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MEDICINE Serving the counties of El Dorado, Sacramento and Yolo
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Request your free copy: 800-356-5672 CAPphysicians.com/SSVBG1 Medical professional liability coverage is provided to CAP members by the Mutual Protection Trust (MPT), an unincorporated interindemnity arrangement organized under Section 1280.7 of the California Insurance Code.
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 SSVMedicine@ ssvms.org or to the author.
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PRESIDENT’S MESSAGE California (Medical Association) Dreaming
Christian Serdahl, MD
EXECUTIVE DIRECTOR’S MESSAGE Saving Private Practice
Aileen Wetzel, Executive Director
Rapid DNA Brings Closure to Camp Fire Families
Eric Williams, MD
2018 Annual Report
BOOK REVIEW A Pandemic and a Sequel Six Decades Later
Karen Poirier-Brode, MD
Bob LaPerriere, MD
Joshua’s House: Hospice for the Homeless
GUEST EDITORIAL A Patient Lost to a Diseased System
Kayla Sheehan, MS III
Caroline Giroux, MD
Public and Enrvironmental Health Committee Report
Incentivizing Care for Chronic Conditions
State Senator Richard Pan, MD
A Tale of Wild Bill, the Ice Man, and the Medical Museum
Jack Ostrich, MD
An ECG on Your Wrist?
Mustafa Bahramand, MS II
All articles are copyrighted for publication in this magazine and on the Society’s website. Contact the medical society for permission to reprint.
Glennah Trochet, MD 30
New SSVMS Members
2019 Committee Appointments
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 At the January 2019 SSVMS Board of Directors meeting, Rajiv Misquitta, MD passed the gavel to Christian Serhdahl, MD, the new President of the SSVMS Board. Dr. Serdahl’s priority as President of the Medical Society for 2019 is to “Save Private Practice.” Photo by Lindsay Coate.
Volume 70/Number 2 Official publication of the Sierra Sacramento Valley Medical Society 5380 Elvas Avenue Sacramento, CA 95819 916.452.2671 916.452.2690 fax firstname.lastname@example.org
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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. 2019 Officers & Board of Directors Christian Serdahl, MD, President John Wiesenfarth, MD, President-Elect Rajiv Misquitta, MD, Immediate Past President District 1 Ashutosh Raina, MD District 2 Adam Dougherty, MD J. Bianca Roberts, MD Vanessa Walker, DO District 3 Ravinder Khaira, MD
2019 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 Ruenell Adams Jacobs, MD Barbara Arnold, MD Natasha Bir, MD Helen Biren, MD Richard Gray, MD Reinhardt Hilzinger, MD Kevin Jones, DO Richard Jones, MD Charles McDonnell, MD Sandra Mendez, MD Sen. Richard Pan, MD Kuldip Sandhu, MD James Sehr, MD Christian Serdahl, MD Ajay Singh, MD John Wiesenfarth, MD Don Wreden, MD CMA Trustees District XI Douglas Brosnan, MD
District 4 Ranjit Bajwa, MD District 5 Sean Deane, MD Cynthia Ramos, MD Vijay Rathore, MD Paul Reynolds, MD Roderick Vitangcol, MD District 6 Carol Kimball, MD District 1 Alternate Harmeet Bhullar, MD District 2 Alternate Ann Gerhardt, MD District 3 Alternate Thomas Valdez, MD District 4 Alternate Richard Bermudes, MD District 5 Alternate Armine Sarchisian, MD District 6 Alternate Christopher Swales, MD At-Large Alternates Megan Anzar Babb, DO Arlene Burton, MD Ronald Chambers, MD Amber Chatwin, MD Harprett Dhatt, MD Adam Dougherty, MD Mark Drabkin, MD Karen Hopp, MD Carol Kimball, MD Derek Marsee, MD Anand Mehta, MD Leena Mehta, MD Rajiv Misquitta, MD Paul Reynolds, MD Ernesto Rivera, MD J. Bianca Roberts, MD Naomi Ross, MD
AMA Delegation Barbara Arnold, MD
Sandra Mendez, MD
Editorial Committee Mustafa Bahramand, MS II Sean Deane, MD Caroline Giroux, MD Sandra Hand, MD Nate Hitzeman, MD Robert LaPerriere, MD George Meyer, MD Steven Nemcek, MS IV
Eric Ovruchesky, MS I John Ostrich, MD Karen Poirier-Brode, MD Neeraj Ramakrishnan, MS III Gerald Rogan, MD Glennah Trochet, MD Lee Welter, MD
Executive Director Managing Editor Webmaster
Aileen Wetzel Ken Smith Melissa Darling
Listen and subscribe to Joy of Medicine - On Call on your favorite Podcast App or visit joyofmedicine.org
Margaret Parsons, MD
CMA Speaker Lee Snook, MD
HOSTED BY DR. RAJIV MISQUITTA
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 membersâ€™ 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. ÂŠ2018 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.
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California (Medical Association) Dreaming By Christian Serdahl, MD email@example.com MY COLLEAGUE, DR. RICHARD JONES, who has been to every annual meeting of the California Medical Association’s (CMA) House of Delegates since Ronald Reagan was president, has often gently urged me to attend. And I finally did last October. No, it wasn’t the free cookies and the free chair massages that made the difference, although those were wonderful bonuses. It was the theme of the meeting: The rising cost of health care. Since I sat down to write this last fall, Gavin Newsom is now governor and the Dodgers have won the World Series. Oh wait, only one of those is true, much to the dismay of Dodger fans. Governor Newsom, unlike his predecessor, is interested in health care cost and accessibility. Both he and our elected state representatives have asked CMA to give input on what changes should be recommended to control costs and increase access. Imagine that—someone asking doctors what we think! I am glad they did not ask me, since the only thing I could come up with was taking a pay cut and going to a four-day work week. Luckily, we have colleagues at the CMA who are way smarter than I am. Some of their suggestions included reducing administrative complexity, reducing overtreatment, and reducing drug costs. The health insurance premium for a family of four in Northern California making $70,000 is currently $19,000 per year. You can buy a new Ford Fiesta for $14,000 and that should last at least 3 years. In Southern California, the same policy is nearly 25% cheaper but still is the equivalent of a new car every year. This is clearly
unsustainable. How did it get this way? Are there physicians out there who have been getting 10 percent raises over the past decade? I don’t think so. One big reason has been the horizontal and vertical health care mergers that some consultants predicted would lower the cost of health care. Our fearless leader at the helm of the CMA is Dustin Corcoran. In his address to the delegates, Dustin let us know that if we as physicians did not come up with some ideas for the governor, someone else will. I took Dustin’s threat seriously because he could probably bench press me and he shaves his head. Another good reason is that he knows what he’s doing.
“I took Dustin’s threat seriously because he could probably bench press me and he shaves his head.” I am glad I finally listened to my partner Dr. Jones, as I enjoyed my experience as an SSVMS delegate to CMA’s House of Delegates. Historically, these meetings have run for six days but now they are two, or about the same amount of time you can afford to spend in Disneyland. The guest speakers were excellent and the parliamentary process entertaining. The CMA is a juggernaut and I am proud to be a member via our Medical Society. Membership has its privileges and gets us a seat at the table. I encourage all physicians to get involved and consider joining our delegation. It’s painless, unless Dustin finds out you forgot to make your CALPAC donation.
Comments or letters, which may be published in a future issue, should be sent to the author’s email or to SSVMedicine@ ssvms.org.
EXECUTIVE DIRECTOR’S MESSAGE
Saving Private Practice By Aileen Wetzel, Executive Director firstname.lastname@example.org PRIOR TO JOINING Sierra Sacramento Valley Medical Society (SSVMS) in 2011 as your Executive Director, I spent twelve years at the California Medical Association (CMA) developing resources to assist physicians and practice managers build and maintain thriving medical practices. In recent years, CMA’s Center for Economic Services has successfully recouped over $29 million on behalf of physician members. While our advocacy efforts benefit physicians in all modes of practice, SSVMS is particularly passionate about providing tools and resources to assist physicians in private practice. The majority of physicians practicing in the Sacramento region are affiliated with one of four large medical groups. At first glance, the size of these groups make it seem as though physicians who choose to go into business for themselves are obsolete, but that is simply not the case. It is estimated that there are over 1,200 physicians in the greater Sacramento Region that practice either solo or within a small or medium size independent practice. While private practice is certainly not obsolete, there is no question it can be a very difficult road to maneuver. To ease the burdens of small business ownership coupled with practicing medicine, physicians can consider SSVMS and CMA their go-to resource for answers to practice management challenges and where to find best practices. In recent years, SSVMS has launched several successful initiatives designed to effect change in health care policy and support physician fellowship and professional development with the intent of bringing joy back to your practice of medicine. It is with these initiatives in mind that we are launching a campaign to provide an entire suite of services specifically designed for independent
Comments or letters, which may be published in a future issue, should be sent to the author’s email or to SSVMedicine@ ssvms.org.
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physicians. SSVMS’ “Saving Private Practice” campaign is designed to help solo and small group practitioners thrive in all aspects of their lives, providing them with a direct connection to the resources they need to sustain a private practice, provide excellent care to their patients, and maintain well-being in their personal lives. In addition to educational and CME offerings, we are pleased to provide private practice physicians a complimentary one-on-one practice assessment. Physicians and practice managers will be guided in the following areas:
SAVING PRIVATE PRACTICE • • • • • • • • • •
Reimbursement Assistance Know Your Rights Best Practices Health Law Mistakes Costing Your Practice Money Malpractice Coverage Business and Workers’ Comp Insurance Clinical Communications Residential and Commercial Real Estate Wealth and Financial Management
Physicians are encouraged to contact Megan Sharpe at email@example.com to schedule a complimentary Saving Private Practice assessment. Depending on your needs, we will provide you with the tools and resources needed to run an efficient and successful practice. With a growing network of preferred partners and resources, SSVMS will customize solutions for any physician in private practice regardless of specialty, so you can do what you do best and give your patients the best care possible. We all know how hard physicians work to help their patients. So while you take care of your patients, let SSVMS take care of you.
Rapid DNA Brings Closure to Camp Fire Families
Comments or letters, which may be published in a future issue, should be sent to the author’s email or to SSVMedicine@ ssvms.org.
