JULY / AUGUST 2017
VOLUME 23 | NUMBER 4
Dr. Scott Benninghoven, SCCMA President for 2016-17, "Passing the Gavel" to Dr. Seham El-Diwany, SCCMA President for 2017-18 INSIDE COVER: MCMS Incoming President Maximiliano Cuevas, MD Receives the Gavel
JULY / AUGUST 2017
VOLUME 23 | NUMBER 4
MCMS Incoming President Maximiliano Cuevas, MD Receives the Gavel From Past President Craig Walls, MD
BULLETIN THE
Official magazine of the Santa Clara County Medical Association and the Monterey County Medical Society
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THE SANTA CLARA COUNTY MEDICAL ASSOCIATION OFFICERS President Seham El-Diwany, MD President-Elect Kenneth Blumenfeld, MD Past President Scott Benninghoven, MD VP-Community Health Cindy Russell, MD VP-External Affairs Vanila Singh, MD VP-Member Services Ryan Basham, MD VP-Professional Conduct Faith Protsman, MD Secretary Seema Sidhu, MD Treasurer Anh Nguyen, MD
CHIEF EXECUTIVE OFFICER
COUNCILORS
William C. Parrish, Jr.
El Camino Hospital of Los Gatos: Lewis Osofsky, MD El Camino Hospital: Vacant Good Samaritan Hospital: Vinit Madhvani, MD Kaiser Foundation Hospital - San Jose: Hemali Sudhalkar, MD Kaiser Permanente Hospital: Martin Wong, MD O’Connor Hospital: Cathy Angell, MD Regional Medical Center: Erica McEnery, MD Saint Louise Regional Hospital: Vacant Stanford Health Care / Children's Health: John Brock-Utne, MD Santa Clara Valley Medical Center: Clifford Wang, MD
CMA TRUSTEES - SCCMA Thomas M. Dailey, MD (District VII) Kenneth Blumenfeld, MD (District VII)
BULLETIN THE
Official magazine of the Santa Clara County Medical Association and the Monterey County Medical Society
THE MONTEREY COUNTY MEDICAL SOCIETY
Printed in U.S.A.
OFFICERS
Managing Editor Pam Jensen
Opinions expressed by authors are their own, and not necessarily those of The Bulletin, SCCMA, or MCMS. The Bulletin reserves the right to edit all contributions for clarity and length, as well as to reject any material submitted in whole or in part. Acceptance of advertising in The Bulletin in no way constitutes approval or endorsement by SCCMA/ MCMS of products or services advertised. The Bulletin and SCCMA/MCMS reserve the right to reject any advertising. Address all editorial communication, reprint requests, and advertising to: Pam Jensen, Managing Editor 700 Empey Way San Jose, CA 95128 408/998-8850, ext. 3012 Fax: 408/289-1064 pjensen@sccma.org © Copyright 2017 by the Santa Clara County Medical Association.
4 | THE BULLETIN | JULY / AUGUST 2017
President Maximiliano Cuevas, MD President-Elect David Ramos, MD Past-President Craig Walls, MD PhD Secretary Alfred Sadler, MD Treasurer Steven Harrison, MD
CHIEF EXECUTIVE OFFICER William C. Parrish, Jr.
DIRECTORS Valerie Barnes, MD Christopher Burke, MD David Holley, MD William Khieu, MD Eliot Light, MD
Phillip Miller, MD Walter Mills, MD James Ramseur, MD Stephen Saglio, MD Diane Sanchez, MD
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Inaugural Speech
T
he following speech was presented at SCCMA’s Annual Awards Banquet and Installation Dinner on June 6, 2017.
President, Santa Clara County Medical Association
SEHAM EL-DIWANY, MD
MESSAGE FROM THE
SCCMA PRESIDENT
INTRODUCTION
Seham El-Diwany, MD is the 2017-2018 president of the Santa Clara County Medical Association. She is a board certified pediatrician with The Permanente Medical Group and is currently practicing with Kaiser Permanente San Jose.
Thank you Scott for your very kind introduction. And thank you SCCMA for this tremendous honor. With your support and the legacy of our visionary leadership, I proudly assume this responsibility.
CORE Our state-wide official brochure lists the top 10 Reasons to join CMA: 1. TOGETHER WE ARE STRONGER 2. SHAPE THE FUTURE OF MEDICINE 3. PROTECT THE PROFESSION 4. LEAD BY EXAMPLE 5. COLLABORATE WITH COLLEAGUES 6. PROMOTE PUBLIC HEALTH 7. PROTECT MICRA 8. STAY IN THE KNOW Now, these last two are really good ones: 9. GET PAID: Members receive one-on-one assistance from CMA’s Reimbursement experts, who have recouped $13 million from payers on behalf of CMA physicians in the past seven years. And 10. HEAD SEAT AT THE POLICY TABLE: This is the one I enjoy most, educating our legislators before they cast their vote on pertinent medical Assembly and Senate Bills. But why the SCCMA? Because we are a force to be reckoned with. • We are the most prominent medical society in California and are an undeniable presence at the HOD and CMA meetings. • Santa Clara County houses an extraordinarily diverse population carrying the highest per capita income and education in the country, and perhaps the world. • We care for and grow with the people who power the world’s most influential hub of technological advancement, thus priming us to showcase advances in medical technology, practice, and prevention to the world. • Our active membership includes over 3,000 physicians in Santa Clara County, which is
6 | THE BULLETIN | JULY / AUGUST 2017
among the highest of all metro areas. • This uptake, which approaches 80%, is a clear and resounding tribute to the tireless dedication of our CEO Bill Parrish over the past 20 years. • Even more important than the quantity is the quality of SCCMA participation at all levels. ȧȧ At the county level, members participate through numerous committees, activities, and advocacy opportunities to focus on issues in our own backyard. ȧȧ At the state level, our members play a vital role in setting the agenda and thus the conversation. ȧȧ And at the National level, California will remain at the forefront of social change and retain its prominent voice in our country’s internal dialogue around human health. • At all levels, our members extend their commitment as physicians to care for patients as members of SCCMA and stewards of our profession.
IN CLOSING I would like to thank Bill Parrish, our CEO, for the superb job he is doing as our leader, Dr. Scott Benninghoven for his mentorship during the last year, the rest of the Executive Committee and all the Trustees for their continued support. To our staff, Mark Christiansen, our BME general manager, Jean Cassetta, Pam Jensen (the main organizer for tonight’s event), Leslie Sorensen and Sandie Moore, I look forward to working with you all even more closely. Special thanks to my family, Monir my husband (you complete me), my son Justin (you inspire me) , my son Ramy (you restore my faith in our noble profession) and Katie my daughter-in-law, and last but not least the cute handsome little boy sitting down there having a good time, Wesley, my grandson. And finally, I would like to thank you all for your continued support and dedication to SCCMA.
Past-President, Santa Clara County Medical Association
SCOTT BENNINGHOVEN, MD
Bill Parrish is an outstanding leader and CEO. He has made my job as President, and I suspect every Presidents job, easier. He knows how to give the right combination of encouragement, guidance, and support. He is so skillful at this that one might delude oneself and think we actually know what we are doing for a moment. Thank you Bill for all you do for SCCMA. I appreciate it. The Executive Council members each have brought great ideas, insight and caring about our patients and the world we live in to all Executive Council meetings. I would like to acknowledge President Elect Dr. Seham El-Diwany, Past President Dr. Eleanor Martinez, VP-Community Health Dr. Cindy Russell, VP-External Affairs Dr. Ken Blumenfeld, VP-Member Services Dr. Ryan Basham, VP-Professional Conduct Dr. Vanila Singh, Secretary Dr. Seema Sidhu, and Treasurer Dr. Ahn Nguyen. Of special note is Dr. El-Diwany who, when I asked her a question expecting just an answer, returned a solution in report format that solved issues that I never considered. She is very thorough, organized and thoughtful. Dr. El-Diwany will be a great SCCMA President. No less important are the Representatives of each hospital in Santa Clara County who come to the meetings to learn and share so that we may all benefit from our colleague’s experiences. These Representatives are a great asset to the organization. Representing El Camino Hospital of Los Gatos, Dr. Lewis Osofsky, Good Samaritan Hospital, Dr. Vinit Madhvani, Kaiser Foundation Hospital-San Jose, Dr. Hemali Sudhalkar, Kaiser Permanente Hospital, Dr. Martin Wong, O’Connor Hospital, Dr. Michael Charney, Regional Medical Center, Dr. Erica McEnery, Saint Louise Regional Hospital, Dr. Faith Protsman, Stanford Health Care, Dr. John Brock-Utne, and Santa Clara Valley Medical Center, Dr. Clifford Wang. I appreciate all the time and energy you give to the Council and SCCMA. There are two staff members of SCCMA with whom I have worked with the most and to whom I owe a big thank you. Jean Cassetta and Editor of The Bulletin Pam Jensen. Jean kept the Council organized and could always find the answer to any question or solve any problem. Pam is a great editor of The Bulletin, encouraging me and pushing me when I needed it to complete my articles. Again I appreci-
MESSAGE FROM THE
T
he following speech was presented at SCCMA’s Annual Awards Banquet and Installation Dinner on June 6, 2017. I don’t know about you but I have had a great year being President of SCCMA. From my perspective it was a quiet and non-confrontational year. I hope you have the same impression. However, that doesn’t mean that there weren’t important issues for physicians being decided, just that we had no major publicly known propositions or legislation this year such as Prop 46 and MICRA, the Tobacco Tax and End of Life Option Act. The major issues this past year, which will all have lasting effects for our profession, generated little public awareness, namely AB72, Out-of Network Billing, which set the ceiling for physician fee-forservice reimbursement, Governor Brown taking the Tobacco Tax money intended by voters to improve access for Medi-Cal recipients, and nationally, the Republican’s attempts to dismantle the ACA. The lobbyists for the CMA and AMA, however, have been working very hard to protect our patients’ interests in Sacramento and Washington D.C. Most of their issues are lobbied using old fashion oneon-one discussion and education of our legislators combined with support from physicians in the form of letters, emails, and personal contacts. Most physicians don’t know how really good our legislative team in Sacramento really is. Fortunately, we have several SCCMA members here tonight who continue to represent us very well at the CMA level; Trustees Dr. Tom Dailey, Dr. Ken Blumenfeld, Vice-Speaker of HOD, Dr. Tanya Spirtos, and Past President of CMA Dr. Jim Hinsdale, who is now our AMA representative. I have and continue to learn from them. There are many people who I need to thank tonight. First is the NBA for not scheduling a Finals game tonight as many of us Warriors fans would be conflicted over where to be right now. Next, and not really second, I would like to give my heartfelt thanks to Dr. Jim Hinsdale, recipient of this year’s Robert D. Burnett, MD Legacy Award, for without whom, I would not have become an active member of SCCMA and met all of you wonderful and giving people. I was encouraged to join SCCMA, go to meetings, represent Saint Louise on the Council, become President Elect, Treasurer and Secretary. When Dr. Hinsdale encourages you, there is only one answer, say “Yes sir” and smile.
