquin General Hospital Decision Medicine 2010

FALL 2021

Noteworthy

PARAMPREET SINGH, MD Internal Medicine, St. Joseph’s Medical Center (PGY-2) • Middle College High School • University of the Pacific • St. George’s Medical School

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San Joaquin Medical Society Member Only Benefits • Complimentary Dark Web Compromise Credential Report ✓ Over 11 billion accounts have been compromised – Has yours?

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• Complimentary Security and Risk Assessment ✓ Have you conducted your Risk Assessment yet?

Call Mark Williams @ 209-623-1023 or email mark@ce-technology.com 44

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FALL 2021

Advanced Interventional Radiology Procedures in Central Valley The interventional radiology (IR) team at Doctors Hospital of Manteca diagnoses and treats medical conditions using X-rays, ultrasound and computerized tomography (CT) in largely an outpatient setting. If your patient needs a minimally invasive image-guided alternative to open surgery, we offer the following core interventional procedures: Arterial study for angioplasty, stent, grafts and thrombolysis

Placing and removing inferior vena cava (IVC) filters

Biopsies

Thoracentesis

DVT/PE thrombectomy, thrombolysis

Urinary tract obstruction or stone management

Dialysis vascular access and maintenance of fistula, AV declot Embolization (uterine fibroid embolization, varicocele, for pelvic congestion and for aneurysms) Epidurals, pain block and myelogram Gastrostomy tube placement

Varicose vein treatment Vascular access (ports and lines) Venous thrombolysis, thrombectomy and recanalization Vertebral augmentation for compression fractures (kyphoplasty and vertebroplasty)

Paracentesis

To refer a patient, please call 855-476-4445 or visit DoctorsManteca.com FALL 2021

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San Joaquin General Hospital Graduates Medical Specialists Each Spring Since 1932, every Spring San Joaquin General Hospital has graduated competent medical residents with a high level of specialty medical education. San Joaquin General Hospital sponsors three residency programs: General Surgery, Internal Medicine and Family Medicine. All residency programs are fully accredited by the Accreditation Council for Graduate Medical Education.

The Hospital’s residency programs provide community-based education, with comprehensive training in inpatient and outpatient services and procedural skills, serving a very diverse San Joaquin County patient population. Medical physicians seeking a specialty through education at San Joaquin General see a wide range of medical conditions. The Hospital trains medical graduates with advanced medical technologies such as robotic surgery and state-of-the-art medical science practices.

“Our 2021 general surgery graduates have achieved a high level of competence and can successfully compete for fellowships and excel in their subsequent surgical practices. I am very proud of these young 2021 surgical graduates and their ability to address their patient’s future needs” said Frederick D. Cason, MD, FACS, Program Director, General Surgery Residency.

The Hospital’s residency programs are affiliated with the University of California, Davis Medical Center. Hospital residents also receive training and education through Dignity HealthSt. Joseph’s Hospital and UCSF Medical Center. The Graduate Medical Education program is overseen by Sheela Kapre, MD, SJGH Designated Institutional Officer and Chief Medical Officer. The intent of the Hospital’s Graduate Medical Education program is to bring experienced specialty physicians to work in the communities of San Joaquin County.

Many of the physicians practicing locally were trained at San Joaquin General Hospital.

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FALL 2021

St. Joseph’s Medical Center Residents Graduate and Stay to Practice Humankindness The Central Valley has a fresh infusion of physicians specializing in humankindness. St. Joseph’s Medical Center recently graduated its first class of 14 physician residents from its Emergency Medicine and Family Medicine residency programs.

“We are so proud of these graduates.

Not only were they our inaugural class of residents, but they have successfully completed their training during the height of a global pandemic,” said Donald J. Wiley, President and CEO of St. Joseph’s. “We are especially thankful for those who have decided to stay on and work in our community.”

The program began in 2018 as an effort to both train and retain physicians in San Joaquin County, an area facing a critical shortage of physicians. Program administrators aim to select residents with local ties whenever possible, having either attended medical school in California or lived here.

