Winter 2015

The Governance Reform Legislative Wrap UP House of Delegates

Edge

Winter 2015 WINTER 2015

SAN JOAQUIN PHYSICIAN

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SAN JOAQUIN PHYSICIAN

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VOLUME 63, NUMBER 4 • DECEMBER 2015

Lodi Memorial Hospital’s Robotic Institute of Northern California

{FEATURES}

13 18 34 44 WINTER 2015

GOVERNANCE REFORM

CMA streamlines governance body to focus on critical issues

LEGISLATIVE WRAP UP

{DEPARTMENTS} 24 IN THE NEWS

New faces and Announcements

Powerfully Benefiting and Protecting the Community

54 PUBLIC HEALTH

THE CUTTING EDGE

56 PRACTICE MANAGEMENT:

Lodi Memorial Hospital’s Robotic Institute of Northern California

HOUSE OF DELEGATES

California Medical Association delegates set policy and elect officers at annual meeting

Reminder: Let’s Wash Our Hands!

Committed to Improving Quality Health Care

59 NEW MEMBERS 61 IN MEMORIAM

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PRESIDENT John Zeiter, M.D. PRESIDENT-ELECT Moses Elam, M.D. PAST-PRESIDENT Ramin Manshadi, M.D. SECRETARY-TREASURER Kwabena Abudofour, M.D. BOARD MEMBERS Raissa Hill, DO, Grant Mellor, M.D., Dan Vongtama, M.D., Alvaro Garza, M.D., Mohsen Saadat, DO, Clyde Wong, M.D., George Savage, M.D., Phillip Yu, M.D., Peter Garbeff, M.D.

MEDICAL SOCIETY STAFF EXECUTIVE DIRECTOR Lisa Richmond MEMBERSHIP COORDINATOR Jessica Peluso ADMINISTRATIVE ASSISTANT Nicole Bojorques

SAN JOAQUIN PHYSICIAN MAGAZINE EDITOR Lisa Richmond EDITORIAL COMMITTEE John Zeiter, Lisa Richmond, Mike Steenburgh MANAGING EDITOR Lisa Richmond

COMMITTEE CHAIRPERSONS DECISION MEDICINE Kwabena Adubofour, M.D. LEGISLATIVE Jasbir Gill, M.D.

CONTRIBUTING WRITERS James Noonan, John Zeiter, M.D.,

COMMUNITY RELATIONS Joseph Serra, M.D.

Alvaro Garza, M.D., MPH, Kelly Rose, MPH

PUBLIC HEALTH Alvaro Garza, M.D.

THE SAN JOAQUIN PHYSICIAN MAGAZINE

SCHOLARSHIP LOAN FUND Janwyn Funamura, M.D.

CREATIVE DIRECTOR Sherry Lavone Design

is produced by the San Joaquin Medical Society

CMA HOUSE OF DELEGATES REPRESENTATIVES

SUGGESTIONS, story ideas or completed stories written

Robin Wong, M.D., Lawrence R. Frank, M.D.,

by current San Joaquin Medical Society members

James R. Halderman, M.D., Roland Hart, M.D.,

are welcome and will be reviewed by the Editorial

Grant Mellor, M.D., Kwabena Adubofour, M.D.,

Committee.

Raissa Hill, D.O., Ramin Manshadi, M.D. 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 Email Address: lisa@sjcms.org MEDICAL SOCIETY OFFICE HOURS: Monday through Friday 9:00 AM to 5:00 PM Closed for Lunch between 12pm-1pm

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Confidence The feeling you have when you are affiliated with Hill Physicians.

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We provide the tools and support that practices need to be financially successful and improve the coordinated care experience for their patients. Our advantages include: • Fast, accurate claims payments • Free eReferrals 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 3,800 independent primary care physicians, specialists and healthcare professionals have joined Hill. Feel confident in the future of your practice and your patients by affiliating with Hill Physicians Medical Group.

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Letter From The Executive Director

STAFF REPORT

THE CHANGING FACE OF MEMBERSHIP If you have ever been by our offices, you have seen the rich history and reminders of the past including old newsletters, physician paraphernalia, and pictures of every President of San Joaquin Medical Society since 1903! It used to be customary for all physicians to join their local medical society. It was a way for independent physicians to get acquainted with the community through networking with local colleagues, build referral bases, and even make new friends. As time as passed and many new care models were introduced, the face of our membership-and consequently-our Board of Directors has changed and expanded to include not only independent physicians, but small groups and large groups such as The Permanente Medical Group and Sutter Gould Medical Group. I believe that embracing the diversity of our membership in every aspect is the key to our success for years to come!

LISA RICHMOND

For this reason, I am excited about this issue’s feature story on the Robotic Institute of Northern California. It is inclusive of our member surgeons from various practice settings and specialties who are enthusiastic about the cutting edge technology that is now available to patients via the two state of the art daVinci robots at Lodi Memorial Hospital. Due to the minimally invasive nature of this technique, patients are experiencing less pain and discomfort and shorter hospital stays. I invite you to read more about RINC on page 34 .

We often talk about advocacy as one of the intangible, yet most important, member benefits of joining SJMS/CMA. Each year a group of seven dedicated SJMS Delegates participate in the legislative process as they meet with hundreds of their peers from throughout California at the annual CMA House of Delegates Conference. They pour through the countless resolutions and make recommendations based on their experience and expertise. It is exciting to see the passion of the physicians as they testify and debate their position on a particular issue, such as Physician Aid-In-Dying. Please read CMA’s 2015 Legislative Wrap for more details regarding this year’s important advocacy and legislation.

NICOLE BOJORQUES

Finally, I am excited to introduce our new Administrative Assistant, Nicole Bojorques. I met Nicole a couple of years ago as a volunteer at our annual golf tournament and am thrilled to have her as part of our SJMS team. Please stop by and introduce yourself at this year’s Holiday Party on Thursday, December 10. The enclosed ad will provide you details on all of this year’s festivities. Hope to see you there!

Happy Holidays,

Lisa Richmond

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SA

AQ N JO

UIN MEDICAL SOC

IET

INVITES YOU TO A

Y

Holiday Party THURSDAY | DECEMBER 10 | 2015 STOCKTON GOLF & COUNTRY CLUB 6:00pm Cocktail Reception | 7:00pm Dinner Join us for hosted cocktails & hors d’oeuvre reception, with a lovely dinner and entertainment $35 Per Person for Physician Members & their Guests $60 Per Person for Non-Members Please make your reservation before December 3 by calling the San Joaquin Medical Society at 209-952-5299

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WINTER 2015

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A message from our President > John Zeiter, M.D.

Getting High on PCP No, this isn’t a throw-back article from the ‘60s. And, yes, this is an article about physicians getting high on PCP--Passion, Compassion and Philanthropy.

Several weeks ago, I was asked to present awards at the March of Dimes VIP Event to three dedicated physicians. Drs. Scott Foster, Timothy Yao, and Ronaldo Hipolito were honored for years of work with premature babies in the Neonatal Intensive Care Units in our area. In addition, these physicians teach at local universities and residency programs, travel to developing countries to share their knowledge, and give back to their communities in various ways. Recently, the Hospice of San Joaquin honored Dr. Robert Brown for his 35 years of service with our local Hospice and his 50+ years of dedicating his life to caring for patients in our community.

At the SJMS annual membership dinner, Dr. Javad Jamshidi received the Lifetime Achievement Award for his nearly 40 years of service as a radiologist in San Joaquin County, his innovation in bringing CT Scans and the MRIs to our area, and for his role in educating the underserved children of Iran where he and his wife, Mitra, have built two schools! At that same event, Dr. Steven Billigmeier was recognized with the Young Physician’s Award for his tireless efforts caring for our children, performing hundreds of volunteer high school physicals, and continuously giving back to his community. I could cite hundreds of other similar examples of physicians in our county, our state, and our country (including one currently running for President of the United States) that pour forth passion, compassion, and philanthropy into their professional and personal lives.

So what motivates these, and so many other physicians, to spend four years after college intensely studying anatomy, physiology, pathology, pharmacology, and every other subject related to the normal and abnormal functions of the human body? And then spending four more ABOUT THE AUTHOR ­ John H. Zeiter, M.D. is the managing partner of Zeiter Eye Medical Group and a Volunteer Clinical Professor at the UC Davis Eye Center. Dr. Zeiter is currently President of the San Joaquin Medical Society.

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A message from our President > John Zeiter, M.D.

years in hospitals, operating rooms, and clinics working 80-100 hours per week training in various specialties of medicine? And then, finally, at age 30-35 starting their life’s journey of caring for patients until they’re 60, 70, or even 80 years old? They have to be high on PCP! Passion is defined as a compelling enthusiasm for something and is known to be an important motivator for an occupation. Individuals who are passionate about their profession tend to get more work done at higher levels of performance, have

(CEOs, attorneys, etc). Compassion compels us to do more than work long hours—it is our active desire to alleviate another’s suffering.

Compassion is a quality abundantly present in the physicians mentioned above and certainly a quality that patients both respect and require.

Recently, Assembly Bill ABX2-15 was signed into law by Governor Jerry Brown after the State Senate overwhelmingly passed this Bill that allows mentally-capable, terminally ill adults the option to request a physician’s prescription

“...people that are passionate about their job tend to work extreme hours, long weeks, and retire later in life (or never retire).” more work satisfaction, and enjoy a higher level of psychological wellbeing. Furthermore, people that are passionate about their job tend to work extreme hours, long weeks, and retire later in life (or never retire).

Does that sound familiar? How many physicians retire in their 50’s or 60’s—not many! In fact, retiring to a physician usually means cutting back office hours or limiting surgeries.

And despite the dramatic changes in healthcare, physicians strive to find ways to adapt, so they can continue to follow their passion of taking care of patients. As I mentioned in my last President’s message, despite tangible deterrents, bountiful numbers of qualified medical school applicants apply to find this passion.

Although passion is a key motivator in most physicians’ lives, it is their compassion that sets them apart from the many other occupations that require passionate leaders

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for aid-in-dying drugs to painlessly and peacefully hasten their death.

The CMA originally opposed this bill; however, the majority of physician members surveyed by the CMA were, in fact, in favor of the bill. Although there are many philosophical, ethical and religious arguments for each side, the known compassion of physicians trumped all the controversy, and the CMA, obligated by the desires of its members, recommended a few changes to the bill and did not oppose the final version.

