Summer 2025

Summer 2025

SERVING SAN JOAQUIN,

TUOLUMNE, ALPINE, AMADOR AND CALAVERAS COUNTY PHYSICIANS

Dr. Gi ll ’s work i n

ROBOTIC SURGERY A DVA N C E S CA R E F O R W O M E N Young Physician Award Legislative Day Risk Management

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11 days after appendectomy, tests for acute abdominal pain revealed a

retained object left inside the patient.

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VOLUME 73, NUMBER 2 • JUNE 2025

6 A MESSAGE FROM EXECUTIVE DIRECTOR

26 LIFETIME ACHIEVEMENT

8 A MESSAGE FROM OUR PRESIDENT

34 CMA PHYSICIAN SERVICES

12 YOUNG PHYSICIAN AWARD 16 LEGISLATIVE ADVOCACY DAY 18 OPERATIONAL VS. CLINICAL RISK MANAGEMENT

20 IN THE NEWS

UNVEILS MEDWAY

37 NEW MEMBERS 38 IN MEMORIAM 40 RESIDENTS REPORT 44 PRACTICE MANAGEMENT 48 PUBLIC HEALTH

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

MEDICAL SOCIETY STAFF EXECUTIVE DIRECTOR Lisa Richmond MEMBERSHIP COORDINATOR Jessica Peluso

SAN JOAQUIN PHYSICIAN MAGAZINE EDITOR Lisa Richmond EDITORIAL COMMITTEE Lisa Richmond, Neelesh Bangalore, MD MANAGING EDITOR Lisa Richmond

COMMITTEE CHAIRPERSONS CMA AFFAIRS COMMITTEE Larry Frank, MD DECISION MEDICINE Kwabena Adubofour, MD MEDICAL EDUCATION PROGRAMS Kelly Savage, MD SCHOLARSHIP LOAN FUND Alexander Fodor, MD CMA HOUSE OF DELEGATES REPRESENTATIVES James R. Halderman, MD, Raissa Hill, DO

CREATIVE DIRECTOR Sherry Lavone Design CONTRIBUTING WRITERS Jo Ann Kirby, Neelesh Bangalore, MD, Sydney Jenkins, MPH and Gwen Callaway, MPH THE SAN JOAQUIN PHYSICIAN MAGAZINE is produced by the San Joaquin Medical Society SUGGESTIONS, story ideas are welcome and will be reviewed by the Editorial Committee.

Richelle Marasigan, DO, Ramin Manshadi, MD Philip Edington, MD , Sujeeth Punnam, MD

PLEASE DIRECT ALL INQUIRIES AND SUBMISSIONS TO:

Sunny Philip, MD, Ripudaman Munjal, MD

San Joaquin Physician Magazine

Stephen Tsang, 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 8:00am - 4:00pm

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EXECUTIVE DIRECTOR’S REPORT

SPRING SPARKS THE BUSY SEASON AT SJMS! March kicked off with exciting news as the Nominating Committee selected this year’s recipients for the Young Physician Award and the Lifetime Achievement Award: Dr. Manreet Basra of Pacific Heart & Vascular Medical Group and Dr. Param Gill of Gill Obstetrics & Gynecology Medical Group. This marks the first time in the history of these awards that both honorees are women — a milestone worth celebrating!

LISA RICHMOND

I recently came across a quote: “Strong women look at a challenge and give it a wink.” It perfectly captures the spirit of these two strong, brilliant, and compassionate physicians. While they make it look effortless, we know the immense dedication, sacrifice, and hard work it takes to deliver exceptional patient care, continually learn and innovate, and raise a family.

In another first, this year also marks the first time a husband and wife have both received the Lifetime Achievement Award, with Dr. Param Gill following her husband, Dr. Jasbir Gill, who was honored in 2017. This issue features stories on Dr. Manreet Basra and Dr. Param Gill — two remarkable physicians whose journeys we’re proud to share.

In April, our dedicated Decision Medicine Committee reviewed 140 applications, interviewed 42 outstanding students, and ultimately selected the 24-member Class of 2025. A huge thank you to Drs. George Khoury, Hyma Jasti, Marina Castillo, Alain Flores, and Vanessa Armendariz (DM ’05) for their time, enthusiasm, and commitment during this intensive process. We can’t wait for this summer!

We’re now seeking physician volunteers to host one of our 24 exceptional students for a “day in the life” shadowing experience on Wednesday, July 16 and/or Wednesday, July 23, from 8:30 AM – 3:30 PM in your office or practice setting. To sign up, please visit www.tinyurl.com/ DMMentors or email Lisa@sjcms.org. This is always a rewarding experience for the students — many of whom have never connected with a physician in a real-world setting.

Keeping pace with the times, SJMS conducted its first-ever electronic vote for open Board of Directors and Delegate positions for the CMA’s House of Delegates. Election results will be announced at our June 8 Awards Dinner, where we’ll also celebrate the ceremonial passing of the gavel from Dr. Neelesh Bangalore to Dr. Sujeeth Punnam. It has been a wonderful year under Dr. Bangalore’s leadership — full of insight and laughter — and we are deeply grateful for his service.

Lastly, we extend our heartfelt thanks to Dr. Cyrus Buhari for his years of leadership and service, both as a board member and during his two terms as SJMS president. His engagement and dedication have left a lasting impact.

Best wishes,

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A message from our President > Cyrus Fram Buhari, DO

My Patients’ experience at the pharmacy I have been practicing medical oncology for the past 25 years and I have seen big changes with respect to patient experiences at the pharmacy. In the past few years, the number of patients NOT receiving the prescribed medications has gone up significantly. Based on evaluation of my patients as a group I estimate approximately 15 to 20% of my patients do not receive the medications as prescribed or do not receive them at all. That is a shockingly high number, and it appears to be getting worse.

Unfortunately, I do not see this situation improving soon. I have been pondering all the potential reasons for the current situation regarding this issue.

First, communication with the pharmacists. In the past, we would get calls from the pharmacists if a specific medication was not available for one reason or the other. Because of that direct communication we were able to change the prescribed medication to a different one in real-time. Lately, those calls have completely stopped. We only get to hear the problem from the patients!. Many patients are so frustrated they do not call us in real time and sometimes decide not to take the medication at all.

ABOUT THE AUTHOR Neelesh Bangalore, MD is the current president of the San Joaquin Medical Society and practices at Stockton Hematology Oncology Medical Group

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Second, prior authorization requirements. This is a huge problem on the weekends. Patients are given a prescription for a specific medication and unfortunately it requires prior authorization. Most of the time because it is not part of the patient’s formulary or in terms of pain medications there are limits placed. That information, however, is tough to get in

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advance even for the prescribing physicians. Therefore, patients end up not receiving the medication until the following week or sometimes end up going to the emergency room. This problem is significantly exaggerated when it comes to pain medications.

pharmacists f lat out refuse to fill the medications because they are not “comfortable”. No calls are made to the doctor’s office to discuss and correct the issue. The burden is again on the patients to tackle the problem.

