2020-Mar/Apr - SSV Medicine by Sierra Sacramento Valley Medical Society

Sierra Sacramento Valley Serving the counties of El Dorado, Sacramento and Yolo

March/April 2020

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Sierra Sacramento Valley

MEDICINE 4

PRESIDENT’S MESSAGE

Homelessness a Complex, Confounding Problem John Wiesenfarth, MD

EXECUTIVE DIRECTOR’S MESSAGE

A Journey of Discovery With The Wild Women of Borneo Aileen Wetzel, Executive Director

OPINION

When Words Can’t Tell The Entire Story Caroline Giroux, MD

SSVMS Annual Report

Glennah Trochet, MD

F. James Rybka, MD and Lucille C. Rybka, RN, Ed.D.

Jack Ostrich, MD

Testing, Community Outreach Needed to Stem Rise in Syphilis

An Aura of Mysticism, A Dose of Skepticism

Nursing History Room Opens At SSVMS Museum

Board Briefs

New SSVMS Members

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. All articles are copyrighted for publication in this magazine and on the Society’s website. Contact the Sierra Sacramento Valley Medical Society for permission to reprint.

Revenge of The Rats Faith Fitzgerald, MD

A Few (Musical) Notes From the OR Lee Welter, MD

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

Normalization of Deviation Gerald Rogan, MD

POETRY

Will My Child Walk? Jon Davids, MD

VOLUME 71/NUMBER 2

Cover photo: An orangutan ponders his new freedom at the Salat Island sanctuary in Central Kalimantan, Borneo. This photo was taken during Executive Director Aileen Wetzel’s recent trip to Indonesia. Read more about her fascinating journey on page 6.

Official publication of the Sierra Sacramento Valley Medical Society

5380 Elvas Avenue Sacramento, CA 95819 916.452.2671 916.452.2690 fax info@ssvms.org

Photo by Sharon David SSV Medicine is online at www.ssvms.org/Publications/SSVMedicine.aspx Comments or letters, which may be published in a future issue, should be sent to the author’s email or to SSVMedicine@ssvms.org.

March/April 2020

Sierra Sacramento Valley 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.

2020 Officers & Board of Directors

John Wiesenfarth, MD, President Carol Kimball, MD, President-Elect Christian Serdahl, MD, Immediate Past President District 1 Vacant District 2 Adam Dougherty, MD J. Bianca Roberts, MD Vanessa Walker, DO District 3 Ravinder Khaira, MD District 4 Ranjit Bajwa, MD

District 5 Sean Deane, MD Farzam Gorouhi, MD Paul Reynolds, MD Roderick Vitangcol, MD Angie Yu, MD District 6 Marcia Gollober, MD

2020 CMA Delegation District 1 Reinhardt Hilzinger, MD District 2 Lydia Wytrzes, MD District 3 Katherine Gillogley, MD District 4 Anand Mehta, MD District 5 Sean Deane, MD District 6 Marcia Gollober, MD At-Large R. Adams Jacobs, MD Barbara Arnold, MD Helen Biren, MD Adam Dougherty, MD Katherine Gillogley, MD Richard Gray, MD Richard Jones, MD Carol Kimball, MD Charles McDonnell, MD Sandra Mendez, MD Rajiv Misquitta, MD Sen. Richard Pan, MD Kuldip Sandhu, MD James Sehr, MD Christian Serdahl, MD Ajay Singh, MD John Wiesenfarth, MD Don Wreden, MD Lydia Wytrzes, MD

District 1 Alternate Megan Babb, DO District 2 Alternate Ann Gerhardt, MD District 3 Alternate Thomas Valdez, MD District 4 Alternate Vacant District 5 Alternate Ernesto Rivera, MD District 6 Alternate Christopher Swales, MD At-Large Alternates Brian Bernhardt, MD Natasha Bir, MD Christine Braid, DO Arlene Burton, MD Ronald Chambers, MD Amber Chatwin, MD Lucy Douglass, MD Mark Drabkin, MD Rachael Ekraib, MD Gordon Garcia, MD Karen Hopp, MD Brian Jones, MD Mohammad Khan, MD Jocelyn Kim, MD Derek Marsee, MD Leena Mehta, MD Neill Parikh, MD J. Bianca Roberts, MD Romero Santiago, MD

CMA Trustees, District XI Douglas Brosnan, MD

Margaret Parsons, MD

CMA President-Elect Lee Snook, MD

AMA Delegation Barbara Arnold, MD

Editorial Committee

Sandra Mendez, MD

Megan Babb, DO Sean Deane, MD Caroline Giroux, MD Robert LaPerriere, MD George Meyer, MD

John Ostrich, MD Karen Poirier-Brode, MD Gerald Rogan, MD Glennah Trochet, MD Lee Welter, MD

Executive Director Managing Editor Webmaster

Aileen Wetzel Ken Smith Melissa Darling

Sierra Sacramento Valley Medicine

HOSTED BY LOCAL PHYSICIANS

Listen and subscribe to Joy of Medicine - On Call on your favorite Podcast App or visit joyofmedicine.org

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&#x20AC;&#x2122; 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. ÂŠ2020 Sierra Sacramento Valley Medical Society SIERRA SACRAMENTO VALLEY MEDICINE (ISSN 0886 2826) is published bimonthly 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.

| FEATURED CONTRIBUTORS |

John Wiesenfarth, MD

Caroline Giroux, MD

Glennah Trochet, MD

SSVMS President John Wiesenfarth, MD looks at one of the most agonizing problems affecting our community—homelessness—and how SSVMS and others are trying help those affected.

In an intensely personal and compelling article, Dr. Giroux tells how the recent downing of a Ukranian plane in Iran brought back memories of a painful decision and how life can change in an instant.

Syphilis, a disease once on the verge of elimination in California, is resurging. The number of congenital cases is particularly alarming. Dr. Trochet offers some recommendations and insight for physicians.

Jon Davids, MD

Jack Ostrich, MD

Faith T. Fitzgerald, MD

Dr. Davids, a pediatric orthopedic surgeon at Shriners Hospital noted for his work treating children with cerebral palsy, offers a touching poem in response to a heartbreaking question: Will my child walk?

We turned Dr. Ostrich loose at the Sacramento Healing Arts Festival so he could get his aura read, chakras checked and pulse diagnosed. And then it was off to (maybe) try “aqueous humic substances.”

Dr. Fitzgerald offers another of her entertaining recollections, this one involving an unconscious truck driver with an unusual hobby that caused a medical mystery. Fortunately, Dr. Fitzgerald was on the case.

drjohn@winfirst.com

jdavids@shrinenet.org

Gerald Rogan, MD

jerryroganmd@sbcglobal.net

This month, Dr. Rogan relates some personal experiences that reflect a growing danger in health care: the normalization of deviation from safety protocols that stand between patients and tragedy.

cgiroux@ucdavis.edu

jmost119@aol.com

trochetg@gmail.com

ftfitzgerald@ucdavis.edu

F. James Rybka, MD and Lucille Rybka, RN

jimrybka@hotmail.com Dr. Jim Rybka, a retired plastic surgeon and member of the Historical Committee, and his wife Lucille Rybka, a retired nurse, write about an important new collection located at the Museum of Medical History: a new room focused on the history and dynamic expansion of the scope of nursing from the mid-19th century to today.

March/April 2020

| PRESIDENT’S MESSAGE |

Homelessness a Complex, Confounding Problem By John Wiesenfarth, MD drjohn@winfirst.com

’ve been practicing in our community for over 20 years, and the number of homeless in our community over that time seems to have increased exponentially. I never used to see a homeless person on my way to work. Now I pass by mini encampments daily. It’s not my imagination. In a count done last summer by Sacramento Steps Forward, there were over 1,900 people on the street in the city of Sacramento and over 5,500 throughout Sacramento County. Those numbers are up over 50% from just two years ago. Nearly 25% of the nation’s homeless population resides in California. In our area, the vast majority— over 70%—of homeless are living outside of shelters. The Sacramento Steps Forward survey found that 93% of the homeless they counted were originally from Sacramento, that the homeless population is split almost evenly between whites and people of color, and that the numbers included 372 families and 688 kids. The homeless are also overwhelmingly male by a two-to-one ratio. Lack of affordable housing, poverty, and debt are major factors. In addition, studies show about 20% are homeless due to substance abuse and about 25% have severe mental illness. The United Nations has compared the state’s homeless camps to the slums of Pakistan, India, Brazil, and Mexico. Consequently, it is important that we seek to understand the problem. My son had a insightful opportunity to live amongst the homeless for 24 hours as part of a high school program. He was taken to Friendship Park in Sacramento where he was given an orientation and then left to fend for himself on the streets, making friends with other homeless people. It was a tremendously eye-opening experience for him. He now better understands that not all homelessness is due to drugs or mental health and he has a deeper understanding of the homeless situation than most of us. To this day he rolls down his window and gives his last few dollars to the person on the street corner panhandling, knowing that he or she needs the 4

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money more than he does. The experience told him that finding a solution for the homeless requires understanding what is important to them, not to those of us who are fortunate enough to not live on the streets. I think that any government official who wants to help the homeless could learn a tremendous amount by spending a night or two on the streets to truly get a grasp on what the best answers may be. There are times when good intentions don’t necessarily lead to results, however. SB 1152, which was signed into law last year, is a good example. It requires hospitals to provide a homeless person who, after care, is discharged from an emergency department with prescriptions, vaccines, warm clothes and a meal. This sounds like good public policy, yet my fellow emergency

My fellow emergency medicine physicians tell me that that they frequently witness homeless patients tossing prescriptions for medication into the trash on their way out the door. medicine physicians from throughout the state tell me that that they frequently witness homeless patients tossing prescriptions for medication into the trash on their way out the door and refusing shelter because they prefer their independence to living with others they do not know. How do we bridge the divide between what makes us feel good and what patients really want and need? We know that being unsheltered is a huge threat to the health of the homeless. Mayor Darrell Steinberg and Governor Newsom have made homelessness one of their top priorities. Mayor Steinberg wants the federal government and local governments to house the homeless and Gov. Newsom announced more than $1 billion in homeless funding, including $750 million for the Access to Housing and Services Fund. He also wants changes to the Medi-Cal system to better serve those

with mental illness who are homelessness. SSVMS, through our Public and Environmental Health Committee, has been studying issues that impact the homeless for several years. Our Medical Society has reached out to each elected body in Sacramento, including the Board of Supervisors and multiple city councils, to encourage them to collaborate to increase housing availability at all levels of income, but particularly for low-income residents of Sacramento County. SSVMS has also urged Sacramento County to authorize and implement Laura’s Law, which allows courtordered assisted mental health outpatient treatment, and to support a Hepatitis A vaccination program for specific populations. We have also encouraged them to enact sanitation strategies, such as access to bathrooms, to prevent a dangerous hepatitis outbreak such as what was experienced by San Diego and Santa

Cruz counties. As a physician, my training has taught me to “seek to understand” and that while it is important to treat symptoms, addressing the root cause is the best goal. The problem of homelessness is complex, frustrating, heartbreaking

and has an impact on all of us. I am proud of what SSVMS has done to address homelessness and the associated personal and public health issues, and I hope that initiatives offered at the state and local level are a step in the right direction.

