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Sierra Sacramento Valley

MEDICINE Serving the counties of El Dorado, Sacramento and Yolo

March/April 2017


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Sierra Sacramento Valley

MEDICINE 2

2017 Education Series

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2017 Committee Appointments

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PRESIDENT’S MESSAGE Reclaiming the Joy of Medicine

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Annual Meeting

Ruenell Adams Jacobs, MD

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Flying Samaritans – A Family Avocation

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EXECUTIVE DIRECTOR’S MESSAGE #SSVMSCares

George Meyer, MD

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Emily’s Story

Aileen Wetzel, Executive Director

Emily Meyer

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GUEST EDITORIAL The “Good Old Days”

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India is at the Center of Diabetes Epidemic

Sooraj Tejaswi, MD

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The Cuban Health Care System

Glennah Trochet, MD

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BOOK REVIEW Deadly Spin

Reviewed by Gerald Rogan, MD

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Sign Language

George Meyer, MD

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SSVMS Annual Report

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Welcome New Members

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Board Briefs

Gerald Rogan, MD

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Open Letter to Congress

Medical Student Leadership, UC Davis

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Addendum: Women’s Health Care on the Chopping Block

Ann Gerhardt, MD

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CMA Federal Update

Elizabeth McNeil

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Over 50 Years in Medicine

Robert Rooney, MD, Abridged by Bob LaPerriere, MD

We welcome articles from our readers by email, facsimile or mail to the Editorial Committee at the address below. Authors will be able to review articles before publication. Letters may be published in a future issue; send emails to e.LetterSSV Medicine@gmail. com or to the author. All articles are copyrighted for publication in this magazine and on the Society’s website. Contact the medical society for permission to reprint.

Visit Our Medical History Museum 5380 Elvas Ave. Sacramento Open free to the public 9 am–4 pm M–F, except holidays.

SSV Medicine is online at www.ssvms.org/Publications/SSVMedicine.aspx Our cover image is by Sacramento otolaryngologist Dr. David Evans. “Sunflowers are the most visually appealing and photogenic crop that the Central Valley has to offer, in my opinion. Each year I cruise around Dixon and Davis looking for fields. The trick is to get them before they start to turn brown, and it is nice to have a few clouds in the sky, which is rare in the Sacramento Valley summer.” − devans@sacent.com

March/April 2017

Volume 68/Number 2 Official publication of the Sierra Sacramento Valley Medical Society 5380 Elvas Avenue Sacramento, CA 95819 916.452.2671 916.452.2690 fax info@ssvms.org

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Sierra Sacramento Valley

MEDICINE The Mission of the Sierra Sacramento Valley Medical Society is to bring together physicians from all modes of practice to promote the art and science of quality medical care and to enhance the physical and mental health of our entire community. 2017 Officers & Board of Directors Ruenell Adams Jacobs, MD, President Rajiv Misquitta, MD, President-Elect Tom Ormiston, MD, Immediate Past President District 1 Seth Thomas, MD District 2 Vijay Khatri, MD Christian Serdahl, MD Vacancy District 3 Thomas Valdez, MD District 4 Alexis Lieser, MD

District 5 Sean Deane, MD Paul Reynolds, MD Sadha Tivakaran, MD John Wiesenfarth, MD Eric Williams, MD District 6 Carol Kimball, MD

2017 CMA Delegation District 1 Reinhardt Hilzinger, MD District 2 Lydia Wytrzes, MD District 3 Katherine Gillogley, MD District 4 Russell Jacoby, MD District 5 Sean Deane, MD District 6 Marcia Gollober, MD At-Large Alicia Abels, MD Ruenell Adams Jacobs, MD José A. Arévalo, MD Barbara Arnold, MD Alan Ertle, MD Richard Gray, MD Kevin Jones, DO Richard Jones, MD Charles McDonnell, MD Janet O’Brien, MD Tom Ormiston, MD Senator Richard Pan, MD Kuldip Sandhu, MD James Sehr, MD Don Wreden, MD

District 1 Anissa Slifer, MD District 2 Ann Gerhardt, MD District 3 Thomas Valdez, MD District 4 Vacant District 5 Jason Bynum, MD District 6 Rajan Merchant, MD At-Large Megan Anzar Babb, DO Natasha Bir, MD Helen Biren, MD Arlene Burton, MD Amber Chatwin, MD Mark Drabkin, MD Karen Hopp, MD Carol Kimball, MD Derek Marsee, MD Sandra Mendez, MD Robert Peabody, MD Armine Sarchisian, MD Eric Williams, MD Vacant Vacant Vacant

CMA Trustees District XI Douglas Brosnan, MD

Margaret Parsons, MD

CMA President Ruth Haskins, MD

CMA Speaker Lee Snook, MD

AMA Delegation Barbara Arnold, MD

Richard Thorp, MD

Editorial Committee John Paul Aboubechara, Sean Deane, MD Adam Doughtery, MD Ann Gerhardt, MD Caroline Giroux, MD Sandra Hand, MD Nate Hitzeman, MD Albert Kahane, MD Robert LaPerriere, MD

MS III George Meyer, MD Steven Nemcek, MS II John Ostrich, MD Gerald Rogan, MD Glennah Trochet, MD Lee Welter, MD Jon Yan Zhou, MD

Executive Director Managing Editor Webmaster Graphic Design

Aileen Wetzel Nan Nichols Crussell Melissa Darling Planet Kelly

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Sierra Sacramento Valley Medicine, the official journal of the Sierra Sacramento Valley Medical Society, is a forum for discussion and debate of news, official policy and diverse opinions about professional practice issues and ideas, as well as information about members’ personal interests. Advertising rates and information sent upon request. Acceptance of advertising in Sierra Sacramento Valley Medicine in no way constitutes approval or endorsement by the Sierra Sacramento Valley Medical Society of products or services advertised. Sierra Sacramento Valley Medicine and the Sierra Sacramento Valley Medical Society reserve the right to reject any advertising. Opinions expressed by authors are their own, and not necessarily those of Sierra Sacramento Valley Medicine or the Sierra Sacramento Valley Medical Society. Sierra Sacramento Valley Medicine reserves the right to edit all contributions for clarity and length, as well as to reject any material submitted. Not responsible for unsolicited manuscripts. ©2017 Sierra Sacramento Valley Medical Society SIERRA SACRAMENTO VALLEY MEDICINE (ISSN 0886 2826) is published bi-monthly by the Sierra Sacramento Valley Medical Society, 5380 Elvas Ave., Sacramento, CA 95819. Subscriptions are $26.00 per year. Periodicals postage paid at Sacramento, CA and additional mailing offices. Correspondence should be addressed to Sierra Sacramento Valley Medicine, 5380 Elvas Ave., Sacramento, CA 95819-2396. Telephone (916) 452-2671. Postmaster: Send address changes to Sierra Sacramento Valley Medicine, 5380 Elvas Ave., Sacramento, CA 95819-2396.

Sierra Sacramento Valley Medicine


PRESIDENT’S MESSAGE

Reclaiming the Joy of Medicine Rediscover Your Lost Medical School Enthusiasm With Good Habits

By Ruenell Adams Jacobs, MD SINCE JOINING THE SSVMS Board in 2014, I have enjoyed representing this region through political advocacy, serving on the Scholarship & Awards and the Public and Environmental Health Committees and working with my fellow Board members, as well as our wonderful SSVMS Executive Director and staff to develop a mission statement and vision for our organization going forward. I am very excited about the new Joy of Medicine program slated to begin this year. When the Joy of Medicine program was presented at the SSVMS Board meeting in early December, the response by Board members and guests was overwhelmingly positive. We all recognize the need for interventions, not only to address and alleviate burnout, but also to provide physicians with various interventions that can help prevent burnout. A comment by one of our Board members particularly resonated with me. He thought it might be hard for some of us seasoned physicians to change our ways. He wanted to make the case for focusing more on early intervention with medical students and physicians in training so that, hopefully, they can cope better with the challenges and complexities of medicine without the adverse consequence of burnout. He had a point. Conventional wisdom suggests that good habits started early on are easier to maintain. However, many of us developed routines and strategies years ago

that were effective in getting us through the challenges of medical school and post graduate training programs. This may have involved some good life balance habits such as exercise, but mostly this involved putting in long hours, sometimes going without adequate sleep and often times putting others’ needs ahead of our own. But those long hours were spent mostly doing what we love about providing patient care; alleviating pain and suffering, promoting wellness, and curing illnesses, among other things. As the health care delivery systems continue to evolve, however, many of those same strategies we used before now have diminishing returns. The long hours and sleep deprivation are often not spent on patient care, but on record keeping. There are many physicians in this region who have made addressing physician burnout a goal of theirs through their respective organizations, and have worked at developing great work life balances for themselves and others. They are excited at the opportunity to join together with SSVMS in this endeavor, as am I. So, I invite you all to participate, regardless of where you are in your careers. Looking forward to seeing you there. adamsr78@comcast.net

March/April 2017

Comments or letters, which may be published in a future issue, should be sent to the author’s email or to e.LetterSSV Medicine@gmail. com.

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EXECUTIVE DIRECTOR’S MESSAGE

#SSVMSCares By Aileen Wetzel, Executive Director

Comments or letters, which may be published in a future issue, should be sent to the author’s email or to e.LetterSSV Medicine@gmail. com.

IN THIS ISSUE OF SSV Medicine, you will find the Medical Society’s first Annual Report, which highlights some of SSVMS’ accomplishments this past year. The mission of the Sierra Sacramento Valley Medical Society is to bring together physicians from all modes of practice to promote the art and science of quality medical care and to enhance the physical and mental health of our entire community. In 2016, we saw an unprecedented growth in membership to over 3,500 members in the three-county region we serve, El Dorado, Sacramento and Yolo. Through our 44-member Delegation to the California Medical Association’s House of Delegates, we contributed to the shaping of health care as we advocated for physicians and the patients we serve at the local, state and national level. We successfully passed legislation and sponsored ballot initiatives that, among other things, protect patients by allowing only trained physicians to perform certain medical procedures, decreased the number of children hooked on tobacco, provided additional funding for Graduate Medical Education and increased provider rates in the Medi-Cal Program. In the area of mental health advocacy, SSVMS’ Emergency Care Committee pioneered the SMART Medical Clearance Form to promote standardized and expedited medical clearance, when appropriate, for patients experiencing a mental health crisis. This evidenced-based and peer-vetted form is being used throughout the region and nation to ensure that patients receive the right treatment at the right time. Our SPIRIT Program, a collaboration between SSVMS, the region’s health systems and the County of Sacramento, works together with partner physicians, who donate their time and expertise, to provide uninsured and medically-

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indigent members of our community the care that helps them lead healthier, more productive lives. This year the SPIRIT Program volunteers have donated 3,100 hours, performed over 40 surgeries, and treated over 3,900 patients accounting for over $500,000 in donated services. In 2016, the SSVMS Medical Student Scholarship Fund granted $12,000 in scholarship grants to deserving medical school students who graduated from a high school in El Dorado, Sacramento or Yolo Counties. Our Museum of Medical History, located at the Medical Society’s building, welcomed over 1,500 visitors and provided tours to over 35 schools and community groups. To our physician members, thank you for helping SSVMS change lives. Not a member? Contact me personally to join one of the fastest growing medical societies in the nation. #SSVMSCares awetzel@ssvms.org

Looking for a Few Good Docs Missed your calling as a writer? Are you an aspiring poet or photographer? Read an interesting book lately? The SSVMS Editorial Committee is looking for colleagues interested in sharing thoughts and experiences. Join an eclectic group of colleagues for lively discussion and content development for SSV Medicine. The Editorial Committee meets the second Thursday of the month during lunch. Call-in available. To submit an article, or to find out more about getting involved, contact SSVMS at info@ssvms.org or call 916-452-2671.


