Winter 2019

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THE WOMEN IN WHITE

FIVE QUESTIONS, FIVE ANSWERS

Legislative Wrap Up House of Delegates 23rd Presidents Gala

Winter 2019

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VOLUME 67, NUMBER 4 • DECEMBER 2019

{FEATURES}

12 20 30 40

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2019 HOUSE OF DELEGATES 23RD PRESIDENTS GALA THE WOMEN IN WHITE COATS 2019 LEGISLATIVE WRAP UP

{DEPARTMENTS} 9 PRESIDENT'S MESSAGE 24 IN THE NEWS 54 PRACTICE MANAGER 56 PUBLIC HEALTH

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PRESIDENT Richelle Marasigan, DO PRESIDENT ELECT Hyma Jasti, MD TREASURER Kismet Baldwin, MD BOARD MEMBERS Sanjay Marwaha, MD, R. Grant Mellor, MD, Shahin Foroutan, MD, Neelesh Bangalore, MD, Benjamin Morrison, MD, Raghunath Reddy, MD, John Zeiter, MD, Cyrus Buhari, DO, Nguyen Vo, MD, Sujeeth Punnam, MD

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

SAN JOAQUIN PHYSICIAN MAGAZINE EDITOR Lisa Richmond EDITORIAL COMMITTEE Richelle Marasigan, DO, Lisa Richmond MANAGING EDITOR Lisa Richmond CREATIVE DIRECTOR Sherry Lavone Design

COMMITTEE CHAIRPERSONS CMA AFFAIRS COMMITTEE Larry Frank, MD

CONTRIBUTING WRITERS Richelle Marasigan, DO, Jo Ann Kirby, Daniel H. Kim Jr., MPH, MCHES, and Kismet Baldwin, MD

DECISION MEDICINE Kwabena Adubofour, MD MEDICAL EDUCATION PROGRAMS R. Grant Mellor, MD PUBLIC HEALTH COMMITTEE Kismet Baldwin, MD

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

SCHOLARSHIP LOAN FUND Gregg Jongeward, PhD SUGGESTIONS, story ideas are welcome and will be reviewed

CMA HOUSE OF DELEGATES REPRESENTATIVES

by the Editorial Committee.

Robin Wong, MD, Lawrence R. Frank, MD, James R. Halderman, MD, Raissa Hill, DO,

PLEASE DIRECT ALL INQUIRIES AND SUBMISSIONS TO:

Ramin Richelle Marasigan, DO, Manshadi, MD,

San Joaquin Physician Magazine

Kwabena Adubofour, MD, Philip Edington, MD,

3031 W. March Lane, Suite 222W

Steven Kmucha, MD

Stockton, CA 95219 Phone: (209) 952-5299 Fax: (209) 952-5298 E-mail Address: lisa@sjcms.org MEDICAL SOCIETY OFFICE HOURS: Monday through Friday 9:00am to 5:00pm Closed for Lunch between 12pm-1pm

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JOIN US FOR A MERRY EVENING ON

THURSDAY | DECEMBER 12 | 2019 featuring

Comedian Jack Gallagher STOCKTON GOLF & COUNTRY CLUB

6:00pm Cocktails & Appetizers | 7:00pm Dinner

$50 Per Person for Physician Members & their Guests / $75 Per Person for Non-Members

RSVP before December 6 by calling the Medical Society at 209-952-5299

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EXECUTIVE DIRECTOR’S REPORT

“ SHE BELIEVED SHE COULD, SO SHE DID”

I n my last article, I mentioned a new group of women rising into leadership on our board of directors. I later noticed that September was the American Medical Association’s Women in Medicine month, which celebrates the accomplishments of female physicians. Women tend to be master jugglers, always with many balls in the air at one time. The physicians highlighted in this issue’s feature are no different and serve as just a handful of examples of the inspiring women among our membership. They strive to provide excellent care to their patients, be present for their families and active in their community. Did you know that there is a San Joaquin County Women Physicians Group that casually meets a few times a year for fun and fellowship? If not, we have more details about how to get involved in the feature on page.

LISA RICHMOND

We often talk about advocacy as once of the most important 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. We are currently recruiting passionate leaders, who are interested in influencing policy and legislation, to serve as Alternate Delegates. Please call our office for more information. We invite you to read about this year’s top issues and hot topics in the HOD and Legislative Wrap Up articles.

Nominations for the 2020 Young Physician and Lifetime Achievement Award are open now online through January 31. You will find the link with criteria for each award on our website at www.sjcms.org under programs. Hard copies of forms will also be mailed to all members in December.

Finally, it has been said that laughter is the best medicine, so in the spirit of wellness, we have invited comedian Jack Gallagher to perform for us this year at our annual holiday party.

His long list of credits includes a recurring role as a physician on the HBO series, Curb your Enthusiasm. We hope you will join us for this festive evening. Please see enclosed advertisement for more details.

Happy Holidays,

Lisa Richmond

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A message from our President > Richelle Marasigan, MD

Digital Healthcare for a Digital World “The human spirit must prevail over technology.” - Albert Einstein We are in the age of digital health, whether we like it or not. We all want to provide excellent health care to patients, but some days it does seem hard to do with a computer in hand and what seems like thousands of “clicks” to get there. We can no longer resist moving to electronic medical records and the upgrades because it is already here, and new developments and technologies are appearing at a rapid pace.

Patients want to be able to e-mail us their ailments, send pictures of their rashes, and make appointments on-line. Patients expect us to deliver a standard of care suited to the needs of their personal schedules and lifestyles, while implementing the new technology available to them. These new technologies impact multiple areas of medicine, including diagnosis and treatment, medical records and data, and patient access to care. There are three main ideas that are being discussed regarding digital health:

• Consumerization of health care

• Access for underserved communities

• Application of big data Digital health is upon us, and we need to embrace it and use it to our advantage.

ABOUT THE AUTHOR ­ Dr. Richelle Marasigan is the President of the San Joaquin Medical Society and is a secondgeneration physician who practices family medicine at HT Family Physicians

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Consumerization of health care Patients are using all the latest technology to manage and track their data. Smart phones, fitness monitors and watches can track so much data on an individual, including sleep patterns, heart rate and activity level. Patients have all this information at their fingertips. For example, Apple has launched Apple Health that has partnered with some health care organizations to let patients use their smartphones to download their own medical records. There are a number of apps to help patients manage their own conditions on a daily basis between their appointments with the physician. These devices and apps that are available to patients have allowed them to be more aware of their health and increase communications with their doctors.

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A message from our President > Richelle Marasigan, MD

The retail health care model is becoming the future of medicine.

Companies like Amazon are making moves into health care that could change access for consumers. Amazon has already made it easy to access medical supplies on-line but is now expanding into the pharmacy space with PillPack and virtual health care. The company has already started providing some of their employees with access to Amazon Care, a program that provides uses with access to health care professionals over video chat and text. Care delivery and insurance coverage needs are not the same for everyone, so it is important for us as providers to keep in mind the diversity of our patients.

Delivery of health care to underserved populations Digital health may help to offer some benefit in the ongoing challenge of access to health care for all. Patients come from a number of different backgrounds and demographics, live in rural and urban locations, and have a range of family and work dynamics. Digital health may help to extend health care to these diverse situations. For example, a low-income patient that cannot afford missing a shift at work could do a 20 minute telemedicine visit on their lunch break. However,

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there are some challenges as these visits are not always best for all situations. Physicians have a responsibility to our patients to provide personalized solutions that fit their needs, but do not compromise the quality of care they receive. Digital health offers new opportunities to help the needs of the patients.

Big data’s role in health outcomes Health care data is highly sought-after information, with organizations trying to analyze and interpret what they collect.

It is important for the focus to be on the right big data for use to have a positive impact on health outcomes. Despite efforts to obtain this from electronic health records, only a fraction comes from these sources. Big data analysis may have the potential of achieving positive health outcomes at a sustainable cost point. Resources like the Integrative Health Model Initiative (IHMI) help connect physicians and health tech companies to develop and improve health care technology solutions. It promotes health fairness by using data to define patients’ needs as individuals and allow data to express the complete picture of a patient.

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2019

HOU OUSE SE OF DELEGATES C MA TAC K L E S 21ST CENTURY HEALTH CARE DIL E MMAS INC LUD I NG A .I ., HOM ELESSNESS , CA N N ABIS AND ADVERSE CHI LD HOOD EXPERI ENCES

The California Medical Association (CMA) recently convened its 148th annual House of Delegates (HOD) meeting in Anaheim.

Over 500 California physicians debated and outlined a policy agenda on major issues that have been determined to be the most important issues affecting members, the association and the practice of medicine.

The association also installed its new officers, including new CMA President Peter N. Bretan, Jr., M.D., a urologist and transplant surgeon who gave up his Bay Area practice to serve patients at a safety net hospital in Watsonville.

The major issues the delegates focused on this year were: + Augmented Intelligence (A.I.): The delegates explored pragmatic solutions that address medical decision-making, new liabilities and privacy concerns inherent with augmented and artificial intelligence in health care, with a focus on keeping physicians at the center of health care delivery. >>

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+ Homelessness: Physicians witness the

The final actions of the House of Delegates, including

homelessness crisis in emergency rooms, clinics

newly established policies, are now posted at

and on the streets of our communities. The

cmadocs.org/hod.

delegates declared that stable and affordable housing is an essential community priority and

ELECTI ONS

an important social determinant of health. They

Watsonville Urologist and Transplant Surgeon

also discussed evidence-based solutions that

Installed as CMA President

address the health care and social needs of those at risk of or experiencing homelessness.

Peter N. Bretan, Jr., M.D., a urologist and kidney transplant surgeon who gave up his Bay Area

+ Cannabis: The delegates weighed in on pressing

practice to serve patients at a safety net hospital

issues, including health impacts associated with

in Watsonville., was elected as the 152nd president

cannabis use, public health protections, federal

of the California Medical Association. Dr. Bretan

legalization, data and surveillance efforts, high-

is the first Filipino-American physician to serve as

quality research, marketing and advertising

president.

practices, cannabis equity programs and more.

“The most important goal, not just in this year of my + Adverse Childhood Experiences (ACE):

presidency, but always, is to take back our profession

Recognizing that ACEs have a strong and life-

by enabling physicians to lead the struggle to

long correlation to numerous health, social and

protect, expand and make universal access to health

behavioral problems, the delegates learned more

care for all of our patients in California,” said Dr.

about data collection, research and incorporating

Bretan. “If we are successful in this state, it will lead

ACE screening practices into routine care.

the way for sustainable universal health care for all of America.”

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Dr. Bretan is the founder and CEO of LifePlant International, a charitable organization that furnishes lifesaving transplants in developing countries, for which he was recognized by the American Medical Association with the Benjamin Rush Award for Citizenship and Community Service. Dr. Bretan has also provided care around the world on medical missions.

“I grew up as a child farm laborer, and I know what it is to be without adequate health care. My greatest motivation is in service to give back to society for my good fortune,” said Dr. Bretan.

After years of practice in Marin and Sonoma counties, Dr. Bretan now provides urologic and laparoscopic surgical care at a safety net hospital in Santa Cruz County. Most of his patients speak no English and have no medical insurance.

“My presidency will be dedicated to giving these patients, and the millions of hard-working Californians like them, a voice,” said Dr. Bretan. “We have an incredible opportunity to boldly change the way health care is delivered. We know that to best serve patients, health care must be physician-led.”

Dr. Bretan has served as a CMA trustee and delegate, and is a three-time county medical society president.

He is the current president of the California Urological Association and serves as an adjunct clinical professor at Touro University, where he has taught classes in health care policy for the past 16 years.

Dr. Bretan earned his B.S. degree in physiology from UC Berkeley and his medical degree from UC San Francisco, where he completed residencies in general surgery and urology, as well as a fellowship in radiology.