SSVMS Upcoming Events MAR 18

Medical Marijuana CME Dinner Presentation - Cooperative of American Physicians, Folsom, CA

Art of Medicine - SSVMS Alliance APR Del Paso Country Club, Sacramento, CA 18

MAY 18

MAY Joy of Medicine CME Dinner Workshop Sacramento, CA 6

Confident Retirement - Ameriprise Financial, Crumley & Associates, El Dorado Hills, CA To RSVP contact Sam Mello at rsvp@ssvms.org or (916) 452-2671

March/April 2020

A Journey of Discovery With The Wild Women of Borneo

here will be a few times in your life when all your instincts will tell you to do something. Something that defies logic and may seem crazy to others. When that happens, trust your instincts and just do it. Since SSVMS launched our nationally recognized Joy of Medicine program in 2017, I frequently ask our physician members what brings them joy. At the end of a particularly grueling week last summer, I found myself asking the same question. Solo travel is my selfcare and “me time” was desperately needed. An internet search led me to Wild Women Expeditions, a Canadian company that specializes in adventure travel for solo female travelers. On an impulse, I clicked on “Untamed Indonesia” and in a few short weeks I was on a flight to Jakarta to meet up with four women I had never met to explore parts of Indonesia that most tourists don’t see. In Flores, we stayed on a sailboat and visited remote villages where we bartered rice for fresh fish, climbed the highest peak on Padar Island to watch the sunrise and snorkeled with manta rays the size of large satellite dishes. We visited uninhabited islands and marveled at the pristine beaches, the sand colored pink from coral. We dropped anchor at sunset to watch thousands of fruit bats, with wing spans measuring between 2 and 3 meters, leave their island cave to feed.

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We trekked across the islands of Rinca and Komodo to see the enormous Komodo dragons. The largest lizard on earth, Komodo dragons measure up to 10 feet long and can only be found on the Indonesian islands of Komodo, Flores, and Rinca. By Aileen Wetzel Their poisonous venom can kill a awetzel@ssvms.org person within hours of a bite. “Komodo dragons can smell blood from 5 miles away and are attracted to the color red,” our guide, Rockman, told us as he handed us each a long, pronged stick. We soon learned that in the event of a dragon attack, we were expected to insert the pronged end of the stick into the dragons’ nostrils. Untamed Indonesia is what I signed up for, I had to remind myself. In Bali, we kayaked across a volcanic crater lake and hiked to the top of Mt. Batur, an active volcano, to watch the sunset. We cooked our dinner in the volcano’s steam vents then made our way down the steep lava rocks in the dark with only our headlamps to light the way. We wore the native sarongs and visited a traditional spirit healer and watched in stunned silence as the healer used hot sticks and stones to pound evil spirits out of the

A balian, or traditional Balinese healer, in Ubud, Bali. Opposite page: Pink Beach, Komodo Island, Indonesia. next week. We floated down the black water of the Kahayan river, stopping along the way to watch wild orangutans swing from the trees and cradle their young. We trekked through the dense rainforest, flicking leeches the size of small rodents off our hiking boots

Photo by Sharon David

local villagers. We had our own Eat, Pray, Love moment cycling across Ubud’s famous rice terraces. The rice fields, the incenseinfused yoga bales, the unimaginably clear blue water. Indonesia is full of dazzling sunsets, picturesque landscapes, and jaw-droppingly beautiful beaches. There are over 17,000 islands in Indonesia, the largest being our next destination— Borneo. Borneo is the third-largest island in the world and one of the most biodiverse. According to the Borneo Project, the Borneo rainforest is home to 15,000 plants of which 6,000 are found nowhere else in the world. Borneo is also home to around 222 species of mammals (44 endemic), 420 birds species of birds (37 endemic) and hundreds of species of amphibians and fish. The Dipterocarp trees in Borneo hold the greatest insect diversity on earth—as many as 1,000 species can be found in just one tree. Arriving in Plangakara, Central Kalimantan, we boarded an Indo nesian longboat, our home for the

Photos by Aileen Wetzel

| EXECUTIVE DIRECTOR’S MESSAGE |

An Asian black hornbill takes flight in Central Kalimantan, Borneo.

and pant legs. We watched a huge python swim alongside our boat, marveled at the crocodiles and black cobras, and kept our eyes peeled for the rare clouded leopard. The highlight of our adventure was spending several days immersed in the culture of the Dayak. The Dayak is a loose term for the indigenous people of Central Kalimantan. There are over 200 river and hill dwelling ethnic subgroups in the interior of Borneo, each with its own dialect, customs, laws and culture. The Dayak are former head hunters, the original “wild men of Borneo.” Although headhunting was outlawed in the 19th Century, the rituals and customs of the Dayak people continue deep in the jungle. Many Dayak live in longhouses, long wooden structures that house dozens of families. Others live in small shacks. Devoid of furniture, generations of families use the large open space of the main room to March/April 2020

Photo by Aileen Wetzel

A Komodo dragon on Komodo Island. Komodo dragons can be over 10 feet long and weigh more than 300 pounds.

Sierra Sacramento Valley Medicine

animals in the Spirit House to protect us from the evil spirits that live in the jungle.” My eyes must have widened considerably. “Do not worry, Ms. Aileen. We no longer use human or animal blood. Now, we use Fanta. If we do not have Fanta, we mix coke with coffee.” After a month of exploring, the Wild Women of Borneo headed to the airport to return to our respective home countries. I started my adventure as a solo traveler and

came home with three new travel sisters. Traveling and connecting with like-minded women is what brings me joy. I am so glad I followed my instincts. As Mark Twain once wrote, “Twenty years from now you will be more disappointed by the things you didn’t do than by the ones you did. So throw off the bowlines. Sail away from the safe harbor. Catch the winds in your sails. Explore. Dream. Discover.”

Photo by Sharon David; opposite page photo courtesy Adytia Anugrah

gather, eat, and dance. In front of each house is a family sandung, also known also as a Bone House. Sandungs are wooden structures shaped like a small house, with ornate roofs, windows, doors, and miniature stairs. They are painted in bright colors and decorated with carvings representing various religious symbols and patterns. The base of the sandung container is usually decorated with a foliage pattern representing the mythical tree of life. Every five years, the Dayak exhume bones of the dead, anoint them and re-intern them in the family sandung. On one hot and unspeakably humid afternoon, our local Dayak guide, Aby, led us on a jungle trek in search of a rare pitcher plant. We walked slowly behind several villagers as they used machetes to clear a path through the dense jungle. Above us a pair of hornbills fluttered about and a family of orangutans watched our progress. I caught sight of a small wooden structure on stilts nearly hidden in the undergrowth. “That is a Spirit House,” Aby informed me. “My people would place the blood of sacrificed

A Balinese Hindu places rice on his forehead to represent a third eye and to thank the gods for rice and life. Right: Aileen’s Borneo trekking guide, Adytia “Aby” Anugrah, in traditonal Dayak costume.

March/April 2020

| OPINION |

When Words Can’t Tell The Entire Story By Caroline Giroux, MD cgiroux@ucdavis.edu

he headlines called it a “plane crash.” My heart sinks, and sinks further when pictures, selfies, ages, nationalities, professions and the whole human potential of the 176 dead are shared through mass media, making them more real, more alive than ever. Apparently, the youngest among the victims was not even two years old. The word played a trick on my mind: Crash. Instead of feeling outraged at first, I felt immensely sad and filled with a more acute urgency to live feverishly, desperately, because life holds by a thread. I assumed some technical bad luck was to blame. But in bits and pieces, the truth, well diluted in all those headlines about Ukrainian International Airlines flight 752, downed by a missile, started to hit even harder. This event, this “crash” was caused by an act of war. A human act. I have been haunted by this tragedy. Earlier today, a colleague in Canada told me she heard an announcement across the institution to observe a minute of silence for the victims, 57 of which were from Canada, my birth country. A great friend of mine who is Persian knows people in her community who knew some of the victims. Needless to say, we are all afflicted 10

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and affected by this. But I begin to realize how “crash” doesn’t begin to describe what actually happened, the stories of those on board, the lives they led, the moments of their lives that led to that day. I also began to realize that there is a parallel with another word that can never tell the entire story: abortion. I frequently have the opportunity to meet amazing people in different venues, and during a recent project I was involved with

a non-viable heart defect. We had a 15-month-old son and were living in Minnesota, isolated from most relatives and friends. Just being told of this abnormality was a total shock to me. And I had just shared the “good” news with family. But we had only a few days to process the surreal ultrasound findings, their implication, and make the toughest decision in my entire life. I was almost 20 weeks pregnant, already showing, and the unre-