While passion and compassion are important motivators for most physicians, it is their tireless philanthropic efforts that not only stimulate the respect of their patients and the community at large, but also provide the inner satisfaction to continue practicing medicine with the same passion and compassion with which they started after medical

school. Philanthropy literally means “love of humanity,” and is defined as an altruistic concern to promote the welfare and advancement of others through goodwill. Our everyday work as physicians caring for patients may be filled with compassion, but it is not philanthropic—we get paid to see patients. However, philanthropy is abundant throughout our profession and especially throughout this community of San Joaquin County. Su Salud, Saint Mary’s Dining Hall, the Gleason House, and the RotaCare clinic are just a few of the many free health clinics staffed by physicians in our community. In addition, hundreds of local physicians treat uninsured patients without compensation, volunteer their time with various local non-profits, travel overseas to perform medical mission work, volunteer teach at local hospitals and surrounding universities, and/or donate their time, talent, and treasure to promote goodwill to fellow members of the human race. The Hippocratic Oath states very clearly that in addition to “upholding specific ethical standards,” the physician is obliged to “remember that I remain a member of society with obligations towards my fellow human beings.”

Interestingly enough, helping mankind by passionately caring for patients every day and compassionately doing to others as you would have them do to you is not enough for most physicians.

Philanthropy is that third virtue that makes the complete physician. So, “physician heal thyself,” “first do no harm,” and “get high on PCP.”

WINTER 2015

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The

Road

to Governance Reform: CMA streamlines governance body to focus on critical issues By: Elizabeth Zima, CMA Staff Writer

With 40,000 members, and one of the

betterment of the medical profession. Over

most skilled and respected staffs in

the years, however, CMA’s democratic

the industry, few would argue that the

governance structure had evolved into one

California Medical Association (CMA) is a

that was sometimes unable to act quickly

dominant force in health care. Whether it’s

on important issues. It was a problem that

defending the Medical Injury Compensation

had been discussed in various committees

Reform Act (MICRA) from repeated

at various times, but it wasn’t until recently

attacks, protecting California’s patients

that the abstract discussions about

from unsafe and unwarranted scope

“governance reform” began to produce

expansions, or ensuring physicians have

concrete results.

the autonomy and stability to provide their patients with high quality care, CMA has

At last year’s annual meeting, CMA’s House

proven once and again to have the clout to

of Delegates (HOD) approved governance

accomplish great things.

reforms that will make CMA even more relevant and effective by focusing the

Those great things are about to get even

association on, and bolstering its resources

greater, with the association poised to

to address, the critical issues of universal

undertake a substantial change to its

importance to physicians. Those reforms

governance structure.

took effect at the close of this year’s meeting, October 18, 2015.

CMA was established in 1856 with a mission

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very similar to the one we follow today—to

The new governance structure will position

promote the science and art of medicine,

our association as a nimble, proactive

the care and well-being of patients, the

organization ready to lead the practice of

protection of the public health and the

medicine for another 150 years. >>

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2010

2011

2012

Then and Now For more than 150 years, CMA has been guided by the House of Delegates (HOD), which meets once a year to set policies and direct resource allocation. This has led to a sometimes unwieldy 581 member HOD; a 50+ member Board of Trustees; a seven member Executive Committee; and hundreds of other members serving as alternate delegates and in various capacities in dozens of councils, committees, sections and mode of practice forums.

Today’s technologies and changing public expectations have led to a more rapid pace with regulations and legislation being put forth throughout the year. CMA’s annual process often did not allow the HOD to react in real time. As a consequence, the HOD had grown increasingly tangential to the public policy debate shaping the direction of health care and the future of the profession.

In 2012, the Governance Technical Advisory Committee (GTAC) was created and charged with offering suggestions to make CMA’s decision-making process more nimble. The GTAC, representing CMA’s diverse physician members, took a careful look at how CMA could better and more quickly protect the interests of its physician members and their patients.

The GTAC concluded that CMA’s governance structure, which vests its ultimate policy- and decision-making authority in a legislative body that meets one weekend a year, was outdated and ultimately encumbers CMA’s effectiveness and ability to move quickly on important issues.

In 2013, the GTAC recommended, and the HOD adopted, a proposal to create a more modern, efficient system of governance and enable more focused and 14

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effective advocacy programs. In 2014, the HOD approved updates to CMA’s bylaws to enable these changes.

CMA’s long-standing traditions of democratic participation and representative governance will continue, but the HOD will focus on the most important matters facing physicians and the practice of medicine. The new HOD structure will focus on a limited number of current major issues—the most pressing matters facing physicians and the practice of medicine each year, while the Board of Trustees will assume responsibility for policy-making on all other matters.

The new bylaws will also allow the submission of resolutions from individuals throughout the year, rather than just once a year, allowing CMA to react quickly—via its democratically-elected Board of Trustees—to critical issues in real time.

Policy on other issues will benefit from a more careful and expert deliberative process throughout the year, rather than a rushed annual exercise. Any CMA member may author a resolution and have it submitted to the Board of Trustees using the yearround process. This approach preserves the ability of individual members to participate in and inf luence CMA policy-making in a more timely way, rather

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2013

than waiting for a once-a-year opportunity at the HOD, which had been CMA’s tradition.

The new year-round resolution process will closely parallel CMA’s existing HOD process. Resolutions will be screened by the HOD Speaker and Vice Speaker, then assigned to councils for study and development for future action. Resolutions will be posted to the CMA website for online testimony from all CMA members before recommendations are developed for Board action.

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2014

The CMA Board of Trustees also approved the restructuring of CMA councils and committees in a way that will equip these bodies to assist the Board and HOD in driving CMA policy. Committees will be assigned to specific subject areas, which will foster the development of expertise in CMA policy-making and bring greater continuity to the process. The new councils will function much like the old HOD Reference Committees, receiving testimony on issues and preparing reports for action by the Board or HOD. >>

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Governance Reform > CMA

2015

The New House of Delegates In 2016, HOD will become a two-day meeting during which delegates will discuss and vote on the most important issues facing CMA members and the practice of medicine, including any items that the Board refers to the House. Delegates will also elect officers, receive annual reports on the actions of the standing councils and committees during the previous year, and attend educational sessions on key issues.

The issues of the day that the full House will debate and vote on will be identified by the Speaker, Vice Speaker and Speaker’s Advisory Committee (composed of delegation chairs)—informed by research and polling of the membership; research and polling within the HOD delegation; a summary of the issues and actions that the Board and the Executive Committee addressed the previous year; copies of reports and recommendations produced by committees and councils during the past year; status reports on the implementation, outcome and actions taken by the Board to implement prior HOD actions; and an assessment by the CMA CEO concerning major issues affecting the practice of medicine and the association as a whole.

One of the most contentious proposals from the GTAC was to downsize both the HOD and the Board of Trustees. Ensuring adequate representation for CMA’s many subgroups, practice types, geographic areas, modes of practice and career phases proved to be a

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delicate balancing act. In the end, the delegates achieved consensus and agreed to reduce the size of the House by 91 members—from 591 to 500 delegates. The board was also slimmed down from 70 members to 35.

CMA would like to thank those members who participated in this three-year process, particularly the GTAC members who worked so hard on this proposal, and the trustees and delegates who debated the issues. CMA hopes the change in governance style will bring about a more versatile and agile association that better represents its members’ needs and ideals.

The distance traveled on the road to reform would not have been possible without a great deal of courage, sacrifice and trust that participating members and leaders have displayed. The cooperative spirit enabling this achievement, carried forward as reforms are implemented and fine-tuned, will further strengthen CMA’s effectiveness in carrying out its core mission.

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One of only 11 California health plans to achieve NCQA Accreditation for its Medi-Cal HMO line of business.

The National Committee for Quality Assurance (NCQA) recently awarded Health Plan of San Joaquin (HPSJ) a Three-Year Health Plan Accreditation for its Medicaid/HMO line of business. The official award recognizes HPSJ as “accredited for service and clinical quality that meet or exceed NCQA’s rigorous requirements for consumer protection and quality improvement.”

Lakshmi Dhanvanthari, MD Chief Medical Officer Health Plan of San Joaquin

Our recent accreditation from NCQA is especially gratifying in that it acknowledges both the quality of care that HPSJ offers to members through our network, as well as the hard work by our providers, together with HPSJ staff, to attain this level of unique national recognition.

T H E C A LI FOR N I A M EDIC A L A SSOCI AT ION

POWERFULLY BENEFITS AND PROTECTS T H E COM M U N IT Y It is difficult to imagine, but the 2015 legislative year was even more challenging than the 2014 legislative year, which included the diversion of staff resources to defeat Proposition 46. With a third of legislators (40 out of 120) serving freshman terms, the California Medical Association’s (CMA) Government Relations staff spent a considerable amount of time during the first quarter educating new legislators and their staff about the mission and policies of CMA. Through our educational efforts, we successfully stopped the introduction of a number of harmful legislative proposals and shifted focus to the passage of CMA’s sponsored bill package.

C M A’ S 2 01 5 L E G I S L A T I V E W R A P U P

BY JANUS L. NORMAN, CMA SENIOR VICE PRESIDENT

SCHOOL VACCINES

A majority of our resources this year went to the passage of SB 277 (Pan and Allen), our sponsored bill eliminating the personal belief exemption (PBE) for school vaccination requirements. We faced relentlessly vocal opposition from anti-vaccine activists, who were supported by the California Chiropractic Association and the newly founded Public Health Council. As it moved through the Legislature, SB 277 had four hearings in various committees, each of which was flooded by protesters. Our strategy to overcome this deluge was to counteract on the same grassroots level from which we were attacked. CMA engaged with school districts, county boards of supervisors and all levels of local government to strengthen support for the bill. Through these and our more traditional lobbying efforts, we were able to see the bill passed out of the Legislature and sent to the Governor’s desk. Although the Governor had 12 days to pass or veto the measure, he chose to sign SB 277 into law less than

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Legislative Wrap Up > CMA

24 hours after he received it. In his signing naturopathic doctors; and SB 622 (Hernandez), for optometrists. Each of the bills claimed to message, he wrote, “The science is clear that expand the scope of practice for allied health vaccines dramatically protect children against professionals as a means of ameliorating a number of infectious and dangerous diseases.

