Winter 2023

Winter 2023

SERVING SAN JOAQUIN,

TUOLUMNE, ALPINE, AMADOR AND CALAVERAS COUNTY PHYSICIANS

Infusion of funds to target

Campus to offer treatment, recovery, and prevention Changing Face of Opioid Crisis Legislative Wrap Up 2023 State Tobacco Tax-Funded Program

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VOLUME 71, NUMBER 4 • DECEMBER 2023

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8 A MESSAGE FROM OUR PRESIDENT

34 IN THE NEWS

12 LEGISLATIVE WRAP UP

44 CMA ELECTS NEW OFFICERS

22 SCHOLARSHIP LOAN FUND

46 RESIDENTS REPORT

24 STATE PROGRAM AWARDS $38 MILLION

48 PRACTICE MANAGEMENT

26 SERVING UNDERSERVED COMMUNITIES

52 PUBLIC HEALTH

28 SCHOOLS PREVENT OPIOID OVERDOSES

56 IN MEMORIAM

30 FUNDS TO TARGET OPIOID CRISIS

58 NEW MEMBERS

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PRESIDENT Cyrus Buhari, DO PRESIDENT ELECT Neelesh Bangalore, MD TREASURER Sujeeth Punnam, MD BOARD MEMBERS Stephen Tsang, MD, Maggie Park, MD, Alain Flores, MD, Manreet Basra, MD, Sanjeev Goswami, MD, Kinnari Parikh, MD, Inderpreet Dhillon, MD, Bhagya Nakka, MD, Sunny Philip, MD, and Ripudaman Munjal, MD

MEDICAL SOCIETY STAFF EXECUTIVE DIRECTOR Lisa Richmond MEMBERSHIP COORDINATOR Jessica Peluso

SAN JOAQUIN PHYSICIAN MAGAZINE EDITOR Lisa Richmond EDITORIAL COMMITTEE Lisa Richmond, Cyrus Buhari, DO MANAGING EDITOR Lisa Richmond

COMMITTEE CHAIRPERSONS CMA AFFAIRS COMMITTEE Larry Frank, MD DECISION MEDICINE Kwabena Adubofour, MD

CREATIVE DIRECTOR Sherry Lavone Design CONTRIBUTING WRITERS Jo Ann Kirby, Cyrus Buhari, DO, Lyn Raible, MD, PhD

MEDICAL EDUCATION PROGRAMS Kelly Savage, MD

THE SAN JOAQUIN PHYSICIAN MAGAZINE

SCHOLARSHIP LOAN FUND Gregg Jongeward, PhD

is produced by the San Joaquin Medical Society

CMA HOUSE OF DELEGATES REPRESENTATIVES Robin Wong, MD, Lawrence R. Frank, MD

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

James R. Halderman, MD, Raissa Hill, DO Richelle Marasigan, DO, Ramin Manshadi, MD

PLEASE DIRECT ALL INQUIRIES AND SUBMISSIONS TO:

Philip Edington, MD , Sujeeth Punnam, MD

San Joaquin Physician Magazine

Sunny Philip, MD, Ripudaman Munjal, MD

3031 W. March Lane, Suite 222W Stockton, CA 95219 Phone: (209) 952-5299 Fax: (209) 952-5298 E-mail Address: lisa@sjcms.org MEDICAL SOCIETY OFFICE HOURS: Monday through Friday 8:30am-4:30pm Closed for Lunch between 12pm-1pm

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EXECUTIVE DIRECTOR’S REPORT

NAVIGATING THE OPIOID CRISIS A few months ago, the SJMS Board of Directors were fortunate to have a presentation by Dr. Lyn Raible, retired family medicine and addiction specialist, on the current state of the opioid crisis in San Joaquin County. It was alarming to hear the statistics surrounding the increase in illicit fentanyl use and overdoses. Later in the month, I attended the San Joaquin County Fentanyl Town Hall Meeting, where I was saddened to hear from the parents and siblings of those lost to Fentanyl in our community.

LISA RICHMOND

Unfortunately, the opioid crisis is ever evolving, so just when you think you have a better understanding, a cheaper, more potent, and addictive drug comes along. It can be like drinking out of a fire hose to try to keep up. Fortunately, San Joaquin Public Health Services, in consultation with Dr. Raible, is building out their website with up-to-date resources and information for providers. Additionally, there are big plans to use opioid settlement funds to expand services in our community. We encourage you to read both articles on this critically important topic.

At SJMS we are grateful for your membership. One of our goals for 2023 was to add more events and engagement opportunities AND to make sure that you are aware of all the benefits available to you. In October, we had lad a lovely dinner and presentation from the UC Davis Health Chief Wellness Officer, Sara Aghamohammadi, MD on “Real Talk About Burnout.”

This event was a great opportunity to learn more about clinician health and well-being, and enable physicians to continue to provide high quality patient care while achieving a better quality of life. Attendees felt comfortable sharing their experiences in a safe space, which led to wonderful, authentic discussions. We plan to hold another in Spring of 2024. Stay tuned!

Last month, we launched our newsletter, which is published every other Monday. We are curating all important information, resources, member benefits, CME, and social events to have at your fingertips. While we know that many are overwhelmed by emails, we hope you will review this one as it will be our main source of communication. If you haven’t seen it, please check your spam file and mark it as “safe.”

Finally, we hope to see you at our annual Holiday Party on Thursday, December 14 at Stockton Golf & Country Club as we enjoy fellowship with friends and colleagues and celebrate a year well done. I wish you all much laughter, joy, good cheer, and time with those who matter most.

Thank you for the privilege of leading the society for another year.

Best Wishes,

Lisa Richmond

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A message from our President > Cyrus Fram Buhari, DO

Perhaps We Are To Blame

ABOUT THE AUTHOR Cyrus Fram Buhari, DO is the current president of the San Joaquin Medical Society and practices at the San Joaquin Cardiology Medical Group

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As the guardians and stewards of the health of our community, we as doctors should have the first voice in the direction of how care is delivered. We should have the first voice in where dollars are spent. We should have the first voice in how resources are allocated. Unfortunately, this is not the case. Apparently, this responsibility has been seeded to politicians, physician politicians (who haven’t seen a patient in years), bureaucrats. As a result, budgets are created by those who have no idea how to budget. Priorities are overlooked in favor of handouts to those who donate the most, lobby the hardest, and contain the largest blocks of healthcare workers. This is what has led to what we see all around us: a lack of funding resources for health outreach programs, healthcare disparities along socioeconomic lines, and red tape at every turn.

Physicians are “nickel-and-dimed” constantly. That comes from insurances, hospitals, CMS, and every other body with some fiduciary responsibility to the health of members of our community. How can they get away with it? Well one way they have done so is to put a physician on the other side. Although that may provide legitimacy, it wreaks conflict of interest. This is standard operating procedure in order to get us physicians in line. I am not in any way saying that we don’t need insurances, hospitals, CMS, and others in this battle against disease. It is merely to say that perhaps all of this can be handled differently. This applies to populationbased health and preventative healthcare as well.

Think about cigarettes for instance. Why have no states banned their sale outright? Is there a doctor in the year 2023 who believes that they have a positive or neutral outcome on community health? Or is it that part of the budget depends on the revenue that the sales of cigarettes bring. Turning our advocacy against vaping seemed more sparkly and flashier than plain old cigarettes.

We seem to be focused on the headline grabbing political things

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in healthcare and not the things that will make a difference in our own budgetary fight. How on Earth are we supposed to address healthcare inequity in our community if CMS is going to cut physician payments by over 3% as of 2024. How can we address healthcare delivery to the historically ignored and marginalized members of our community if the physicians are getting squeezed to the point of moving or retiring. I doubt a practicing physician came up with this brilliant budget cut. Rest assured some bureaucrat is sipping scotch and patting themselves on the back after figuring out where to get the funds for the next pork-barrel pet project of theirs. We as physicians and healthcare providers in this community need to do everything, we can to stop this.

California Medical Association (CMA) is leading the fight against these cuts. I have met with members of Congress along with other members of the San Joaquin Medical Society (SJMS) board and have impressed

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upon them the total short-sightedness of these ridiculous cuts. If we lay down now, then there is no end to this. Year after year there will be more cuts. Patients will be the main recipient of the pain of this and that, my friends, and colleagues, is unacceptable and we should not stand for it. Any politician that does not raise their voice against this lunacy must be told that they will not have the support of thousands of physicians (who happen to be voting constituents).

We are only to blame if we remain silent. We must make our argument as loudly as we can. I urge all of us to stand and make our individual voices heard. I urge all of us to engage our colleagues and patients in this fight. CMA and your SJMS are the unified voice that is needed now more than ever. If your colleague is not a member of SJMS, encourage them to join. There is much to gain from all of us being a united voice in this fight. We are always stronger together.

SAN JOAQUIN PHYSICIAN 9

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CMA’S 2023 Legislative Wrap-Up

By Stuart Thompson, CMA Senior Vice President of Government Relations

B

efore launching into the recap of the 2023 legislative session, I want to take a moment to express my gratitude for being back at CMA and I am honored to be given the responsibility of representing the profession in front of the California Legislature. I spent five years at CMA as a staff lobbyist from 2014 to 2018 and then spent four years in the Governor’s Office as the Chief Deputy Legislative Secretary. But coming back to CMA felt like coming home.

The theme of 2023 in the California State Legislature was one of change at the top. Robert Rivas became the new Assembly Speaker in July after a year-long tussle with the previous Speaker, Anthony Rendon, who held the position for seven years.

Members loyal to Speaker Rivas will ascend to important chairmanships and key leadership positions over the coming months.

The California Senate also saw a change in leadership, albeit with much less drama, as Senate President pro Tempore Toni Atkins announced she will be transitioning power to Senator Mike McGuire sometime next year. Pro Tem Atkins’ term expires in 2024, and she is ineligible to run for the state Legislature again. This transition will be watched very closely to determine when a new pro tem might take over and whether Senator McGuire will change the current pro tem leadership team.

Senator Atkins was the first woman elected as Senate president pro tem when she took the position in 2018. She has fiercely advocated for women’s reproductive rights, LGBTQ+ rights and affordable housing in California. In 2022, in the shadow of the U.S. Supreme Court’s decision to overturn Roe v. Wade, Senator Atkins introduced a state constitutional amendment permanently protecting abortion care as a fundamental right in California. Our physicians are grateful for the work Senator Atkins has done to protect patient access to reproductive care for Californians and the nation.

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The changes in leadership in both houses were preceded by an election that saw an enormous influx of new members in both the Assembly and Senate. The Assembly saw 30 new members, including Jasmeet Bains, M.D. Dr. Bains is a boardcertified family physician providing care in the Central Valley and has been a member of CMA and its House of Delegates for several years. Her focus during her first year in office has been fighting the fentanyl crisis plaguing California.

The Senate also saw 10 new members, and we hope to see Assemblymember Akilah Weber, M.D., join their ranks in 2024! There is no advocacy that can rival having actual physicians on the floors of the state Legislature, and we are beyond thrilled to have these two physician champions in the state Legislature.

LEGISLATIVE MATTERS State Budget CMA was successful this year in advocating for the largest influx of new Medi-Cal dollars the state has ever invested into the program. That we were able to accomplish this in a budget environment where most programs were being cut is a testament to CMA’s advocacy. The funding is based on the renewal of the MANAGED CARE ORGANIZATION (MCO) TAX, which allows the state to tax managed care plans in an effort to draw down federal funding to support the Medi-Cal program. To secure this historic deal, CMA led a coalition effort that included the hospitals, clinics, Planned Parenthood, emergency transport providers, and health plans with the goal of ensuring Medi-Cal enrollees receive the same level of coverage as other members of their community.

The MCO Tax – which is broadly supported by our health plan partners – will raise a total of $19.4 billion, with much of it being spent on the state’s health care infrastructure.

Starting in 2024, Medi-Cal provider rates will be increased to at least 87.5% of Medicare for primary care, maternity care and non-specialty mental health services. Starting in 2025, the MCO Tax will also provide a new infusion of $6 billion for the Medi-Cal program and the health care workforce. Specifically, there will be an annual appropriation of $1.38 billion in primary care rate increases; $1.15 billion in specialty care rate increases; $700 million to increase emergency department access (including $200 million for emergency department physicians); at least $500 million for family planning and reproductive health care;

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and $600 million for behavioral health facilities, including increasing inpatient psychiatric beds.

Prior Authorization CMA SPONSORED SB 598 (SKINNER) – a reintroduction of last year’s SB 250 (Pan) – which would provide physicians with an exemption from prior authorization if they had a good history of prior authorization approvals. Additionally, the bill would have discontinued prior authorization for a service if the health plan approves it 95% or more of the time and required insurance reviewers for denials to have the same medical expertise as the treating provider.

Unfortunately, Assembly Appropriations Committee Chair Chris Holden held SB 598 in committee and prevented prior authorization reform legislation from advancing for the second straight year (he also held SB 250 last year).

This action would have required CMA to introduce a new bill next year and start the legislative process from the beginning for the third time. However, CMA was successful in lobbying the Speaker’s Office to allow us to gut and amend another bill currently in Assembly Appropriations Committee, SB 516, to include SB 598’s provisions.

Adopting this approach will give us the necessary time to negotiate with the Newsom Administration to address their implementation concerns with the reform package and allow us to pick up right where we left off with SB 598. This bill will remain a top priority for CMA in the coming year.