I began to realize “crash” doesn’t begin to describe what actually happened, and that there is a parallel with another word that can never tell the whole story: abortion. three out of five women disclosed having had an abortion at some point in their young lives. One was relieved to no longer have nightmares about the experience, and another, a survivor of sexual assault, was 14 at the time and was even told the due date after it was clear she was going to terminate the pregnancy. It was a traumatic situation for all because they were in some way shamed for choosing this, condemned to silence. I could relate to that part of the experience. Eleven years ago, my husband and I had to make a very painful decision after we were told that our baby-to-be had

solved grief from a miscarriage less than nine months earlier came flooding back. There was not really a fitting word to put onto my experience, nor the intervention we had to go through. There was no name for all the aftermath, which included crying every time I took a shower as I was reminded of the brutal change in my body, my heavy sadness and the thought I would never be able to laugh again, and the alienating effect on my marriage (at the risk of sounding stereotypical here, parents from different genders do grieve differently). It turns out it was not so easy to find counseling about our options,

because there didn’t seem to be guidelines to help people like us. I had to be proactive and seek them out because I must say I was terrified by the thought of going through what we call abortion. I was grateful to have an excellent OB/Gyn who explained a more natural way to do this. But I wish I hadn’t read those brochures with stories about people who had chosen to terminate a pregnancy because of the fetus’ condition and then had to fear anti-choice protesters after having driven a long distance to find a Planned Parenthood clinic. I wish I hadn’t told certain individuals from my extended family, after an aunt who is a religious fanatic tried to influence our decision and immediately sent me unsolicited Pentecostal handouts. At the time in Minnesota, billboards claiming to know when life started seemed suddenly so offensive to me and my family. In some books, doing what we eventually opted to do to avoid the suffering of a child and those around her might have been labeled as murder. Even other uses of the word abortion have such a negative connotation, like a failure to take off. Who likes to admit a project dear to them “aborted”? But worse, it is many people’s attitudes towards abortion that seems the most damaging, as it constitutes an attack on everyone’s right to choose their own destiny, including as a potential parent. Maybe part of the solution would be to replace the word abortion with a more positive connotation such as “bravely choosing to not bring a child into this world,” because this really corresponded to

our mindset at that particular time. I have been thinking about the three brave, bright and inspiring women who shared their story with me the other day, and started wondering how many more women in my life have been through this but have been too afraid to talk about their experience. How many are still grieving in silence? I could grasp these women’s need to talk, and yet no one lets them talk about this multifaceted experience or

deliveries or losses, there should be a similar platform where parents who chose to not carry a pregnancy to full term can explore and integrate their losses. And by the way, this is never an easy process, even for women who are comfortable with their decision of terminating a pregnancy. In my clinical settings, the need for a grief process seems universal. If women must hush this, then what is left for them? I recently

We had to make a very painful decision after we were told that our baby-to-be had a non-viable heart defect. the conflicting emotions that can co-exist (fear, regret, relief, guilt, shame, hope). And I still struggle with why this happened to us. I also think that our society needs to make more room for these stories. Just like The Vagina Monologues help women deconstruct their complex gender identities to heal from patriarchal trauma, or the Sacramento Delivered Slam allows people to process difficult

co-authored a book chapter on humanism and physicians and two of us co-authors shared a pregnancy loss experience in the manuscript. But these sections were deleted during the editing process. Not naming realities like rape or warfare won’t make them less painful or go away—quite the opposite. I make a point of telling my children that we have lost two tiny babies. I tell them that there is no good

March/April 2020

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justification to declare war. I refuse to add these taboos in our lives. These past few years, there is a strong subtext that exerts a gravitational pull in my life, attracting certain messages and lessons into my awareness. Among these are the growing need to speak up, to join the choir of people hurt in their personhood or womanhood, to name taboo realities. My perseverance led to the unexpected acceptance of a manuscript on reproductive rights in a scientific journal, after being rejected by another one (one of my co-authors alluded to the controversial nature of the topic). I worry about children, my own and those in war-torn nations whose destiny is in the hands of the over-identification with capitalistic and narcissistic values. I must not let down my nieces, whom I often worry about, in an era that seems so medieval. To me, to live fully is at the intersection of speaking freely and loving fearlessly. My vocal cords are connected with my pulsating heart somehow. I must honor the memory of the daughter I never had, whose heart was missing an important cavity. I must be her voice while being fully me, not having her as an excuse to live vicariously through. None of this will really matter once my ashes are blended and spread with my daughter’s. But my deepest hope is that by then, her brothers and their children won’t be afraid to name human suffering and to examine what is wrong in society. May they eventually taste the universal triumph of a revolution of compassion within a safer world to explore. And thrive.

2 0 1 9 ANNUAL REPORT

Proudly Serving over 6,000 Physicians in El Dorado, Sacramento & Yolo Counties www.ssvms.org facebook/ssvms @ssvms 916.452.2671 info@ssvms.org 5380 Elvas Ave., Suite 101 Sacramento, CA 95819

March/April 2020

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 6,000 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.

membership growth

2019 president-elect message

6000

The mission of the Sierra Sacramento Valley Medical Society has been constant since it was founded in 1868. For over 150 years it has been there to support us, physicians from all specialties and modes of practice in our region. I am both honored and delighted to John Wiesenfarth, MD take us into 2020 as the new SSVMS president and, in that role, to promote the well-being of our honored profession. We are physicians from Sacramento, El Dorado, and Yolo Counties. We are some 6,000 in number, which makes SSVMS one of the largest medical societies in California. Our membership also includes hundreds of residents and medical students in our area who are the next generation in medicine. What we do and achieve, therefore, has farreaching consequences both now and in the future. The most important thing that this or any medical society must do well is ensure our ability to care for our patients, which we can best accomplish by speaking with a concerted and powerful voice that represents your voice as a physician. Fighting for you is a more complicated and intense process than it may often seem. Every day, we see that physicians in this state and around the country are at risk from some non-medical entity wanting to shape our jobs and intervene in the physician-patient relationship. That is why it is so essential for SSVMS, in conjunction with CMA, to be a strong voice for its members and their patients. If you are already a member of SSVMS, I sincerely thank you for your engagement and membership. If you are not yet a member of the Medical Society, I welcome you to join us.

5000 4000 3000 2000 1000 2015

2016

2017

2018

2019

shaping healthcare in 2019 Together, SSVMS and CMA: • Announced the first ever CalHealthCares awards, which will pay off $67 million in student loans for 240 physicians and 38 dentists who commit to see more Medi-Cal patients. • Secured $2.2 billion in provider rate increases through the Proposition 56 tobacco tax. • Sponsored AB 744, which revamps the rules regarding telehealth services to increase access to care and ensure physicians are fairly compensated for telehealth services. • Led the fight to pass SB 276, which cracks down on fraudulent medical exemptions for childhood vaccinations. • Advocated for local public health policies to increase access to care for the uninsured, patients seeking medication assisted treatment and patients experiencing a mental health crisis. • Recouped more than $1.3 million from payors on behalf of physician members.

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~ John Wiesenfarth, MD; DrJohn@Winfirst.com

2019 medical society happenings

Joy of Medicine El Dorado Hills Peer Group

Richard Kaplan, MD and Peter Yellowlees, MD (Host) Record an Episode of Joy of Medicine - On Call

Denise Satterfield, MD Receives the Golden Stethoscope at SSVMS Honors Medicine

Physicians and Medical Students Celebrate at the SSVMS Winter Social

Medical Students Members Advocating at the Capitol with Assemblymember Kevin McCarty, Assembly Dist. 7

Melody Law, MD, Participating in an Opioid Addiction Anti-Stigma Public Service Announcement for SSVMS RX Safe Physicians March/April 2020

ssvms community programs spirit 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 $12 million in donated care, treated over 53,000 patients and performed over 1,100 surgeries. In 2019, many new specialty procedures were available to patients including specialty consults, colonoscopies and vision exams.

museum of history medical SSVMS’ Museum of Medical History 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, open to the public and provides guided tours for local schools and healthcare and professional programs. In 2019, the museum added several new exhibits including a full-scale diarama of a 1950’s physician office.

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 2019, over $20,000 in scholarships were awarded to students that attend the following medical schools: U.C. Irvine School of Medicine, Albany Medical College, Virginia Commonwealth School of Medicine and Harvard Medical School.

smart medical clearance SSVMS pioneered SMART Medical Clearance to standardize the medical clearance process across all emergency departments and inpatient psychiatric hospitals. SMART Medical Clearance facilitates the safe and timely transfer of patients to appropriate treatment centers. In 2019, the protocol was adopted at additional regional hospitals and has been implemented in other medical communities in states including: CA, WI, MI, IL, and NC. For more information and to access resources visit www.smartmedicalclearance.org. 16

Sierra Sacramento Valley Medicine

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 2019, thanks to grants from the California Deptartment of Public Health, SSVMS produced and distributed two opioid addiction anti-stigma public service announcements. Check out www.sacopioidcoalition.org for more information.

2019

statistics

SSVMS Community Programs are supported through grants and generous donations from the medical community. Consider making a tax deductible donation at www.ssvms.org/programs.

donate now

150+

physician volunteers

1,750

visitors to the museum

$710,000 500+ 200+ in-kind donated SPIRIT patient ser vices

SPIRIT patients treated

125

SPIRIT

Physician Resiliency Consultations

surge rie s donated

$20,500

access to healthcare improve health outcomes mental health advocacy physician well-being future of medicine

medical student sc holarships granted

March/April 2020

joy of medicine physician meetups Monthly Physician Peer Groups Joy of Medicine provides physicians with the opportunity to meet with a group of colleagues for sessions facilitated by psychologists and life coaches. Groups meet monthly at a local physicianâ&#x20AC;&#x2122;s home in Davis, El Dorado Hills, Newcastle, Rocklin, Sacramento and Elk Grove. In 2019, over regularly participated in a peer group. To join a group, contact info@ssvms.org.

100 physicians

Poetry and Creative Writing Group Share your poetry and short stories with other physician writers who meet on a monthly basis! Submit a poem or short story to poetry_joyofmedicine@ssvms.org. There are no submission restrictions and group members are encouraged to share writings from any genre. Contact info@ssvms.org to join the group.

joy of medicine summit

175 physicians

The 3rd Annual Joy of Medicine Summit successfully provided with the tools and resources needed to cope with the stressors that are part of practicing medicine. This half-day summit featured sessions on the power of positive psychology and a panel of medical group leaders addressing systemic solutions to burnout. Save the date for the 4th Annual Joy of Medicine Summit scheduled for September 26, 2020.

podcast: joy of medicine

- on call

Listen in as host Peter Yellowlees, MD, interviews local physicians and medical students about their journeys . Listen now on through medicine. In 2019, the popular monthly podcast had over iTunes, your favorite Podcast App or at www.JoyofMedicine.org.

2,000 downloads

whitepaper: assessing physician well-being in the sacramento region Released in 2019, the whitepaper utilized survey results from over 500 local physicians to craft

strategies to promote physician well-being at the individual and organizational level. The whitepaper made four recommendations to area medical groups on ways to increase the professional fulfillment of physicians. Read about these strategies by downloading the whitepaper at www.JoyofMedicine.org.