California’s access to care crisis, but, in reality, While it’s true that no medical intervention posed a danger to patients. Through diligent is without risk, the evidence shows that lobbying and with the engagement of our immunization powerfully benefits and protects physician members calling and writing their the community.” legislators, CMA convinced lawmakers of SB 277 also garnered tremendous support in that truth. Each bill was successfully killed in the press and from the physician community at either a policy or fiscal committee, sending an large. All through the year, this bill made state unequivocal rejection of scope expansions as an and even national headlines. The New York answer to access to care issues. Year after year, Times, often regarded as the national “newspaper these expansions are rejected by the Legislature, of record,” even editorialized in support of demonstrating that the physician voice still the bill. After SB 277 became law, Senator “Our strategy to overcome this deluge was to counteract on Richard Pan, M.D., the same grassroots level from which we were attacked.” was lauded by TIME magazine as a “hero of vaccine history,” while holds sway at the Capitol. the Journal of the American Medical Association Scope of practice fights generally play out pointed to SB 277 as a potential catalyst and similarly, except, this year, for one unique model for stricter vaccine requirements across experience. An amicable solution was reached the nation. The New England Journal of Medicine on AB 1306 (Burke), relating to certified nurse chronicled the entire SB 277 story, describing a midwives (CNMs). Negotiations with the sea change in the national politics of vaccination.

CNMs were productive and in time we were We continue to regularly field calls from allies able to reach an agreement, moving CMA to a across the country who are seeking to learn more neutral position. Ultimately, however, this bill, about what we accomplished and how we did it. too, died in committee.

Unfortunately, our time to celebrate the hardwon victory was not long, as we quickly had to PHYSICIAN AID-IN-DYING turn our attention to new attacks: a referendum Another fruitful negotiation centered on SB 128 to overturn the new law and a recall effort (Wolk and Monning), the physician aid-in-dying against Dr. Pan for his authorship of it. Through bill. This controversial measure demanded a lot CMA’s political action committee, CALPAC, we of attention from CMA. We began the year with will continue to work to defend Dr. Pan and his a longstanding House of Delegates-established important law from this spurious attack. policy of opposition to this subject. It soon

SCOPE OF PR ACTICE

Throughout the year, CMA dedicated a vast amount of resources to the successful defeat of several scope-of-practice expansion attempts that were before the Legislature.

These measures were: SB 323 (Hernandez), for nurse practitioners; SB 538 (Block), for

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became clear, though, that this was no longer the overwhelming stance of the membership that it once was. CMA’s physician leaders began a conversation with our physician members so that we could update our official policy to reflect the new, nuanced views of our members.

CMA became the first medical association in the nation to move from opposition to neutrality

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Legislative Wrap Up > CMA

on physician aid-in-dying. Having received CUR ES permission from our Council on Legislation and In the final days of the session, while almost all from our Board of Trustees to engage with the eyes were watching the major political fights, bill’s proponents in hopes of reaching solutions, CMA staff went to work with Assemblymember CMA’s lobbyists, in conjunction with CMA’s Travis Allen to extend the Controlled Substance Center for Legal Affairs, entered exhaustive Utilization Review and Evaluation System negotiations. Although CMA had become (CURES) registration deadline for all prescribers neutral on the concept of physician aid-in-dying, and furnishers. On Thursday, September 10, there were still concerns to be addressed about CMA and Assemblymember Allen gutted and the bill’s language. Through countless meetings, amended AB 679 to extend the deadline from a final comprehensive solution was reached and CMA officially ”AB 533 would have drastically changed the current health became neutral on the bill. care marketplace by allowing a massive transfer of negotiating The crucial amendments power to the health plans at the expense of physicians.” that were secured to reach that agreement included the strongest statutory immunity protections for physicians, January 1, 2016, to July 1, 2016. This extension voluntary participation protections and mental will allow the Department of Justice to roll out health evaluations. After SB 128 failed in the its automated registration process and protect Assembly Health Committee, its cause was doctors from being disciplined by the Medical revived through a bill, ABX2 15 (Eggman), Board of California during the system roll-out. in the special session on health care called by In two days, the bill was heard in Senate the Governor. This bill ultimately retained our Business and Professions Committee, on the negotiated amendments and our neutrality, and Senate Floor and on the Assembly Floor. AB was passed by the Legislature on its last day in 679, as amended on September 10, passed the session. On October 5, the Governor signed the Legislature without receiving a single “no” vote. bill into law.

The measure also included an urgency clause, meaning the bill goes into effect as soon as it is WOR K ERS COMP signed by the Governor.

The physician aid-in-dying bill was far from our only instance of exhaustive negotiations “SUR PR ISE” BILLING this year. CMA also took part in extensive Our other focus in the final days was the discussions regarding AB 1124 (Perea), a bill completion of a year-long fight. AB 533, that would require the Division of Workers’ introduced by the Chair of the Assembly Compensation to establish a prescription Health Committee, Rob Bonta, initially seemed formulary. After several months of diligent like a matter of negotiation. We had a good negotiations, we reached an agreement with relationship with the author, and we shared his the author’s office that moved our position to goal of addressing the “surprise billing” problem. neutral. Through negotiations on this bill, CMA Instead, over the course of the year, those solidified its standing as a full stakeholder in negotiations became increasingly hostile until workers’ compensation. they finally deteriorated to an all-out war.

Going into the last week of the legislative session, AB 533 would have drastically changed

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SAN JOAQUIN PHYSICIAN

21

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SAN JOAQUIN PHYSICIAN

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Legislative Wrap Up > CMA

the current health care marketplace by allowing a massive transfer of negotiating power to the health plans at the expense of physicians. The bill would have required noncontracted physicians and dentists to accept Medicare rates as payment in full when performing services in a contracted or “in-network” facility. In addition, the bill would have implemented barriers for PPO patients seeking to access their out-ofnetwork benefits. Overnight, the bill became essentially a health plan-sponsored bill, with the strong support of consumer groups and organized labor.

With myriad resources, the health plans spent tens of thousands of dollars hiring contract lobbying firms to lobby in favor of AB 533. The California Federation of Labor, the California Firefighters and most of organized labor, who were misinformed about the full contents of the bill, also lent their political muscle to the passage of bill, for they believed it would protect patients from exorbitant, unexpected bills. Finally, the California Chamber of Commerce and consumer groups, led

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by Health Access, also spent their political resources in favor of the bill.

In order to defeat AB 533, it was all hands on deck at CMA and we called upon our Legislative Key Contacts, CMA officers and medical executives, asking them to call their legislators on the last night of session to ask them to vote no on AB 533.

CMA was also able to call upon the specialty societies and two of our closest allies to stand in opposition: the California Dental Association and the California Podiatric Medical Association.

After countless hours of lobbying and passionate debate in the halls and on the floors of the State Capitol, CMA and our allies defeated the measure on the floor of the State Assembly. This CMA victory was the final act taken by the Legislature in 2015, solidifying this year as one of the most challenging and one of the most successful.

FOR MORE DETAILS ON THE MAJOR BILLS THAT CMA FOLLOWED THIS YEAR, VISIT HTTP:// CAL.M.D./LEG-WRAP-2015.

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23

In The News

IN THE

NEWS New Physician-In-Chief appointed for Kaiser Permanente in the Central Valley

Sanjay Marwaha, M.D., a head and neck surgeon, has been selected as the new physician-in-chief of Kaiser Permanente’s Central Valley Area.

Dr. Marwaha succeeds Moses Elam, M.D., who served in this role for the past 12 years..

As Physician-in-Chief, Dr. Marwaha has responsibility for more than 2,300 physicians and support staff who provide medical services at Manteca and Modesto medical centers, and in Kaiser Permanente’s medical offices in Modesto, Stockton and Tracy.

Partnering with Kaiser Foundation Hospital/Health Plan leaders, he oversees the health care of more than 295,000 Kaiser Permanente members in Stanislaus and San Joaquin counties.

“It is a great honor and privilege to Sanjay Marwaha, M.D. be selected by The Permanente Medical Group’s Board of Directors to take on this physician leadership role,” Dr. Marwaha said. “I came to Kaiser Permanente to provide exceptional medical care to patients, and I am proud to be part of an excellent team of physicians, nurses and staff in the Central Valley who are fully committed to delivering the highest quality health care in the area.”

Dr. Marwaha joined The Permanente Medical Group in

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

1998 and has held numerous leadership roles, including Chairman of Head and Neck Surgery and assistant Physician-in-Chief. As an Otolaryngologist, he cares for adults and children with ear, nose and throat problems, cancer, and voice problems. In addition, he performs facial plastic surgery.

Dr. Marwaha received his medical degree from Johns Hopkins University School of Medicine in Baltimore, and completed his residency at the University of Maryland. He is also board-certified in Head and Neck Surgery.

Foad Elahi, M.D. joins Doctors Hospital of Manteca specializing in Pain Medicine, and Physical Medicine and Rehabilitation

Foad Elahi, M.D. has joined Doctors Hospital of Manteca.

He is double board-certified through the American Board of Physical Medicine and Rehabilitation in Pain Medicine and Physical Medicine and Rehabilitation.

He currently practices at California Center of Pain Medicine & Rehabilitation in Manteca.

He is a graduate of Shahid Beheshti Medical Sciences in Tehran, Iran and practiced neurosurgery for 14 Foad Elahi, M.D. years. Previously he was Assistant Professor at the University of Iowa Hospital and Clinics. He has spent the last 5 years practicing pain management.

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In The News

Dr. Elahi’s office is located in Manteca at 1144 Norman Dr. #104. Dr. Elahi is accepting new patients. For more information please call 209-824-4400.

Jack Andrew Harvey, M.D. joins Doctors Hospital of Manteca specializing in Podiatric Medicine.

Dr. Harvey was born and raised in Manteca, CA. After graduating from Manteca High School in 2000, Dr. Harvey received his B.S. in Biochemistry from the University of California at Los Angeles. After completing his undergraduate education, he went on to obtain a Doctorate in Podiatric Medicine in 2012 from the California School of Podiatric Medicine at Samuel Merritt University in Oakland, CA. He was accepted as a resident at one of Jack Andrew Harvey, M.D. the country’s best residency programs at the Kaiser North Bay Consortium based in Vallejo, CA, where he became familiar with a variety of advanced techniques and procedures, including rear foot and ankle surgery. Dr. Harvey is excited to be able to return to his home town along with his wife and three children.

Dr. Harvey’s office is located in Manteca at 1210 E. North St. Dr. Harvey is accepting new patients. Dr. Harvey is also fluent in Spanish. For more information please call 209-823-2700.

San Joaquin General Hospital Receives the Stroke Gold-Plus Quality Achievement Award -Stroke Roll Elite

San Joaquin General Hospital has received the American Heart Association/American Stroke Association’s Get With The Guidelines®-Stroke Gold Plus Quality Achievement Award with Target: StrokeSM Honor Roll Elite. The award recognizes the hospital’s commitment and success ensuring that stroke patients receive the most appropriate treatment according to nationally recognized,

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research-based guidelines based on the latest scientific evidence.