Third, pharmacies do not carry the medication. Most Sixth, drug to drug interactions. Most pharmacists tell of the time patients are told the pharmacy does not the patients that because of drug-to-drug interactions have the medication in stock and will need to order they should not be receiving a specific medication. It that. They do not is never explained communicate with clearly. Patients get I estimate approximately 15 to the doctor’s office. very frustrated and We come to know anxious. From a 20% of my patients do not receive about that either physician perspective, the following day or the medications as prescribed or when there is drug to sometimes many days drug interaction, there later. The burden must be an increased do not receive them at all is on the patients level of awareness, to call us to send and follow-up of the the prescriptions to a different pharmacy or change patients. Drug dosages may need to be changed. It the medication. If the patient calls the pharmacy does not mean patients can never be on 2 drugs that in advance and asks if the medications are available interact with each other. We do it all the time. pharmacies do not reveal that information until the In summary, pharmacists and pharmacies clearly play a patient arrives there. That is completely unacceptable critical healthcare role. In 2023 based on a Gallup poll but happens every day. pharmacists were regarded as the third most trusted Fourth, the expense of the medication. Anticoagulants, medical professionals, with 84% satisfaction score. targeted medications for oncology patients, However, a JD power study in August 2024 revealed potassium chelation agents have become so expensive only 51% of patients found their own pharmacist that patients are unable to afford copayments. trustworthy. Clearly ref lecting a gap between trusting Unfortunately, that information does not get to us in the profession versus individual encounters. I sincerely real time. Pharmacies tell the patients to contact the feel pharmacists should be an integral part of the doctor’s office for an alternative. For the patient who is patient care team and there should be significantly going through a lot, it becomes another thing to do, and higher levels of communication between pharmacists they get very dejected. and healthcare providers. That will invariably improve the quality of care for our patients. I wrote this article Fifth, the problem with pain medications. As an to express my opinion and frustration at the situation. oncology practice, I prescribe hundreds of gram Other doctors may have different experiences with quantities of narcotics to patients with cancer who their patients. I would welcome any feedback. justifiably need them. Unfortunately, when they reach the pharmacy, they feel they are being judged, often they do not receive the medications, and in some cases

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Recognized for Excellence Heart & Vascular Institute Designated heart attack and stroke receiving center.

Cancer Institute San Joaquin County’s only nationally accredited cancer center.

Orthopedic & Spine Center Certification of distinction for total hip and knee replacement from the Joint Commission.

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YOUNG PHYSICIAN AWARD

Recipient is seen and heard

Experienced cardiologis t cares for the whole patient

BY JO ANN KIRBY

Ten years ago, Dr. Manreet Basra moved with her family to Stockton and joined the Pacific Heart and Vascular Medical Group only to find herself the sole woman in a meeting full of cardiologists. Although women are significantly underrepresented in cardiology, making up just 15.5 percent of 22,243 practicing cardiologists, according to the National Institutes of Health, Dr. Basra had practiced primarily on the East Coast, where it wasn’t so unusual for women to practice the specialty. >>

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“I sat back, watched and listened,” the board-certified cardiologist said of those first male-dominated meetings where she felt like her biggest challenge was to be taken seriously. “I wanted to keep quiet and read the room at first.” She soon found her voice and her colleagues would learn that the young physician had a lot of experience and expertise to bring to the table. “It was quite a culture shock for me and then when I started speaking up, I think that it was a shock for everyone.”

Today, she is both seen and heard. And as a result, Dr. Basra who also serves as the Director of St. Joesph’s Medical Center’s Non-Invasive Cardiology Laboratory and its Cardiac Rehabilitation Department, is being recognized with SJMS’ Young Physician Award. “It means the world to me to earn this award and to inspire other people,” she said.

“I feel honored.”

While this achievement is gratifying, she continues to set goals that will help improve patient outcomes. “I try to do or learn a new skill every year, like in 2024, I got certified in cardiac CT imaging,” Dr. Basra said, adding that her biggest goal is to continue to balance her professional and personal life and remain happy coming to work every day. “I’m most proud of being able to work my way around my professional

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and personal life. I think for the most part I’ve been able to keep it balanced thanks to everyone around me who helps.”

She not only preaches self-care, she practices it. To that end, she credits her daily workouts with keeping her mentally and physically strong. “I work out for an hour every day, that’s what keeps me sane,” the mother of two, said. “I play tennis, I like to run, and I do weightlifting.” She has a quiet place on the levee near her house that brings her peace. “You can see Mt Diablo on a good day and you can see all kinds of birds.

It’s really beautiful.”

Dr. Basra is a middle child and both her parents; her older sister and younger brother are all physicians. “I grew up in a medical household. I saw my parents working hard all throughout their lives,” she said. Seeing their accomplishments made her realize that, although it wouldn’t be easy, she could do it, too. “I don’t think they expected anything less, but I think they are very proud of what I’ve achieved,” she said of her parents.

She and her husband, Dr. Gurtej Malhi, a gastroenterologist, are the parents of Waaris and Nishaan. He does the morning school drop-off routine, and she takes the boys to their swim practices with the Brookside Mallards swim

SUMMER 2025

team or Big Valley Water Polo, depending on the season. Besides being involved in her sons’ sports activities she is also active in their school’s PTA. Will they follow in their family’s footsteps? “I don’t think I’m focusing on making them become doctors, I just want them to be good human beings,” she said.

After graduating from Sri Guru Ramdas Institute of Medical Sciences in India, the new doctor would complete her internal medical residency at the University of Buffalo in New York, followed by a cardiovascular disease fellowship there, as well. There she met her mentor and friend, Dr. Susan Graham, who worked with Dr. Basra as her inpatient supervising physician and later as a colleague. “Her patients know she is there for them,” Dr. Graham said. “She is efficient, balancing a busy job, her home, and extended family obligations. She has been an inspiration to me even though we live far apart.”

From Dr. Graham, she learned to consider other factors besides the patient’s health. “She introduced me to the social aspect of medicine,” Dr. Basra said.

“If someone needs a medical device, can they afford it, can they take care of it?

It’s not just saving lives. It’s saving lives and looking at a person as a whole.”

Her clinical training revealed the medical profession’s tendency to under-treat and under-diagnose heart disease in women who can experience different symptoms from men. “I wish women did not keep ignoring their symptoms,” she noted. “Women have heart attacks less than men, but if a woman has a heart attack, they have higher mortality because they are way sicker. They are so busy taking care of everyone else, sometimes they don’t pay attention to their own health.”

Dr. Basra’s lifelong friend, who met her in medical school back in India, says she doesn’t back down from challenges and speaks her mind. “She is a very hard-working woman and has a great personality,” said Dr. Anureet Gill, a primary care physician and medical director of Dignity Health Medical Group in Stockton. “She treats everyone with respect whether it’s her colleagues or staff.”

Today, Dr. Basra may not be the only woman in a room full of cardiologists. There are now about a half dozen women practicing the specialty in San Joaquin County and room for so many more in our medically underserved community. What advice would she have for young women considering a career in her field? “I would say if you want to do it, put all your heart into it, regardless of the time it takes,” she said, adding that medicine is a noble profession. “If they get the opportunity to go down that road, they should do it and do it proudly.”

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HUNDR EDS GATHER FOR CMA’S

51st ANNUAL LEGISLATIVE ADVOCACY DAY CMA recently hosted its 51st annual lobby day, with more than 350 physicians, medical students and residents taking time out of their busy schedules to speak with legislators on the issues impacting the delivery of health care in California.

The California Medical Association (CMA) recently hosted its 51st annual Legislative Advocacy Day. On April 9, 2025, more than 350 physicians, medical students and residents from across the state gathered in Sacramento to advocate for important health care issues affecting Californians.