GUEST EDITORIAL

The “Good Old Days” By Gerald Rogan, MD Guest Editorials are welcome, as are comments regarding the editorials themselves. MANY FOLKS ARE speculating about how our government-sponsored health care insurance, including the ACA (Obamacare), will change under the Trump administration – so a review of how we arrived at Medicare today may be instructive. Once upon a time in an administration long ago, Medicare became law. Suddenly lots of folks over 65 years of age gained federal payment for their reasonable and necessary care for illness or injury. The average life expectancy was 67. With lots of federal money available, and Medicare support for graduate medical education, specialties proliferated, hospitals created ICUs, infectious diseases became controlled, and some cancers were cured, while others became chronic diseases. Heart disease was a big killer. By 1975, we had cardiac cath labs, paramedics, advanced cardiac life support, CCUs, pacemakers, many more cardiac drugs, and statin drugs for prevention. COPD decreased as folks quit smoking. During these times, Medicare paid usual and customary charges. Hospitals were paid according to their relatively unconstrained costs. Inefficiency was tolerated. High technology services proliferated. Fee-for-service hospitals competed for patients refusing to share resources. Capital infrastructures were needlessly duplicated despite certificate of need legislation. We developed trauma units, CT scans, MRI, PET and focused radiotherapy for cancer. The Medicare candle burned at both ends; it was such a lovely sight, death was delayed for many folks, but the cost became a fight. The Sustainable Growth Rate (SGR) was

enacted. The amount of payment gradually grew. Diagnostics became the reflex mode, but few patients cared or knew. Marginal services proliferated. Providers called them “gimmicks.” To earn extra income from guaranteed payment, there seemed to be no limit. Billing companies marketed coding skill to “maximize reimbursement.” Thanks to Medi-Gap insurance and MediCal for the dual-eligibles, most Medicare patients paid nothing extra for care. Copayments and deductibles only applied to those who could not afford Medi-Gap and were not eligible for Medicaid − about 20 percent of beneficiaries. These were the “good old days.” In response, a “stark” federal reality constrained referrals. Congresswoman Jackie Speier quickly championed the same constraints under new California laws. Physicians (including me) were forced to divest of their (previously) legal, lucrative, inter-practice joint ventures, such as MRI, CT, Lab, and Mammography, designed to capture profits from excessive fees. Only surgery centers remained available for passive investments. Some larger fee-for-service group practices brought diagnostics “in office” to increase passive income. The new financial watchword was “in-office referral exemption.” During the 1980s, payment by diagnostic related groups (DRG) forced hospitals to become more efficient (Medi-Cal was about 25 years behind Medicare). Medicare B physician fees were set by a “relative value” formula developed by a Harvard professor. But the docs remained in charge of determining the relative value of each service, assuring higher reimbursement for procedures compared to thinking. Primary care became the lowest paid specialty in a sea of highly-paid physicians compared to other developed countries. March/April 2017

Comments or letters, which may be published in a future issue, should be sent to the author’s email or to e.LetterSSV Medicine@gmail. com.

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As federal payouts escalated faster than inflation or GDP, Medicare focused on overpayments. The correct coding initiative (CCI) bundled some services and denied others, saving billions of dollars. Medicare administrators sifted through claims data to discover overuse indicators. Computer edits were placed to track multiple claims for the same patient over time. Code modifiers flourished. Follow-up visits for surgery became bundled into one all-inclusive fee. Multiple procedure discounts evolved. Post-payment review became “heavy handed.” Our CMA convinced CMS (the Centers for Medicare & Medicaid Services) to develop a less burdensome process called “Progressive Corrective Action.” Managed care, called Medicare C, now Medicare Advantage, started to replace fee-for-service, growing to 30 percent of beneficiaries with no limit in sight. Organized crime found ways to collaborate with a few naïve docs in order to steal Medicare money, such as by paying beneficiaries (particularly dual eligibiles) to appear sick and receive non-invasive tests, such as sonograms. Beneficiaries were not punished. The Office of Inspector General (OIG) showed up after the crooks disappeared. Some criminals found ways to steal a doc’s identity, bill for fake patients, and then disappear back to some foreign country. Medicare’s watchword was “trust but verify.” Verification typically was too late. Up to 7 percent of the Medicare B budget was stolen, which contributed to the threat of significant reduction of fees across the board (except for physician administered drugs) under the SGR calculation. Medicare was a success. Patients now live 10-17 years longer, on average. However, because services rose faster than warranted by medical advances and aging, the SGR deficit threatened to cut the payment rate by 20 percent. In 2003, payment for physician-administered drugs changed. Oncologists (happily) were paid more fairly for their services, not for the profit from drugs. Medicare D was enacted subject to some market controls, but not with

fee controls which physicians must accept. In this decade, to better finance Medicare’s success, Medicare B premiums became tied to income (earned and unearned) with five tiers of part B premium payment − from $121.80 to $389.80 per month. The Medicare tax was applied to all earned income. “Unearned” income, including tax-free bond income, became subject to a Medicare tax. Nonetheless, Medicare’s success in extending average life expectancy continues to compel a shift income from the worker to the retiree, from the poor to the rich, but less so than before. In the “good old days,” Medicare paid for performance. The worse the performance, the more Medicare paid (i.e. for care of complications). MACRA (Medicare Access and CHIP Reauthorization Act of 2015) was enacted with bipartisan support to eliminate the SGR. In exchange, docs agreed to obligate themselves to become financially penalized for suboptimal quality. Hospital payment is cut when an unstable patient is discharged and returns or develops a hospital-acquired complication. CMS is trying to figure out how to measure quality and illness burden, and physicians are needed to help. In the “good old days” Medicare was a major socialistic initiative, just like Social Security. This part has not changed. In the ”good old days,” there was a lot more money to spread around over fewer beneficiaries. Now we have aging baby boomers, expanded Medicare benefits (preventive exams and tests, obesity as a disease, destructive lifestyle counseling), supported by fewer workers per retiree, a huge national debt, two wars, and a federal deficit each year. Will the Medicare taxes change? Will the ACA be repealed and replaced? Will Medicare be affected? Will the Republicans repeal and repent? I predict the ACA will be modified just as Medicare has been modified for decades, and most recently by MACRA. The Republicans will claim the modification is a replacement so they do not lose face. To “Make America Great Again,” we are all in this together, more than in the “good old days.” jerryroganmd@sbcglobal.net

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Open Letter to Congress By Medical Student Leadership, UC Davis EDITOR’S NOTE: This letter was the local version of a national petition signed by more than 4,000 medical students and health professions students across the country. 207 UC Davis signatures were on the letter, including physicians, residents and students. The #ProtectOurPatients petition was delivered to members of Congress on January 9, representing nearly all of the accredited medical schools in the U.S. The views expressed may not necessarily reflect the position of the Editorial Committee, or the SSVMS Board of Directors.

To Members of the U.S. Congress:

Comments or letters, which may be published in a future issue, should be sent to the author’s email or to e.LetterSSV Medicine@gmail. com.

We, the undersigned health care providers, are deeply concerned that the prioritized repeal of the Affordable Care Act (ACA) will result in 30 million people losing health insurance coverage across the country, including 3.8 million people in California. As a nation, we continue to remain the only industrialized democracy that does not guarantee decent, affordable health care to all of our people. We urge our lawmakers in the U.S. Congress to reject any legislation that would threaten or reduce health insurance coverage or health access for Americans. Impact in California: Repealing the ACA may result in the loss of health insurance to 3.8 million Californians who have gained coverage through the ACA. With the loss of federal funding, we have no current alternative to sustain the access to care that was created by the ACA. In addition, a repeal would deny hundreds of thousands of California senior citizens savings on important medications, as each senior insured by the ACA saved over $1,000 in prescription benefits in 2015. National Impact: Repealing the ACA will cause immeasurable harm to the 30 million

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people nationwide who will lose their health insurance. Especially frightening, millions of children nationally have gained coverage since 2014; if the ACA is repealed, many of these children will also lose coverage. Between 2010 and 2014, 3.6 million fewer Americans with pre-existing conditions went uninsured. Even if the ACA is replaced, the health insurance market will be severely destabilized, compromising health care for all Americans. We strongly urge Congress to keep the ACA intact, particularly the following provisions: 1. Bar insurance companies from discriminating against patients with pre-existing conditions or from setting yearly or lifetime caps on insurance benefits. 2. Keep the individual mandate requiring most Americans to obtain and maintain health insurance, which is critical to making point #1 possible. 3. Maintain the health insurance marketplaces, which promote free market competition and allow individuals and small businesses to access health insurance. 4. Continue subsidizing the cost of health insurance, making coverage more affordable for all Americans. 5. Maintain the expanded threshold of Medicaid coverage, and continue the federal commitment to match state Medicaid expenses. These are our most vulnerable patients. 6. Maintain the requirement that insurers cover “essential health benefits,” in order to guarantee quality health insurance plans. We make this statement in solidarity with #ProtectOurPatients, a national movement of medical and health professional students standing for access to healthcare for all Americans.


As medical professionals, we take an oath to “do no harm.” In keeping with this commitment, we advocate to keep our country’s most vulnerable populations insured and urge the U.S. Congress to oppose repeal of the ACA. We sign this document as concerned individuals. This is not a statement by the UC Davis Health System or the University of California and does not represent their views as not-for-profit, publiclyfunded entities.

Massachusetts statement is typical: “Each year, Planned Parenthood health centers provide nearly 400,000 cervical cancer screenings and nearly 500,000 breast exams. Additionally, Planned Parenthood provides over 2.1 million contraceptive services and nearly 4.5 million tests and treatments for sexually transmitted infections, including HIV. These services improve women’s health, prevent an estimated 516,000 unintended pregnancies, and decrease infant mortality...