He also completed a fellowship at The Cleveland Clinic Foundation in transplantation and renovascular surgery. Dr. Bretan is a member of the San Francisco Marin Medical Society and the Mendocino-Lake County Medical Society.

STAYI NG I NVOLVED Already have ideas for next year’s House of Delegates or want to continue the fight to support CMA? Even though HOD might be over, there are plenty of ways to stay involved and dedicated to CMA. Grassroots Action Center CMA boasts some of the best advocates and lawyers in the capital - but YOU are the most powerful advocate.

As someone who serves on the front lines of health care delivery, elected officials and policymakers need to hear your voice to make informed policy, legislation and regulations. Visit cmadocs.org/grassroots to see how you can get involved.

Submit a Resolution CMA is proud of its resolutions process because it preserves the value of each member’s perspectives and experiences, and empowers physicians to shape the ever-changing health care landscape and ensure that CMA is speaking with its members’ voices in its advocacy.

From internal governance to ambitious statewide advocacy, every policy is crafted, reviewed and approved by the dedicated team of physician leaders that make up CMA’s organizational structure.

Visit cmadocs.org/resolutions to submit a resolution.

Nominate Yourself or a Colleague Members of CMA councils and subcommittees play crucial roles in

Sacramento Pain Specialist Named CMA President-Elect Sacramento pain specialist Lee T. Snook, Jr., M.D., was

shaping health care policy. You can find out more about available opportunities and awards at cmadocs.org/nominations.

named president-elect of CMA. He will serve on the

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Executive Committee as president-elect for one year.

medical review officer and a qualified medical

Dr. Snook will be installed as president following next

evaluator.

year’s House of Delegates.

Dr. Snook graduated from the University of Nevada A CMA member since 1985, Dr. Snook has served

School of Medicine in Reno, NV. He did his internal

as speaker and vice speaker of the CMA House

medicine and anesthesiology residencies at the

of Delegates. He has also served as chair of the

University of Wisconsin Hospitals and Clinics in

CMA Worker’s Compensation Technical Advisory

Madison, WI.

Committee for the past eight years and as a member of CMA’s Board of Trustees for the past 10 years. Dr.

He is an American Medical Association delegate

Snook is a member of the Sierra Sacramento Valley

for the American Society of Interventional Pain

Medical Society.

Physicians and an alternate delegate for the California Society of Anesthesiologists. He is also a board

Dr. Snook is an outspoken advocate for physician

member at California Public Protection and Physician

wellness and was an advocate for approaches to

Health, Inc.

preventing physician burnout long before it became a popular thing to talk about. He has spent the past

AWARD S AND HONORS

25 years working to develop policies and programs

San Bernardino Anesthesiologist Receives CMA

that have achieved positive results for the health

Speaker’s Award

and wellness of all physicians and for the practice of

San Bernardino anesthesiologist Thelma Z. Korpman,

medicine.

M.D., received the 2019 Gary Krieger Speaker’s Recognition Award. The recipient of this award

Dr. Snook is a medical director, president and founder

is hand-selected by the Speaker of the House for

of the Metropolitan Pain Management Consultants,

remarkable contributions to CMA and its House of

Inc., in Sacramento. He is board-certified in

Delegates.

anesthesiology, internal medicine, addiction medicine

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and pain medicine. He is a fellow of the American

“The recipient of this year’s Krieger Award is a woman

College of Physicians and the American Society of

whose dedication and service has been nothing short

Addiction Medicine. Dr. Snook is also a certified

of incredible and inspirational,” said Speaker Lee T.

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Snook, Jr., M.D. “A true role model and prolific leader

Dr. Soper has an impeccable reputation for

she has contributed to organized medicine since she

providing first-rate, and sometimes life changing,

started practicing anesthesia in 1977. As a member of

care for many of Humboldt and Del Norte

her beloved San Bernardino County Medical Society

counties’ most mentally ill clients. He will see

(SBCMS), she has led the way, over and over again.”

patients regardless of their insurance, including Medi-Cal and Medicare.

Dr. Korpman has been a member of CMA since 1978 and of SBCMS since 1977. She has been a member of

“I keep reminding myself that I am very lucky

the House of Delegates for 11 years. She has served as

to do this,” said Dr. Soper. “People keep inviting

Chair of the District 2 Delegation to the CMA and is the

me into their very personal lives. And when you

current Chair of the HOD Rules Committee.

watch people get better, it’s very gratifying.”

The full 2019-2020 CMA Executive Committee includes:

For 15 years, Dr. Soper has also served as chair of

+ President: Peter N. Bretan, Jr., M.D., Watsonville

his local physician well-being committee, which

+ President-Elect: Lee T. Snook, Jr., M.D., Sacramento

aids physicians who may have health problems

+ Chair of the Board: Robert E. Wailes, M.D.,

that could impair their ability to practice

Oceanside/Encinitas

medicine.

+ Vice-Chair of the Board: Shannon L. UdovicConstant, M.D., San Francisco + Speaker of the House: Tanya W. Spirtos, M.D., Redwood City + Vice-Speaker of the House: Jack Chou, M.D., Baldwin Park + Immediate Past President: David H. Aizuss, M.D., Los Angeles

CALPAC RECEIVES ST RONG SUPPORT

Eureka Psychiatrist Honored with CMA’s Prestigious

The CMA Political Action Committee (CALPAC)

Plessner Award

raised over $170,000 during CMA’s annual House

Eureka psychiatrist Robert Soper, M.D., received CMA’s

of Delegates meeting. Donations to CALPAC are

most prestigious award, the Frederick K.M. Plessner

used to support candidates for office who share

Memorial Award. The award honors a California

medicine’s priorities.

physician who best exemplifies the ethics and practice of a rural country practitioner.

Join CALPAC Today!

Please join your colleagues in supporting

For the past 30 years, Dr. Soper has been practicing

CALPAC and help strengthen our political voice.

psychiatry in rural Humboldt and Del Norte counties,

Please visit calpac.org/donate to contribute

where there are very few psychiatrists. He would

to CALPAC. Different levels of support are

regularly drive 90 minutes over curvy winding roads to

available along with monthly options that make

provide psychiatric services in Del Norte county, where

supporting the House of Medicine easier than

there were no other practicing psychiatrists.

ever.

“As a physician who needs to refer some difficult

To mail a check, please make payable to CALPAC

psychiatric patients, there wasn’t a single, solitary time,

and send to: CALPAC, 1201 K Street, Ste 800,

that he told me I cannot see a patient,” said Caroline

Sacramento, CA 95814.

Connor, M.D. “He was open, he always called me back if he didn’t answer immediately, and he always accepted

For more information about CALPAC,

everyone. For family physicians on the firing line, that

visit calpac.org.

was unbelievably comforting.”

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“His commitment to keep his practice open shows

commitment to the San Diego community. Dr.

a true dedication to serving the more complex

Bazzo is the immediate past-president and a current

psychiatric patients in the community who

member of the San Diego County Medical Society;

would otherwise have to travel out of the area for

he was president of the San Diego Academy of

treatment,” said Corinne Frugoni, M.D., a family

Family Physicians in 2005 and currently serves as

physician in Arcata who has worked with Dr. Soper on

president-elect of the California Academy of Family

the local physician well-being committee.

Physicians. He serves as Head Team Physician for the San Diego Seals (professional indoor lacrosse) and is

Dr. Soper has been a member of CMA and Humboldt-

team physician or consulting physician for numerous

Del Norte County Medical Society since 1991.

other sports teams in the San Diego area including professional level teams like the San Diego Chargers

San Diego Physician Receives CMA’s Physician

and the San Diego Sockers (professional indoor

Health and Well-Being Award

soccer) and other Olympic, collegiate, and high school

San Diego family medicine physician David Bazzo,

level teams. His peers voted him one of San Diego’s

M.D., was awarded the 2019 Gary S. Nye Award for

“Top Doctors” for the last 14 years in family medicine

Physician Health and Well-Being. This annual award

and/or sports medicine.

honors a CMA member who has made significant contributions toward improving physician health and

Dr. Bazzo has been a member of the California

wellness.

Medical Association since 1990. He has served on CMA’s Council for Ethical, Legal and Judicial Affairs

Dr. Bazzo is honored with this award for his

and serves in CMA’s House of Delegates representing

commitment to the Physician Assessment and

District 1.

Clinical Education (PACE) program at UC San Diego.

Since 1996, the PACE program has promoted a culture

CMA Recognizes Two Recipients with

of ongoing quality improvement and professional

Compassionate Service Award

development in the medical field. The mission of the

This year, CMA named two recipients deserving of

PACE program is to better the quality of health care

the Compassionate Service Award, created in 2015 to

throughout the nation by offering assessment and

honor CMA member physicians who best illustrate

remediation services to medical professionals. This

the association’s commitment to community and

nationally recognized program is a model for how

charity care.

practicing physicians can get assessment, education and assistance.

The first recipient is family medicine physician Melissa Bishop, M.D. Dr. Bishop is a family medicine physician

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For the last 20 years, Dr. Bazzo has helped physicians

who has worked with medically underserved patients

who enter the PACE program. Through his

since completing her residency in 1997. For 17 years,

involvement with organized medicine, he has worked

she worked with Piedmont Health Services (PHS), a

to study risk factors and develop interventions to

group of federally qualified health centers in central

benefit physicians and help them overcome burnout

North Carolina. While at PHS, she cared for a rural,

and remediation. As it currently exists, the PACE

low-income population, many of whom were recent

program intervenes at the end of a physician’s

immigrants from Latin America. In addition to patient

disciplinary process, but Dr. Bazzo understands

care, she wrote a weekly “Ask the Doctor” column

that interventions earlier in the process might help

for the Spanish language newspaper, served on

prevent remediation and burnout in the first place

the board of the North Carolina Community Health

and is actively developing ways to promote early

Center Association and conducted numerous quality

intervention practices.

improvement initiatives.

In addition to his commitment to physician wellness,

In 2015, she relocated to Escondido and joined

Dr. Bazzo is well decorated and recognized for his

Neighborhood Healthcare (NHC), another federally

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WINTER 2019

qualified health center providing care for low-

Riverside County Medical Association started Project

income, medically and socially complex patients in

K.I.N.D. to address the acute health care needs of

San Diego and Riverside counties. NHC is frequently

elementary, middle and high school age children

spotlighted as an organization that has achieved

who would otherwise “fall through the cracks” of

excellent quality outcomes despite the challenges of

the health care system. Today, Project K.I.N.D. works

caring for patients with limited resources.

with school districts throughout Riverside County to screen low income students for health needs. These

Dr. Bishop currently serves as NHC’s Medical Director

children are then referred to Project K.I.N.D. to treat

of Quality and she has worked tirelessly to make it

acute health care needs through a network of over

easier to take good care of patients by spearheading

140 volunteer physicians, dentists and optometrists.

numerous quality improvement projects including

All Project K.I.N.D. services offered by the treating

provider education, system redesign and team-based

providers are at no cost to the families.

care.

Project K.I.N.D. is 100% grant funded and currently Dr. Bishop has provided care to asylum seekers at

serves the Alvord, Beaumont, Corona-Norco, Moreno

the various shelters in San Diego and Tijuana since

Valley and Riverside school districts. These five

the arrival of the migrant caravan last fall. Since

districts represent 167 schools and 158,000+ students.

November 2018 she has screened over 500 people in migrant shelters. In addition, she has volunteered as

Accepting the award was Project K.I.N.D. Medical

a medical provider with the Refugee Health Alliance

Director Harold Jackson, M.D.

at several migrant shelters located in Tijuana.

Reliving House of Delegates 2019 The award’s second recipient was Project K.I.N.D.

Couldn’t get enough of HOD? Check out our Flickr

(Kids in Need of Doctors). Project K.I.N.D. has been

page for photos of HOD 2019 and relive all the glory

addressing the acute health care needs of low-

and memories!

income, immigrant, single-parent and Spanish-

Flickr.com/californiamedicalassociation

speaking families in Riverside County for the last 25 years.