CMA physicians held 133 meetings with 116 of 120 legislative offices, speaking to CMA’s priority issues including a bill to establish a physician health and wellness program and a package of bills dedicated to reforming the prior authorization process.

“Thank you to all the physicians who took time out of their busy schedules to attend CMA’s Legislative Advocacy Day. Physician voices are essential in shaping health policy at this pivotal moment,” said CMA President Shannon Udovic-Constant, M.D. “This year, the more than 350 CMA physicians in attendance met with 116 of 120 legislative offices, providing physicians with a chance to share their real-world experiences with policymakers.”

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Legislative Advocacy Day attendees also enjoyed hearing from freshman Assemblymember Nick Schultz (D-Burbank), who told physicians, “We need your voices now, more than ever” and encouraged them to continue advocating throughout the legislative process.

CMA’s prior authorization legislative package got some attention with a press conference featuring CMA President Dr. Udovic-Constant and bill authors Assemblymember John Harabedian, Assemblymember Pilar Schiavo and Senator Josh Becker.

AND THE GOLDEN GAVEL GOES TO….

The CMA Political Action Committee (CALPAC) also concluded its 5th annual Golden Gavel contest in conjunction with Legislative Advocacy Day, ending with a fundraising total of just over $20,500.

The annual contest challenges physicians from each county medical society to make a new donation or upgrade their current level of giving to CALPAC. In a tight contest, the physicians of the San Francisco Marin Medical Society took the top spot with dozens of members contributing toward the effort. Physicians of the Sierra Sacramento Valley Medical Society were a close second followed by the Orange County Medical Association.

SEE YOU NEXT YEAR! We are grateful for the time everyone took out of their busy schedules to speak with legislators on the issues impacting the delivery of health care in California. We hope to see you next year for CMA’s 52nd Legislative Advocacy Day!

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OPERATIONAL VS. CLINICAL RISK MANAGEMENT Risk management is the ongoing and systematic process of identifying, evaluating, and mitigating the potential threats, vulnerabilities, and events that negatively impact businesses or organizations. This article focuses on two types of risk management: operational and clinical risk management.

OPERATIONAL RISK MANAGEMENT

Operational risk management focuses on how businesses run and the human-made errors inherent in operations that effectively threaten a business’ assets and reputation.

The causes of risk are as unique as any organization, but the primary sources are usually people (including workforces), incomplete or failed processes, system issues (software or equipment vulnerabilities), and external events (geopolitical events, broken contracts). Operational risk assessment begins with identifying what could go wrong in the day-to-day activities and prioritizing those issues by severity using data benchmarks and industry knowledge. A designated member of upper management will guide team members on developing

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effective strategies to help report reduce, anticipate, and prevent these risks while maintaining government compliance.

CLINICAL RISK MANAGEMENT

The purpose of clinical risk management is to identify and mitigate risks and adverse events associated with patient care.

Clinical risk management addresses the circumstances and human-made practices that contribute to medical errors, compromise safety, and that negatively impact a healthcare institution. The process endorses a culture of teamwork, training, and transparency, relying on the willingness of all parties involved in patient care to participate in the development of an effective risk management plan. These plans guide the development or revision of protocols and procedures with the aim of improving quality of care, promoting safe practices, and reducing the potential for liabilities.

Further information on operational and clinical risk management is available in ProAssurance’s Knowledge Center: https://proassurance.com/knowledge-center

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In The News

IN THE

NEWS

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

St. Joseph’s Earns Third Consecutive ‘A’ Hospital Safety Grade from The Leapfrog Group Dignity Health St. Joseph’s Medical Center earned a third consecutive “A” Hospital Safety Grade from The Leapfrog Group, an independent national nonprofit watchdog focused on patient safety. Leapfrog assigns an “A,” “B,” “C,” “D” or “F” grade to general hospitals across the country based on over 30 measures of errors, accidents, injuries and infections as well as the systems hospitals have in place to prevent them. St. Joseph’s also received an “A” rating in Spring 2024 and Fall 2024.

“St. Joseph’s is honored to receive our third consecutive ‘A’ Safety Grade from The Leapfrog Group,” said David Ziolkowski, President and CEO of St. Joseph’s Medical Center. “The grade is a direct reflection of our staff and providers’ commitment and dedication to providing the highest quality care to the Stockton and surrounding communities. We are proud to be the quality leader in this region.”

St. Joseph’s Heart and Vascular Institute Celebrates Life-Saving Procedural Milestones Dignity Health St. Joseph’s Medical Center (SJMC) has reached the milestone of completing its 200th WATCHMAN FLX™ case and 600th transcatheter aortic valve replacement (TAVR) procedure.

“We are incredibly honored to achieve these momentous milestones during American Heart Month,” says Tina

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200th WATCHMAN FLX™ Munoz, BSN, Director of the Morrissey Family Heart and Vascular Institute at St. Joseph’s. “Through the lifesaving procedure and technology, we are able to offer our patients the highest quality of care, while staying closer to home.” St. Joseph’s Cardiovascular Surgery Program has been ranked

by Society of Thoracic Surgeons as the highest category for quality and successful outcomes in both coronary artery bypass grafting (CABG) and Aortic Valve Replacement (AVR) procedures.

Meet Dr. Maranda Pahlkotter: A Collaborative Approach to Cancer Care We are pleased to welcome Maranda Pahlkotter, MD, a surgical oncologist who recently joined Dignity Health Medical Group – Stockton and St. Joseph’s Medical Center, who brings extensive expertise to the fight against

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cancer. Dr. Pahlkotter emphasizes a compassionate, patient-centered approach, believing that the best outcomes arise from strong collaboration with patients and their families.

Known for her open and honest communication, she Maranda Pahlkotter, MD empowers individuals to make informed decisions about their care journey. Dr. Pahlkotter possesses a wealth of experience treating a wide range of conditions and cancers, from common diagnoses to complex and rare cases.

Meet Dr. Bradley Digney: Expertise and Individualized Care in General Surgery In the complex world of general surgery, finding a physician who combines expertise Bradley Digney, MD with genuine patient care is essential. Dr. Bradley Digney, who recently joined Dignity Health Medical Group – Stockton and St. Joseph’s Medical Center, does just that. With patient-centered care as his guiding principle, Dr. Digney emphasizes clear communication and individualized treatment plans, drawing upon years of experience and a deep understanding of the latest medical advancements.

Dr. Digney is committed to empowering patients to actively participate in their health care journey. He is board-certified in general surgery and performs a wide

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range of procedures, including robotic and minimally invasive surgeries, colon and gallbladder surgeries, and hernia repairs.

Honoring Dr. Sujeeth Punnam: The Impact of Physician Philanthropy St. Joseph’s Foundation of San Joaquin proudly recognizes Dr. Sujeeth Punnam as one of this year’s O’Connor Society Sujeeth Punnam, MD Award recipients. As a trusted physician and committed donor, Dr. Punnam exemplifies how medical professionals can profoundly shape the future of patient care—not just through their clinical expertise but also through philanthropy. Physicians uniquely understand the immediate impact of charitable giving, and Dr. Punnam’s support has helped advance technology, patient services, and caregiver education across our hospital. His generosity inspires a culture of giving and reinforces the powerful connection between healing and hope.