Local Contacts: Nancy Rodriguez, MD Candidate, UC Davis School of Medicine (2019), nybrodriguez@ ucdavis.edu

...federal law already requires

Nhi Tran, MD Candidate, UC Davis School of Medicine (2018), nht772@mail.harvard.edu

funds are used for abortion...

Ian Kim, MD Candidate, UC Davis School of Medicine (2017), iankim@ucdavis.edu

“Approximately 60 percent of Planned Parenthood patients access care through Medicaid and Title X, in addition to those who rely on other essential programs, including maternal and child health programs and Centers for Disease and Prevention (CDC) breast and cervical cancer screening programs... federal law already requires health care providers to demonstrate that no federal funds are used for abortion...” They and the MN/ND/SD society “strongly oppose any effort to prevent Planned Parenthood health centers from participating in federal health programs, including Medicaid and the Title X family planning program... At a time when we should be focused on improving the health of all people, it is frustrating to witness ongoing attempts to cut off access to life-saving preventive care.” Though it may exist, I couldn’t find an ACOG policy statement concerning the juxtaposition of losing both the ACA and Planned Parenthood funding. Logic dictates that repealing the ACA in the absence of a back-up source of affordable care would not be good for women’s health.

Umer Waris, MD Candidate, UC Davis School of Medicine (2019), muwaris@ucdavis.edu

Addendum: Women’s Health Care on the Chopping Block By Ann Gerhardt, MD About 20 million people stand to lose health insurance with the demise of the Affordable Care Act. The new administration seems bent on defunding Planned Parenthood also. This double whammy to women’s health care has gynecologists very worried. OB/GYN friends have told me that many of their patients received their preventive gynecological care at Planned Parenthood clinics prior to acquiring ACA insurance. If both sources of health care coverage disappear, non-rich, non-insured women will have no access to affordable care. The American Congress of Obstetricians and Gynecologists (ACOG), and numerous state ACOG societies, have strong policy statements opposing Planned Parenthood defunding. The

health care providers to demonstrate that no federal

algerhardt@sbcglobal.net

March/April 2017

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CMA Federal Update Health Care Reform and MACRA

By Elizabeth McNeil, VP, Federal Government Relations

Comments or letters, which may be published in a future issue, should be sent to the author’s email or to e.LetterSSV Medicine@gmail. com.

WITH THE ELECTION OF Donald Trump to the U.S. Presidency, and Republicans in control of both the U.S. House of Representatives and Senate, Republican leaders are moving swiftly to fulfill a cornerstone campaign promise to repeal the Affordable Care Act (ACA). On January 13, the House followed the Senate in passing a non-binding budget resolution (S.Con.Res.3) that sets 2017 spending targets and provides instructions to the Congressional Policy Committees to: 1) Develop a majority-vote Budget Reconciliation bill that repeals the ACA by late February; 2) Achieve savings from the ACA repeal legislation; and 3) Develop an ACA replacement plan. The budget reconciliation bill would repeal the ACA, but it would not take effect for two to three years while Congress works on a replacement plan. It is unclear the potential health care reform legislation that will replace the ACA, but none of the proposals provide as much coverage as the ACA. Instead, the proposals only repeal the ACA insurance provisions, individual mandate and Medicaid expansion for low-income adults. They replace the ACA with a private, voluntary health insurance marketplace where insurers may sell insurance across state lines. It is unclear how the individual market would successfully operate. Some bills allow states to establish high-risk pools and expand Health Savings Accounts. Most provide tax credits, and some provide subsidies to help low-income families afford coverage. Several bills allow individuals to deduct the cost of health insurance premiums while eliminating such deductions for employer-sponsored coverage. Most bills repeal the ACA insurance

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reforms, such as the requirements for insurers to dedicate 85 percent of revenues to patient care and to provide coverage to those with pre-existing conditions. All of the bills eliminate the Medicaid expansion and cap federal funding for Medicaid, either through block grants or per capita cap funding in exchange for greater state flexibility. Speaker Ryan’s bill replaces the Medicare-defined benefit program with Medicare premium support that provides vouchers to seniors to purchase private health insurance coverage. And finally, several proposals include MICRA-like medical liability reform. CMA is actively involved in shaping the future of health care reform at the national level and has extensive policy on health care reform issues. Based on that policy, CMA’s overriding goal will be to ensure that Californians who have coverage today do not lose coverage or access to care. An underfunded health care system places unsustainable burdens and unfunded mandates on physicians. It also creates access to care problems, health care delays and economic hardship for patients. CMA will be a voice for patient choice in the new health care system. CMA physicians are committed to the health and well being of our patients. And finally, CMA will fight to maintain the hard-fought insurance reforms that require insurers to dedicate 85 percent of their revenues to direct medical care, community rate and submit premium increases to regulators, as well as prohibit insurers from placing lifetime or annual limits on benefits, blocking coverage for pre-existing conditions or rescinding coverage when a patient becomes ill. CMA has fought health plan mergers over the years to promote


an open, competitive health care marketplace in California. CMA also recognizes that the ACA has serious shortcomings that need to be addressed. More than one in three Californians are now enrolled in the state’s Medi-Cal program, yet few have true access to a doctor. Because the Medi-Cal reimbursement rates are among the lowest in the nation, most physicians cannot afford to participate. Moreover, the payment rates and physician networks in the Covered California Exchange are inadequate, and many families continue to express concerns about the affordability of insurance in the Exchanges. The individual market needs more stability, and while the ACA significantly expanded coverage, it did not expand access to care for many Californians. CMA has developed overarching health care reform principles to guide CMA’s advocacy through the debate. CMA’s overriding goal is to ensure that Californians maintain access to quality, meaningful, affordable coverage. emcneil@cmanet.org

CMA’s Core Priorities for the Future of Federal Health Care Reform 1. Ensure Californians do not lose coverage or access to care.

6. Maintain the important insurance reforms that protect physicians and their patients, such as coverage for pre-existing conditions.

2. Improve access to care. 7. Stabilize the individual insurance market. 3. Protect state and federal health care funding for Californians. Support appropriate and broadbased health care financing. 4. Continue tax policies and subsidies that help low-moderate income patients afford coverage.

8. Provide access to affordable prescription drugs. 9. Medical liability reform that does not undermine California’s MICRA law.

5. Advocate for broad patient choice of physicians, plans and coverage through Health Savings Accounts, private contracting, private insurers and health plans, as well as government programs.

March/April 2017

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Over 50 Years in Medicine A Local Doctor Looks Back from 1922

By Robert Rooney, MD, Abridged by Bob LaPerriere, MD THE FOLLOWING IS A slightly abridged version of an article written in 1922 and published in the California State Journal of Medicine, Vol. XX, No. 10 by Robert F. Rooney, MD, of Auburn California. Dr. Rooney was born June 17, 1842 in Quebec, Canada. He came to Placer County in 1877 and first settled in Colfax. In 1880, he came to Auburn and practiced medicine with Dr. T. M. Todd. He founded the Placer County Medical Society and, at the age of 90, he wrote the first medical history of the area. Rooney was Auburn’s second mayor, and served as Placer County coroner and public administrator. He died Dec. 31, 1931.

Comments or letters, which may be published in a future issue, should be sent to the author’s email or to e.LetterSSV Medicine@gmail. com.

In June, 1866, I entered upon the study of medicine in a small town in the Province of Lower Canada, now the Province of Quebec. There I imbibed my anatomy and physiology in the intervals afforded between the compounding of mixtures, the rolling of pills, and the mixing and folding of powders. I believe such training to be good for a young man, and makes him better able to handle his own patients, rather than the student who enters college without such experi­ence. Shortly after entering the office of my preceptors, one of them took me to visit a hopeless case. The patient was a young Scotchman who had just arrived at the local hotel with his wife, whom he had married before leaving the old country, and who knew no word excepting Gaelic. He came with a few pounds in cash, intending to buy a farm and become a settler. He was almost at once stricken with what was, no doubt, an attack of appendicitis, in the face of which the profession then stood helpless, calling it “periton­itis” and

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keeping the unfortunate under the influ­ence of opium until death closed the tragedy. The scene at the bedside has haunted me throughout the years. The man lay gasping out the last of his life, and his young wife knelt by the bedside with her arms outflung across his body, and her face buried therein, crying out in the rhythmical cadence the Gaelic words, “Hamish sorg ma Dheelish!” It was the despairing cry of a broken heart in a new world, without friends, and even without knowledge of the language spoken around her. Often, later in life, when the abdominal cavity had ceased to be sacro-sanct, those mournful sounds came back to me, as a reminder that this poor fellow’s young life might have been saved by a comparatively trifling operation In the autumn, I entered the medical depart­ ment of McGill University. It was the year that a four-year course was first adopted. Only two other colleges on the continent demanded a four-year course. I gradu­ated and received my M. D., C. M., on March 31, 1870 and began practice in a neighboring town until 1877, when the glamor of California overwhelmed me and I came west. The years of my medical life have been epochal. They compass the great majority of the wonderful discoveries of medicine and surgery. Also it has been prolific in fads and cults. At the outset of my career, Virchow had just promulgated his cell theory which revolutionized medicine; and Lister had revolutionized surgery with his antiseptic teachings and practice. Where thou­sands formerly died, thousands now recover, due to the labors of this one man. In my graduation year died Dr. James Y. Simp­ son, with whose name chloroform is


carved on the pillars of medical progress, and to the introduc­tion of this agent into obstetrics, relief to woman’s pangs is due. Although McDowell, an humble country doc­ tor, performed successfully and almost unaided and alone, the operation of ovariotomy in 1809, no one had the courage to follow in his footsteps until into the ’70’s, when Sims made the abdominal cavity an open road to surgery. But it was some years before the surgeons, in the absence of soluble ligatures, ceased to clamp the stumps of the removed tumors outside the abdo­men. The discovery of absorbable ligatures, and aseptic silk and other material, gradually did away with danger. I might here add that to Lawson Tait of England, we are greatly indebted for his teaching of asepsis, instead of antisepsis. Then one brilliant discovery after another came within the compass of my medical life. Charles Louis Laveran, an obscure regimental surgeon in the French Army, buried in the lonely sands of Africa, found the plasmodium malariae in the blood of malarial victims. For this he was hooted at, and belittled by the medical big-wigs of Paris, but “Truth is mighty and must prevail,” and very soon his discovery was verified throughout the scientific world. Then came Robert Koch, another obscure man, who demonstrated the whole life history of the TB, and so thorough was he, that he said prac­tically the last word concerning it to this day. He also demonstrated the cholera spirillum, and he, too, was ridiculed by the “know-it-alls,” and Pettinkoffer, a celebrated German scientist, said he would undertake to swallow, and did swallow, a tube of cholera germs to prove the falsity of Koch’s claims, and thereby nearly lost his life. After his recovery he was magnanimous enough to acknowl­edge Koch’s discoveries, and to give him full honor therefor. In 1885 Pasteur, one of the most brilliant men that ever lived, a chemist and not a physician, did the greatest thing for medicine that the nineteenth century witnessed. He demonstrated the immuniz­ ing treatment for rabies and inaugurated serum-therapy. By the discovery of cells and germs, the micro­ scope came into its own as an instrument of real

scientific value. The stethoscope was just coming into general use, and I well remember my first one, used in my student days. It was turned out of one piece of cedar and about six inches long. Also I remember the first clinical thermometer used in the Montreal General Hospital. It was about sixteen inches long, fastened to a scale, with the end containing the mercury bent at a sharp angle so that it lay snugly in the axilla while the body of the instrument lay upon the breast of the recumbent patient. It was truly a fearful and wondrous instrument. Later in my time, instru­ments of precision came to aid the clinician — the sphygmograph, the sphygmomanometer, the count­ing chamber, the hematocrit, the hemaglobinometer and many lesser aids to medical science. In the ’90’s came the era of the wombslitters, made possible by the perfection of the speculum. There was a time when every doctor owning one of these instruments was slitting the cervix uteri for all female troubles. These were followed by the menders—with much language. Dr. Robert Rooney of Auburn, CA

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Dr. Robert Rooney. Photos courtesy of the Placer County Museum.