WHEN THE CAMP FIRE wiped out almost the were put to the test as they dealt with the entire town of Paradise, California, destroying challenge of taking on a central role in one of nearly 14,000 homes in November, there Northern California’s greatest disasters. was little time for escape or rescue. The fire At the request of the California Office of spread so rapidly that cars leaving the area were Emergency Services, the Sacramento County often engulfed in flames, and many residents, Coroner’s Office delivered a small refrigerated especially the elderly, had little warning or ability truck and a deputy coroner to Butte County the to leave the area. This fire, the deadliest and morning after the fire started. The deputy coromost destructive ever in California, spread its ner worked with Butte in the recovery stage, and smoke not only south, inundating Sacramento each evening for the first week drove the fire and restricting outdoor activity for a week or victims found during the day to the morgue in more, but was even detected in the eastern Sacramento County where they were processed United States. and examined. Identification in some cases was Once survivors were safe and the flames were quickly confirmed, but in others the intense controlled came the sad job of locating those heat had left little behind. who were not so lucky. Day by day, the mortality Within two weeks all the victims were rate rose until it topped off at 86. From fairly examined by a pathologist, and within three intact bodies to a pile of charred bones, the weeks all were examined by an anthropologist. search went on. Over 500 people were involved During this identification process, the staff in searching for survivors and remains—a at the Coroner’s Office attempted fingerprint major challenge as over 2,000 people were initially reported missing. In addition, rain combined with the ash to create a claylike substance that complicated finding remains. As remains were found, the next step was to identify them. With the holidays approaching, trying to provide closure for families was vital. All the deceased were moved to the Sacramento County Coroner’s Office, the largest such facility in Northern California. As a regional ANDE’s mobile lab enables rapid DNA ID at the scene of natural site serving disasters, they disasters.
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By Bob LaPerriere, MD firstname.lastname@example.org
A technician loads chips into ANDE’s Rapid DNA processor. A DNA ID can be generated in less than two hours. Below: Sacramento County provided regional aid and played a central role in identifying fire victims.
but is a much more accurate means of identification than a fingerprint. Besides identifying an individual, DNA IDs can do only two other things: indicate biological gender and determine if individuals are close biological relatives, the application that played such a a vital role in the aftermath of the Camp Fire. Within about two weeks of ANDE’s arrival on site, 80 percent of the remains had DNA IDs and more than half were identified by DNA matches to relatives. This not only provided closure for the families of the deceased but also allowed the relatives to obtain death certificates necessary for the proper disposition of the remains, filing life insurance and Social Security claims, and so much more. The Sacramento County Coroner’s Office continues to process cheek swabs from family members of the missing to enable all of the remains to be identified.
Photo: Bob LaPerriere
comparison on five victims that were positive matches. They also worked with a team of odontologists, or forensic dentists, who were able to make thirteen positive confirmations. The massive effort to identify fire victims by the Coroner’s Office shined a light on a relatively new technology that provided answers for families in a fraction of the time needed in the past. The Coroner’s Office worked very closely with staff from ANDE Corporation, a leader in Rapid DNA, a new approach to DNA analysis. Where DNA identification had often taken weeks or months, ANDE’s equipment generates a DNA ID in less than two hours to identify an individual. This team approach allowed for a much quicker turnaround time on the identifications and ultimately gave families closure much sooner than normal in a tragedy of this magnitude and severity. DNA identification fortunately has progressed markedly over the last several years. ANDE became involved as the only company with technology capable of generating DNA identifications from degraded human remains on site. The company donated its staff, time and use of its instruments as a humanitarian effort. The next step was to get cheek swabs from relatives to enable a match. This was often accomplished with the cooperation of law enforcement offices in areas where relatives resided. Rapid DNA also has applications for criminal cases, and in June 2018 ANDE’s system became the first technology of its type to be approved by the FBI. California is one of 32 states that allows law enforcement to take a cheek swab from certain arrestees in order to generate a DNA ID, and DNA processing has normally required sending samples to forensic labs and then waiting an extended time for results. With the passage of federal legislation in 2017, FBI-approved Rapid DNA systems can now be used in police stations to generate results in less than two hours. Such information can dramatically speed up an investigation and allows law enforcement to link a suspect to related cases before the suspect is released. California is one of five states that worked with the FBI to pilot Rapid DNA in police stations in 2018. The Rapid DNA technology is a fully automated, hands-free process of creating a DNA ID from a swab. Unlike a genetic profile, which is designed to assess the health of an individual and contains essentially every piece of genetic information in the human genome, a DNA ID simply identifies an individual. It contains less than one-millionth of the information of a genetic profile
A Patient Lost to a Diseased System By Caroline Giroux, MD email@example.com TODAY, I LOST ANOTHER PATIENT. Not to suicide. Not to wildfire. Not to a chronic illness. But to a serious, yet preventable, medical problem—a grave “medical error,” so to speak. This medical problem is not EMR’s fault, it is a collective one. It is a medical problem that affects us all and has something to do with the value system in our field, and the way we prioritize. It is the problem of the medical system itself, one of the most significant social injustices of our time. He was transferred to me by a colleague who left six months ago. I had come to appreciate his poise, kindness and humility. This morning, he came with a bag of Meyer lemons. Finances are tight, he’s hoping to find a job, but our patients still find a way to give. Next month, he will be eligible for Medicare. I didn’t see that as a problem. “We take Medicare,” I thought. Yes… but. It is always more complicated than it seems. Apparently, since our institution does not take “Medicare managed care,” he will have to establish care elsewhere where they take his combination of Medicare plus something else which I have already forgotten because the names are as ephemeral as names for apps. Managed care… I am so tired of having some external forces manage what we, doctors, should have a say on. Of course, he could technically receive care here, out-of-pocket, but at what cost? He would have to sacrifice his quality of life, his ability to use disposable income to enjoy his freedom. He already spent too much time and life energy calculating, looking at different options, ruminating. This is nonsense, people shouldn’t have to worry about health coverage. As a result, they don’t live their life to the fullest because
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their minds are too cluttered with these insane internal debates, causing anxiety, depression, and, of course, a need for care and co-payments. When are we going to say “enough is enough”? When are we going to approach life and health pragmatically? Access to health care is a human right! This is so incomprehensible to many progressive—shall we say, civilized—nations. I have known people who lost their homes because of the astronomic bills from emergency medical care or urgent surgery. People who can’t afford insurance often wait until they are on the verge of death before seeking medical care. So what we end up witnessing is a “putting-outfires” type of medicine. How can we let that be? How can we expect people to choose between a roof over their head or a monthly premium for health coverage? I find this not only unsustainable, but immoral. And demoralizing. I was not able to understand all the details attached to the constraints, for co-pay, deductibles and premiums are the words I despise the most. As he was talking, I was thinking that this reality, this soporific language is not going to survive the epochs. Not like the ancient Greek philosophers whose wisdom still resonates with us because it is still relevant to what we are as human beings. Or like Mozart’s musical legacy because it speaks to the grandiosity in all of us. But that insurance crap? To whom will it make sense 200 years from now? We are faced with an aberration that is specific to the superficial creations of systems with limited perspective, as opposed to elements of deep transformation. It will die, just like the way this civilization, based on greed, competition and division, is collapsing. Time to be co-intelligent, people. Time to remind ourselves
that no one will come out of this alive, so we might as well join forces and contribute to a positive, inclusive legacy. Beyond my own pain when a patient severs the therapeutic bond (people come and go in our lives), I think about the disruption in the patient’s own life, having to open up to a new physician, not knowing how long each of the new “in network” providers will be around (the doctor turnover must be as high as patients’ due to all kinds of issues, such as burnout, dissatisfaction, suicide…). I am deeply frustrated about such problems generated by society and that do not have to be: As I have said many times, in countries with universal care, even with less money, health outcomes are better. In fact, since most people are not indifferent to the dollar sign and start taking issues seriously when they are translated into financial losses, it would be interesting to quantify the burden of disrupting continuity of care. The need to emphasize sustainability in medicine cannot be ignored; it is interesting that I learned more about sustainable medicine in the context of a multi-site initiative in North America to tackle the issue of burnout, or physician decreased morale. In addition to medical waste increasing our carbon footprint, there are so many resources that our profession squanders on a regular basis, and two of the most valuable are time and talent.
“There are so many resources that our profession squanders on a regular basis, and two of the most valuable are time and talent.” I am sure we could argue that the disruption and fragmentation in health services affect people’s general morale and quality of care, thus making them less productive, which ultimately leads to an even more devastating impact on their financial security and the global economy. The current system doesn’t support prevention but rather forces people to be on their own in regards to lifestyle and health choices, hence using the medical system for crises, emergencies or when it’s too late. We should ensure certain resources are more widely available, especially since we must adapt to the needs of our aging population; providing medical care for minor concerns over the phone can eliminate unnecessary travel, for instance. Hospitals, in addition to being fiscally expensive, have high carbon costs. Initiatives to keep patients out of hospitals by improving home care and end of life services can
greatly decrease these demands (Thompson and Ballard, 2011)1. I would add that patients who are in-between physicians because of loss of longitudinal care are at highest risk of ending up in the emergency department. The fragmented care creates financial costs for the system and psychological costs for the patient and medical provider that outweigh the benefits, if there are any. Another compelling example that baffles me is this Catch-22 our own wounded healers find themselves in. A resident who had to be on a medical leave for a treatable condition worried about a lapse in insurance—but she had to take some extra time off work to engage in the treatments needed to heal in order to get back to work and maintain her insurance! Insurance coverage shouldn’t be tied to employment status. It is discrimination based on economic factors, often equivalent to social inequities because they are tied to characteristics such as race, gender and age. Primum non nocere. This is our motto in medicine. Hippocrates’ legacy. Yet, we are operating in a structure that harms patients. For-profit medicine is cumbersome, intimidating, abusive. Not eco-friendly. It interferes with one of the most important aspects in psychiatry and so many other specialties: longitudinal care. We are healers, not interchangeable robots. Our health care system is diseased. And I am beyond sick of it. To quote a highly esteemed physician who echoed what I deeply think, this country seems to care more about its cars and its guns. We need a pain-free, world-friendly health care delivery structure. La plaisanterie a assez duré. This farce has lasted way too long. Doctors, it’s time to practice medicine in a way that helps others while not creating barriers in this land of the free. The way we let other interests rule our profession is slowly poisoning our ability to provide meaningful, effective care and our capacity to experience joy in the job. Eventually, it is my hope that the essence of human nature will prevail over these institutions that create obstacles to care for all, and will dispatch the language and aberrations from common sense that come with them. To quote Alice Walker, “We are the ones we have been waiting for.” Source: 1. Dufort A et al. Resilience in the Era of Sustainable Medicine. From: Resilience in the Era of Sustainable Physicians: An International Training Endeavour, edited by Hategan et al. 2018.