Heal th Care Worker Minimum Wage SB 525 (DURAZO), which will gradually raise wages of health care workers to $25 an hour, has been signed by Governor Newsom.

CMA had an oppose unless amended position on SB 525 and was advocating in coalition with other stakeholder groups. When SB 525 was amended during the last week of the legislative session to reflect a deal negotiated between some health care industry stakeholders and labor, CMA engaged in kind to limit the impact to our members.

CMA negotiated exemptions for IPAs and small practices with 24 physicians or less, as well as a gradual implementation of the wage increase. The ramp-up more closely aligns with wage trajectories that are anticipated to naturally occur due to economic pressures outside of SB 525, including other legislation that will raise the minimum wage for fast food workers to $20 per hour starting in April

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2024. Under that bill, a council will have the authority to increase the fast food minimum wage annually.

All of this is against the backdrop that California now requires an annual assessment and adjustment of the minimum wage to reflect inflation. Such an adjustment will occur on January 1, 2024, bringing California’s minimum wage up to $16 per hour.

SB 525 will neutralize efforts to enact health care worker minimum wages via local ballot measures across the state. Those efforts – assuming they resemble previous ballot measures in the cities of Inglewood and Downey – would have involved an immediate increase. The following chart shows when SB 525 wage increases would go into effect: SECTOR

2024

Physician groups with 25 or more physicians

$21

Physician groups part of large health systems with more than 10,000 workers and dialysis clinics

$23

Community clinics

$21

Hospitals with high mix of Medi-Cal and Medicare patients and rural independent hospitals

$18

CMA’s advocacy ensured that physician practices would not face more drastic and immediate wage increases that would be more difficult to weather. CMA will be closely monitoring how the new law impacts physician practices and patient care, especially small rural practices, hospitals and clinics.

Administrative Burden AB 1751 (GIPSON) was introduced at the request of the

California Chiropractic Association. The bill would have required physicians prescribing opioids to obtain signed consent that they talked to patients about alternative treatments to pain – including but not limited to chiropractic, mental health and acupuncture services – regardless of whether those treatments would even be beneficial. The bill was essentially an attempt to require physicians to talk to their patients about chiropractic services every single time they prescribed an opioid. AB 1751 was set to be heard in the Assembly Health Committee on two separate occasions but was never heard because of CMA’s grassroots and lobbying efforts. The bill must be acted upon in January 2024, or the bill will be considered dead.

2025

2026

2027

$23 $24

2028

$25

$25 $22

$25

Increase 3.5% annually until it reaches $25 in 2033 against the bill and prevented it from being taken up in its first committee, forcing it to become a two-year bill. AB 1570 must be acted upon by the end of January 2024, or the bill will be considered dead. We anticipate the proponents advancing some type of proposal in January, and CMA will be closely following any developments.

SB 524 (CABALLERO) would have allowed pharmacists

at retail pharmacy chains to furnish medications to treat COVID-19, influenza, streptococcal pharyngitis, STIs and conjunctivitis as part of the large chains’ attempt to establish small clinics within pharmacies. Thanks to CMA’s advocacy, the bill was held in the Senate Appropriations Committee.

Reproductive Heal th

Scope of Practice

California has long been known for supporting reproductive rights and the right for women to have autonomy over their bodies. This year, the Legislature burnished California’s reputation for reproductive rights even further by helping to provide protections not just for patients, but also for providers. With 14 states having some form of a ban on abortion, patients are forced to seek reproductive care in other states, with California being a primary destination.

Last year, Assemblymember Evan Low introduced AB 2236, which would have allowed optometrists with minimal training to infringe on the scope of ophthalmologists, including widening their scope to allow them to perform surgery and use lasers. CMA worked hard to persuade Governor Newsom to veto the bill. This year, Assemblymember Low introduced AB 1570, which was identical to the bill that Governor Newsom had vetoed just a few months earlier. CMA lobbied

Senate Pro Tem Toni Atkins authored CMA-SPONSORED SB 487, which prevents providers from having their MediCal provider eligibility threatened by states with abortion bans. Previously, if a state were to take action against a provider’s license for performing reproductive services that are lawful in California, they would automatically become ineligible to be a Medi-Cal provider. SB 487 allows providers who fall into this category to avoid losing their Medi-Cal

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provider eligibility simply because a state they previously worked in passed laws to ban those services. Gov. Newsom signed this bill into law on September 27, 2023.

Additionally, physicians have informed us that their liability insurance has been denied, terminated, or seen drastically increased premiums for providing reproductive and genderaffirming care services. CMA and other organizations in the California Future of Abortion Council co-sponsored AB 571, authored by Assemblymember Cottie Petrie-Norris, to alter the insurance code to prevent insurance companies from unreasonably increasing liability premiums or denying coverage to providers based on the services they provide. Gov. Newsom signed this bill into law on September 27, 2023.

Language Concordance Patients who receive linguistically concordant care experience better health outcomes. However, due to California’s diverse and growing population, physicians often need translators to communicate with their patients. CMA set out to help physicians close that communication gap and strengthen the patient-physician relationship by sponsoring AB 470, authored by Assemblymember Avelino Valencia. AB 470 allows physicians to take specific language courses to fulfill some continuing education requirements. The bill made it through the Legislature without opposition and was signed into law by Gov. Newsom on October 7, 2023.

Medical Board SB 815 is the bill extending the administration’s authority of the Medical Board of California. This bill amends various sections of the Medical Practice Act. CMA focused on six priority issues in the bill: license fee increase, public member majority, lowering the evidentiary standard to preponderance of evidence, license revocation related to felony convictions, postgraduate training licenses and the medical board’s financial reserves.

CMA successfully reduced the proposed $487 license fee increase (which would have been a nearly 60% increase) to a $288 increase (33% increase). Additionally, CMA successfully removed the provision to institute a public member majority on the board, as well as the sections of the bill related to a lowered evidentiary standard. CMA also ensured that the overly broad language in the bill relating to licensure revocation for felony convictions was explicitly clarified with specific serious crimes.

In addition, SB 815 expanded the timelines and flexibility for postgraduate training licensure. This bill also establishes

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a cap of six months for the financial reserves the medical board can retain; this is reduced from the original 24-month proposal. Lastly, SB 815 extends the sunset for the medical board for four years, until January 1, 2028.

Heal th IT An egregious problem physicians face is price gouging from electronic health record (EHR) vendors. When the state mandates a new EHR feature, software update or other change, vendors are charging physicians upwards of $30,000 to make the required changes. California physicians are forced to dig deep and pay outrageous fees or face being out of compliance.

CMA investigated and found there were no regulations on how much EHR vendors can charge, nor was there a regulator to oversee vendor activities. To correct this oversight, CMA sponsored SB 582 by Senator Josh Becker to fold EHR vendors into the state’s Data Exchange Framework, placing them under an entity that can regulate and take enforcement actions against vendors in California. Unfortunately, this bill was vetoed by the governor for being “premature” since the Data Sharing Governing Board has not yet been established.

CMA will pursue this policy again next fall.

Financial Disclosures Assemblymember Freddie Rodriguez introduced AB 616, which would require audited financial reports and statements from medical groups to be released to the public on the Department of Health Care Access and Information (HCAI) website. The bill would reverse a previous agreement made last year during the establishment of California’s Office of Health Care Affordability. This information becoming public could create an escalation of consolidation in the health care industry by allowing private equity and corporate interests to use the financial data to make acquisitions that will lead to higher costs and negatively impact patient outcomes.

CMA led a coalition to oppose the bill in the Legislature.

Despite CMA’s efforts, the bill made it to the governor’s desk during the last week of the session by the slimmest of margins. Ultimately, however, CMA succeeded in advocating for a veto of the bill by the governor.

On the following pages, you will f ind summaries of many of the key bills that CMA was involved with in 2023.

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SPONSORED AB 470 (VALENCIA): CONTINUING MEDICAL EDUCATION: PHYSICIANS & SURGEONS

are patient safety and fraud and waste protections built into the bill that are consistent with current practice and law.

Additionally, SB 516 would require health plans to provide a true peer-to-peer, within the same or similar specialty, when a physician is appealing a prior authorization denial.

Status: Signed by Governor (Chapter 330, Statutes of 2023)

SB 582 (BECKER): HEALTH INFORMATION

AB 470 will affirm the importance of cultural competency and language fluency as a core tenet of continuing medical education. This legislation will help physicians better communicate with patients in diverse communities across the state. California is a melting pot of cultures and languages, making it a minority-majority state. These important adjustments in state law will improve the quality of care by helping physicians effectively communicate with patients in diverse communities where English is a second language.

AB 571 (PETRIE-NORRIS): MEDICAL MALPRACTICE INSURANCE

Status: Signed by Governor (Chapter 256, Statutes of 2023)

AB 571 will ensure California’s reproductive and gender-affirming health care providers are able to obtain professional liability insurance without the fear of discrimination based on the services they provide. AB 571 prohibits insurers from refusing to issue professional liability insurance to licensed health care practitioners solely because they offer abortion, contraception or genderaffirming services.

SB 487 (ATKINS): ABORTION – PROVIDER PROTECTIONS

Status: Signed by Governor (Chapter 261, Statutes of 2023)

SB 487 will strengthen the civil protections for California’s reproductive health care service providers. It will prohibit payors from discriminating or taking adverse actions against providers who are subjected to civil, criminal or professional license actions for providing reproductive health care services to patients that have traveled from out of state.

SB 516 (SKINNER): HEALTH CARE COVERAGE – PRIOR AUTHORIZATION

Status: Two-Year Bill – In Assembly Appropriations Committee

SB 516 (previously SB 598) will reform the prior authorization process to ensure timely access to treatments and care, improve patient health outcomes and increase the efficiency and effectiveness of physician practices. SB 516 is a balanced approach that ensures physicians who practice within a plan’s criteria are exempt from prior authorization, thereby allowing physicians to care for the needs of their patients without undue burdens from health plans. There

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Status: Vetoed by Governor

SB 582 would have authorized the California Health and Human Services (CalHHS) Data Exchange Framework to create policies and procedures for including EHR vendors in the legal structure of the framework and incorporate federal standards for the reasonableness of vendor fees. The bill was vetoed due to it being premature, with the advisory groups still in their infancy.

SUPPORT AB 33 (BAINS): FENTANYL MISUSE & OVERDOSE PREVENTION TASK FORCE

Status: Signed by Governor (Chapter 887, Statutes of 2023)

AB 33 will establish the Fentanyl Misuse & Overdose Prevention Task Force to undertake various duties relating to fentanyl abuse, including collecting and organizing data on the nature and extent of fentanyl abuse in California and evaluating approaches to increase public awareness of fentanyl abuse.

AB 85 (WEBER): SOCIAL DETERMINANTS OF HEALTH – SCREENING AND OUTREACH

Status: Vetoed by Governor

AB 85 would have added social determinants of health screenings as a covered benefit under commercial coverage and Medi-Cal. Additionally, the bill would have required health plans to connect providers with community health workers to assist with patient care coordination. Finally, AB 85 would have required HCAI to convene a working group to develop a standardized model and procedures for providers to use to implement the requirements of the bill and identify gaps in research and data, which would help to improve state policies on social determinants of health.

AB 360 (GIPSON): EXCITED DELIRIUM

Status: Signed by Governor (Chapter 431, Statutes of 2023)

AB 360 eliminates “excited delirium” as a medical diagnosis and prohibits the term from being listed as a cause of death on a death certificate. Amid concerns that physicians would be limited when describing a patient’s behavior, CMA staff assisted in crafting language to clarify that only the term excited delirium is prohibited.

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AB 576 (WEBER): MEDI-CAL – REIMBURSEMENT FOR ABORTION

AB 907 (LOWENTHAL): COVERAGE FOR PANDAS & PANS

Status: Vetoed by Governor

AB 907 would have required health plans to cover treatment for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and pediatric acute-onset neuropsychiatric syndrome (PANS) prescribed by a licensed physician. The bill would not allow copays, deductibles or any other form of cost-sharing to be imposed if it was more than what is applied to similar covered benefits. The Governor vetoed the bill due to cost concerns.

AB 576 would have required the Medi-Cal program to reimburse providers prescribing medication to fully terminate a pregnancy.

AB 765 (WOOD): PHYSICIANS & SURGEONS – MEDICAL SPECIALTY TITLES

Status: Two-Year Bill – Held in Assembly Appropriations Committee

AB 765, the “California Patient Protection, Safety, Disclosure and Transparency Act,” is aimed at strengthening protections for health care consumers by addressing gaps in our current prohibition on use of the term “physician” by non-physician providers. The bill does so by ensuring consumers are not misled or deceived into believing their health care provider is a physician or surgeon. The bill also ensures that non-physician health care providers with advanced degrees do not confuse the public with the use of “ologist” titles like anesthesiologist or dermatologist or other similar combination of “physician-equivalent” titles.

AB 815 (WOOD): HEALTH CARE COVERAGE – PROVIDER CREDENTIALS

Status: Two-Year Bill – in Senate Health Committee

AB 815 would streamline the physician credentialing process with health plans and take significant steps in removing administrative waste within the care delivery system. AB 815 would require CalHHS to create a stakeholder board to approve independent entities credentialing physicians for health plans. If an approved entity credentials a physician, health plans would be required to accept physicians’ credentials from that entity.