CONFIDENTIAL CONVENIENT

COMPETENT COST-FREE

resiliency consultations

Recognizing the crushing stress and workload that physicians face, SSVMS sponsors up to six (6) wellness sessions with vetted psychologists and/or life coaches for physicians in Sacramento, El Dorado, Yolo, and Placer Counties. In 2019, assessed this service took place. To schedule an appointment, and over contact a Vetted Provider directly and mention that you are a physician accessing the SSVMS Joy of Medicine Program.

75 physicians 200 sessions

Psychologists: Joy of Medicine Psychologists are well versed in the needs of physicians. They are contracted and licensed providers, not employees of the Sierra Sacramento Valley Medical Society. Amy Ahlfeld, PsyD | (916) 799-3866 | drahlfeld@gmail.com Daniel Rockers, PhD | (916) 273-1740 | daniel.rockers@gmail.com Lori Roberto, PhD | (916) 206-1741 | drlori@drloriroberto.com Marcella Kreysa, PsyD | (916) 672-0870 | drkreysa@gmail.com Patricia Bach, PsyD, RN | (916) 662-0767 | pbachpsd@gmail.com

Life Coaches: Joy of Medicine Life Coaches are experienced in working with the unique needs of physicians. They are contracted independent consultants, not employees of the Sierra Sacramento Valley Medical Society. Please note that life coaches are not licensed therapists. Angela Trapp | (305) 962-1936 | 3coaching.cc@gmail.com Kathy James, ThD | (916) 549-9363 | mamaesther@me.com Michael Parr, MD | (916)761-1838 | msparr@msn.com Steve Seay | (916) 715-9252 | stevendseay@gmail.com

www.joyofmedicine.org

American River Photo Courtesy of SSVMS Member David Evans, MD

thank you 2019 donors

Jose Abad, MD Alicia Abels, MD James Affleck, MD Kathryn Amirikia, MD Thomas Atkins, MD Cleve Baker, MD Jonathan Beck, MD Joanne Berkowitz, MD George Thomas Bolton, MD Nicole Braxley, MD Marcia Britton-Gray, MD Donald Brown, MD Jack Bruner, MD Michael Burman, MD Harvey Cain, MD Amber Chatwin, MD

Ronald Cole, MD Stephen Cyphers, MD Sean Deane, MD Robert Diamond, MD David Dozier, MD Christine Fernando, MD Ray Fitch, MD Kieran Fitzpatrick, MD Jason Flamm, MD James Foerster, MD Richard Frink, MD Alan Frueh, MD Nancy Gilbert, MD Alexander Grand, MD Hanns Haesslein, MD

Robert Hales, MD Cary Hart, MD Shawn Hersevoort, MD Julian Holt, MD Donald Hopkins, MD Bruce Jensen, MD Weldon Jordan, MD Forrest Junod, MD Bernard Kao, MD Rosalind Kirnon, MD Ralph Koldinger, MD Monice Kwok, MD Michael Lawson, MD Marion Leff, MD Michael Luszczak, DO

Alexander Massey, MD Robert Meagher, MD George Meyer, MD Patrick Moore, MD Yi Yi Myint, MD Anh Huynh Nguyen, MD Jan Okimoto, MD John Osborn, MD Richard Park, MD Mary Pat Pauly, MD Gail Pirie, MD Karen Poirier-Brode, MD Margaret Portwood,MD John Rice, MD Gerald Rogan, MD

Jack Rozance, MD Patrick Ryan, MD Christian Serdahl, MD Kuppe Shankar, MD Myo Shin, MD Elaine Silver, MD Marian Te Selle, MD Sadha Tivakaran, MD Glennah Trochet, MD John Vallee, MD James Vassar, MD John Whitelaw, Jr., MD John Wiesenfarth, MD Gordon Wong, MD Ramiro Zuniga, MD

CA Dept. of Public Health Dignity Health Kaiser Permanente Mercy Medical Group

NORCAL Group Foundation Sac County Health Services Serotonin Surge Charities

Sierra Community Medical Fdn. SSVMS Alliance Sutter Independent Physicians

Sutter Medical Group The Permanente Medical Group UC Davis Health System

Vitalant Vituity Woodland Medical Group

Thank you Family of Paul J. Rosenberg, MD, for a very generous donation to the SSVMS Medical Student Scholarship Fund. thank you 2019 volunteers Sallie Adams, MD Muhammad Afzal, MD Sharon Aghili, MD Richard Areen, MD Richard Astorino, MD Imran Aurangzeb, MD Yekaterina Axelrod, MD Mustafa Bahramand, MS II Robert Bellinoff, MD Brian Belluci, MD Paul Bilunos, MD Lawrence Bistrong, MD Christopher Bowlus, MD Barton Bradshaw, MD Jacob Brubaker, MD John Canio, MD Peter Carruth, MD Melony Chakrabarty, MD Margaret Chang, MD George Chiu, MD David Cupp, MD Richard Defelice, MD Edward Denz, OD Kapil Dhawan, MD Rahul Dhillon, MD Robert Equi, MD Malcolm Ettin, MD Michael Fazio, MD Christine E. Fernando, MD

Timothy Fife, MD Richard Fike, MS, PT Stacy Frawley, MSN, FNP Francine L. Gallawa, MD Juan Garcia, MD Marvin Gatz, MD Caroline Giroux, MD Brian Golden, MD David Goldfarb, PA-C Elizabeth Gonzalez, MD Nathaniel Gordon, MD Jeffrey Graham, MD Alexander Grand, MD Eli Groppo, MD Richard Grutzmacher, MD James Hamill, MD Kevin Hansen, MD Ruth Haskins, MD G.H. Hayat, MD Saman Hayatdavoudi, MD Wesley Hilger, MD Julian Holt, MD Donald Hopkins, MD Mary Horner, MD Ronald Hsu, MD Andrew Hudnut, MD Peter Hull, MD Daniel Ikeda, MD

2019 board of directors Officers

President - Christian Serdahl, MD President - Elect - John Wiesenfarth, MD Immediate Past President - Rajiv Misquitta, MD Secretary - Carol Kimball, MD Treasurer - Paul Reynolds, MD

Directors

District 1 - Ashutosh Raina, MD District 2 - Adam P. Dougherty, MD, MPH District 2 - Bianca Roberts, MD District 2 - Vanessa Walker, DO District 3 - Ravinder Khaira, MD District 4 - Ranjit Bajwa, MD District 5 - Sean Deane, MD District 5 - Cynthia Ramos, MD District 5 - Vijay Rathore, MD District 5 - Roderick Vitangcol, MD Executive Director - Aileen E. Wetzel

Gabriel Jacob, MD Joelle Jakobsen, MD Michelle Jaromay, FNP Mary Ann Johnson, MD Richard Jones, MD Burzeen Karajawala, MD Amit Karmakar, MD Michael Kearns, MD Abdul Khaleq, MD Jocelyn Kim, MD Richard Kim, MD Samira Kirmiz, MD Rosalind Kirnon, MD David Kissinger, MD Christiana Kopf, MD Robert LaPerriere, MD Michael Lawson, MD Huong Le, MD Michael W. Leathers, MD Dennis Lee, MD Samuel Lee, MD Richard Lewis, MD Mark Lischner, MD Nilufar Maboudi, MD Anand Madan, MD Michael Mahoney, MD Joseph Marsano, MD Elisabeth Mathew, MD

Delegates

Ruenell Adams Jacobs, MD Barbara Arnold, MD Helen Biren, MD Sean Deane, MD Adam Dougherty, MD, MPH Katherine Gillogley, MD Marcia Gollober, MD Richard Gray, MD Reinhart Hilzinger, MD

Russell Jacoby, MD Richard Jones, MD Carol Kimball, MD, Charles McDonnell, MD Sandra Mendez, MD Rajiv Misquitta, MD Tom Ormiston, MD Senator Richard Pan, MD

Paul Reynolds, MD Kuldip Sandhu, MD James Sehr, MD Chris Serdahl, MD Ajay Singh, MD John Wiesenfarth, MD Don Wreden, MD Lydia Wytrzes, MD

Megan Anzar Babb, DO Brian Bernhardt, MD, Natasha Bir, MD Arlene Burton, MD Ronald Chambers, MD Amber Chatwin, MD Lucy Douglass, MD Mark Drabkin, MD

Rachel Ekaireb, MD Gordon Garcia, MD Ann Gerhardt, MD Karen Hopp, MD Brian Jones, MD Mohammad Khan, MD Jocelyn Kim, MD Derek Marsee, MD

Anand Mehta, MD Leena Mehta, MD Neil Parikh, MD Ernesto Rivera, MD Bianca Roberts, MD Romero Santiago, MD Christopher Swales, MD Thomas Valdez, MD

Alternate Delegates

Douglas Brosnan, MD, JD

Sierra Sacramento Valley Medicine

Kanwaldeep Randhawa, MD Jasbir Rangi, MD J. Brian Reed, MD Gerald N. Rogan, MD James Rybka, MD Jaskaram Sandhu, MD Denise Satterfield, MD Jaâ&#x20AC;&#x2122;Nahn Scalapino, MD Catherine Schnepp, MSN, FNP Christian Serdahl, MD Patricia Sierra, MD Alicia Silva, MD Christianna Stuber, MD Christian Swanson, MD David Telander, MD Brian Tracy, OD Glennah Trochet, MD, MPH Tony Tsai, MD Randell Vallero, MD Brent VanHoozen, MD Vanessa Walker, DO Lee Welter, MD Robert Wendel, MD Stephen Wilmarth, MD Daniel Wong, MD Alan Yee, MD Peter Yellowlees, MD Jeanne Yu, MD

2019 ssvms delegation to cma house of delegates

District XI Trustees

Conor McLaughlin, MD Carlos Medina, MD Roger Mendis, MD George Meyer, MD Rajiv Misquitta, MD Imran Mohammed, MD Peter Murphy, MD Richard Murray, MD Haritheertham Nagaraj, MD Bill Naseer, MD Steven Nemcek, MD Helen Nutter, MD Herminio Ojeda, MD Patricia Ostrander, MD John H. Ostrich, MD Randall Ow, MD Senator Richard Pan, MD, MPH Margaret Parsons, MD Arun Patel, MD Chiraag Patel, MD Sarju Patel, MD Mary Pauly, MD Robert Peabody, Jr., MD Joel Pearlman, MD Kent Perryman, PhD Gail Pirie, MD David Pompa, MD Ajay Ranade, MD

Margaret Parsons, MD

Will My Child Walk? The child Feels safe in Her motherâ&#x20AC;&#x2122;s lap

Will My child Walk?