Incentivizing Care for Chronic Conditions By State Senator Richard Pan, MD firstname.lastname@example.org
A CENTURY AGO, THE PRIMARY CAUSES of death were acute conditions such as infectious diseases and injuries. Life expectancy was only 54 years for men and 56 years for women, and that was a dramatic improvement from 1918 when the flu pandemic dropped life expectancy to just 37 years for men and 42 years for women. Thanks to advances in modern medicine and public health, people now survive most acute diseases. Life expectancy is now over 78 years with chronic conditions becoming the primary causes of morbidity and mortality. Yet, the way we pay for and deliver health care does not encourage improvements in the management of chronic conditions. Forty percent of Californians have at least one chronic condition and the cost of caring for these conditions represents between 70 and 80 percent of health care spending. In addition, only 3.5 percent of health care costs go towards the healthiest half of the population while the sickest ten percent are responsible for two-thirds of health care spending. A fundamental challenge in any health system is persuading people who are healthy to pay for the care of people with chronic conditions. The difficulty is illustrated by the failure of the state high risk pool for people with very expensive conditions, where there was never the political will to adequately fund the pool. However, as families, businesses, and government worry about rising health care spending, improvements in chronic disease care offer opportunities for greater value and lower spending. Currently, the success or even survival of organizations that bear financial risk for health care, including health plans, depends
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on managing their case mix or, in other words, attracting healthy patients and avoiding patients with chronic conditions who cost more than the premiums they pay.
“The way we pay for and deliver health care does not encourage improvements in the management of chronic conditions.” This is known as adverse selection. A plan that attracts too many patients with chronic conditions may go into what is referred to as a “death spiral” in which rising spending on care requires premium increases, driving healthy patients to leave for lower premiums. That ultimately forces the plan to further raise premiums until it becomes financially insolvent. Prior to the Affordable Care Act, many health plans managed this risk by refusing to cover, or charging higher premiums for, pre-existing conditions in the individual and small group market. It should be recognized that government also seeks to avoid financial risk. Over more than two decades in California, governors of both parties have transformed Medi-Cal from a state administered health program to a program where the state contracts out financial risk and administration to health plans that are paid a negotiated capitated rate. Thus, there are significant disincentives to invest in improvements in care for chronic conditions. First, if the investment is successful and attracts more people with chronic conditions to join that plan, the plan then risks a death spiral. Second, even high-quality care of chronic conditions with cost reductions still
Photo: Lindsay Coate
expanding access with the goal of achieving universal access to quality, affordable health care. Families, businesses and govern ment are struggling with rising health care spending, which now averages $10,739 per person and 17.9 percent of our nation’s Gross Domestic Product. There have been many proposals to limit this spending including direct regulation of premiums and prices and global budgets. However, payment cuts alone can result in access problems or dysfunctional behaviors. Rate reductions often result in increased Senator Pan meets with Sacramento-area physicians and medical students utilization by providers in response. during CMA’s legislative day. This may cause payors to exert increased utilization controls, which drives up overhead costs and results in requires spending more than the cost of care for healthy greater spending on administration with less funding for people in the plan. To incentivize continuous improveclinical care and reduced access. ment, investments in care need to result in net revenue for With the majority of health care spending on care for reinvestment, not just smaller losses. chronic conditions, there needs to be a focus on removing With health plans being renewed and frequently disincentives to continuously investing in care improvechanged annually, there is also little incentive to invest in ments for chronic conditions. Instead of avoiding enrollcare that results in savings realized beyond the enrollment ees with chronic conditions, success can be measured period. Churn in health plans, which affects both publicly by an increase in the number of health plans and other and privately funded coverage, disrupts continuity of care organizations that accept risk by seeking to enroll more and may increase utilization. Yet, long term savings for patients with chronic conditions such as diabetes or care of chronic conditions are key to reducing overall asthma because they provide that care with the greatest health care spending. efficiency and quality. The ACA contained many provisions to halt discrimiFoundations, health plans, hospitals, and medical nation against people with pre-existing conditions and groups have funded and/or implemented numerous pilots mitigate adverse selection, including establishing a stanof effective approaches to managing chronic conditions dard benefit package and requiring community rating including patient-centered medical homes and care coorwith age bands. An individual mandate encouraged more dination payments to primary care physicians. Yet, these healthy people to join the risk pool and stabilized the pilots are rarely taken to scale despite their positive individual insurance market while increasing access to outcomes. preventive care and reducing the number of uninsured Continuous quality improvement and innovation by over half. The ACA also included a risk adjustment occurs at the front lines of medicine where patient care program which transfers funds from plans with lower-risk is actually delivered. However, government, as both the enrollees to plans with higher-risk enrollees; however, last regulator and a major payor, should seek to establish a year the Trump administration suspended the $10 billion financing framework that incentivizes delivery reforms to program, driving up premiums. promote quality, efficient care for patients with chronic Despite the current federal administration’s efforts conditions. By realigning incentives to meet the needs to destabilize the insurance market, resulting in an of patients today, we can reduce increases in health care additional five percent increase in insurance premiums spending while improving the quality of care throughout for Covered California plans, California is committed our health care system. to successful implementation of the ACA and to further
A Tale of Wild Bill, The Ice Man, and The Medical Museum By Jack Ostrich, MD email@example.com
A COUPLE OF YEARS AGO on Sacramento Museum Day, when museums around the region open their doors to the public for free, a flashy sports car rumbled into the SSVMS driveway. A tall, bearded fellow and a lady walked into the Medical Museum hand-in-hand and signed the guest book. It said: “Wild Bill Hill and Roxanne.” For Wild Bill and Roxanne, “the love of his life,” as he calls her, it was the start of a relationship with the museum that continues to this day. But the story begins long ago, thousands of years ago, and is one told with the help of a mountain man found in the ice more than 5,000 years after his death. When two hikers high in the Tyrolean Alps came upon a human corpse in 1991, they notified police thinking it was possibly a recently deceased mountaineer. But when the body was extricated from the surrounding rocks and ice, it became clear that the remnants of garments and a copper axe found nearby were of ancient provenance. An archeologist from the University of Innsbruck estimated that the fellow now nicknamed “Otzi,” because he had been discovered in the Otzal alpine region, had lived about 4,000 years previously. Carbon dating later revealed he was about 5,200 years old. Otzi, much like Wild Bill, was heavily tattooed. He had 61 tattoos, mostly across his back and legs, non-representational and mostly linear, but possibly just as steeped in symbolism as the designs preferred by today’s devotees of body art. A CT scan showed significant
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degenerative changes were present in the spine, knees and ankles, mostly near or directly under the tattoos. The tattoos were found to be soot tattoos, created by rubbing soot into skin that had been punctured by finely pointed instruments such as a thorn or sharpened twig, and may have been meant to be therapeutic as well. Otzi’s body, now displayed at the Archeology Museum in Bolzano, Italy, is the oldest specimen of a tattooed human, although some Japanese figurines dating back about 10,000 years have decorations thought by some to represent tattoos. But even Egyptian mummies, which have been found with representational tattoos, aren’t nearly as old as Otzi. Tattoos were associated with wealth and social status before the Roman Empire, and the custom was possibly widespread throughout Eurasia. The Romans, who eschewed tattoos
Photos Courtesy Wild Bill Hill
themselves, used tattoos to mark criminals, slaves and mercenaries who were much more likely to desert their units than regular Roman legionnaires. They had encountered widespread body art in Scotland on people they called Picti, or painted ones—we now call them Picts— but considered them barbarians. The word tattoo itself wasn’t even in use until the late 18th century, after Captain James Cook met Polynesians who called their body art “tatau,” possibly coming from an onomatopoeic word meaning to strike, tap or mark. As Christianity rose, tattoos had been associated with paganism and criminals. But when King George V began sporting a dragon tattoo and Edward VII followed with a cross on his body, acceptance spread across Europe and to America where Martin Hildebrandt, who had been tattooing sailors since 1846, opened the first tattoo parlor in New York City around 1859. Even earlier, a young sailor had a red star tattooed on his arm prior to setting out to sea on a whaling ship at age 15; his name was Rowland H. Macy, and to this day that star is the logo for Macy’s Department Store. But back to Wild Bill, who opened his first tattoo parlor in Roseville nearly 140 years after Macy and his red star set sail. He acquired his name, and his first tattoo, at an early age due mainly to his lifestyle. That first tattoo, done at age 14, was the name of his girlfriend. The second tattoo came not long after and covered up her name. Around age 20, Wild Bill became somewhat less wild and a bit more introspective. He also embraced sobriety, which he has maintained ever since. Still, at six feet six inches and a walking gallery of body art, even though his lifestyle may have calmed down no one would question whether his nickname still fits. “I eat, drink and sleep tattoos,” he said. He’s been the canvas for famous tattoo artists such as Ed Hardy, Brian Everett and Jack Rudy. He estimates that he has spent around 800 hours under the needle, adding, “and that’s a conservative estimate.” Wild Bill does not have any facial or neck tattoos, nor do they extend beyond his wrist or ankles. He has always abstained from tattoos on those areas and counsels his clients to do likewise. In fact, his shop will not do any tattoos on areas that can’t be covered, and for over 25 years he even wouldn’t do a woman’s arm without a long talk about the possible ramifications. “Things change,” he says. “Now you can’t walk into a happening night spot without seeing pretty girls with full sleeves or large coverage of tattoos on them. Most
Above: Wild Bill; opposite page, Bill’s leg tattoos.