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Strong community partnerships lead to happier, healthier people.

With nearly 345,000 members, Health Plan of San Joaquin continuously works to improve the health of our community by partnering with providers, resource agencies and local businesses to deliver on our mission.

888.936.PLAN (7526) TTY/TDD 711 www.hpsj.com 22

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In The News

IN THE

NEWS

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

Dr. Pathan is very excited to lay his Zeiter Eye Medical roots in Stockton alongside his wife Group Welcomes Dr. and dogs (Jake and Ali). Both Dr. Mohammad Pathan Pathan and his wife are committed The physicians at Zeiter Eye Medical to forming long lasting relationships Group are pleased to welcome with the community. their newest ophthalmologist to the Zeiter team, Dr. Mohammad Pathan. Prior to joining Zeiter St. Joseph’s Internal Eye, Dr. Pathan practiced Medicine Residency comprehensive ophthalmology in western Pennsylvania. Dr. Pathan Program Receives completed his undergraduate degree Accreditation at Clemson University in South St. Joseph’s Medical Center will be Carolina, he attended medical launching a new Internal Medicine school at the Medical University Residency program in July 2020. of South Carolina in Charleston The newly accredited program will and completed his ophthalmology welcome 10 new Internal Medicine residency at the University of residents to St. Joseph’s. With plans Mohammad Pathan, MD Pittsburgh’s Eye and Ear Institute. to launch 12 residency programs

over the next five to seven years, At Zeiter Eye, Dr. Pathan will be St. Joseph’s Graduate Medical practicing general ophthalmology to include: Education Program plans to train more than 180 doctors · Cataract surgery yearly, once the program is fully implemented, making it one · Glaucoma management of the largest and most complex graduate medical education · Medical intervention for conditions affecting the programs in Northern California. With both primary care retina such as diabetic retinopathy and wet macular physicians and specialists being in chronically short supply in degeneration the Central Valley, St. Joseph’s Graduate Medical Education

Program will help to meet both the current and future need for As an ophthalmologist in Pennsylvania, Dr. Pathan was an care in our community. active member of the medical community and volunteered his services for several free eye clinics. He is an avid college football fan and enjoys cheering on his alma mater the Clemson Tigers.

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to improving health care quality and safety for consumers and purchasers.

The Safety Grade assigns an ‘A’, ‘B’, ‘C’, ‘D’ or ‘F’ grade to all general hospitals across the country based on their performance in preventing medical errors, injuries, accidents, infections and other harms to patients in their care.

David Russell, MD

Christopher Russo, MD

Recognizing Physicians with Humankindness Each quarter, St. Joseph’s Medical Center recognizes physicians in the community that go beyond clinical excellence to deliver healing with compassion and kindness, also known as humankindness. Most recently, David Russell, MD, OB/GYN, Christopher Russo, DO, Internal Medicine, Dean Sloan, MD, General Surgery, and Kirti Solanki, MD, Internal Medicine, were recognized by their patients and peers for going above and beyond and displaying genuine kindness to their patients.

St. Joseph’s invites you to nominate physicians practicing humankindness at St. Joseph’s or in the community to receive recognition. Call 209.467.6486 or email Catherine.

Swenson@dignityhealth.org for more information.

Dean Sloan, MD

Kirti Sokanki, MD

St. Joseph’s Nationally Recognized With An ‘A’ For the Fall 2019 Leapfrog Hospital Safety Grade St. Joseph’s Medical Center was awarded an ‘A’ in fall 2019 Leapfrog Hospital Safety Grade, a national distinction recognizing St. Joseph’s achievements protecting patients from harm and providing safer health care. The Leapfrog Group is an independent national watchdog organization driven by employers and other purchasers of health care committed

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St. Joseph’s Voted Best of San Joaquin by The Record’s Readers St. Joseph’s Medical Center was once again voted Best Hospital by The Record’s readers in the Best of San Joaquin 2019 poll. St. Joseph’s is honored to have consistently received this recognition since the recognition program’s inception.

Additionally, St. Joseph’s Emergency Department, Cardiac Services, and Home Health Care were also voted Best of San Joaquin., St. Joseph’s Behavioral Health Center, which offers a wealth of inpatient and outpatient mental health services, was

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In The News

IN THE

NEWS voted Best Mental Health Services in San Joaquin County.

Nominations for this award took place in June and voting took place from July through August.

Stockton Physicians Featured on Dignity Health Hello Healthy Podcast Dignity Health recently launched the Hello Healthy Podcast, an audio series featuring expert physicians from the central valley, speaking on an array of health related topics. The latest physicians from Stockton to be featured include Amod Tendulkar, MD, sharing about breakthrough technology to prevent strokes, Pavan Khanna, MD, sharing information about advanced treatments for liver cancer and Kwabena Adubofour, MD, sharing insights on diabetes management. The Hello Healthy audio podcasts are available at StJosephsCares.org and also on several podcast platforms including Apple Podcasts, Spotify, iHeart Radio and Stitcher.

Revamped for providers –PlanScan, Health Plan of San Joaquin’s quarterly newsletter To better support physicians in its provider network, HPSJ has changed the PlanScan layout. For example, the Fall Issue – now in provider offices – is the HEDIS/MCAS (Managed Care Accountability Sets) Issue. It makes clearer the specific steps needed to meet required measures for some highlighted HEDIS and MCAS measures, including Well-Child Visits and Controlling High Blood Pressure.

Stay informed and up-to-date with HPSJ’s latest quarterly PlanScan – and the PlanScan archive –by bookmarking the new featured, online section, www.hpsj.com/PlanScan.

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

San Joaquin General Hospital Welcomes Ilia Gur, M.D. to its Surgical Staff.

Dr. Ilia Gur has joined SJGH as a full time hepatopancreatic biliary surgeon (HPB) and is accepting referrals from local medical oncologists and medical Ilia Gur, MD professionals. While serving on the staff of San Joaquin General Hospital, Dr. Gur will also be available for surgical cases at St. Joseph’s Medical Center in Stockton as well as San Joaquin General. Dr. Gur accomplished his residency at Huntington Memorial Hospital in Pasadena and received a fellowship in Hepatobiliary and Pancreatic Surgery from Oregon Health & Science University, Portland.

Insurance programs accepted at San Joaquin General Hospital supporting Dr. Gur are Blue Shield, Health Net, California Health & Wellness, Health Plan of San Joaquin and Medcore (Anthem Blue Cross Medicare Advantage, Humana Medicare Advantage, Health Net Medicare Advantage, Cigna Medicare Advantage, Central Health Medicare Plan, United Healthcare Medicare Advantage}.

Dr. Ilia Gur, previously with Sutter Health- Stockton, will see

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patients at his new office location at 2209 N California Street in Stockton, he can be reached for appointments and consultation at (209 468-5400.

Winner of a 2019 HPSJ Health Careers Scholarship and the National ACAP Scholarship Award –Health Plan of San Joaquin Celebrates Joanna Valenzuela!

Health Plan of San Joaquin has announced that for the second year in a row, one of its local Health Careers Scholarship Program awardees has also won the prestigious ACAP scholarship from the nationwide Association for Community Health Plans (ACAP).

California, Merced where she received a Bachelor of Science degree in her double major: Biology and Physics.

Joanna Valenzuela currently is a nursing student at Modesto Junior College and plans to transfer to California State University, Stanislaus to obtain a Bachelor of Science degree in Nursing. She is determined to become one of her generation’s leaders in health care, dedicated to providing quality healthcare access for Central Valley under-served families.

Joanna, who is bilingual, is also a graduate of University of

HPSJ’s Health Career Scholarship Program, which just celebrated its 10th anniversary, awards $3,000 scholarships to aspiring medical professionals to increase the number of future physicians, nurses, and other clinical experts in San Joaquin and Stanislaus counties. Two students from San Joaquin Medical Society’s DECISION MEDICINE program also are annually selected to receive HPSJ scholarships.

Joanna Valenzuela and Amy Shin

CALL FOR Nominations

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In The News

IN THE

NEWS

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

Health Plan of San Joaquin has a new mailing address for initial and corrected paper claims submissions Effective October 1, 2019, all paper claim submissions for Health Plan of San Joaquin should be mailed, using the complete zip code, to:

Julius Maximilian Universität in Würzburg, Germany, and University of California in Davis, followed by a fellowship in adult reconstruction and joint replacement at the University of British Columbia in Vancouver, Canada.

Health Plan of San Joaquin (HPSJ) Paper Processing Facility P.O. Box 211395 Eagan, MN 55121-2195 As a reminder, All HPSJ claims should be submitted electronically, unless required documentation is needed to process claims. Any provider or practice with questions is asked to please contact the HPSJ Customer Service Department at 209-942-6320.

Alexander J. Nedopil, MD patient’s quality of life.

Adventist Health Lodi Memorial welcomes orthopedic surgeon Alexander J. Nedopil, MD Adventist Health Lodi Memorial is pleased to welcome orthopedic surgeon Alexander J. Nedopil, MD. He will join Stephen M. Howell, MD, in practice. Nedopil specializes in primary and complex hip and knee reconstruction. He cares for patients with osteoarthritis, sports injuries, failed arthroplasty and more.

Nedopil earned his medical degree from Technische Universität München in Munich, Germany. He completed his internships at Metu-Karl Hospital in Metu, Ethiopia, and Hopital du Jura Site de Delemont in Basel, Switzerland.

He then completed his residencies in orthopedic surgery at

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Nedopil became a physician because he wanted to apply his knowledge and skill to improving each

“I love what I do. Satisfied patients, enjoying their newly gained mobility, make me extremely happy,” Nedopil said.

A native of Germany, Nedopil is fluent in German, English and French. When not caring for patients, he enjoys spending time with his wife, Sukhmine, a general surgeon, and young son.

Nedopil is accepting new patients at Adventist Health Lodi Memorial, located at 975 S. Fairmont Ave. in Lodi, and has a second office location at 8120 Timberlake Way, Suite 112, in Sacramento. More information and appointments are available by calling 209-339-7870.

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Mary Irwin, DNP, FNP Adventist Health Physicians Network – Gastroenterology Welcomes Mary Irwin, DNP, FNP Adventist Health Physicians Network Gastroenterology is pleased to welcome Mary Irwin, DNP, FNP, a board-certified nurse practitioner specializing in gastroenterology. She cares for patients with hepatitis C, liver cirrhosis, gastroesophageal reflux disease and more.

Irwin earned her Doctor of Nursing Practice (DNP) degree from the University of San Francisco and completed her residency at Feather River Health Center in Paradise. She also earned a Master of Science degree in nursing and family practice degree from Sonoma State University. She is board-certified as a family nurse practitioner (FNP).

Irwin has been a nurse for more than 40 years and pursued a doctorate because she loves working in nursing and wanted to expand her ability to care for patients. She finds working with patients who have hepatitis C especially rewarding because they can recover and regain their quality of life.

When not seeing patients, she enjoys spending time with her five grandchildren.

Irwin is accepting new patients at Adventist Health Physicians Network Medical Office – Gastroenterology, located at 999 S. Fairmont Ave., Ste. 125, in Lodi. More information and appointments are available by calling 209-334-8514.

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MD

the women in white

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five questions. five answers More women than ever on their way to becoming doctors, according to the Association of American Medical Colleges. It found that for the second year in a row, women were the majority of new enrollees in 2018 to medical school.

BY JO ANN KIRBY Photo from left to right Hymavathy Jasti, MD Param Gill, MD Syung Min Jung, MD Krystle Balduzzi, MD San Tso, DO

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The AAMC is hopes that the increasing number of women will help with the nation’s chronic physician shortage. As STEM fields work to attract more girls, women in medicine are creating a work-family balance that works for them.

That wasn’t always the case, though. And being a woman, these doctors are juggling a lot. Finding balance? That’s tricky. Get to know these five incredible women physicians in San Joaquin County who have carved out impressive medical careers and a whole lot more. >>

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W would be more challenging as a working mom. Sorry dads, but at the end of the day, kids go to their mom.