SCCMA PAST-PRESIDENT
Outgoing President’s Address
Scott Benninghoven, MD is the 2016-2017 president of the Santa Clara County Medical Association. He has a general surgery practice in the South County and practices at Saint Louise Regional Hospital, Regional Medical Center of San Jose, as well as O’Connor and Good Samaritan Hospitals.
Continued on page 9
JULY / AUGUST 2017 | THE BULLETIN | 7
Planning Ahead – ACA Repeal?
President, Monterey County Medical Society
MAXIMILIANO CUEVAS, MD
MESSAGE FROM THE
MCMS PRESIDENT
E
Maximiliano Cuevas, MD is the 2017-2018 president of the Monterey County Medical Society. He is currently the Chief Executive Officer at Clinica de Salud del Valle de Salinas.
arlier this year, the U.S. Senate voted in favor of the procedural motion that begins the process for repealing and replacing the Affordable Care Act (ACA). The U.S. House of Representatives passed the American Health Care Act (AHCA), its version of replacement. The U.S. Senate now is attempting to convince the American people that it can develop a replacement for the ACA with its Better Care Reconciliation Act (BCRA). The result would be that if this legislation is passed, 24 million Americans will be without healthcare insurance coverage and millions more will lose coverage as a result of reduced funding of the Medicaid program. In Monterey County, only 60% of the lowincome community is reached with current health care resources. There are more than 51,000 people who are income-eligible but not accessing primary care through our health care delivery system and its “safety net.” These low-income populations experience higher rates of obesity, diabetes, and hypertension than state averages. With the removal of the ACA, and the loss of health programs such as MediCal, the safety-net system will become the only resource for tens of thousands of new patients. The implications are daunting for the health and well-being of the entire region. The Monterey County Medical Society must be involved to make sure that families in Monterey County are not impacted adversely by decisions contemplated by our Congress in Washington, DC. We must be aware of the very ominous future the health care safety net (including our hospitals) is facing if the BCRA is enacted. The mechanisms are in place to legislate a poorly-conceived healthcare bill and to administer the poorly-conceived program that it creates to not deliver healthcare services to lower income Americans. Both the Secretary of Health and Human Services and the Director for the Centers for Medicare and Medicaid Services have previously expressed their policy preferences for reducing overall funding for the health care safety net in the U.S. So independently of what happens with the repeal and replace of the ACA, funding for programs that provide valuable access to primary health care services to vulnerable working poor in this nation may well be eliminated. The consequences cannot be viewed merely as being a lack of access to health care, but rather must be seen as having a serious and structural impact on the economy of Mon-
8 | THE BULLETIN | JULY / AUGUST 2017
terey County, on the agricultural and service sectors of this state and nation, and the overall economic well-being of the U.S. The repeal of the ACA threatens the health of the California and Monterey County economies. A 2016 UC Berkeley Labor Center study predicts that repeal of the Affordable Care Act would eliminate more than 200,000 jobs in California and impact the state and local economic picture. Counties such as Monterey County with large populations in the Medi-Cal program would be among the hardest hit. With the proposed repeal, 135,000 of the 209,000 jobs eliminated statewide would be in the health care sector, with hospitals, physician offices, labs, outpatient centers, and dental offices shedding staff members as consumers lose insurance coverage or Medi-Cal eligibility. The study also predicted that the economic impact would affect other industries, such as health care suppliers, restaurants and food service, janitorial services, and accounting firms. The projections include 8,000 job losses for restaurants and drinking establishments, 6,000 in real estate, 6,000 in insurance and related businesses, and 5,000 in employment services. Per the report, the health care industry has been a major source of employment growth in California during our recovery from the great recession. Monterey County experienced higher than average unemployment and joblessness rate during that economic downturn. Monterey County is also at particular risk with ACA repeal because of the large percentage of its population enrolled in Medi-Cal. Monterey County is one of 17 counties in California where at least 4 out of 10 individuals (40%) residing in the county receive health care coverage through Medi‐Cal’s system of care. 80% of Medi-Cal members are served by our safety net providers and 20% are served by our private physicians/medical group practices in Monterey County. The proposed repeal legislation would eliminate the federal Medicaid expansion, which made millions of single adults eligible for Medi-Cal in California including unprecedented numbers in Monterey County. 11,843,081 people in California are covered by Medi-Cal or the Children’s Health Insurance Program, including 5,102,963 children and 1,360,665 seniors and people with disabilities covered by both Medicaid and Medicare. The ACA expanded Med-
icaid eligibility and strengthened the program for those already eligible. 1,188,000 Californians have health insurance today because California expanded Medi-Cal under the ACA. Coverage improves access to care, financial security, and health, resulting in an estimated 136,000 more Californians getting all needed care, 169,000 fewer Californians struggling to pay medical bills, and 1,430 avoided deaths each year. Given that over 40% of the entire population of Monterey County relies on Medi-Cal for insurance, repeal of this health plan will have devastating consequences for over 170,000 Monterey County residents. With the ACA in place in 2014, 40% of uninsured individuals in the region still reported that they are unable to afford insurance1. 48% of uninsured individuals living in the Central Coastal region of California cited cost as a reason for forgoing care2, this is an important indicator that the ACA still puts medical care out of reach of a significant percentage of the population. Even while recognizing that the ACA is not a magic bullet, it is still a vital foundation for the health care safety net and protects the health and wellness of Monterey County. From increased access to insurance and premium subsidies to mandates to cover preventative care and insure patients with pre-existing conditions the ACA has transformed the healthcare landscape in California and in Monterey County. However, regardless of whether the ACA is repealed and possibly replaced with some alternative, our medical provider networks and institutions will continue to do what we each do best to serve the health care needs of Monterey County residents. Now is the time to define what our health care delivery system will look like in Monterey County if ACA is eliminated and to define how our local resources will be utilized to care for the many residents who will no longer have health insurance. The system that we develop must work to minimize duplication and negative competition, and insure that all regions and communities are adequately covered and serviced while better utilizing and applying the health resources we all control. I would like to recommend that a working group be formed of the
health care provider networks and institutions to present our perspective and share our experiences. This working group would begin meeting to evaluate resources that are available and to determine what will be needed. Whether certain portions of the ACA are transferred to a replacement legislative initiative or a completely new bill is developed, we can propose specific measures we believe would be responsive to the issues we have raised to seriously improve on gaps that have developed over many years that ACA did not address, but present serious impediments to effectively serving the needs of Monterey County. Some of the initiatives that can be considered and proposed: 1. Because the new administration has indicated that it plans on giving states health block grants and that health care is better handled at the state and local level, it is consistent to provide funding incentives to localities to create countywide integrated health delivery systems; 2. It is a known fact that there are an insufficient number of physicians, in all medical specialties, to serve those most vulnerable and without sufficient funds to cover these costs. The problem of workforce shortages will be worse for rural communities and the problem facing residents that speak other languages and cannot access a physician that speaks their language is worse in those communities. This was a major shortcoming before, during, and after the ACA was developed and enacted. Medical schools throughout the nation have been reluctant to include in their curriculums cultural and linguistic classes that will greatly improve their ability to communicate with key patient populations that have cultural and linguistic barriers to care. We must mandate the incorporation of cultural, linguistic, and diversity classes in medical schools.
ENDNOTES 1 2
ACA411 – California HealthCare Foundation ACA411 – California HealthCare Foundation
Outgoing President’s Address, from page 7 ate both of you for your assistance and advice. Finally, I will take a lesson from Dr. Hinsdale who at every award acceptance or thank you speech, and there have been many, has thanked the most important person in his life.
I need to acknowledge my wife of 14 months, Pam. I could not be doing any of this: surgery, trauma group, SCCMA, family or any of our activities that I love so much without your love, support and organization. You keep me going. I
have learned only recently how much there is to experience, how much we can give and improve the lives of others around us and so live much richer lives. Pam, thank you for making my life richer every day.
JULY / AUGUST 2017 | THE BULLETIN | 9
MEMBER NEWS & HAPPENINGS
MONTEREY COUNTY MEDICAL SOCIETY’S ANNUAL PHYSICIANS OF THE YEAR BANQUET AND INSTALLATION The Monterey County Medical Society held its annual Physicians of the Year Banquet and Installation on Thursday evening, June 1, 2017, at the Bayonet and Black Horse in Seaside. Approximately 115 members and special guests attended, including Keynote Speaker Ted Mazer, MD (CMA President-Elect). Luis Alejo (District 1 Supervisor) presented proclamations to the Awardees and Simon Salinas (District 3 Supervisor) presented lapel pins to the Board of Directors. Craig Walls, MD, PhD 2016-2017 MCMS president, was honored as the outgoing president. Dr. Walls is the chief medical officer at Natividad Medical Center in Salinas. Dr. Walls oversees a team of 360 providers including physicians, nurse practitioners and physician assistants. He has worked at Natividad since 2006, spending nearly a decade as an emergency room physician. He’s held several positions, including medical director of the emergency department. He received the Faculty Teaching Award
Dr. Maximiliano Cuevas, MCMS President for 201718, “receives the gavel” from Dr. Craig Walls, MCMS President for 2016-17.
