Bulletin: Reproductive Health 2024 Q2 by SCCMA

In this issue

SCCMA is a professional association representing over 4,500 physicians in all specialties, practice types, and stages of their careers. We support physicians like you through a variety of practice management resources, coding and reimbursement help, training, and up to the minute news that could affect your practice. The Bulletin is our quarterly publication.

Santa Clara County Medical Association

SCCMA OFFICERS

President | Gloria Wu, MD

President-elect | Fahd Rahman Khan, MD

Secretary | Randal Pham, MD

Treasurer | Shahram Gholami, MD

Immediate Past President | Anlin XU, MD

VP-Community Health | Santosh Pandipati, MD

VP-External Affairs | Christine Doyle, MD

VP-Member Services | Sam Wald, MD

VP-Professional Conduct | Lewis Osofsky, MD

SCCMA STAFF

CEO/Executive Director | Marc E. Chow, MS

Director of Membership & Programs | Angelica Cereno

Governance & Advocacy Associate | Emily Coren

Facilities & IT Manager | Paul Moore

Executive Assistant | Rashida Mirza

SCCMA COUNCILORS

El Camino Hospital of Los Gatos | Jaideep Iyengar, MD

El Camino Hospital – Mountain View | Carol A. Somersille, MD

Good Samaritan Hospital | CK Park, MD

Kaiser Foundation Hospital - San Jose | Veena Vanchinathan, MD

Kaiser Permanente Hospital | Reena Bhargava, MD O’Connor Hospital | OPEN

Regional Medical Center | Raj Gupta, MD

Saint Louise Regional Hospital | Kevin Stuart, MD Santa Clara Valley Medical Center | Patricia Salmon, MD

Stanford Health Care/Children’s Health | Karen Kim, MD

Managing Editor | Emily Coren

Production Editor | Prime42 – Design | Market | Host

Opinions expressed by authors are their own, and not necessarily those of The Bulletin or SCCMA. 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 of products or services advertised. The Bulletin and SCCMA reserve the right to reject any advertising.

Address all editorial communication, reprint requests, and advertising to:

Emily Coren, Managing Editor

700 Empey Way

San Jose, CA 95128

408/998-8850

Fax: 408/289-1064

emily@sccma.org

A Message from the President

Gloria Wu, MD SCCMA President

YOU ARE SUPER HEROES!

Dear Colleagues,

As we reach the midpoint of 2024, I am delighted to reflect on the remarkable progress we have witnessed in healthcare, particularly in AI, health technology, and innovation. This year has seen significant strides that directly impact many of our physicians across their practices, health systems and hospitals. It is crucial that our members and all physicians learn and become knowledgeable about these developments. As we continue to learn and begin to use these tools, I am inspired by our collective dedication to advancing healthcare in 2024 and beyond. These innovations and health technologies serve as valuable tools that enhance our capabilities and empower us to provide exceptional care to our patients.

Our ongoing Saving Private Practice program continues to offer webinars tailored to address the unique challenges faced by private practitioners and small groups across the Bay Area. Join us this July through October as we feature new guest speakers and insightful sessions aimed at empowering physicians.

Physician wellness is paramount, not only for our well-being but also for the quality of care we provide to our patients. This retreat offers a valuable opportunity to recharge, prioritize self-care, and cultivate holistic health practices essential in our demanding roles. Please consider registering for this event as space is limited.

By spotlighting these topics, we aim to foster awareness and drive meaningful progress in this vital area of healthcare.

I am pleased to announce the success of our recent Summer Social, held on June 27th at Meso in Santana Row. It was a wonderful evening where our members gathered to celebrate our meaningful daily work in managing and maintaining the health of our patients and the community across Santa Clara County. I personally enjoyed reconnecting with old friends and making new friends. The SCCMA staff looks forward to hosting more events in the future. I strongly encourage you to attend and learn more about opportunities to engage with your medical association.

Additionally, our second annual Wellness Retreat scheduled for August 16-18 is designed to address the unique challenges we face as physicians.

Proposition 35 is a critically important measure that will be on the November 2024 ballot that is sponsored by the California Medical Association and the Coalition to Protect Access to Care. Proposition 35 is essential to ensuring the accessibility of health care services for the one in three Californians with Medi-Cal coverage, including half of the state’s children. Importantly it recognizes the vital role that physicians play in achieving this vision. Without raising taxes on individuals, the measure will bring more federal funds back to California to ensure that the patients of California can get the care they need, when and where they need it. The participation and support of California’s physicians will be key to advancing this initiative. We will have more information for you in the coming weeks and you can check the campaign website at Voteyes35.com

In this quarter’s bulletin, we focus on the critical issue of reproductive health in the United States. Our selection of articles underscores women’s health challenges, opportunities, and advancements. By spotlighting these topics, we aim to foster awareness and drive meaningful progress in this vital area of healthcare.