Family medicine is one where if you wanted, you could have more of a 9 to 5 job. The beauty of private practice is that I can book my time around my kids’ schedules.

Q: What is a self-care practice that works for you?

A: Exercise. I just realized I’ve been calling myself a runner all these years, but I might be more of a jogger. I’m a rogger or a junner. But seriously, I try to exercise an hour a day, six days a week. Vacation is something important. You really must take time to take a vacation. We like to go to Sea Ranch or the Mendocino coast. Of course, going to my kids’ events and supporting them.

Q: What do you wish for your patients?

A: I want them to take care of themselves. It’s probably the biggest frustration. Half of the things are preventable, but habits are hard to break. There are a lot of things we can’t prevent, but the things we can?

We must always try to do our best.

San Tso, DO, is a family medicine doctor in private practice at HT Family Physicians. She and her husband have two teenage children and are active in their north Stockton neighborhood.

She’s been an involved parent, coaching Science Olympiad, helping with swim team and always makes time to cheer her kids on at their water polo games. In the office, she’s a kind and empathetic doctor who takes time to listen.

Question: What made you decide to practice family medicine?

Answer: So, when I first decided to go to med school, I actually wanted to be a psychiatrist. Then when I was on that rotation, I realized it wasn’t a good fit for me. Later, I became interested in OB/GYN but the lifestyle at the time meant you spent a lot of time on call and I knew I wanted to start a family. I never thought I couldn’t do it as a woman, but I just knew some fields

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Q: What do you think a woman physician brings to family medicine that is unique?

A: Most females like to see a female provider. I think most wives want their spouses to see a female physician because they think they are better listeners.

I actually see a lot of tears in my work because patients don’t just make an appointment when they are sick. Sometimes, they are struggling with something and they just need to talk.

We have an incredible shortage of behavioral health access in our community. I’ll have patients come in because their spouse died, or they just lost their job.

Q: What was something you did that made a difference in work/life balance?

A: I met my husband in my third year of residency. He had just started his own heating and air business. When we had kids, he decided not to work during the day. We just really thought it was important to always have one parent at home. So, he would care for the kids during the day and take jobs at night. We did that for about four years and then we hired a nanny.

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kindergartners, vaping talk to middle schools or prenatal course for expecting families.

Krystle Balduzzi, MD, is Sutter Gould’s Chief of Pediatrics. She and her husband, an allergist, have two young daughters. Bet you didn’t know she was a college athlete, attending University of the Pacific on a softball and academic scholarship. She finds community outreach one of the most rewarding parts of her career.

Question: What attracted you to your medical specialty?

Answer: Working with children has always been something I enjoyed, so Pediatrics was a natural fit. Kids are inspiring, full of energy and super tough. Working with them helps to instill similar qualities in myself and my staff. Our tiny patients don’t allow us to slow down!

Q: What is a typical work day like for you?

A: I start my day by checking my patient messages or preparing my daily social media post to educate or inspire my followers. I’m in the office seeing patients daily as I feel it’s important to be available to my families when they need me. I usually block an hour once a week to do a community event. This could be a germ talk to

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Q. What brings you the most job satisfaction?

A: My community work is by far my favorite. It breaks up the days and allows me to interact with my patients and families in their community or schools.

Kids light up when you see them outside of the office. It also creates a bond that strengthens our doctor patient relationship.

Q: Is it possible to achieve work/life balance in your profession?

A: I’m finding the work life balance is a constant struggle. What I have decided is that I am the boss of my life.

I define success and I set the rules and boundaries. Waiting for someone else to define success is not ok. I have my foundation of health and sleep that keep me energized. I have learned to outsource things that don’t bring me joy so that I can focus my time on my passions. As a female physician I feel that at times I have to work harder and be available to do anything. … the more you do, the more you are asked to do. So, getting comfortable saying no to nice people is still something I am learning to do.

Q: What is an ideal day off like for you?

A: My husband would say that doesn’t exist for me. I love to spend my days off with my girls. I bring them with me to community events to show them what I do and how they too can help others just by being active in the community.

They have gotten very familiar with selfies as we often take them around town to promote local small businesses.

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W Hymavathy Jasti, MD, and her husband, a pharmacy professor, have two daughters, 20 and 22. One is in medical school and another is looking at accounting. Dr. Jasti credits her mother, a widow and two-time cancer survivor, for being her strongest advocate, her most inspiring mentor and the reason why she’s able to oversee 130 physicians and 132 staff in her role as chief of adult and family medicine at Kaiser Permanente.

In case her mom doesn’t know it, she’s profoundly grateful for her support at home, which enabled her to take on leadership roles at work.

Question: What advice would you give a young woman considering medical school?

Answer: Everyone is going to expect perfection, more kindness, and more empathy from you. Know this, but all you can do is try your best. Be yourself, know your strengths and weaknesses, and most importantly, know your limits. Advocate for yourself and support your female coworkers as much as possible.

Q: How do you feel about the news that more women are entering medicine?

A: Women play a big role in the health industry. Though we need to make sure to treat each of our doctors as individuals and not generalize, I have seen women physicians work especially efficiently, empathetically, with amazing people skills, management skills and listening skills.

The phenomena of women supporting women creates a stronger community for everyone. There is a need for more women doctors in the community to work as a strong team, as most of the support staff we have are women, and we can help support girls who want to become doctors in the future.

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Q: What are the biggest challenges you’ve faced in your career?

A: Balancing work with family is definitely the biggest challenge I’ve faced in my career. People do expect women to give 110% at work, but then also at home and with friends and family. Everyone expects things to be perfect when a woman is in charge. I am proud that the work I do is good, but I know that these expectations put stress on all women.

Q: Who has been an important mentor for you?

A: My mom is a silent mentor to me. She has been a widow and a single mom since she was 38 and I’ve learned a lot watching how she handles different issues in life, maintaining relationships, and making new friends. Being strong comes from within and circumstances will teach you how to use that inner strength.

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Q: What do you bring differently to your work as a physician from a female perspective?

A: I bring compassion and kindness to my work. I care for my people. I try to know my colleagues and staff at a personal level and be there for them to share, celebrate, and comfort so that they can do their best at work. My mantra is to Lead by

Example. We do the right thing and results will follow. People will recognize your hard work. Be content, show your gratitude, and be humble. I am proud to say I am a woman physician and ready to take the challenge of taking care of my patients, staff, family, and MYSELF.

Sisters in medicine

Building connections and community together

By Jo Ann Kirby There are some things doctors who are women experience that only their peers would understand, no back story necessary.

So, for that, these sisters in medicine try and get together several times a year for dinner where they can commiserate, form connections and feel like part of a community. And like any good ladies’ night, there are no men allowed!

“We’ve decided to call ourselves the San Joaquin Women Physicians Group. We have such a wonderful group of women who work so hard every day to give great care,” Dr. Linda Sakimura, a Stockton pediatrician and the current de-facto organizer of the loosely knit tribe, said. “I think we lose sight of doctors as individuals and being able to get to know them has been so fulfilling. I’m honored to know them and be part of this. I think a lot of them, I wouldn’t have met without this group.”

They try to meet up three or four times a year, depending on whether they have a physician who wants to entertain in her home or an organization that wants to host at a venue such as a restaurant or winery. Because doctors are always lifelong learners, there is often a presentation about a women’s health-related topic, self-care trend or local nonprofit.

The group has its origins back in the 1970s, and throughout the years, participation has had its own ebb and flow.

One constant has been a Christmas get together hosted at one of the physician’s homes.

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“What we have dealt with since the beginning is that balance of work and family,” she said. “It’s still not equal and it’s something we can talk more freely about when it’s just us. We talk a lot about trying to balance whether it’s taking care of your children or your aging parents or your patients.”

She said working in private practice can be a bit isolating in terms of meeting other physicians in the area, especially for those who don’t make rounds.

“The group gave me a sense of belonging and purpose to reach out to others,” she said, adding that it opens up opportunities for mentorship. “It helps to know we are all doing this, it can be done, it’s been done before. We are cross specialty and cross generational.”

Dr. San Tso, who practices family medicine in Stockton, said a bonus is the events are always fun.

“It is great to meet up with our colleagues who we may not see except for these times,” she said.

“Socially, we get a chance to meet our colleagues on a more personal level and professionally we get more information about our colleagues that we refer to – at our last get together my partner and I saw our attending physician from residency that we had not seen for over 18 years.”

The annual holiday gathering will be held Friday, December 6 at 6pm. For more information about this event or to be added to the mailing list for the future, please contact Lisa Richmond, executive director of the San Joaquin Medical Society, at 952-5299 or lisa@sjcms.org.

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W Syung Min Jung, MD, FAACP, is an internal medicine physician and the director of the Internal Medicine Residency Program at San Joaquin General Hospital where she’s in charge of the education and training of residents. She and her spouse have a son in elementary school, and she is the daughter of a surgeon. She knew when she was a young child that she wanted to be a doctor.

Question: What was the most challenging part of getting to the point where you are today?

Answer: The most challenging part has been balancing my work and my family as a working mom. I think medicine and family both require much dedication and care. While it can be challenging, the two are among the most rewarding careers.

Q: What’s something you would like to do on a day off?

A: Spending a day hiking and exploring nature with my family. My husband and I have been making our rounds around the national parks with our son. His favorite so far was Lassen Volcanic National Park.

Q: Of what are you most proud?

A: It is most rewarding working with our resident physicians and seeing them grow in their abilities to take care of patients and become “good doctors”. I feel very privileged to work with our team and our residents and am proud to contribute back to the community by sending out compassionate caring doctors.

Q: Who has had the biggest influence on you and what did you learn most from that person?

A: I am thankful to have had many mentors and teachers, especially within

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San Joaquin General Hospital. Among them, Dr. Sheela Kapre has been a special influence on me during both my residency and my time as a physician at the hospital. Her knowledge of medicine and her genuine compassionate approach to patient care and resident training remains an inspiration to me.

Q: If you had the power to change one thing in your profession what would it be?

A: In the era of continuing and advancing technology, I would like to see a reemphasis on fundamental bedside skills and practices. New advances in technology should augment, rather than replace this essential part of being a physician.

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Param Gill, MD, and her husband have raised three sons and their passion for patient care at Gill Obstetrics and Gynecology is evident. Gill is the largest OB/GYN practice in the county with nearly two dozen physicians.

To this day, Dr. Gill still gets a special joy from all the thousands of babies she’s delivered, and she’s been a leader and a trailblazer in her field.

Question: In 1974, just 22.4 percent of medical school entrants were women but last year more women than men enrolled in medical school for the second year in a row. How does this progress make you feel?

Answer: When I finished medical school 42 years ago there were very few women physicians. I was the first crop of women physicians in this community. I have been the only woman Chief of Staff at both St. Joseph’s Medical Center and Lodi Memorial Hospital. It is wonderful to see an increase in the percentage of women entering medical school nowadays. I used to speak annually at the local high school career day to talk to young women who were interested in a medical career and now I am mentoring medical students from UC Davis, California Northstate and Touro University, as well as local residents to help them blossom into intellectual, caring physicians of the future.

Q: What has been the most rewarding aspect of your career?

A: The two most rewarding aspects of my career are bringing new life into the world and doing robotic surgery, which has improved the lives of so many women. Minimally invasive surgery has helped patients with quicker recuperation, smaller incisions and less blood loss, all of which allows women to go back to work faster and cut down on their pain and suffering Q: Share the most important advice you have for striking a work/life balance.

A: When you feel passionate about your work and you get positive feedback from your patients, it’s not work at all. It is also important to have hobbies and stop and smell the roses. My family is very important to me. When my sons are home, I love cooking and spending time with them. I now have a beautiful granddaughter who is the center of my universe, reading to her and hoping to take Disney trips with her in the near future. I enjoy traveling, it just rejuvenates me.