Next came one of the most important aids to the modern surgeon — the Roentgen Ray — or so- called X-Ray, discovered by Wilhelm Konrad Roentgen in 1895, which bares men’s inner secrets. Radium followed in its footsteps. And so we progress. Next I will speak of the fads and cults in medicine which have sprung up in my time. The Thompsonians, founded by Thompson, of Massa­ chusetts, which afterward developed into the eclec­tic school, was just coming into vogue about the time I became a student. The homeopathists, founded by Hahnemann in Germany, was attaining a hold upon the Ameri­can public at the same time. Next came osteopathy, founded in 1874 by Dr. A. T. Still. Following this in the latter years of the century came Christian Science, evolved from the foolish emanations of the addled brain of a paranoiac. Next comes the natureopath, and then the crowning joke of all — the Chiropractor — who can cure typhoid fever, diphtheria, cancer, gonorrhea, syphilis, or any other old thing, with the chiro­practic thrust. It is to laugh! But, gentlemen, I see a better day coming. The Homeopaths now require almost, if not quite, as thorough a scientific training as the regular pro­fession and are becoming as broad-

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minded as science can make them. The Eclectics are also approaching nearer and nearer to us in their standards, and within another lifetime, like my own, will stand side by side with us. The Osteopaths also are requiring a better education and are demanding a thorough training in anatomy and physiology, especially, and will ultimately blend with us. But the Christian Scientists and the Chiroprac­tors are simply ulcers on medicine and must have their day, until they die out, which they undoubt­edly will in the not too distant future. It costs nothing to become a Christian Science practitioner, and any waiter, farm-hand, laborer, etc., who can command $100 to buy a diploma, can become a Chiropractor. The Serologists and Organotherapists should also be mentioned, as they have both got quite a stand­ ing, both in and out of the profession. Some of these theories have a real value, but most of them prove to be duds. And now we are in the midst of the Endocrinologic craze and the era of Vitamines. The latter class seems proven, although they do not yield their secrets to either the chemist or the microscopist, but they do their work! But the Endocrinologist needs the hobbles of caution put upon his enthusiasm until much more research is made. The giant, the midget, the fat boy and the human skeleton are regarded now as victims to their own glands, and hopes are enter­ tained that these processes can be controlled and the ancient mysteries of disease will be explained, so that what have been considered hopeless cases can be satisfactorily treated. The conditions of the body that control these glands of internal secretion are still almost entirely unknown. As yet only two endocrine products are chemically known — thyroxin and epinephrin. The latter is very potent intraven­ ously, but inert when swallowed. Until we know more about them all, we can not be sure that they are not altered or destroyed in the digestive canal. Therefore, why talk about Hormones? Again, to what degree is substitution therapy possible? Its value has been proved in thyroid deficiency, but it is useless in pancreatic diabetes. The facts should be faced that endocrine


physiology is unproven, despite positive statements to the contrary. Every medical publi­cation vaunts the use of some endocrine fad, even down to gland transplantation. This opens the door for exploitation of the medical profession by charlatans, quacks and unscrupulous manufacturers. Medicine is humiliated by accept­ing, as gospel, every claim made with sufficient positiveness. However, I do not wish to condemn endocrin­ ology, nor to lessen the just claims that it has earned, but I do ask you for a

proper scientific attitude toward the data that are advanced. And now I have gone over my fifty-odd years in general practice, necessarily omitting many dis­ coveries that have come to the saving of human life and well-being, during that period, and trying to keep down my own personality, but I can say with Virgil’s hero, “Pars fuit erat.” Believing that our work is all the better for a little play, I will conclude with something in a lighter vein. I will give you a few verses written by myself on…

THE OLD PRACTITIONER The old Doctor’s getting older every year. We watch his failing powers, year by year. His step is growing slower; His head is bowing lower. And we note his lessening vigor, year by year. His eyes are growing dimmer, year by year. His legs are getting slimmer, year by year. He has a tremble in his voice, And his breath it makes more noise. As he toddles down life’s pathway, year by year. His teeth are dropping out, year by year. His false ones rattle about, year by year. He mumbles at his food, His digestion is not good, And dyspepsia grips him harder, every year. If you think he is down and whining, owing to years, You’ve got another think a-coming, for this year. For he’s just as good at poker, And the same old jolly joker; He’s a fighter from away back, through the years. His mind is, maybe, duller, year by year. But his experience is fuller, every year. In his finger-end’s an eye, That your inner ills can spy, And he makes better diagnoses, every year.

When the young men make their blunders, all the years. The old cock stands by and wonders, year by year. At the things they think they know, That so surely are not so, And knows that they’ll grow wiser with each year. So he’s growing old and older, every year. He sees his finish nearer, every year. Gray hairs are getting thicker, Has less capacity for licker, And he’s worse and worse a kicker, every year. In his every fault we love him, through the years. There are none that rank above him, in the years. Soon the Lord will call upon him, With his good and bad traits on him, And he’ll go to join his fathers for all the years. — Robert F. Rooney, MD

The original paper can be seen on pages 354-356 at http://bit.ly/2jN7ZTE. ssvmsedcom@gmail.com

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Sierra Sacramento Valley Medical Society 2017 Committee Appointments Editorial Drs. Sean Deane, Adam Dougherty, Ann Gerhardt, Caroline Giroux, Sandra Hand, Nate Hitzeman, Albert Kahane, Robert LaPerriere, George Meyer, John Ostrich, Gerald Rogan, Glennah Trochet, Lee Welter, Jon Yan Zhou; Medical Students, John Paul Aboubechara, MS III (UCD), Steven Nemeck, MS II (CNSU), and Nan Crussell, Managing Editor.

Emergency Care Drs. Peter Hull, Chair; Seth Thomas, Vice Chair; Nicole Braxley, Matthew Donnelly, Troy Falck, Roel Farrales, Hernando Garzon, Kendrick Johnson, Vinh Le, Alexis Lieser, Maurice Makram, Devin Merchant, Joseph Morris, Karen Murrell, Jeff Rogerson, Dwight Stalker, R. Steve Tharratt, Sam Turnipseed, Justin Wagner, William Webster, Lee Welter, David Wisner, and Rodolpho Zaragoza.

Collins, Anthony DeRiggi, Ann Gerhardt, Maya Heinert, Maynard Johnston, Samira Kirmiz, Olivia Kasirye, Donald Lyman, Stephen McCurdy, Robert Meagher, Dennis Michel, Robert Midgley, Paul Phinney, Richard Sun, Nancy Williams, Jon Yan Zhou.

Scholarship and Awards Drs. Margaret Parsons, Chair; Ruenell Adams Jacobs, Sean Deane, Kristina Ishihara, Paul Kaplan, Paul Kelly, Samira Kirmiz, George Meyer, Travis Miller, Susan Murin, Jack Ostrich, Mary Pauly, Patricia Samuelson, James Sehr.

Wellness Committee Drs. Michael Parr, Lee Snook, and Captane Thomson.

Tracy Zweig Associates INC.

Historical Drs. Robert LaPerriere, Chair; Richard Astorino, Peter Carruth, Malcolm Ettin, Francine Gallawa, James Hamill, Julian Holt, Donald Hopkins, Rosalind Kirnon, Elisabeth Mathew, Jack Ostrich, Gail Pirie, and James Rybka; Kent Perryman, Ph.D (guest).

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REGISTRY

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PLACEMENT

FIRM

Physicians Nurse Practitioners ~ Physician Assistants

Judicial − Reappointments Drs. José Arévalo, Jose Cueto, Shahid Manzoor, James Sehr.

Public and Environmental Health

Locum Tenens ~ Permanent Placement

Drs. Glennah Trochet, Chair; Ruenell Adams Jacobs, Regan Asher, Ronald Chapman, Clinton

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V oi c e : 8 0 0 - 9 1 9 - 9 1 4 1 o r 8 0 5 - 6 4 1 - 9 1 4 1 FA X : 8 0 5 - 6 4 1 - 9 1 4 3

tzweig@tracyzweig.com w w w. t r a c y z w e i g . c o m


ANNUAL MEETING

Annual Meeting THE 2017 SIERRA SACRAMENTO Valley Medical Society and Alliance Annual Awards and Installation Dinner was held January 19, 2017 at the Hyatt Regency Hotel in Sacramento. Ruenell Adams Jacobs, MD, Family Practitioner with Sutter Medical Group, was installed as the 143rd President of SSVMS. Also installed were the following SSVMS 2017 Officers and Board of Directors: Rajiv Misquitta, MD, President-Elect; Sean Deane, MD; Vijay Khatri, MD; Carol Kimball, MD; Alexis Lieser, MD; Tom Ormiston, MD, Immediate Past President; Paul Reynolds, MD; Christian Serdahl, MD; Seth Thomas, MD; Sadha Tivakaran, MD; Thomas Valdez, MD; John Wiesenfarth, MD; Eric Williams, MD. The Society’s highest honor, the Golden Stethoscope Award, was presented to Gordon A. Wong, MD, a pulmonary medicine/infectious disease specialist. Dr. Wong received the award for his devotion to patient care and the medical needs of the community. The Medical Honor Award was presented to Tim W. Grennan, MD, in recognition of his outstanding achievements as a physician, medical educator and researcher in the advancement of cancer treatment. The Medical Community Service Award was given to the La Familia Counseling Center for its work with the uninsured multicultural population in our region by providing community-based, appropriate services and programs to low income, at-risk youth and families in Sacramento County.