SCCMA President

Environmental Health Committee Come join the

Are you a doctor in Santa Clara County who wants to advocate for healthier environment? We are now advocating for:

Climate Change

Clean Air

Clean Water

Reduced Environmental Toxins

CMA Statement on Supreme Court Decision Maintaining FDA Approval of Mifepristone

Tanya W. Spirtos, M.D., president of the California Medical Association (CMA), issued the following statement in response to the U.S. Supreme Court’s decision in Alliance for Hippocratic Medicine v. U.S. Food and Drug Administration (FDA), which preserves FDA approval of the abortion medication mifepristone:

“As physicians, we at CMA believe it is essential that patients have access to vital, often life-saving, reproductive health care. CMA stands committed to protecting the fundamental right to access reproductive health services. We will continue to work to ensure that personal medical decisions are made by patients in consultation with their health care providers.”

Medical Board Endorses CMAsponsored Bill to Remove Stigma Around Physician Mental Health

The Medical Board of California recently adopted a support position on California Medical Association (CMA)-sponsored Assembly Bill 2164, which would help ensure physicians can access mental health care without fear of jeopardizing their careers.

The medical board licensure application for physicians and surgeons, including postgraduate training licensees, may inadvertently discourage physicians from seeking mental health services. The process perpetuates stigma around mental health and can exacerbate issues of burnout and depression within the medical community.

Interested in Joining a Committee?

SCCMA has various committees that convene on matters for Legislative Advocacy, Environmental Health, Bioethics, Physician Wellness, and Membership Engagement that do focused

CMA Publishes 2024 Mid-Year Legislative Update

CMA has published a Mid-Year Legislative Update, which provides an up-to-date overview of CMA’s advocacy on legislation impacting California patients, the medical profession and public health for the 2024 legislative session.

CMA has been at the forefront of key legislative battles, ensuring that many bills that would have negatively impacted patients and the practice of medicine would not move forward through the legislative process.

CMA successfully defeated several pieces of legislation that would have jeopardized patient safety by creating an exemption to the ban on the corporate practice of medicine; imposed burdensome regulations on physician practices; heightened the risk of unnecessary lawsuits against physician practices; and legislated the practice of medicine.

CMA-sponsored Bill Addressing ER Violence Clears Senate Public Safety Committee

A bill sponsored by the California Medical Association (CMA) to establish parity in the penalty for violence committed against health care workers in emergency departments has advanced out of the Senate Public Safety Committee.

At a June 4, 2024, hearing in the Senate Public Safety Committee, Anna Yap, M.D., a Sacramento-based emergency medicine physician represented CMA and provided supporting testimony about her experiences with violence in the workplace and the impact it has on health care workers.

work within the Association. If you want to get involved in one of these committees, please call SCCMA Office at (408) 998 – 8850.

CONNECT, RECHARGE AND UNPLUG AT OUR ALL-INCLUSIVE

WELLNESS RETREAT

Friday, August 16 to Sunday, August 18

1440 Multiversity – 800 Bethany Drive, Scotts Valley, CA 95066

Three-day, Two-night Program

$400 per person in private room; $550 per pair in a double-occupancy room

Together with 1440 Multiversity, the Santa Clara County Medical Association (SCCMA) is pleased to offer an all-inclusive Wellness Retreat for our m embers. Attendees will have the opportunity and intentional, uninterrupted time to connect and cope with the stress and anxiety of everyday work, exacerbated by the pandemic, and now also staff shortages.

This Wellness Retreat is a three-day, two-night program at 1440 Multiversity, a 75-acre the Santa Cruz Mountains. Attendees will be immersed in a beautiful backdrop of nature as they unplug over the course of the weekend and participate in sessions aimed at delivering healing All guests are served fresh, organic, plant-based food that is geared towards and supportive care. a healthy integrated lifestyle with a “food as medicine” approach to nutrition.

Limited Space – Register by July 26 before spaces are filled!

Scan the QR code to register. Contact angelica@sccma.org or call (760) 671–2315 for any questions.

campus in

The physicians in Santa Clara County go above and beyond the role of their jobs to make the community a healthier and happier place to live. Here we are honoring just a few of the outstanding physician leaders that have made exceptional contributions to our community.

Gary Gechlik, M.D.

Emergency Physician, Good Samaritan Hospital

“I grew up in Northern, New Jersey, attended Rutgers, then Ohio State, and finally Stanford. They were all beautiful places with good friends and interesting experiences.

These days, I am often in Saratoga where my kids attend Saratoga High School. I technically live in Palo Alto, on Skyline Boulevard, but years ago, they changed the school district and we lucked out. As time passes, I have come to appreciate easy going people more and more. We are very fortunate at Good Samaritan Hospital to have the nicest patients in all of California. It is pretty obvious when you visit other places. Traveling always confirms how good we have it at Good Sam!

I want to thank everyone who has helped me help patients along the way, including all the other physicians and nurses and technologists and administrative staff, that makes emergency medicine possible.”