Kaiser Permanente Modesto and Manteca Hospitals Recognized for Patient Safety Kaiser Permanente’s Modesto and Manteca hospitals have been recognized with an “A” grade for patient safety as part of a longstanding commitment to provide safe, high-quality care to our members and patients.

According to The Leapfrog Group’s biannual Hospital Safety Grades report, 15 Kaiser Permanente hospitals in Northern California this spring received A grades including: Antioch, Fresno, Manteca, Modesto, Oakland, Roseville, Redwood City, Santa Clara, San Francisco, San Leandro, San Rafael, Santa Rosa, South Sacramento, South San Francisco, and Vacaville.

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Welcome, David Ziolkowski, President & CEO of Dignity Health St. Joseph’s Medical Center!

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“We take great pride in this achievement, which serves as a reminder of our ongoing commitment to deliver the high-quality, safe patient care expected by our members and patients,” said Aphriekah Duhaney-West, senior vice president and area manager for Kaiser Permanente Central Valley. “Providing a safe environment for our patients, members, and the communities we serve is paramount in all that we do.”

Leapfrog reviews hospital clinical data, assigning hospitals grades based on approximately two dozen measures that analyze patient injuries, medical and medication errors, and infections.

Hospitalists of Modesto Medical Group Joins Doctors Hospital of Manteca The Hospitalists of Modesto Medical Group (HOMMG), under the direction of Dr. Ramanjeet Singh and Dr. Arashdeep Goraya, is now the hospitalist group at Doctors Hospital of Manteca (DHM). Having HOMMG provides consistency and continuity of care across all three Central Valley Doctors Health System hospitals, and nearly all of DHM’s established hospitalists are transitioning to the new group, which also provides consistency for DHM colleagues and patients.

“This top safety rating is the result of the tireless commitment to exceptional care that our physicians, nurses and teams deliver every day,” said Sanjay Marwaha, MD, physician in chief for Kaiser Permanente Central Valley.

“We remain focused on meeting the health care needs of our communities in a safe, welcoming and caring environment.”

San Joaquin General Hospital Debuts Expanded Outpatient Surgery Clinic, Doubling Capacity San Joaquin General Hospital (SJGH) is pleased to announce the expansion of its Outpatient Surgery Clinic, doubling the number of exam rooms to accommodate over 1,400 patients monthly for general surgery, neurosurgery, vascular surgery, urology and podiatry.

As the only provider of neurosurgery services, and one of the region’s top vascular surgery providers, SJGH continues to lead the way in specialized care for the residents of San Joaquin County. This expansion, coupled with the latest technological advancements, including using the Da Vinci Surgical System for robotic-assisted surgery, ensures that patients have equitable access to the most innovative and effective surgical procedures.

The SJGH Outpatient Surgery Clinic is located at 7777 Freedom Road in French Camp. For more information, please visit sanjoaquingeneral.org.

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I, Robot…

I, Robot…

Doctors Hospital of Manteca recently celebrated two milestone cases in the area of robotic surgeries. Two general surgeons – Dr. Philip Ding and Dr. Yong Shih – have shown their expert command of the da Vinci robot for minimally invasive surgeries and each celebrated performing 1,000 cases using the robot.

“I love doing surgeries at Doctors Hospital of Manteca,” said Dr. Ding. “The reason is because of the team: they are always ready, well trained, and very precise. The anesthesia, the easy scheduling…everything is excellent there. That’s why the patients always have a high satisfaction with the surgeries at Manteca.”

Doctors Day Highlights Dr. Michael Davis at DHM On March 28, Doctors Hospital of Manteca (DHM) celebrated Doctors Day with a special recognition of Dr. Michael Davis. Dr. Davis, a pulmonologist that is loved by

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In The News

IN THE

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

NEWS

In addition to specializing in diseases of the lungs and the thorax, Dr. Davis has also been a leader in the area of sleep disorders – in fact he has overseen sleep studies in the region going back to the early 2000’s. He has treated a wide range of pulmonary conditions, including Sleep Apnea, Chronic Obstructive Pulmonary Disease (COPD), Emphysema, Asthma, Pulmonary fibrosis, and Pleural Effusion.

Doctors Hospital of Manteca Welcomes New Med Staff Director Kelli Bruns has joined Doctors Hospital of Manteca (DHM) as Medical Staff Director, which provides leadership, management and operational oversight of the Medical Staff Office. Ms. Bruns joins DHM from historic Chinese Hospital in San Francisco, where she managed both the Medical Staff and Medical Services. Prior to that, she held the positions of Medical Supervisor and Credentialing Coordinator for El Camino Health, which has acute-care hospitals in Los Gatos and Mountain View, as well as nearly 20 primary care, multi-specialty care and urgent care facilities in that region. Ms. Bruns also has served as the Credentialing Coordinator for Stanford Health Care Tri-Valley.

Dr. Michael Davis at DHM colleagues and patients alike, has been practicing at DHM for 37 years. Dr. Davis is a past Chairman of the hospital’s Governing Board and helped DHM grow from the only 53 beds in 1987 when he moved to Manteca in 1987.

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From emergencies and screenings to surgical and procedural services, Doctors Hospital of Manteca delivers quality healthcare and compassionate care close to home.

Doctors Hospital of Manteca offers: • 24-Hour Emergency Care and Convenient Online Check-Ins • 24/7 Critical Care Coverage Led by Intensivists • Bariatric Center of Excellence • Blue Distinction Center for Hip and Knee Replacement • 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 or visit DoctorsManteca.com SUMMER 2025

JOAQUIN PHYSICIAN 25 1205 E. North St. SAN Manteca, CA 95336

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Dr. Gi ll ’s work i n

ROBOTIC SURGERY A DVA N C E S CA R E F O R W O M E N Lifetime Achievement Award honoree a leader in S.J. community

BY JO ANN KIRBY

Dr. Param Gill has much to celebrate in a year where she marked her 70th birthday, attended the Presidential Inaugural ball in the nation’s capital, and will be honored with the 2025 San Joaquin Medical Society’s Lifetime Achievement Award. As busy as ever, she has no plans to rest on her laurels.

Her dad, in fact, lived to be 110 years of age.

“I tell my competition, they have to watch out for me for 40 more years,” said Dr. Gill, who leads thriving Ob/Gyn practices in Stockton and Lodi. Gill Ob/Gyn Medical Group, Inc. is the largest private Ob/Gyn practice in San Joaquin County with 8 physicians, three physician assistants, several ultrasound technicians and 55 other staffers. She founded the practice with her husband Dr. Jasbir Gill, who is retired from medicine but keeps busy managing the family’s vineyard and wine operations. Her energy and enthusiasm is evident as is her passion for a career where she puts patients first. “I love what I do so, if you love what you do, it’s really not work.” >>

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SAN JOAQUIN PHYSICIAN 27

Dr. Gi ll "SHE IS A REAL LEADER I N T H E C O M M U N I T Y, SHE'S A LEADER IN THE H O S P I TA L , S H E P U T S T H E SAFETY OF HER PAT I E N T S F I R S T " - DR. NANCY LITTLE

Colleagues said it wasn’t always easy for her, being a woman of color in a small town Lodi when she started out just over 40 years ago, but Dr. Gill proved herself time and time again with fortitude, determination and hard work. The woman who dreamed of being a physician, ever since she was a young girl in India and saw the respect afforded to women who served as physicians in the military, knew her purpose.