A Special Recognition Award was presented to Retinal Consultants Medical Group for the group’s outstanding contributions to the SPIRIT Program and commitment to providing medical care to all patients. SSVMS retired member, Dr. Irma West, who recently celebrated her 99th Birthday, was recognized for her long life of contributions to the field of medicine and its history. The Alliance presented its highest honor, the Dorothy Dozier Helping Hands Award, to Patty Roberts for devoting her time, energy and talents to the Alliance and community. Guests at the event were entertained with traditional jazz music by Cyr’s Combo, a group of young musicians from the Sacramento area who play regularly throughout California.

March/April 2017

L-R Tom Ormiston, MD, Outgoing President, Ruenell Adams Jacobs, MD, 2017 President, Rajiv Misquitta, MD, 2017 PresidentElect.

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ANNUAL MEETING

Sierra Sacramento Valley Medical Society and Alliance Annual Dinner, January 19, 2017, Hyatt Regency Hotel Photos by David Flatter (flickr.com/davidflatter)

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ANNUAL MEETING

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2017 SSVMS Board Members Present at the Event include, L-R Drs. Tom Valdez, Tom Ormiston, Chris Serdahl, Carol Kimball, Sean Deane, Ruenell Adams Jacobs, Paul Reynolds, Rajiv Misquitta and Eric Williams. Cyr’s Combo

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L-R Alliance Past President, Gabrielle Neubuerger and Patty Roberts, 2017 Dorothy Dozier Helping Hands Recipient.

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L-R Mary Sterner-Sosa, Alliance President, Gabrielle Neubuerger, Drs. Senator Richard Pan, Clifford Marr and Gustavo Sosa.

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L-R George Meyer, MD, Tim Grennan, MD, recipient of the Medical Honor Award, Margaret Parsons, MD, Chair Awards Committee and President, Ruenell Adams Jacobs, MD.

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Medical Student Nadija Rieser and CMA President, Ruth Haskins, MD.

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Medical Students from California Northstate University College of Medicine with Dean Joe Silva, MD and Dr. Alvin Cheung.

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L-R Tony Tsai, MD accepting a Special Recognition Award on behalf of Retinal Consultants Medical Group from L-R Margaret Parsons, MD and Ruenell Adams Jacobs, MD.

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Incoming President, Ruenell Adams Jacobs, MD congratulates Gordon Wong, MD recipient of the Golden Stethoscope Award.

10 Medical Community Service Award recipients, La Familia Counseling Center with Dr. Ruenell Adams Jacobs and CSERF SPIRIT staff. 11 Dr. Irma West, 99 Years Old, was acknowledged for her long life of contributions to medicine and its history.

March/April 2017

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Flying Samaritans – a Family Avocation By George Meyer, MD EDITOR’S NOTE: Details of the Flying Samaritans program in this article were obtained from their website, www.flyingsamaritans.net. THE FLYING SAMARITANS, a volunteer non-sectarian organization of physicians, dentists, nurses, translators, and pilots, provides medical assistance and education to the people in rural areas of the Mexican State of Baja California. I became interested in Flying Samaritans in 2000 after reading about the loss of three volunteers in a plane crash. My wife, Lynn, an RN, and I traveled several times to San Quintin in Baja, but stopped until recently when our son, Robert, a commercial pilot and flight instructor, and his daughter Emily, a high school senior who is bilingual in Spanish and English, showed interest in the effort.

History of the Sams According to the group’s website, the original volunteer medical team began on November 16, 1961. A group of people from San Diego were flying from La Paz, Baja California. In those days, travel by small plane in Baja was challenging and dangerous. Although the weather was good as the group left La Paz, when they landed about three hours later in Bahia de Los Angeles, they encountered a brisk wind and were told there were strong winds in the greater Los Angeles area. About 45 minutes after taking off from Bahia de Los Angeles, they encountered gusty sandstorms that closed Tijuana and Ensenada airports. The pilot, Aileen Saunders, chose a clearing on the top of a mesa outside the village of El Rosario. Dodging a large pothole, they landed safely just ahead of the dust storm. The

area Fish and Game Warden who knew Aileen and had heard the plane circling the village, drove up to retrieve them. The town’s Mayor permitted them the use of his office. Anita Espinosa, the proprietor of the local general store, who had been educated in a San Diego Mission school, served as interpreter while generously offering the group hot chocolate and apologizing for the accommodations. She told of the local devastation from the drought and the pitiless existence of the people there. She said she would be grateful for any clothing contributions, especially for the children, and she, herself, would see that they were distributed. The people of the village were not only impoverished; they were also not healthy. On the Saturday before Christmas of that year, an armada of single engine planes departed Gillespie Field in San Diego bound for Baja, every one loaded to the top with toys, food, clothing, and good will. Among the volunteers was a doctor who had his medical bag with him. Once in El Rosario, he was mobbed by people needing care. Thus was born the Flying Samaritans, first dubbed the Flying Angels by the people of El Rosario. That first doctor was quickly joined by nurses, dentists, and other health care providers whose services were so desperately needed. In the early days, the trips were made every other week. The government-owned Hospital Civil de El Rosario served as the first clinic site. Although it had been virtually abandoned, the Flying Samaritans and the people of El Rosario, working together, soon had a facility from which the people could be seen and treated. Over the years, the Flying Samaritans grew to

March/April 2017

Comments or letters, which may be published in a future issue, should be sent to the author’s email or to e.LetterSSV Medicine@gmail. com.

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become an international organization which serves 19 clinics, organized in 10 chapters (two in Arizona, seven in California and one in Mexico) with over than 1,500 members. Each clinic is held monthly at various locations in Baja Mexico. One of my own most memorable flights was our first when there were strong Santa Ana winds on our return. Flying to San Diego from San Quintin we hit several areas of turbulence where the plane was all over the sky. In fact, we could predict where the turbulence would occur when we saw white caps in the ocean directly across from valleys where the winds were blowing westward. One of our passengers wore out her Rosary on that segment of the flight, and left us at the Brown County airport near San Diego. She flew back to Sacramento commercially, even though the weather for us north of San Diego back to Sacramento was perfect for flying.

Four Basic Missions The Flying Sams have four basic missions − primary care, specialty care, education and emergency care. In the primary care role, the Sams fly (and drive) to clinics where they provide non-emergency services such as family medicine, optometry, audiology, dentistry, dental hygiene, and preventive health care. The Meyer family on a Flying Samaritan trip to Baja. From left to right are George Meyer, MD, his wife Lynn, granddaughter Emily, and son Robert.

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Most patients are the 60 percent of the Mexican population who do not receive medical care under the Mexican Social Security system. The second mission, specialty care, is a cooperative effort to provide services such as surgery and treatment that requires medical follow up. Specialty care is provided only at locations, such as the Buen Pastor Hospital in San Quintin, where follow-up care is available. Occasionally, patients are brought to the U.S. when care is not available in Mexico. The third mission is to assist in the training of pasantes, medical and dental graduates interested in gaining practical experience and enhancing their skills while working in close cooperation with our providers at the clinics. The Flying Sams work at the invitation of, and with close collaboration with, the Autonomous University of Baja California (UABC). Lastly, to meet medical emergencies, Flying Sam professionals assist with disaster relief and other critical medical needs of their clinic local communities. The Flying Samaritans organization currently has over 1,500 members and is governed by an International Board of Directors with representatives from all 10 chapters. geowmeyer@icloud.com


Emily’s Story By Emily Meyer MY FIRST EXPERIENCE with Flying Samaritans out because there were cases that seemed out was one I will never forget. The trip incorporated of my league (penile lesions don’t exactly fall so many interests of mine that it made up the under my area of expertise). perfect experience. On the trip, I got to use At the end of the day when we all came my Spanish, do some flying, observe medical together at Jardines restaurant − doctors, pilots, practices, and help people. and translators, what stood out to me most The flight down to Mexico was a very was the amount of help such a diverse group interesting component in the trip. I have to say, of people with such different backgrounds was walking back and forth between the customs able to give, and how well we all got along. windows in Mexicali’s airport for nearly an Thank you for letting me be a part of such an hour was a truly unique experience. Once we amazing group! finally arrived in Los Pinos and began our drive to the hotel, I was amazed to see the Emily Meyer (age 18) technological advancements that had reached the farm. From the covered crops to the water filtration system, I was left dumbfounded, especially once we reached the hotel which was the opposite of what I expected. I was pleasantly surprised to find that the hotel was a beautiful beachside oasis! My stay there was perfectly pleasant. As a trusted partner to businesses and families across generations When we arrived at the clinic on since 1919, Baird has seen investors through many market cycles. Saturday, I was really nervous upon And the insight we’ve gained from this experience informs all we do seeing the line of people outside today as we strive to create great outcomes for our clients throughout the clinic. I thought that maybe their financial lives. my years of Spanish wouldn’t be

Expertise you can rely on.

enough to help these people who had lifetimes of Spanish. But after only a few minutes of working with my grandfather, Dr. George Meyer, I stopped needing to think about the words I was going to use and just let it flow. I saw all the doctors, nurses, and translators starting to flow as well. Everyone was working as a welloiled machine, helping people on command, and I felt honored to be a part of the action. However, there were some times when I had to step

Put Baird’s time-tested expertise to work toward your long-term goals. Patty M. Estopinal, CIMA®, CDFA Director Private Wealth Management 916-783-6554 . 877-792-3667 pestopinal@rwbaird.com pattyestopinal.com Investment Management Consultants Association is the owner of the certification mark “CIMA®” and the service marks “Certified Investment Management AnalystSM,” “Investment Management Consultants AssociationSM” and “IMCA®.” Use of CIMA® or Certified Investment Management AnalystSM signifies that the user has successfully completed IMCA’s initial and ongoing credentialing requirements for investment management consultants. ©2016 Robert W. Baird & Co. Incorporated. Member SIPC. MC-48079. Robert W. Baird & Co. does not provide tax or legal advice.

March/April 2017

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India is at the Center of Diabetes Epidemic By Sooraj Tejaswi, MD

Comments or letters, which may be published in a future issue, should be sent to the author’s email or to e.LetterSSV Medicine@gmail. com.