“Graduate Medical Education has enabled us to recruit great physicians to serve as faculty, train great new physicians and keep them in our area, as well as shift the culture at our facility with an infusion of learners, challenging

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JALEN, AGE 16

The Pediatric Rehabilitation Program

at Shriners Hospitals for Children — Northern California If your patient has experienced an acute illness, traumatic injury, or complex surgery Shriners Hospitals for Children — Northern California’s Pediatric Rehabilitation Program will provide a child with comprehensive and compassionate care to restore their ability, confidence and independence. Our hospital is nationally ranked for pediatric care and offers specialized, advanced treatment tailored to each child’s unique needs. We serve patients from birth until transition to adulthood with various medical conditions including: » Spinal cord injury » Brain injury » Multiple trauma » Deconditioning

» Acquired amputations and limb deficiencies

» Other musculoskeletal and neurological disorders

» Peripheral nerve disorders (e.g. Guillian Barre)

To Refer a Patient: Call: (916) 453-2191 Fax: (916) 453-2395 Email: referrals.ncal@shrinenet.org

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FALL 2021

us all to be better caregivers,” said Scott Neeley, MD, Chief Medical Officer for St. Joseph’s. “In addition, the Medical Staff at St. Joseph’s has been instrumental in the success of the program, with physicians embracing their role as medical educators.”

Currently nearly 100 physician residents are training at St. Joseph’s, in the areas of emergency medicine, family medicine, internal medicine, anesthesia, psychiatry and transitional year. Additional programs in the works include orthopedic surgery, urology, neurology and interventional radiology.

And the program is working. Of the 14 residents that graduated from the program, nearly half are staying onboard either at the hospital or in the area. Those who aren’t staying local are pursuing fellowships or are leaving to be closer to family.

“This is a great place to work. Residents are really able to develop their clinical chops at St. Joseph’s,” said Sam Kaplan, MD, a graduate who will be staying on as an Emergency Room physician at St. Joseph’s. “The program has amazing leadership and a hybrid approach that provides an opportunity for physicians to help train new physicians, and that’s something I really wanted to be a part of.”

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Graduates of the program appreciate the welcoming atmosphere, clinical excellence and the supportive medical staff at St. Joseph’s. Those sentiments were echoed by Daisy Li, DO, a graduate of St. Joseph’s Family Medicine Residency Program who is opening her own primary care private practice clinic here in Stockton. Dr. Li attended Touro Medical School and was introduced to St. Joseph’s as part of her third-year clerkship.

“I really appreciate the help that St. Joseph’s has been giving to everyone who wants to stay here. There’s definitely a need for primary care physicians in Stockton and that’s both part of why I came to St. Joseph’s for residency training and that’s why I decided to stay here,” said Dr. Li.

FALL 2021

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T: 209.478.2000

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Public Health

Update

New Resources to Combat Opiod Overdoses in san Joaquin County As a follow up to the article entitled “Public Health Update: A Look at the Opioid Crisis in San Joaquin County” in the Winter 2019 issue of San Joaquin Physician, this Update will share new opportunities for physicians in helping to mitigate the evolving opioid overdose epidemic.

In early 2016 in California, the epidemic began to see a steep rise in fentanyl overdose deaths. Fentanyl is a powerful synthetic opioid that is about 100 times more potent than morphine, 30-50 times more potent than heroin. Just two milligrams of fentanyl can be lethal depending on a person’s body size. It is often mixed in with heroin and/or cocaine and meth as a combination drug with or without the user’s knowledge. Illicitly produced fentanyl has also been identified in counterfeit pills, mimicking pharmaceutical drugs such as oxycodone.1 While pharmaceutical fentanyl has been around for years as a transdermal patch or lozenge used to treat severe pain, such as in advanced cancer, the number of overdose deaths as a result of diversion to misuse and abuse had been relatively low. However, cases of fentanyl-related overdoses and deaths have now been associated with illegally made fentanyl and its analogs. As a result, the state saw a 9.5 times increase in overdose deaths from synthetic opioids (excluding methadone) through the third quarter of 2020. Locally, San Joaquin County also saw a steep 15-fold increase in the rate of overdose deaths in just a short period, between the end of 2018 (0.37 per 100K residents) to quarter 3 of 2020 (5.63).