She attended a strict Catholic school in India with Irish nuns as her teachers. “They instilled discipline into my DNA at a young age.” The child prodigy was accepted into medical school at the young age of 16 but had to wait a year because the starting age was 17. By 21, she had completed medical school and would come to California to finish her training and become a board-certified Ob/Gyn. She is a graduate of Jabalpur University in India with a Bachelor of Science degree, with honors, and earned her Doctor of Medicine degree at the Medical College of Jabalpur. In 1984, when she started practicing medicine in San Joaquin County, just after attending the Summer Olympics, she was one of the

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first few women physicians practicing medicine in Lodi.

“People would say to my face, I’m not letting a woman operate on me,” she said. “They would say women are supposed to be nurses, not doctors.” Dr. Gill believes people cannot hide behind saying “I’ve been discriminated against.

You have to fight for everything you want. It takes courage to break barriers. You have to put in the hard work and not make excuses.”

In nominating her for the SJMS award, Dr. Vincent Pennisi said that Dr. Gill heads the largest OB/GYN private practice in San Joaquin County and has a rich history of serving generations of women throughout San Joaquin County and maintaining excellence in the dynamic field of women’s health, while providing the highest level of innovative medical services in the area. He said Dr. Gill has brought a lot of new gynecological surgery procedures to benefit the patients in the area, including Robotic Hysterectomy with Da Vinci technologies and is now leading a team of surgeons who are robotically trained in San Joaquin County.

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Her passion is robotic surgery, and she earned a master’s in robotic surgery in 2015 and earned the designation of Surgeon of Excellence in the field. Dr. Pennisi credits her with starting the robotic surgery program at Lodi Memorial Hospital and then at St. Joseph’s Medical Center, which enables patients to have their hysterectomy done and be sent home the same day. This, he says, is important for working women as the minimally invasive technique allows for minimal scaring, less blood loss and better recovery so patients can resume their normal activities.”

“She is a real leader in the community, she’s a leader in the hospital, she puts the safety of her patients first,” Dr. Nancy Little, a urologist, who counts Dr. Gill as a friend and colleague. Dr. Gill and Dr. Little performs surgery together, for instance in cases where a woman might need a hysterectomy and a bladder lift. “We have developed a very safe and systematic approach for evaluating, operating and caring for patients after surgery,” Dr. Little said. “Whenever a new technology comes out, she investigates it thoroughly and makes sure it’s safe before putting it into practice.” Dr. Little said her colleague always puts the patients first and is incredibly empathetic to the underserved and generous with her financial contributions to the community. Having lost count of the tens of thousands of babies she has delivered; Dr. Little is proud to count her own children as having been delivered by Dr. Gill.

Dr. Gill would go on to gain so much respect in the community and in her practice that she would serve stints as Chief of Staff at both St. Joesph’s Medical Center and Lodi Memorial Hospital.

She has been inducted into the Lodi Community Hall of Fame and was even awarded the key to the City of Stockton along with her husband, Dr. Jasbir Gill. As a leader, the Ob/Gyn has served on the Board of Directors of both Lodi Memorial Hospital and St. Joseph’s Medical Center

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and was honored with an Award for Excellence in Medicine by the California State Assembly. She presently serves as Adjunct Assistant Professor in Obstetrics & Gynecology at Touro University California College of Osteopathic Medicine and Assistant Clinical Professor in Obstetrics & Gynecology at University of California, Davis.

As someone who serves many roles, Dr. Gill counts as being a mother of three sons, Chaman, Vick and Ricky, as one of her biggest accomplishments and beams with pride when she catches people up on their achievements. And through her family, she’s enjoying being a grandmother. “Now that my sons are grown up, I love spending time with my three grandchildren who are the love of my life,” she said. “Kareena, who is 7, Jashan, who is 5 and Kaysar, who is 2 years old.

Her son Ricky, who is serving in the Trump Administration as a Special Assistant to the President and National Security Council Senior Director for South and Central Asia, said his mother has an incredible work ethic and always made time for their family. He says, “This accolade encapsulates her life’s work. She is a terrific mother and always empathetic to our concerns. She was always our first call for support or advice.” He also reflected on the many mother-son trips taken together and his mother’s tireless efforts to keep up with him. On her unique personality, Ricky says his mother has “an unflappable approach to life, someone who is poised beyond measure, all while maintaining a sense of humor that is appreciated by friends and family.”

Dr. Gill says the success of her family is her greatest achievement and credits her husband for being her rock of Gibraltar. She’s thrilled to be honored with the Lifetime Achievement Award because now she’s in the same company as her husband, who received this award in 2017. “Now, he can’t say he has something that I don’t,” she said, laughing.

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Dr. Gi ll D R . G I L L S AY S T H E SUCCESS OF HER FA M I LY I S H E R G R E AT E S T A C H I E V E M E N T AND CREDITS HER HUSBAND FOR BEING HER ROCK O F G I B R A LTA R .

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ANNUAL MEMBERSHIP DINNER honoring our

2025 Lifetime Achievement Award Recipient

Parampal K. Gill, MD and

Young Physician Award Recipient

Manreet Basra, MD

SUNDAY, JUNE 8, 2025 Cocktail Hour 6:00pm Dinner 7:00pm

STOCKTON GOLF & COUNTRY CLUB 3800 Country Club Boulevard Stockton, California

PREMIER LEVEL SPONSORS

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CMA PHYSICIAN SERVICES UNVEILS MEDWAY, A NEW SERVICE TO HELP INDEPENDENT PRACTICES THRIVE Independent practices now have a powerful ally in overcoming the challenges of modern healthcare management: MedWay – a comprehensive, affordable, and tailored administrative solution designed to help practices thrive without sacrificing autonomy. This new service is being launched by CMA Physician Services, a subsidiary of the California Medical Association (CMA).

“Independent practices are navigating unprecedented challenges that threaten their sustainability,” said David Ford, CEO of CMA Physician Services. “MedWay will further empower these practices with expert support that ensures they can focus on what matters most – delivering exceptional patient care.”

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MedWay officially launched in April 2025 and is available to all physician-led practices and health centers in California, regardless of CMA membership. MedWay plans to grow its offerings over time, with a focus on alleviating independent practices’ administrative burdens.

COMPREHENSIVE SERVICES TAILORED TO INDEPENDENT PRACTICES MedWay offers a robust suite of administrative services designed to meet the unique needs of healthcare providers:

ands-on HR, Backed by Tech: MedWay combines H personalized HR support with a cloud-based system

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built for practices, streamlining workforce management while giving your team the support it deserves.

Smarter Payroll: MedWay handles complex pay needs like on-call shifts, overtime, and tax filings through its automated system, helping practices minimize manual errors, simplify filings, and manage payroll operations. ll-in-One Platform: Track time, manage PTO, update A documents, run performance reviews, and handle benefit elections – all through MedWay’s integrated platform.

C ompetitive Employee Benefits: Attract and retain talent with access to cost-effective medical, dental, vision, and disability plans through trusted partners.

ealthcare-Specific Expertise: MedWay’s solutions H are tailored to the unique operational and compliance needs of healthcare providers, ensuring customized support that drives success.

P ersonalized, Expert Support: Every practice is supported by dedicated professionals who proactively address challenges, ensuring smooth operations and peace of mind.