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Q: Describe the most challenging aspect of your career.

A: Many decades ago patients thought women could not be doctors let alone surgeons. So early in my career, I had to spend a lot of time educating patients that I was a surgeon as well.

Now that we have many more women physicians, this is no longer an issue. I was the first woman surgeon in Lodi’s history.

Q: What’s it been like working in a practice with your husband?

A: It was great practicing with my husband, especially since he was in the same field. The routine and mundane day to day work, we would leave at the office or the hospital; however, if I had a complex patient, I would get another opinion. As you know two minds are always better than one!

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Karen Swarer, M.D.

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Rishikesh Kulkarni, M.D.

Anubhi Kulkarni, M.D.

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The

REMEDY for all your

Financial

NEEDS

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

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

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

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California Medical Association’s 2019 Legislative Wrap-Up In January, California witnessed something completely new. The swearing in of Governor Gavin Newson marked the first time in state history that a Democratic governor was succeeded by another Democratic governor. Political history is flush with examples of challenges facing the incumbent party attempting to hold on to statewide power.

Typically, voters seize the opportunity for change by electing a leader of a different party. But this time, voters chose to move from a moderate Democrat (Jerry Brown) to a progressive Democrat (Gavin Newsom).

The transition from Brown, who retained tight control of the state’s budget and legislative process, to a first-time governor provided the legislature with an opportunity to reshape California’s policy landscape.

Discussion, debate, dialogue and compromise were the overwhelming themes of the 2019 session. Since Governor Newsom did not have a public veto or signing history, his

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policy perspective was not yet set in stone. Legislators saw this as an opportunity to bring nearly every recycled and newly minted policy idea to the proverbial table.

The tone of the 2019 legislative session was overall one of unbridled optimism. Such political environments pose many risks and opportunities, with many competing interest groups jockeying to raise their priorities.

The California Medical Association (CMA) successfully collaborated with the legislature on proactive efforts to expand public health initiatives, reduce administrative burdens, increase physician reimbursements and strengthen the physician workforce. However, over the course of the legislative year, additional reactive efforts emerged as various stakeholders launched unmerited attacks against the profession.

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cmadocs.org | Page 1

RELIEVING ADMINISTRATION BURDENS In January 2019, CMA was faced with an immediate crisis: flawed implementation of a new state law—intended to improve the security of physician prescription pads as a solution to the opioid crisis—left pharmacies unable to fill prescriptions and patients being refused necessary medications.

•

DEFEATED an attempt to dramatically increase

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DEFEATED multiple attempts to publicly disclose

During the last weeks of the legislative session, the United Healthcare Workers Union went after the physician community and sought to shame physicians for the compensation they receive. CMA successfully stopped the union’s sponsored bill, AB 1404 (SANTIAGO), which would have required targeted physician groups to disclose the total compensation of their physician partners as a means of creating leverage in union contract negotiations.

Such attacks don’t belong in the health care legislative space; they increase the difficulty of recruiting the quantity of physicians needed to serve patients and negatively impact efforts to constrain health care costs.

In addition to the above, CMA took the following actions to either relieve existing administrative burdens or stop the creation of new burdens:

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PASSED legislation to alleviate burdens associated with mandatory use of the CURES database

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DEFEATED legislation to change prescription labeling requirements

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DEFEATED legislation to require referral to alternative medicine practitioners prior to prescribing an opioid

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physician reimbursement and contracted rates

This year’s budget contained $120 MILLION to support loan repayment programs for physicians and dentists (administered by Physicians for a Healthy California)

CMA quickly worked with the Newsom Administration, the California Department of Justice and the legislature to resolve the matter. The result was the swift approval and enactment of CMA-sponsored AB 149 (COOPER), which allowed patients to immediately start receiving their prescriptions and physicians to utilize their existing prescription pads until July 2021.

CMA also sponsored AB 744 (AGUIAR-CURRY) to revamp the rules regarding the payment of health care services provided via telehealth in order to increase access to care. Under existing law, physicians are incentivized to require patients to physically enter medical offices for services that could otherwise be delivered utilizing telehealth. Health plans sought to maintain existing law as a means of creating barriers to care. However, CMA worked with legislators from both rural and urban areas, showcasing the benefits of telehealth and the necessity for plans to pay for physician expertise regardless of the modality under which it is delivered. Despite the opposition of the health insurer lobby, the measure received only one “no” vote throughout the entire process.

physician licensing fees

ACCESS TO CARE In June, Governor Newsom signed his first state budget.

The process for the 2019-2020 budget was dramatically different than prior years. Consistent with his campaign promises, Newsom prioritized health care. Not only did he expand health care insurance coverage, he was equally committed to funding access to care. This year’s budget contained: •

$2.2 BILLION for provider rate increases funded by

•

$120 MILLION to support loan repayment

•

$250 MILLION for the creation of a Value-Based

•

$150 MILLION for developmental and trauma

•

EXPANDED MEDI-CAL ELIGIBILITY, which

•

A STATE-LEVEL INDIVIDUAL MANDATE to

the Proposition 56 tobacco tax

programs for physicians and dentists (administered by Physicians for a Healthy California)

Payment Program within Medi-Cal screening supplemental payments

now includes all young adults aged 19-25, regardless of their immigration status

obtain health coverage

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cmadocs.org | Page 2

PUBLIC HEALTH AND POLICING THE PROFESSION The physician members of CMA hold sacred the trust patients and communities have in the medical profession.

On countless occasions, the leaders of state, county and specialty societies wrestle with a variety of policy questions. And while there are many perspectives from which a policy can be debated, inevitably the question will be asked: how will this impact our patients and the trust the public places in physicians to look after their best interest and health?

In 2015, CMA sponsored SENATOR RICHARD PAN, M.D.’S SB 277 to eliminate the personal belief exemption from the statutory requirements for childhood vaccinations.

The fight to enact SB 277 was fierce. Thousands of anti-vaxxers flooded the hallways of the Capitol. New security protocols were required for Senator Pan and CMA headquarters. The bill was heavily protested at the Capitol and in local districts; thousands of rabid anti-vaxxers spewed inflammatory rhetoric and threats of bodily harm.

When Governor Jerry Brown signed that measure into law, Sacramento assumed the chapter on vaccines was closed.

The result of SB 277 was positive overall, and statewide vaccination rates improved. However, a number of geographic pockets of unvaccinated children emerged due to vaccine hesitancy and a few physicians willing to inappropriately monetize the moment by providing vaccine exemptions with questionable medical rationales. While some abuse was anticipated, the quantity of exemptions issued by a few physicians was alarming. On social media, parents openly discussed how to purchase exemptions, which physicians were open to such transactions and what medical symptoms to highlight in the visit. As such behavior persisted, Senator Pan and CMA faced a dilemma: how to respond to physicians whose actions threaten to erode public trust in the physician community?

CMA’s obligation to protect the integrity of the profession and the public trust in the physician community outweighed the fear of facing fierce, threatening opposition.

Similar courage was necessary on other fronts, including the legislature’s response to the sexual misconduct of gynecologist George Tyndall in student health centers at the University of Southern California. CMA ensured important due process protections for physicians remained, while not protecting the deplorable behavior of a specific physician.

Navigating such troubling matters is complex, and CMA successfully preserved fundamental protections, while building our creditability with the legislature that CMA is an association that stands for quality physicians with the ability to self-police the profession.

Courage to fight for patients, courage to fight for the betterment of the profession and courage to fight for the public’s health is why CMA is the most effective advocacy organization in the Golden State!

In unity,

Janus L. Norman CMA Senior Vice President Centers for Government Relations and Political Operations

Courage! CMA and Dr. Pan chose to once again brave the turbulence and introduced legislation (SB 276) to increase vaccination rates by cracking down on inappropriate physician behavior. The reaction of the opposition exceeded our expectations. We knew there would be threats and a high number of anti-vaxxers protesting at the State Capitol and in the districts. We did not expect blood to be thrown onto the Senate floor from the gallery or parents forming chains to block the entrance of the Capitol.

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SPONSORED BILLS AB 149 (COOPER): CONTROLLED SUBSTANCES: PRESCRIPTIONS AB 149 is the clean-up to AB 1753 (Low) of 2018, which required new, uniquely serialized numbers to be printed on secure prescription pads. AB 149’s language is a collaboration of work of the medical board, pharmacy board, retail pharmacists, CMA and the Department of Justice (DOJ). It gives DOJ until January 1, 2020, to ensure that the serial numbers that are developed to be printed on security prescription pads are compliant with all state and federal laws as well as national industry standards. The bill also deems all prescription pads that were valid before January 1, 2019, as well as those printed since January 1, 2019, to be valid and allows prescribers to use up the supply of prescription pads they previously had as well as the ones recently purchased to be in compliance with the new law. These “older” prescription pads are valid until January 1, 2021, when the newest set, which is compliant with all national and industry standards, must begin to be used.

Status: Signed by the Governor (Chapter 4, Statutes of 2019).

AB 744 (AGUIAR-CURRY): HEALTH CARE COVERAGE: TELEHEALTH AB 744 strengthens existing laws around telehealth coverage to ensure that health plans do not treat services differently just because they are provided through telehealth technologies. If a health plan covers the service provided in-person, the bill states that the plans must also cover the service – if the exact same service – when provided through telehealth.

Status: Signed by the Governor (Chapter 867, Statutes of 2019).

SB 276/SB 714 (PAN): IMMUNIZATIONS: MEDICAL EXEMPTIONS The bill protects community immunity rates by ensuring that the implementation of SB 277 (CMA sponsored bill in 2015 to remove the personal and religious belief exemptions for vaccinations) effectively brings up the vaccination rates in all California neighborhoods. SB 276 develops a peer-review modeled process that ensures that only those who are truly immunocompromised, or who have a medical need, are granted a medical exemption. As a result of ongoing negotiations with the governor’s office, SB 276 was passed and moved to the governor’s desk. SB 714 was subsequently amended to address late concerns from the governor. The most notable change is limiting

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California Department of Public Health review to medical exemptions written on or after Jan. 1, 2020, unless the physician has been disciplined by the medical board. This bill is the product of negotiations between the author, the governor’s office and CMA. Status: Signed by the Governor (Chapter 278, Statutes of 2019 / Chapter 281, Statutes of 2019).

SB 441 (GALGIANI): ELECTRONIC HEALTH RECORDS: VENDORS SB 441 would have created a state regulatory structure for the enforcement of federal requirements related to interoperability and the provision of technical assistance with electronic health record vendors to increase efforts toward true interoperability and the benefits it could provide related to access, quality and affordability of health care.

Status: Held in the Senate Health Committee.

AB 1268 (RODRIGUEZ): HEALTH CARE COVERAGE: PROSPECTIVE REVIEW This bill would have required health plans and insurers to report the approval, denial, modification and delay rates on the top 30 services most utilized by physicians that require a prior authorization. AB 1268 also encouraged insurers to take this information into account when updating their utilization review criteria. The bill also included a provision authorizing regulators to at least annually compare the information collected in the bill to the grievances they receive from enrollees for the same services. If, upon a finding that there is a trend of bad behavior by plans, they may assess a penalty on the plan or insurer.

Status: Held in the Assembly Appropriations Committee.

CO-SPONSORED BILLS AB 764 (BONTA): SUGAR-SWEETENED BEVERAGES: NONSALE DISTRIBUTION INCENTIVES This bill would have prohibited beverage manufacturers from offering a coupon or other promotional incentive on any sugar-sweetened beverages to their partnering manufacturer, distributor or retailer as a way of subsidizing the lower retail cost of the beverage.

Status: Held on the Assembly Floor.

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AB 765 (WICKS): HEALTHY CHECKOUT AISLES FOR HEALTHY FAMILIES ACT

AB 1174 (WOOD): HEALTH CARE: ANESTHESIA SERVICES

This bill would have limited which beverages could be made available for purchase near the checkout counter at supermarkets, large grocery stores, supercenters and warehouse clubs, prohibiting sugar-sweetened beverages.