the time, they have more than the guys they’re with.” Although he doesn’t currently perform tattooing himself, he actively oversees and manages his bustling shop. There is a soft side to Wild Bill. He and his staff have donated $233,000 to the UC Davis Children’s hospital through their annual “Tattoo-A-Thon,” held from 8 a.m. to midnight on the last Saturday in February. All receipts generated on that day are turned over to the hospital. Part of the pediatric ICU is now dedicated to Wild Bill’s Tattoo. Wild Bill collects exotic and unusual cars, including the Panoz Esperante—a high-performance car company bankrolled by Don Panoz, the co-founder of Mylan Pharmaceuticals—that brought him to SSVMS. He is a renowned photographer whose pictures have graced the covers of dozens of body art and motorcycle magazines. He is also a collector of antique, and some modern, electronic (or “galvanic”) medical devices. He has built a relationship with the SSVMS Medical Museum and has donated items that are currently on display in the newly expanded museum, including a circa-1920 Acme electric Continued on page 23
An ECG on Your Wrist? New wearable tech causes a flutter in the medical community By Mustafa Bahramand, MS II firstname.lastname@example.org
WEARABLE TECHNOLOGY is a fast-growing sector in the tech industry and an inevitable addition to the world of smart phones and wireless devices. Recently, new medical devices have entered this arena with the goal of providing practical diagnostic and monitoring tools for patients to operate on their own. These devices have exciting potential to benefit both the ill and the healthy, but they are not without their pitfalls. The Apple Watch’s new electrocardiogram (ECG) function has stirred up debate over the efficacy and benefit of such wearable devices. In September 2018, Apple announced to a raucous audience of tech enthusiasts that the next Apple product would include an electrocardiogram built into its digital “smart” watch. This announcement was met with both excitement and skepticism from the medical community. While many lauded the potential for atrial fibrillation (AFib) patients to monitor their hearts on demand and be notified of dangerous arrhythmias, others worried about the possible overdiagnosis and unnecessary burdens on health systems resulting from millions of healthy individuals testing their own cardiac rhythms. How does the ECG function work? Electrodes on the back and crown of the watch function as a single lead ECG. While the watch is worn on the wrist, a finger from the opposite hand is placed on the digital crown of the watch for 30 seconds. The display will then show an ECG reading as well as a heart rate measurement. The reading can be saved as a PDF and sent to a physician, who can include the readings in a patient’s chart and monitor them over time. For patients with intermittent arrhythmia symp-
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toms, the watch can facilitate a self-monitoring process and will also provide warnings whenever it detects a rapid heartbeat. The potentially life-saving benefits and convenience of having an accurate warning device cannot be understated for high-risk individuals, particularly those who face barriers to health care access or who would otherwise forego electrophysiological screenings. Many patients have trouble seeing a physician due to geographical, economical, or physical constraints, and a portable ECG can give AFib patients a way to communicate their heart rhythm status to their physicians without having to make an ER or office visit. Physicians can then reassure their patients that they are experiencing a normal rhythm or request that they seek medical attention if necessary. The United States Food and Drug Administration’s approval of the ECG function gave the watch some credibility in the eyes of many health care professionals, including some cardiologists. Even the president of the American Heart Association, Ivor Benjamin, MD, made an appearance onstage during Apple’s product launch and voiced his support for the product. However, it should be noted that the FDA approval was specifically for the detection of atrial fibrillation and not other arrhythmias or heart conditions. According to the statistics Apple submitted to the FDA, in a clinical trial with 600 subjects the watch’s AFib detection function had 98.3% sensitivity and 99.6% specificity. While these numbers are impressive for a simple 30 second diagnostic test, they are usually applied in the context of screening
patients with some level of clinical suspicion for a heart condition. Skeptics have argued that given the consumer demographics of Apple products, especÂi ally that of the Apple watch, those who will be using the device skew younger and are relatively healthy. Despite the accuracy of the device, the test population almost ensures that there will be a higher proportion of false positives to true positives. A false positive can be cleared up with an ECG reading at a hospital or clinic, albeit after causing some stress and concern for the individual. Time will tell if a wrist watch electrocardiogram will yield a net benefit for the public. While it will not be a substitute for a controlled ECG study supervised by clinicians, this device may very well save some lives over time. Due to the growing demand for personalized medicine and diagnostic tools, the trends in wearable medical technology will not dissipate. Given this seeming inevitability, it may be best for the health care community to embrace the technology and learn to take advantage of its potential benefits, while informing individuals of its limitations and drawbacks.
Appleâ€™s Series 4 Watch received FDA clearance and generates a reading similar to a single lead ECG by touching a finger to the digital crown for 30 seconds. It also can detect falls and, with apps, monitor glucose.
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Serving Over 4,000 Physicians in El Dorado, Sacramento & Yolo Counties
ssvms.org | facebook/ssvms | @ssvms | 5380 Elvas Ave. Suite 101, Sacramento, CA 95819 | 916.452.2671
The Sierra Sacramento Valley Medical Society (SSVMS) is 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. In continuous operation since 1868, SSVMS is the oldest medical society in California with over 4,000 physician members in Sacramento, El Dorado and Yolo Counties. SSVMS is a nonprofit organization, and is a component society of the California Medical Association (CMA). SSVMS provides many benefits to our members by advocating for physicians and their patients to ensure access to quality healthcare. We achieve this through: Dedicated physician -led committees; A 46-member delegation that develops and recommends health care policy at the local, state and national levels; Economic advocacy, legal and practice management assistance to help physicians and their practices; Events throughout the year to provide physicians fellowship and professional development opportunities; Programs that help physicians reclaim the joy of practicing medicine; Philanthropic programs that are committed to supporting the future of medicine and providing access to care to those in need. In essence, SSVMS’s core activities help physicians maintain practice viability, connect with fellow physicians, and allows them to focus on what’s most important - caring for patients.
With the unprecedented change in the health care delivery system in the United States, many physicians feel that their role as healers, comforters, and listeners is diminished. SSVMS is passionate about helping physicians in the Sacramento Region find happiness and fulfillment in their profession. In 2017, we launched the Joy of Medicine program to engage local physicians in a long-term conversation to help recognize the signs of burnout, build meaningful resiliency and help physicians thrive.
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shaping healthcare in 2018 Together, CMA, SSVMS and our physician members: • Defended Medical Staff self-governance and ensured that medical staffs stay distinct and separate from hospitals. • Secured $220 million to establish a loan repayment program to incentivize physicians and dentists to serve Medi-Cal patients and $40 million in GME funding for residency programs in California. • Defended the medical profession from dangerous legislation (AB 3087) that would have significantly cut physician reimbursement and decreased access to care. • Stopped predatory practices by health insurance companies, including attempts to substantially limit same-day services (modifier -25 payments), and automatically downcode emergency services based upon the ultimate diagnosis. • Advocated for local public health policies to increase access to care for the uninsured, patients seeking medication assisted treatment and patients enduring a mental health crisis. 18
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celebrating joy of medicine To support these efforts, physician leaders from Mercy Medical Group, The Permanente Medical Group, Sutter Medical Group, Sutter Independent Physicians, UC Davis, Woodland Medical Group and independent practitioners came together to form the Joy of Medicine Advisory Committee. Thanks to dedicated fundraising and the Advisory Committee, services and resources are now available to all practicing physicians in the region to help them reclaim their joy of practicing medicine.
RESILIENCY CONSULTATIONS Recognizing the crushing stress and work load that physicians face today, SSVMS sponsors up to six (6) lifetime sessions with licensed and vetted psychologists and life coaches for physicians living and working in Sacramento, El Dorado, Yolo and Placer Counties. Counseling and coaching through this program are confidential, competent, convenient, and cost-free to physicians. Since the program’s inception, over 50 physicians have accessed the service with over 175 appointments. Currently, there are five psychologists and three life coaches available to any physician in the region. To access this service, visit www.joyofmedicine.org to schedule your appointment.
50+ physicians 175+ sessions
JOY OF MEDICINE - ON CALL In September 2018, SSVMS launched Joy of Medicine - On Call, a podcast where we explore the many paths physicians take to bring joy into their practice of medicine. The podcast aims to promote and increase access to physician wellness by focusing on topics of mindfulness, managing stress and joy. Download and subscribe on iTunes or your favorite podcast app by searching for “Joy of Medicine - On Call”.
ANNUAL JOY OF MEDICINE SUMMIT SSVMS’ 2nd Annual Joy of Medicine Summit successfully provided 175 local physicians with the tools and resources needed to cope with the stressors that are part of practicing medicine. This half-day summit featured sessions on journaling, happiness and working with the EHR. Save the date for the 3rd Annual Joy of Medicine Summit scheduled for September 28, 2019.
PHYSICIAN PEER GROUPS To promote collegiality among physicians from various health systems and practices in the Sacramento region, Physician Peer Groups monthly sessions are held in colleagues’ homes in Davis, Elk Grove, Newcastle, Carmichael and El Dorado Hills, with more locations on the way. Over 60 physicians actively participate in these facilitated group interactions. To sign up for a peer group, visit www.joyofmedicine.org.
www.JoyOfMedicine.org March/April 2019
community programs S i e r r a S a c r a m e n t o Va l l e y M e d i c a l S o c i e t y access to healthcare improve health outcomes mental health advocacy physician wellness future of medicine spirit
museum of history medical SSVMS’ Museum of Medical History
SSVMS’ Sacramento Physicians’ Initiative to Reach out, Innovate and Teach (SPIRIT) program recruits and places physician volunteers to donate medical services to the medically indigent and uninsured members of our community. Since its inception, SPIRIT has provided over $11 million in donated care, treated over 53,000 patients and performed over 1,000 surgeries. In 2018, many new specialty procedures were available to patients including specialty consults, colonoscopies and vision exams.
showcases the history of medicine in our region and features medical artifacts from the fields of Surgery, Clinical Diagnosis, Infectious Disease, Pharmacy, Radiology, Chinese Medicine, Obstetrics and Gynecology, Medical Quackery and more. The museum is free of charge and open to the public. In 2018, the museum doubled it’s physical footprint thanks to a generous donation in memory of Al Kahane, MD.
medical student scholarship fund Since 1969, SSVMS has supported the future of medicine
by providing scholarships to deserving medical students who have graduated from a high school in El Dorado, Sacramento or Yolo Counties. In 2018, five students were awarded scholarships, including the Paul J. Rosenberg Medical Student Scholarship recipient, Ashley N. Kyalwazi, MS1, Harvard Medical School.
smart medical clearance SSVMS pioneered the SMART Medical Clearance protocol to standardize the medical clearance process across all emergency departments and inpatient psychiatric hospitals to facilitate the safe and timely transfer of patients to appropriate treatment centers. In 2018, the protocol was implemented at four regional hospitals, bringing the total number of facilities to nine. For more information and to access to resources visit www.smartmedicalclearance.org.
warmth 20 generosity
gratitude Valley Medicine warmth Sierra Sacramento
rx safe physicians
SSVMS’ RX Safe Physicians program is a partnership with the Sacramento and the El Dorado Opioid County Coalitions. The program focuses on educating providers on safe prescribing, promoting medication assisted treatment and increasing access to naloxone. In 2018, the “Got Pain?” Campaign was launched to promote resources for treatment and complementary therapies. For more information, visit www.sacopioidcoalition.org. generosity
SSVMS Community Programs are supported through grants and generous donations from the medical community. Volunteer or consider making a tax deductible donation at www.ssvms.org/programs.