Discover how MedWay can transform your practice today. Schedule a demo at MedWayDocs.com or call (916) 775-0175.

Practice Insurance That Fits: Get connected to malpractice, workers’ comp, and business liability coverage that’s tailored to your practice needs. etirement & Financial Tools: MedWay R offers access to low-expense 401(k) plans and financial planning, helping your team plan ahead.

S trategic Hiring Support: Plan your workforce and post jobs with expert guidance – and gain access to full-service recruitment with over 100K pre-vetted healthcare professionals when you need them.

THE MEDWAY DIFFERENCE What sets MedWay apart from other HR, payroll, and staffing support services? Its unwavering focus on empowering independent practices with:

Full Autonomy: MedWay ensures practices maintain complete control over their operations, including employees, business, and clinical decisions – offering support without the constraints of co-employment or third-party interference.

WHAT SETS MEDWAY APART FROM OTHER HR, PAYROLL, AND STAFFING SUPPORT SERVICES? ITS UNWAVERING FOCUS ON EMPOWERING INDEPENDENT PRACTICES WITH:

ABOUT CMA PHYSICIAN SERVICES CMA Physician Services is a subsidiary of the California Medical Association, the nation’s leading state-based physician association. CMA Physician Services is dedicated to supporting independent practices with tailored administrative solutions that enhance efficiency, reduce costs, and uphold the autonomy of healthcare providers.

ost-Effective Solutions: On average, MedWay is 30% C more affordable than comparable services, making key administrative tools and support accessible to practices of all sizes.

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Celebrating 60 years of excellence and unwavering commitment to businesses and families in California’s Central Valley and East Bay communities

Photos from left to right: Ron Berberian, President and Board Chairman; Dana Bockstahler, Board Vice Chairman and former CEO; Dante Tosetti, Chief Executive Officer; Jackie Verkuyl, Executive Vice President and Chief Operating Officer; Bill Trezza, Board Member and former CEO.

Formed in Brentwood, CA, BAC first opened for business May 21, 1965.

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LODI 1610 West Kettleman Lane

(209) 367-9400

STOCKTON CAL-WEBER 517 East Weber Ave

(209) 944-1807

STOCKTON MARCH LANE 2001 West March Lane

(209) 473-6859

www.bankbac.com/solutions

Member FDIC

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8 NEW

SJMS MEMBERS THIS SPRING!

...and even more on the way.

Jasleen Kaur, MD

Sukhbir Randhawa, DO

Rajan Saini, MD

Internal Medicine

Internal Medicine

Internal Medicine

1800 N California St

1721 W Yosemite Ave

2505 W Hammer Ln

Stockton, CA 95204

Manteca, CA 95337

Stockton, CA 95209

GMC Amritsar, 2011

Pacific Northwest University of Health

Kottayam Medical College,

Sciences, 2013

Kerala University, 2001

Family Practice

Elena Madan, MD

Baljit Dhesi Singh, MD

701 E Channel St.

Anesthesiology

Cardiology

Stockton, CA 95202

7373 West Ln

415 E Harding Way, Ste D

University of Illinois College of

Stockton, CA 95210

Stockton, CA 95204

Medicine, 1997

Tufts University

UC Davis School of Medicine

Juan Lopez-Solorza, MD

Soungmin Cho, MD

School of Medicine, 2019

Opthalmology

Katy Kirk, MD

1617 St. Mark’s Plaza, Ste D

Family Practice

Stockton, CA 95207

7373 West Ln

Loma Linda University

Stockton, CA 95210

School of Medicine, 2020

East Carolina University School of Medicine, 2014

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SAN JOAQUIN PHYSICIAN 37

In Memoriam

In Memoriam JAMES R. MCFARLAND, MD 1936 - 2024

James R. McFarland, MD, a devoted husband, father, grandfather, veteran, and dedicated physician, passed away peacefully at the age of 88. He leaves behind a legacy of wisdom, service and compassion. Jim is survived by his beloved wife of 66 years, Elna McFarland, his children Pamela Woodruff, Lori McFarland, and John McFarland, and his cherished grandsons Ryan Woodruff, Luke and Ashton Werney.

Mirage, California.

His advocacy for family medicine and primary care resonated deeply, shaping both his community and his profession.

Born on October 21, 1936, Jim led a life rich with purpose and achievement. After completing his medical education, Jim proudly served his country in the United States Air Force and became a highly respected general practitioner, serving the communities of Galt and Lodi from 1966 to 1999. For over 34 years, he was a trusted healer, mentor, and advocate for family medicine, touching countless lives with his expertise and compassionate care.

After his retirement, Jim and Elna embraced their love of travel, exploring the world together.

From golfing in Scotland to visiting historic landmarks, their adventures brought them closer and filled their later years with treasured memories.

In addition to his practice, Jim was a guiding force at NORCAL Mutual Insurance Company, where he served on the Board of Directors. Over his two decades there, he held key leadership roles, as Vice Chairman, and Chair of numerous committees. His steadfast commitment to advancing primary care medicine and supporting his colleagues left an indelible mark on the organization and the broader medical community.

Furthering his professional achievements, Jim served as President of the San Joaquin Medical Society and Chairman of the Board of the Community Blood Bank in Rancho

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Jim’s life was filled with joy and passion. An avid golfer, he found peace on the fairways, and his love for crossword puzzles and books reflected his insatiable curiosity and sharp mind. His warm smile and kind spirit were truly exceptional.

Jim will be remembered for his unwavering dedication to improving the lives of others, his tireless work ethic, and his remarkable ability to inspire those around him. His legacy lives on in the countless lives he touched and the example he set as a man of integrity, humility, and kindness. He will be deeply missed and forever cherished.

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In Memoriam

In Memoriam ROBERT L. PROTELL, MD 1945 - 2025

Dr. Robert Lawrence Protell, beloved husband, father and friend, passed away on March 29, 2025, at the age of 79.

Born in New York City to Seymour and Carolyn Protzel on July 3, 1945. He lived in New York City, Charlottesville, Seattle, Tucson, Stockton, and Pebble Beach before moving to Carmel Valley in 2016 where he lived until his passing.

Dr. Protell (Bob to his close friends and family) is survived by his loving wife, Elizabeth; his children, Page (Trip Hartigan), Charles (Deborah Longley) and Peter (Tracy Schegg), his sister Mary Stuart (Larry Keesen) and his grandchildren; Connor, Tyler, Andrew, Brandon, Piper, Jillian, and his faithful dog, Poppy.

Bob graduated Summa Cum Laude from Rutgers University in 1967, where he was elected to Phi Beta Kappa and played on the varsity tennis team. He then earned his medical degree at Weill Cornell Medical College in 1971, where he was elected to the Alpha Omega Alpha Honor Society.

He completed his internship and residency programs at the University of Virginia, which is also where he met his wife Elizabeth Holt (after she was dared to date such a young bohemian doctor). He obtained a specialty in Gastroenterology at the University of Washington in Seattle.

Bob had a long and distinguished career in medical research and academia, with positions at the University of Virginia, University of Washington, University of Arizona and UC Davis. He taught countless medical students, residents and fellows and published over 20 research papers. In 1988 he started his private practice in Stockton, California, where he

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treated his patients with the same kindness and care that he had for his family and friends.

He was a member of the San Joaquin Medical Society for 30 years.