To receive the Gold Plus Quality Achievement Award, hospitals must achieve 85 percent or higher adherence to all “Get With The Guidelines-Stroke” achievement indicators for two or more consecutive 12-month periods and achieved 75 percent or higher compliance with five of eight “Get With The Guidelines-Stroke” quality measures.

To qualify for the Target: Stroke Honor Roll Elite, hospitals must meet quality measures developed to reduce the time between the patient’s arrival at the hospital and treatment with the clot-buster tissue plasminogen activator, or tPA, the only drug approved by the U.S. Food and Drug Administration to treat ischemic stroke. If given intravenously in the first three hours after the start of stroke symptoms, tPA has been shown to significantly reduce the effects of stroke and lessen the chance of permanent disability. San Joaquin General Hospital earned the award by meeting specific quality achievement measures for the diagnosis and treatment of stroke patients at a set level for a designated period.

According to the American Heart Association/American Stroke Association, stroke is the number five cause of death and a leading cause of adult disability in the United States.

On average, someone suffers a stroke every 40 seconds; someone dies of a stroke every four minutes; and 795,000 people suffer a new or recurrent stroke each year.

Jason Whitney joins Lodi Health as Assistant Vice President of Business Development and Integration

Lodi Health has announced the appointment of Jason Whitney as the new assistant vice president of Business Development and Integration. In his new role, Whitney will serve on the organization’s executive leadership team and report to President and CEO Daniel Wolcott.

Whitney will oversee business development, community Jason Whitney development,

SAN JOAQUIN PHYSICIAN

25

In The News

IN THE

NEWS marketing, public relations and IT. He will also play a crucial role in Lodi Health’s move to a new healthcare delivery system.

“I am excited to have Jason join Lodi Health,” Wolcott said. “His experience and energy will enhance our ability to fulfill our mission and to extend our services that we provide to this community.”

Whitney has spent over five years in business strategy, and since 2012 has served as Adventist Health’s director of business strategy. Prior to that, Whitney spent five years in various roles in IT. He has had responsibilities in mergers and acquisition, as well as market development. He played a key role in every stage of the Lodi HealthAdventist Health affiliation and has

been working closely with many staff at Lodi Health. His first day in Lodi will be Nov. 2.

Whitney has a Bachelor’s degree from Pacific Union College in Angwin, Calif. and Master of Business Administration with an emphasis in finance and strategic management from the University of California, Davis.

Whitney and his wife, Jenny, have two children: Allison and Justin, and plan to relocate to Lodi.

Dr. Jorge Oceguera awarded 2015 Physician of the Year Mission Award

Lodi Health’s Dr. Jorge Oceguera, M.D., has been awarded the 2015 Physician of the Year Mission Award by Adventist Health. The organization annually selects a

Jorge Oceguera, M.D. winner from each of its hospital/clinic systems. Those selected meet criteria focused on the provision of total health care with an emphasis on wellness, spiritual health and quality care with compassion.

Dr. Oceguera brings a positive attitude and focus to Lodi Health Physicians Galt Family Specialty Care, where he mentors his staff,

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 lisa@sjcms.org one month prior to publication (February 1st for the Spring issue, May 1st for the Summer issue, August 1st for the Fall issue and November 1st for the Winter issue).

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In The News

encourages teamwork, and assures patients are cared for and pleased with their experience.

“You will often see Dr. O in the background living as an example we are all fond of in this journey of life,” said Executive Director of Physician’s Administration Pam Schneider, RN, MSN. “He is compassionate, caring and understands the ‘whole-person care’ philosophy.”

Dr. Oceguera has worked at Lodi Health for 14 years and is well-respected by colleagues and friends. He lives in the Galt community and is honored to be a part of Lodi Health. Dr. Oceguera was honored at the 2015 Physician of the Year Mission Award event in October, where 20 of Adventist Health’s physicians were recognized and celebrated.

Dameron Hospital Recognized for Quality Bariatric Surgery

Dameron Hospital has been recognized by Blue Shield of California as a Blue Distinction® Center in bariatric surgery as part of the Blue Distinction® Centers for Specialty Care program. Blue Distinction Centers are nationally-designated healthcare facilities shown to deliver quality specialty care, based on objective measures that were developed with input from the medical community, for patient safety and better health outcomes.

To receive a Blue Distinction Center for Bariatric Surgery designation, a healthcare facility must demonstrate success in meeting patient safety as well as bariatric-specific quality measures,

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including complications and readmissions for gastric stapling and/or gastric banding. A healthcare facility must also have earned national accreditations at both the facility level and the bariatric care-specific level.

According to Dameron Hospital President and Chief Executive Officer Lorraine Auerbach, this designation is another validation of the excellent quality of the hospital’s programs and services, which includes the bariatric surgery program. Dameron Hospital’s bariatrics program has also been recognized by the American College of Surgeons as an accredited bariatric center.

Bariatric surgeries are among the most common elective surgeries in the U.S. There were 179,000 bariatric surgeries performed in 2013, according to the American Society of Metabolic and Bariatric Surgery, and the average cost is more than $28,000 per episode, according to the Journal of the American Medical Association.

“Dameron Hospital has been consistently increasing its volume of bariatric procedures and the number of participants in its weight loss program,” said Dameron Hospital Vice President of Medical Affairs and Chief Medical Officer Brad Reinke, M.D.. “In health care, performing a high volume of specific surgical procedures strengthens clinical expertise in that area. Research shows that facilities designated as Blue Distinction Centers demonstrate better quality and improved outcomes for patients compared with their peers.”

Marc Radner Health Plan of San Joaquin (HPSJ) Appoints New Human Resources Vice President

Marc Radner has been appointed human resources vice president at HPSJ, where he brings extensive senior leadership and human resources experience with special skills in workforce optimization, performance and talent management, training, change management, leadership development, labor and employee relations, and process improvement.

Radner said, “As HPSJ strives to improve healthcare delivery for increasing numbers of underserved Central Valley families and individuals, I am eager to bring my experience and expertise, developing and delivering strategic solutions and change-management initiatives across growing and complex organizations, to HPSJ.” Radner continued, “HPSJ has a committed and talented staff that has been working with extraordinary dedication to meet the needs of vastly expanded numbers of MediCal recipients. I am eager to do what I can to enable and encourage the HPSJ staff as they work to deliver on our mission.”

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27

In The News

IN THE

NEWS HPSJ Chief Executive Officer Amy Shin added, “Marc is an expert when it comes to human resources and has a strong knowledge of the California health care landscape, which is especially important for expanding health plans. I am confident that he will add tremendous value as we continue to develop, retain and grow our hardworking, talented staff to meet the needs of our HPSJ membership.”

Health Plan of San Joaquin Appoints New Medical Director

Robert W. Castillo, M.D., FAAP, has joined Health Plan of San Joaquin (HPSJ) as Medical Director. Castillo, who is a Fellow of the American Academy of Pediatrics (FAAP), has extensive experience as a practicing physician, as well as a senior leader of complex healthcare organizations where he has specialized in quality programs, and medical and utilization management.

“As a Pediatrician and an administrator,” Castillo said, “I am delighted to join HPSJ as it continues to improve healthcare delivery for increasing numbers of families and individuals throughout the richly diverse communities of California’s Central Valley.”

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Health Plan of San Joaquin (HPSJ) Appoints New Director of Quality and Accreditation

Robert W. Castillo, M.D., FAAP HPSJ Chief Medical Officer Lakshmi Dhanvanthari, M.D., noted, “His passion for working with the underserved is paramount. That he believes in a collaborative approach between the plan and the providers is essential to our never-ending efforts to improve the care provided to our members.”

Castillo, who graduated from the University of California, Davis with a B.S. in Applied Behavioral Science, received his medical degree at the University of California, Irvine, where he also completed his internship and residency in Pediatric Medicine. As a board-certified Pediatrician, Dr. Castillo has been practicing medicine since 1989. As part of his military service, he was Co-Director of the Drug and Alcohol Rehabilitation Program for the Eighth Army in Seoul, Korea.

Health Plan of San Joaquin (HPSJ) has announced that Catherine Flanagan, RN, has joined the organization as Director of Quality and Accreditation. Flanagan has extensive senior leadership and Medicaid managed care experience, including developing clinical management and quality improvement programs for complex health care organizations. Flanagan is expert in management of health care quality measurement systems such as HEDIS and NCQA. Flanagan said, “As HPSJ strives to improve health care delivery for increasing numbers of underserved Central Valley families and individuals, I am eager to continue

Catherine Flanagan, R.N.

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In The News

the fine work already in progress to ensure all our members not only have access to health care, but also to the very finest quality of health care.”

Flanagan, who is relocating to the Central Valley and HPSJ’s headquarters in French Camp, previously was in senior quality and accreditation leadership positions, including at Health First (Rockledge, Florida), Molina Healthcare of Missouri (St. Louis), CareSource Managed Care (Dayton, Ohio), and Optima Health/Sentara Healthcare System (Virginia Beach, Virginia). Flanagan holds a nursing degree from West Texas State University (Canyon, Texas). She is a Registered Nurse.

St. Joseph’s Launches Lung Cancer Screening Program

St. Joseph’s Cancer Institute is proud to have a launched a new Lung Cancer Screening Program. Active and former smokers aged 55-74 years old, or over 50 with a family history of lung cancer, should talk to their primary care doctor about getting screened for lung cancer. To be a candidate for lung screening, an individual must have an order for a low-dose Chest CT from their primary care physician.

The screening process is conducted using a low-dose computed tomography (LDCT) scan and results are sent directly to the patient’s primary care physician.

If the scan shows something that looks abnormal, a physician in the Cancer Institute will consult with the patient’s primary care physician for further planning. If no problems are found, the patient will receive a letter with follow-up recommendations.

Now that lung cancer screening is covered by Medicare Part B and all major insurances, it’s easier than ever for those qualified to get screened.

Find out more at StJosephsCares.org/LungScreening.

St. Joseph’s Awarded Green Business Certification

by State of California

St. Joseph’s Medical Center has recently received Green Business Certification by the California Green Business Program. There are currently around 2,800 businesses with this certification and St. Joseph’s Medical Center is the first hospital in the state to be certified green.

To obtain Green Business certification, St. Joseph’s had to demonstrate actions taken to conserve resources and prevent pollution in both the facility and through its operations. The certification process required addressing various topics including energy usage, pollution, water usage, solid waste, wastewater, general housekeeping, spill prevention, and general ecology initiatives.

In all, the certification process included 195 measures that were required to be assessed. Upon completion of the application process, the San Joaquin County Green Team conducted an onsite survey to verify the measures.

St. Joseph’s Named Consumer’s Choice

By National Research Corporation

For the 19th consecutive year, consumers in San Joaquin County have once again named St. Joseph’s Medical Center as the area’s Consumer’s Choice for hospitals.