Dr. Steven Harrison receives “Physician of the Year” Award from Dr. Craig Walls. 10 | THE BULLETIN | JULY / AUGUST 2017
from Natividad Medical Center in 2011-2012. Dr. Walls said he applied for the CMO position because he is passionate about community health, especially for underserved populations. He holds a doctorate in community health and earned his medical degree from the University of Illinois at Urbana-Champaign. He completed his residency in emergency medicine at Johns Hopkins University, and joined Natividad after working as an ER physician at MacNeal Hospital in Chicago and St. Mary Medical Center in Hobart, Illinois. Walls and his wife, an attorney, relocated to Monterey County after she completed her clerkship. The couple was deciding where to settle down. “We said what’s the nicest place that we can think of? Monterey Bay. And there was a job available in Salinas,” Walls said. The couple lives in Watsonville and has four children. Dr. Walls has been a member of MCMS/CMA for 9+ years. He has
served in the roles as President, President-Elect, and Director on the Board and on the Executive Committee. Maximiliano Cuevas, MD, was welcomed as MCMS’s incoming president for 2017-2018. Dr. Cuevas has been with Clinica de Salud del Valle de Salinas, since 1986 – First as a practicing OBGYN (Obstetrician & Gynecologist) in Salinas, and currently as CEO. Dr. Cuevas graduated from University of California Davis School of Medicine in 1981 and has been in practice for 36 years. He completed a residency at Kern Medical Center. Dr. Cuevas has been a member of MCMS/ CMA for 27+ years. He has also served as a Director on the Board and Executive Committee. Serving in the current fiscal year with Dr. Cuevas are: Craig Walls, MD, PhD, as past president; David Ramos, MD, as president-elect; Alfred M. Sadler, Jr., MD, as secretary; and Steven W. Harrison, MD, as treasurer. The MCMS board of directors are Valerie Barnes, MD; Christopher Burke, MD; David Holley, MD; William Khieu, MD; Eliot Light, MD; Philip Miller, MD; Walter Mills, MD; James Ramseur, Jr, MD; Stephen Saglio, MD; and Diane Sanchez, MD. Award honoree Glenn Hudgens, MD was one of the two physicians that received an award for “Physician of the Year.” Dr. Hudgens has served on many committees at CHOMP over the past 25 years. He is a very attentive General Practitioner. He has served as Chairperson of Medical Services, providing medical care for years at the AT&T Golf Tournament, U.S. Open and numbers of golf tournaments in the community. He is a compassionate doctor who is well liked by patients and his colleagues. Dr. Hudgens has been a member of MCMS/ CMA for 45+ years; he has also served on the Medical Review Advisory Committee as a member. Award honoree Steven Harrison, MD was the other physician that received an award for “Physician of the Year.” Dr. Harrison trained at the University of Maryland and is part of the faculty of UCSF. He has years of service to the patients of South County, Monterey at Mee Memorial, and Natividad Medical Center. Under his leadership the residency program, which has trained 41 years worth of
providers for Central Coast and the USA, was expanded. By leading the training as Program Director, scores of our physicians serving at every hospital and clinic system in Monterey County, Dr. Harrison Dr. Glenn Hudgens receives “Physician of the Year” has had a greater imAward from Dr. Richard Murtland. pact on the practice of medicine in our counexpansion. He has been actively involved with ty than almost any other practicing physician in County Counsel in developing memoranda of the MCMS. understanding to support our relationships with He is involved in supporting the County both Touro University and UCSF. efforts for incorporation of Kenneth GinsDr. Harrison has been a member of MCMS/ berg’s “Reaching Teens” process as outlined in CMA for 19+ years. He has also served in the his excellent American Academy of Pediatrics roles as President, President-Elect, Past Presiintegrated curriculum. He has supervised the dent, Treasurer, Director and Member of the expansion of the residency from 8 residents per Executive Committee. year or 24 total, up to 10 residents per year or 30 The annual banquet was a great success and total. This involved getting County approval for a lot of fun! MCMS members, their families, and the finances, getting ACGME (American Coun- special guests enjoyed a fantastic meal, camaracil on Graduate Medical Education) approval for derie, and a great program to wrap-up the evethe expansion of the family medicine residency ning. clinic as well as the residency itself, and hiring the appropriate faculty and staff to support the
JULY JULY // AUGUST AUGUST 2017 2017 | THE THE BULLETIN BULLETIN | 11 11
Dr. Steven Harrison (Physician of the Year) poses with his Residents from Natividad.
MONTEREY COUNTY MEDICAL SOCIETY
2017 “Physicians of the Year” and Installation JUNE 1, 2017
Dr. Steven Harrison celebrates his special evening and honor with his wife, Cheryl. 12 | THE BULLETIN | JULY / AUGUST 2017
Dr. Ted Mazer (CMA President Elect and Keynote Speaker) and Dr. Maximiliano Cuevas (2017-18 MCMS President).
Dr. Steven Harrison (Physician of the Year), Luis Alejo (Monterey District 1 Supervisor), and Dr. William Lewis.
2016-17 MCMS President Dr. Craig Walls.
Dr. James Hlavacek (MCMS Past President), Dr. Ted Mazer (CMA President Elect and Keynote Speaker) and Dr. Maximiliano Cuevas (2017-18 MCMS President).
Dr. Maximiliano Cuevas (2017-18 MCMS President) poses with the Board of Directors at Clinica de Salud del Valle de Salinas (Gold Level Sponsor).
MCMS members, Awardees, their families and special guests enjoyed the beautiful venue at the Bayonet and Black Horse in Seaside.
Simon Salinas (Monterey District 3 Supervisor) presented lapel pins to the MCMS Board of Directors. JULY / AUGUST 2017 | THE BULLETIN | 13
MEMBER NEWS & HAPPENINGS Dr. Scott Benninghoven receives an appreciation plaque from Dr. Seham El-Diwany for his outstanding leadership as President for 2016-17.
Santa Clara County Medical Association Award Presentations and Installation The Fairmont Hotel’s Club Regent, in San Jose, provided the setting for Santa Clara County Medical Association’s Annual Awards Banquet and Installation. Nearly 200 members and guests were in attendance this year. Scott Benninghoven, MD, 2016-2017 SCCMA President, following his outgoing president’s speech, presented Seham El-Diwany, MD, with 14 | THE BULLETIN | JULY / AUGUST 2017
the presidential gavel for 2017-2018. Serving in the current fiscal year with Dr. El-Diwany are: Ken Blumenfeld, MD, as President-Elect; Cindy Russell, MD, as Vice President of Community Health; Vanila Singh, MD, as Vice President of External Affairs; Ryan Basham, MD, as Vice President of Member Services; Faith Protsman, MD, as Vice President of Professional Conduct; Scott Ben-
The evening’s festivities culminated with the recognition of those who have dedicated their lives to furthering the high quality of medical care. Dr. El-Diwany made the following presentations:
MARGARET MCLEAN, PHD CITIZEN’S AWARD This award is given to an individual who is not a member of the Medical Association, who has achieved public recognition for a significant contribution in the health field. Dr. McLean holds a doctorate degree in clinical pathology from the Medical College of Wisconsin and a Masters of Divinity from Luther Seminary. She has a second doctoral degree in ethics from the Graduate Theological Union in Berkeley. She is currently the Director of Bioethics at the Markkula Center for Applied Ethics at Santa Clara University. As a Senior Lecturer in Religious Studies and affiliate faculty in Bioengineering, she teaches courses on ethics including health care ethics and ethics and biotechnology. In 2006, she received the Brutocao Award for Curriculum Innovation. She is a member of the Bioethics Committee at O’Connor Hospital (San Jose), Seton Medical Center (Daly City), St. Louise Regional Hospital (Gilroy), Santa Clara Valley Medical Center (San Jose), the Infant & Children Bioethics Committee at Valley Medical Center, and
Seham El-Diwany, MD, 2017-18 SCCMA President
ninghoven, MD, as Past President; Anh T. Nguyen, MD, as Treasurer; and Seema Sidhu, MD, as Secretary. The SCCMA Councilors are: Cathy Angell, MD (O’Connor Hospital); Vinit Madhvani, MD (Good Samaritan Hospital); Erica McEnery, MD (Regional Medical Center); Hemali Sudhalkar, MD (Kaiser Foundation Hospital – San Jose); Clifford Wang, MD (Santa Clara Valley Medical Center); and Martin Wong, MD (Kaiser Permanente Hospital-Santa Clara).
JULY / AUGUST 2017 | THE BULLETIN | 15
our very own Santa Clara County Medical Association Bioethics Committee on which she has served for over a decade and has been instrumental in drafting many bioethics policies, which are now used in our area hospitals. As a non-physician member of our Ethics committee, she displays a breadth of invaluable knowledge in many clinical situations. From 1999 until 2002, she was an advisor to the California Senate Select Committee on Genetics and currently is a consultant to the California Department of Public Health. She is widely quoted in the media and has written extensively on ethical issues for professional publications as well as the local and national press. Her article on disaster preparedness published in 2013 in Health Progress received a 2014 Gold Award from the American Society of Healthcare Publication Editors and a bronze award from the Association Media & Publishing EXCEL. She is currently involved in End of Life Decision Making project with focus on the unrepresented patients. It is a great honor to recognize Margaret McLean, PhD as one of the recipients, tonight, for this award.
ASSEMBLYMEMBER ASH KALRA CITIZEN’S AWARD This award is given to an individual who is not a member of the Medical Association, who has achieved public recognition for a significant contribution in the health field. Ash Kalra is a graduate of UC Santa
Barbara, and has a law degree from Georgetown University. Ash Kalra was elected to represent the 27th Assembly District in November 2016. He chairs the Aging and Long-Term Care Committee, and serves on Housing and Community Development, Judiciary, Labor and Employment as well as Privacy & Consumer Protection Committees. Previously he represented the 2nd District on the San Jose City Council, where he was the first Indian American elected to that body. As a council member, he provided a voice on a number of issue areas, including improved schools and transportation options, and a cleaner environment as well as providing the tools for effective public safety. He has impacted the “health” of the entire community with his annual “Holiday Warm-Up” event, which occurs on Black Friday to help the homeless. It is a great honor to recognize Assemblymember Ash Kalra as one of the recipients, tonight, for this award.