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In December 2020, the Centers of Disease Control and Prevention (CDC) issued a Health Alert Network (HAN) Advisory to alert public health departments, healthcare professionals, first responders, harm reduction organizations, laboratories, and medical examiners and coroners that substantial increases in drug overdose deaths starting in 2019 through now have primarily been driven by synthetic opioids (excluding methadone) such as fentanyl. In addition, the advisory also noted that the acceleration of increase in overdose deaths occurred from March 2020 to May 2020, coinciding with the nationwide implementation of COVID-19 mitigation strategies. Finally, CDC provided targeted recommendations for communities and organizations to respond to the evolving overdose crisis.

The need for broadly disseminated overdose prevention education was emphasized. The recommendations also urged expanding the provision of naloxone, a drug antagonist that is easy to administer as a nasal spray and reverses the effects of opioids within minutes, albeit temporarily.

Naloxone Distribution Program (NDP)

Three years ago, the California Department of Health Care Services (DHCS) created a Naloxone Distribution Program (NDP) to provide free naloxone, in its nasal spray formulation, Narcan. Doses have been distributed broadly across the state, ranging from first responders, fire and law enforcement to harm reduction organizations and homeless programs, to religious organizations, and schools, as well as

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County Public Health and Behavioral Health Agencies. Since October 2018, the NDP has distributed over 600,000 units of naloxone and recorded over 30,000 overdose reversals.

Where do physicians fit in the response to the opioid crisis?

Healthcare providers are often in a position not only to identify individuals who are at risk for substance use disorders and potential overdose but also to provide the necessary resources to educate and prevent overdose deaths. Counseling patients about the changing illicit drug supply and the risks for overdose and exposure to fentanyl can be supported with prescribing or coprescribing naloxone. Individuals who are at risk for overdose, such as those with a prior history of overdose, those with opioid use disorder (OUD), and individuals using illicit opioids and other drugs that might be mixed with illicitly manufactured fentanyl would benefit in having naloxone available so that others around them could potentially reverse an overdose situation, thus avoiding accidental death. Link for application for “free” naloxone: https://www.dhcs.ca.gov/individuals/Documents/NDP-Application. pdf Healthcare providers can expand access to and provide treatment for individuals with OUD. Treatment with the FDA-approved medications methadone, buprenorphine, suboxone, or naltrexone are lifesaving and the most effective forms of treatment for OUD. Assistance through referrals to ensure treatment access can be critical for those transitioning from institutional settings, such as the criminal justice system, residential treatment, or a recent hospitalization.

Medication Assisted Treatment (MAT) Services

While illicit opioids, including heroin and fentanyl, and some

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prescribed opioids that are misused are the most commonly utilized that result in overdoses, it is necessary to acknowledge that opioid use disorder behaviors are responsible for these situations and can be treated through the initiation and referral to medication assisted treatment (MAT) services. One objective for San Joaquin County is to increase the availability and access to Buprenorphine/Naloxone (Suboxone) and other FDA-approved medications, including counseling and behavioral therapies designed to reduce opioid dependency.

How can physicians prescribe Buprenorphine for OUD?

The Drug Addiction Treatment Act of 2000 (DATA 2000), part of the Children’s Health Act of 2000, permits physicians who meet certain qualifications to treat opioid dependency with narcotic medications approved by the Food and Drug Administration (FDA)—including buprenorphine—in treatment settings other than Opioid Treatment Programs (OTPs). Physicians need to obtain a waiver from the separate registration requirements of the Narcotic Addict Treatment Act – 1974. The SUPPORT Act (2018) now affords practitioners greater flexibility in the provision of MAT and extends the privilege of prescribing buprenorphine in office-based settings to qualifying other practitioners such as Nurse Practitioners and Physician Assistants.