St. Joseph’s received the 2015/2016 Consumer Choice Award by National Research Corporation. The annual award identifies hospitals across the United States that health care consumers choose as having the highest quality and image.

Winners are determined by consumer perceptions on multiple quality and image ratings collected in the company’s Market Insights survey, the largest online consumer health care survey in the country.

National Research surveys around 300,000 households in the country.

Hospitals named by consumers are analyzed and ranked based on Core Based Statistical Areas defined by the U.S. Census Bureau, with winning facilities being ranked the highest.

St. Joseph’s To Host Annual Cancer Symposium

St. Joseph’s Cancer Institute will be holding the 18th Annual Professional Cancer Care Symposium, on February 20, 2016. This year’s conference, titled “Colon and Rectal Cancer: Bums the Word” will provide participants with an opportunity to gain insight from expert speakers about current diagnosis and treatment options, maintaining digestive health during and after treatment, and posttreatment pelvic floor rehabilitation options. Physicians, pharmacists, nurses and others involved in cancer care or those wishing to expand their knowledge in this area are encouraged to attend this one-day symposium. Continuing education credits will be offered at all levels.

The conference will take place in the Auditorium at St. Joseph’s Medical Center, on Saturday, February 20 beginning at 8:00 am (continued on Page 31)

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WINTER 2015

In The News

and ending with lunch at 1:30 pm.

Cost is $49 to attend. For more information or to register, call 209-467-6331.

St. Joseph’s Women’s Imaging Center Named Breast Center of Excellence

St. Joseph’s Women’s Imaging Center has been designated a Breast Imaging Center of Excellence by the American College of Radiology (ACR). To receive this designation, St. Joseph’s Women’s Imaging Center underwent a rigorous review process to insure that they thoroughly met all nationally accepted standards. With this award, the ACR recognizes that St. Joseph’s Women’s Imaging Center has earned accreditation in mammography, stereotactic breast biopsy, and breast ultrasound.

Located at 3439 Brookside Road, St. Joseph’s Women’s Imaging Center provides complete imaging services, including digital mammography, breast ultrasound, stereotactic biopsy and bone density testing. Learn more about St. Joseph’s Women’s Imaging Center at StJosephsCares.org/Mammo.

Volunteer Opportunities at San Joaquin General Hospital

San Joaquin County Hospital has been in operation for over 150 years of serving the community. In 1996 construction began breaking ground to build a new state of the art-hospital with 220-bed acute care facility to better serve the sicker growing community.

The hospital is famous for having the best Neonatal Intensive Care Nursery. The hospital also has health care services covering Public Care

San Joaquin General Hospital Volunteers Services, Mental Health, Substance Abuse and a Trauma Center for treating emergency services.

Our Auxiliary and Volunteer services help our doctors and nurses by creating a warm and personal environment which is sensitive to patients’ emotional and physical needs.

Our volunteers work four hour shifts at the main information desk to fill the request of our customers, also volunteers collect magazines to fill waiting rooms and offer reading materials to healing admitted patients by offering a wide variety of magazines. San Joaquin General Hospital is looking to bring new opportunities in the following months ahead. If you would like to volunteer time, we can be reached at 209-468-6041 or email us at lcarmona@sjgh.org. We look forward to hearing from you.

New Physicians join Gill Obstetrics & Gynecology Medical Group, Inc.

Gill Obstetrics & Gynecology is pleased to announce the association of Eugenia Hurlbut, D.O, Chikanele Okorie, M.D., and Kayla Mapps, M.D. Gill OB/GYN has been voted #1 as the best OB/GYN practice by The Record’s Best of San Joaquin this year and feels privileged to have served the community for over 60 years.

Eugenia Hurlbut, D.O.

Dr. Hurlbut grew up in Half Moon Bay, CA and knew from a young age that she wanted to be a doctor and have been chasing her dream ever since. She started at Cal Poly in San Luis Obispo, CA

Eugenia Hurlbut, D.O. and graduated with a Bachelor of Science in Biological Sciences and a minor in Spanish. From there, she went to medical school at Lake Erie College of Osteopathic Medicine in Bradenton, FL. She completed a traditional rotating internship at Rowan UniversitySOM (formerly University of Medicine and Dentistry of New Jersey-SOM) in Stratford, NJ. She finished her residency in Obstetrics and Gynecology at Albany Medical Center in Albany, NY. Areas of special interest include Obstetrics and caring for women in all stages of life. (continued on Page 33)

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31

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In The News

NY, and completed her OBGYN residency at Temple University Hospital Philadelphia, PA. She is very passionate about women’s health with interests in preventive medicine, minimally invasive surgery and advocating for the underserved population.

Chikanele Okorie, D.O. Chikanele Okorie, D.O.

Dr. Okorie was born and raised in Lagos, Nigeria. She received her medical degree from Albert Einstein College of Medicine Bronx,

Kayla Mapps, M.D.

Dr. Kayla Mapps is a Texas native graduating from The University of Texas Medical School in Houston in 2007. She then went on to complete a 4-year residency program in Obstetrics & Gynecology at Louisiana State University in

Kayla Mapps, M.D. Baton Rouge in 2015. Dr. Mapps is currently pursuing her board certification. She has a passion for women’s healthcare and is a true patient advocate.

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33

A dedicated team of surgeons at Lodi Memorial Hospital’s Robotic Institute of Northern California is using two, state-of-the-art robotic surgery systems to advance the level of care in the Central Valley.

The STORY BY JAMES NOONAN l PHOTOS BY DALE GOFF

Edge SURGERY, BY NATURE, IS AN INTENSELY PERSONAL EXPERIENCE.

At its most basic level, the practice consists of one human being physically intervening in the internal workings of another - one body, entering a second, with the aim of repairing an ailment. The word itself – “surgery” – reflects the uniquely human elements of this relationship, coming from the combination of the ancient Greek words for “hands” and “work.”

As the field of medicine has advanced, however, the “hands” entering the body of the patient have been equipped with better, more technologically advanced tools – tools that, today, are beginning to replace the hands altogether. >>

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Lodi Memorial Hospital > Robotic Institute of Northern California

As evidence of this development, one need only look to Lodi Memorial Hospital’s Robotic Institute of Northern California (RINC), where a skilled group of surgeons has been offering care using the cutting-edge da Vinci Robotic Surgical System, allowing them to perform even the most complex and delicate procedures by entering the body robotically, using incisions that can be smaller than an inch.

“We love that we have it,” Dr. Thomas Sorbera, chair of the robotic surgery department and practicing urologist. “This is state-of-the-art technology that is helping patients recover faster, getting them home from surgery sometimes as soon as the same day.”

While RINC is now being viewed as something of a game changer for Lodi Memorial Hospital, Sorbera notes

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that there was some initial hesitation on the part of hospital regarding the sizeable financial investment required to acquire the robotic system, whose average costs range from $1.5 to $2 million.

“Early on, the initial question was much the same as it was across the whole country. Mainly, ‘Is it worth it?’ and ‘Does it work?,’” Dr. Sorbera said. “It was being picked up all over the country, but usually in much bigger places. Lodi picked it up, and we’re a much smaller facility. The question was asked whether it was worth the risk, financially. Given the success we’ve had using the system, I think we can safely say it has been.”

In October of 2012, Lodi Memorial Hospital began using the da Vinci “Si” model robot in the areas of general,

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RINC SURGEONS: Tom Fahey, MD Nagui Sorour, MD Lodi Health Plaza Surgical Care Param Gill, MD Jacqualin Miller, MD Gill Obstetrics & Gynecology Adam Dodd, MD Leslie Sackschewsky, MD Robert Howen, MD Sutter Gould Medical Group Thomas Sorbera, MD Golden State Urology

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urological, and gynecological surgery. Since its launch, the hospital’s robotic surgical program has been an overwhelming success, performing hundreds of procedures while offering surgeons enhanced visualization, improved dexterity, and greater precision when performing operations.

“These procedures are extremely precise because of the level of magnification we’re getting with the robots,” said Dr. Param Gill, a da Vinci trained surgeon and OB/GYN who has completed more than 200 surgeries using the da Vinci machines.

In addition to the high level of magnification, da Vinci robots also offer physicians a state-of-the-art, three-dimensional field of vision that would be impossible to create using the cameras typically seen on laparoscopic instruments.

“The vision is phenomenal,” said Dr. Leslie Sackschewsky, an OB/GYN who has been with RINC since its launch in 2012. “With laparoscopy, it’s like trying to operate in your mirror at home. It’s two-dimensional, so you have no measure of depth. With the robot, it’s like you’re physically standing in the patient’s belly.”

In addition to providing a more precise experience for the surgeon, procedures done with the aid of the da Vinci machines also tend to require less recovery time and cause less discomfort for the patient, even when compared to other minimally invasive methods such as laparoscopic surgery.

“At first, I didn’t believe it,” Sorbera said, referring to the long list of benefits to patients undergoing robotic surgery. “Today, we’re seeing patients experiencing less discomfort

and going home much earlier following these procedures. A one day difference in recovery time might not seem like a lot, but on some of these bigger surgeries we’re seeing patients going home two or three days earlier. And throughout that time, the reduction in pain is significant.”

“It’s a much quicker recovery. It’s much less painful for the patient, and it’s extremely precise because of the level of magnification that we can receive from the robots,” Gill said.

“With the optics being what they are, blood loss during the procedure is less, as is the scar tissue following the surgery.”

As evidence of just how precise robotic surgeries are when compared to traditional, open surgeries, Gill points out that a single-site hysterectomy done with a da Vinci robot can be completed using only a 2.5 centimeter incision, compared to the six to nine inch cut required during an open hysterectomy.

“From a cosmetic perspective, that’s a huge benefit, but it also helps with the recovery process” she said.

“With these smaller incisions, people are able to get up and walk around, sometimes as soon as the same day as the procedure.”

Dr. Sackschewsky echoes this sentiment, noting that she once removed a 2.2 pound uterus from a patient using the da Vinci machine, only to have that patient out working in her garden the very next day.

“Laparoscopically, I wouldn’t have even had attempted removing a uterus that large, and she was out deadheading her roses only a day later,” she said.

Given the high level of success that surgeons have experienced with the

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Lodi Memorial Hospital > Robotic Institute of Northern California

initial “Si” robot, Lodi Memorial’s RINC recently opted to expand their robotic surgery program, purchasing the new da Vinci “Xi” model earlier this year. As a result, the RINC is now the only program in San Joaquin county offering both the da Vinci “Si” and “Xi” robots.