JAMES G. HINSDALE, MD ROBERT D. BURNETT, MD LEGACY AWARD This award is given to a physician member of the Medical Association who has demonstrated extraordinary visionary leadership, tireless effort, selfless long-term commitment, and success in challenging and advancing the health care community, the well-being of patients, and the most exalted goals of the medical profession. This award has been given out only five times so far, the first recipient 16 | THE BULLETIN | JULY / AUGUST 2017
was Dr. Robert Burnett himself in 2006. Dr. Hinsdale received his Medical Degree from University of Illinois in Chicago and his Surgery Residency at Stanford. After five years teaching trauma surgery in Brooklyn, NY, he joined San Jose Medical Center where he took part in establishing a Trauma Center and later, the transfer of trauma service to Regional Trauma Center. He is the founder of the Northern California Trauma Group as well as the executive medical director of CALSTAR helicopter transport. He is currently serving as chief of staff at Good Samaritan Hospital. Dr. Hinsdale has played a major role in mentoring and nurturing the careers of dozens of surgeons in Santa Clara County. He has been on staff of every single hospital in Santa Clara County at one time or another. He is known for his ability to bring together diverse groups of doctors to deliver better patient care. Dr. Hinsdale has served in many leadership roles, chief among which: president of SCCMA 1999-2000, President of CMA 2010-2011, Chair of the Board of Trustees at CMA, and as AMA delegate. Among the many previous awards he received are “The Outstanding Contribution to the Medical Association” in 2010 and “The Benjamin Cory, MD Award” in 2013. It is with great pleasure that I present Dr. Hinsdale with the “Robert D. Burnett, MD Legacy Award.”
versity and decided to go to medical school after a skydiving accident, breaking both legs in her senior year. She went just down the road to attend University of North Carolina, Chapel Hill for medical school and did her residency training in Obstetrics and Gynecology there. She joined The Permanente Medical Group (TPMG) in 1987 when husband Bill (her former skydiving instructor) joined HP at the Cupertino site a mile away from the Kiely Hospital Location. Dr. Smarr assumed many leadership roles throughout her career at TPMG. Currently she serves as Physician-In-Chief and Chief-of-Staff at the Santa Clara Kaiser Permanente Medical Center, supporting over 900 physicians and 5,000 staff providing exceptional care for 360,000 Silicon Valley members. She serves on the Advisory Board of the Markkula Center for Applied Ethics at Santa Clara University as well as the Board of Joint Venture Silicon Valley: and is a senior fellow with the American Leadership Forum Silicon Valley and California Health Care Foundation. She has served as a Board Examiner for the American College of Ob-Gyn for over 10 years.
Continued on page 18
SUSAN C. SMARR, MD BENJAMIN CORY, MD AWARD This award is for a physician member of the Medical Association who has displayed forward-looking, pioneering ideas, enterprise, enthusiasm, and prolonged professional stature and ability. Recipients of this award in prior years included Dr. Robert Burnett in 1982. Dr. Smarr graduated magna cum laude from Duke UniJULY / AUGUST 2017 | THE BULLETIN | 17
Upper Extremity Surgery. He joined The Permanente Medical Group in 2000. He currently serves as the Chief of the Orthopedic and Sports Medicine department at Kaiser Santa Clara Medical Center. Dr. Le has diverse clinical interests in the field of Orthopedic Surgery including hand and upper extremity surgery, sports medicine, and microscopic surgery of the peripheral nerves. He has authored several research papers in his field. His publications include numerous book chapters, review articles, and much of his work has been presented at national meetings. Dr. Le has been named as one of the “Best Physicians” in Silicon Valley and in California by his peers. He has and continues to make many unique contributions to the betterment of patient care during his medical career. It is with great esteem and admiration that we recognize Dr. Tung Le with this award.
PATRICK J. KEARNS, JR., MD OUTSTANDING CONTRIBUTION IN MEDICAL EDUCATION
Dr. Smarr received the “YWCA Tribute to Women Award” in 2016, Silicon Valley / San Jose Business Journal 2012 Judges Choice “Health Care Hero” for her physician innovation program and California Senator Elaine Alquist’s 2012 “Woman of the Year” for Santa Clara County. It is a privilege and a distinct honor to present this distinguished award to Dr. Susan Smarr.
TUNG B. LE, MD OUTSTANDING ACHIEVEMENT IN MEDICINE AWARD This award is for a physician member of the Medical Association who, during his medical career, has made unique contributions to the betterment of patient care, for which he has received widespread recognition. Consideration is given to research and/or the development of procedures, methods of treatment, pharmaceutical agents, or technological advances in the field of medicine. Dr. Le received his Medical Degree with honors from Georgetown University and completed his Orthopedic Surgery residency training at Johns Hopkins School of Medicine. At Hopkins, he received numerous awards for his research in orthopedics and in nerve regeneration. His fellowship at Stanford was in the area of Functional Restoration, Hand and 18 | THE BULLETIN | JULY / AUGUST 2017
This award is for a physician member of the Medical Association who has exhibited sustained interest and participation in one or more medical education activities over and above the membership at-large. Dr. Patrick Kearns attended UC Berkeley, received his Medical Degree from UCLA being inducted into (AOA) and completed his Internal Medicine Residency at VMC. He served as an affiliate Clinical Professor of Medicine at Stanford and published numerous professional articles, book chapters, and monographs. He has given numerous
medical grand rounds lectures as well as regional and national lectures. He served on the CMA Foundation Obesity Prevention Project from 2006-2008. Dr. Kearns has had board certification in internal medicine, critical care medicine, nutrition, and geriatric medicine. Dr. Kearns is an innovator in medical care and education. His ability to recognize and adopt new ideas in medicine and teach them to others has been unique. At VMC, he made significant and long lasting contributions to the training of interns, residents, fellows and Stanford medical students for over 30 years. He served as the VMC Internal Medicine Residency Program Director from 1986 to 1990. In 1997, he founded the Hospitalist Program at VMC and was the first author on an important academic paper highlighting the value of a hospitalist program in internal medicine. He received the “Medicine Teacher of the Year Award” in 2001 and, in 2007 was recognized together with VMC by the California Department of Public Health and the California Hospital Association for leadership in achieving high standards in the Health and Hospital System category. Recently, after retiring from VMC, he developed the Senior Health Center at El Camino Hospital in 2012. This collaborative care for older adults earned a special recognition from the National Committee for Quality Assurance’s Patient-Centered Medical Home. It is with great admiration and pleasure that we recognize Dr. Kearns with this award.
HOWARD SUTKIN, MD OUTSTANDING CONTRIBUTION TO THE MEDICAL ASSOCIATION This award is given to a physician member of the Medical Association who has exhibited sustained interest and participation in one or more activities of the Association over and above that expected of the membership at-large. Dr. Sutkin received his Medical Degree from University of Chicago and completed his Residency Training in Plastic Surgery at Stanford. He is board cer-
tified in Plastic Surgery and has been in private practice for over 25 years. Dr. Sutkin has been an active member of the Medical Association since 1995. In addition to being President of the Association for two consecutive years (2008-2010), he has served on the Council representing Los Gatos Community Hospital, the Executive Committee as Vice-President, Awards Committee, Finance Committee, Medical-Legal Liaison Committee, Well Being of Physicians Committee and Lunch with Legislators. He has also served as Chair for the Member Services and Professional Standards Committee, as well as V.P. of Member Services, and has been a CMA Delegate for 13 years. Dr. Sutkin has made immense contributions to our Medical Association and it is with much pleasure that we recognize his time, input and generous service with this award.
Continued on page 20
JULY / AUGUST 2017 | THE BULLETIN | 19
KRIS KARLEN, MD OUTSTANDING CONTRIBUTION IN COMMUNITY SERVICE This award is given to a physician member of the Medical Association who has exhibited sustained interest and participation in one or more activities of the community over and above that expected of the membership at-large. Dr. Karlen received his Medical Degree from Albert Einstein College of Medicine in New York and completed his residency training in Ophthalmology at Boston University. He is an ophthalmologist at TPMG Milpitas and had recently stepped down as the chief of his department. Dr. Karlen serves as the Vice President on the board of Help is on the Way Ministries (HIOTWM) (a nonprofit, humanitarian organization dedicated to bringing physical, spiritual, social, and financial assistance to
the poor in developing countries mostly in West Africa.). For almost three decades Kris has lead annual missions with HIOTWM to Ghana. Together, with his team, they performed a remarkable number of sight restoring surgeries in a country that currently has less than 50 ophthalmologists to serve a population of 20 million people. “Although restoring sight to the blind may sound like something that would require a miracle, for the poor in West Africa, it’s a very realistic goal,” says Dr. Kris Karlen. Most of the blindness in Ghana is curable by surgery. Dr. Karlen was voted by the Bay Area Consumers’ Checkbook as one of the area’s “Outstanding Ophthalmologists.” It is with much admiration and respect that we present this award to Dr. Kris Karlen. And we have Charles Narh (The founder of Help is on the Way Ministries) and Dr. Carol Munch with us to receive the award on behalf of Dr. Karlen who could not be with us tonight.
Charles Narh (The founder of Help is on the Way Ministries) and Dr. Carol Munch receive the Award on behalf of Dr. Karlen.