With eyes twinkling She shares a Hopeful smile

The question Does not need To be articulated

And allows me To examine Her slender legs

But my answer To their dreams Must be

Spasticity and contractures At the hips Knees and ankles

The guidelines For predicting The future

Her legs Are only good for Sitting and crawling

Persistent Primitive Reflexes

Cerebral palsy Cause never To be known

Delayed Developmental Milestones

A motherâ&#x20AC;&#x2122;s guilt Lasts for A lifetime

My response Must be Carefully crafted

I know Why she has been brought To see me

Such pronouncements Can suck all hope Out of the room Leaving parent And child Gasping in despair

By Jon Davids, MD jdavids@shrinenet.org

For information on joining the SSVMS poetry group, contact Sam Mello at (916) 452-2671 or email smello@ssvms.org.

March/April 2020

| PUBLIC HEALTH |

Testing, Community Outreach Needed to Stem Rise in Syphilis Startling Increase in Congenital Syphilis Found

t its November 2019 meeting, the Public and Environmental Health Committee heard from all three counties we serve that sexually transmitted infections in general are on the rise. Public health departments have had a hard time keeping up with the deluge of reports of chlamydia. As of this year, cases of chlamydia are no longer reportable by clinicians, although positive chlamydia tests are still reportable by laboratories. Most concerning is the significant rise in cases of syphilis, especially because there has been a surge in congenital syphilis. Syphilis is once more causing untold harm to children who are born with its congenital form. At the end of the 20th century, California was on the brink of eliminating syphilis. Because there was such a low incidence, routine testing in jails was discontinued and the requirement for a syphilis test in order to obtain a marriage license was removed. Syphilis numbers for both men and women have increased in all regions of the state over the past 10 years, according to the California Department of Public Health (CDPH). Those at highest risk are men who have sex with men, but in recent years the greatest increase has been seen in women of childbearing age. From 2008-2018, the total number 22

Sierra Sacramento Valley Medicine

of reported early syphilis cases statewide increased 743% among women compared to 268% among men. Cases of congenital syphilis increased 391% over the same period. The information from El Dorado, Sacramento and Yolo counties is consistent with these trends. Sacramento County, which has the largest population in the region, had the largest increase in cases of

By Glennah Trochet, MD trochetg@gmail.com

syphilis. Testing for syphilis can be challenging. The most popular tests are treponemal immune assays, which are really screening tests. If positive, they need to be followed up by a non-treponemal test such as the RPR or VDRL, which will give titers that can be followed to ensure that treatment is successful. A comprehensive explanation of how to interpret these tests can be found

The Caifornia Department of Public Health has these screening recommendations for pregnant women: • All pregnant women should be screened for syphilis at their first prenatal visit. • Women at high risk for syphilis and women who live in areas with high syphilis morbidity should be retested for syphilis between 28 and 32 weeks and at delivery. Contact your local health department to find out which areas are considered to have high syphilis morbidity. • Stat RPR should be performed at delivery for women with no prenatal care. • No infant or mother should leave the hospital without having maternal syphilis status documented at least once either during pregnancy or at delivery. • Any woman who delivers a stillborn fetus after 20 weeks gestation should be tested for syphilis. • Pregnant women who are seropositive should be considered infected unless they have documentation of adequate treatment with appropriate serologic response to treatment and titers are low and stable. • Women with prior adequate treatment, appropriate response to treatment and low serofast titers (VDRL) may not require retreatment. • Women with persistent higher antibody titers may indicate reinfection.

on the CDPH website (tinyurl.com/ tbhzq36). This document contains algorithms on how to interpret the tests and what follow-up tests should be done. The treatment of syphilis remains the same as it has been for decades: 2.4 million units of benzathine penicillin IM in a single dose is enough to treat primary and secondary syphilis. Having said that, it is sometimes difficult for physicians to obtain the medication. Although penicillin is the second oldest antibiotic known to medicine, its price has been increasing significantly in the United States. A check on drugs.com in January showed that 10 doses of 2.4 million units /4 milliliters were being sold for $3,376.07, and single dose units were not available. As a result, individual practitioners who may not see many patients with syphilis have difficulty keeping the medication in stock. For providers who are having trouble finding the medication, the best thing to do is call the public health department in the jurisdiction where the patient lives. Public health departments may be able to get the medication at lower prices. The disease is reportable to them anyway, and they may have resources to help with treatment and to identify sexual contacts who also need evaluation and treatment. Sacramento County Public Health, for example, will provide the medication to physician offices that request it for a patient living in its jurisdiction. In response to the epidemic, there is now a clinic available to any resident of Sacramento County who needs to be tested or treated

CS cases

Congenital Syphilis Cases Statewide

Source: California Dept. of Public Health

329

350

288

300 250

The numb with con increa 6th y

214

200

148

150

104

100 50 0

33 2012

58 2013

2014

2015

2016

2017

2018

Since 2012 103 s neon due to con

The number of infants born with congenital syphilis has increased for six straight years. Since 2012, there have been 103 stillbirths or neotatal deaths due to congenital syphilis.

for a sexually transmitted infection. The countyâ&#x20AC;&#x2122;s sexual health clinic is at 4600 Broadway, Suite 1300, in Sacramento. It is open on Wednesdays from 8 a.m. until noon and from 8 a.m. to 5 p.m. on Thursdays and Fridays. Physicians are reminded that when a patient is at very high risk for having syphilis, it is fine to treat presumptively instead of waiting for test results. This is especially true if it will be difficult to find the patient again for treatment if the test results do come back as positive. This should be a consideration when seeing someone who has been exposed to a partner with primary or secondary syphilis. The alarming increase in congenital syphilis must be addressed. We heard at our meeting that many of the women with syphilis presented in labor without prenatal care. Some may have been unable to obtain care because of homelessness or avoided care due to addictions or other psychosocial problems. Pregnant women diagnosed with

later stages of syphilis may require 3 doses of benzathine penicillin. with 7 days between doses. This can be very challenging for women who are homeless. As a community, we should increase efforts to reach out to all pregnant women so they can obtain pregnancy care in a timely fashion. There were 329 children born in 2018 with congenital syphilis in California. Some of them were born in our region or may well move here. These children are at higher risk for developmental disabilities and need for special education or other services through California Children Services. This is a preventable tragedy. We must do what we can to prevent future cases. Comprehensive information on syphilis can be found on the cdph. ca.gov website (you can go directly to the syphilis section by using tinyurl.com/t5lw4jx), or call your local Public Health Department if you need help.

March/April 2020

An Aura of Mysticism, A Dose of Skepticism Alternative Therapies Abound at Healing Arts Festival, Chiropractic Seminar

he was an ordinary, perhaps a bit frowsy, looking lady, standing near her booth, one of about 60 such booths at the Sacramento Healing Arts Festival. The poster over her booth identified her as a shaman, and, having never before met a shaman (as far as I knew), I introduced myself as a retired allopathic physician, then picked up one of her brochures. It identified her as a “natural born shaman.” I asked her how and when it was that she knew she had shamanic talent. She told me that “it dawned on me many years ago when I realized I could look into my friend’s soul and I knew what was truly there.” After she immigrated to the U.S.A. from Brazil, she studied under “well known American shamans” and also immersed herself in Native American shamanism. She said her training was excellent and she now feels very competent. She described herself as a “conduit between dimensions” and a “shamanic and ceremonial healer.” Inveighing against online shamanic education courses, she advised me to “just look at their websites and you

Traditional Chinese medicine uses pulse diagnosis to detect disease. As many as 28 different pulse qualities are said to be identifiable. 24

Sierra Sacramento Valley Medicine

By Jack Ostrich, MD jmost119@aol.com

can tell how crappy they are.” So I did. And she was right. One offered 4.5 hours of on-demand videos, 62 downloadable resources, various assignments, and a certificate of completion for $13.64, “marked down from $154.99, but only for the next 24 hours!” When one completed the course, the title “Certified Master of Shamanic Journeying, Ritual & Ceremony” would be bestowed. I thanked her, and moved on to a nearby booth. There I saw a fellow, sitting, facing a lady who was seated before him. He appeared to be palpating her radial pulses. She was gazing intently at him, and he

She described herself as a “conduit between dimensions” and a “shamanic and ceremonial healer.” was gazing into the distance, as if deep in thought. The lady at the table that fronted the booth asked me if I wished to sit for a free exam. But, she warned, it might be over an hour for my turn to come because each exam took several minutes and there were many “patients” already registered. No, thanks, I told her, but what is going on here ? “Pulse diagnosis,” she replied. She found a brochure, opened it, and we read together: “Pulse diagnosis is the oldest and most respected (method of) diagnosis in Chinese Medicine (done by) interpreting the flow of blood through the radial arteries at the wrist.” She told me that the palpator a few feet in front of me was gently sensing subtle variations in his patient’s radial pulses using the tips of his second, third, and fourth fingers. She said that it took many years to learn the art, but that it was “an extremely accurate way to detect disease or impending health problems.”

Once a diagnosis was made, individually crafted herbal, “natural,” remedies would be formulated to “treat the imbalances” and offered for sale to the customer/patient. If plain old musculoskeletal pain was the main complaint, the palpator could handle that as well, as he is a California certified acupuncturist to boot. Other therapies that he offered included nutritional therapy, massage, and moxibustion. A 29-item list of “Conditions We Treat” was prominently displayed. Among them were anxiety, insomnia, cystitis, chronic fatigue, hemorrhoids, hypertension, and substance abuse. My last stop, as I was leaving, was at a booth in the lobby. The pleasant lady standing there was from southern California, and she travels widely to promote, and sell, her ability to produce images of our “auras” and “chakras.” All of us have auras and chakras, she said. Auras are “invisible force fields” that envelop our bodies and “interact with other dimensions of time and space, energy and matter.” A northern California aura researcher, Guy Coggins, invented the AuraCam many years ago. It produced color photographs of human auras, and Coggins developed a colorometric atlas to interpret the images. The latest model, the AuraCam 6000, costs about $10,000. Highly trained psychics can often “see” our auras, but the AuraCam captures them accurately every time. As for chakras, some say there are five, seven, and perhaps many, many more in each of us. They are foci of “life energy,” located anterior to the spine and responsible for, as you might suspect, energizing

“Healer and hug expert” Hugh Hall has been at every Sacramento Healing Arts Festival since 1999. various parts of us. The equipment that this lady owns can image the aura as well as seven chakras. You are presented with a printed out interpretation, or the lady will sit down with you, if you prefer, and go over the results one-on-one. She also offered other interventions, such as DNA Activation, Quantum Healing, and Multi-Dimensional Energy Balancing. The Sacramento Healing Arts Festival returns to the Scottish Rite Masonic Center on the first weekend in April of this year.