The need for a second robot was the result of the incredibly high demand for robot-assisted procedures coming from throughout the region.

“One of the reasons we went out and got a second robot is that we were fully utilizing our ‘Si’ machine,” Sorbera said.

“We were being asked to do more surgeries than we had the capability to do with just one robot.”

Sorbera explains that da Vinci’s “XI” machine also opens up new possibilities to the surgeons at RINC. By using smaller and more mobile arms than its predecessor, the “XI” is able to operate on multiple quadrants of the body, allowing many of the benefits of robotic surgery to be applied to more complicated procedures.

“Before, we were limited by the technology available,” he said. “Many of those limitations have now gone away.”

Using both the “Si” and “Xi” machines, the team at RINC is now completing urological procedures such as prostatectomies, complex hysterectomies and other gynecological procedures, as well as general surgery

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procedures such as gallbladder removal, hernia repair, appendectomies and colon surgeries.

“Today, we’re probably one of the most successful small hospitals anywhere that’s using this technology,” Dr. Sorbera said.

While the da Vinci machines offer increased dexterity when compared to laparoscopic procedures and are widely considered safer and less painful than traditional, open methods, these benefits don’t come without a price. As with any new technology in the medical field, utilizing the da Vinci robots requires surgeons to undergo an intensive training program on how to use the machines both safely and effectively.

When training to use the da Vinci machines, physicians begin on a virtual simulator that instructs, times, and assesses their performance in using the robots. Once the requisite number of simulator hours is complete, physicians move on to training on animal cadavers before having a certified proctor come in to oversee their performance.

Physician performance is also monitored during the first 20 cases, and is compared to national norms in a variety of categories.

Once they are certified as “da Vinci trained,” surgeons are expected to continue their education by undergoing advanced seminars and maintaining regular practice

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Lodi Memorial Hospital > Robotic Institute of Northern California

sessions on the machine.

As of today, there are only eight surgeons who make up the team at Lodi Memorial Hospital’s RINC. “It’s not something that’s for every surgeon. If you really want to get good at this, you have to be willing to constantly want to improve,” Sackschewsky said. “It’s great technology if you are committed to it, but to stay good at it, you really need to be continuously practicing.”

“You don’t just sit down and hit home runs right away,” said Dr. Thomas Fahey, a general surgeon who has been performing roboticassisted, single site surgeries such as gallbladder removals and appendectomies with da Vinci machines since November of 2012.

“Once you get the hang of it, you really start to see the benefits for both the surgeon and the patient.”

The rigorous training and highlevel of scrutiny that comes with any cutting-edge medical advancement has translated to a safer experience for patients at RINC. “When you have a program like we do, many of the concerns of the patients, questions like ‘Is my surgeon good?’ or ‘A m I getting the best care?’ are eased,” Sorbera said. “When you have a robotics program, you really drill down on every aspect of the surgery. There’s more oversight, their training is being looked at more closely than it is other places.”

Gill echoed many of these sentiments, also nothing that the that the nature of robotic surgery allows participating parties – the surgeon, nurses, anesthesiologists and others – to be much more involved and aware during the surgical process.

“I like to say that it’s like a football

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team. As the surgeon, you’re the quarterback, but the whole team is responsible for the surgery,” she said.

“Everyone needs to be on the same page.”

Given the high level of success that the team of surgeons at RINC has experienced in only a few years, most believe that hospitals that haven’t

already adopted robotic technology will do so in the future in an effort to keep up with a rapidly advancing field.

“I’m a believer in bringing the latest and best technology to our patients,” Gill said. “This is the trend of the future, and there’s nothing that can be done to reverse it.”

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WINTER 2015

2015 House of

Delegates California Medical Association

delegates set policy and

elect officers at annual meeting More than 500 California physicians, residents and medical students convened in Anaheim October 16-18, 2015, for the California Medical Association’s (CMA) annual House of Delegates (HOD). On the following pages are highlights of the actions taken at this year’s meeting. >> STORY BY ELIZABETH ZIMA l PHOTOGRAPHY BY JEFF WALTERS

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2015 This year saw an expanded “virtual” reference committee process, with all reference committee testimony conducted online. The reference committee members met via conference call in advance of HOD to develop recommendations that were presented to the House for f loor debate. This was the final year that the HOD will meet in its current format, with the new governance reforms approved at last year’s meeting taking effect at the close of the 2015 meeting.

(For more details on the new governance process, see page 13.)

The House also installed a new president, Riverside infectious disease specialist Steven E. Larson, M.D., M.P.H., and Folsom OB/GYN Ruth Haskins, M.D., was tapped as president-elect.

THE FULL 2015-2016 CMA EXECUTIVE COMMITTEE INCLUDES: • President Steven E. Larson, M.D., M.P.H., Riverside • President-Elect Ruth Haskins, M.D., Folsom • Speaker of the House of Delegates Theodore M. Mazer, M.D., San Diego • Vice-Speaker of the House of Delegates Lee T. Snook, Jr., M.D., Sacramento • Chair of the Board of Trustees David Aizuss, M.D., Los Angeles • Vice-Chair of the Board of Trustees Robert E. Wailes, M.D., Encinitas • Immediate Past President Luther F. Cobb, M.D., Eureka

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Reports and Resolutions Below are a sampling of the resolutions adopted as policy.

(The full actions of the HOD are available for members only at www.cmanet.org/hod. Click on “Annual Meeting Resolutions” then on the “Documents” tab.)

TOBACCO (RES. 107-15): CMA reinforced its long-established

stance against tobacco use, with the passage of a resolution that strongly objects to pro-tobacco efforts by the U.S. Chamber of Commerce in other parts of the world. CMA calls on the Chamber to immediately halt all advocacy efforts on behalf of tobacco companies and urges all conscientious companies that are members of the Chamber to either take similar action or quit their membership to protest such anti-health efforts.

PUBLIC HEALTH FUNDING (RES. 112-15): The delegates voted

unanimously to urge the State of California to restore public health funding. The resolution calls on CMA to work with state health and legislative officials, through the state budget process, to develop a plan to repair California’s public health infrastructure and funding for vital prevention services.

BIOMEDICAL CAREERS (RES. 609-15): The delegates directed

CMA to support pipeline programs targeting underrepresented minority and disadvantaged students, to help increase ethnic minority physicians in medically underserved areas.

IMPLICIT BIAS TRAINING (RES. 610-15): Acknowledging

their impact on patient care, the delegates urged CMA to support studies of the impact on patient care of “implicit bias” – defined as the positive or negative perceptions, feelings and stereotypes that impact our comprehension and behaviors in an unconscious way. The resolution also called on CMA to support the inclusion of implicit bias training in medical school curriculums and continuing medical education programs.

HSA LIMITS (RES. 411-15): The delegates passed a resolution

directing the association to support increasing the dollar amounts eligible for tax-free deposit into a health savings account (HSA) to cover a greater proportion of an enrollee’s potential out-of-pocket costs in a high-deductible health plan.

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Gill Obstetrics & Gynecology

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House of Delegates > CMA

HOSPITAL AFFILIATION REQUIREMENTS (RES. 402-15): The delegates passed a resolution opposing

the health plan practice of requiring physicians to maintain a hospital affiliation in order to contract with the plan. Many physicians, for a variety of reasons, no longer physically practice in a hospital setting. As such, requiring physicians to have hospital privileges at an in-network facility in order to contract with a health plan unfairly penalizes physicians.

ADMINISTRATIVE BURDENS (RES. 404-15): In

an effort to reduce the administrative burdens on physicians, the delegates passed a resolution that supports a requirement that each health plan provide a single comprehensive information resource (telephone or online) that can address all inquiries related to benefit eligibility, provider plan participation and service per-certification.

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POWDERED ALCOHOL (RES. 104-15): The

delegates passed a resolution directing CMA to encourage an established health research entity to evaluate powdered alcohol products for potential health and societal impacts. The resolution also calls on CMA to advocate for the development of regulatory controls for powdered alcohol products similar to those for liquid alcohol products. This resolution was referred for national action.

MEDICAL LOAN FOR UNDOCUMENTED MEDICAL STUDENTS (RES. 602-15): The resolution directs

CMA to work with the state to create and fund a loan program for undocumented medical students, including public service loan forgiveness for this loan program.

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CMA ELECTS SACRAMENTO OB/ GYN RUTH HASKINS, M.D., AS 2015-16 PRESIDENT-ELECT

Awards and Elections CMA INSTALLS RIVERSIDE INFECTIOUS DISEASE SPECIALIST AS 2015-16 PRESIDENT

Riverside infectious disease specialist Steven E. Larson, M.D., M.P.H., was installed as CMA’s 2015-16 president.

“It is an enormous honor to serve the 40,000 plus members of CMA as their president,” said Dr. Larson, speaking to the more than 500 delegates in attendance. “As we face some of the most rapidly changing times in health care that this country has ever seen, I look forward to working with the county medical societies and my colleagues across the state in unifying together as one voice to tackle whatever obstacles lie ahead.”

Dr. Larson practices in both Riverside and San Bernardino counties. He is currently the Chief Executive Officer and Chairman of the Board of Riverside Medical Clinic and serves as a clinical professor of biomedical sciences at the University of California, Riverside, School of Medicine.

Dr. Larson earned his medical degree from the Medical College of Wisconsin and completed his residency in internal medicine and a fellowship in infectious diseases. He earned a Masters in Public Health from Loma Linda University and is board certified in both internal medicine and infectious diseases.

In addition to his experience with CMA, Dr. Larson also serves as a delegate to the American Medical Association, is a member of the Medical Group Management Association, the Infectious Disease Society of America, Southern California Infectious Disease Society and the American College of Physicians.

“California will be faced with many exciting changes to health care in the coming year, including a ballot measure to increase the state’s tobacco tax, which will help to save lives and reduce teen smoking,” said Dr. Larson. “With a vested interest in public health and a commitment to serve my colleagues and my patients, I’m looking forward to what the year will bring.”

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Sacramento OB/GYN Ruth Haskins, M.D., was selected as the association’s president-elect. She will serve in this capacity for one year and will be installed as president at the conclusion of next year’s HOD. “I am thrilled to have been elected to become CMA president and cannot wait to positively contribute to ensure this wonderful organization, and the doctors it represents, continues to move closer to achieving its full potential,” said Dr. Haskins.

As one of her main goals, Dr. Haskins plans during her term to encourage the active participation of all CMA members by optimizing the year-round process of policy-making.

“I encourage all physicians to incorporate health advocacy as an integral part of the practice of medicine,” said Dr. Haskins. “I encourage doctors to look at health advocacy as an outlet for enhancing their passion for practicing medicine by the empowerment gained by speaking out in the political arena.”