visitors to the museum
$530,000 in-kind donated SPIRIT patient ser vices
SPIRIT patients treated
SPIRIT surgeries donated
$18,000 medical student sc holarships granted gratitude
increase in x-waivered physicians
l i v e s saved through nalaxone project
generosity 2019 March/April
A Pandemic and a Sequel Six Decades Later By Karen Poirier-Brode, MD email@example.com
TWO BOOKS, 1918: THE GREAT PANDEMIC and 1980: The Emergence of HIV, both by Dr. David Cornish, are entertaining and enlightening glimpses into the stories of two powerful viruses and the humans they touched. In 1918, Dr. Edward Noble, a WWI army physician with an infectious disease background and his wife, Lillian, a pioneering epidemiologist, are confronted with the infamous wave of influenza of the title year. The author, who won a first place award for literary fiction for the book in 2014 from the Independent Publishers of New England, vividly illustrates the powerful path of this deadly virus through a world in conflict and as human strengths and weaknesses affect its direction and spread. The interweaving themes of a loving family, human jealousies, conflicting priorities in a world confronted with a horrific war, a passion for medicine and the well-being of mankind make the story particularly interesting to lovers of medicine and history. There is some technical detail that could be difficult for some lay readers, some very detailed lists in descriptions and quite frankly, even this reviewer wanted to shout, “Enough already!” when confronted with yet another set of vital signs. But 1918: The Great Pandemic paints an intense picture of the ravages of a virus gone amok in a world without a clear understanding of severe influenza and its early days before
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vaccination. To be fair, one does get an excellent picture of the disease with the medical information and it becomes more compelling when put in the context of the unnecessary deaths from H1N1 in the 2018-2019 flu season. When scientific fact does not compel individuals to sensible measures like vaccination, perhaps wider readership of a book such as this might. Even with its awkward literary moments, 1918: The Great Pandemic is a fascinating exploration of the story of the Great Flu Pandemic in a solid piece of historical fiction. I recommend a read. 1980: The Emergence of HIV is the recently published second work of fiction by Cornish. While the narrative begins 14 million years ago, it quickly moves through this interesting back story of the human immunodeficiency virus as it focuses on the tale of the grandson of Dr. Edward Noble, Dr. Arthur Noble. Once again, Cornish has skillfully woven the path of an authentic and deadly virus into a compelling story. Dr. Arthur Noble fatefully leaves the East Coast, where he lives in the shadow of his famous family, to do his post-medical school training in San Francisco. Arthur is a brilliant physician but very human. Once again, complicated relationships, jealousies, human frailties and emotion-based political decisions, both by
the government and the gay community, add twists to the plot in which the real main character is not Arthur Noble, but an indiscriminate viral illness that kills, HIV. Cornish skillfully informs the reader of the pathophysiology of the virus in a very understandable fashion as he weaves in the experiences of the real people affected by HIV in compelling subplots. Dramatic scenes and even humorously lurid accounts of other clinical dilemmas and “fascinomas” make the medical world of the characters come alive. Cornish has developed his narrative skills and this is a very captivating story, one I was reluctant to put down. I highly recommend you read this book, too. In the interest of full disclosure, I will note that the author, David Cornish, is a personal friend. David Cornish
M.D., FACP, AGAF worked as a gastroenterologist with The Permanente Medical Group in the California Central Valley Service Area, which is how I came to know him. I was ready to read 1980: The Emergence of HIV, but after learning from David that the books followed the same family of fictional physicians, I took his suggestion that it is best to start by reading 1918: The Great Pandemic first. 1918: The Great Pandemic was self-published by the author in 2013 and is available through Amazon in paperback for $22.71 or on Kindle for purchase at $4.99. It can be read for free if you have Kindle Unlimited. 1980: The Emergence of HIV was published by BookBaby last year and is available on amazon.com in paperback for $19.99 or on Kindle for $4.99.
Wild Bill and the Man in Ice Continued from page 13
shock machine and an Electro-Life water-powered generator that attaches to a faucet to create power. Mr. Hill is a renaissance man with a big heart in an intricately decorated body who happens to spend a lot of time in a tattoo parlor on the second story of an office building in Roseville. Even though they are separated by more than 5,000 years and just as many miles, he and Otzi share a bond of using their bodies to tell their stories. If you’re thinking about a tattoo, Wild Bill will be more than happy to help you tell your story as well. Wild Bill’s love of motorcycles is reflected in the tattoos on his back by famed tattoo artist Ed Hardy.
SSVMS Museum of Medical History Free to the public Monday through Friday 9:00am to 4:00pm 5380 Elvas Ave., Sacramento
Presenter: Mitzi Young California Medical Association Center for Economic Services
Saving Private Practice: Key Strategies for Practice Success Dinner Presentation
Wednesday, May 15, 2019 Registration & Dinner at 5:30pm | Presentation 6:00pm-8:00pm Sierra Sacramento Valley Medical Society, 5380 Elvas Ave. Sacramento, CA 95819 No cost for SSVMS Physician Members | Non-Members: $10 RSVP with Mei Lin Jackson at firstname.lastname@example.org or call (916) 452-2671
CME Credit Pending
“Being part of organized medicine is imperative for any physician. You are connected with many helpful physicians who SSVMS Vetted Vendor Partners to Help You Thrive: have been in your shoes at one point or another and can help answer any questions. SSVMS takes pride in seeing that physicians’ needs are met.” Drs. Anand and Leena Mehta
BLOODSOURCE IS NOW VITALANT! BloodSource has served this community for over 70 years and we will continue to serve you - and those you care for – as Vitalant (pronounced Vye-TAL-ent). Our new name embodies something vital and alive.
We have deep roots here. A change in our name does not change our commitment to this community or its people. In fact, we believe we will have greater impact and more capacity to welcome even more donors. As ten blood centers across the nation unify as Vitalant, we connect people, resources, and the possibility to transform lives. All donations have the possibility of informing life-transforming research and can route to where patients most urgently need blood across the United States. Learn more at Vitalant.org 877.258.4825 (877.25VITAL)
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Joshua’s House: Hospice for the Homeless By Kayla Sheehan, MS III Kayla.Sheehan1253@cnsu.edu ANNA WAS EVICTED from her apartment after she lost her job due to epilepsy. She became homeless, and not long after developed lung cancer. She feared dying alone and leaving no legacy behind her. Unfortunately, she succumbed to her multiple illnesses while living on the street, with no one at her side. Anna’s story, sadly, is not unique. It is a story Joshua Lee, the namesake of Joshua’s House, Sacramento’s future hospice for the homeless, would have wanted us to hear. Every six days, someone like Anna dies on the streets of Sacramento. In 2017, 124 homeless people died in Sacramento County. While many of these deaths are due to overdose and injuries, a growing percentage can be attributed to chronic and terminal illness. Surviving the elements has drastic effects on aging and significantly lowers an individual’s life span. For someone living on the street, life expectancy hovers between 42 and 52 years, compared to 78 years in the general population. Additionally, our homeless population is aging. Over half of people who are homeless are over 50 and have no connection to our healthcare system other than emergency departments. Many homeless people will seek treatment in the emergency department, only to be discharged back to the street. Forty percent of homeless deaths occur outdoors. Last October, Sacramento declared an emergency homeless shelter crisis. Our homeless population increased 30 percent between 2015 and 2017, and a census done in November of 2017 counted 3,665 people living on the streets. This number is likely an underestimate. People who are homeless have an increased risk of mental illness, substance use disorder, PTSD, violence, and illness compared to the
general population. An estimated 80 percent of our homeless population suffers from chronic health conditions such as cancer, diabetes, and COPD. Unfortunately, the vast majority of people who are homeless lack access to primary care, mental health services, medication, education, and insurance. Providing quality care to this population can be a daunting task at any stage of illness, but is particularly difficult towards the end of a person’s life. Traditionally, hospice care is provided in a patient’s home, though care can be provided in a multitude of facilities. As a Medicare benefit, hospice services are covered for eligible patients, but room and board is not. For people who are homeless and terminally ill, these services are difficult, if not impossible, to access. As a result, people like Anna die alone on the street, often in great pain physically, mentally, and spiritually. After her grandson Joshua died on the streets of Omaha in 2014, Dr. Marlene von Friederichs-Fitzwater was compelled to take action. Throughout his time living on the street, Joshua had seen many homeless people die alone, often scared and in great pain. He had a vision of providing a place for people who are homeless and terminally ill to receive comfort care, and where they would feel accepted and respected, filling their final days with love and compassion. In short, a place they could call home. Joshua died when he was 34, but his legacy lives on through Joshua’s House, a hospice for the homeless, opening this year in Sacramento. Joshua’s legacy is in the best possible hands. Dr. von Friederichson-Fitzwater has nearly 30 years of experience in the nonprofit sector March/April 2019
Dr. Marlene von Friederichs-Fitzwater; opposite page, a rendering of the Joshua’s House lobby.
and is the founder and executive director of the nonprofit Health Communication Research Institute, Inc., which has worked to address and reduce healthcare disparities and inequities for the past thirty years. She is also a retired UC Davis professor, cancer researcher, and a cancer survivor herself. When she saw cancer patients being discharged to the street, she realized this was an important issue receiving too little attention. After talking to Joshua about what he had seen, she began doing her own research. She personally interviewed over 100 homeless men and women, and found that their biggest fear was dying alone on the street, confirming what her grandson had told her. She has worked tirelessly ever since to build Joshua’s House, the first hospice for the homeless on the west coast and the seventh in the nation. Last summer, Joshua’s House secured a location at 1501 North C Street, close to Loaves and Fishes, a nonprofit that has been serving Sacramento’s homeless population for over 30 years. The property for Joshua’s House, a 100-year-old warehouse, will be transformed into a 20-bed facility complete with an indoor garden of living trees and plants, a water feature, sky lights, and communal spaces such as a kitchen, library, and chapel as well as individual rooms for privacy. Patients will be provided with hospice care on a rotating basis by local health systems and will have access to addi-
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tional programs such as art and music therapy. Because many people who are homeless die without their families ever knowing, volunteers at Joshua’s House will work to reconnect them with their families if the patient desires. Joshua’s House will also arrange for loving homes for every one of its residents’ pets. Every major Sacramento hospital has pledged to support the endeavor, both monetarily and by agreeing to refer qualifying patients to Joshua’s House when the time comes. These hospital groups will also cover care for patients without insurance. This act of generosity comes with some benefits to the hospital groups as well, as studies have shown that providing patients who are homeless with shelter decreases trips to emergency rooms, readmissions to ICUs, and lengths of hospital stays. The benefits are more than spiritual and humanitarian: annual savings are estimated to be around $6,607 per chronically homeless patient, and the cost of providing shelter falls below the cost of an average hospital stay. The ripple effects of Joshua’s House are already revealing themselves, with multiple other cities reaching out to Dr. von FriederichsFitzwater for advice on how to start programs of their own. While a tremendous amount of work has been done to move the project forward, additional donations large and small are needed to meet the program’s 2019 fundraising goal of $3.5 million. Donors can also sponsor and name an area of Joshua’s House, including the library, kitchen, dining room, multi-purpose room, reception room, and individual rooms. For information on how to sponsor a room, email email@example.com. With 11 community partners, the support of every major health system in Sacramento, an army of passionate volunteers and a true visionary at its helm, Joshua’s House represents a community coming together to provide basic human needs for our most underserved population at their most vulnerable time. Joshua’s House gives people combatting homelessness and terminal illness the promise of peace, comfort, and respect, so that in the final chapter of their lives, they can finally find home.