AB 874 (WEBER): HEALTH CARE COVERAGE – OUT-OF-POCKET EXPENSES

Status: Two-Year Bill – Held in Assembly Appropriations Committee

AB 874 would ban the use of copay accumulator programs and ensure that any offered copay assistance benefits patients. Copay accumulator programs prevent copay assistance given to patients from counting toward their deductible and other out-of-pocket spending, which leaves patients facing increased and unexpected costs once the copay card is maximized and their deductible is deemed to have not been met. The use of these programs means patients are often forced to leave the pharmacy without the medication they need due to an inability to pay.

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Status: Vetoed by Governor

AB 977 (RODRIGUEZ): EMERGENCY DEPARTMENTS – ASSAULT & BATTERY

Status: Two-Year Bill – Held in Assembly Public Safety Committee

AB 977 makes an assault or battery committed against a physician, nurse or other health care worker of a hospital engaged in providing services within the emergency department punishable by imprisonment in a county jail not exceeding one year and by a fine not exceeding $2,000, making the crime a felony.

AB 1089 (GIPSON): FIREARMS

Status: Signed by Governor (Chapter 243, Statutes of 2023)

AB 1089 prohibits unlicensed individuals from using a computer numerical control (CNC) milling machine or a 3D printer for manufacturing a firearm and a “digital firearm manufacturing code” to be shared or distributed.

Additionally, AB 1089 sets criteria for how a person can lawfully relinquish possession of a CNC or 3D printer intended to manufacture firearms.

AB 1194 (CARRILLO, WENDY): CA PRIVACY RIGHTS ACT OF 2020: EXEMPTIONS – ABORTION SERVICES

Status: Signed by Governor (Chapter 567, Statutes of 2023)

AB 1194 expands the exemptions under the California Privacy Rights Act of 2020 regarding protecting an individual’s information related to accessing or searching for services such as reproductive health care services, including contraception and abortion.

AB 1203 (BAINS): SALES & USE TAXES: EXEMPTIONS – BREAST PUMPS & RELATED SUPPLIES

Status: Signed by Governor (Chapter 833, Statutes of 2023)

AB 1203 removes the sales tax on the sale of breast pumps and other related supplies, including breast milk storage bags, cleaning supplies, nursing bras, creams and ointments, etc.

SAN JOAQUIN PHYSICIAN 17

AB 1701 expands the scope of resources and interventions provided under the Black Infant Health Program.

meals meet nutritional standards recommended by leading health experts. Additionally, SB 348 will maximize the federal Summer Electronic Benefit Transfer Program for Children nutrition benefits and build upon the federal program to further prevent childhood hunger during the summer.

AB 1731 (SANTIAGO): CURES DATABASE – BUPRENORPHINE

SB 357 (PORTANTINO): VEHICLES – PHYSICIAN & SURGEON REPORTING

Status: Signed by Governor (Chapter 144, Statutes of 2023)

Status: Two-Year Bill

AB 1731 will exempt a physician from having to consult the CURES database when they prescribe or furnish buprenorphine in the emergency department of a hospital. The administration of buprenorphine in an emergency department must be done in the most efficient and timely manner to save a patient’s life. While the CURES database is an extremely valuable clinical tool to ensure the safe prescribing of opioids, consultation in an emergency department where a patient is experiencing an overdose can delay and inhibit a health care worker from administering life-saving treatment. This bill ensures that patients who need buprenorphine to save their lives can get the treatment as fast as possible.

SB 357 seeks to remove outdated language from the Vehicle Code that discriminates against specific conditions, including epilepsy, and to protect the patient-physician relationship by giving physicians greater discretion when reporting patients that experience lapses of consciousness to the Department of Motor Vehicles.

AB 1701 (WEBER): BLACK INFANT HEALTH – CALIFORNIA PERINATAL EQUITY INITIATIVE

Status: Signed by Governor (Chapter 154, Statutes of 2023)

SB 2 (PORTANTINO): FIREARMS

Status: Signed by Governor (Chapter 249, Statutes of 2023)

SB 2 will strengthen the state’s existing concealed carry laws by developing new requirements for gun licensure applicants and renewals. Most notably, the bill increases the minimum age for a licensee to 21 years of age and develops a training program applicants must complete before receiving a license.

SB 43 (EGGMAN): BEHAVIORAL HEALTH

Status: Signed by Governor (Chapter 637, Statutes of 2023)

SB 43 will update the definition of “gravely disabled” to include a new focus on preventing serious physical and mental harm stemming from a person’s inability to provide for their needs for nourishment, personal or medical care, or shelter, or to attend to self-protection or personal safety, due to their mental health condition or substance use disorder.

SB 119 (COMMITTEE ON BUDGET & FISCAL REVIEW): MEDI-CAL: MANAGED CARE ORGANIZATION TAX

Status: Two-Year Bill – Referred to Budget Committee

SB 119 was this year’s budget trailer bill that contained the MCO Tax proposal that was successfully negotiated by CMA. The proposal will provide over $2 billion annually for Medi-Cal rate increases and provide new residency slots.

OPPOSE AB 236 (HOLDEN): HEALTH CARE COVERAGE – PROVIDER DIRECTORIES

Status: Two-Year Bill – Held in Assembly Appropriations Committee

This bill would have required health plans to annually audit and meet accuracy standards for the provider information on their network directories and would have required a health plan to remove a provider from the directory if the plan has not compensated the provider for at least five claims in a year. The measure did not minimize the compliance burden on physician practices by failing to clarify that the burden to maintain accurate provider directories is the sole responsibility of the health plan. CMA was successful in holding the bill this year and will work constructively with the author to address the issue of inaccurate provider directories.

AB 616 (RODRIGUEZ): MEDICAL GROUP FINANCIAL TRANSPARENCY ACT

Status: Vetoed by Governor

AB 616 would have required audited financial reports and financial statements from medical groups to be released to the public on the HCAI website. AB 616 would have erased critical antitrust and privacy laws that have protected patient access to high-quality, cost-efficient care and would have hindered the ability of physician groups to recruit providers and employees into rural and low-income communities.

SB 348 (SKINNER): PUPIL MEALS

AB 1036 (BRYAN): HEALTH CARE COVERAGE – EMERGENCY MEDICAL TRANSPORT

Status: Signed by Governor (Chapter 600, Statutes of 2023)

Status: Two-Year Bill

SB 348 will ensure children attending public or charter schools have access to free breakfast and lunch and that the

AB 1036 required a physician to certify in the treatment record whether an “emergency medical condition” existed

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for every single patient that was transported to the hospital by an ambulance. This bill would have created an enormous administrative burden on emergency room physicians and exposed them to unwarranted liability.

AB 1091 (WOOD): HEALTH CARE CONSOLIDATION AND CONTRACTING FAIRNESS ACT OF 2023

Status: Two-Year Bill – Held in Assembly Health Committee

AB 1091 would prohibit health plans and insurers from steering patients to another provider or facility or require the plan or insurer to contract with other providers or facilities that are affiliated with the original provider/facility and would essentially codify the court case involving Sutter and exclusive contracting. The bill would require a medical group, hospital or hospital system, health care service plan, health insurer or pharmacy benefit manager (all defined very broadly) to provide written notice to the Attorney General (AG) before entering into an agreement to make a material change to the entity’s organizational structure/corporate structure with a value of $15 million or more. The bill would authorize the AG to consent to, give conditional consent to or not consent to the agreement. If the AG does not consent to the agreement, the structural change/acquisition may not move forward.

AB 1094 (WICKS): DRUG & ALCOHOL TESTING – INFORMED CONSENT

Status: Two-Year Bill – Held in Assembly Health Committee

AB 1094 would require health care providers to receive written and verbal consent from a pregnant or perinatal person or the person authorized to consent for a newborn before performing drug or alcohol tests.

AB 1180 (RODRIGUEZ): EMERGENCY MEDICAL SERVICES

Status: Two-Year Bill – Held in Assembly Appropriations Committee

AB 1180 would remove the existing requirement that the Emergency Medical Services Authority Director be a licensed physician or surgeon. The administration has claimed it has struggled to find qualified candidates under this requirement.

AB 1369 (BAUER-KAHAN): OUT-OF-STATE PHYSICIANS AND SURGEONS: TELEHEALTH – LICENSE EXEMPTION

Status: Signed by Governor (Chapter 837, Statutes of 2023)

AB 1369 allows for a physician or surgeon licensed in another state to provide care via telehealth, with the requirement that the patient has a life-threatening condition.

The author of this bill has a constituent who had trouble accessing a California physician for an undisclosed rare disease. They believe this bill will solve the issue by allowing access to out-of-state physicians through telehealth.

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AB 1570 (LOW): OPTOMETRY – CERTIFICATION TO PERFORM ADVANCED PROCEDURES

Status: Two-Year Bill – Held in Assembly Health Committee

AB 1570 would expand the scope of practice for optometrists to perform advanced surgical and laser procedures with minimal training. These procedures include corneal crosslinking and laser trabeculoplasty, among others. Under this bill, optometrists would qualify to perform these advanced procedures after completing only 43 various surgical eye procedures.

AB 1751 (GIPSON): OPIOID PRESCRIPTIONS – INFORMATION: NONPHARMACOLOGICAL TREATMENTS FOR PAIN

Status: Two-Year Bill – Held in Assembly Health Committee

AB 1751 would force physicians to inform patients about nonpharmacological treatments for pain, including chiropractic, acupuncture and mental health services.

Additionally, this bill would require physicians to provide redundant patient notifications and get patient signatures through a cumbersome informed consent process. Under this bill, the only exception to the above requirements would be a patient in hospice care. CMA was successful in ensuring this bill did not have the votes to be heard in its first policy committee.

SB 481 (NIELLO): PHYSICIANS & SURGEONS – SPECIALTY CERTIFICATIONS & PRACTICE

Status: Two-Year Bill – Referred to Senate B&P

SB 4841 would have required the Medical Board of California and the Osteopathic Medical Board of California to annually post a report regarding the number of physicians and their specialty statewide and by county.

CMA opposed this bill because this information is already publicly available and collected by other state departments.

Additionally, this bill would have created a new cost for both boards, directly resulting in a request for more funding.

CMA was successful in stopping this legislation.

SB 524 (CABALLERO): PHARMACISTS: FURNISHING PRESCRIPTION MEDICATIONS

Status: Two-Year Bill – Held in Senate Appropriations Committee

SB 524 would have authorized pharmacists to furnish and prescribe treatments for any positive test outlined in this bill.

This includes antibiotics for various illnesses, conditions, and diseases. Under this bill, physicians would have been removed from the patient care process if the patient chose to test and treat at a pharmacy. The California Retailers Association, including CVS, Walgreens and Rite Aid, were the sponsors of this bill. CMA was successful in stopping this legislation.

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SB 625 (NGUYEN): HEALING ARTS – PREGNANCY & CHILDBIRTH

Status: Two-Year Bill – Held in Senate Judiciary Committee

SB 625 would require the California Department of Public Health to get written consent from the parent of a minor if the minor’s blood sample is to be used for research purposes. This bill would also not allow a residual newborn screening specimen to be released for law enforcement or forensic database purposes. This bill would add unnecessary administrative burdens to physicians who frequently collect blood draws for the purposes of genetic disease detection, while also threatening the financial stability of the genetic screening program.

SB 779 (STERN): PRIMARY CARE CLINIC DATA MODERNIZATION ACT

Status: Signed by Governor (Chapter 505, Statutes of 2023)

SB 779 will require all clinics, including those exempt from licensing requirements, to report information to HCAI related to patient demographics; payor mix; assigned enrollees in the Medi-Cal program and the prospective payment system rate they receive; an expansive and detailed workforce report; all mergers and acquisitions the clinic/system took part in; a report of quality and equity measures per patient; and a report of the workforce development programs the clinic/ system participates in (such as residency programs, allied health care professions degree programs and behavioral health professional degree programs).

SB 784 (BECKER): HEALTH CARE DISTRICTS – EMPLOYMENT

Status: Two-Year Bill – Held in Senate Appropriations

SB 784 would create an exemption to the Ban on the Corporate Practice of Medicine (Corporate Bar) for health care districts and nonprofit corporations with a health care district as its sole corporate member that owns or controls a general acute care hospital. SB 784 does away with those patient protections and creates a permanent exemption to the Corporate Bar by allowing a health care district to employ physicians in their hospitals. The exemption contained in the bill would subject patient care decisions to the whims and pressures of financial or political interests.

SB 815 (ROTH): HEALING ARTS

Status: Signed by Governor (Chapter 294, Statutes of 2023)

SB 815 amends various sections of the Medical Practice Act; however, there were six priority issues CMA tackled: license fee increase, public member majority, lowered evidentiary standard, license revocation related to felony convictions, post-graduate training licenses and the Medical

20 SAN JOAQUIN PHYSICIAN

Board of California’s financial reserves. CMA successfully reduced the proposed $487 fee increase (which would have been a nearly 60% increase) to $288 (a 33% increase).

Additionally, CMA successfully removed the public member majority board composition provision and the sections related to a lowered evidentiary standard. CMA ensured that the originally overly broad section related to licensure revocation for felony convictions was explicitly clarified with specific serious crimes.

SB 815 also expanded timelines and flexibility for postgraduate training licensure. This bill also establishes a cap of six months for the financial reserves the medical board can retain; this is reduced from the original 24-month proposal. Lastly, SB 815 extends the sunset for the medical board for four years until January 1, 2028.