***

Continuing my search for nonallopathic therapeutic options, my next stop was a two-hour “seminar” at a nearby chiropractic office,

having heard a radio advertisement suggesting that, at the end of the seminar, the attendees would be apprised of gentle and safe regimens that would lower their risk of cancer, cardiovascular disease, GI miseries, and diabetes, among others. I signed up and off I went. There were 50 or so people gathered in a common room just inside the entrance to the chiropractor’s office and exam room complex. The audience was mostly couples in their 30s, 40s, and 50s, plus a few kids. The walls were bedecked with large placards and posters. One proclaimed, “Vertebra Of The Week: L5!!” Another: “Medicine: The study of disease and what causes men to die. Chiropractic: The study of health and what causes a man to

March/April 2020

The maker of Restore™ says it uses carbon-based molecules from ancient fossilized soil to restore communication between bacteria in the gut, mitochondria, and cells in the body.

Sierra Sacramento Valley Medicine

live.” And another: “Look well to the spine for the cause of disease. (Hippocrates).” I have been unable to verify that attribution. The host began to speak without introducing himself, and I had the impression that all in the room already knew him. He began by declaring that most cancer is caused by too much “sugar in our diet.” “Healthy cells,” he said, “don’t need sugar. What they need, he told us, “is a proper nerve supply.” Cancer cells “use a lot of sugar and need a lot of sugar, and they like an acidic environment, and don’t like oxygen.” Surgery for cancer “increases the likelihood of metastatic disease” and “chemotherapy is always toxic and poisonous to our bodies.” Risk factors for cancer included “chronic stress” that leads to “immune system damage from chronic inflammation,” poor sleep, low vitamin D levels, and “lack of

The doctor opined that vaccines were generally all “neurotoxic” and urged all of us to eschew “conventional meat and dairy products.” physical activity with secondary obesity.” In addition, we all need to nurture a proper gut microbiome wherein lies “an immune system powerhouse that is directly linked to our brains.” To better promote gut/brain health, he recommended a proprietary supplement called “Restore.” It costs about $70 for a month’s supply, and contains “aqueous humic substances” that “have been shown to strengthen the proteins in the gut lining” thereby blocking the absorption of toxic molecules and poisonous particles into the bloodstream. We were also urged to have a “screening test for general and

brain health” called “BrainSpan.” BrainSpan is a combination of blood testing (“just a finger stick drop of blood”) and a brief cognitive test. The blood test measured fatty acid levels and calculated a “cellular inflammation balance marker.” The cognitive test was designed to reveal any ongoing decline. If deficits were discovered, dietary changes and oral supplements would be prescribed. The price of the test was usually $169, but if done right after the meeting, it would be only $119. I declined. The doctor further opined regarding vaccines, which, he said, were generally all “neurotoxic.” He urged all of us to eschew “conven-

tional dairy and meat products.” Regarding chiropractic adjustment treatment, he advised that children needed chiropractic exams and spinal adjustments beginning in infancy and regularly thereafter. He reported that he himself submits to monthly adjustments, “whether I think I need it or not.” Before I left the room, I studied a table covered with a variety of “Dietary and Metabolic Supplements” for sale. I briefly thought about buying a bottle of “Restore,” because I was curious what “aqueous humic substances” might taste like. But, at $70 per bottle, no thanks.

March/April 2020

Revenge of The Rats An Unconscious Truck Driver, Rodents and a Medical Mystery

was called by my Internal Medicine Service resident early one morning, as I was the team attending and a middle-aged man had just come to us from the emergency room. The story we got from the ER was that our new patient had parked his truck at night on a not-too-busy freeway near our hospital. A passing highway patrol officer saw through the truck window that the driver’s head was facing down against his chest. The officer thought that the man was asleep or unconscious or dead, and he pulled up ahead of him, got out of his police car, knocked on the window and spoke loudly to him. There was no response. The officer then opened the unlocked door. The man inside did not move. An ambulance was called and took the truck driver to our nearby emergency room where he was found to have deep unresponsiveness and impressive jaundice. The ER resident who saw him thought he had probable alcoholic hepatitis (common for us to see in our hospital ER). In addition, the man had red conjunctivae and widely scattered petechiae and ecchymoses. His heart and lungs were OK, and neither the liver or spleen seemed enlarged. Initial labs were drawn in the emergency room, but—this having happened decades ago—the results were not as rapidly returned as they are now. A saline IV infusion bottle was started, containing vitamins and empiric antibiotics, and he was admitted to the Internal Medicine Service on ward East 8. We had sent away for his old (pre-EMR) handwritten

Sierra Sacramento Valley Medicine

By Faith T. Fizgerald, MD ftfitzgerald@ucdavis.edu

chart, which arrived on East 8 later in the afternoon of the day I first saw him. I found, in reading it, that he had experienced a similar event several years before; according to that chart, he got rapidly better and was able to talk after several days. He had then described himself as a lifelong teetotaler who didn’t touch alcohol, but the physician notes in that old chart made clear that they hadn’t believed him. It was no surprise that an alcoholic could lie—but two to three days later after we had him on our current ward, he was also much improved and showed no signs of alcohol withdrawal. He began to answer my questions, and again denied alcohol use. I quizzed him on other possible causes of hepatitis (the icterus was surprisingly getting better already) and he knew of none. I found him to be a man dedicated to work and neither an alcohol drinker nor drug user. He was also without evidence of cardiovascular, pulmonary or GI disease, malignancy or any cerebral spinal fluid abnormality. I finally asked him, thinking of other possibilities, whether he was exposed to any toxins in his work as a trucker. He said no. When I asked him about hobbies, however, his face lit up. “You have hobbies?” I asked. “Just one,” he replied. “What is your hobby?” “I shoot rats.” “You shoot rats?” “I hate rats! Ugly vermin!” He went on to tell me that whenever he had free

time, which was seldom, he would go to the rice paddies north of Sacramento, which was a favorite place for rats to dwell. He took a rifle with him, and every time he saw a rat he would shoot it. Then, when the shooting was done, he would go into the rice paddies, which were full of water, and pick up dead rats by their tails to hang on a fence surrounding the paddies as a warning to other rats. For me, it came suddenly together, an “aha! moment.” A diagnosis of what could cause conjunctival hemorrhage, scattered dermal

purpura, easy bleeding, CNS changes, renal failure, and hepatic disease: Weils disease (Leptospirosis), which is caused by the spirochetal organism, Leptospira ictohemorrhagica! The Leptospire can live in the rice paddies along with the rats, which are unaffected by them. Both time and antibiotics saved our patient’s life even though we did not know, initially, what we were doing. He promised to give up his beloved (and only) hobby, and I asked him if he had a hobby in mind to replace his previous one. He said he’d think about it, and was

discharged. I called him two or three weeks later. He felt fine, he said. I asked him if he had found another hobby, and he said he had. “What is it?” I asked. “I shoot bats” he answered. “Oh, no! Bats? They can give you rabies!” He started to laugh. ”I’m kidding,” he said and I then started to laugh with him. “OK,” he said, still laughing. “I lied. I’ve taken up target shooting.” I have not seen him since.

A Few (Musical) Notes From the OR

laying music in the operating room was once a controversial issue that triggered serious discussion. It seemed that anesthetists responsible for supervising other anesthetists were opposed to OR music, but those who were on their own tended to favor it. With the advent of CDs, a wider variety of music choices rapidly became available as the price of CD players fell quickly from about $1,200 to under $500. One anesthetist began asking patients entering the OR if they liked music and which genre they preferred. Responses were generally favorable. One patient favored jazz, particularly Dixieland jazz. As the music began, someone asked, “Is that Turk Murphy’s band?” It was the patient who gave an affirmative answer and said, “I’ve heard that tune hundreds of times. I used to travel with the Turk Murphy Band.” Another patient, a woman who seemed on the brink of panic, asked for “beautiful music.” As the music began, tears started streaming down her cheeks. “Did I choose music that makes you sad?” the anesthetist asked. “No,” the patient replied. “This is the music I chose for my wedding.”

A man entering the OR for open heart surgery favored “Country — yes, Johnny Cash is perfect.” As the lyrics of “I Walk the Line” sounded, the patient chuckled, the OR team chuckled, and finally they all burst into By Lee Welter, MD laughter. That first line is, “I’ll leewelter43@gmail.com keep a close watch on this heart of mine.” Nursing staff appreciated the mood elevating effect of music, particularly with a very somber surgeon. If the surgical process became stressful, the music promptly faded away to avoid distraction. Most surgeons expressed their own music preferences. One whose taste was strictly rock and roll, and could identify almost all “one hit wonder” garage bands, recognized the anesthetist’s bias toward classical music. “I don’t want to hear music from dead composers— unless they died of a drug overdose,” he said. Music seemed to be therapeutic for nearly all concerned, and few give it a second thought today.