INDIA MADE A SPLASH recently by overtaking its former colonizer Great Britain as the 6th largest world economy. But the impending diabetes epidemic threatens to derail India’s economy. Ancient India was at the forefront of science. The ancient ayurvedic treatise Charaka Samhitha described the four cardinal principles to prevent lifestyle-related diseases such as diabetes as far back as 3,000 years ago, namely “achar, ahar, vyayam and yoga.” However, today India unintentionally finds itself bang in the center of the diabetes epidemic. As of 2011, there were 61 million diabetics in India. This is more than the diabetic population in USA, Russia, Brazil, Japan and Mexico combined! But the actual number may be much higher, as it is suspected that up to 60 percent of diabetics in India remain undiagnosed. By 2030, India is projected to have more than a 100 million diabetics. Today, an Indian is 2-3 times more likely to develop diabetes than whites. Furthermore, an Indian is likely to develop diabetes 10 years earlier than people of other races. Diabetes is a disease that spares no organ in the body. Diabetics are three times more likely to have high blood pressure, four times more likely to die from a heart attack, and four times more likely to have a stroke. Diabetes is particularly hard on the Indian kidneys, causing kidney failure at a 10-40 times higher rate. On a more sensitive note, diabetic men are three times more likely to become impotent, and they do so 10 years earlier than non-diabetics. Today, diabetes is no longer a disease of just the rich and old. Type 2 diabetes, which is

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usually diagnosed at the age of 40-50 years, is now being reported in kids as young as 9. In fact, Indian kids develop diabetes at an 11 times higher rate than white children in Britain. Youth account for 70 percent of India’s population. If status quo prevails, a large chunk of them will fall victim to diabetes, which will cripple India’s economy, and is likely to have global implications. Diabetes is not a disease limited by a country’s borders, and has followed Indians to every part of the globe. Indians are the fastest growing minority in the USA, and are the 2nd largest ethnic group in Britain. Interestingly, 87 percent of Indians in the USA were born in India, and are likely to have the same lifestyle risk factors as those residing in India. Overseas, Indians have double the rate of diabetes compared to whites. In fact, among a sample of patients above the age of 50 years at the University of California, Davis, the prevalence of diabetes was 31 percent in South Asians, compared to 14.3 percent among whites. There are many simple, but very effective, measures to counter the diabetes risk among Indians. For example, eating a diet that contains complex carbohydrates (whole grains, vegetable, and fruits) instead of simple sugars (Coke, Pepsi, sweets, refined wheat flour called maida used to make “naan bread,” polished rice, etc.) causes less stress on the pancreas. Eating a plant-based protein diet (dals/ lentils, peas, nuts, seeds, etc.) leads to less hunger, and consequently, better blood sugar control. Healthy fats (mono and poly unsaturated fats) in moderation are both essential and beneficial for health. On the contrary, the so-called “fat


free” foods are likely to lead to poor diabetes control. The spices routinely used in Indians’ kitchens (jeera, methi, sarson, kali mirch, etc.) tend to lower blood sugar and cholesterol levels. A healthy diet, combined with regular physical activity can reduce the risk of diabetes by 71 percent. For every kilogram of excess weight lost, the risk of diabetes falls by 16 percent. Yoga reduces blood sugar levels within hours, and leads to sustained benefits in diabetes by as early as three months. Unfortunately, this major public crisis is not getting the attention it warrants. Despite having less than half the number of diabetics as India (30 million compared to 70 million), the USA spends about $320 billion on diabetes care, according to the International Diabetes Federation. India, on the other hand, does not even figure in the list of top 10 countries for diabetes-related health expenditure. It spends 4 percent of its GDP on health care, compared to 17 percent by the USA. Only about 17 percent of the population is insured (12 percent Government-sponsored, 3 percent employersponsored, 2 percent individually purchased).1,2 The cost of diabetes care in India is borne by either the individual or his/her family. Ironically, despite being the global hub for manufacture of cheap generic drugs, drug costs constitute more than 50 percent of expenditure, followed by hospitalization costs, physician visits, laboratory tests and transportation.3 All currently approved diabetic medications are available in the Indian market. These include biguanides (metformin), sulfonylureas (glipizide, etc.), glitazones (pioglitazone), alphaglucoside inhibitors (acarbose), meglitinides (repaglinide), DPP-4 inhibitors (sitagliptin, etc.), GLP-1 agonists (exanetide, etc.) human (regular and NPH) and analog insulins (lispro, glargine, etc.). But the high cost of some of the newer medications may put them out of the reach of the common man. To tackle the burden of drug costs on diabetics, the government has established the “National List of Essential Medicines.” Drugs included in this list are price-controlled by the government, and are expected to be universally

available in government-run health centers. The revised list, published in 2015, includes glimeperide, metformin, and insulin (soluble, NPH, and premixed), which constitute only 8 percent of the Indian pharmaceutical antidiabetic market.4 These drugs are effective and have a strong safety record. But one study found that these medicines were available 100 percent in one state (Karnataka) versus only 3.8 percent in another state (West Bengal).5 Another study found that medication compliance was only around 30 percent among diabetics in the lower socioeconomic groups due to issues with drug affordability.6 Several studies, which have examined spending patterns between the lower and higher income groups, noted that while higher income groups spent more, lower income groups spent a higher proportion of their income for diabetes care, and hence carried a higher economic burden. Though less studied than direct costs of diabetes, indirect costs are reported to include loss of income to the individual (61 percent) and the caregiver (39 percent) in one study. There are few data on the impact of diabetes on the country’s economy due to absenteeism, disability, and premature death. As India embarks on an ambitious project to achieve universal health coverage by 2022, diabetes looms large as a formidable challenge to overcome. stejaswi@ucdavis.edu References 1 La Forgia G, Nagpal S. Government-Sponsored Health Insurance in India: Are You Covered? Washington DC: World Bank Publications; 2012 2 Reddy, KS. India’s aspirations for universal health coverage. N Engl J Med. 2015; 373: 1-5 3 Kumar A, Nagpal J, Bhartia A. Direct cost of ambulatory care of type 2 diabetes in the middle and high income group populace of Delhi: The DEDICOM survey. J Assoc Physicians India 2008, 56:667-674 4 www.businesstoday.in/storyprint/227558 5 Kotwani A, Ewen M, Dey D, Iyer S, Lakshmi PK, Patel A, et al. Prices and availability of common medicines at six sites in India using a standard methodology. Ind J Med Res 2007; 125:645-54 6 Shobhana R, Begum R, Snehalatha C, Vijay V, Ramachandran A. Patients’ adherence to diabetes treatment. J Assoc Phys India 1999; 47:1173-5

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The Cuban Health Care System Accomplishing Much With Very Little

By Glennah Trochet, MD

Comments or letters, which may be published in a future issue, should be sent to the author’s email or to e.LetterSSV Medicine@gmail. com.

MY FAMILY AND I SPENT four months in Cuba in 1960, when my father was invited to be a visiting professor at the Presbyterian Seminary in Matanzas. We arrived at the end of 1959. I remember well the all-night party that took place on the first anniversary of the success of the Revolution on New Year’s Day 1960. We lived in a town called Varadero. My sister, Phoebe, and I attended a primary school called La Progresiva, in the town of Cardenas. As a result of this experience, I have always had a friendly interest in Cuban affairs. When Fidel Castro died at the age of 90 in November of last year, much was said about his life and what his rule of Cuba during 47 years did not accomplish. Many articles that were published in the U.S. were critical of the authoritarian and repressive regime. What was missing from many articles was mention of some of the successes of the Cuban government. Indeed, this impoverished nation has one of the lowest infant mortality rates in the world, the highest literacy rate in the Americas and a longer average life expectancy for its population than we have in the United States. Despite circumstances such as the U.S. embargo that have decimated the economy of Cuba and provided an excuse for any economic missteps of the government, Cuba has been a leader in medical care. It’s Latin American School of Medicine (Escuela Latino Americana de Medicina) has graduated medical doctors from many countries, including the U.S. Their training is strong in public health

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and prevention, creating physicians who can work effectively in third world countries, using diagnostic and treatment skills that don’t rely entirely on technology. Cuban doctors have been at the forefront of many humanitarian missions, including working in Africa and Haiti. In January of 2014, then Secretary-General of the United Nations, Ban Ki-Moon had this to say: “As Secretary-General of the United Nations, I travel to many difficult places. Desperate places hit hard by earthquakes, hurricanes or other natural disasters. Remote places of deep deprivation. Forgotten places far off many peoples’ radar of concerns. And so many times in these different communities − I have seen the same thing: Doctors from Cuba − or doctors trained in Cuba, helping and healing.”1 During disasters, Cuban doctors are the first to arrive and the last to leave. They do not seek the media spotlight, and frequently are ignored by reporters who prefer to talk with physicians from non-governmental organizations. This was particularly notable during the response to the Haitian earthquake in 2010. Cuba immediately had 400 physicians working on the ground, while U.S. reporters chose to interview representatives of Doctors Without Borders, never mentioning the Cuban relief effort.2 When the Cuban revolutionaries took over from the Batista regime in 1959, Cuban doctors were well trained and respected. However, they were concentrated in urban areas with very little access available for the poor and those living in rural areas of the island. The government


began to address these inequities with two large campaigns: one was a literacy campaign that enlisted 200,000 young volunteers to teach over 700,000 people to read and write; the other was developing a single national public health system. The Cuban Constitution enshrines these principles: • Health care is a right, available to all equally and free of charge. • Health care is the responsibility of the state. • Preventive and curative services are integrated. • The public participates in the health system’s development and functioning. • Health care activities are integrated with economic and social development. • Global health cooperation is a fundamental obligation of the health system and its professionals.3 Over the years, the Cuban health care system has evolved to recognize how social and economic circumstances affect health. The social determinants of health have been taught in the Cuban medical curriculum since the late 1970s. They have also integrated public health and clinical medicine. Family physicians and nurses, who are located in a community, are expected to provide health education and preventive health interventions, as well as clinical care. Their efforts are supported by a robust data collection system and a “neighborhood health diagnosis” that is gleaned from the medical records available, as well as an analysis of diseases, risk factors, and environmental influences. This information is used to set priorities for health education and preventive campaigns. The emphasis on preventive and primary care has resulted in a 98 percent immunization rate for children at 2 years of age, and an infant mortality rate of less than 5 per 1,000 births, lower than that of the U.S. (2008 data). Cuba was the first country in the world to completely eliminate mother-to-child transmission of HIV.4 There is no question that there has been ample political commitment to improving the health of all Cubans over the last 50 years. However, there is a significant lack of resources.