NEUTRAL AB 242 (WOOD): CRITICAL ACCESS HOSPITALS – EMPLOYMENT

Status: Signed by Governor (Chapter 641, Statutes of 2023)

AB 242 removed the sunset date for a current pilot program allowing critical access hospitals to employ physicians directly, which was due to expire on January 1, 2024, thus making the program permanent. In 2016, AB 2024 (Wood) established the pilot program and required a report to be created by the Office of Statewide Health Planning and Development (now HCAI) to determine the usage and efficacy of the program and its impact on patient care.

AB 1005 (ALVAREZ): IN-HOME SUPPORTIVE SERVICES – TERMINAL ILLNESS DIAGNOSIS

Status: Two-Year Bill – Held in Senate Appropriations

AB 1005 would require a physician, upon diagnosing a patient with a terminal illness and before discharge, to disclose information about the In-Home Supportive Services program, including eligibility criteria and a physical application.

AB 1029 (PELLERIN): ADVANCED HEALTH CARE DIRECTIVE FORM

Status: Signed by Governor (Chapter 171, Statutes of 2023)

AB 1029 would have allowed an individual to declare a separate agent for mental health services on an Advanced Health Care Directive Form. Following conversations with CMA staff, the author substantially amended the bill to clarify the treatments a health care agent has the authority to consent to on behalf of the patient.

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9

AB 1070 (LOW): PHYSICIAN ASSISTANTS – PHYSICIAN SUPERVISION: EXCEPTIONS

Status: Signed by Governor (Chapter 827, Statutes of 2023)

AB 1070 originally would have removed any sort of cap on the number of physician assistants that a physician could manage as it relates to gathering patient information and performing health examinations for patients in the in-home health evaluation setting. CMA worked through a cumbersome negotiating process with the author and stakeholders on this legislation to ensure there is a cap of eight physician assistants to one supervising physician for the tasks outlined in the bill and that this bill is explicitly limited to in-home health evaluations.

AB 1286 (HANEY): PHARMACY

Status: Signed by Governor (Chapter 470, Statutes of 2023)

AB 1286 will give a pharmacist in charge the autonomy to make staffing decisions based on the pharmacy’s needs and the pharmacy staff’s condition, among other decisions unrelated to the practice of medicine. This bill originally allowed pharmacy technicians to perform Clinical Laboratory Improvement Amendments waived testing, administer vaccines and perform other duties if deemed qualified by the pharmacist in charge. However, CMA ensured that pharmacy technicians would have a severely limited ability to test or administer vaccines while also requiring them to be certified in basic life support.

AB 1341 (BERMAN): PUBLIC HEALTH – ORAL THERAPEUTICS

Status: Signed by Governor (Chapter 276, Statutes of 2023)

AB 1341 originally would have allowed for pharmacists to furnish U.S. Food and Drug Administration (FDA) authorized COVID-19 oral therapeutics after administering and confirming a positive test for COVID-19, with minimal parameters. CMA worked closely with the author throughout the legislative process to ensure a sunset date of January 1, 2025, was added for furnishing oral therapeutics and to require all pharmacists who are furnishing oral therapeutics for COVID-19 to follow FDA clinical guidelines.

SB 339 (WIENER): HIV PREEXPOSURE PROPHYLAXIS AND POSTEXPOSURE PROPHYLAXIS

Status: Two-Year Bill

SB 339 would allow pharmacists to indefinitely furnish a recurring 90-day supply of HIV preexposure prophylaxis without a prescription ever being issued. Existing law allows a pharmacist to furnish a 60-day supply of HIV preexposure prophylaxis every two years if certain criteria and documentation requirements are met. CMA ensured that a provision was added to explicitly clarify that this bill

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cannot expand the scope of practice for a pharmacist related to furnishing PrEP and PEP. SB 525 (DURAZO): MINIMUM WAGES – HEALTH CARE WORKERS

Status: Signed by Governon (Chapter 890, Statutes of 2023)

This bill sets a $25 minimum wage for health care workers in virtually every health care setting and facility. Depending on the facility, location and practice size, the minimum wage will be increased incrementally to allow employers to adjust to the wage requirements. CMA negotiated exemptions for IPAs and small practices with 24 physicians or less as well as a gradual implementation of the increase.

The ramp-up more closely aligns with wage trajectories that are anticipated to naturally occur due to economic pressures outside of SB 525. Without a legislative deal, labor unions were planning on filing a statewide ballot initiative to require a $25 statewide minimum wage requirement starting in 2025 that would apply to all health care settings.

SB 667 (DODD): HEALING ARTS: PREGNANCY & CHILDBIRTH

Status: Signed by Governor (Chapter 497, Statutes of 2023)

SB 667 would have originally expanded the duties that a Certified Nurse Midwife (CNM) could perform, specifically allowing CNMs certain privileges related to furnishing and prescribing prescriptions; admitting and discharging patients on the CNM’s own authority; authorization to be a lab director of a birth center; and performing various minor surgical procedures, typically performed by physicians.

CMA successfully removed the ability for CNMs to prescribe Schedule II and III controlled substances unless there are mutually agreed upon policies and protocols with a physician.

SAVE THE DATE FOR CMA’S LEGISLATIVE ADVOCACY DAY! April 10, 2024 | Sacramento CMA will host its 50th annual Legislative Advocacy Day in Sacramento on Wednesday, April 10, 2024.

Attendees will have the opportunity to meet with legislators on priority health care issues. This unique event is free of charge to all CMA physician members, residents and medical students. Plan to join your colleagues as they prepare to lobby their legislative leaders and serve as champions for the house of medicine!

SAN JOAQUIN PHYSICIAN 21

10

SCHOLARSHIP

loan

FUND

making a positive impact on the

physician shortage in San Joaquin County. Gratitude pays dividends.

Empowering the next generation of physicians was the cornerstone for the San Joaquin Medical Society’s Scholarship Loan Fund (SLF) established in 1962.

Since its inception, 330 recipients have benefited from $4.2 million in educational loans for physicians, physician assistants, nurse practitioners and nurses.

Use this QR Code to make an immediate gift online or mail checks to the office. A receipt will be provided.

SJMS Scholarship Loan Fund 3031 W. March Lane, Ste 222W Stockton, CA 95219

donate

22 SAN JOAQUIN PHYSICIAN

More than sixty years later, our focus is to grow our own healthcare providers for San Joaquin County. In August 2023, The San Joaquin Valley was recognized as a doctor desert, with the least number of doctors, nurses, and practitioners per 100,000 of any area in California and 22% fewer primary-care physicians than the state average.

The Scholarship Loan Fund strives to support local, academically talented students along their long (and costly) journey to medicine and has created new incentives for those who choose to come back to establish practice in one of the San Joaquin Medical Society (SJMS) member counties of San Joaquin, Alpine, Amador, Calaveras or Tuolumne.

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The Board takes great care to select recipients who are passionate about serving the community in which they grew up. Of the current 8 active loan recipients, 87% participated in the San Joaquin Medical Society’s successful Bridge to Medicine and /or Decision Medicine programs.

Growing our own, embraces physician leaders grateful to serve and inspire the next generation of

By Georgette Hunefeld, practitioners who will philanthropy specialist, University don the white coat. Two of the Pacific and member of the of our recipients, Dr. Scholarship Loan Fund Board.

Vanessa Armendariz, and Dr. David Araiza, recently returned home to practice family medicine at Community Medical Centers. They are a shining example of those who have benefited from SLF and will share their stories at the SJMS Holiday Party on December 14. We hope you will join them.

As the end of the year draws near, please consider a tax-deductible donation to the SJMS Scholarship Loan Fund for your end of the year charitable giving. Talk to you accountant or financial advisor to direct your end of year charitable giving. If you are 70 ½ consider: IRA rollover, a gift from retirement fund or those with Required Minimum Distribution (RMD,) or a gift from Donor Advised Fund (DAF.) Consider highly appreciated stocks or if you had a large taxable event, a gift to Scholarship Loan Fund could help offset taxation from the gain.

For more information about the Scholarship Loan Fund, please visit

www.sjcms.org/programs/scholarship-loan-fund.aspx.

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SCHOLARSHIP LOAN FUND

Board of Directors Caroline Andersen, PA-C Stockton Cardiology Medical Group Eric Chapa, MD Family Medicine 1975 Loan Recipient Alexander Fodor, MD The Permanente Medical Group 2015 Loan Recipient Janwyn Funamura, MD Pediatrician Elizabeth Grady San Joaquin Medical Society Alliance Georgette Hunefeld University of the Pacific Gregg Jongeward, PhD University of the Pacific Lisa Lucchesi RN, MSN San Joaquin Delta College 1993 Loan Recipient Richard Waters, MD Stockton Cardiology Medical Group 1998 Loan Recipient

SAN JOAQUIN PHYSICIAN 23

State tobacco tax-funded program awards $38 million to expand state’s health care workforce Demand for CalMedForce GME funding at all time high with over $121.9M requested Physicians for a Healthy California (PHC) today announced more than $38 million in CalMedForce awards across the state to support medical training and residency programs and help grow the physician workforce.

The sixth round of CalMedForce funding, generated by the voter-approved Proposition 56 tobacco tax of 2016 and administered by PHC, supports 217 residency positions in 138 graduate medical education (GME) programs at hospitals and clinics, with an emphasis on those serving medically underserved groups and communities. This cycle marks the largest applicant pool to date, with 155 programs requesting over $121.9 million in funding to support 698 resident positions.

The California Future Health Workforce Commission estimates that California will need an additional 4,700 primary care clinicians by 2025 and 4,100 more by 2030 to meet demand. PHC, in partnership with the University of California (UC), established the CalMedForce grant program to help address California’s physician shortage by supporting residency programs where medical school graduates continue their training prior to obtaining a medical license and caring for patients independently.

“The continued increase in applications over the last six years demonstrates the high demand and need for graduate medical education funding in California to close our physician shortage gap,” said PHC President and CEO Lupe AlonzoDiaz, MPA. “CalMedForce funds provide essential support to residency program to continue to grow the physician workforce and ensure access to care for all Californians.”

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UC is the designated recipient of Proposition 56 funding and has contracted with PHC to administer CalMedForce. All accredited residency programs in the state that meet guidelines are eligible to apply for funding. Of this year’s CalMedForce awardees, approximately 22 of the 138 awarded GME programs are sponsored by UC. To date, CalMedForce has allocated over $226.6 million for 638 awards to 167 GME programs across California to retain and expand residency slots in primary care (family medicine, internal medicine, pediatrics, and obstetrics and gynecology) and emergency medicine.

“The increasing demand for funding reflects the importance of this program in supporting the health workforce of California and improving the access to high quality care, particularly for medically underserved groups and communities.” said Deena McRae, MD, Associate Vice President for Academic Health Sciences in the University of California’s Office of the President. “Funding of these residency programs helps the state make critical steps towards achieving health equity.”

“This year’s funding is another crucial step towards strengthening our physician workforce to meet the demands and address access to care challenges in California’s growing and changing patient population,” said Alonzo-Diaz.

For more information, visit CalMedForce.org. (@PHCdocs / #CalMedForce)

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Feeling lost and overwhelmed?

Let us help you regain control and take your life back. At St. Joseph’s Behavioral Health Center, we are committed to providing compassionate, quality care, in an environment that fosters communication, trust, and personal growth. Our inpatient and outpatient programs are dedicated to helping those we serve to achieve their goals and improve their quality of life. In addition, we have a Medication-Assisted Treatment Program designed to meet the needs of adults who are uninsured or underinsured with a history of opioid or stimulant use dependency.

Whether you need assistance dealing with depression, anxiety, or substance dependency, or are seeking counseling, we can help.

Learn more at dignityhealth.org/stockton/behavioralhealth.

The Medication Assisted Treatment Program described is supported by Grant Number H79TI084141 from SAMHSA. WINTER 2023

SAN JOAQUIN PHYSICIAN 25

California Continues to Support Health Care Professionals Serving Underserved Communities The California Department of Health Care Services (DHCS) and Physicians for a Healthy California (PHC) announced a new commitment of $73.4 million to help pay down student loans for 266 physicians and 36 dentists in California to expand the health care workforce and increase access for Medi-Cal members.

“These awards enable physicians and dentists to care for Medi-Cal members without the financial stress of student loans,” said DHCS Director Michelle Baass. “Our aim is for these providers to continue serving Medi-Cal members throughout their careers.”

WHY THIS IS IMPORTANT: The CalHealthCares student loan repayment program supports

and incentivizes physicians and dentists to increase their participation in the Medi-Cal program. Funding provided

by CalHealthCares has relieved these providers of the burden of student loan debt, improving access to care and supporting underserved communities.

“Year after year, the unprecedented demand in CalHealthCares demonstrates that providers are eager to serve

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communities that need better access to care,” said PHC CEO Lupe Alonzo-Diaz. “CalHealthCares lifts the burden of student loan debt and allows physicians and dentists to focus on providing high-quality care to patients who need it most.”

“ Year after year, the unprecedented demand in CalHealthCares demonstrates that providers are eager to serve

ABOUT THE 302 AWARDEES: • 62% represent diverse communities.

• More than 77% speak a language other than English.

• 52 areas of specialty medicine and seven

communities that need better access to care, CalHealthCares lifts the burden of student loan debt and allows physicians and dentists to focus on providing highquality care to patients who need it most.”

- PHC CEO LUPE ALONZO-DIAZ

dental specialties are represented.