20 | THE BULLETIN | JULY / AUGUST 2017
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Congratulations to all Award Ho
Awardees (Left to Right): Dr. James Hinsdale (Robert D. Burnett, MD Legacy Award); Assem Medical Association); Dr. Tung Le (Outstanding Achievement in Medicine); Dr. Susan Smarr (B (Outstanding Contribution in Medical Education); and Dr. Kris Karlen (Outstanding Contribut photo, accepted award on his behalf). 22 | THE BULLETIN | JULY / AUGUST 2017
onorees this Year!
mblymember Ash Kalra (Citizen’s Award); Dr. Howard Sutkin (Outstanding Contribution to the Benjamin Cory, MD Award); Margaret McLean, PhD (Citizen’s Award); Dr. Patrick Kearns, Jr. tion in Community Service – he is not in picture, but Dr. Carol Munch and Charles Narh, in the JULY / AUGUST 2017 | THE BULLETIN | 23
SCCMA Equals Extraordinary Le
SCCMA Past Presidents and President pose for a memorable photo at th
Left to Right: Past Presidents Drs. Donald Prolo, Tony Nespole, Howard Sutkin (also Awardee) AMA Delegate), Seham El-Diwany (Current President), Martin Fishman, Eleanor Martinez, Tom 24 | THE BULLETIN | JULY / AUGUST 2017
eadership
he 2017 Awards Banquet.
), Robert Andonian, Philipp Lippe, Jim Hinsdale (also Awardee, CMA Past President and Current Dailey (also CMA Trustee), Tanya Spirtos (also Vice-Speaker of HOD), and Scott Benninghoven. JULY / AUGUST 2017 | THE BULLETIN | 25
Dr. Seham El-Diwany celebrates her special evening of installation as our President with her beautiful family.
SANTA CLARA COUNTY MEDICAL ASSOCIATION
2017 Annual Awards Banquet and Installation JUNE 6, 2017
Photos: Brandon Vaccaro Studio
William Parrish (SCCMA CEO) poses with his good friend Dr. Jim Hinsdale (Recipient of Robert D. Burnett, MD Legacy Award). Great smiles!! 26 | THE BULLETIN | JULY / AUGUST 2017
Dr. J. Augusto Bastidas and his lovely wife Pat.
Dr. Hinsdale’s friends and colleagues join in celebrating his special evening and well deserved honor.
Award Honoree Assemblymember Ash Kalra celebrates his special evening with his father Mr. Kalra.
(L to R) Dr. Tom Dailey (Past President and CMA Trustee) and his wife Rosemary, Dr. David Campen, Dr. Hanley Yoffee, Irene Chavez, Dr. Niraj Singh, Assemblymember Ash Kalra (Awardee) and his father Mr. Kalra, and Dr. Chris Chang.
(L to R) Mary Ritter, Erika Sutkin, Dr. Barry Brummer, Natasha Sutkin, Award Honoree Margaret McLean, PhD, William Parrish (CEO), Dr. Howard Sutkin (Award Honoree and Past President), and Erin Parks.
Both Awardees, Dr. James Hinsdale poses with Assemblymember Ash Kalra. Well deserved honors to both! JULY / AUGUST 2017 | THE BULLETIN | 27
Award Honoree Dr. Patrick Kearns celebrates his special evening with his family and friends.
Dr. Susan Smarr (Award Honoree) enjoys her special honor with family and friends. A special thank you to Kaiser for your very generous sponsorship!
(L to R) Dorine Leong, Dr. Robert Lin, Dr. Tony Nespole (Past President), Dr. Eleanor Martinez (Past President), Dr. Kenneth Blumenfeld (Incoming President Elect and CMA Trustee) and his wife Ellen, Dr. Martin Fishman (Past President), Dr. Robert Andonian (Past President), Christopher Moylan, and Eric Blumenfeld.
Eric Blumenfeld, Dr. Kenneth Blumenfeld (Incoming President Elect and CMA Trustee) and his wife Ellen; and Darina and Paul Kavanaugh.
SCCMA-BME staff: Jean Cassetta, William Parrish (CEO), Paul Moore, Sandie Moore, Shannon Landers, Leslie Sorensen, Pam Jensen, and Mark Christiansen. 28 | THE BULLETIN | JULY / AUGUST 2017
Ngoc Pham, Dr. Seham El-Diwany (2017-18 President), and Dr. Tung Le (Award Honoree).
Elegant ladies Dr. Eleanor Martinez (Past President) and Dr. Seham ElDiwany (President 2017-18).
Award honoree Dr. Susan Smarr won the raffle drawing for an iPad donated by Standard Business Machines.
Dr. Howard Sutkin (Award Honoree and Past President), his wife Erika and daughter Natasha.
William Parrish (CEO) and his lovely wife Luanne. JULY / AUGUST 2017 | THE BULLETIN | 29
(L to R) Dr. Michael Contro and his wife Debbie, Dr. Madhur Bhatnagar and her son Dr. Rishi Bhatnagar, Omar Chughtai, Joe Deschryver, Pat Bastidas, Dr. J. Augusto Bastidas, and Michelle Hamilton.
Award Honoree Margaret Mclean, PhD and Mary Ritter.
William Parrish (CEO) and Dr. James Hinsdale (Award Honoree and Past President SCCMA & CMA.)
Dr. Scott Benninghoven (2016-17 President) poses with his lovely wife Pamela. 30 | THE BULLETIN | JULY / AUGUST 2017
(L to R) Colin and Karen Cady, Laurie Duckham-Shoor, PhD, Donald and Linda Waters, Benjamin Pither, Joe Greaves, Dr. Eileen Corsorti, and Dr. Ken Wharton.
Dr. James Hinsdale celebrates his special evening with his beautiful family.
Past President Dr. Martin Fishman and CEO William Parrish.
Award Honoree Dr. Susan Smarr poses with part of her Kaiser family.
(L to R) Dr. Philipp Lippe (Past President), Dr. R. Lawrence Sullivan, Dr. Donald Prolo (Past President), Stacie Shih, Dr. Randal Pham, Assemblymember Ash Kalra (Award Honoree), Gail Lippe, Dr. Tanya Spirtos (Past President and Vice-Speaker of HOD), Joanne Prolo, Quetzalma Gomez, and Lawrence Pizzella.
(Head table) L to R: Dr. Scott Benninghoven (President 2016-17) and his wife Pamela, Luanne Parrish, William Parrish (CEO), Kathy Weitsman, Monir El-Diwany, PhD, Wes, Dr. Seham El-Diwany (President 2017-18), Justin El-Diwany, Dr. Ramy El-Diwany and his wife Katie. JULY / AUGUST 2017 | THE BULLETIN | 31
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The Story of Smallpox By Michael Shea, MD Leon P. Fox Medical History Committee Smallpox was eradicated, worldwide, in 1979. This was verified by a commission of prominent scientists and endorsed by the World Health Assembly in 1980. This accomplishment was due to the efforts of the World Health Organization (a United Nations agency), which launched a worldwide immunization program in 1967. At that time two to three million people died of smallpox every year. The origin of the disease has been traced back 10,000 years to Northern Africa. It was detected on the faces of Egyptian mummies from the time of the eighteenth and twentieth Egyptian Dynasties (1570-1085 BC). The disease greatly affected the development of western civilization. The first stages of the decline of the Roman Empire (AD 108) coincided with a large scale epidemic: the plague of Antonine, which resulted in the deaths of almost seven million people. Unknown in the new world, smallpox was introduced by the Spanish and Portuguese conquistadors. The disease decimated the local population and was instrumental in the fall of the Aztec and Inca empires. The case fatality rate varied from twenty to sixty percent and left most survivors with disfiguring scars. Treatment of the disease began with the observation that survivors were immune to subsequent outbreaks. This led to inoculation (sometimes called variolization), which used live viral lesion fluid grafted onto the patient’s skin by use of a lancet. Who started this treatment is not known, but it was recorded in Africa, India, and China, long before the eighteenth century. It was introduced into Europe at the beginning of the eighteenth century. Nobility were the initial recipients. This led to trials on prisoners and eventually to the commoners. There were risks with this early treatment. Two to three percent of variolated persons died from the treatment, became the source of another epidemic, or suffered from diseases such as cellulitis and syphilis, transmitted by the procedure itself. However, it still had a ten times lower fatality rate than the naturally occurring disease. The regular practice of variolation reached the New World in 1721. Rev. Cotton Mather (1663-1728) and Dr. Zabdiel Boylston (1679-1766) inoculated as many citizens in 34 | THE BULLETIN | JULY / AUGUST 2017
Boston as they could during the 1721 epidemic. Approximately 12,000 citizens of Boston contracted smallpox. The fatality rate among the non-vaccinated group was fourteen percent. Whereas Boylston and Mather reported a mortality rate of only two percent among variolated individuals. A safer vaccine was in the offing due largely to Edward Jenner. He was born May 17, 1749 in Gloucestorshire, England. He developed a strong interest in science and nature. At age thirteen, he was apprenticed to a country surgeon in Sodbury. It was here that he heard a dairymaid say she would never get smallpox because she had contracted cowpox (a milder illness) from her exposure to infected cows. In 1764 Jenner began an apprenticeship with George Harwicke, an accomplished physician and surgeon. It was not until 1796 that Jenner took the first step toward eliminating smallpox. Remembering the dairymaid, he found another dairymaid, Sarah Nelms, who had fresh cowpox blisters on her hands and arms. On May 14 1796, using matter from Nelms’ lesions, he inoculated an eight year old boy, James Phipps. He developed a mild fever and axillary discomfort but, by the tenth day, had completely recovered. July 1796, Jenner inoculated the boy again, this time from a fresh “smallpox” lesion. No disease developed and Jenner concluded that protection was complete. His paper on this experiment was initially rejected. He then published a small booklet where he introduced the new term vaccination (the latin word for cow is vacca and cowpox is vaccinia). The results of Jenner and others’ vaccination trials resulted in England prohibiting
variolation and replacing it with vaccination in 1840. Vaccine reached the United States in 1800 and Thomas Jefferson implemented a national vaccination program shortly thereafter. On the local scene, inoculation was first used by the Spaniards at Monterey in 1786. The first widespread use of vaccine in California occurred in 1828. James Pattie, a fur trapper, was put in jail by the Mexican Governor Echeandia in San Diego. A smallpox epidemic broke out in Northern California at the same time. It was sweeping down the state, heading for San Diego. Pattie had some cowpox innoculum left over from his father’s supply (which had been used to immunize workers in his copper mine in New Mexico). Pattie offered to immunize all of California for a dollar per person and freedom for himself. Echeandia, due to public pressure, agreed. Pattie’s journal showed he treated 22,000 Californios and mission indians. He also vaccinated 1500 Russians at Fort Ross for $100 Edward Jenner (1749-1823) in cash. Pattie replenished his supeleven, smallpox vaccine has been stockpiled ply by using the lesion fluid formed on the skin in amounts sufficient to immunize the entire of persons he had vaccinated. population of the United States. It is currently Smallpox vaccinations (derived from cow- used only for scientists and military personnel pox) were used in the United States until 1972. engaged in the handling of the vaccine. It was used on most young children, military recruits, and many travelers. After nine-
Leon P. Fox Medical History Committee The Leon P. Fox Medical History Committee meets bi-monthly, the first Monday at noon (lunch provided). The purpose of the committee is to identify, collect, and preserve archival material, memorabilia, and artifacts representing the medical history of Santa Clara County. A guest speaker gives a historical presentation at each of the meetings, which is then transcribed for SCCMA’s Medical History archives. If you are interested in joining this committee, please contact Pam Jensen at SCCMA at (408) 998-8850 or pjensen@sccma.org.