This is due to Cuba’s very poor economy. There is a notable lack of medical supplies in the country, as well as facilities in need of modernization and repair. Health professional salaries are very low and remain stagnant. The emphasis on prevention is a rational response to the lack of resources for treatment of disease. However, those who still get sick may have difficulty finding treatment modalities because of the shortages of medications and technology. In the 1980s, the Cuban government decided to invest in biotechnology. This resulted in discovery of products such as vaccines, testing kits and therapeutics that are used within Cuba, and also exported internationally in partnership with firms from countries such as Canada, Great Britain, Brazil and China. Cuba provides medical services in some of the poorest countries in the world at no charge, but charges others for these services. There are Cuban doctors serving in about 70 countries in the world. The contracts for services have resulted in significant income for the Cuban government. The contractual arrangement with richer nations has been criticized as one of involuntary servitude for the Cuban medical professionals. In Venezuela, for example, Cuban doctors’ salaries are much lower than those of Venezuelan physicians. Doctors who have fled claim that they are not allowed to bring their families with them when they are posted to foreign missions, as a way of forcing them to return to Cuba when the mission is over. Others seem to have no problem with the way they are treated. All of them have been trained for free by the Cuban government and have no burden of student loans. Not everything about the Cuban medical system is bad, and much of it is very good. The United States could learn a lot from the Cuban health care experience if we were willing to set

Author Glennah Trochet, right, and her sister, Phoebe, in their school uniforms waiting for the minibus (called “guaguita” in Cuba) that took them to school every day.

continued on Page 29

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Deadly Spin An Insurance Company Insider Speaks Out on How Corporate PR Is Killing Health Care and Deceiving Americans, By Wendell Potter; Publisher Bloomsbury Press; ISBN13: 978-1608194049

Reviewed By Gerald Rogan, MD DEADLY SPIN by Wendell Potter, published in 2010, explains how commercial health care insurance companies may make profits and abundantly reward senior management. Profits are guaranteed by monopolies in local areas by raising deductibles and co-payments, and by excluding small companies whose employees are sicker than average. Potter traces the history of governmentdriven health care reform, which resulted in the enactment of the Medicare and Medicaid Programs in 1965. Then he explains the transition of non-profit “blue” insurance plans organized in the 1930s into for-profit companies, such as Blue Cross of California into Wellpoint Health Network, Inc. in 1993. Potter suggests that the conversion of commercial, non-profit health insurance companies into for-profit companies, as permitted by the California Legislature in 1994, contributes to rising health care costs compared with the costs in other developed countries, as measured by a percentage of the respective gross

Comments or letters, which may be published in a future issue, should be sent to the author’s email or to e.LetterSSV Medicine@ gmail.com.

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domestic products (GDPs) paid for health care. He also adds that not only are for-profit health insurance company executives highly compensated, but stock options provide additional compensation, so long as the stock prices increase. Here are some facts about profits and compensation which I found for my own report, below. I selected a comparison to a large non-profit insurer, Highmark of Western Pennsylvania. References are on file. All five of the for-profit companies listed are in the S&P500 index, which assures demand for the stocks via purchases of index mutual funds and exchange traded funds (ETFs). Company insiders own about five percent of the stock. Profits drive up the stock price and thereby the value of stock options, which are earned by corporate employees. Stock options are an important part of executive compensation. Potter explains the limitation of liability of self-funded employer insurance plans to


employees under the 1974 federal statute ERISA − the Employee Retirement Income Security Act of 1974, enacted to prevent improper non-payment for some reasonable and necessary services. ERISA underpins employer-sponsored health plans. The author explains that President Bill Clinton’s health plan proposal in 1994 included a new national insurance program for people under age 65, and that the health insurance industry defeated his attempt. In summary, Deadly Spin is about for-profit health insurance companies. The book will help the reader appreciate the potential benefit of a government-sponsored health insurance program for the individual market for persons under age 65 (i.e. “single payer”), instead of continuing to rely on government subsidies of individual premiums paid to commercial health insurance companies under the ACA.

The Cuban Health Care System continued from Page 27 aside our prejudices. If a nation with so few resources can achieve such good health outcomes, we could too. But first we would need to recognize that health care is a human right and not just a commodity. It is unlikely that we will have the political will to do so in the near future. trochetg@gmail.com References 1 https://www.un.org/sg/en/content/sg/statement/2014-01-28/secretary-generalsremarks-officials-latin-american-school-medicine 2 http://www.truth-out.org/buzzflash/commentary/dave-lindorff-cuba-is-missingfrom-us-reports-on-the-international-response-to-haitis-earthquake 3 The Curious Case of Cuba, Keck and Reed, Am J Public Health. 2012 August; 102(8): e13–e22. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3464859/ 4 Elimination of mother-to-child transmission of HIV and syphilis in Cuba and Thailand Ishikawa et al Bull World Health Organ. 2016 Nov 1; 94(11): 787–787A. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5096356/ Cuba Answers the Call for Doctors http://www.who.int/bulletin/volumes/88/5/10-010510/en/

jerryroganmd@sbcglobal.net

Giving What’s Needed There are more ways than ever to help patients in need. Donors have a variety of options to donate blood components that help patients in specific ways. Individuals can give priceless gifts by donating whole blood, red blood cells, platelets, transfusable plasma and source plasma. Emily needed a variety of blood components to help her survive leukemia.

Visit bloodsource.org or call 866.822.5663 to learn more about the best way(s) you are able to help others. Schedule an appointment at a BloodSource Donor Center or mobile blood drive soon. Together, we do save lives.

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Sign Language By George Meyer, MD EDITOR’S NOTE: Do you have some favorite travel photos that are health-related and would like to share them with our readers? Let us know! George Meyer, MD, submitted these from his ventures abroad. “When I travel, I enjoy taking photos of health-related signs in other countries. In this sequence are three signs, one each from Japan, Peru and Brazil.” 1) The Solmáforo is a traffic light equivalent which tells the levels of UV light alerting the population with a code based on five different colors. This was in a park in Miraflores in Lima, Peru. 2) The poster board in the conference room level of a large Japanese hospital shows the amount of sugar in various nonalcoholic drinks available in Japan. The numbers in the upper right corner depict the number of sugar

containers (probably the equivalent of one teaspoon) in each drink. You can count them in the photo. Note that Coca Cola is tied for first with 19 sugars! 3) This billboard in Brazil boasts that in the Amazon state, the rate of maternal mortality has been decreased 35 percent. 2

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2016

ANNUAL REPORT

Proudly Representing Over 3,400 Physicians in El Dorado, Sacramento and Yolo Counties

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Serving Physicians in El Dorado, Sacramento & Yolo Counties

2016 preSident-elect MeSSage The Sierra Sacramento Valley Medical Society (SSVMS) proudly represents physicians in El Dorado, Sacramento and Yolo counties. We are dedicated to bringing together physicians from all modes of practice to promote the art and science of quality medical care and to enhance the physical and mental health of our entire community. We achieve 2017 President this through: dedicated physician led Ruenell Adams Jacobs, MD committees; a 44-member delegation that develops and recommends healthcare policy positions; programs that help you reclaim the joy of practicing medicine; and finally, philanthropic programs that are committed to supporting the future of medicine and providing access to care for those in need. In 2016, more physicians than ever became members of SSVMS. I invite you to join, to get involved, to contribute, and to connect with your fellow physicians. Thank you for choosing me to serve as the President of SSVMS in 2017. I look forward to representing you in our community. ~AdamsR@ssvms.org

3500 3000 2500 2000 1500 1000 500 2013

2014

SSVMS advocates for physicians and the patients they serve at the local, state and national level. In 2016, we successfully passed legislation and sponsored ballot initiatives that, among other things, will protect patients by only allowing trained physicians to perform certain medical procedures, decrease the number of children hooked on tobacco, provide additional funding for Graduate Medical Education and increase provider rates in the Medi-Cal program. Learn more at ssvms.org.

Mental health advocacy

MeMberShip growth

2012

Shaping healthcare in 2016

2015

2016

SSVMS’ Emergency Care Committee pioneered the SMART Medical Clearance Form to promote standardized and expedited medical clearance, when appropriate, for patients experiencing a mental health crisis. This evidence-based and peer-vetted form is being used throughout the region to ensure that patients receive the right treatment at the right time. To learn more, visit ssvms.org.

Joinover over3,500 3,500physician physicianmembers membersthat thatare aremaking makingaadifference differencein inthe thelives livesof of colleagues colleaguesand andthe thepatients patientsthey theyserve. serve. Join 32

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Sierra SacraMento valley Medical Society caring For phySicianS & the patientS they Serve For over 150 yearS

behind every nuMber iS a liFe changed Warmth. Generosity. Gratitude.

Spirit prograM

Medical Student ScholarShip Fund

MuSeuM oF Medical hiStory

#SPIRITHeals

#SSVMSCares

#SSVMSTeaches

SPIRIT is a collaboration between SSVMS, the region’s health systems and the County of Sacramento. Working together with partner physicians that donate their time and expertise, we provide uninsured and medically indigent members of our community the care that helps them lead healthier, more productive lives. In 2016:

The SSVMS Scholarship and Awards Committee grants scholarships to deserving medical students who graduated from a high school in El Dorado, Sacramento, or Yolo counties. In 2016:

The SSVMS Museum of Medical History is staffed by the Medical Society’s Historical Committee and is operated entirely from donations from the community. The museum is free of charge and open to the public. In 2016:

3100+ HOURS DONATED

40+

SURGERIES PERFORMED

35

+

3900+

VOLUNTEERS

$ 500k

+

IN DONATED SERVICES

PATIENTS TREATED

$ 12k+

GRANTED

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YEARS

1500+ VISITORS

35+

SCHOOLS & COMMUNITY GROUPS

SUPPORTING THE FUTURE OF MEDICINE

Help SSVMS change lives. Volunteer or consider making a tax deductible donation at ssvms.org/programs.