• 67% committed to maintaining a MediCal caseload of 65% or higher.

• A mong dentists, 67% treat patients ages 0-3, and 78% treat special needs patients.

For this round of funding, CalHealthCares received 767 applications totaling approximately $195 million in funding requests to support applicant educational debt of nearly $251 million. The selection process considered various criteria, such as geographic impact, specialty distribution, equity elements (i.e., languages spoken in addition to English), and the dental treatment of children ages 0 to 3 and special needs patients. The process also assessed the long-term commitment of awardees to provide Medi-Cal members with equitable, coordinated, and accessible care.

HELPING ADDRESS THE PROVIDER SHORTAGE: Many California physicians and dentists enter practice with hundreds of thousands of dollars in educational debt. The average debt burden of CalHealthCares applicants for all five years of the program is nearly $322,000, based upon applications received.

In 2018, Senate Bill (SB) 849 established the Proposition 56 Medi-Cal Physicians and Dentists Loan Repayment Program and appropriated a one-time allocation of $220 million for the loan assistance program for recently graduated physicians and dentists. An additional

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$120 million was added to the program in the 2019-20 state budget, for a total of $340 million. SB 395 (Chapter 489, Statutes of 2021) provided ongoing funding for the program. With recent funding sources made available by SB 395, CalHealthCares looks forward to continuing the great work of the program with additional awardee cohorts.

BACKGROUND: Since CalHealthCares

launched in 2019, it has awarded nearly $323 million in student loan repayments to 1,420 providers across California, increasing access to care for Medi-Cal members. CalHealthCares awards up to $300,000 in student loan debt relief to eligible physicians and dentists in exchange for a five-year commitment to maintaining a patient caseload of at least 30 percent Medi-Cal patients.

Providers within the first five years of service are eligible to apply for this opportunity. Alternatively, eligible dentists can apply for a practice support grant of up to $300,000 in exchange for a 10-year service obligation. The practice support grant is open to providers in the first 15 years of practice.

For more information, visit CalHealthCares. org (#CalHealthCares on social media).

SAN JOAQUIN PHYSICIAN 27

California congressmen introduce lifesaving bill to help schools prevent opioid overdoses

California congressional representatives Adam Schiff and Raul Ruiz, M.D., recently introduced the Helping Educators Respond to Overdoses Act (HERO) Act, legislation that would save lives by expanding access to opioid overdose reversal drugs, such as Narcan (naloxone), in schools, providing critical training for staff, and implementing educational resources for students and communities to combat the opioid and fentanyl epidemic.

According to the CDC, 106,699 Americans died from a drug overdose in 2021. Of these deaths, it is estimated that 75% involved at least one opioid, with 66.5% involving synthetic opioids— primarily illicitly manufactured fentanyl or fentanyl analogs. Expanding access to opioid overdose reversal drugs and these additional resources would help to dramatically reduce the amount of student deaths caused by overdose each year.

“As an emergency physician, I have cared for many patients overdosing on opioids and comforted family members of patients who were not able to receive lifesaving Narcan in time. The opioid crisis is worsening in our country and impacting children and teens,” said Dr. Ruiz. “Our children are at risk of drug overdoses and our schools are not properly equipped to handle these situations. That

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is why Rep. Schiff, and I are introducing the Helping Educators Respond to Overdoses Act, which will provide critical training for schools, Narcan, essential supplies, and educational resources to combat the opioid epidemic. We must continue to fight for families across the country who have been affected by this crisis and prevent the further loss of children’s lives.”

“The California Medical Association (CMA) is proud to support the HERO Act, which builds on California’s ‘Melanie’s Law’ to prevent fentanyl overdoses,” said CMA President Donaldo Hernandez, M.D. “Fentanyl overdoses among our youth are on the rise and physicians are eager to partner with schools and communities to save the lives of our teens and stop this epidemic.”

The HERO Act is co-sponsored by Representatives Annie Kuster (D-N.H.), Jill Tokuda (D-Hawaii), Linda Sánchez (D-Calif.), David Trone (D-Md.), and Bonnie Watson Coleman (D-N.J.), and endorsed by the California Medical Association, American College of Emergency Physicians, American Federation of Teachers, Cedars-Sinai, Education Law Center, Los Angeles Unified School District, National Alliance on Mental Illness, National Association of School Nurses, National Education Association.

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SAN JOAQUIN PHYSICIAN 29 GILLPRIMARYCARE.COM • ACCEPTING NEW PATIENTS

Infusion of funds to target

Campus to offer treatment, recovery, and prevention

By Jo Ann Kirby

County agencies in San Joaquin County continue to work together to educate health providers and community stakeholders about a growing opioid epidemic and now an infusion of millions of dollars is giving new life to the battle. >>

30 SAN JOAQUIN PHYSICIAN

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Greg Diederich, director of the San Joaquin County Health Care Services Agency said the county’s $58 million share of a national opioid settlement is just a portion of the funding his agency is securing to build an ambitious new health campus that offers treatment, recovery and prevention.

In San Joaquin County, 138 opioid-related deaths were recorded in 2021. Fentanyl was responsible for 48 of the 138 deaths. The number of fentanyl-related deaths would nearly double the following year.

medications,” said Rachel Zerbo, public health educator with the San Joaquin County Opioid Safety Coalition, which had worked hard to educate the community of the importance of following their prescription dosage instructions and stressed that doctors be aware of their patients’ other medications before prescribing. “But then we started seeing overdoses from illicit opioid use as it became harder to get a prescription for pain killers,” she said.

Pharmaceutical fentanyl is prescribed by doctors to treat severe pain, especially after surgery and for advanced-stage cancer.

“In 2022, 91 people in San Joaquin County died due to However, most recent cases of fentanyl-related overdoses fentanyl-related overdoses, are linked to illicitly 45 of these lives lost were manufactured fentanyl, among young people,” Dr. Zerbo said. Fentanyl is Maggie Park, San Joaquin being added to other Public Health Officer, said drugs resulting in in a video introduction at something cheaper, “ In 2022, 91 people in San the San Joaquin County more addictive, and Fentanyl Town Hall Joaquin County died due more dangerously Meeting on October 9. “This powerful. to fentanyl-related is a fight that San Joaquin overdoses, 45 of these lives County refuses to lose.”

“We saw a flood of fentanyl incorporated lost were among young The town hall, organized by into pills. People people. ” - Dr. Maggie Park San Joaquin County Public think they are buying Health Services, the San Percocet or Xanax and Joaquin County Opioid it’s contaminated with Safety Coalition, the San fentanyl,” Zerbo said.

Joaquin County Office of Education and the San The opioid problem Joaquin County District didn’t just cause a spike Attorney’s Office, highlighted efforts to battle a growing crisis. in deaths. A California Overdose Surveillance Dashboard, It included emotional letters penned by family members updated by the California Department of Public Health, shows to beloved young people in our community who died due there were 315 emergency department visits and 93 hospital to fentanyl poisoning. The letters, tearfully read out loud, stays for opioid-related overdoses in 2022. emphasized that their family would forever be grieving. “I have The national opioid settlement is pumping money into never felt a hurt as deep as this,” a mother’s letter to her late son the fight. In 2021, multiple national lawsuits against drug Gabriel Hernandez, who started taking drugs in 7th grade, manufacturers and distributors accused of aiding the opioid read. epidemic resulted in a $26 billion settlement. Our county The town hall highlighted the fact that some while some received $58 million from the national opioid settlement and victims are overdosing after a long struggle with addiction, county health officials have an ambitious plan to address the others are being unknowingly poisoned after taking just one growing epidemic. counterfeit pill that had been laced with a lethal amount of Central to their goal of treatment, recovery and prevention is fentanyl. Compounding the problem, is the ease of access the development of the San Joaquin Be Well Campus, which to illicit drugs via social media platforms like Snapchat and San Joaquin County Behavioral Health Services Director Instagram.

Genevieve Valentine says is modeled off a similar program “Prior to 2018, we saw primarily overdoses from prescription in Orange County but tailored to fit San Joaquin County’s

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SAN JOAQUIN PHYSICIAN 31

“ We will have a sobering center, which is an alternative to jail." - Genevieve Valentine

needs. She calls SJ Be Well, a one-stop shop with a campus of facilities, proposed in two phases, on county-owned land in French Camp, near both San Joaquin General Hospital and the San Joaquin County Jail. The first phase will include a dual diagnosis point of entry, a sobering center, medical detoxification, a psychiatric health facility, and a crisis stabilization unit.

“We will have a sobering center, which is an alternative to jail.

Instead of exiting to the right to the jail when they are heading south, we want law enforcement to bring them to the left to this sobering center where they can receive treatment,” Valentine said of her vision to treat drug addiction.

The second phase focuses on youth services and includes transitional residential cottages, expanded perinatal programming, a youth substance use disorder residential treatment facility, and youth after-care outpatient programs.

“We are hoping to have a more robust adolescent substance abuse program,” Valentine said.

The Health Plan of San Joaquin will be involved in the

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project, contributing capital and facilitating a feasibility study. Other funding will come from grants, state allocations and more. “It’s aspirational,” Diederich said, but the fact that it will be constructed on land already owned by the county makes it more doable. “It’s go big or go home. The opioid settlement represents a once in a generation opportunity for significant capital investments in new treatment facilities.”

Diederich said ultimately the Be Well Campus, slated to open in the 2025-2026 fiscal year, will be supported by billable services, expanding to address mental health and homelessness.

Until then, San Joaquin County Public Health is continuing to address the fentanyl crisis. The recent town hall meeting even included a demonstration on how to administer Naloxone, an opioid reversal drug known by its brand name Narcan.

Participants were able to take Narcan home in case they need it to save a life. “We are doing a lot of education around the dangers of fentanyl,” Zerbo, said. “The first line of treatment is to provide them with Narcan. It can be administrated by a lay person.”

San Joaquin Public Health is also working to educate medical professionals about the opioid epidemic as more and more health service providers begin to see opioid use disorders in patients.

Dr. Lyn Raible, a retired addiction medicine specialist, is working on an Opioid Safety section that will launch in the near future on San Joaquin County Public Health Services

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Lyn Raible, MD, PhD

Greg Diederich website that she hopes will be useful to physicians and other health providers.

“Part of the problem for practicing physicians is that there is always so much new information out there about so many things. And what they really need is a place to get up to date information about opioids,” she said. “We want to become the one stop shop for all their opioid education, resources, and patient care. I just remember in my own days in practice you don’t have time for an extensive internet search. All this information needs to be brief and easy to find. That’s the goal.”

In the meantime, Zerbo says the opioid epidemic continues to evolve. She said reports of an even deadlier street drug on the East Coast that combines fentanyl with xylazine, a tranquilizer, are troubling. “We have concerns this is a looming crisis,” she said.

To learn more about what physicians can do to identify opioid use disorder and save lives in this ever-changing epidemic, read Dr. Raible’s accompanying article on Page 52.

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Genevieve Valentine, LMFT SAN JOAQUIN PHYSICIAN 33

In The News

IN THE

NEWS

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

UCD Prenatal Clinic Grand Opening Stockton prenatal clinic opens new location A new Stockton clinic location for patients with high-risk pregnancies has opened this week.

the-art ultrasound machines. The space also enables the fetal echocardiography team to increase patient access from two days per month to weekly, on Mondays.

The space houses UC Davis Health Prenatal Diagnosis of Northern California as well as the UC Davis Fetal Cardiology Clinic. Both clinics are linked to the UC Davis Fetal Care and Treatment Center, the first comprehensive multidisciplinary fetal diagnosis and therapy center in inland Northern California.

“We look forward to providing excellent care and service in the San Joaquin Valley in this newly expanded, state-of-theart space,” said Herman Hedriana, director of Maternal-Fetal Medicine at UC Davis Health. “With our new clinic, we will be able to help more patients from south Sacramento to lower central California, as far east as the Nevada border and west to Sonoma.”

The community-based clinic is located at 5757 Pacific Ave., Suite 132-A, in the Stonecreek Village Shopping Center in Stockton. It provides comprehensive counseling, genetic screening, and diagnostic testing for fetal anomalies. The newly expanded footprint triples patient capacity compared to the former clinic location and includes six dedicated state-of-

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In early 2024, the space will also include a complex family planning care clinic and access to the UC Davis Early Pregnancy and Miscarriage Center.

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“This prenatal clinic expansion is three years in the making.

It involved tremendous, dedicated work and vision from a multidisciplinary team,” said Ann Tompkins, director of Ambulatory Operations, Women’s and Children’s Services at UC Davis Health. “I feel incredibly privileged to applaud the clinical team that is expanding access and exceptional care to our patient community in Stockton.”

Doctors Hospital of Manteca Implements New Artificial Intelligence Platform to Treat Stroke Patients Doctors Hospital of Manteca is now utilizing Artificial Intelligence (AI) technology to elevate the care of its stroke patients.

Doctors Hospital of Manteca recently implemented a diagnosis-to-action technology that features AI, giving its teams the ability to diagnose stroke patients with Large Vessel Occlusion (LVO) within minutes of the CT scan being completed. Subsequently, the hospital is able to offer faster treatments and interventions, which may have a significant impact on outcomes.

“This technology enables us to extend the broader use of AI and increase access to lifesaving treatments for our neuro and stroke patients,” said Paul Bhangu, Director of Imaging Services at Doctors Hospital of Manteca. “With stroke, every minute matters and timely diagnosis and treatment are critical.