DATA 2000 requires training but it has never been easier!

Under new US HHS Practice Guidelines, physicians are no longer required to complete an eight-hour training course to prescribe buprenorphine if they are treating no more than 30 patients at a time. They are also exempt from certification requirements related to counseling and other ancillary services.

These clinicians still must be licensed under state law and have a valid Drug Enforcement Administration registration, and they are required to submit a notice of intent to the Substance Abuse and Mental Health Services Administration (SAMHSA)

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stating their intention to prescribe the drug to receive a federal waiver.

Pain Management Guidelines

Many prescribers involved in pain management may be feeling the pressure of medical boards, law enforcement, and thirdparty payers, not to mention patients that are often demanding and who have unreasonable and unrealistic expectations for their opioid analgesia treatments. Current guidelines for pain management and national prescriber best practice recommendations are readily available.

In summary, this is a call for providers to intervene early with those individuals who are at the highest risk for overdose.

Instituting overdose prevention education, treatment and/or linkage to care and medications for OUD, as well as naloxone distribution can all help to reduce the deadly toll exacted by misuse and abuse of opioids.

References • San Joaquin Physician. Public Health Update: A Look at the Opioid Crisis in San

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Joaquin County https://issuu.com/sjms/docs/sjp_winter_web_2019/56?e=1446001/72667860 • CDC. Fentanyl: CDC’s Response to the Opioid Overdose Epidemic. https://www.cdc.gov/opioids/basics/fentanyl.html • California Opioid Dashboard https://skylab.cdph.ca.gov/ODdash/ • SAMHSA MAT Statutes, Regulations, and Guidelines https://www.samhsa.gov/medication-assisted-treatment/statutes-regulations-guidelines • DATA 2000 Waiver Training Payment Program FAQs https://help.hrsa.gov/plugins/servlet/mobile?contentId=127402850#content/ view/127402850 • US HHS Practice Guidelines for the Administration of Buprenorphine for Treating Opioid Use Disorder. 2021 Apr 28. https://www.federalregister.gov/documents/2021/04/28/2021-08961/practiceguidelines-for-the-administration-of-buprenorphine-for-treating-opioid-use-disorder Authors: Daniel Kim, MPH, CHES Supervising Health Educator and Coordinator, SJC Opioid Safety Coalition San Joaquin County Public Health Services dkim@sjcphs.org Adam Kaye, Pharm.D., PhC, FASCP, FCPhA Clinical Professor of Pharmacy University of the Pacific akaye@pacific.edu

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In Memoriam

In Memoriam ANNIE MARIE SANTOS, MD 1954-2021

Annie Marie Santos was a loving mother and sister, dedicated physician, and an incredibly generous soul. She passed away suddenly on June 24th, at the age of 67.

She was born to Ignacia and Francisco Santos in Hagatna, Guam, on January 19th, 1954, and was one of five children, including Frank, Marie, Tony, and Felix Santos. After losing her parents at a young age, she decided to pursue a career in medicine, starting in Guam, and eventually, Honolulu, Hawaii. In Honolulu, she and her then-husband, Rexford Reynolds, had their only child, Adrienne Santos Reynolds.

Shortly thereafter, the three moved to Lodi, California.

It was here where she practiced medicine for the next 29 years, even opening up her own practice, specializing in family medicine and women's health, helping countless mothers in the delivery room, and eventually finding her true passion, hospice care and home health. She was a member of the San Joaquin Medical Society for 26 years.

Annie was vivacious and loved life. She had a special gift for connecting with others and making them feel loved.

She loved dancing, spending her time with friends and family, and was a lifelong learner. Her favorite flowers were gladiolas.