Photo and Rendering: Joshua’s House
For more information, visit joshuashousehospice.org. References: Basu A, Kee R, Buchanan D, Sadowski LS. Comparative Cost Analysis of Housing and Case Management Program for Chronically Ill Homeless Adults Compared to Usual Care. Health Services Research, 2012; 47(1.2):523– 543. Sadowski LS, Kee RA, VanderWeele TJ, et al. Effect of a Housing and Case Management Program on Emergency Department Visits and Hospitalizations Among Chronically Ill Homeless Adults: A Randomized Trial. JAMA. 2009; 301:1771-1778. Song, J., Bartels, D.M., Ratner, E.R., Alderton, L., Hudson, B., Ahluwalia, J.S. (2008). Dying on the streets: homeless persons’ concerns and desires about end of life care. Journal of General Internal Medicine, 22(4): 435-441.
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Public and Environmental Health Committee Report By Glennah Trochet, MD email@example.com
IN 2018 THE PUBLIC AND ENVIRONMENTAL Health Committee concentrated its efforts on learning more about the mental health system in our community. We heard from the leaders of mental health services in El Dorado, Yolo and Sacramento counties and from these presentations we learned that there is a shortage of mental health providers in the region. We need to advocate for access to more mental health services and to support programs that would serve all the population that needs mental health treatment. The California Medical Association, through its lobbying efforts, supports the increase in behavioral health services throughout California. In June we heard about firearm violence prevention. Physicians have a major role in educating their patients about this issue. Dr. Garen Wintemute, who runs the Violence Prevention Research Program at UC Davis, recommended that physicians use the strategies described in the “What You Can Do To Stop Firearm Violence” website, which can be found at https://health.ucdavis.edu/vprp/WYCD.html This web page describes how physicians can ask questions and give information to individual patients to help prevent firearm violence in their homes. Dr. Bill Durston of Americans Against Gun Violence recommended that physicians take a more active role in advocating for legislation to control firearm violence. This discussion turned out to be very timely, when in November 2018 the National Rifle Association tweeted that “Physicians should stay in their lane,” prompting the “This is our lane” movement describing how doctors confront the effects of firearm violence in every emergency department in this country. The committee wants to see an article Sierra Sacramento Valley Medicine
on firearm violence prevention in the SSVMS magazine. While concentrating mostly on one topic, the committee tries to keep track of other issues of importance. We are fortunate to have representation from public health departments at our meetings and hear about the issues of importance in El Dorado and Sacramento Counties. We would very much like to have representation from Yolo County Public Health, which we hope to have in 2019. We hear periodically about efforts to curb opioid related deaths in the counties we serve. Also, we keep track of efforts to increase access to health care. The committee recommended that the Board of SSVMS support increasing the number of uninsured residents of Sacramento eligible to be served by the Healthy Partners program at the Sacramento County Primary Care Clinic, as well as removing the age limit, and the Sacramento County Board of Supervisors voted to do both in mid-2018. Other recommendations of the committee included supporting the designation of Harm Reduction Services (HRS) as a countywide syringe exchange program in Sacramento County. We were pleased that the California Department of Public Health did indeed give this designation to HRS, thus making the program operational throughout the county, and not just within the City of Sacramento limits. We also recommended signing several letters from the American Lung Association that supported a variety of strategies for cleaner air. In October of 2018, Dr. Donald Lyman and I testified on behalf of SSVMS before the Sacramento City Council’s Law and Legislation Committee in support of banning the sale of flavored tobacco products in the city. There is
Photo: © UC Regents
good evidence that these products, which are used mostly in electronic vapor devices, are conduits for nicotine addiction in adolescents, many of whom then progress to cigarette smoking. Toward the end of 2018 we heard from Dr. Caroline Giroux regarding adverse childhood experiences and how they affect the health of people throughout their lifetime. Dr. Giroux then wrote an article on this topic that was published in the September-October 2018 issue of Sierra Sacramento Valley Medicine. In December of 2018 the committee reviewed our activities from 2017 through 2018 and decided that we would concentrate on issues of children’s health and on the health effects of climate change in 2019. Although these will be our main topics, we will continue to monitor and follow up on other issues of interest to the committee members. For example, we had heard in 2017 about the challenges of implementing regulations for recreational marijuana, which became legal in California in 2018, and in 2019 we plan to find out how this implementation is being accomplished and what are the consequences, both positive and negative, of this legalization. Governor Newsom’s agenda includes addressing homelessness and universal health care in California. The committee plans to keep track of progress in both these arenas and recommend actions to the SSVMS Board as they may be needed. In January 2019 the committee learned about efforts to increase access to dental care for children who have Medi-Cal. The program, called Every Smile Counts, has three pilot programs in Sacramento County. Sacramento is unique in that there is dental geographic managed care in this county. On paper, every child receiving Medi-Cal has an assigned dentist but many parents are not aware of this benefit and have difficulty finding out who their dental provider is and how to access services. Every Smile Counts is funded by federal money, funneled through the California Department of Health Care Services. Funding will end in 2020, but it is hoped that the programs will be well institutionalized by then and will continue with other funding. The first of these pilot programs is the Virtual Dental Home, in which a team consisting of a dental hygienist and a navigator visits schools in the Twin Rivers School district and gives preventive dental care as well as takes X-rays of children on-site at their school. A dentist then reviews the findings at the office and if the child needs follow up care with a dentist, the navigator helps arrange
Garen Wintermute, MD
the appointment for the child. The second program is the Medical Dental Partnership, which does outreach to primary care providers to teach them to evaluate oral health, provide fluoride varnish in their office, provide a caries risk assessment and refer children to their assigned dentist. The pilot is currently working closely with River City Medical Group but would like to expand to other providers who accept Medi-Cal patients. Using expansion money they are receiving in 2019, they plan to place a dental hygienist in doctors’ offices to do the dental screenings on the spot. In addition, they hold learning collaboratives in which dentists, physicians and other providers get together to discuss issues of children’s dental health. SSVMS members can access information on how to make a dental appointment for their patients and get educational materials for parents at first5sacdental.org/esc.resources. The third pilot program, Community Outreach and Parent Education, provides outreach and education to as many families as possible. The materials found at first5sacdental.org/esc.resources are part of this effort. All three pilots are also expanding to Amador County. In February, Dr. Maynard Johnston provided information to the group on issues of children who are in the Child Protective Services system. These children are among the most vulnerable in our community. The committee meets in the SSVMS Board room at 12:30 pm on the third Tuesday of most months of the year. Non-members are welcome to attend if the topic of the meeting is of interest to you.
Board Briefs December 10, 2018 Meeting: The Board:
Approved the following Scholarship and Awards Committee recommendations for the 2018 annual awards: Denise Satterfield, MD, Golden Stethoscope Award; David A. Herbert, MD, Medical Honor Award; Society for the Blind, Medical Community Service Award. The awards will be presented at the SSVMS Honors Medicine event on February 28, 2019 at the Tsakopoulos Library Galleria. Approved the 2019 Committee Appointments. Approved the resignation of Jose F. Abad, MD as Director, representing District 5, Office 5 due to his relocation to the East Coast. Approved the appointment of Roderick Vitangcol, MD to fill the one-year vacancy (2019) remaining in the Director, District 5, Office 5. Approved the 2019 Budgets for the Sierra Sacramento Valley Medical Society (SSVMS) and the Community Service, Education and Research Fund (CSERF). Approved the 3rd Quarter Financial Statements, Investment Reports and Recommendations. Approved the Following Membership Reports: November 5, 2018 For Active Membership — Mohamed Ali, MD; Mohammad Arshad, MD; Ardavan Aslie, MD; Philip Avedschmidt, MD; Angella Barr,
Sierra Sacramento Valley Medicine
MD; Manjula Bobbala, MD; Jacqueline Calkin, MD; Celia Chang, MD; Andres Crowley, MD; Deborah Dossick, MD; Jenny Du, DO; Abida Faiz, DO; Lin Lin Gao, MD; Mary Paz Golingho, MD; Farzam Gorouhi, MD; Mandeep Grewal, MD; Susan Guralnick, MD; Casuarina Hart, MD; Griffith Harsh, MD; Shawn Hersevoort, MD; Donovan Huynh, MD; Samuel Hwang, MD; Thomas Konia, MD; Satyan Lakshminrusimha, MD; Francis Lam, MD; Lara Levin, MD; Hao Harry Li, MD; Nijhu Mahbub, DO; David Mazariegos, MD; Nida Ali, MD; Matthew Mell, MD; Marvi Montano-Ip, MD; Jodi Mrosko, MD; Minh-Bao Mundschenk, MD; Laura Nasatir, MD; Albert Nayeri, MD; Baran Onder, MD; Mikala Pacifique, MD; Joshua Rae, MD; R. Lor Randall, MD; Kaela Reinert, MD; Jamal Sadik, MD; Kiran Sampley, MD; Kiarash Shahlaie, MD; Sarah Shelton, MD; Tiffany Shiau, MD; Gerard Somers, DO; Eric Steinman, MD; Caleb Sunde, MD; Leslie Tamura, DO; Azadeh Toofaninejad, DO; Natascha Tuznik, DO; Mark Waheed, DO; Charlie Wang, MD; Paterra Yang, MD; Serena Yang-Loudin, MD; Zoe Yu, MD. For Resident to Active Membership — Elizabeth Pontarelli, MD. For Resident Active Membership — Brittany Bartolome, MD; Leland Bourdon, MD; Laura Nasatir, MD; Lauren Perry, MD. For Reinstatement to Active Membership — Alison Boudreaux, MD; Trang Dinh, MD; Eric Tepper, MD. For Retired Membership — Gregory Cox, MD; John Dein, MD; Alan Ertle, MD; John Friend, MD; Robert Hales, MD; Hanns Haesslein, MD; Stephen McCurdy, MD; William Pevec, MD; Kathleen Quadro, MD; Frank Reynolds, MD;
J. Dale Smith, MD; Fern Takemoto, MD; Mary Jess Wilson, MD. For Active 65/20 Membership — Russell Jacoby, MD. For Resignation — Mohamed Omran, MD. Deceased — Lawrence Bugbee, MD; Herbert Cronin, MD; Thomas Edwards, MD; Robert Myers, MD. December 10, 2018 For Active Membership — Ali Amirzadeh, MD; Sarah Shaffin, MD; Matthew Gibson, MD; Robert Ghiselli, MD; Mina Hah, MD; Isaac Kim, MD; Hai Luong, DO; Toussaint Mears-Clarke, MD; Sarah Medeiros, MD; Lisa Mills, MD; Nancy Nguyen, DO; David Pai, MD; John Tomaich, MD; Kim Wang, MD. For Reinstatement to Active Membership — Ricardo Bardales,MD; Parimal Bharucha, MD; Frank Boutin, Jr., MD; Timothy Lee, MD; James Liu, MD; Alexander Massey, MD; Michelle Mattison-Kelly, MD; Catherine Moizeau, MD; Timothy Takagi, MD; Mary Jess Wilson, MD. For Retired Membership — John Ballenger, MD; Fern Takemoto, MD. For Resignation — Jose F. Abad, MD (moved out of state); Michael Ajakaiye, MD (moved out of state); Alan Lee, MD (moved out of state); James Littlejohn, MD (moved out of state); Elizabeth Madarang, MD (moved out of state); Michael Moore, MD (moved out of state); Frank Reynolds, MD (retired and license delinquent).