Modeled after several local ordinances nationwide, this bill would have impacted the “impulse” purchasing of unhealthy beverage products.

The bill would have required health care service plans and health insurers notify their respective regulators if they, or their delegated entity, plan to terminate or let expire a current contract for the provision of anesthesia services.

The regulator would then be required to ensure that the health care service plan/insurer/delegated entity has a contract with at least one anesthesiologist who is contracted with the health facility and that an enrollee requiring anesthesia services shall have access to a contracted anesthesiologist at all times and for all procedures at each of the health care service plan’s/insurer’s/delegated entity’s contracted health facilities.

Status: Held in the Assembly Health Committee.

AB 766 (CHIU): UNSEALED BEVERAGE CONTAINER PORTION CAP This bill would have limited the portion size of unsealed sugar-sweetened beverage sales to 16 ounces. Modeled after action taken in New York City, this bill would have impacted sales of fountain drinks at all restaurants, movie theaters, fast-food establishments, delis, sports stadiums, and corner stores or gas stations.

Status: Held in the Assembly Health Committee.

PRIORITY SUPPORT BILLS AB 528 (LOW): CONTROLLED SUBSTANCES: CURES DATABASE This bill provides critical fixes to the mandatory check requirement of the Controlled Substance Utilization Review and Evaluation System (CURES). It changes the requirement that a provider check the system every four months when a prescription remains part of a patient’s treatment plan to upon renewal if at least six months have passed; allows for delegate access to CURES; and relieves physicians of having to login to the CURES system when a patient’s record already contains a CURES report from within the last 24 hours. It also requires dispensers to report controlled substances dispensed to the CURES system within one working day of dispensing and includes Schedule V medications in the drugs that must be reported to the system by dispensers.

Status: Signed by the Governor (Chapter 677, Statutes of 2019).

AB 138 (BLOOM): CALIFORNIA COMMUNITY HEALTH FUND This bill would have imposed a fee on sodas and other sugary beverages, at a rate of $.02 per ounce, and used the new revenue to offset health and economic costs associated with overconsumptions of sugar.

Status: Held in the Assembly Revenue and Taxation Committee.

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Status: Held in the Assembly Appropriations Committee.

AB 1264 (PETRIE-NORRIS): MEDICAL PRACTICE ACT: DANGEROUS DRUGS: APPROPRIATE PRIOR EXAM This bill clarifies within existing prescribing laws that an appropriate prior examination does not require a real-time or synchronous face-to-face telehealth visit between the provider and patient. Planned Parenthood sponsored AB 1264 to clarify that birth control can be prescribed after an asynchronous patient interaction. CMA worked with the author and sponsor to ensure that AB 1264 ensured a broader application so that other prescriptions, if the physician feels appropriate, can be provided after an asynchronous visit as well.

Status: Signed by the Governor (Chapter 741, Statutes of 2019).

AB 1639 (GRAY): TOBACCO PRODUCTS This bill would have established tobacco control measures to reduce consumption of vapor products among youth.

Specifically, it would have increased enforcement and penalties on underage sales of tobacco products and implemented prohibitions against advertisements of vaping products.

Status: Held in the Senate Health Committee.

SB 347 (MONNING): SUGAR-SWEETENED BEVERAGES: SAFETY WARNINGS This bill would have required a warning label on all sugarsweetened beverages. Specifically, it would have required labeling on any sealed beverage container and on any vending machine or beverage dispensing machine.

Status: Held in the Assembly Health Committee.

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SUCCESSFULLY NEGOTIATED BILLS

cost more than a reasonable fee to the patient based on the time and effort necessary to complete the form.

AB 5 (GONZALEZ): WORKER STATUS: EMPLOYEES AND INDEPENDENT CONTRACTORS

Status: Failed in the Assembly Health Committee.

This bill seeks to codify the California Supreme Court’s recently announced new test for determining whether a worker is an employee or an independent contractor in the landmark decision of Dynamex Operations West, Inc. v.

Superior Court of Los Angeles, No. S222732 (Cal. Sup. Ct. Apr. 30, 2018). CMA secured an exemption for physicians to ensure they could maintain independent contractor status in the state.

Status: Signed by the Governor (Chapter 296, Statutes of 2019).

AB 241 (KAMLAGER-DOVE): IMPLICIT BIAS: CONTINUING EDUCATION: REQUIREMENTS This bill requires that all continuing medical education courses for physicians and surgeons contain curriculum that includes an understanding of positive and negative perceptions, feelings and stereotypes that impact decisionmaking in an unconscious way. The bill also requires the Physician Assistant Board and Board of Registered Nurses to implement similar implicit bias training into their licensees’ continuing medical education courses.

Status: Signed by the Governor (Chapter 417, Statutes of 2019).

AB 288 (CUNNINGHAM): CONSUMER PRIVACY: SOCIAL MEDIA COMPANIES This bill would have allowed social media users to have their information permanently deleted by social media companies at their request. The definition used in the bill for “social media company” was broadly defined to include any entity providing electronic services and accounts; therefore CMA successfully negotiated an exemption for physicians and medical services to ensure they weren’t inadvertently captured under the legislation.

Status: Failed in the Assembly Privacy and Consumer Protection Committee.

AB 370 (VOEPEL): PHYSICIANS AND SURGEONS: FORMS: FEE LIMITATIONS This bill would have capped at $25 the amount that a physician can charge for filling out a State Disability Insurance form, and also allowed the Medical Board of California to increase the fee annually by an amount equal to the Consumer Price Index increase. CMA successfully negotiated amendments that stated that the forms shall not

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AB 743 (GARCIA, EDUARDO): PUPIL HEALTH: SELF-ADMINISTRATION OF PRESCRIBED ASTHMA MEDICATION CMA, in collaboration with teachers’ and school nurses’ associations, successfully negotiated AB 743 to allow for a physician contracted with a prepaid Mexican health plan, licensed in California, to write a note authorizing students to use their asthma rescue inhaler at school. The note must contain specific information including the medication, dose, duration and the physician’s contact information, in both Spanish and English.

Status: Signed by the Governor (Chapter 101, Statutes of 2019).

AB 845 (MAIENSCHEIN): CONTINUING EDUCATION: PHYSICIANS AND SURGEONS: MATERNAL MENTAL HEALTH This bill requires the Medical Board of California to consider adding a course in maternal mental health to the continuing medical education requirement.

Status: Signed by the Governor (Chapter 220, Statutes of 2019).

AB 929 (RIVAS, LUZ): CALIFORNIA HEALTH BENEFIT EXCHANGE: DATA COLLECTION This bill classifies Covered California as a health oversight authority, giving it more authority over products on the health insurance exchange and other parts of the health care market. In addition, AB 929 requires plans to report a host of information including contracted rates, disparity information, encounter data and cost detail directly to Covered California for review and inspection to help address shortfalls in coverage on the exchange. CMA obtained amendments that put the reporting requirements on the health plans, not the physicians, and ensured that any cost detail information would not be made public. CMA also secured amendments that prevent Covered California’s new oversight authority from applying to providers directly.

Status: Signed by the Governor (Chapter 812, Statutes of 2019).

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A COMMUNITY BUILT ON

COLLABORATION Doctors Hospital of Manteca is excited to introduce a first-of-its-kind resource for physicians and patients in Manteca: the da Vinci Xi robot. Local access to roboticassisted surgery techniques provides doctors the ability to offer helpful benefits for treating a range of conditions with less invasive surgery, shorter hospital stays, faster recovery times and less scarring.

To learn more about the program, call (209) 988-2283.

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AB 1035 (MAYES): PERSONAL INFORMATION: DATA BREACHES This bill would substantially limit the amount of time allowed for a business to report a known privacy breach to 45 days. CMA successfully negotiated an exemption for physicians, who are already subject to medical privacy laws that would now conflict with this broader state law.

Status: Failed in the Senate Judiciary Committee.

AB 1131 (GLORIA): MEDI-CAL: COMPREHENSIVE MEDICATION MANAGEMENT This bill would have established comprehensive medication management (CMM) services as a covered benefit under the Medi-Cal program, and would have required CMM services to include the development of a care plan in collaboration with the beneficiary and the beneficiary’s health care providers to address identified medication therapy problems. CMA collaborated with the author and sponsors to limit the instances when pharmacists can perform CMM, to if the physician refers the patient due to specific criteria outlined in the bill.

Status: Failed in the Senate Appropriations Committee.

AB 1395 (CUNNINGHAM): INFORMATION PRIVACY: OTHER CONNECTED DEVICE WITH A VOICE RECOGNITION FEATURE This bill builds upon existing law around “connected televisions” and requirements that their manufacturers must provide certain privacy notifications to consumers.

The bill adds and defines other connected devices in the law as those with a voice recognition feature and a wireless speaker and voice command device sold in this state with an integrated virtual assistant that offers interactive actions and hands-free activation. CMA raised concerns initially that the bill could be broad enough to capture medical devices and other health care technologies; however, the bill was amended so it would no longer impact health care.

Status: Failed in the Senate Judiciary Committee.

AB 1510 (REYES): SEXUAL ASSAULT AND OTHER SEXUAL MISCONDUCT: STATUTES OF LIMITATIONS ON CIVIL ACTIONS This bill specifies that a civil action may be brought against any person or entity who owed a duty of care to the plaintiff for committing sexual assault or other criminal sexual conduct. The bill would also revive sexual misconduct claims, brought by or on behalf of a patient who suffered sexual misconduct at a student health center. The author

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took CMA’s amendments to significantly narrow the bill to apply to victims of George Tyndall. Amendments also limited the provisions to the dates at which George Tyndall worked at USC. Status: Signed by the Governor (Chapter 462, Statutes of 2019).

AB 1611 (CHIU): EMERGENCY HOSPITAL SERVICES: COSTS AB 1611 would have required a health care service plan contract or an insurance policy to provide that if an enrollee or insured receives covered services from a non-contracted hospital, the enrollee or insured is prohibited from paying more than the same cost sharing that the enrollee or insured would pay for the same covered services received from a contracting hospital. The bill would have also required a health care service plan or insurer to pay a non-contracted hospital for emergency services (excluding poststabilization services) rendered to an enrollee or insured pursuant to the reasonable and customary value of the services provided. CMA secured amendments that would have ensured that the provisions of the bill did not apply to physicians and surgeons.

Status: Failed in the Senate Health Committee.

SB 41 (HERTZBERG): CIVIL ACTIONS: DAMAGES SB 41 prohibits the estimation, measure or calculation of civil damages from being based on, or considering, race, ethnicity, gender, religion or sexual orientation, except to determine life expectancy for calculating damages. The amendments limiting the prohibition in the bill to using race, ethnicity or gender in calculating lost earnings or impaired earning capacity ensure that these factors are used in their relevant context (i.e., life expectancy) and do not allow for the use of earnings tables to reduce earnings damages directly.

Status: Signed by the Governor (Chapter 136, Statutes of 2019).

SB 58 (WIENER): ALCOHOLIC BEVERAGES: HOURS OF SALE This bill established a pilot that would have allowed qualified cities to apply for an additional hours license to authorize the selling or purchasing of alcoholic beverages between the hours of 2 and 3 a.m.

Status: Failed on the Assembly Floor.

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SB 159 (WIENER): HIV: PREEXPOSURE AND POSTEXPOSURE PROPHYLAXIS This bill authorizes a pharmacist to furnish up to 60 days of preexposure prophylaxis (PrEP) and 30 days of postexposure prophylaxis (PEP) to patients who meet specific conditions consistent with federal guidelines. The bill sets a limitation on use that ensures physician oversight for the long-term use of PrEP medication while increasing access for patients.

Status: Signed by the Governor (Chapter 532, Statutes of 2019).