She is survived by her daughter, Adrienne, her son-in-law, Brian Holman, Adrienne's father, Rexford Reynolds, and her brother, Frank Santos, his wife Soledad, her niece, Marisa, her nephew, Marcus, and her great-nephew, Niko.

DONALD EUGENE KOBRIN, MD 1936- 2021

Donald Eugene Kobrin, MD passed away peacefully at the age of 84 after battling several medical issues in recent years.

Don was a respected neurologist and diagnostician, as well as a skilled debater. He held strong opinions and would love to argue many issues including current events, religion, morality or the best French movies!

Don Attended Roosevelt University in Chicago before studying medicine at the University of Geneva, in Switzerland. He did his internship at Columbia Presbyterian Hospital in New York City, and residencies in neurology at the Cleveland Clinic and UCSF. He opened his private practice in Stockton in 1974, retiring in 2004. He instituted and chaired the first medical 54

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ethics committees at San Joaquin County Hospital, as well as St. Joseph's and Jackson Hospitals.

Don was born in Chicago Illinois in 1936. He was a member of the San Joaquin Medical Society for 47 years.

He is survived by his wife Erdmunda Symon. He is preceded in death by his parents Robert Marcus Kobrin and Goldie Nora Gerber. He is also survived by his former wife, Charlene McIntire, and their two sons; Reuben, his wife Zita, and 3 daughters, as well as Joshua and his wife Talia and their daughter. He is survived by his brothers Richard, and Edward and his wife Shirley as well as many nieces and nephews.

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In Memoriam

In Memoriam RICHARD (DICK) EDWIN BALCH, M.D. 1930–2021

Dick Balch, who passed away at the age of 90, was one of a handful of neurosurgeons who served our area. Trained at UCLA, Balch joined Tom Huff and Don Lamond in 1966, working at St. Joseph’s, Dameron and San Joaquin General Hospitals.

They were the first trio of neurosurgeons to bring their much-needed skills to our county. Later he went out on his own and recruited Karl Gregorius, a fellow UCLA alum; the two practiced in an office that Balch built at 2209 North California Street.

The building has served as the main outpatient center for neurosurgery since the early 1990s.

Balch was an excellent technician, with superb judgment and impeccable medical ethics. Gregorius, his partner for thirteen years, calls him an exemplary model of integrity and skill. Among Balch’s contributions to San Joaquin Neurosurgery was his special interest in acoustic neuromas, a tumor rarely treated in a community setting. In this endeavor, Balch collaborated with his good friend Bill Hambly, an ENT surgeon. Together they set up an anatomy

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lab where they refined the skills that they then applied in the operating room.

Balch trained under Eugene Stern, the founder of the Neurosurgery training program at UCLA and its legendary chief. Gregorius recounts how Balch, during his residency, taught Stern how to perform the anterior cervical discectomy, a procedure that in those days was new and risky. Those who knew Stern find it hard to imagine how such a role switch could have happened.

Stern taught his residents that neurosurgeons were primarily neurologists (the residency required an entire year of neurology), and that morality was the most important basis of neurosurgical practice. Balch exemplified those ideals. In addition to his surgical skill, he was a gifted clinical neurologist and an extremely modest, moral person.

After his retirement in 1991 at age 60, Balch spent three decades in California’s Sea Ranch and Gualala communities.

There he volunteered his carpentry skills for the restoration of the historic barn where the Sea Ranch Thespians perform, and for the building of the Gualala Art Center. He was an avid supporter of environmental conservation and enjoyed numerous backpacking trips to the Sierras.

Balch was born in Los Angeles, California, in 1930. He was the oldest son of Harry Balch, a physician, and Phoebe (Gift) Balch, a nurse. His brother, Michael, followed fourteen months later. The boys initially enjoyed a rural lifestyle, growing up in Stirling City (Butte County), California, where their father was the only physician in town.

During World War II, Harry Balch was stationed in the

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historic Vancouver Barracks in Washington State.