March/April 2020

Normalization of Deviance When Safety Protocols Are Repeatedly Ignored, Accidents Aren’t Really Accidents

suspected congestive heart failure. The delirium cleared with time. The hospitalist risked an improper diagnosis and treatment because she did not follow the protocol critical to the value hospitalists provide: to rapidly assess a deteriorating inpatient. While my intervention prevented what may have been a lethal error, thousands of inpatients every day may face similar deviations—and not all are lucky enough to have a medical professional family member at their bedside to compensate for impaired safety. This episode represents a declining but still persistent problem in health care: the normalization of deviance, or the repetition of risky behavior contrary to an accepted protocol which, nonetheless, is allowed by an organization because it hasn’t—yet—caused catastrophic results. Protocols are designed to prevent medical errors. Danger lurks when an institutional culture does not object to deviations from its safety protocols, thereby allowing the deviation to become accepted practice. When I reported my father’s experience to the chief of the hospitalists, he refused to take action. Unlike the paramedics and emergency department staff, the hospi-

Photo: Wikimedia Commons/ Bruce Englehardt

n 2004, I was called to my 87-year-old father’s hospital bedside. Two days earlier, while rising from dinner at a restaurant, he fell backwards striking his head. Fortunately, the paramedics arrived promptly. Although he could move his extremities, they followed their standard head injury precautions and applied cervical stabilization just in case he had broken his neck. The hospital emergency department team followed the same protocol and soon discovered a fracture of his C-2 vertebra. His “hangman’s fracture” could have killed him instantly, but the emergency professionals saved him without paralysis by not deviating from their head injury protocols. After admission, however, his physician deviated from her protocol. On his third hospital day he developed what his nurse called “wet lungs,” for which his new hospitalist internist prescribed IV Lasix without first evaluating him face-to-face. I arrived just in time, stopped the nurse and quickly evaluated my father. I diagnosed retained secretions due to delirium induced by the psychoactive drug Risperdal his radiologist had ordered in order to keep him still during each of his two MRI scans. I suctioned his airway and cured his

By Gerald Rogan, MD jerryroganmd@sbcglobal.net

These grounded Boeing 737-Max jets are an example of what can happen when practices are allowed to deviate from accepted protocols up to the time a catastrophic event occurs. 30

Sierra Sacramento Valley Medicine

talist culture had essentially made a routine deviation from its protocol (emergency face-to-face assessments) normal, thereby risking the health care of its patients. My father’s case wasn’t an isolated event. At another time in the same hospital, my 91-year-old mother arrived in its emergency department with black stools and weakness. The ED physician attempted to pass a diagnostic nasogastric tube into her stomach, but it coiled up in the back of her throat. Her medical chart documented a cervical esophageal diverticulum (outpouching), a condition for which the placement of the NG tube was contraindicated. Fortunately, her diverticulum was not perforated by the NG tube, so the failure to check her past medical history did not cause harm. But the deviation from accepted medical practice—their failure to review her past medical history—had allowed the contraindicated procedure. But because it occurred without consequence, the deviation remained acceptable to the health care professionals. By contrast, while preparing for a replacement of a failed artificial hip at another medical care system, I was

When deviation is normalized, an adverse consequence isn’t an “accident.” It is a predictable surprise. required to visit my dentist for any needed work—to be completed at least two months pre-op—as part of a strict protocol. The requirement is explained in the operation booklet handed to each patient and reinforced by support staff at a required pre-operative orientation. As a result, surgeons need not personally instruct their patients to follow it. My medical care system does not allow a deviation from its protocol, even though the post-operative infection rate for this surgery is so low that a deviation would likely be inconsequential. But it is this low risk of a complication that can lead an institution to normalize a deviation from its safety protocol until, eventually and predictably, a disaster happens that is improperly classified as an “accident.” One of the most egregious deviations from a safety protocol took place at Redding Medical Center, where over 600 patients received unnecessary heart surgery

between 1997 and 2003. The RMC leaders allowed a department’s chief physician to deviate from its peer review protocols established to assure patient safety. But by immolating effective peer review, a few powerful people within the institution grew rich while the hospital supplemented its cash flow by $100 million annually. Powerful leaders created a hospital culture of impaired safety, partially through intimidation. This unmitigated, supercilious leadership caused our federal government, through the Centers for Medicare and Medicaid Services, to disenroll the hospital and force its owner, Tenet Health Care, to sell it. Normalization of deviance is more common than one might expect. It was central to the mismanagement of the Space Shuttle Program by NASA, and astronaut Mike Mullane has said it led to the explosions of the Challenger (1986) and the Columbia (2003), killing their crews. More recently, investigations into the two 737-Max crashes have shown similar management dysfunction problems. Insiders were suppressed when they attempted to follow their established safety protocol. Their suppression has cost the Boeing Corporation hundreds of millions of dollars, caused its CEO to be fired, and led to the avoidable deaths of hundreds of passengers. Complicated systems, including those that provide medical care, space travel, and manufacturing, include quality assurance protocols for a reason, even when following them can appear to be a waste of time and energy. Unfortunately, learning is slow and often only comes in the wake of a catastrophe that might involve one person or hundreds. Thankfully, over the past 20 years medical professionals increasingly have designed, and are following, protocols to improve patient safety. Many institutions support them: Examples include protocols for time-out before surgery, use of check-lists, more frequent hand washing, bar-coding, and decision-making protocols that require a departure justification. Had my father died from the Lasix, or my mother from a perforated esophagus, or me from a prosthesis infection, one might think it was bad luck, an unavoidable risk. Others might opine medical negligence. The critical question is whether or not an institution allows a culture in which deviation from established and rigorous safety protocols may become normalized, and how far it will go before disaster occurs.

March/April 2020

| MUSEUM OF MEDICAL HISTORY |

Nursing History Room Opens At SSVMS Museum Displays Celebrate Pioneer Nurses and Evolution of the Profession

ast year, the Society’s Medical History Museum was able to practically double its space, thanks to a grant from Mildred D. Kahane, M.S.N. in memory of her husband, Dr. Albert Kahane. This generous donation sparked a message to our curator, Dr. Bob LaPerriere, that we physician-historians may have been remiss in not better recognizing our nursing colleagues. This is about to change with the development of our Nursing History Room. The plan of the room divides nursing history roughly into two sections. The first tells of the early development of the profession by the pioneers, including Florence Nightingale and Clara Barton, up until the first part of the 20th century. The second describes the regulations and dynamic expansion of the scope of nursing from these years until today. Both Florence Nightingale (1820-1910) of England and Clara Barton (1821-1912) of America developed their missions by assisting in the care of the wounded in their respective national wars: the British against the Russians in Crimea, and the Americans in the U.S.

The Nursing History Room includes a wide selection of books used in nursing education through the years. 32

Sierra Sacramento Valley Medicine

By F. James Rybka, MD and Lucille C. Rybka, RN, Ed.D. jimrybka@hotmail.com

Civil War. They learned quickly how good nursing care should not cease at sundown. At her military hospital in Scutari, Florence Nightingale determined that far more—10 times more— soldiers were dying from typhus, typhoid, cholera and dysentery than they were from battle wounds. She used a lamp at night when making her rounds to observe the status of her patients, and issued rules to improve their sanitary conditions and malnourishment. Clara Barton devoted her life towards public health and delivered numerous lectures about nursing training throughout America. When she served at a field hospital during the Civil War, she observed that surgeons had to stop their work at nightfall. In response, she installed lanterns found in her supply wagons that allowed them to continue. In 1881, Barton founded the American Red Cross in Washington, DC. Our room contains a number of photographs of Red Cross nurses and volunteers from past years, as well as uniforms and artifacts that include a canvas stretcher from the World War I era. Shortly after the Civil War there was an influx to the U.S. of Catholic nuns, particularly the Sisters of Mercy from Ireland. Over the next fifty years, these women went on to establish hundreds of hospitals and nursing schools, including Mercy Hospital in Sacramento. Our new Nursing History Room includes several photos of nurses in schools that they founded. The room also includes a pictorial tableau about Florence Nightingale, as well as a copy of a photograph of Clara Barton. There is a cabinet of artifacts that includes a replica of Florence Nightingale’s lamp as well as needle sharpeners, containers for sterilizing used syringes, and salts for making balanced saline solutions, all of which were used by hospital nurses before commercial sterile supplies were available. Well-preserved nursing uniforms from past years,

Photos by Ken Smith

A vintage uniform from Children’s Hospital of San Francisco is one of several on display. with their capes and neatly starched blouses and aprons, many with their school insignias, are displayed around the room. There is also a display of nurses’ caps worn through the years. (The museum thanks Rytina Cleaners for donating services to clean and restore these uniforms.) Nursing schools developed as adjuncts of hospitals, as well as schools within academic colleges. In both situations, once the students had completed their nursing education, a nursing pinning ceremony took place as a symbolic welcoming of the graduates into the nursing profession by the faculty in the presence of their family and close friends. The SSVMS Museum of Medical History intends to build a display of these school pins. If you are a former nurse who would like to donate your pin, please contact us at ssvmuseum@ssvms.org. Donated pins will be secured on a banner with the names and schools of the donors. The second section of the Nursing History Room details the development of modern day regulations and evolution of nursing education since the early 1900s. At that time, there were over 400 training schools, the quality of which varied considerably. It became clear that standards were needed and that trained nurses had to be registered for public safety. Gradually, each state developed a Board of Registered Nurses to protect the title of registered nurse (RN). On the walls of the room are charts that explain the entry level of modern nursing and how those attracted to the profession are trained to become nurse assistants, certified as licensed vocational nurses (LVNs) or licensed as practical nurses (LPNs). LVNs or LPNs are tasked with basic patient care and

minor administrative duties under the direct supervision of a registered nurse or a physician. Many with these certificates wish to further their education to become RNs, which requires successfully completing courses in anatomy, microbiology, chemistry and physiology. Some RNs also advance to become nurse anesthetists, The charts go further to tell how a number of registered nurses have advanced their basic RN certificate to gain a bachelor’s degree or a master’s degree in nursing science. Thereafter, some may go further to become clinical nurse specialists, nurse practitioners, or physician assistants. At this level, they are able to diagnose health problems and prescribe medications. This has been of great help towards expanding health care to areas where there is a shortage of physicians. Some nurses with these degrees have advanced further to the doctoral level as a Ph.D or Ed.D in nursing, where they may become academic leaders and administrators of nursing schools. Another aspect of nursing the room features is the growing number of men in nursing. During the Vietnam War, there was a shortage of female nurse volunteers to work in the military hospitals. As a result, each of the services began to train non-commissioned service men to become OR scrub techs. Upon returning to civilian life, a number of them found that they enjoyed this work and went back to school to become emergency medical technicians or paramedics. Some advanced further to become LVNs, RNs, or physicians. A photo of a 1967 graduating nurses class from Sacramento City College in our room shows an array of 43 female nurses adorned in white dresses and nurses caps. In the center is a lone male nurse, attired in a white scrub suit with no cap. He is crouching down, like the center of a butterfly, with the women fanned out from him like wings. The room contains photographs of present-day nurses, male and female. These show how they are no longer dressed in the old uniforms in our display and are instead in gender-neutral hospital scrub suits. These are more practical and hygienic in that they are freshly laundered each day. Although our basic mission is to record nursing history, it is also our goal to describe modern nursing and to attract the interest of young students who might consider becoming nurses or physicians. The Nursing History Room and Museum of Medical History are within the SSVMS office building at 5380 Elvas Avenue in Sacramento. The museum is open Monday through Friday (except holidays) from 9 a.m. to 4 p.m. March/April 2020

| BOARD BRIEFS |

Board Briefs

For Resident Physician Active — Tommy P. Saborido, MD.