SB 223 (HILL): PUPIL HEALTH: ADMINISTRATION OF MEDICINAL CANNABIS: SCHOOL SITES This bill authorizes schools to adopt a policy that allows a parent or guardian of a pupil to possess and administer non-smokeable and non-vapeable medicinal cannabis to the authorized pupil at a school site. CMA successfully negotiated the removal of a requirement that the pupil’s primary care physician must also attest to knowing that the pupil uses medicinal cannabis.

Status: Signed by the Governor (Chapter 699, Statutes of 2019).

SB 260 (HURTADO): AUTOMATIC HEALTH CARE COVERAGE ENROLLMENT SB 260 requires Covered California to enroll an individual who is no longer eligible for Medi-Cal in the lowest cost silver plan upon receiving the individual’s electronic account from a county or other entity. The bill would require enrollment to occur before Medi-Cal coverage is terminated, and would prohibit the premium due date from being sooner than the 30th day of the first month of enrollment. CMA secured amendments that provide protections for physicians to either receive payment from plans/insurers or to collect payment from a patient upfront.

Status: Signed by the Governor (Chapter 845, Statutes of 2019).

SB 377 (MCGUIRE): JUVENILES: PSYCHOTROPIC MEDICATIONS: MEDICAL INFORMATION This bill would require that, in order for the Medical Board of California to receive a juvenile ward of the court’s medical records for purposes of investigating overprescribing of psychotropic medication, there must be authorization by the child or child’s attorney to release the medical information. Also, the bill provides that the Judicial Council must develop the authorization form and

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specify that the medical information given must be relevant to the investigation of the prescription of psychotropic medication.

Status: Signed by the Governor (Chapter 547, Statutes of 2019).

SB 425 (HILL): HEALTH CARE PRACTITIONERS: LICENSEE’S FILE: PROBATIONARY PHYSICIAN’S AND SURGEON’S CERTIFICATE: UNPROFESSIONAL CONDUCT This bill requires that all patient complaints of sexual misconduct, made in writing, must be given to the appropriate licensing board by the entity that receives the complaint. The bill also ensures the same privacy protections are in place for these complaints as would apply to any complaint made to the medical board or appropriate licensing board.

Status: Signed by the Governor (Chapter 849, Statutes of 2019).

SB 464 (MITCHELL): CALIFORNIA DIGNITY IN PREGNANCY AND CHILDBIRTH ACT This bill requires hospitals that provide perinatal care, and alternative birth centers or primary clinics that provide services as an alternative birth center, to implement an implicit bias training program for all providers employed by the hospital. It also requires such facilities to make that training voluntarily available to physicians and surgeons not employed by the hospital. Additionally, the bill would require the department to track and publish data on pregnancy-related death and severe maternal morbidity.

Status: Signed by the Governor (Chapter 533, Statutes of 2019).

SB 639 (MITCHELL): MEDICAL SERVICES: CREDIT OR LOAN This bill strengthens consumer protections by prohibiting providers from offering medical credit cards or loans with deferred interest provisions; prohibiting providers from signing consumers up for these products in treatment areas; and simplifying the notice language. CMA negotiated amendments to limit the instances when providers are required to provide an alternate treatment plan.

Status: Signed by the Governor (Chapter 856, Statutes of 2019).

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SB 697 (CABALLERO): PHYSICIAN ASSISTANTS: PRACTICE AGREEMENT: SUPERVISION SB 697 replaces the one physician to one physician assistant (PA) delegated services agreement with a flexible practice agreement that allows one agreement to bind a group of physicians who work in a setting to a PA who also works in that setting. It also removes specified chart review requirements and leaves that up to the practice agreement.

Additionally, SB 697 repeals outdated provisions that relate to physician application and fees to supervise PAs and removes references to a PA board-maintained registry of physicians supervising PAs. These changes allow for more flexibility for physicians in their relationships with PAs and give PAs more parity with nurse practitioners.

Status: Signed by the Governor (Chapter 707, Statutes of 2019).

SB 701 (JONES): FIREARMS: PROHIBITED PERSONS This bill would make it a misdemeanor for a person with an outstanding warrant to own or possess a firearm or ammunition.

Status: Vetoed by the Governor.

OPPOSED BILLS AB 156 (VOEPEL): EYE CARE: REMOTE ASSESSMENT This bill proposed limitations around the ability of ophthalmologists and optometrists to provide services via telehealth modalities. Specifically, it would have prohibited a person from operating an assessment mechanism to conduct an eye assessment or to generate a prescription for contact lenses or visual aid glasses unless numerous unnecessary requirements were met. The bill would have defined “assessment mechanism” to mean any type of telehealth modality and limited the locations where patients could seek such services.

Status: Failed in Assembly Business and Professions Committee.

AB 290 (WOOD): HEALTH CARE SERVICE PLANS AND HEALTH INSURANCE: THIRD-PARTY PAYMENTS

existing plan/provider contract if a patient is receiving financial assistance, and instead puts in place the Medicare rate or an Independent Dispute Resolution Process that favors the health plans.

Status: Signed by the Governor (Chapter 862, Statutes of 2019).

AB 503 (FLORA): GUN-FREE SCHOOL ZONE This bill would have allowed an individual who holds a concealed carry license to carry their firearm in a church, synagogue or other place of worship, and on the grounds of a public or private school with permission from the school.

Status: Failed in the Assembly Public Safety Committee.

AB 613 (LOW): PROFESSIONS AND VOCATIONS: REGULATORY FEES This bill would have provided for an automatic licensing fee increase every four years on all licensing boards under the Department of Consumer Affairs (DCA), not to exceed the increase in the Consumer Price Index. This fee increase would have only needed to be approved by the director of DCA, with exemptions, and would not be need-based or in any way tied to enforcement or caseload.

Status: Failed in Senate Business, Professions and Economic Development Committee.

AB 715 (NAZARIAN): RICHARD PAUL HEMANN PARKINSON’S DISEASE PROGRAM Current law requires health care providers diagnosing or providing treatment to Parkinson’s disease patients to report each case to the California Department of Public Health. This bill extends the reporting requirement an additional year, beyond the current date of January 1, 2020.

CMA defeated a budget request in this last budget cycle (2019-20) for $10 million over three years to continue the program, in the interest of reducing the administrative burden to physicians of data collection to support disease surveillance.

Status: Signed by the Governor (Chapter 806, Statutes of 2019).

This bill establishes requirements for any entity making third-party premium payments if that entity is a provider that receives a direct or indirect financial benefit from the third-party payments, or if that entity receives the majority of its funding from one or financially interested health care providers. AB 290 includes provisions that break an

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AB 780 (BROUGH): HEARING AID DISPENSERS: PRACTICE: CERUMEN MANAGEMENT: APPRENTICE LICENSE

AB 1038 (MURATSUCHI): HEALTH DATA: RATES FOR HEALTH CARE SERVICES: PHYSICIANS AND SURGEONS

AB 780 sought to expand the scope of practice for hearing aid dispensers to include tympanometry and cerumen management. AB 780 also would have removed continuing education requirements and an exam related to tympanometry, created an “advanced practice certificate,” and added in supervision by a mentor or trainer.

This bill would have required every licensed provider in the state to report to the Office of Statewide Health Planning and Development the negotiated rate for each health care service for each contract a provider has with a plan or insurer, and to also report the amount patients are charged for each of those services. AB 1038 would have made the aggregated data public by geographic region and would have compared the negotiated rates to Medicare rates.

Status: Failed in the Assembly Appropriations Committee.

AB 888 (LOW): OPIOID PRESCRIPTIONS: INFORMATION: NONPHARMACOLOGICAL TREATMENTS FOR PAIN This bill would have required a prescriber to offer patients receiving opioids a referral to a non-pharmacological treatment provider such as a chiropractor or acupuncturist.

AB 888 also sought to make prescribers obtain written, informed consent from patients receiving an opioid with specific informed consent language.

Status: Failed in the Assembly Health Committee.

AB 1105 (GIPSON): SICKLE CELL DISEASE This bill would have established a three-year pilot to develop regional sickle-cell disease centers to help patients access team-based medical, behavioral health, mental health, social support and surveillance services to adults with sickle cell. The bill did not require that the health services provided at the pilot centers be done through a licensed physician or allied health care professional under the supervision of a licensed physician.

Status: Failed in the Senate Business, Professions and Economic Development.

Status: Failed in the Assembly Appropriation Committee.

AB 890 (WOOD): NURSE PRACTITIONERS: SCOPE OF PRACTICE: UNSUPERVISED PRACTICE

AB 1270 (STONE, MARK): FALSE CLAIMS ACT

This bill would have allowed nurse practitioners (NP) to practice without physician supervision, with additional education and training requirements for certain settings.

The legislation contained a framework for the additional education, training and consumer protection requirements, but lacked significant details as to what specifically NPs would have to do to prove competency beyond the current educational requirements.

Status: Failed in the Assembly Appropriations Committee.

AB 1030 (CALDERON): PELVIC EXAMINATIONS: INFORMATIONAL PAMPHLET This bill would have required a physician to, prior to a patient’s first gynecological exam, provide the patient with a pamphlet that outlines what a patient may expect during the appointment. The bill required that certain information be included in the pamphlet and that the physician provide the pamphlet to the patient for review and signature immediately prior to the exam.

AB 1270 would have based materiality of a false record or statement off of the potential effect, instead of the actual effect, of the false record or statement when the record or statement was made. The bill would also specify that amount of damages that may be awarded include consequential damages.

Status: Failed in the Senate Appropriations Committee.

AB 1404 (SANTIAGO): NONPROFIT SPONSORS: REPORTING OBLIGATIONS This bill would have required a health care entity to disclose a contracted physician’s complete compensation information, including base compensation, deferred compensation, and any bonuses and incentives that are part of their total compensation package, on its public website.

Status: Failed on the Senate Inactive File.

Status: Failed on the Senate Inactive File.

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AB 1670 (HOLDEN): HEALTH CARE COVERAGE AB 1670 would have authorized a provider that contracts with a health care service plan or health insurer to bill an enrollee or insured for a service that is not a covered benefit if the enrollee or insured provides initial written consent to the bill. The bill would have required a contracting physician to provide an enrollee or insured with a written estimate of the total cost, based on the standard rate the provider would charge for the service, if the service sought is not a covered benefit.

Status: Failed in the Assembly Health Committee.

SB 201 (WIENER): MEDICAL PROCEDURES: TREATMENT OR INTERVENTION: SEX CHARACTERISTICS OF A MINOR SB 201 would have prohibited a physician from performing any treatment or procedure on the sex characteristics of an intersex minor until the minor patient provides informed consent to the physician. The bill makes an exception for any procedure or treatment that is deemed medically necessary, which is defined in such a way that cannot properly address the complexity of such cases.

Status: Failed in the Senate Business, Professions and Economic Development Committee.

SB 480 (ARCHULETA): RADIOLOGIST ASSISTANTS

SB 673 (MORRELL): COMPREHENSIVE SEXUAL HEALTH EDUCATION AND HIV PREVENTION EDUCATION This bill would have required, for a student in a grade lower than 7th, an active parental “opt-in� for sexual health education and HIV prevention education in that year and in the upcoming year. Current law requires all students in 7th grade and above to participate in sexual health education and HIV prevention education unless a parent actively opts their child out of such education.

Status: Failed in the Senate Education Committee.

SB 689 (MOORLACH): NEEDLE AND SYRINGE EXCHANGE PROGRAMS This bill would have placed barriers on cities or other specified entities who seek to establish a needle exchange program.

Status: Failed in the Senate Health Committee.

SB 746 (BATES): HEALTH CARE COVERAGE: ANTICANCER MEDICAL DEVICES SB 746 would have required health care service plan contracts and health insurance policies that cover chemotherapy or radiation therapy for the treatment of cancer to also cover anticancer medical devices.

Status: Failed in the Assembly Appropriations Committee.