JULY / AUGUST 2017 | THE BULLETIN | 35
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Fitness Trackers Accurately Measure Heart Rate but Not Calories Burned A Stanford inquiry into the accuracy of seven wristband activity monitors showed that six out of seven devices measured heart rate within 5%. None, however, measured energy expenditure well, ranging anywhere from 27% to 93% inaccurate. Millions of people wear some kind of wristband activity tracker and use the device to monitor their own exercise and health, often sharing the data with their physician. But is the data accurate? Such people can take heart in knowing that if the device measures heart rate, it’s probably doing a good job, a team of researchers at the Stanford University School of Medicine reports. But if it measures energy expenditure, it’s probably off by a significant amount. An evaluation of seven devices in a diverse group of 60 volunteers showed that six of the devices measured heart rate with an error rate of less than 5%. The team evaluated the Apple Watch, Basis Peak, Fitbit Surge, Microsoft Band, Mio Alpha 2, PulseOn and the Samsung Gear S2. Some devices were more accurate than others, and factors such as skin color and body mass index affected the measurements. In contrast, none of the seven devices measured energy expenditure accurately, the study found. Even the most accurate device was off by an average of 27%. And the least accurate was off by 93%. “People are basing life decisions on the data provided by these devices,” said Euan Ashley, DPhil, FRCP, professor of cardiovascular medicine, of genetics and of biomedical data science at Stanford. But consumer devices aren’t held to the same standards as medical-grade devices, and it’s hard for doctors to know what to make of heart-rate data and other data from a patient’s wearable device, he said. A paper reporting the researchers’ findings was published online May 24 in the Journal of Personalized Medicine. Ashley is the senior author. Lead authorship is shared by graduate student Anna Shcherbina, visiting assistant professor Mikael Mattsson, PhD, and senior research scientist Daryl Waggott.
HARD FOR CONSUMERS TO KNOW DEVICE ACCURACY
Manufacturers may test the accuracy of activity devices extensively, said Ashley, but it’s hard for consumers to know how accurate such information is or the process that the manufacturers used in testing the devices. So Ashley and his colleagues set out to independently evaluate activity trackers that met criteria such as measuring both heart rate and energy expenditure and being commercially available. “For a lay user, in a non-medical setting, we want to keep that error under 10%,” Shcherbina said. Sixty volunteers, including 31 women and 29 men, wore the seven devices while walking or running on treadmills or using stationary bicycles. Each volunteer’s heart was measured with a medical-grade electrocardiograph. Metabolic rate was estimated with an instrument for measuring the oxygen and carbon dioxide in breath
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— a good proxy for metabolism and energy expenditure. Results from the wearable devices were then compared to the measurements from the two “gold standard” instruments. “The heart rate measurements performed far better than we expected,” said Ashley, “but the energy expenditure measures were way off the mark. The magnitude of just how bad they were surprised me.”
HEART-RATE DATA RELIABLE
The take-home message, he said, is that a user can pretty much rely on a fitness tracker’s heart rate measurements. But basing the number of doughnuts you eat on how many calories your device says you burned is a really bad idea, he said. Neither Ashley nor Shcherbina could be sure why energy-expenditure measures were so far off. Each device uses its own proprietary algorithm for calculating energy expenditure, they said. It’s likely the algorithms are making assumptions that don’t fit individuals very well, said Shcherbina. “All we can do is see how the devices perform against the gold-standard clinical measures,” she said. “My take on this is that it’s very hard to train an algorithm that would be accurate across a wide variety of people because energy expenditure is variable based on someone’s fitness level, height and weight, etc.” Heart rate, she said, is measured directly, whereas energy expenditure must be measured indirectly through proxy calculations. Ashley’s team saw a need to make their evaluations of wearable devices open to the research community, so they created a website that shows their own data. They welcome others to upload data related to device performance. The team is already working on the next iteration of their study, in which they are evaluating the devices while volunteers wear them as they go about a normal day, including exercising in the open, instead of walking or running on a laboratory treadmill. “In phase two,” said Shcherbina, “we actually want a fully portable study. So volunteers’ ECG will be portable, and their energy calculation will also be done with a portable machine.” The work is an example of Stanford Medicine’s focus on precision health, the goal of which is to anticipate and prevent disease in the healthy and precisely diagnose and treat disease in the ill. Other Stanford co-authors are clinical nurse specialist Heidi Salisbury, RN, MSN; clinical exercise physiologist Jeffrey Christle, PhD; Trevor Hastie, PhD, professor of statistics and of biomedical data science; and Matthew Wheeler, MD, PhD, clinical assistant professor of cardiovascular medicine. Ashley is also a member of the Stanford Cardiovascular Institute, the Stanford Child Health Research Institute and Stanford Bio-X. Hastie is a member of CHRI, Bio-X, the Stanford Child Health Research Institute and the Stanford Neurosciences Institute. Stanford’s departments of Medicine, of Genetics and of Biomedical Data Science supported the work.
CDPH Issues First Report on Controversial End of Life Option Act The California Department of Public Health (CDPH) has issued its first report on the End of Life Option Act. The controversial law went into effect June 9, 2016. According to the data generated from forms doctors were required to submit between June 9 and Dec. 31, 2016, a total of 191 people received life-ending drugs after being diagnosed with having less than six months to live; 111 people took them and died. The Act requires CDPH to provide annual reports, including information on the number of prescriptions written and the number of known individuals who died using aid-in-dying drugs. Additionally, the report includes demographic information on these individuals, including age and underlying illness. The organization reports that nearly 500 hospitals and health systems and more than 100 hospice organizations allow aid-in-dying to be offered to their patients and 80% of insurers statewide cover expenses related to it. The California law created a process for dying patients to ask their doctors for a lethal prescription that they can then take privately, at home. “What the numbers are showing is that the law is working incredibly well, that it’s working as the lawmakers intended,” said Matt Whitaker, the organization’s point person for California and Oregon, which both have aid-in-dying laws. For some patients, finding a doctor willing to prescribe the life-ending drugs can be difficult, in part because the law allows doctors to opt out of prescribing – even when the hospital where they work has agreed to participate in assisting patients. “It’s a very nuanced decision,” said Elizabeth Dzeng, MD, PhD, MPH, an assistant professor of hospital medicine at the University of California, San Francisco, where she estimates about three dozen patients have made the request so far. Dr. Dzeng said the decision to prescribe doesn’t come easy for many doctors. “Even if they’re in support of aid-in-dying they don’t necessarily want to be the person identified as the go-to person for aid-in-dying because that’s a very different implication,” she said. Stephanie Harman, MD, medical director of palliative care services for Stanford Health
Care, has taken a deep dive into the issue at Stanford. In a recently published paper, she and her co-author reported that 6 of the 13 patients had taken the medicine to end their lives. Dr. Harman said about half of those 13 patients couldn’t get the lethal drugs from their own doctor. One reason, she said, is that “there is a certain stigma for being known as a physician who writes these prescriptions. There is in the field, in medicine, a question of whether this is an ethical act for a physician.” Other hospitals and health systems statewide are also trying to get a sense of what their terminally ill patients are experiencing. At UCLA, about 20 patients so far have received prescriptions – but only about half of them have gone on to take the meds, said Neil Wenger, MD, MPH, a professor of medicine at UCLA and director of the UCLA Health Ethics Center. Dr. Wenger has helped develop the UCLA protocol that guides doctors through the requirements of administering the medication to qualified patients. Story By: Stephanie O’Neill | California Healthline
California, June 2016 — December 2016 • 59% had cancer. • 46% were male. • 90% were white, 3% Latino and 5% Asian. • 58% had a bachelor’s degree or higher. • 57% had Medicare, Medicaid or another type of government insurance; 31% had private insurance; 4% were uninsured. • The rate of lethal prescription deaths was 6 per 10,000 total deaths in the state. • 19% died before even taking the drugs. • 87% were 60 years old or older. • 258 individuals started the endof-life option process, as set forth in the Act, by making two verbal requests to their physicians at least 15 days apart. • 173 unique physicians prescribed 191 individuals aid-in-dying drugs. • Of the 191 individuals who were prescribed such drugs, 111, or 58.1%, were reported by their physician to have died following ingestion of aid-in-dying drugs prescribed under EOLA. • 21 individuals, or 11%, died without ingestion of the prescribed aid-in-dying drug(s). • The outcome of the remaining 59 individuals, or 30.9%, who have been prescribed aid-in-dying drugs, is currently undetermined as there has been no outcome reported for these individuals within the time period covered by this report. • 500 hospitals and health systems and more than 100 hospice organizations allow aid-in-dying to be offered to their patients. • 80% of insurers statewide cover expenses related to it.