January 14, 2019 Meeting: The Board: Welcomed Christian Serdahl, MD as the 2019 SSVMS President. Extended a thank you to outgoing President Rajiv Misquitta, MD, for his leadership in 2018. Also welcomed new Directors Ashutosh Raina, MD, representing District 1 (North Area); Adam Dougherty, MD, representing District 2 (Central Area); and Roderick Vitangcol, MD, representing District 5 (The Permanente Medical Group). Elected Carol Kimball, MD 2019 Secretary and Paul Reynolds, MD 2019 Treasurer. Received a presentation from Douglas Crumley, Jr. and Dominick Anton, of Crumley & Associates, a private wealth advisory practice of Ameriprise Financial Services,
Inc. Crumley & Associates have been approved as an SSVMS vetted vendor. Received an update from Megan Sharpe, SSVMS Physician Relations Manager, regarding the new membership campaign, Saving Private Practice. Approved the Financial Statements Ending December 31, 2018. Approved the Membership Report: For Active Membership — Latifat Alli-Akintade, MD; Galen Baker, DO; Bharat Bhatt, DO; Daniel Cohen, MD; Geoffrey D’Cruz, MD; Jenny Dong, MD; Erica Dorfman, MD; Doria Easter, DO; Erika Escobedo, MD; Luz Fletcher, MD; Lindsay Frost, MD; Samuel Galle, MD; Kanwal Gill, MD; Darshdeep Gosal, DO; Sanaz Hajizadeh Barfjani, MD; Yong He, MD; Maowen Hu, MD; Salwa Hussain, MD; Vivian Igilige, MD; Emily Kassenbrock, MD; Muhammad Khan, MD; David Kim, MD; Kristine Kjellsson, MD; Erik Kvamme, MD; Kathy Kyo, MD; George Lai, DO; Chai-Li Lai, MD; Candace Lawson, MD; Jessica Lee, MD; Alice Lin, DO; Jonathan Liu, MD; Julie Loewen, MD; Nicole Makram, MD; Mollie Massy, DO; Cynthia Mendez-Kohlieber, MD; Megan Merrill, DO; Janelle Minter, MD; Lesle Naliboff, MD; Ei Mon Oo, MD; John Panuska, MD; Alice Park, MD; Kory Parsi, DO; Minal Patel, MD; Maria Persianinova, DO; Hoang N. Pham, MD; Joanna Shepherd, MD; Shawn Skarpnes, MD; Sahand Sohrabi, MD; Edward Sorenson, MD; Jeffrey Stenger, MD; Bina Vasantharam, MD; Lynne Vong, DO; Benjamin Voronin, MD; Jasmine Win, MD; Angie Yu, MD; Karen Zhou, MD. For Reinstatement to Active Membership — Diane Apostolakos, MD; Allison Buss, MD; Philip Buss, MD; Karyn D’Addio-Riley, DO; Laura Emge, MD; Petra Hoette, MD; Bernard Ormsby, DO; Jonathan Perlman, MD; Anna Peter, MD; Lin Soe, MD; Harrison Tong, DO; Wesley Tsai, MD; Brooke Vuong, MD; Stephanie Yee-Guardino, DO. For Resident Active to Active Membership — Ron Martin Menorca, MD. For Resident Active Membership — Andrew Matthys, MD. For Retired Membership — Paul Bilunos, MD; Roger Gilbert, MD; Ralph Koldinger, MD; Stacie Walton, MD. For Transfer of Membership — Carol Havens, MD (TPMG-Alameda Contra Costa); Mylapore Niranjank, MD (TPMG-Placer Nevada); Tamas Vidovszky, MD (TPMGSanta Clara); Guanglan Zhu, MD (TPMG-Alameda Contra Costa). For Resignation — Ramotse Saunders, MD (moved out of area).
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New SSVMS 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. — Carol Kimball, MD, Secretary. APPLICANTS FOR ACTIVE MEMBERSHIP: Latifat Alli-Akintade, MD, General Medicine, The Permanente Medical Group Ali Amirzadeh, MD, Allergy, Mercy Medical Group Diane Apostolakos, MD, Hospitalist, The Permanente Medical Group Galen Baker, DO, Emergency Medicine, The Permanente Medical Group Ricardo Bardales, MD, Pathology, Outpatient Pathology Associates Parimal Bharucha, MD, Pulmonary Critical Care Medicine, Mercy Medical Group Bharat Bhatt, DO, General Medicine, The Permanente Medical Group Frank Boutin Jr, MD, Orthopaedic Surgery, Mercy Medical Group Allison Buss, MD, Pediatrics, The Permanente Medical Group Philip Buss, MD, Emergency Medicine, The Permanente Medical Group Sarah Chaffin, MD, Family Medicine, Mercy Family Medicine Residency Program Rekha Cheruvattath, MD, Gastroenterology, Mercy Medical Group Daniel Cohen, MD, General Medicine, The Permanente Medical Group Karyn D’Addio-Riley, DO, Anesthesiology, The Permanente Medical Group Geoffrey D’cruz, MD, Hospitalist, The Permanente Medical Group Jenny Dong, MD, Pathology, The Permanente Medical Group Erica Dorfman, MD, General Medicine, The Permanente Medical Group Doria Easter, DO, General Medicine, The Permanente Medical Group Laura Emge, MD, Pediatrics, The Permanente Medical Group Erika Escobedo, MD, Pediatrics, Mercy Medical Group Luz Fletcher, MD, Obstetrics/Gynecology, The Permanente Medical Group Lindsay Frost, MD, Pediatrics, The Permanente Medical Group Samuel Galle, MD, Orthopedics, The Permanente Medical Group Matthew Gibson, MD, Family Medicine, Mercy Family Medicine Residency Program Kanwal Gill, MD, Emergency Medicine, The Permanente Medical Group Robert Ghiselli, MD, Pathology, Diagnostic Pathology Medical Group Darshdeep Gosal, DO, Family Medicine, The Permanente Medical Group Mina Hah, MD, Psychiatry, Synapse Association
Sanaz Hajizadeh Barfjani, MD, General Medicine, The Permanente Medical Group
Michelle Mattison-Kelly, MD, Pediatrics, Mercy Medical Group
Yong He, MD, Dermatology, Mercy Medical Group
Toussaint Mears-Clarke, MD, Family Medicine, Mercy Family Medicine Residency Program
Petra Hoette, MD, Obstetrics/Gynecology, The Permanente Medical Group Maowen Hu, MD, Radiology, The Permanente Medical Group Salwa Hussain, MD, General Medicine, The Permanente Medical Group Vivian Igilige, MD, General Medicine, The Permanente Medical Group Thomas Imperato, MD, Gastroenterology, Mercy Medical Group
Sarah Medeiros, MD, Emergency Medicine, UC Davis Cynthia Mendez-Kohlieber, MD, General Medicine, The Permanente Medical Group Ron Martin Menorca, MD, General Medicine, The Permanente Medical Group Megan Merrill, DO, Urology, The Permanente Medical Group Lisa Mills, MD, Emergency Medicine, UC Davis
Emily Kassenbrock, MD, Pediatrics, The Permanente Medical Group
Janelle Minter, MD, General Medicine, The Permanente Medical Group
Muhammad Khan, MD, Emergency Medicine, The Permanente Medical Group
Catherine Moizeau, MD, Family Medicine, Shingle Springs Health & Wellness Center
David Kim, MD, Radiology, The Permanente Medical Group
Lesley Naliboff, MD, Obstetrics/Gynecology, The Permanente Medical Group
Isaac Kim, MD, Vascular and Interventional Radiology, The Permanente Medical Group
Nancy Nguyen, DO, Family Medicine, Mercy Family Medicine Residency Program
Kristine Kjellsson, MD, Obstetrics/Gynecology, The Permanente Medical Group
Ei Mon Oo, MD, General Medicine, The Permanente Medical Group
Erik Kvamme, MD, Emergency Medicine, The Permanente Medical Group
Bernard Ormsby, DO, General Medicine, The Permanente Medical Group
Kathy Kyo, MD, General Medicine, The Permanente Medical Group
David Pai, MD, Nephrology, Capital Nephrology Group
George Lai, DO, Radiology, The Permanente Medical Group
John Panuska, MD, Occupational Medicine, The Permanente Medical Group
Chia-Li Lai, MD, Radiology, The Permanente Medical Group
Alice Park, MD, Psychiatry, The Permanente Medical Group
Candace Lawson, MD, Family Medicine, Dignity Health
Kory Parsi, DO, Dermatology, The Permanente Medical Group
Jessica Lee, MD, Surgery, The Permanente Medical Group
Minal Patel, MD, General Medicine, The Permanente Medical Group
Timothy Lee, MD, Cardiovascular Disease, Mercy Medical Group
Jonathan Perlman, MD, Ophthalmology, Perlman Center for Eye & Eyelid Surgery
Alice Lin, DO, Hospitalist, The Permanente Medical Group
Maria Persianinova, DO, General Medicine, The Permanente Medical Group
James Liu, MD, Internal Medicine, Mercy Medical Group
Anna Peter, MD, Emergency Medicine, The Permanente Medical Group
Jonathan Liu, MD, Neuro-Surgery, The Permanente Medical Group
Hoang N. Pham, MD, Internal Medicine, Mercy Medical Group
Julie Loewen, MD, Internal Medicine, Mercy Medical Group
Joanna Shepherd, MD, General Medicine, The Permanente Medical Group
Gilbert Luceno, MD, Family Medicine, Mercy Medical Group
Shawn Skarpnes, MD, General Medicine, The Permanente Medical Group
Hai Luong, DO, Physical Medicine and Rehabilitation, The Permanente Medical Group
Lin Soe, MD, Hematology/Oncology, Marshall Hematology & Oncology
Nicole Makram, MD, Pediatrics, The Permanente Medical Group
Sahand Sohrabi, MD, Radiology, The Permanente Medical Group
Alexander Massey, MD, Pulmonary Disease, Marshall Pulmonology
Edward Sorenson, MD, General Medicine, The Permanente Medical Group
Mollie Massy, DO, General Medicine, The Permanente Medical Group
Jeffrey Stenger, MD, Hospitalist, The Permanente Medical Group Continued on page 35