After the war the family settled in Costa Mesa, California, where Balch graduated from high school. He served in the US Coast Guard as an electronics technician for three years during the Korean War, beginning in 1950. While stationed in Honolulu, Hawaii, he met his first wife, Mary Jo (Hamrick) Balch a schoolteacher. They were married for twenty-six years and raised four children before breast cancer claimed her. His second wife, Marilynn (Dittbrener) Balch, was a friend of Mary Jo’s and helped care for her in her final days. The Assistant Director of Nursing at St. Joseph’s at the time, Marilynn had been a nun in the Dominican Order before marrying Balch. She survives him after many happy years together.

Following discharge from the Coast Guard, Balch completed premedical studies at UC Berkeley and medical school at USC. He first came to San Joaquin County as a surgical intern under Bill Brock, who subsequently recommended him to his old UCSF colleague, Eugene

Stern, for neurosurgical residency. After completing his residency, Balch returned to Stockton for his career as an attending neurosurgeon.

In addition to his wife Marilynn, Balch is survived by his four children from his first marriage: Susan Harrington of Aptos, CA; Steven Balch of Santa Rosa, CA; Daniel Balch of Colorado Springs, CO; and James Balch of Stockton, CA, as well as ten grandchildren and ten great-grandchildren.

Dick Balch was an unassuming, no-nonsense person with a lively, dry – sometimes biting – sense of humor. He got directly to the point in any conversation. Well-read and knowledgeable in any number of topics, Balch brewed his own beer and was skilled in carpentry and woodworking.

Ulrich Batzdorf, neurosurgeon, close friend and fellow resident at UCLA, who hosted Balch’s retirement party in 1990, characterized his friend as “a common man with uncommon common sense.” The attribute fits Richard E. Balch perfectly.

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In Memoriam

In Memoriam ROBERT LILIENSTEIN, MD 1928-2021

Robert Wolfgang Lilienstein, age 93, passed away peacefully at home on June 30, 2021. A native of Hamburg, Germany, Robert was born Wolfgang Lilienstein on March 8, 1928 to Isidor and Hilde (Stern). He came to New York City with his parents in 1936 to escape Nazi Germany and immediately became a New Yorker. He fondly remembered each place he lived in the city, friends he had, bakeries and delis he frequented, and that his first job was shining shoes outside of the subway in 1940. He was a proud graduate of The Bronx High School of Science (1946). He served 2 years in the US Navy on the USS Missouri before attending New York University and The Chicago Medical School (1955). He married Henrietta “Honey” Robinson on October 27, 1956 in Yonkers, New York and they were married for 60 years.

He completed his internship at Los Angeles County

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Hospital and his residency at San Luis Obispo County Hospital before completing an anesthesia residency at UCSF. They moved to Stockton, California in 1962 where they raised their 4 children. He was a practicing Anesthesiologist with Stockton Anesthesia Medical Group for over 30 years and spent some time as Chair of the Anesthesia Department of St. Joseph’s Hospital. He was a member of the San Joaquin Medical Society for 52 years.

He was known for his dedication to his job and was passionate about the art and science of his profession, spending free time reading medical journals and anesthesia articles. He enjoyed family trips to Silver Lake, skiing, and spending time with family on the boats that he owned over the years. He and Honey were members of Temple Israel of Stockton for over 59 years and enjoyed extensive world-wide travel in retirement. Robert is survived by his four children, Joanne (Steve), Frieda (Ross), Peter (Lynette), and David (Sandy), ten grandchildren, and three great-grandchildren.

He was preceded in death by his parents, Isidor Theo and Hilde Johana Lillienstein, his sister Ruth (Lilienstein) Liepman, his brother, Manfred Lilienstein, and his wife, Henrietta “Honey” (Robinson) Lilienstein. The family wishes to thank the staff of Community Hospice and the caregivers of Visiting Angels for their thoughtful service and tender care over the past 4 years. In lieu of flowers donations can be made to Community Hospice.

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