JULY / AUGUST 2017 | THE BULLETIN | 39
House Passes Bill Limiting Medical Malpractice Damages The U.S. House of Representatives passed a bill in late June that would set a federal limit on settlements for patients in medical malpractice lawsuits, keeping “pain and suffering” (non-economic) damages at $250,000. If the bill were to become law, the Protecting Access to Care Act of 2017 (PACA) would apply to lawsuits that involve coverage provided through federal programs such as Medicare or Medicaid or to coverage that is partly paid for by a government subsidy or tax benefit. In addition to the financial cap, the bill would implement other limits, including on attorney fees, and implement a three-year statute of limitations. The Congressional Budget Office (CBO) estimates that PACA will lower premiums for medical malpractice insurance and reduce the incentives for physicians to practice defensive medicine with all its unnecessary services. According to the CBO analysis, PACA would decrease national health spending by 0.4% and save the federal government almost $50 billion over the next 10 years. The estimate was based on the experience in the many states that have already enacted similar measures. The White House backs the bill, stating on the official website: “The rising cost of healthcare is a major concern in our Nation. State medical liability rules often allow for unlimited non-economic damages. This encourages providers to practice defensive medicine, increases the cost of healthcare, and imposes a significant burden on healthcare providers.” In a statement, the American Medical Association (AMA) applauded House passage of PACA. “For too long, our broken medical liability system has resulted in increased healthcare costs and slowed access to care for patients,” said AMA President David O. Barbe, MD. “This legislation is an important step toward fixing that system – a step that reins in defensive medicine, reduces the growth of healthcare costs, and strikes the correct balance by promoting speedier resolutions of disputes – while maintaining an injured patient’s access to just compensation. By redirecting healthcare spending from defensive medicine, additional dollars can go to patient care, safety and quality improvements, and to health information technology systems that would help improve care and outcomes.”
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Tip of the Month:
Are You Connected…
They say, “Knowledge is Power.” CMA produces a number of publications to keep members up-to-date
on the latest health care news and information affecting the practice of medicine in California. Members can subscribe to any of these publications by visiting your account dashboard. New users: create a free web account to manage your subscriptions.
CMA Newswire - CMA publishes a biweekly e-newsletter, CMA Newswire (formerly CMA Alert), to keep its members up-to-date on critical issues affecting the practice of medicine in California. To view the current issue, http://www.cmanet.org/cma-alert/current-issue.
CMA Practice Resources - CMA Practice Resources (CPR) is a free monthly e-bulletin from the California Medical Association’s practice management experts that focuses on critical payor and healthcare industry changes and how they directly impact the business of a physician practice. Each issue includes tips on reimbursement and contracting related issues along with information on the latest practice management news. To view the current issue, http://www.cmanet.org/cpr/current-issue.
CMA Press Clips - Get daily reports on health care policy and medicine from newspapers and magazines throughout California and around the nation delivered to you by e-mail.
Legal Case List - CMA’s Center for Legal Affairs publishes the Legal Case List regularly. The Case List provides a summary and the current status of litigation in which CMA is a party or has filed a brief as amicus curiae. To view the most recent issues, http://www.cmanet.org/resource-library/list?filter&keyword=154.
Legislative Hot List - CMA's Center for Government Relations publishes the Legislative Hot List during the
legislative session. The Hot List provides a summary and the current status of CMA-sponsored bills, as well as the progress of other significant legislation. To view the most recent issues, http://www.cmanet.org/resourcelibrary/list?filter&keyword=155.
OMSS Advocate - CMA's Organized Medical Staff Section publishes the OMSS Advocate, a newsletter that
provides CMA-OMSS member medical staffs with updates on current events and issues. You must be an OMSS member to receive this newsletter. Email medstaffhelp@cmanet.org for more information. For more information about advertising in any of our publications, email advertising@cmanet.org. - Missed a Webinar – Get Them on Demand – Go to www.cmanet.org/resource-library/detail/?item. • • • • •
Cannabis in Medicine: A Review of Policy and Scientific Evidence Implementing Strategies to Enhance Advance Care Planning Gender Identity and Cultural Competency in Health Care Aligning Clinical Practice with Diabetes Prevention: Screen, Test and Refer Assembly Bill 72: What Physicians Need to Know About the New Law on Payment and Billing for Out-OfNetwork Services
To join, call Leslie at 408.998.8850/831.455.1008 or email leslie@sccma.org.
JULY / AUGUST 2017 | THE BULLETIN | 41
Stanford’s Inaugural Health Trends Report Looks at Big Data’s Impact on All Stages of Medicine Stanford Medicine released its inaugural Health Trends Report last month, a comprehensive review and analysis of existing healthcare research and open-source data, combined with insights from Stanford faculty and external healthcare experts, on the current and emerging trends facing the healthcare sector. The report, which will be published annually, found the promise and challenge of big data to be the most important forces driving change and improvements across healthcare. The report outlines how all stages of the medical experience are being affected by big data, beginning with medical research and extending into and beyond the doctor’s office, and suggests that the following areas must be prioritized if the impact of big data in health is to be fully realized: • Doctors and other members of the medical community must be more data literate and skilled in data analytics. • Healthcare organizations need to have the right systems, processes and structures in place to manage big data.
• Silos and roadblocks across healthcare organizations that prevent effective data-sharing must be broken down, but protecting the privacy and security of patient data is paramount. • Encouraging patients to take an active role in their own care and adopt healthier lifestyles remains critical, if challenging. • Rising costs across the U.S. healthcare system threaten to undermine the role big data can play. • Reforms to electronic health records through the use of better technology and data management will help doctors provide more personalized patient care. This means that it is crucial to train doctors and other medical professionals for a future in which analyzing and managing big data will be a core part of their roles. Improving their skills and literacy in computing and analytics, data management and assessment, information processing and software and technology-infra-
structure development will be vital if the profession is to take advantage of the benefits of big data. This will require changes to how healthcare providers are taught the skills to deliver successful patient outcomes. Similarly, the rise in wearable devices, genetic testing and other technologies gives patients more information than ever about their own health, making greater efforts to promote health literacy necessary so they can make informed decisions. “Today, healthcare is becoming increasingly connected but also increasingly complex. This unique dichotomy poses both an opportunity and a challenge for institutions like our own, whose job it is to heal, innovate and educate,” said Lloyd Minor, MD, dean of the School of Medicine. “In publishing this report, we hope to show how big data is the most important trend facing the sector and, in the process, inform and educate the entire medical community —including patients, doctors, the private and public sectors — who are actively shaping the future of health care.”
El Camino Hospital Increases Community Benefit Grants to $3.28M for 2018 The El Camino Hospital Board of Directors has approved $3.28 million to be allocated to 41 health initiatives in fiscal year 2018. This investment represents an increase in the total number of organizations to receive funding through the hospital’s Community Benefit Grants Program. Through the El Camino Hospital Benefit Community Grants Program, the Los Gatos hospital is collaborating with area organizations to create Healthy Bodies, Healthy Minds and Healthy Communities. In the past five years, the program has invested more than $10 million to vital community-based health improvement projects. El Camino Hospital’s total Community Benefit contribution, including the Grants Program, subsidized health services, financial assistance and more, was nearly $53 million in fiscal year 2016. “El Camino Hospital is committed to partnering with local nonprofits to significantly impact the health needs of the communities we serve in Santa Clara County,” said Barbara Avery, director of Community Benefit, El Camino Hospital. “The Hospital Board seeks to serve vulnerable community members by expanding direct healthcare services and innovative prevention programs in 2018.”
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The Community Benefit Grants Program will allocate funding to programs in these key areas: • Healthy Body grants include overall health and wellness initiatives, school nurse programs, dental screenings, schoolbased nutrition and physical activity programs, diabetes screenings, treatment and education, asthma management for children, and medical support for at-risk populations. • Healthy Mind programs include school-based mental health counseling, support and counseling for foster, abused and other at-risk youth, counseling for adults with developmental disabilities, initiatives to reduce depression and isolation in seniors, and treatment for those with severe mental health conditions. • Healthy Community grants include awareness and testing for pre-diabetes, a bike ride and safety program for underserved communities, cancer support programs, home gardens program in affordable housing developments, domestic violence services, and basic support assistance for low-income community members.
California Billionaire MD Acquires Majority Stake in Local Hospitals Patrick Soon-Shiong’s company NantWorks has acquired a majority stake in Integrity Healthcare, Verity Health System’s management company, according to an announcement last month from the billionaire physician. Nonprofit Verity Health employs more than 6,000 staff statewide at hospitals with a total of 1,650 inpatient beds, six active emergency rooms, a trauma center and a host of medical specialties including tertiary and quaternary care. Verity’s hospitals include Santa Clara County’s O’Connor Hospital in San Jose and St. Louise Regional Hospital in Gilroy and San Mateo County’s Seton Medical Center in Daly City and Seton Coastside in Moss Beach, as well as St. Francis Medical Center in Lynwood and St. Vincent Medical Center in Los Angeles. Verity Health also includes Verity Physician Network and Verity Medical Foundation, encompassing hundreds of physicians across a variety of practice models, independent practice associations, ambulatory surgery centers and urgent care centers. According to the statement, NantWorks combines the collective promise of science and technology, making the latest advances accessible to every patient, no matter who or where they are, so they can stay one step ahead of their
medical conditions. The Los Angeles-based company is led by Dr. Soon-Shiong, a surgeon, professor, scientist, entrepreneur, businessman and philanthropist who has devoted much of his life to finding a cure for cancer and advancing healthcare solutions that reduce costs, increase access and improve quality of care. Dr. SoonShiong will join Verity’s Board of Directors. “Our commitment is to enhance the scope and resources of Verity Health so that, together, we can deliver the breakthrough treatments and cures that save lives, provide better patient outcomes and improve well-being,” Dr. SoonShiong said. “We will achieve this by applying the limitless powers of collaborative science and technology to transform healthcare practices and create a more efficient, more effective health system. Medical care is local, and we strongly believe that community health systems should be supported with investment, technology and science to build next-generation clinically integrated networks to drive better outcomes at a lower cost. “Verity and NantWorks said they are committed to working together to ensure that every man, woman and child finds the right care and the right treatment at the right time, with a focus on results. This collaboration will include the addition of groundbreaking technologies
and expanded oncology, cardiac, orthopedic, neurology, urology, transplant and pediatric services. The system will invest in state of the art diagnostic and imaging services and next-generation stem cell therapy. We are excited that Dr. Patrick Soon-Shiong and NantWorks have taken a significant interest in the continued progress of Verity Health,” said Jack Krouskup, chairman of the independent Verity Health System Board of Directors. “We look forward to partnering with NantWorks to further empower our hospitals and strengthen our Medical Foundation to deliver better outcomes for patients today and tomorrow.” “We are grateful for the ongoing support of BlueMountain and our Verity Board of Directors and the new opportunities to collaborate with NantWorks to accelerate our revitalization efforts,” said Andrei Soran, chief executive officer of Verity Health. “Much has been accomplished across Verity Health, including the recruitment of experienced hospital leaders, physician engagement, acquisition of new technology, upgrades to our facilities and enhancements to our clinical programs,” Soran continued. “Our commitment is to revitalize our hospitals and create an integrated healthcare system that delivers better quality care.”