This bill would have created a new class of licensees, called radiologist assistants, and defined their supervision and scope. The bill also limited supervision of these radiologist assistants to solely radiologists.

Status: Failed in the Senate Business, Professions and Economic Development Committee.

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Call Today to Schedule a Tour!

To qualify for Stockton PACE enrollees must meet all of the following: • Be age 55 or older • Reside in San Joaquin or Stanislaus counties (zip codes are listed at stocktonpace.com) • Be certified by the State as eligible for nursing facility level of care • Be able to live safely at home and in the community with PACE services without jeopardizing health and safety of themselves and others

582 E. Harding Way • University Park • Stockton, CA 95204 209-442-6077 • StocktonPace.com

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practice manager

resources

Free to SJMS/CMA Members!

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. Nonmembers 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 11TH, 2019: 11:00AM TO 1:00PM “2020 MEDICARE UPDATES”

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~ Associate Director, CMA Center for Economic Services

JANUARY 8TH, 2020: 11:00AM TO 1:00PM “MANAGING CHANGE”

FEBRUARY 12TH, 2020: 11:00AM TO 1:00PM “PHYSICIAN OFFICE OSHA REGULATIONS; ARE YOU IN COMPLIANCE?”

EnviroMerica, a 20-year-old Bay Area consulting firm, approved by CMA as their exclusive Vendor for compliance and Medical waste will provide an OSHA compliance course which outlines how to fulfill regulatory requirements and provides physician offices with the latest changes in the law.

Attendees will learn:

Nobody likes change except a baby! Physicians, managers and staff often find any change difficult and stressful. The healthcare landscape is changing rapidly. Managers must be proactive, nimble and able to manage change effectively within their organizations.

What causes OSHA inspections and how to prevent it?

Following participation in this session, learners should be able to:

What are the latest Standards & Protocols in Cal-OSHA Regulations?

Assess growth strategies including merging, adding locations or providers

Julian Goduci~ President/CEO of EnviroMerica, Inc.

Advise physicians on the financial, cultural and control aspects of being acquired or staying independent Create the desire for change, communicate the benefits and overcome objections.

Debra Phairas~ President of Practice & Liability Consultants, LLC

What are the components of an OSHA compliant facility?

What is it like to experience a Cal-OSHA inspection?

What are the requires Cal-OSHA Standards required for Medical facilities?

Public Health

Update

A Look at the Opioid Crisis In San Joaquin County

By Kismet Baldwin, MD and Daniel H. Kim Jr., MPH, MCHES

Over the past three years, the opioid epidemic in the United States has been in the forefront of the news. The U.S. Health and Human Services Agency declared the opioid crisis as a “Public Health Emergency.� The U.S. Surgeon General issued an advisory on naloxone, recommending that more individuals including family, friends, and those who are personally at risk for opioid overdose keep the opioid reversing drug on hand. The U.S. Centers for Disease Control and Prevention (CDC) issued its Guideline for Prescribing Opioids for Chronic Pain in 2016 and has subsequently updated data to alert public health and health care professionals about developments in the evolving opioid overdose epidemic.

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According to the CDC, in 2017 there were more than 70,000 drug overdose deaths in the U.S. with almost 68% involving a prescription or illicit opioid, which equals a rate of 21.7/100,000.

What are we seeing in San Joaquin County? According to the California Opioid Dashboard, San Joaquin County (SJC) had high rates of opioid-related overdose deaths (9.18 per 100,000 residents) when compared to California (5.22/100,000) in 2017. The prescription opioid-related overdose death rate in SJC (7.08/100,000) also surpassed California (3.70/100,000).

SJC rates have consistently trended higher than California’s average rates in terms of all opioid deaths since 2007. More SJC residents (618.26/1000) received an opioid prescription during 2018 than California (456.90/1000) as a whole. This indicates a higher percentage of SJC residents are at risk for opioid dependency and/or perpetuating an existing addiction.

A higher rate of SJC residents (17.53/1000) had high doses of opioids (>90mg/day) prescribed for daily consumption than the rest of California (14.40/1000). Higher doses of prescribed opioids are associated with an increased risk for dependency. In addition to high daily doses of prescribed opioids, overlapping opioid prescriptions is also associated with an increased risk for dependency and can create an environment where addiction can form. SJC residents (11.61/1000) have higher rates of overlapping opioid prescription regimens than the rest of California (10.24/1000). SJC has achieved a 12.2% decrease in opioid prescriptions from 2017 to 2018 which is a significant improvement. However, there is still work to be done towards decreasing the rate of methamphetamine overdose deaths, which has also consistently exceeded the state rate and continues to increase.1 How did we get here? In the late 1990s, pharmaceutical companies reassured the medical community that patients would not become addicted to opiod pain relievers; health care providers began prescribing opioids at greater rates.

Increased prescribing of opioid medications led to widespread misuse of both prescription and non-prescription opioids before it became clear that these medications could be highly addictive. The second wave began in 2010, with rapid increases in overdose deaths involving heroin. The third wave began in 2013, with significant increases in overdose deaths involving synthetic opioids, particularly those involving illicitlymanufactured fentanyl (IMF). The IMF market continues to change, and IMF can be found in combination with heroin, counterfeit pills, and cocaine. 2 Methamphetamines have been and remain the predominant drug in California. However while the New England and Midwest areas have been hit hardest by the opiod epidemic, California is not immune nor is San Joaquin County. Illicitly manufactured fentanyl

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and an array of potent fentanyl analogs such as carfentanil, estimated to be 10,000 times more potent than morphine and 3-methylfentanyl (4x more potent than fentanyl) have become prevalent across the U.S., contributing to the rising number of deaths.2 Opioids-mainly synthetic opioids (other than methadone)- are currently the main drivers of drug overdose deaths.2 What other avenues can providers and the county pursue?

With the help from the Sutter Health Foundation, San Joaquin County Public Health Services (SJC PHS) has formed an opioid coalition that includes county stakeholders ranging from mental health and law enforcement to emergency department physicians, pharmacists, and treatment centers to develop key goals and strategies to combat the opioid problem in our county.

Since its inception in early 2018, the San Joaquin County Opioid Safety Coalition has centered on a population-based approach to address the opioid crisis. Coalition health care providers have reached out to other community providers to deliver peer-to-peer opioid education in an effort to improve the way opioids are prescribed. Opioid prescribing through clinical practice guidelines can ensure patients have access to safer, more effective pain treatment while reducing the number of people who potentially misuse or overdose from these drugs.

Reducing exposure to prescription opioids, for situations where the risks of opioids outweigh the benefits, is a crucial part of prevention.

As part of community education and awareness, the coalition developed a marketing campaign with billboards and radio ads, highlighting the potential risk of addiction from prescription opioids in as little as 5 days. These were targeted to reach areas with the highest rates of opioid overdose deaths in the county.

In addition, the coalition has promoted Safe Drug Disposal sites and the National Prescription Drug Take Back Day as methods to help reduce the supply of medications at home that could become fuel for addiction, resulting in an overdose or accidental poisoning. Safe Drug Disposal bins are accessible year-round at participating police departments and pharmacies, where they provide a safe and environmentally sound method of disposal, instead of flushing them down the drain into waterways or in the trash where they may be found and misused. Drug Take Back Days provide an opportunity twice a year for residents to disposal of their unused and expired drugs in the community setting.

To further assist in reducing the harm caused by opioids, the California Department of Public Health (CDPH) provided each county in California with intranasal naloxone to

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distribute within the county. The idea behind this wide scale distribution was to provide as many agencies, organizations and citizens the ability to potentially save the life of a person who has overdosed due to opioids. While this may not prevent the opioid user from using an opioid again, it can prevent death. Thus far, SJC PHS has provided free naloxone to Behavioral Health Services, Correctional Health Services and Emergency Medical Services. PHS has also directly distributed naloxone kits to people at local homeless shelters and to anyone requesting naloxone at the health department.

Another focus has been increasing the number of providers and agencies that provide medication-assisted treatment (MAT) for opioid use disorder (OUD). Increasing and optimizing the opportunities to provide MAT in combination with counseling and behavioral therapies is another necessary step in combating the opioid crisis. MAT is effective in the treatment of opioid and other substance use disorders and can help some people to sustain recovery 3, 4, 5. It can also lead to decreased recidivism: jail-based MAT has the potential to stem the cycle of arrest, incarceration, and release associated with inmates with OUD who return to the community without connection to treatment. Untreated former inmates have the highest risk for drug overdose death as a result of potential relapse to drug use and the loss of tolerance to the drug after a period of abstinence. 6 As stated by Jonathan F. Thompson, executive director and CEO of the National Sheriffs’ Association, “Jails represent perhaps the most unique place to get individuals off drugs and on the path to long-term recovery.7 Coalition partners are also applying MAT principles in the emergency department (ED) setting with assistance from the California Bridge Program. Through a federally funded grant, St. Joseph’s Medical Center and San Joaquin General Hospital are now piloting a program to enable emergency rooms and acute care hospitals to initiate treatment of OUD in the ED, where individuals can access around-the-clock treatment for substance use disorders. This model changes traditional referral systems for OUD to an immediate treatment focus that could result in a quicker road to recovery.

More must be done to facilitate treatment options and the development of therapies to address OUD as a chronic disease with long-lasting effects. This means helping more people secure MAT, which requires us to break the stigma

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often associated with some of the medications used to treat OUD. To win the war on opioids, there must be a collaborative, multi-faceted approach. Health care providers can help by critically evaluating the number and doses of opioid prescriptions written, limiting the number of refills and preventing prescription overlapping, and considering alternate forms of pain management. Health care providers can also obtain an x-waiver, allowing them to prescribe and initiate MAT treatment with effective and long-term control medications, such as buprenorphine and naltrexone.

Hospitals, emergency departments, and clinics must work with their healthcare providers and prescribers (not just physicians but also dentists and other specialists) by establishing a universal prescribing guideline that limit the amount of opioids prescribed and provide alternative treatment options for pain. Finally, health care providers’ perspectives and ideas are crucial in the development and implementation of successful strategies to address the opioid epidemic, therefore their participation in local opioid coalitions should be considered.

References https://discovery.cdph.ca.gov/CDIC/ODdash https://www.cdc.gov/drugoverdose/data/ Dunlap B, AS Cifu. Clinical Management of Opioid Use Disorder. JAMA. 2016 July; 316(3):338-9.

Clark RE, Baxter JD, Gideon A, O’Connell E, Fisher WH, Barton BA. Risk Factor for Relapse and Higher Costs among Medicaid Members with Opioid Dependence or Abuse: Opioid Agonists, Comorbidities, and Treatment History. J Subst Abuse Treat. 2015 Oct; 57: 75-80.

Amato L, Minozzi S, Davoli M, Vecchi S. Psychosocial Combined with agonist maintenance treatments versus agonist maintenance treatments alone for treatment of opioid dependence. Cochrane Database Syst Rev. 2011 Oct; 10: CD 004147. https://www.drugabuse.gov/publications/medications-to-treat-opioid-addiction/ how-opioid-use-disorder-treated-in-criminal-justice-system#targetText=In%20 national%20surveys%2C%20utilization%20of,79%20jails%2C80%20and%20 prisons.&targetText=Thus%2C%20opioid%20use%20disorder%20goes,use%20 often%20resumes%20after%20release.

National Sheriffs’ Association, National Commission on Correctional Health Care. Jail-Based Medication-Assisted Treatment. Promising Practices, Guidelines, and Resources for the Field. 2018 Oct.

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San Joaquin Medical Society Member Only Benefits • Complementary Security and Risk Assessment of your IT Infrastructure (valued at $500) • 10% Discount of Monthly Managed Services for the first year (valued at a maximum of $5,000) • Waived Set-up Fee (valued between $1,000 - $2,000 – user dependent) • Complementary Data Back-Up and Anti-Virus Service for the first 6 months (valued at $840+) • Monthly newsletter and Weekly Tech Tips for Cyber Safety

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

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