Although throughout his life he was dedicated to the practice of medicine and to his patients, he also made time to pursue his love of tennis, golf and skiing with his family. He spent many winters in Bear Valley skiing and volunteering as the medical director of the ski patrol. He also regularly enjoyed spending time at The Beach Club in Pebble Beach.

Bob was a true gentleman, and will be remembered for his warm compassion, sharp intellect, quiet strength, sense of humor and unwavering integrity.

He will be missed dearly, but not forgotten by those whose lives were made better by his care as a physician, friend, husband, father and grandfather.

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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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SJGH Celebrates 2025 Family Medicine Graduates Staying in San Joaquin County San Joaquin General Hospital is proud to acknowledge four outstanding Family Medicine residents who have chosen to remain in San Joaquin County and continue serving our underserved communities. We recognize these residents not only for their accomplishments, but especially for their commitment to remain in our region and serve where they are most needed. Their choice to stay reflects a deep dedication to making a lasting impact on the lives of patients and families throughout San Joaquin County.

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Farwa Feroze, DO

Mohammed Rafae, DO

Dr. Feroze was a participant in the San Joaquin Medical Society’s Decision Medicine Program, which supports high-achieving, underrepresented students in pursuing careers in medicine.

She will continue her journey as a Family Medicine physician at Sutter Manteca, fulfilling the program’s goal of retaining talent within the community.

Dr. Rafae will also be joining Sutter Manteca as a Family Medicine physician, continuing his service to San Joaquin County and strengthening access to primary care in the region.

Tricia Scales, MD

Felipe Chavez, MD Dr. Chavez will join the faculty at San Joaquin General Hospital, supporting Family Medicine attendings and playing a key role in training the next generation of healthcare providers committed to serving our community.

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Dr. Scales will remain at San Joaquin General Hospital to complete an Obstetrics Fellowship, expanding her expertise to include maternal and women’s health and ensuring continued care for growing families in our area.

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San Joaquin General Hospital Celebrates Resident Fellowship Matches San Joaquin General Hospital is excited to announce the outstanding the Internal Medicine and General Surgery residents who have matched into prestigious fellowship programs. Their dedication to excellence and commitment to advancing surgical care are truly commendable.

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Amina Tahir, MD Sleep medicine, University of California, Davis

Lobsang Marcia, MD Vascular Surgery, University of Colorado

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Kirandeep Bains, MD Abdominal Transplant Surgery, Loma Linda University

Olga Slabchak, MD Bariatrics/MIS, Advanced Laparoscopic Surgical Associates Medical Group, Fresno, CA

SAN JOAQUIN PHYSICIAN 43

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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June 11th, 2025: 11:00AM to 1:00PM

Medical Practice Efficiencies Through Improved Communication Effective communication is the key to a well-run practice. Join this presentation to learn how improving communication with both staff and patients can streamline operations, reduce inefficiencies and enhance patient satisfaction.

Topics will include: • How clear staff communication can improve workflow, reduce errors and boost morale • Strategies for improving patient communication to enhance trust, adherence and satisfaction • Best practices for preventing no shows and discussing financial responsibility up front to reduce surprises • The benefits of daily staff huddles and structured meetings for increased efficiency • Strategies for optimizing staff coordination and daily workflow • Maximizing resource allocation for a smoother practice operation Mitzi Young is the Associate Director, Practice Strategy for the California Medical Association, Center for Economic Services.

Mitzi brings over 29 years of experience in the health care industry. In Mitzi’s current role, her focus is Practice Management and Operations. She focuses on the day-to-day operations of CMA’s member practices. Mitzi recommends areas of improvement within a physician prac-tice to achieve financial health, education, staff morale, and development of new internal systems. Mitzi presents seminars on practice management and health care regulations.

Mitzi started her career working for a third-party administrator as a claim and eligibility processor for San Bernardino County hospital’s medically indigent adult program. She went on to further her educa-tion and worked as an operations and business manager for specialty practices and for ambulatory sur-gery centers overseeing all personnel and business operations. She brings with her a vast knowledge of medical billing and collections, contracting, accreditation, and personnel and business management. She understands the

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needs of physicians and their staff, the challenges that face medical practices, and is very passionate about advocating on behalf of providers on succeeding in the ever-changing challenges of the healthcare landscape.

September 10, 2025: 11:00AM to 1:00PM

Annual OSHA Staff Training This workshop provides up-to-date changes and practice requirements to meet the Annual OSHA mandates.

Topics included: Bloodborne Pathogens, Aerosol Transmissible Disease Guidelines, Violence in the Workplace, as well as several other OSHA related topics.

Carrie Champness, RN, BSN Safety Compliance SpecialistCarrie has been an OSHA compliance specialist for over 35 years and provides up-to-date information about changes and practice requirements to meet all OSHA mandates.

CMA PRACTICE RESOURCES CMS finalizes 2026 Medicare Advantage and Part D rule: What physicians need to know UHC delays Designated Diagnostic Provider program in CA until Jan. 1, 2022 The Centers for Medicare & Medicaid Services (CMS) has finalized policy and payment updates for Medicare Advantage (MA) and Part D plans for Calendar Year 2026, with several provisions that directly affect physicians and patients in California.

Key highlights include: MA Payment Increase: CMS projects a 5.06% average increase in MA plan payments for 2026, driven by a 9.04% effective growth rate. While this boost helps MA plans manage higher-risk patient populations, physician groups—including the California Medical Association (CMA)—remain deeply concerned about the growing disparity between the MA increases for health plans and the stagnant or declining physician fee schedule payment rates over the past five years.

SAN JOAQUIN PHYSICIAN 45

Prior Authorization Reforms: CMS finalized important updates to prior authorization rules: MA plans must now honor inpatient prior authorization approvals through a patient’s discharge.

Appeal rights have been expanded to cover decisions made during ongoing treatment. These changes are a step towards reducing administrative burdens and improving continuity of care.

Part D Coverage Updates: CMS declined to expand coverage to include antiobesity medications for weight loss, citing statutory limits and high projected costs.

In line with the Inf lation Reduction Act, CMS will eliminate cost-sharing for adult vaccines and cap cost-sharing for insulin products.

Guardrails on Artificial Intelligence (AI): CMS acknowledged concerns about the use of AI in utilization management and plans to continue evaluating how to ensure algorithmic tools do not exacerbate health inequities, though no specific rules were issued.

CMA continues to advocate for broad Medicare payment reform While hospitals, Medicare Advantage plans, and other providers receive annual updates that account for inf lation and rising costs, physicians remain the only provider group without an automatic inf lationary adjustment in their payment formula.

Instead, Medicare physician payments are based on a f lawed system that has resulted in cuts or f lat funding year after year—even as the cost of delivering care continues to rise.

CMA is working with national partners and Congress to fix this broken system and ensure physicians receive sustainable, predictable reimbursement that ref lects the realities of modern medical practice. Without meaningful reform, continued financial pressure will threaten access to care for patients across California and beyond.

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Brown and Toland delay implementation of changes to specialty pharmacy reimbursement On March 14, 2025, Brown and Toland announced it would be adjusting reimbursement rates for buy-and-bill specialty pharmacy products. The announced change would reduce reimbursement for physician administered specialty pharmacy drugs.

Alternatively, physicians would have the option to submit specialty pharmacy scripts as a referral to Brown & Toland for procurement from its preferred vendor, also known as “white bagging.” The change would impact all in-network providers and was scheduled to become effective May 1, 2025.