By incorporating this platform into our team’s neurological workflow, we’ll be able to expedite care for these patients, potentially limiting disability and saving lives.”

The tools are HIPAA compliant and available to the stroke care team via cell phones or tablets. Care teams using the platform can potentially save critical minutes, or even hours, in the triage, diagnosis and treatment of strokes and other disease states. The hospital works with Viz.ai to implement the AI technology in the coordination of stroke care.

Doctors Hospital of Manteca Honors International Overdose Awareness Day Team members at Doctors Hospital of Manteca wore purple in honor of International Overdose Awareness Day on Aug. 31, 2023. It’s the world’s largest annual campaign to end overdose.

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DHM Overdose Awareness Day It’s a day to: • Remember loved ones who have died from drug overdose and acknowledge the grief of the family and friends left behind.

• Take action to encourage support and recovery for everyone impacted by substance use and overdose.

• End overdose by spreading awareness of overdose prevention strategies.

Wearing purple commemorates those lost to drug overdose and sends out a message that every person’s life is valuable.

Doctors Hospital of Manteca received a grant from the California Bridge Program (CA Bridge) to place substance use navigators in its emergency department to help patients battling substance use disorders. Substance use navigators are a vital part of successful treatment, working both in the hospital and the community to connect people to treatment.

Doctors Hospital of Manteca’s sister hospital in Modesto, Doctors Medical Center, also has substance use navigators in place within its emergency department.

Adventist Health Lodi Memorial and Dameron Hospital Receive Get With The Guidelines® Stroke Awards Adventist Health Lodi Memorial and Dameron Hospital both received the American Heart Association/American Stroke Association’s 2023 Get With The Guidelines®-Stroke Gold Plus Quality Achievement Award.

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The prestigious awards recognize both hospitals’ commitment to ensuring stroke patients receive the most appropriate treatments, according to nationally recognized, research-based guidelines.

To receive the Gold Quality Achievement award, Adventist Health Lodi Memorial had to receive 85 percent or higher adherence to all Get With The Guidelines-Stroke achievement indicators for at least 24 consecutive months. The Gold Plus Quality Achievement is an even more advanced level of recognition, acknowledging the hospitals’ consistent compliance with quality measures.

Adventist Health Lodi Memorial earned further recognition for Target: Stroke Honor Roll Elite, which means 75 percent or more of acute ischemic stroke patients who were treated with IV tPA, received thrombolytic therapy within 60 minutes.

Additionally, both hospitals received the Association’s Target: Type 2 Diabetes Honor Roll award. To qualify for this recognition, hospitals must meet quality measures developed with more than 90 percent of compliance for twelve consecutive months for the “Overall Diabetes Cardiovascular Initiative Composite Score.”

Dameron Hospital Welcomes Dr. Minghui Liu, Cardiothoracic and Vascular Surgery Dameron Hospital welcomes Minghui Liu, MD, PhD, an experienced cardiothoracic and vascular surgeon, who recently joined the Dameron Hospital Cardiac Surgery Program.

Dr. Liu comes to Dameron from Central Valley Medical Group, a well-established cardiothoracic and vascular practice in Modesto, California, where he has been practicing since 2011. He completed his cardiothoracic surgery residency at UC Davis Medical Center and his general surgery residencies at Lahey Clinic Medical Center in Burlington, Massachusetts and Oregon Health & Science University in Portland, Oregon.

Dr. Liu also earned his cardiothoracic surgery fellowship from the Starr-Wood Group of Cardiothoracic Surgery at St. Vincent Hospital and Medical Center in Portland, Oregon.

With 30 years of experience that includes performing more than 5,000 complex cardiac, thoracic and vascular surgery procedures, his expertise across several surgical specialties has established him as a sought after, highly respected surgeon in the Central Valley.

Referrals can be made by contacting the AHPN Stockton

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Minghui Lin, MD Surgical Specialties Department at Dameron at 209-242-7098 or by fax at 209-461-7579.

Adventist Health Lodi Memorial and Dameron Hospital receive Geriatric Emergency Department Accreditation Adventist Health Lodi Memorial and Dameron Hospital have achieved Geriatric Emergency Department Accreditation from the American College of Emergency Physicians. This accreditation means that the hospitals’ emergency services are equipped with the necessary expertise, resources, and staff to provide excellent care, specifically tailored to older patients.

“As we see a rise in our geriatric population in the coming years, it is of the utmost importance that our hospitals can provide the highest level of specialized care to our community’s elders,” says Adventist Health Lodi Memorial president Brooke McCollough. “This accreditation is a testament to both Emergency Departments’ unwavering commitment to elevating the standard of care for our elderly, ensuring their well-being and dignity are upheld throughout their healthcare journey.

To achieve accreditation, emergency department staff focused on standardizing approaches to care for common geriatric issues; ensuring optimal transitions of care from the emergency department to other settings, including inpatient units, home or rehabilitation and long-term care centers; and accomplishing a series of geriatric-focused quality improvements.

SAN JOAQUIN PHYSICIAN 37

In The News

IN THE

NEWS Older adults visit the emergency department at higher rates than other age groups and often arrive with multiple chronic conditions. Seniors who visit hospitals accredited by the American College of Emergency Physicians can be confident that they have enhanced staffing, education and geriatricfocused policies and protocols to provide appropriate care and help get older patients back to their daily lives after an emergency occurs.

“We are incredibly proud to provide two locations in San Joaquin County that are ready and able to provide leading geriatric care,” says McCollough. “While we hope they never need emergency care, we hope our older neighbors can rest a little easier knowing that quality care is available, close to home.”

St. Joseph’s Medical Center Holds Blessing of the Rigs for Local First Responders Dignity Health St. Joseph’s Medical Center (SJMC) held their second annual Blessing of the Rigs event on Wednesday, November 1st, in recognition of National First Responders Day (October 28th).

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

Services Department performing the blessings for the first responders and their respective rigs. In addition to the blessing, each first responder received lunch and a token to show appreciation from SJMC.

Growing St. Joseph’s Graduate Medical Education Program CalMedForce, a program of Physicians for a Healthy California, visited St. Joseph’s Graduate Medical Education on October 4, 2023. The event was organized by St. Joseph’s Foundation of San Joaquin whose purpose is to raise and administer funds (through grants and private donors) to support the needs of St. Joseph’s Medical Center. CalMedForce toured the state-of-theart Simulation Laboratory and heard from St. Joseph’s Program Directors and hospital leaders about growth and need.

Since 2018, CalMedForce has funded $7.86 million in grants to St. Joseph Graduate Medical Education - $2.58 million to

SJMC offered a county-wide invitation to all city and county fire, police, sheriff and highway patrol departments, and county ambulance companies to attend. Festivities entailed a drive-thru interfaith blessing of the vehicles and first responders, which also included air medical services and motorcycles.

Nearly 40 first responders attended, with Chaplains from the Spiritual

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CalMedForce visit GME Program Simulation Lab

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In The News

IN THE

NEWS the Family Medicine Residency Program, $2.025 million to the Internal Medicine Residency Program and $3.255 million to the Emergency Medicine Residency Program.

Their support has been vital to growing St. Joseph’s Graduate Medical Education program which is currently hosting 161 resident physicians in 10 different programs for the 2023-2024 academic year.

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

Covered California Rates Kaiser Permanente’s Health Plan the Highest in the State for Providing Members and Patients with Quality Care and Service Kaiser Permanente has the highest rated health plan in the state for overall quality and is also rated highest by members for care and service experience, according to the health plan ratings for 2024 by Covered California – the state’s health insurance marketplace under the Affordable Care Act. Kaiser Permanente Northern California, combined with Kaiser Permanente Southern California, earned 5 stars, the highest possible rating for Covered California’s “Overall Quality” rating.

The health plan was compared to approximately 200 plans nationwide, and Kaiser Permanente’s 5-star plan scored among the top plans in the country.

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“Kaiser Permanente is a national leader in providing our members and patients with high-quality, compassionate care and service,” said Carrie Owen Plietz, FACHE, president of Kaiser Permanente’s Northern California region.

“We take great pride in knowing that our own members and patients rated their experiences with Kaiser Permanente 5 stars – the highest of any health plan in the state.”

In addition to achieving a 5-star “Overall Quality” rating for quality, Kaiser Permanente received 5 stars for “Members’ Care Experience,” which is

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HealthCare.

Better Together.

Doctors Hospital of Manteca is now part of the Central Valley Doctors Health System, expanding your access to services close to home.

From emergencies and screenings to surgical and procedural services, we deliver quality healthcare and compassionate care.

Doctors Hospital of Manteca offers: • 24-Hour Emergency Care and Convenient Online Check-Ins • 24/7 Critical Care Coverage Led by Intensivists • Advanced Orthopedics for Knee and Hip • Weight Loss Surgery Center of Excellence

• Imaging Services, Including Open MRI and PET/CT • Surgical Services • Women’s Health, Including 3-D Mammography • Wound Care Center

To refer a patient, call 844-632-5727 1205 E. North St. Manteca, CA 95336 WINTER 2023

or visit DoctorsManteca.com SAN JOAQUIN PHYSICIAN 41

In The News

IN THE

NEWS based on patient surveys asking about their recent experiences when visiting the doctor and getting medical care; “Getting the Right Care,” a measure of care that is given, comparing with the national standards for care and treatments proven to help patients; and “Plan Services for Members,” which analyzes a health plan’s efficiency, affordability, and management.

Kaiser Permanente is the only health plan in the state to receive 5 stars in every category. Kaiser Permanente is also the only health plan in the state to receive a 5-star “Overall Quality” rating in each of the last five years.

Providing staff, physicians, and patients with relevant & up to date information This is the latest of several accolades and awards for Kaiser Permanente Northern California. Most recently, Kaiser Permanente Northern California Medicare and commercial health plans were highest rated in California – and among the highest in the nation – for overall treatment, prevention and equity, and patient experience, according to the National Committee for Quality Assurance (NCQA) 2023 Health Plan Ratings. Kaiser Permanente Northern California hospitals have also been rated among the best in the nation for maternity care and treatment of stroke and heart failure patients.

Julio Narvaez M.D. Andrew Chen M.D. Alan Nakanishi M.D. Pamela Tsuchiya M.D. On-Tat Lee M.D. Hana Rha O.D. Aamun Garcha O.D.

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CMA ELECTS NEW OFFICERS Redwood City ob-gyn Tanya W. Spirtos, M.D., installed as CMA’s 155th president Redwood City ob-gyn Tanya W. Spirtos, M.D., today was installed as the 155th president of the California Medical Association (CMA) – only the fourth woman to hold that position – at the close of association’s annual House of Delegates meeting.

Dr. Spirtos is a board-certified obstetrician-gynecologist in fulltime practice in a group of six physicians now part of foundation model Packard Medical Group/Stanford Medicine. She is also on the active medical staff of El Camino Hospital and Sequoia Hospital.

Dr. Spirtos earned her undergraduate degree at the University of Chicago and her medical degree at Northwestern University Medical Center. She completed her residency at Los Angeles County Medical Center/ University of Southern California and is a fellow of the American Congress of Obstetricians and Gynecologists.

She was a member of the Board of Trustees of Sequoia Hospital Systems from 2003-07 and served on the Community Board of Directors of Sequoia Hospital from 2007-15. She has also been an adjunct clinical faculty of Stanford University Medical School

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since 1995, with an academic appointment as adjunct clinical assistant professor from 2006-14. Since 2010 she has served at the Arbor Free Clinic with the Stanford medical students and has been recognized for exemplary contributions in teaching. Despite this—and her participation on various health boards—she receives 100% of her compensation from patient care.

Dr. Spirtos has been a member of the CMA and AMA since 1985 and is a member of both the San Mateo County Medical Society and Santa Clara County Medical Association—the latter of which she served as president from 2005-06. She was elected to the CMA Board of Trustees in 2009 and continues to serve on the CMA delegation to the AMA. Since 2016, she has served on the CMA Executive Committee, first as vice speaker of the House of Delegates, then as speaker, and most recently as president-elect.

San Francisco pediatrician Shannon Udovic-Constant, M.D., becomes CMA president-elect San Francisco pediatrician Shannon Udovic-Constant, M.D., was named California Medical Association (CMA) presidentelect at the association’s annual House of Delegates meeting.

She will serve on the executive committee in that role for one year, and will be installed at the conclusion of next year’s annual meeting.

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Dr. Udovic-Constant has served as chair of the CMA Board of Trustees since 2020, after serving as vice chair for three years.

Dr. Udovic-Constant is with The Permanente Medical Group in San Francisco and is a long-time advocate for policies to improve the health of children and communities. She is the past chair of the California American Academy of Pediatrics (AAP) State Government Affairs committee. In 2012, she was named the recipient of the AAP Martin Gershman, M.D. Child Advocacy Award, an honor given annually to a pediatrician who has “shown outstanding dedication and commitment to promoting the health and well-being of children in California through educating policymakers and advocating for appropriate legislation, regulation, policies, funding or programs.”

She is a former President of the San Francisco Medical Society (now the San Francisco Marin Medical Society) and currently serves on The Permanente Medical Group Board. She is an Assistant Clinical Professor in Pediatrics at UC San Francisco, where she teaches medical students and residents.