Dr. Haskins attended the University of Pittsburgh School of Medicine. She was selected in 1980 for a Health Professions Scholarship Program position and while in medical school began active duty in the U.S. Air Force (USAF) with the rank of Second Lieutenant. Upon graduation, she reported to the David Grant USAF Medical Center at Travis Air Force Base, for training in Obstetrics and Gynecology, at the rank of Captain.

Dr. Haskins completed her four-year

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House of Delegates > CMA

IMPERIAL VALLEY PHYSICIAN RECEIVES CMA’S 2015 “COUNTRY DOCTOR” AWARD

residency and was transferred to Scott Air Force Base Medical Center in Illinois. She was promoted to Major in 1991, and was involved in the military’s readiness campaign during Desert Storm and Desert Shield. In 1992 she was appointed Chairman of the Department of Obstetrics and Gynecology at Scott Air Force Base.

From 1997 through 2008, Dr. Haskins was an Associate Professor at the University of California, Davis. There, she initiated a course in legislative advocacy that grew into an annual lobby day for OB/GYN residents, which just celebrated its 10th anniversary.

Today, Dr. Haskins has a very busy solo practice in the Sacramento area. She has been a member of CMA and the Sierra Sacramento Valley Medical Society for 22 years, serving as CMA trustee from 2013 to 2015 and as chair of the CMA Council on Legislation from 2010 to 2013. She has also been an active delegate representing the voice of the American College of Obstetricians and Gynecologists in the House of Delegates for over 20 years.

“Now I look forward to being the voice for all doctors and an advocate for all patients of California,” she said.

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George Carr Fareed, M.D., was awarded CMA’s Frederick K.M. Plessner Memorial Award, which honors the California physician who best exemplifies the ethics and practice of a rural country practitioner.

Dr. Fareed has been described by patients as an empathetic doctor and has become a friend to many patients. Before he moved to the Imperial Valley in 1991, he had a distinguished history as a clinical researcher, worked as the team doctor for the U.S. tennis team and established three HIV specialty care clinics for underserved patients in the Imperial Valley, which borders Mexico.

From 1970 until 1991, Dr. Fareed was a successful clinical researcher as an assistant professor of medicine at Harvard Medical School and then an associate professor at the University of California, Los Angeles Geffen School of Medicine. He continues there today as an adjunct associate professor. After his years in academic research, he moved into public and private biotech work as the director of cancer biotherapy at INGENER, director of new product development for XOMA Corp. and as president of Advanced Antigens, Inc. He developed processes that led to three U.S. patents in the biotech field.

After two decades spent in research, he decided that he wanted to use to put his clinical skills into action and headed out to the Imperial Valley to establish his practice in the town of Brawley. He started by establishing three HIV clinics through a partnership with Clinicas De Salud Del Pueblo, because there was little treatment available in the area for those with the infection. These clinics were the first in the area to serve patients on both sides of the border.

Dr. Fareed has an active interest in sports medicine and was able to put this interest into practice as the team physician for the U.S. Davis Cup tennis team, working with such tennis greats as Michael Chang, Jim Courier, Andre Agassi, John McEnroe and Pete Sampras from 1991 to 2003.

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House of Delegates > CMA

SACRAMENTO PHYSICIAN RECEIVES CMA’S INAUGURAL COMPASSIONATE SERVICE AWARD

Sacramento ophthalmologist Barbara Arnold, M.D., was awarded the first annual Compassionate Service Award, which honors the California physician who best illustrates the association’s commitment to community and charity care.

In addition to being a skilled and compassionate physician, Dr. Arnold is a gifted artist who teaches art classes through the Crocker Art Museum for visually impaired and legally blind individuals. Since the program’s inception in 2012, her efforts have helped

Other News

ANNUAL GALA RAISES IN EXCESS OF $60,000 FOR PUBLIC HEALTH PROGRAMS

The CMA Foundation hosted the 19th Annual President’s Reception and Awards Gala at Disney’s Grand Californian Hotel and Spa in Anaheim during CMA’s annual House of Delegates meeting. The event raised in excess of $60,000, including $32,500 for medical student grants— thanks to the generosity of our sponsors and donors.

Honored at the event were new CMA President Steven E. Larson, M.D.; the 2015 Robert D. Sparks, M.D., Leadership Achievement Award winner, San Diego physician David Folsom, M.D.; and the 2015 Adarsh Mahal, M.D., award winner, San Francisco physician Michael LeNoir, M.D. After a cocktail reception and dinner, guests were treated to the music of the band Power Mix, a 17-piece orchestra with a full horn section, three strings and eight lead vocalists. The band covered old favorite dance hits from yesterday and today.

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visually impaired individuals develop creative and meaningful hobbies with rewards far beyond the students’ hopes and expectations. Currently, there is a waiting list for Dr. Arnold’s classes. Many of her students come from out of the Sacramento area, some travelling with their guide dogs via Amtrak to take her classes.

Dr. Arnold has been teaching ophthalmology to residents at the University of California Davis Eye Center for more than 20 years. She is an Emeritus Chair in the UC Davis Department of Ophthalmology and was the department chair for 26 years.

Among the big ticket items auctioned off were an evening of good food and political insight with CMA’s CEO, Dustin Corcoran – also known as the defender of MICRA and the destroyer of Proposition 46; a chance to see golf ’s most talented players at Augusta Masters Golf Tournament in Georgia; and a San Francisco 49er weekend package featuring Club Level seats in the new Levi’s Stadium to watch the team play.

To view more photos from the event, visit CMA’s Flickr page at www.flickr.com/californiamedicalassociation.

CALPAC FUNDRAISING RECORD SHATTERED AT HOUSE OF DELEGATES

CMA’s Political Action Committee, CALPAC, shattered all previous fundraising records in the history of the PAC by raising roughly $173,000 during CMA’s annual meeting.

In a record-setting show of support for CALPAC, CMA members bested last year’s mark of $119,000 while also exceeding the $140,000 goal established at the opening of the House of Delegates meeting.

The donations collected over the weekend, as well as all contributions made to CALPAC, will be used to support candidates who share medicine’s agenda and priorities and will work to affect policies beneficial to the House of Medicine.

For more information about CALPAC, visit www.calpac.org.

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Public Health

Update

Reminder: Let’s Wash Our Hands!

Alvaro Garza, M.D., MPH and Kelly Rose, MPH

The 8th annual Global Hand-Washing Day was observed on 15 October 2015. It is meant to increase awareness and understanding of hand-washing with soap and water as an effective way to prevent disease around the world. As in the rest of the world, we need to remind all our patients and friends in San Joaquin County (SJC) of the importance of hand hygiene.

The reason? We’re still in the thick of a significant shigellosis outbreak and, with the upcoming flu season, proper hand-washing will continue to be one of the most effective ways to stop the spread of these infections.

SHIGELLA Shigellosis is a highly infectious disease caused by bacteria in the genus Shigella. There are four species of Shigella, with S. sonnei accounting for the largest percentage of infections, about 75% in the U.S. In SJC, over 90% of shigellosis cases are due to S. sonnei.

In early 2015, a novel situation occurred here. SJC Public Health Services (PHS) initially received eight lab results with only shiga toxin type 1 (Stx1) detected in feces. Stx1

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is common with S. dysenteriae and Escherichia coli (E. coli) but it’s mainly a marker for E.coli, often known as STEC, for shiga toxin-producing E. coli.

Expecting STEC, PHS investigators interviewed patients with a state-required E.coli oriented questionnaire and waited for culture confirmation before closing the investigations. After two to three days, instead of positive cultures for E.coli, the reports were for S. sonnei. After multiple case reports of Stx1-producing S. sonnei in SJC,

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PHS coordinated with the California Department of Public Health to initiate enhanced shigella focused interviews in order to further characterize the cases, trace contacts, and determine the source of the infections.

Between January 1, 2015, and October 16, 2015, 111 cases of Stx1-producing S. sonnei were reported and confirmed by laboratory testing, with an additional 33 suspected cases.

This is significantly higher than the county’s reports of 30 cases of Shigella (any species) in 2014 and 13 cases in 2013.

The majority of the confirmed cases live in Stockton (86%), are female (52%), and Latino (48%). The median age is 27 years with a range of 1 to 75 years. Among the cases with available clinical information: 82% had diarrhea, 57% had bloody diarrhea, 74% had abdominal cramps, and 47% had fever. S. sonnei commonly causes milder symptoms and resolves without medical intervention, but the majority of these cases had to visit a hospital emergency room (54%) or required hospitalization (28%). Symptoms typically last four to seven days but the median duration of illness was 14 days with a range of 2 to 30 days. To date, no deaths or severe complications have resulted from these infections.

While an initial source has not been identified for this community-wide outbreak, the majority of the cases seem to have been secondary due to an infected close contact (e.g., family member or friend). Stx1-producing S. Sonnei is quite rare and was initially detected in San Diego County in 2014. The SJC cases did not match the San Diego cluster as measured by pulsedfield gel electrophoresis (PFGE) pattern tests (their “fingerprint”). It is a bit worrisome that these infections may soon demonstrate spread in California and the U.S. Unfortunately, Shigella is easily transmitted with as few as 10 organisms causing infection and cases continue to be reported here. Poor hand-washing and hygiene (especially after changing diapers or toileting) increases the risk of infection and contaminating objects/ food. Shigella outbreaks are

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often large and protracted but, hopefully, as in the past and with frequent hand-washing by all, the number of cases will subside in late fall or winter (see Figure).

INFLUENZA The flu “season” is an annual flu epidemic causing significant morbidity and mortality. In 2014, eight deaths due to flu were reported in people under the age of 65 years in SJC. Flu deaths in those over 65 years of age are not captured in surveillance numbers and flu hospitalizations that require ICU care are voluntarily reported to PHS. Several influenza A outbreaks in congregate settings were also reported in the county in early 2015.

The single best action to prevent flu infections is the annual flu vaccine, recommended for everyone 6 months of age and older, including pregnant women. Vaccines are widely available now (check online at http://flushot.healthmap.org/). The other imperative steps we all need to take during flu season is hand-washing, proper respiratory hygiene (coughing or sneezing into our arms at the elbow area), and staying home from work or school or other public spaces when ill.

Hand-washing is like a “do-it-yourself ” vaccine that reduces the spread of diarrheal and respiratory infections.

Prevention starts with good regular hand hygiene, not only for shigellosis and flu but for many other infectious diseases as well. It bears repeating, let’s all remember, and remind others, to wash our hands.

SAN JOAQUIN PHYSICIAN

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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 – 1:00PM 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.