Sierra Sacramento Valley Medical Society Upcoming Events MAR 21
“Understanding the New Tax Law” Ameriprise Financial Services Dinner Presenta�on, Thursday, March 21, 2019, Sacramento, CA
“CyberRisk -- Is Your Prac�ce at Risk?” Cooperative of American Physicians, CME Dinner Presenta�on, Wednesday, March 27, 2019, Folsom, CA
“Scope of Pain,” One Community Health and Boston University Breakfast Presenta�on Saturday, April 6, 2019, Sacramento, CA
“Mindfulness and Money,” SAFE Credit Union Dinner Presenta�on, Tuesday, April 9, 2019, Folsom, CA
Legisla�ve Advocacy Day, California Medical Association Wednesday, April 24, 2019, Sacramento CA
“Running a Private Prac�ce: Surviving or Thriving” CME Dinner Presenta�on, Wednesday, May 15, 2019, Sacramento, CA
Race for the Clinics, Serotonin Surge Charities 5K/10K Run/Walk, Saturday, May 18, 2019, Sacramento, CA
Contact Mei Lin Jackson at (916) 452-2671 or email firstname.lastname@example.org to RSVP to any of the events above! 34
Sierra Sacramento Valley Medicine
Applicants for Active Membership Continued from page 33 Timothy Takagi, MD, Family Medicine, Mercy Family Medicine Residency Program
Kim Wang, MD, Pathology, Diagnostic Pathology Medical Group
John Tomaich, MD, Oral and Maxillofacial Surgery, Tomaich Oral Surgery
Jasmine Win, MD, General Medicine, The Permanente Medical Group
Harrison Tong, DO, General Medicine, The Permanente Medical Group
Stephanie Yee-Guardino, DO, Pediatrics, The Permanente Medical Group
Wesley Tsai, MD, General Medicine, The Permanente Medical Group
Angie Yu, MD, Psychiatry, The Permanente Medical Group
Bina Vasantharam, MD, Emergency Medicine, The Permanente Medical Group
Karen Zhou, MD, Hospitalist, The Permanente Medical Group
Lynne Vong, DO, Internal Medicine, The Permanente Medical Group Benjamin Voronin, MD, Emergency Medicine, The Permanente Medical Group Brooke Vuong, MD, Surgery, The Permanente Medical Group
APPLICANTS FOR RESIDENT ACTIVE MEMBERSHIP: Andrew Matthys, MD, Pulmonary Disease, UC Davis – 2022
SIERRA SACRAMENTO VALLEY MEDICAL SOCIETY 2019 COMMITTEE APPOINTMENTS EDITORIAL Drs. Sean Deane, Caroline Giroux, Robert LaPerriere, George Meyer, John Ostrich, Karen Poirier-Brode, Gerald Rogan, Glennah Trochet, Lee Welter; Medical Students: Mustafa Bahramand, MS II, Steven Nemeck, MS III, Eric Ovruchesky, MS I, Neeraj Ramakrishnan, MS III; Ken Smith, Managing Editor. EMERGENCY CARE Drs. Peter Hull, Chair; Seth Thomas, Vice Chair; Katie Baker, Nicole Braxley, Matthew Donnelly, Andrew Elms, Roel Farrales, Hernando Garzon, Vinh Le, Maurice Makram, Devin Merchant, Joseph Morris, Karen Murrell, Dwight Stalker, R. Steve Tharratt, Sam Turnipseed, Justin Wagner, William Webster, David Wisner, Rodolpho Zaragoza. Invited Guests: Drs. Christopher Bradburn, Joseph Chiang, Kevin Jones, Aimee Moulin, Andrew Wong. HISTORICAL Drs. Robert LaPerriere, Chair, Richard Astorino, Peter Carruth, Malcolm Ettin, Christine Fernando, Francine Gallawa,
James Hamill, Julian Holt, Donald Hopkins, Rosalind Kirnon, Elisabeth Mathew, Jack Ostrich, Gail Pirie, and James Rybka; Invited Guest: Kent Perryman, PhD. JUDICIAL – Appointed as needed. PUBLIC AND ENVIRONMENTAL HEALTH Drs. Glennah Trochet, Chair; Ruenell Adams Jacobs, Regan Asher, Richard Astorino, Ron Chapman, Clinton Collins, Anthony DeRiggi, Christine Fernando, Jessica Fortin, Ann Gerhardt, Maya Heinert, Maynard Johnston, Olivia Kasirye, Donald Lyman, Robert Meagher, George Meyer, Dennis Michel, Robert Midgley, Mary Pat Pauly, Karen Poirier-Brode, Richard Sun, Nancy Williams, Medical Students Kryls Domalaon, MS II, Dayna Isaccs, MS II, Mariam Soni, MS I. SCHOLARSHIP AND AWARDS Drs. Margaret Parsons, Chair, Sean Deane, Ruth Haskins, George Meyer, Travis Miller, Susan Murin, James Sehr.
Contact SSVMS to Access Your
Member Only Benefits
email@example.com | (916) 452-2671 BENEFIT
Reimbursement Helpline FREE assistance with contracting or reimbursement.
CMA’s Center for Economic Services (CES) www.cmadocs.org/reimbursement-assistance | (888) 401-5911
Legal Services CMA On-Call, Legal Handbook (CPLH) and more…
CMA’s Center for Legal Affairs www.cmadocs.org/legal-resources | (800) 786-4262
Insurance Services Life, Disability, Long Term Care, Medical/Dental, Workers’ Comp, etc.
Mercer Health & Benefits Insurance Services LLC www.countycmamemberinsurance.com | (800) 842-3761
Travel Accident and Travel Assistance Policies This is a free benefit for all SSVMS members.
Prudential Travel Accident Policy & AXA Travel Assistance Program www.ssvms.org/Portals/7/Assets/pdf/AXA-travel-accident-policy.pdf
Career Center Member groups receive free basic job postings and access to the Career Center resume bank.
California Physician ™ Career Center www.careers.cmadocs.org
Mobile Physician Websites Save up to $1,000 on unique website packages.
MAYACO Marketing & Internet www.mayaco.com/physicians
Auto/Homeowners Insurance Save up to 10% on insurance services.
Mercury Insurance Group www.mercuryinsurance.com/cma
Car Rental Save up to 25% - Members-only coupon codes required.
Avis or Hertz
CME Certification Services Discounted CME Certification for members.
Institute for Medical Quality (IMQ) www.imq.org
Student Loan Refinancing Members receive a rate discount of 0.25% off the approved loan rate.
Healthcare Messaging Free secure messaging application
HIPAA Compliance Solutions Members receive a discount on the Toolkit.
PrivaPlan Associates, Inc www.privaplan.com
Magazine Subscriptions Members get up to 89% off the cover price of popular magazines.
Subscription Services, Inc www.buymags.com/cma
Confidential Physician Wellness Resources 24-hour confidential assistance hotline is free and will not result in any disciplinary action. Additional Physician wellbeing resources also available through SSVMS’ Joy of Medicine.
Physicians’ Confidential Line (650) 756-7787 www.cmadocs.org/confidential-line www.joyofmedicine.org
Medical Waste Management Save up to 30% on medical waste management and regulatory compliance services.
Office supplies, facility, technology, furniture, custom printing and more… Save up to 80%
Physician Laboratory Accreditation 15% off lab accreditation programs and services Members only coupon code required
COLA (800) 981-9883
Security Prescription Products RxSecurity Members receive 15% off tamper-resistant security subscription pads. www.rxsecurity.com/cma-order
SSVMS Vetted Vendor Partners SSVMS’ Vetted Vendors are trusted partners of the Medical Society. Each business has gone through an application process and provided multiple physician references that can attest to their satisfaction with the business. Access Vetted Vendors 916-452-2671 or firstname.lastname@example.org. Cooperative of American Physicians (CAP) Medical professional liability protection to over 12,000 of California’s finest physicians.
Sotheby’s International Realty Mela Fratarcangeli is consistently ranked in the top 5% of all real estate agents in the Sacramento Valley serving the buyers and sellers at all levels in the Sacramento Region.
Crumley & Associates Drawing on more than 120 years of experience, Crumley & Associates emphasizes sound financial planning, along with a variety of personal financial services.
The Mortgage Company The Mortgage Company brings a wealth of experience to every purchase and refinance loan, and exceptional concierge level service.
Bank Card USA By eliminating the middleman, Bank Card USA is able to offer special pricing for our members.
If the road remains open, Everyone has a chance to win.
RACE FOR THE CLINICS Sacramento, CA
SATURDAY, MAY 18
Join us for our 2nd Annual Race for the Clinics held near Downtown Sacramento. Our 5K/10K Run/Walk raises funds for safety-net medical clinics in the greater Sacramento Region. These clinics provide 250,000 visits per year to the under-insured and uninsured.
Register today by visiting
• Free Kids Fun Run (10 & Under) • 5K (3.1 miles) & 10K (6.2 miles) • Post Race Health Expo • Corporate Team option available • Entry includes a t-shirt & medal
The Sierra Sacramento Valley Medical Society (SSVMS) is a professional association representing physicians in all modes of practice and spec...
Published on Mar 1, 2019
The Sierra Sacramento Valley Medical Society (SSVMS) is a professional association representing physicians in all modes of practice and spec...