Monterey County Gets Stanford Trustees Approve $6 Million to Expand Budget and Construction Mental Health Services Projects in South County Monterey County mental health officials have received a three-year grant for $6 million to expand services in South County. The money will be used to establish two new rehab centers in King City and a sobering center in Salinas. The rehab center is expected to serve at least 100 people. The grant was provided by the California Board of State and Community Corrections, and it comes from Proposition 47, a voter initiative that reduces felonies to misdemeanors for certain low-level crimes and directs the savings to rehabilitative programs. The sobering center will give drunken drivers an opportunity to sober up outside the local jail and receive information about programs available to help them stay sober.
The Stanford University Board of Trustees has approved the university’s $6.3 billion Budget Plan for 2017-2018, which includes improvements to several healthrelated facilities: • Expansion of the Environmental Health and Safety Facility and the Center for Academic Medicine, the first of two planned buildings in the School of Medicine that will add administrative and research space. • The new Children’s Center of the Stanford Community, able to accommodate 130 children ranging from infants to preschoolers, and is part of the Center for Academic Medicine • Public Safety Building The Center for Academic Medicine will primarily house clinical faculty, computational researchers and departmental administration and leadership. The one-story center will give clinical educators a higher enrollment priority, but its services will be available to all Stanford faculty, staff and students. JULY / AUGUST 2017 | THE BULLETIN | 43
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MEDICAL SUITES • GILROY First class medical suites available next to Saint Louise Hospital in Gilroy, CA. Sizes available from 1,000 to 2,500+ sq. ft. Timeshare also available. Call Betty at 408/8482525.
BEAUTIFUL MENLO PARK OFFICE TO SHARE New office, upscale and modern - to share with existing pain management practice. Ideal for psychologist or psychiatrist. Contact Dr. Maia Chakerian at 408/832-3930.
MEDICAL OFFICE SPACE TO SHARE • CAMPBELL Convenient location. 5+ exam rooms M-F. In-office digital x-ray. Two large private offices, shared waiting room and front office. Total office size 3,000 sq. ft. Available now. Call 408/376-3305 or marlene@svspine.com.
MEDICAL OFFICE SPACE TO SUBLET • MTN VIEW Mountain View Medical Office space to sublet. 1,100 sq. ft. Available three days a week. In large medical complex, behind El Camino Hospital. Basement storage, utilities included. Large treatment rooms, small lab space, bathroom, private office, etc. Call Dr. Klein. Cell 650/269-1030.
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MEDICAL OFFICE SPACE TO SUBLET • GILROY Medical Suite available next to Saint Louise Hospital in Gilroy. Please call today and get in tomorrow. Can share staff, phone, Internet. Contact Mil at (650) 618-1661.
EMPLOYMENT OPPORTUNITY OCCUPATIONAL MEDICINE PHYSICIANS • PRIMARY CARE, ORTHOPEDICS, & PHYSIATRY Our occupational medical facilities offer a challenging environment with minimal stress, without weekend, evening, or “on call” coverage. We are currently looking for several knowledgeable and progressive primary care and specialty physicians (orthopedist and physiatrist) interested in joining our team of professionals in providing high quality occupational medical services to Silicon Valley firms and their injured employees. We can provide either an employment relationship including full benefits or an independent contractor relationship. Please contact Rick Flovin, CEO at 408/228-0454 or e-mail riflovin@allianceoccmed.com for additional information.
INTERNAL MEDICINE PHYSICIAN NEEDED We are looking for an internal medicine physician for our multi-specialty group. Please email your CV to kaajhealthcare@ gmail.com.
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PHYSICIAN, PHYSICIAN-ASSISTANT OR NURSE PRACTITIONER LOCUM OPPORTUNITY WITH ESTABLISHED SOUTH SAN JOSE FAMILY PRACTICE Position available immediately for a Physician, Physician-Assistant or Nurse Practitioner for part-time contract work, which could lead to full time employment. Clinical services include a broad range of primary care, but no Ob or Pediatrics. This is an excellent opportunity to work in a relaxed medical practice where we work as a team and support each other in a congenial team atmosphere. Our office is located in South San Jose with convenient access via Hwy. 101 and Hwy. 85. Flexible hours will be considered for the right team member. For immediate consideration, please email your resume to SJFamilyPractice2017@gmail. com. Principals only please. Our medical practice is an equal opportunity employer.
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PROVIDING MEDICAL RECORDS By Susan Wolbarst MEDICAL RECORDS AND THE LAW Managing Editor, Medical Board of California This article is reprinted with the permission of the Medical Board of California, originally printed in their Newsletter, Spring 2017. Hardly a day goes by that the Medical Board of California (Board) doesn’t receive phone calls and emails from consumers attempting to obtain copies of their medical records. Medical records are defined as records relating to the health history, diagnosis, or condition of a patient, or relating to treatment provided or proposed to be provided to the patient. This includes films and tracings from diagnostic procedures such as x-ray, CT, PET, MRI, ultrasound, etc.
Medical records are not owned by the patient. They are the property of the medical provider (or facility) that prepares them. However, pursuant to Health and Safety Code section 123110, the patient (or the patient’s representative) has a legal right to see them and to obtain copies of most records. (An exception is mental health records if the physician determines there is substantial risk of significant adverse or detrimental consequences to the patient if inspection or copying were permitted. Such exceptions are subject to specific conditions. See Health and Safety Code section 123115 for details.) There is no central repository for medical records. The protocol a pa-
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tient should follow — even if the physician is deceased — to obtain medical records is to put the request in writing and send it to the physician’s address of record, which can be located on the Board’s website http://www. mbc.ca.gov by clicking “License Search” and following the prompts. A physician is required to provide copies of medical records to the patient within 15 days of receiving the written request. If a physician moves, retires, or dies, another physician may buy out or take over his or her practice. The “active” patients are usually notified by mail (as a courtesy) and told where to obtain their records. If the physician died and did not transfer the practice to someone else, the local Probate Court may be able to supply the name of the executor, who may be able to supply copies of the records. A physician may charge “a reasonable fee” for costs of copying medical records. The fee cannot exceed 25 cents per page (or 50 cents if copied from microfilm). The physician may also charge “reasonable clerical costs,” which are not specifically defined in the law. If the physician’s office advises that a fee will be charged for the records, then the records do not have to be provided to the patient until the fee is paid. If a consumer requests in writing that his or her medical records be transferred to a different physician, the first physician may transfer them to the other physician for free, as a professional courtesy, but is not required by law to do so. A patient who has complied with the requirements outlined in the Health and Safety Code, but has not received his or her medical records from the physician after 15 days may file a complaint with the Board. The physician will be contacted to determine the reason for failing to provide copies of the patient’s medical records.
PHYSICIANS’ FAILURE TO COMPLY
In addition to requests for information regarding how to get medical records, in fiscal year 2015-2016, the Board received 25 complaints relating to the allegation of “failed to provide records to patient/representative.” To put that in perspective, the total number of complaints filed during that time period for all reasons combined was 8,679. The Board may take action against a physician for failing to provide patient medical records within the legal time limit. Such action can range from making sure the physician provides the consumer with copies of the records he or she requested to issuing a citation and fine or taking formal disciplinary action against the physician’s medical license. Any adult patient who inspects his or her medical records pursuant
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to Health and Safety Code section 123111 has the right to provide a written addendum of up to 250 words to any item the patient believes to be incorrect or incomplete. The patient must clearly indicate in writing that he or she wants the addendum to be part of his or her medical record and give it to the health care provider. The provider must attach it to the medical records and include it when making a disclosure of the allegedly incomplete or incorrect portion of the patient’s records to a third party.
Keeping and Storing Medical Records How long does a physician need to keep medical records? There is no general law requiring a physician to maintain medical records for a specific period of time. However, there are situations or government health plans that require a provider/physician to maintain records for a certain period of time. Several laws specify a three-year retention period: Welfare and Institutions Code section 14124.1 (which relates to Medi-Cal patients), Health and Safety Code section 1797.98e(b) (for services reimbursed by Emergency Medical Services Fund), and Health and Safety Code section 11191 (when a physician prescribes, dispenses or administers a Schedule II controlled substance). The Knox-Keene Act requires that HMO medical records be maintained a minimum of two years to ensure that compliance with the act can be validated by the Department of Managed Health Care. In Workers’ Compensation Cases, qualified medical evaluators must maintain medical-legal reports for five years. Health and Safety Code section 123145 indicates that providers who are licensed under section 1205 as a medical clinic shall preserve the records for seven years. The Centers for Medicare & Medicaid Services (CMS) require that providers submitting cost reports retain all patient records for at least five years after the closure of the cost report. CMS requires Medicare managed care program providers to retain patient records for 10 years. For more information, https:// www.cms.govIOutreach-and-EducationIMedicare-LearningNetworkMLNIMLNMattersArticlesldownloadsl SE1022.pdf. The HIPAA (Health Insurance Portability and Accountability Act) Privacy and Security Rules prohibit digital and paper medical records containing confidential information from being thrown away in a public dumpster or recycling bin until they have been rendered unreadable or indecipherable by shredding, burning or other destruction. More information about medical records is available on the Board’s website at http://www.mbc.ca.gov/Consumer/Complaints_FAQ/Medical_Records_FAQ.aspx#6.
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