Welcomed John Wiesenfarth, MD as the 2020 SSVMS President. Extended a thank you to outgoing President Chris Serdahl, MD for his leadership in 2019. Also, welcomed new Directors, Marcia Gollober, MD, representing District 6 (Yolo County); Farzam Gorouhi, MD and Angie Yu, MD, representing District 5 (The Permanente Medical Group).

For Multiple Membership — Marcy Ahrons, MD; Guadalupe Avila-Kirwan, MD; Michael Boyd, MD; Apeet Hundal, MD; Jeffrey Lee, MD; Katherine Lee, MD; Tennyson Lee, MD; Dan Merck, MD; James Nichol, MD; Karen Panek, MD; Narges Shariati Varnosfaderani, MD; John Youngblood, MD; Ethelwoldo Guerrero, MD; Andrew Oh, MD; Sanyukta Pawar, MD; Lily Chaput, MD; Afshine Ghaemi, MD; Veeraparn Kanchananakhin, MD; Karin Kordas, MD; David Mach, MD; Mohammad Malaekeh, MD; Thomas Maney, MD; Nesser Ramirez, MD; Mushfeka Sharif, MD; Alan Truong, MD; Yunli Zheng, MD.

Elected J. Bianca Roberts, MD 2020 Secretary and Paul Reynolds, MD 2020 Treasurer.

For Retired Membership — S. David Koh, MD; Andrew Klonecke, MD; Russell F. Jacoby, MD.

Guest Speaker, Peter Hull, MD, Chair of the Emergency Care Committee, updated the Board on current committee activities.

For Termination of Membership Due to Expired License — Jack E. Russo, MD; Paul B. Sobelman, MD.

January 13, 2020 THE BOARD:

Approved the 2020 Committee Appointments. Approved the November 2019 Financial Statements and Investment Reports. Approved First Citizens Bank as a Vetted Vendor.

APPROVED THE FOLLOWING MEMBERSHIP REPORT December 2019 For Active Membership — Carlton Z. Adams, Jr., MD; Charles P. Aguilar, MD; Katie G. Alton, MD; Geoggrey T. Beck, MD; James C. Becker, MD; Christina W. Ching, MD; Jana Chtchetinin, MD; Patricio C. Clavecillas, MD; Trinh T. Dao Nguyen, MD; Alexander R. Facque, MD; Joanna M. Finn, MD; Freshta Kakar, DO; Joey H. Kim, MD; Lisa J. H. Mao MD. Andreea C. Medina, MD; Matthew R. Melchione, DO; Shirin s. Melchio ne, DO; Shireen Mirza, MD; Nicole A. Nakamaru, MD; Nhung P. T. Pham, MD; Sudhakar Rendla, MD; Colin C. Ryan, MD; Rasanamar K. Sandhu, MD; Sara M. Sani, DO; Mee N. Song, MD; Dimitri Steblovsky, MD; Anna A. R. Storelli, MD; Walaa M. Treki, MD; Jessica L. Wall, MD; Joshua I. Wilner, MD; Lillian Xiong, MD. For Reinstatement to Active Membership — Rupinder K. Chima, MD. For Resident to Active Membership — Christopher M. Beck, MD; Melissa Itsara, MD; Ernest P. Stewart, III, MD; Susanne J.H. Stewart, MD. 34

Sierra Sacramento Valley Medicine

For Resignation — Jose F. Abad, MD (moved to VT); Jawad T. Ali, MD (moved to TX); Manjula Bobbala, MD; Vikant Gulati, MD (left area); Jennifer L. Gullo, MD (moved to OH); Theodore W. Hoehn, MD (moved to NV); Cheri WP. Leng, MD (left area); Ragini Sastry, MD (left area); Penelope C. Thomas, MD (moved to FL); Julie A. Wood, MD (moved to AZ).. For Transfer of Membership — Pryanka Wani, MD (to Santa Clara). Deceased — Marion W. McArthur, MD.

Seeking Physician Mentors for Medical/PA Students Are you a physician willing to donate a few hours of your time to mentor medical, PA, and NP students? The Joan Viteri Memorial Clinic, a UC Davis School of Medicine student-run clinic, is searching for physicians to serve as mentors and preceptors to teach students from 10:30 a.m to 2 p.m. Scheduling is flexible, volunteer physicans are welcome to come as often as they desire. For more information, please contact jvmclinic@gmail.com.

| NEW MEMBERS |

New SSVMS Members

The following applications have been approved by the Sierra Sacramento Valley Medical Society. Information pertinent to consideration of any applicant for membership should be communicated to the Society. â&#x20AC;&#x201C; J. Bianca Roberts, MD, Secretary.

New Active Members

*Physician specialty abbreviated following name.

Carlton Z. Adams, Jr., MD, VS, Solo

Maja Mircic, MD, P, The Permanente Medical Group

Charles P. Aguilar, MD, AN, The Permanente Medical Group

Shireen Mirza, MD, IM, The Permanente Medical Group

Katie G. Alton, MD, OBG, The Permanente Medical Group

Nicole A. Nakamaru, MD, OBG, The Permanente Medical Group

Archana Anantharaman, MD, IM, The Permanente Medical Group

Phi D. Nguyen, MD, EM, The Permanente Medical Group

Pamela E. Apolaya, MD, IM, The Permanente Medical Group

Akhila Pamula, MD, EM, The Permanente Medical Group

Christopher M. Beck, MD, EM, The Permanente Medical Group Geoffrey T. Beck, MD, FM, The Permanente Medical Group James C. Becker, MD, GS, The Permanente Medical Group Apurva A. Bhatt, MD, FM, The Permanente Medical Group Hans U. Bueff, MD, ORS, The Permanente Medical Group Charlotte V. Burke, MD, OBG, The Permanente Medical Group

Amir Obbehat, MD, IM, The Permanente Medical Group Nhung P. Pham, MD, IM, The Permanente Medical Group Sudhakar Rendla, MD, PD, Marshall Center for Pediatrics Claudia Ruiz, MD, IM, The Permanente Medical Group Colin C. Ryan, MD, IM, The Permanente Medical Group Manu S. Saini, MD, FM, The Permanente Medical Group

Rupinder K. Chima, MD, EM, The Permanente Medical Group

Rasanamar K. Sandhu, MD, OPH, The Permanente Medical Group

Christina W. Ching, MD, PD, The Permanente Medical Group

Sara M. Sani, DO, IM, The Permanente Medical Group

Jana Chtchetinin, MD, GS, The Permanente Medical Group

Armine P. Sarchisian, MD, OBG, The Permanente Medical Group

Patricio C. Clavecillas, MD, FM, The Permanente Medical Group Trinh T. Dao Nguyen, MD, FM, The Permanente Medical Group Barak J. Davis, MD, EM, The Permanente Medical Group Alexander R. Facque, MD, PS, The Permanente Medical Group Joanna M. Finn, MD, IM, The Permanente Medical Group Michael A. Flaningam, MD, IM, Sutter Medical Group Bethany S. Fleming, MD, EM, The Permanente Medical Group Muhammad A. Gill, MD, HOS, Mercy Medical Group Angelique D. Goodhue, MD, P, The Permanente Medical Group Pritika Gupta, MD, EM, The Permanente Medical Group Terrence R. Horan, MD, EM, The Permanente Medical Group Anne C. Hsii, MD, PD, The Permanente Medical Group Melissa Itsara, MD, A, The Permanente Medical Group Freshta Kakar, DO, OBG, Mercy Medical Group Joey H. Kim, MD, IM, The Permanente Medical Group Dong Lee, MD, IM, The Permanente Medical Group Tim H. Lee, MD, AN, The Permanente Medical Group

Philip M. Sinatra, MD, ORS, The Permanente Medical Group Prabhbir Singh, MD, HOS, Mercy Medical Group Shawn D. Skaife, MD, FM, The Permanente Medical Group Roberto A. Solis, MD, FM, The Permanente Medical Group Mee Na Song, MD, IM, The Permanente Medical Group Dimitri Steblovsky, MD, EM, The Permanente Medical Group Ernest P. Stewart, III, DO, CCM, The Permanente Medical Group Suzanne J. Stewart, MD, PD, Marshall Center for Pediatrics Dora A. Storelli, MD, ORS, The Permanente Medical Group Xiannan Tang, MD, N, The Permanente Medical Group Holly K. Thompson, MD, NM, The Permanente Medical Group Walaa M. Treki, MD, HOS, Mercy Medical Group Behnam Vahdati Nia, DO, FM, Woodland Clinic Medical Group Rani Vatti, MD, IM, The Permanente Medical Group Jessica L. Wall, MD, FM, The Permanente Medical Group John T. Waring, MD, AN, Sacramento Anesthesia Medical Group

Theresa B. Manaloto, MD, FM, Mercy Medical Group

Catherine S. Watson, MD, OBG, The Permanente Medical Group

Esther S. Manolarakis, MD, OPH, The Permanente Medical Group

Lillian Xiong, MD, R, The Permanente Medical Group

Joshua I. Wilner, MD, FM, The Permanente Medical Group

Lisa J. Mao, MD, R, The Permanente Medical Group Donald K. Matthews, MD, ORS, The Permanente Medical Group Andreea C. Medina, MD, FM, The Permanente Medical Group Matthew R. Melchione, DO, FM, The Permanente Medical Group Shirin S. Melchione, DO, PD, The Permanente Medical Group

New Resident Physician Active Member *Physician specialty abbreviated following name.

Tommy P. Saborido, MD, FM, UCD

Matthew J. Mermer, MD, ORS, The Permanente Medical Group

March/April 2020

Contact SSVMS to Access Your

M e m b e r O n ly B e n e f i t s

info@ssvms.org | (916) 452-2671 BENEFIT

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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

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SSVMS Vetted Vendor Partners Maloof Law Group Nicholas Maloof, Esq. Estate planning, business transactions. Physician members receive a 10% discount on all services. Cooperative of American Physicians (CAP) Medical professional liability protection to over 12,000 of California’s finest physicians. NORCAL Group Medical professional liability insurance, risk management solutions and provider wellness resources.

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.

www.ssvms.org/physician-resources/vendor-partners. Questions: dbrooks@ssvms.org

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