Los Angeles psychiatrist George Fouras, M.D., elected vice speaker of the CMA House of Delegates Los Angeles psychiatrist George Fouras, M.D., was newly elected as vice speaker of the California Medical Association (CMA) House of Delegates at the association’s annual meeting this past weekend. He will join Speaker Jack Chou, M.D., on the dais to lead delegates as they shepherd resolutions into successful policy.

Dr. Fouras has been a CMA member since 1996. He has served in the CMA House of Delegates for more than a decade and has held many leadership positions during his 27 years of membership. He is a past president of the San Francisco Marin Medical Society (SFMMS), the Northern California Regional Organization of Child and Adolescent Psychiatry and the Southern California Psychiatric Society. He is a past chair of the SFMMS Political Action Committee, the current chair of the Los Angeles County Medical Association (LACMA) Political Action Committee (LACPAC), a councilor- at- large for LACMA, and the current secretary-treasurer of CMA’s Political Action Committee (CALPAC). Dr. Fouras also serves as a California delegate to the American Medical Association.

Dr. Fouras is board certified in General Adult Psychiatry by the American Board of Psychiatry and Neurology and the National Board of Physicians and Surgeons. He is a Distinguished Fellow of the American Academy of Child and Adolescent Psychiatry and is on the register of specialist consultants with the General Medical Council of the United Kingdom.

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CMA Speaker Jack Chou, M.D., was also re-elected by acclamation for a second term. A board-certified family medicine physician and a fellow of the American Academy of Family Physicians, Dr. Chou is a Partner of the Southern California Permanente Medical Group (SCPMG), where he is also Regional Chair for Health Information Management and Regional Co-Chair for Scanning Oversight Committee.

San Diego physician Sergio Flores, M.D., and Hesperia physician Eric Hansen, D.O., to lead the CMA Board of Trustees San Diego physician Sergio R. Flores, M.D., has been elected chair of the California Medical Association (CMA) Board of Trustees, after serving as vice chair since 2020.

Board certified in gastroenterology and internal medicine; Dr. Flores is a partner at San Diego Digestive Disease Consultants.

He serves on the Board of Directors and is the President of Sharp Community Medical Group. Dr. Flores is a past president of the San Diego County Medical Society and continues to serve on its board. He also serves on the Board of Directors and Finance Committee at Sharp HealthCare.

Joining Dr. Flores to lead the Board of Trustees is Hesperia family practice physician Eric R. Hansen, D.O., who was elected vice chair.

Dr. Hansen is a past president of the San Bernardino County Medical Society and has served in many leadership positions in his 22 years of membership, including serving on the CMA Political Action Committee (CALPAC) Board of Directors as a past chair of the CMA Solo and Small Group Practice Forum.

Board certified in family medicine, Dr. Hansen is an independent physician with Choice Medical Group IPA, where he also serves on the board. He sits on the Legislative Committee for CAP-MPT, on the Legislative Council for Aledade and on the Healthcare Advisory Board for Congressman Jay Obernolte.

Dr. Hansen is also a clinical faculty member for Western University of Health Science’s School of Osteopathic Medicine and associate clinical professor for the California University of Science and Medicine’s School of Medicine.

About the CMA Board of Trustees CMA’s Board of Trustees is composed of CMA’s seven elected officers and elected trustees from 11 districts, as well as elected trustees representing the Specialty Delegation, Medical Student Section, Resident and Fellow Section, Young Physician Section, Organized Medical Staff Section, Ethnic Medical Organization Section and Mode of Practice Forums.

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RESID

ENTS' REPORT A PLACE FOR ALL NEWS HIGHLIGHTING RESIDENTS AND GRADUATE MEDICAL EDUCATION

The Resident’s Report is dedicated to all the good news related to our hard-working residents training at San Joaquin General Hospital and St. Joseph’s Medical Center.

Please email your submissions, written in third person with accompanying photo to Lisa@sjcms.org.

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SJMC AWARDED ABIM GRANT FOR BUILDING TRUST AND EQUITY THROUGH DIVERSITY Dr. Kwabena Adubofour, the Assistant Program Director at SJMC Internal Medicine Residency, and the IM Residency were one of the awardees for ABIM’s Building Trust Grant. They will implement DEI principles by using didactic education and experiential opportunities to enhance understanding of the relationship between social determinants of health and the importance of health equity.

Dr. Adubofour and the residents have partnered with three local CBOs (NAACP, El Concilio, and APSARA) and McKinley Elementary School for the project. A learning round table with patients is being coordinated with El Concilio to measure community members’ trust in their healthcare providers. A cultural competency and sensitivity curriculum will be introduced to increase their awareness of the beliefs, values and biases they bring to patient encounters, and improve their ability to interact effectively with individuals different from themselves.

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ST. JOSEPH’S MEDICAL CENTER INAUGURAL CLASS FOR ORTHOPAEDIC SURGERY June wrote its first chapter for the St. Joseph’s Orthopaedic Surgery Residency as the inaugural class of 2028 has begun their residency. Their unique experience as our inaugural class has given our residents the opportunity to set the foundation of our program. These three resident physicians are pivotal to the programs short and long-term goals and successes. Of the three interns two are California natives, one of the inaugural residents is from Los Angeles and one from San Lorenzo. Our other resident is from Newburyport, Massachusetts. St. Joseph’s continues to strive to recruit and retain passionate residents for a greater, healthier, and impactful future.

ST. JOSEPH’S MEDICAL CENTER GRADUATES INAUGURAL CLASS FOR INTERNAL MEDICINE June wrote a new chapter for the St. Joseph’s Internal Medicine Residency as the inaugural class graduated.

Their unique experience as an inaugural class and entering their intern year at the height of the pandemic in 2020 truly molded the 10 resident physicians into resilient healers. Aside from being pivotal in the real-time collaborative evolution of our residency curriculum, the residents were also heavily involved with the local community with Decision Medicine; Virgil Gianelli Medical Clinic at St. Mary’s Kitchen; the Stockton chapter of the NAACP; Asian Pacific Self-Development and Residential Association; and El Concilio.

Of the seven California natives, two of the inaugural residents were Stockton natives and one from Ripon.

All three have committed to staying or returning after specialty fellowship training to care for our local community. Two additional graduates were retained within greater Central California. St. Joseph’s continues to strive to retain our residents for a greater, healthier future.

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Practice News and Resources Free to SJMS/CMA Members!

The Office Managers Forum empowers physicians and their practice manager staff with valuable tools via expert led education sessions from industry professionals who are committed to delivering quality healthcare. This quarterly forum is normally held on the second Wednesday of March, June, September and December at Papapavlo's in Stockton.

Registration is required!

If you don’t receive an invitation via E-Mail, please email Jessica@sjcms.org

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December 13th, 2023: 11:00AM to 1:00PM

" Medicare Changes 2024 and Beyond” 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 of CMA’s Center for Economic Services

March 13th, 2024: 11:00AM to 1:00PM

“ 2024 Employment Law Updates” Discover how to navigate complex employment law changes and stay on track for a successful year.

This will help businesses navigate California’s challenging employment and labor laws.

Jamie Bossuat, a shareholder and employment lawyer at Kroloff will present an update on the most pressing issues in employment law and will offer practical suggestions for reducing liability. Issues will include recent changes in wage and hour requirements, updates to leave of absence laws, and current litigation trends.

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CMA PRACTICE RESOURCES Medi-Cal Rx reinstates prior auth requirements for more pharmacy benefits UHC delays Designated Diagnostic Provider program in CA until Jan. 1, 2022 On November 10, 2023, the California Department of Health Care Services (DHCS) implemented Phase IV, Lift 4 of the Medi-Cal Rx transition plan. Under Phase IV, Lift 4, prior authorization requirements have been reinstated for all therapies for standard therapeutic classes 68, 86 and 87, which includes enteral nutrition products, and Brand Medically Necessary prescriptions for members 22 years of age and older.

DHCS also recently announced that based on stakeholder feedback it would not reinstate Reject Code 80 (Diagnosis Code Submitted Does Not Meet Drug Coverage Criteria) for Code 1 drugs on November 10, 2023, as previously announced. MediCal Rx will continue to engage with stakeholders on the reinstatement of Reject Code 80 and will provide notice at least 30 days in advance of an implementation date.

Last month, DHCS reinstated Reject Code 76 (Plan Limitations Exceeded), under Phase IV, Lift 3.

CalHHS now accepting applications for Round 3 of data sharing grants With a January 31, 2024, deadline approaching for many entities to begin securely exchanging health information under the Data Exchange Framework (DxF), the California Health and Human Services Agency’s (CalHHS) Center for Data Insights and Innovation (CDII) is now accepting applications for the third round of Data Sharing Agreement (DSA) Signatory Grants starting June 30, 2023.

California entities that have signed the DSA can apply to receive direct support for DxF implementation, with financial assistance ranging from $15,000 to $50,000, or more via enhanced funding to entities serving underserved communities.

The grant program provides health and social services entities with resources to address critical operational, technical and technological barriers to DxF implementation. Entities that have signed the DSA and can demonstrate that additional support and capabilities are needed to meet their DSA requirements are eligible to apply.

SAN JOAQUIN PHYSICIAN 49

The available grants prioritize investments in organizations and practices operating in underresourced geographies and/or serving historically marginalized populations and underserved communities. These areas and populations are often the most impacted by siloed records and discontinuous care, health care barriers the DxF seeks to resolve. Enhanced funding maximums are available for those that meet certain criteria to help mitigate inequities. This additional assistance helps ensure that Signatories, regardless of size or location, have the resources they need for smooth implementation of the DxF. To support the range of activities that may be needed comply with the DSA requirements

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and varying capacity for grant application and management, CDII is offering two types of grants: • Technical Assistance: This is a flexible, “buildyour-own-solution” pathway. DSA Signatories identify a range of technical and operational activities and manage the entire process of applying for and managing funds directly.

• Qualified Health Information Organization (QHIO) Onboarding: This is an “assisted” pathway in which grantees receive support to onboard to a CDII Qualified HIO that will act as an exchange intermediary, enabling the signatory to fulfill their DSA requirements.

WINTER 2023

Together with UC Davis Children's Hospital

Pediatric Orthopedic Care for Kids of All Ages Shriners Children's Northern California understands the complexities of pediatric orthopedic care. Our team is specifically trained to understand children’s physical development and provide the best treatments at every age and stage of growth.

Our multidisciplinary pediatric orthopedic care includes: Malformations and Deformities Developmental and Acquired Conditions Dysplasias and Tumors Neuromuscular Conditions Traumatic and Post-Traumatic Conditions

Scan here to learn more!

WINTER 2023

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

SAN JOAQUIN PHYSICIAN 51

Public Health

Update

Saving Lives in the Changing Face of the Opioid Crisis

BY LYN RAIBLE, M.D., PH.D.

Just before the arrival of COVID, it seemed that the intensive efforts of the medical community to combat the opioid crisis by changing prescribing practices had halted the rapid escalation in opioid overdose deaths. Indeed, these efforts were paying off. However, the trajectory changed yet again as fentanyl began to replace prescription opioid pills and heroin. Indeed, the arrival of illicit fentanyl on the opioid drug market signaled a dramatic change in the opioid landscape.

Historically, the overwhelming majority of people dying from an unintentional opioid overdose were aware they were taking an opioid. However, illicit fentanyl, which starts as a powder, is pressed into pills and sold as hydrocodone, oxycodone, or even as Xanax. As a powder, it may be mixed with, or falsely labeled as, cocaine or methamphetamine. Thus, it is increasingly common for people who don’t even know they are taking an opioid to die of an accidental opioid overdose. Our community has many examples of people, including teens, who did not recognize the danger in their hands and died because of it.

One of the most important public health services we can provide to our patients is education regarding both opioid use disorder and the newer dangers, to them and their families, of taking any pill they did not themselves pick up from the pharmacy. One pill can kill.

Fentanyl and Beyond Fentanyl began as a carefully controlled, carefully utilized pain medication, was generally prescribed as a 72-hour patch. The more even blood levels created by the patch improved pain relief for those with chronically painful conditions. The patch form was also more difficult to misuse than the pill form of other opioids. Unfortunately, drug cartels began to synthesize powdered fentanyl in labs. Not only are the ingredients inexpensive, the manufacture of synthetic opioids in labs eliminates the need, expense, and risk of growing opium poppies. Even a small lab can create enough fentanyl to generate considerable wealth.

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WINTER 2023

What Physicians Can Do to Save Lives Post in the office educational posters and have informational pamphlets regarding opioids/ fentanyl.

The CDC website is an excellent source, examples include: 

Know the Risks (poster)



Take Action to Prevent Addiction (poster)



Fentanyl Facts (handout)



Naloxone Fact Sheet for Family and Caregivers (handout)

https://www.cdc.gov/opioids/healthcareprofessionals/prescribing/posters.html Educate patients about the prevalence of “counterfeit” pills that can look like hydrocodone, oxycontin, alprazolam, etc., but are made from fentanyl.

It would be a mistake to believe that dealing with fentanyl would solve the opioid crisis. Our true crisis is now a synthetic opioid crisis. Indeed, isotonitazene, the opioid that may replace fentanyl is already knocking on the door of the Central Valley. Like fentanyl, isotonitazene (20 times more potent than fentanyl) first appeared on the East coast of the United States. However, earlier this year, the DEA noted text messages from drug dealers in San Francisco indicating they had isotonitazene for sale. It’s availability and use are likely to continue to increase.