The California Medical Association (CMA) reached out to Brown & Toland to express concerns that reductions in reimbursement for drug costs, which represent fixed costs for practices, could place significant financial strain on in-network physician practices. And the alternative “white bagging” process, where physicians obtain medications through the payor’s designated vendor, can add administrative burdens and operational challenges that may delay treatment and compromise patient safety.

Brown & Toland shared with CMA that it has delayed implementation until July 1, 2025, to allow additional time for further engagement with physicians affected by this change. CMA, along with several specialty societies, is also continuing discussions with Brown & Toland regarding our significant concerns with this policy.

Practices with questions or concerns are encouraged to contact Brown & Toland Customer Service at (800) 225-5637 or by emailing the Physicians Relations Department at physicianrelations@altais.com.

Practices can also contact CMA at (800) 786-4262 or economicservices@cmadocs.org.

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Public Health

Update

Behind the Scenes of Public Health: The Role of Emergency Preparedness

BY SYDNEY JENKINS, MPH AND GWEN CALLAWAY, MPH

When we think of Emergency Preparedness (EP) in the context of Public Health, what may come to mind are stockpiled vaccines, disaster drills, or rooms filled with thousands of pieces of personal protective equipment. While these are certainly important elements, they represent only a small part of the bigger picture.

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THE BIGGER PICTURE OF EMERGENCY PREPAREDNESS

of scenarios, from communicable disease outbreaks to biological weapon threats. Since all county employees are designated Disaster Service Workers (DSWs), we provide training in the Federal Emergency Management Agency’s (FEMA) Incident Command Structure (ICS). We also continuously seek out new training opportunities to enhance our staff’s EP skills.

The EP program has a unique role—we collaborate with every program within Public Health Services (PHS) and with numerous external stakeholders to ensure our entire public health system is prepared, applying federal emergency preparedness models to strengthen infrastructure, coordinate large-scale response efforts, and protect the health and safety of the community at large. This includes comprehensive planning, training, strategy development, Business | Litigation | Estates & Trusts response coordination, recovery efforts, Employment Law | Agriculture Law | Real Estate Law and simulation exercises to prepare for a wide range of threats, from infectious diseases to natural disasters, and chemical, nuclear and bio-terror events.

Understanding how EP functions is critical—not just during times of crisis, but as a continuous, proactive strategy that enables readiness and resilience, KROLOFF IS NOW A CERTIFIED both during and between emergencies.

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7540 Shoreline Drive, Stockton, CA 95219

Jamie M. Bossuat Shareholder

Rebecca H. Sem Shareholder

The only law firm in San Joaquin County to earn this designation.

Giving you four (more) good reasons to work with Kroloff.

Allison Cherry Lafferty Managing Shareholder

At the core of EP is something called the preparedness cycle - a continuous process of planning, organizing, training, equipping, exercising, evaluating, and taking corrective action. As part of that cycle we maintain several departmental emergency plans covering a wide array

WOMEN-OWNED BUSINESS

Kerry L. Krueger Shareholder

EP is also unique in that we partner with various other San Joaquin County departments, including Emergency Medical Services (EMS), the Office of Emergency Services (OES), Behavioral Health Services (BHS), and the Office of the Medical Examiner (OME). We are also an integral part of the Medical Health Operational Area Coordination (MHOAC) system, through which we can request resources and services from across the state. Participating in joint exercises with these agencies strengthens local partnerships and extends our reach into community sectors we collaborate with less often.

EP thrives on maintaining these relationships—both in blue sky times and during a response.

T: 209.478.2000

KROLOFF.COM

SAN JOAQUIN PHYSICIAN 49

FAMILY EMERGENCY PLANNING CHECKLIST FAMILY CONTACTS Name:

Date of Birth:

SSN: Important Medical Information:

BUILD A KIT First aid kit Pet food, water, and supplies Important documents

Name:

Date of Birth:

SSN: Important Medical Information:

Name:

Date of Birth:

SSN: Important Medical Information:

Name:

Date of Birth:

SSN:

Cash and change Warm and cold weather clothing

Shelf stable food and water Battery powered or hand crank radio

CONTACTS Telephone: Email: Telephone: Email:

Important Medical Information:

Telephone: Email:

EMERGENCY CONTACTS Mobile: Telephone: Email: Mobile: Telephone: Email:

Doctor

Dentist

Specialist

Veterinarian Telephone: Email:

INSURANCE Type: Policy Number: Telephone:

MEETING LOCATIONS Neighborhood: Additional:

PLANNING, TRAINING, AND REALTIMED LESSONS LEARNED To address our specific priorities and needs, we regularly conduct exercises to test and refine our plans and response capabilities.

We run exercises utilizing WebEOC, CHEMPACK, CaHAN, and mass vaccination. These are internal services we use to check our communication with ourselves and other county agencies.

It is vital to ensure we can receive and pass along information during emergencies. The planning tools involve surveillance, early detection systems, interagency coordination (federal, state, and local), public communication strategies, and focused protections for vulnerable populations. The COVID-19 pandemic put this system to the test in real-time, revealing both strengths and areas for improvement. In the aftermath, as part of continuous quality improvement, we developed an After-Action Report (AAR) capturing lessons learned and are actively updating our emergency plans, procedures, and policies to reflect these insights.

PHS is responsible for operating Point of Dispensing (POD) centers, mobile and stationary vaccine clinics and shelter support

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facilities. EP works closely with our Disease Control and Prevention (DCP) team to coordinate drills and to support vaccine clinics. The goal is to streamline processes and ensure we provide effective support to both staff and patients. POD centers are designated locations, typically somewhere in the community, where we can distribute health products. There we utilize Medical Countermeasures (MCMs)— products like vaccines, medications, and diagnostic tools used to prevent and treat conditions during public health emergencies. This is also a way to get our community involved in the response effort, and to build trust for those who need our services. Our team is trained to deploy MCMs through PODs in response to outbreaks or other events, and we offer ongoing training for both staff and external partners to ensure readiness.

WHAT ROLE CAN PROVIDERS PLAY? When it comes to the healthcare provider’s role in EP, one of the most impactful things you can do is help your patients prepare. OES operates warming and cooling centers across the county, but many patients may not know these exist. We understand the time constraints of patient care, and preparedness may not always come up in conversation—but we encourage you to incorporate it whenever possible. Sharing EP resources, even briefly, can lead to significantly better outcomes for patients in times of crisis. Consider the family emergency planning checklist on the next page, which is also available on our website at https://www.sjcphs.org/programs-and-services/emergencypreparedness/make-a-plan/. Included are an emergency supply checklist, medical information, medication lists, emergency contacts, and even steps to protect our furry friends. We encourage you to print this resource and make it accessible to your patients.

Helping your patients and their families create emergency plans that align with EP best practices will lead to a more effective response and better outcomes for our community.

PREPAREDNESS IS A DAILY COMMITMENT Emergency preparedness is not just about what happens when the sirens go off—it’s about the choices we make every day to protect those who trust us. It is a vital part of making everything we do in public health work. We remain constant and are ready to respond when our community needs us.

SUMMER 2025

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 SUMMER 2025

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

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Creating Equitable Access to Quality Healthcare Through partnership with our network of dedicated providers and community support services, we can continue to address health disparities together, ensuring access to quality care for the unique and diverse members we serve.

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