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thank you 2016 donorS Jose Abad, MD Alicia Abels, MD Ruenell Adams Jacobs, MD Helen Armstrong, MD William Au, MD Yekaterina Axelrod, MD Cleve Baker, MD Jonathan Beck, MD Joanne Berkowitz, MD Richard Beyer, MD BloodSource, Inc Walton Brainerd, MD Donald Brown, MD Jack Bruner, MD Michael Burman, MD Harvey Cain, MD JD Aaron Cook, MD Jose Cueto, MD

Benjamin Cutshall, MD Sean Deane, MD Anthony DeRiggi, MD R.L. Scotte Doggett, MD David Dozier, Jr., MD Ray Fitch, MD Faith Fitzgerald, MD Kieran Fitzpatrick, MD M. Daniel Flamm, MD Richard Frink, MD Alan Frueh, MD Francine Gallawa, MD Edward Gammel, MD Ann Gerhardt, MD Nancy Gilbert, MD Tim Grennan, MD Guy Guilfoy, MD Cary Hart, MD

James Hepler, MD Gregory Herrera, MD Julian Holt, MD Monte Ikemire, MD Kristina Ishihara, MD Willie Johnson, MD Maynard Johnston, MD Forrest Junod, MD Robert Kahle, MD John Kailath, MD Rosalind Kirnon, MD Michael Klein, Jr., MD Ralph Koldinger, MD Scarlet La Rue, MD Melissa Lares, MD Michael Lawson, MD Rodney Loeffler, MD Stephen Mandaro, MD

Daniel McCrimons, MD Robert Meagher, MD George Meyer, Jr., MD Robert Meyers, MD Aimme Moulin, MD Michael Joseph Murphy, MD Yi Yi Myint, MD Anh Huynh Nguyen, MD Steven Orkand, MD John Ostrich, MD Richard Park, MD Susanna Park, MD Margaret Parsons, MD Mary Pauly, MD Gail Pirie, MD David Rausch, MD Harold Ray, MD John Rice, MD

Susanne Roessler, MD Gerald Rogan, MD Patrick Ryan, MD Michael Schermer, MD Kuppe Shankar, MD Myo Shin, MD. Elaine Silver, MD Craig Smith, MD Sarah Stolz, MD Coy Swanson, MD Fern Takemoto, MD Sadha Tivakaran, MD Glennah Trochet, MD James Vasser, MD Amy Wandel, MD Irma West, MD John Whitelaw, Jr., MD

Thank you Family of Paul J. Rosenberg, MD, for a very generous donation to the SSVMS Medical Student Scholarship Fund.

thank you 2016 volunteerS Yekaterina Axelrod, MD Robert Bellinoff, MD Michael Beneke, MD Patricia Bradshaw Congressman Ami Bera, MD Jacob Brubaker, MD George Chiu, MD David Cupp, MD Pooja de Sa, MD Adnan Din, MD Mark Endicott, MD Robert Equi, MD

Malcolm Ettin, MD Christine Fernando, MD Francine Gallowa, MD Brian Golden, MD Jeffrey Graham, MD Alexander Grand, MD Eli Groppo, MD Richard Grutzmacher, MD James Hamill, MD Ruth Haskins, MD Donald Hopkins, MD Susan Hooten, MD

board oF directorS - 2016 Officers

President - Thomas W. Ormiston, MD President- Elect- Ruenell Adams Jacobs, MD Immediate Past President - Jason P. Bynum, MD Secretary - Christian L. Serdahl, MD Treasurer - Rajiv K. Misquitta, MD

Directors

District 1 - Seth C. Thomas, MD District 2 - Vijay P. Khatri, MD District 2 - Darin A. Latimore, MD District 3 - Thomas A. Valdez, MD District 4 - Alexis F. Lieser, MD District 5 - Paul D. Reynolds, MD District 5 - Sadha C. Tivakaran, MD District 5 - John M. Wiesenfarth, MD District 5 - Eric S. Williams, MD District 6 - Ann M. Neumann, DO Executive Director - Aileen E. Wetzel

Julian Holt, MD Andrew Hudnut, MD Gabriel Jacob, MD Joelle Jakobsen, MD Mary Ann Johnson, MD Richard Jones, MD Paul Kelly, MD Samira Kirmiz, MD Rosalind Kirnon, MD Robert LaPerriere, MD Michael Lawson, MD Michael Leathers, MD

Dennis Lee, MD Eric London, MD Elisabeth Mathew, MD David Naliboff, MD Helen Nutter, MD Herminio Ojeda, MD Jack Ostrich, MD Jessica Oliver, MA Arun Patel, MD Senator Richard Pan, MD Robert Peabody, Jr., MD

Ken Perryman, MD Gail Pirie, MD Ajay Ranade, MD Kathleen Rooney, MD James Rybka, MD Garrett Ryle, MD Patricia Sierra, MD Christianna Stuber, MD Christian Swanson, MD Michael Trauner, MD Tony Tsai, MD

delegation - 2016 Delegates

Ruenell Adams Jacobs, MD Alicia Abels, MD Jose Arevalo, MD Barbara Arnold, MD Sean Deane, MD Alan Ertle, MD Katherine Gillogley, MD Marcia Gollober, MD

Alternate Delegates Natasha Bir, MD Helen Biren, MD Arlene Burton, MD Jason Bynum, MD Ann Gerhardt, MD

District XI Trustees

Douglas Brosnan, MD, JD

I WANT TO ENSURE ACCESS TO CARE & SUPPORT THE FUTURE OF MEDICINE BY DONATING TO SSVMS’ CHARITABLE PROGRAMS!

Richard Gray, MD Reinhart Hilzinger, MD Karen Hopp, MD Russell Jacoby, MD Kevin Jones, DO Richard Jones, MD Charles McDonnell, MD

Janet O’Brien, MD Tom Ormiston, MD Senator Richard Pan, MD Anthony Russell, MD Kuldip Sandhu, MD James Sehr, MD Lydia Wytrzes, MD

Sandra Mendez, MD Rajan Merchant, MD Robert Peabody, MD Armine Sarchisian, MD Anissa Slifer, MD

John Tiedeken, MD Thomas Valdez, MD Eric Williams, MD Don Wreden, MD

Margaret Parsons, MD

ssvms.org facebook/ssvms @ssvms

Name: _______________________________________________________ Address: _____________________________________________________ City:________________________________State:____ Zip:_____________ Email:________________________________________________________ Phone:_______________________________________________________ To make a tax-deductible donation to SSVMS’ Community Service, Education & Research Fund (CSERF), mail your payment to: CSERF 5380 Elvas Ave. Suite 101 Sacramento, CA 95819 or donate online at ssvms.org/programs

#SSVMSGives


Welcome New Members The following applications have been received by the Sierra Sacramento Valley Medical Society. Information pertinent to consideration of any applicant for membership should be communicated to the Society. — Chris Serdahl, MD, Secretary. APPLICANTS FOR ACTIVE MEMBERSHIP: Ronald Chapman, MD, Public Health Officer, University of Southern California School of Med – 1989, Yolo County, 137 N Cottonwood Street, Woodland, CA 95695 Pin Chieh Chiang, DO, Family Practice, Touro Univ Coll Of Osteo Med – 2009, Woodland Clinic, 2330 W. Covell Blvd., Woodland, CA 95616 K. Michael Conroy, MD, Internal Medicine, University of Illinois College of Medicine – 1988, Sutter Medical Group, 2700 Gateway Oaks, Sacramento, CA 95833 Timothy M. Davis, DO, Internal Medicine, Western University of Health Sciences – 2010, Woodland Clinic, 2081 Bronze Star Dr., Woodland, CA 95776 Shannon Dillon, MD, Pediatrics, University of Michigan Medical School – 2004, The Permanente Medical Group, 2155 Iron Point Rd., Folsom, CA 95630 Gerardo Guerra Bonilla, MD, Family Practice, University of Monterrey School of Medicine, Mexico – 2009, Woodland Clinic, 632 W. Gibson Rd., Woodland, CA 95695

Lynne Hackert, MD, Plastic Surgery, Michigan State Univ – 1997, Sutter Medical Group, 3 Medical Plaza Drive, Suite 200, Roseville, CA 95661

Sreenivas Ravuri, MD, Internal Medicine, Guntur Med Coll, India – 1978,Mercy Medical Group, 6501 Coyle Ave., Carmichael, CA 95608

Eva Holdbrook, MD, Ob/Gyn, Ross University School of Medicine – 2008, Camellia Women’s Health, 5821 Jameson Court, Carmichael, CA 95608

Ingrid V. Sarmiento Lopez, MD, Family Practice, University Juan N. Corpas, Bogota, Colombia – 2006, Woodland Clinic, 2081 Bronze Star Dr., Woodland, CA 95776

Melissa Marshall, MD, Family Practice, Washington University School of Medicine – 2001, CommuniCare Health Centers, 2051 John Jones Road, Davis, CA 95617

Riaz A. Shah, MD, General Surgery, Aga Khan University, Karachi, Pakistan – 2000, Woodland Clinic, 1321 Cottonwood St., Woodland, 95695

John M. Martinez, MD, Family and Sports Medicine, Albany Med Coll – 1996, Woodland Clinic, 2081 Bronze Star Dr., Woodland, CA 95776

Samuel M. Siegel, MD, Pediatrics, Jefferson Medical College – 2012, Woodland Clinic, 632 W. Gibson Rd., Woodland, CA 95695

Jane Maloney, MD, Ob/Gyn, Creighton University School of Medicine – 1991, Mercy Medical Group, 3000 Q. St., Sacramento, CA 95816

Thomas D. Wendel, MD, Emergency Medicine, University of Cincinnati College of Medicine – 1985, Woodland Clinic, 2081 Bronze Star Dr., Woodland, CA 95776

Kalpana Phadnis, MD, Ob/Gyn, Seth G.S. Medical College, India – 1984, 2081 Bronze Star Dr., Woodland Clinic, Woodland, CA 95776 Thomas Pounds Jr., MD, Nuclear Medicine, Tulane University – 1980, Sutter Medical Group, 2801 K St #502, Sacramento, CA 95816

APPLICANTS FOR RESIDENT MEMBERSHIP: Freshta Obaidi, MD, Family Practice, Rosalind Franklin University of Medicine and Science – 2016, Sutter Health Family Medicine Residency Program

Board Briefs January 9, 2017 The Board: Welcomed Ruenell Adams Jacobs, MD, as the 2017 SSVMS President. Extended a thank you to outgoing President, Tom Ormiston, MD for his leadership in 2016. Also welcomed new Directors, Carol Kimball, MD, representing District 6, Yolo County and Sean Deane, MD, representing District 5, The Permanente Medical Group. Received an update from Director Seth Thomas, MD regarding the activities of the Emergency Care Committee and the implementation of the SMART Medical Clearance Form by regional emergency departments, as well as nationally. Elected Chris Serdahl, MD, 2017 Secretary, and John Wiesenfarth, MD 2017 Treasurer.

Approved the 2016 Unaudited Year-End Financial Statements. Approved the January 9, 2017 Membership Report For Active Membership − Ronald Chapman, MD; Pin Chieh Chiang, DO; Timothy M. Davis, DO; Gerardo Guerra Bonilla, MD; Eva Holdbrook, MD; Melissa Marshall, MD; John M. Martinez, MD; Kalpana Phadis, MD; Ingrid V. Sarmiento Lopez, MD; Riaz A. Shah, MD; Samuel M. Siegel, MD; Thomas D. Wendel, MD. For Reinstatement to Active Membership − Kamyar Farhanfar, MD; Thomas Pounds, Jr., MD; Guanglan Zhu, MD; Sreenivasa Ravuri, MD. For Transfer of Membership from San Joaquin −Jane Maloney, MD.

March/April 2017

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Sierra Sacramento Valley Medicine is the official journal of the Sierra Sacramento Valley Medical Society (SSVMS) and promotes the history,...

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