Even more concerning, both fentanyl and isotonitazene are being combined with xylazine (AKA Tranq), a veterinary grade large animal tranquilizer that acts as an a2 receptor agonist. Xylazine is being added to fentanyl and isotonitazene because it changes and prolongs the nature of the opioid high. However, people may or may not know that there is xylazine in the what they are using. Even if they do know, as with synthetic opioid powders, there is no way to know how much xylazine is actually present. An overdose of xylazine can cause cessation of breathing, and this will not respond to Narcan. In addition, there is no easily accessible reversal agent. Thus, for a good outcome, artificial respiration must begin in a timely fashion and



We do not always know the secrets of our friends. Someone who gives a friend a “Norco” for their back pain may be unknowingly handing them fentanyl. ·

Patients should never take a regulated substance they did not themselves pick up from the pharmacy

·

Children have died because they, or a friend who shared, took a pill from their parents’ medicine cabinet

Integrate questions about substance use by patients and their family members into initial visits and yearly follow-up visits.  Ask parents about medication storage: Addictive medications should be stored in a locked box outside of the medicine cabinet, with only a few days’ supply more easily accessible. continued on next page >>

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SAN JOAQUIN PHYSICIAN 53



Particularly when there is a family history of alcohol misuse, ensure patients are aware that many of the genetic variations that predispose to alcohol misuse also predispose to opioid misuse.



If parents have a history of either alcohol or opioid misuse, ensure they understand there is a strong genetic component to both disorders (genetics contribute about 70% to addiction risk). Their child may have inherited the variant(s) and, when age appropriate, needs to understand their risk.



Ensure patients understand that many people who develop OUD report that initial exposure to opioids, even 5 mg hydrocodone, resulted in feeling energized and focused (not sedated or nauseated).

This is not a typical response and indicates they may carry a variant that leads to an atypical neurochemical response in the brain.



If you are prescribing an opioid for the first time for the patient, inform them that having this response is a warning sign and that they should contact your office for further guidance. ·

· 

Addiction can occur within one week, even if a patient is taking the medication as prescribed.

Willpower does not prevent neurologic restructuring

Ask parents with children about their conversations with kids regarding illicit drug use ·

Parent conversations should include asking the child (tweens and teens) if they have heard about opioids, particularly synthetics that are pressed into pills that can look like many other substances.



Become familiar with San Joaquin County’s medication-assisted treatment options and referral processes.



Consider offering medication-assisted treatment to your patients with opioid use disorder.

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continue until xylazine levels no longer suppress breathing.

There have been confirmed xylazine deaths in our region.

Reversing the Opioid Crisis Reversing the opioid crisis, and the deaths it produces, will require years of effort. It will not be reversed by ridding ourselves of synthetic opioids, an impossible task. Instead, as with tobacco, progress will be made by intensive efforts to educate the public. This education needs to present information about the risks of opioids, pills and powders from the streets, and the benefits of medication-assisted treatment for those with an opioid use disorder (OUD).

Physicians are in an ideal setting to provide this education, particularly when working in conjunction with San Joaquin County Public Health Services.

How San Joaquin County Public Health Services Plans to Support Physicians In support of the efforts to reverse the opioid crisis, San Joaquin County Public Health Services will be adding a provider-specific Opioid Safety section to its website. This site will contain several sections that offer handouts, links to handouts, and links and other relevant resources. To date, the site will contain the following sections: 1. Opioid Alerts and County Data 2. Talking with Patients about Opioids 3. Diagnostic Criteria for Opioid Use Disorder 4. Incorporating Buprenorphine Treatment for Your Patients Into Your Practice 5. Referring Patients to Medication-Assisted Treatment for OUD 6. Free Training to Satisfy the New DEA Licensing Requirement 7. Links to Important Resources (includes websites & videos for providers and for patients).

The Opioid Safety section for providers is scheduled to launch in time for 2024.

San Joaquin Public Health Services looks forward to partnering with physicians to counter the alarming impact of opioids in our community.

WINTER 2023

The most advanced cancer-fighting technology, closer to home.

Now at St. Joseph’s Cancer Institute, the TrueBeam Linear Accelerator combines imaging, radiation beam delivery and sophisticated motion management to accurately and precisely target tumors with speed.

The TrueBeam provides breakthrough technologies that allow our experts to treat more challenging cancers with precisely targeted, highly concentrated doses of radiation, given in less time, and with less impact on healthy tissue.

Learn more at dignityhealth.org/stockton/cancercare.

WINTER 2023

SAN JOAQUIN PHYSICIAN 55

In Memoriam

In Memoriam CHARLES FREDERICK WILCOX III, M.D. October 1924 – August 2023

C. Fred Wilcox, M.D. passed away peacefully of natural causes on August 23rd, just two months before his 99th birthday in Thousand Oaks, CA. Living a life filled with accomplishment, sacrifice and good works, he approached all he did with character, integrity, courage and humor.

Born in 1924 in Salt Lake City, UT, the son and grandson of doctors, Fred and his family moved to Huntington Park and then to Hollywood when he was in grade school. He graduated from Fairfax High School on the day of the Battle of Midway in 1942. Serving in a Navy Reserve V12 unit, he completed an accelerated curriculum at USC until called up in 1944. After the war, he met and married Nancy Volker, who supported him through medical school at Temple University. He interned at Los Angeles County General Hospital, worked for a Japanese- American surgeon in downtown Los Angeles, and completed a fellowship in Obstetrics and Gynecology in 1957 at the Mayo Clinic while simultaneously earning a master’s degree, also in OB/GYN. During this time, he and Nancy had four daughters. They chose to move to Stockton, California for its smaller, welcoming community. They had two more daughters and a son in the ensuing years, as Fred quickly built his practice.

Known as a skilled medical practitioner and surgeon with the highest standards, excellent training and a kind, approachable manner with his patients, Fred practiced OB/GYN medicine in Stockton for 50 years, retiring at 83. He delivered over 5,000 babies and performed countless surgeries for his many patients.

During these years, he helped raise his family, tended to patients, was a diplomate of the American Board of OB/GYN, a member of the American College of Obstetricians and Gynecologists, and a

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Fellow of the American College of Surgeons, serving on its Board of Governors. He was a member of the San Joaquin Medical Society, CMA, AMA, the San Francisco and California Gynecological Societies. He served as Chief of OB/GYN at St. Joseph’s Medical Center from 1970-75 and closed out his career as a doctor with Sutter-Gould Medical Group.

Fred and Nancy married young and enjoyed 73 years of love and a partnership that was rare. They raised a close-knit family, providing an excellent example of respect, harmony and kindness.

Thirteen years ago, they moved to Thousand Oaks, California, to be near their children and grandchildren, where they enjoyed meeting new friends and frequent family visits. Together, they have 13 grandchildren and, so far, 12 great-grandchildren.

A curious, lifelong learner, Fred kept himself informed of world events by reading three daily newspapers, and enjoyed reading biographies, books about WWI and II, politics, history, and sports.

An avid sports fan, he knew all about the players on many teams, especially his beloved USC Trojans, San Francisco 49ers and Giants, Golden State Warriors, and the Lakers. He was a master teller of jokes and lit up a room with his stories and humor. One of his greatest joys was teaching others. He taught at San Joaquin General Hospital and would share his knowledge and techniques with anyone willing to learn. He was a favorite with the student nurses who cared for him during his last few months, as he would quiz them on medications and procedures and encourage them in their studies. He educated anyone who would listen about World War II. Fred was a fiercely loyal friend, a beloved husband and father, an admired colleague, and a patient, skilled physician, one of the last members of the Greatest Generation. He will be missed by his loving family and friends always. Fred is survived by his daughters, Nancy Lovell (Fred), Mary Arnold (Gary), Linda Sopo (Joe), Mari Gilbert, son Fred (Gina), 13 grandchildren and 12 greatgrandchildren. He is preceded in death by his wife Nancy Volker Wilcox, daughters, Virgina Urfer (Jim), and Joan Wilcox, as well as his parents, C. Fred and Shari Wilcox, and sisters Shari Daynes and Joy Cook.

WINTER 2023

In Memoriam

In Memoriam EDWARD H. CAUL, MD 1925-2023

Edward passed away on August 29. 2023 at the age of 98. He was a man of vision, compassion, integrity, and perseverance.

These attributes were accompanied by a keen sense of humor with a twinkle in his eye. He set high standards that were well recognized.

Ed graduated from Harvard University in 1950. He served in both the Navy and Army from 1942-1953 and did his internship at the University of Chicago clinics. Later he did Internal Medicine residencies at the Veterans Hospital Ft. Miley and French Hospital in San Francisco and a cardiology fellowship at Stanford University.

He began his practice in Stockton with Dr. Donald Fowell in 1956. Their association would later become Stockton Cardiology Medical Group. Ed retired after 40 years in 1996.

Ed wanted his patients and the community to have cutting edge cardiac services at St. Joseph’s Medical Center.

He became an active leader and served on numerous committees, including, but not limited to, Chief of Staff, Chief of Medicine and Medical Director of Cardiac services and the Chairman of the Intensive Care Unit, later known as Coronary Care Unit (CCU), which was one of the first in the state.

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To achieve his vision of superior cardiac services, he was instrumental in the development of the of the ECHO department, the EKG department, the noninvasive cardiac lab, the cardiac rehab unit and the previously mentioned CCU which was dedicated to him in 1997. The level of expertise in cardiac services led to the establishment of the cardiac surgical program.

Ed’s gift of communication and his close liaisons with others to attain his lofty goals was inspirational. His relationship with Ed Schroeder and other hospital administrators was one of mutual respect and trust.

In addition, to his practice and dedication to the cardiac program at St. Joseph’s, he was involved with many local organizations. He was an active member of the San Joaquin Medical Society for 55 years, serving on multiple committees.

Ed was a board member for the San Joaquin Foundation for Medical Care, the American Heart Association of San Joaquin County and was an adjunct professor at the University of the Pacific in the department of pharmacology.

Ed was a renaissance man. He loved family, life, people, nature, the practice of medicine, photography, tennis, sailing, hiking, gardening, and teaching his favorite things to children and grandchildren. He retreated to his beloved cabin in the Sierras, CAMOREST, for relaxation, family gatherings, outside activities and reading.

To encapsulate this wonderful, warm loving man in a few short sentences is impossible. His passing leaves an enormous loss that can never be filled.

SAN JOAQUIN PHYSICIAN 57

New Members

8 NEW

SJMS MEMBERS THIS WINTER!

...and even more on the way.

Robert Assibey, MD

Jeetinder Sohal, MD

Mandeep Dhindsa, MD

Mariam Lotia, MD

Maricel Binongcal, DO

Muhammad Choudry, MD

Family Medicine 500 W Hospital Rd French Camp, CA 95231 Ross University School of Medicine, 2017

Hospitalist 1800 N California St. Stockton, CA 95204 Ziauddin University, 2011

Shailesh Kumar Singh, MD Hospitalist 1800 N California St Stockton, CA 95204 Kasturba Medical College, Manipal India, 2011

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OB/GYN 500 W Hospital Rd French Camp, CA 95231 St George’s University School of Medicine, 2003

Emergency Medicine 500 W Hospital Rd French Camp, CA 95231 Touro University College of Osteopathic Medicine, 2012

Internal Medicine 747 Channel St. Stockton, CA 95202 University of Rajasthan, S.M.S Medical College, 2001

Interventional Cardiology 2333 N California St. Stockton, CA 95204 Allama Iqbal Medical College, 2008

Anil Andani, MD

Family Medicine 1801 E March Ln, Ste D470 Stockton, CA 95210 St. George’s University School of Medicine, 2016

WINTER 2023

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

• Complimentary Phone System Assessment ✓ Is your phone bill higher than you would like? Does your phone system allow you to work from anywhere?

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

Call Mark Williams @ 209-623-1023 or email mark@ce-technology.com WINTER 2023

SAN JOAQUIN PHYSICIAN 59

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

PRSRT STD. U.S. POSTAGE

PAID

Permit No. 60 Stockton, CA

RETURN SERVICE REQUESTED

The Medi-Cal redetermination process is still underway for over 14 million California enrollees. This includes approximately 600k San Joaquin and Stanislaus County residents.

The Department of Health Care Services (DHCS) is asking Medi-Cal beneficiaries to update their contact information at BenefitsCal.com. This will ensure that beneficiaries receive their renewal packets and are able to respond to requests for information that will help determine their eligibility.

You can continue to communicate the details of the renewal process to your Medi-Cal patients and let them know they will receive a letter or envelope in the mail. Encourage them to take action to keep their coverage by: • Visiting BenefitsCal.com to update personal information • Returning renewal forms as quickly as possible in person to their local Medi-Cal office, by mail, or online at BenefitsCal.com

You may have patients that did not turn in renewal forms or have experienced loss of coverage and have questions: “I did not turn in my renewal form or information. I got a notice that my Medi-Cal is ending. What can I do?”

“I got a notice that I no longer get medical. I think I still should get it. What can I do?”

You can find answers to those questions and more at www.dhcs.ca.gov/keep-yourMedi-Cal/Pages/faqs.aspx

Flu season is around the corner.

Encourage your patients to get vaccinations and boosters during their routine visits. HPSJ rewards members for completing certain wellness exams.

Find more information at www.hpsj.com/myrewards.

www.hpsj.com/provider | 1-888-936-PLAN (7526) 60 SAN JOAQUIN PHYSICIAN

WINTER 2023