DECEMBER 9TH 2015: “MEDICARE UPDATES 2016” 11:00AM to 1:00PM Join us for our annual Medicare Update workshop for physicians and office staff. This 2-hour seminar will cover relevant information about current, future, and proposed changes for the coming year. ~Cheryl Bradley- CMA Center for Economic Services. Cheryl is passionate about sharing her knowledge with practices and her presentations are not only very educational but also extremely engaging!

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

from the is thly bulletin This bulletin is a free mon nomic Services. practice Eco ces (CPR) f improve tice Resour ciation’s Center for r office staf CMA Prac ical Asso ns and thei sicia Med phy nia ifor CMAtool Cal , sign Practice s to help Resources (CPR) is Aetna to require addition and up to date a free monthl tips Californ stay of To y al bulletin . ia accredit full Medical RS: from the ation requireAssociation’sNEW ments SLETTE Econom and viability : in order to be atio ire- surgical paidnfor CMA Center for certain requ efficiency full of tips andANY tools OTH ewsletters.ic Services. This eagues. is toERhelp physicia y services In this issuepatholog t.ornsg/n accredit and their office staffrs and collbulletin efficienc CPR OR viability orke improve practice additional certain surgical www.cmane ire Update 1 SUBSCRIBE TO y and on two ptions at . for Anthem Blue Cross 1 to your cow Aetna to requ r to subscri SUBSCR be paid issues pending IBE TO CPR OR ANY this bulletin with ardOTHER up for free CMA NEWSLE ments in orde ices the Department of Managed Health up for Please forw D:subscrip free 1 serv Meet Your CMA s issues pending Care tions at www.cmanet.org TTERS: To stay up toem ts THE WOR pathology Center for Economic 1 Cros SPREAD SPREAD /newsletters. uir date,ensign Blue req Services em n Care THE WORD: Please Anth : Markaged tio two Advocate LaneHealth forward this redita bulletin seracc Update on of Man to your coworkers 2 artm CMAent andycolleagues.

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JANUARY 13TH 2015: “EMPLOYMENT LAW UPDATES” 11:00AM to 1:00PM Each year, the area of employment law changes and evolves. Come learn about the new laws and court decisions from 2015 that will affect your business in the new year. Topics covered will range from recruiting and hiring to leave of absence issues to pay stub requirements. ~Velma Lim & Jamie Bossuat- Kroloff, Belcher, Smart, Perry & Christopherson

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FEBRUARY 10TH 2015:

CMA Practice Resources (CPR)

“TBD” 11:00AM to 1:00PM

is a free monthly e-mail bulletin

MARCH 9TH 2016: “STEPS TO REDUCE BAD DEBT” 11:00AM to 1:00PM Ana Molina~ CB Merchant Services Collections Manager with over 30 years accounts receivable and collection experience and is directly responsible for compliance and training of collection personnel.

from CMA’s Center for Economic Services. This bulletin is full of tips and tools to help physicians and their office staff improve practice efficiency and viability.

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SAN JOAQUIN PHYSICIAN

WINTER 2015

New Members

8 NEW

MEMBERS THIS FALL!

...and even more on the way.

Philip Edington, M.D.

Eugenia Hurlbut, M.D.

Mitchell Blum, M.D.

1805 N California St., Ste. 101 Stockton, CA 95204

1617 N California St., Ste. 2A Stockton, CA 95204

2160 W Grant Line Rd., Suite 250 Tracy, CA 95377

University of California School of Medicine - San Francisco

George Washington University School of Medicine

Drexel University/ Hahnemann College of Medicine

(209) 948-5515

(209) 466-8546

(209) 834-0626

Barry Wilson, M.D.

Chikanele Okorie, M.D.

Gordon Tom Fahey, M.D.

University of Texas Medical Branch

1617 N California St., Ste. 2A Stockton, CA 95204

999 S. Fairmont Ave., Ste 100 Lodi, CA 95240

Albert Einstein College of Medicine

Medical College of Georgia

-Yeshiva University (209) 466-8546

(209) 334-2010

Opthalmology

Anesthesiology

Gary Schenck, M.D. Anesthesiology

1901 N California St. Stockton, CA 95204 (209) 946-6800

OB/GYN

OB/GYN

Otolaryngology

General Surgery

Josephine Nguyen, M.D. Otolaryngology

2545 W Hammer Ln. Stockton, CA 95209 (209) 943-5185

WINTER 2015

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SAN JOAQUIN PHYSICIAN

WINTER 2015

In Memoriam

In Memoriam Dr. E. Lewis Cobb, M.D. • Dr. John Patrick Rooney

Dr. Cobb was a respected member of the San Joaquin Medical Society for 43 years. He served on various committees including the Public Health, Family Planning, and Ethics.

WINTER 2015

DR. E. LEWIS COBB M.D. April 25, 1936 - October 9, 2015

Dr. E. Lewis Cobb, M.D., died on October 9th, 2015, at the age of 79.

Lew is survived by his wife, Letty and children: Missy, Cathy, Bryson, and Melanie. His oldest son Granger passed away on Sept. 22, 2015. Lew is also survived by his brother Jay Cobb.

Lew was born on April 25th, 1936, in Filer, Idaho to Florence and Howard Cobb. He graduated from UC Berkeley in 1963 with a major in Zoology. He married Letty Wilen, the love of his life, in 1959.

They welcomed their first child, Granger, while Lew was stationed at Fort Ord for military service in 1960.

They moved to Wisconsin in 1963.

They welcomed two more kids, Melissa and Catherine, while Letty taught and put Lew through medical school at the University of Wisconsin-Madison. In 1967 they moved back to French Camp, California. Lew did his residency and they welcomed their two youngest children, Bryson and Melanie. Lew began working for Schmitt, Gallagher & Cobb in 1971 and they settled in Morada, where they would stay for many years. He had a very successful and

fulfilling OB-GYN practice, bringing countless babies into the world, until his retirement in 2010.

In a personal memoir that Lew was asked to write, the only entry was his thoughts on a poem by Henry Wadsworth Longfellow: Lives of great men all remind us We can make our lives sublime, And, departing, leave behind us Footprints on the sands of time: Footprints that perhaps another, Sailing o’er life’s solemn main, A forlorn and shipwrecked brother, Seeing, shall take heart again.

Lew wrote: “If Henry had children, this poem would be different! Family is my immortality. With my family I will live forever!! I have Granger, Missy, Catherine, Bryson, Melanie; then I have Caitlin, Cassie, Wilson, Haley, Abbey, Austin, Lee-Lee, Luc, Estelle, Tessa, and Cutter who will carry my genes on forever!! Too bad, guys!!”

Dr. Cobb was a respected member of the San Joaquin Medical Society for 43 years. He served on various committees including the Public Health, Family Planning, and Ethics.

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SAN JOAQUIN PHYSICIAN

WINTER 2015

In Memoriam

In Memoriam Dr. E. Lewis Cobb, M.D. • Dr. John Patrick Rooney

He liked sports, but loved his boys, and supported them in pursuing all of their passions.

Pat possessed a keen intellect, an uncannily accurate moral compass, a tireless work ethic, and undying devotion to his wife and sons

DR. JOHN PATRICK ROONEY February 19, 1942 - November 9, 2015

In the early morning hours of November 9, 2015, after a nearly ten-year battle with Lewy Body Dementia, Dr. John Patrick (Pat) Rooney, 73, breathed his last breath. Fittingly, he did so in the company of the love of his life and wife of 46 years, Miriam. Born in Indianapolis, Indiana, on February 19, 1942, Pat was predeceased by his parents, John Patrick (J.P.) and Grace Walsh Rooney. He was also predeceased by Miriam’s mother, Eleanor Smith, her father, Richard A. Smith, and his sister, Sister Patricia Rooney. Pat is survived by his four sons and their families: Sean Patrick and Caroline (Green) Rooney and their son, Declan, and daughter, Quinn, San Francisco; Bryan Richard and Jennifer (Baucher) Rooney and their daughter, Brooke, and son, Liam, Clayton; Kevin James and Kate (Harden) Rooney and their daughters, Emma and

Annie, and son, John Patrick, Lodi; and Brendan Michael and Rachel (Hansen) Rooney, Folsom. He is also survived by his brother, Jim Rooney; his sisters: Eileen (Rooney) Callaghan, Mary (Rooney) Belmonte and husband, Peter Belmonte; and Margaret (Rooney) Wellington and husband, Peter Wellington; and their respective families.

As a child, he and his family moved to Cleveland, where “Mickey,” as he was known to his family, attended St. Ann’s School and St. Ignatius High School.

During this time, he also became an Eagle Scout. Upon graduation from St. Ignatius, Pat stayed in Cleveland to attend John Carroll University. Pat then became the first John Carroll graduate to be accepted into and to graduate from Cornell University Medical College in New York City. While living in the Big Apple, he met a young Irish Catholic nurse from (continued on Page 65)

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SAN JOAQUIN PHYSICIAN

WINTER 2015

In Memoriam

In Memoriam Dr. E. Lewis Cobb, M.D. • Dr. John Patrick Rooney

DR. JOHN PATRICK ROONEY February 19, 1942 - November 9, 2015

Long Island named Miriam Smith who was destined to be his wife.

Their first dates consisted of long walks through Manhattan during their breaks from the hospital and library.

Following his graduation in 1968, Pat and Miriam were married in 1969 in New York. Pat’s medical training led them west to St. Louis, Missouri, where he completed his internship and residency in internal medicine.

Immediately thereafter, service in the U.S. Navy brought them all the way west to Southern California.

Following his two years of service, he completed a cardiology fellowship in Long Beach, California before his training ultimately led the family up the west coast to the Stanford Medical Center, where he worked as a resident in cardiothoracic surgery under heart transplant pioneer Dr. Norman Shumway.

Following a five-year stay in Santa Rosa, California, Pat brought his

WINTER 2015

talents to Stockton at the request of his mentor, Shumway. As any of his patients and their loved ones can attest, medicine was Pat’s true calling.

He was an active member of the San Joaquin Medical Society for 23 years.

As the boys grew older, you could often find Pat, fresh from the operating room, quietly watching his boys’ baseball, basketball, and football games from the bleachers.

He liked sports, but loved his boys, and supported them in pursuing all of their passions. Pat possessed a keen intellect, an uncannily accurate moral compass, a tireless work ethic, and undying devotion to his wife and sons. He will be sorely missed and remembered fondly by his family and his community.

His family owes a great deal of gratitude to his doctors, all of the staff at Somerford Place of Stockton, where he lived for the last twenty months of his life, and Hospice of San Joaquin County.

SAN JOAQUIN PHYSICIAN

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

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