Jane Varner, MD

Department of Family Medicine physician Member of the Sutter Health Bay Area Board of Directors

Sutter Health Physician Champion for Screening for Social Drivers of Health

Maia Chakerian,

M.D.

Sereno Santé

I am honored to be nominated as a physician superhero! I am most proud of the work that my team has done this past year to advance us on the path to a more wholistic approach to caring for people. My team has endeavored to reinvigorate the collection of information regarding race, ethnicity, preferred language, sexual orientation and gender identity as well as implement a seamless way to screen for social needs like housing, healthy food, transportation, the ability to pay for utilities, and intimate partner violence. This represents somewhat of a paradigm shift, and change is always difficult, especially in a system that is already stressed. However, I believe that if we can understand our patients more wholistically, we have a much better chance at not only healing them, but also preventing disease like diabetes and high blood pressure. I am overjoyed that health equity is at the center of every conversation in health care right now, and to address disparities in a meaningful way, we need this basic information about our patients. Let’s keep the effort going organically through open dialogue and sharing of best practices, and systemically by advocating at the policy table.

I’m honored to be nominated as a physician hero, though I’m unsure why I deserve this recognition. My journey began in Albuquerque, where I pivoted from plastic surgery to anesthesiology and discovered my passion for pain management.

As a pain specialist, I’ve navigated the opioid crisis by using sound medical judgment and prioritizing patient care. I embraced technology early, adopting electronic records and managing my own billing. Facing dwindling reimbursements, I expanded into aesthetics in 2015, returning to my roots.

In 2019, I transitioned my pain practice to a concierge model, allowing me to dedicate more time to each patient. This move has been transformative, deepening my relationships and reigniting my fulfillment in practice.

Today, I balance pain management with an expanding aesthetics practice, constantly learning and seeking ways to improve patient outcomes. If I’m considered a “hero,” it’s because of my willingness to evolve, stand up for what’s right, and continually enhance patient care.

Thank you for this recognition. I’m truly grateful and will strive for excellence in all aspects of my medical practice.

Sarah Owens, MD

Ob/Gyn Resident Physician at Stanford University

Some notable accomplishments of mine recently include lobbying to legislators in the California State Capitol with the California Medical Association and being elected Education Chief by my peers and mentors in my residency program at Stanford. I am passionate about provider education and simulation training, and am currently planning on presenting a project in which I tested different fruits for uterine aspiration simulation to improve simulation training methods, particularly for providers in states where they are restricted by legislative bodies.

Destigmatizing Abortion Care EVEN IN CALIFORNIA

BY DR. LAURA DALTON

Planned Parenthood Mar Monte

Chief Medical Operating Officer

Our philosophy has been to re-evaluate the standard of providing care, which has been focused on health center workﬂow and patient volume.

In two years since the U.S. Supreme Court overturned Roe v. Wade, resulting in virtual elimination of abortion rights across half the nation, California has rightfully been held up as a leader on the vanguard of protecting and expanding access. But even here, and in other “reproductive freedom” regions, there has been a longstanding practice of unintentionally stigmatizing abortion because of the way the care is provided.

Abortion-stigma isn’t only reflected by the flood of extreme restrictions that has deluged so many states. California counties that have embraced our state’s commitment to protecting and expanding reproductive rights, often still make abortion care available only on certain days and times and only with certain providers, other than at a patient’s health care home. Though one in four women will have an abortion by the age of 45, according to the Guttmacher Institute, a national reproductive health and rights research organization, this care is often singled out -- even by those determined to provide it -- as being in a category by itself. That needs to change.

At Planned Parenthood Mar Monte (PPMM), headquartered in Santa Clara County, my team of clinicians has integrated aspiration abortion care at more of our sites throughout mid-California, including Silicon Valley and the Central Valley, as well as northern Nevada. This makes on-site aspiration abortion as easily accessible as the wide range of other preventive health care we provide -- including contraception, cancer-screenings and prenatal care – for more than 160,000 patients annually.

Though PPMM, the largest Planned Parenthood in the country, has long provided integrated medication abortion care at our 34 health centers, we knew we needed to go a step further. Several years before Roe was overturned, we began to offer more access to aspiration abortion, combatting the perception that abortion services are not part of family medicine.

The effect of cordoning off abortion from other sexual reproductive health care is to label this essential service as “not normal,” feeding into the notion that abortion is somehow wrong or risky. This decades-long perception of abortion has almost institutionalized a feeling of shame, perpetuating health care inequity by limiting access, requiring more appointments to receive care, and often requiring additional travel.

One of my most memorable moments when I was first working at PPMM was during a day in the health center that I was caring for a newborn in one exam room, another clinician was seeing a teenager for birth control and to treat her asthma, and down the hall another clinician was performing an aspiration abortion.

I realized that’s how this care should be. We need to integrate abortion into the normal sexual reproductive health journey that a patient

experiences.

When PPMM began the process of expanding availability of aspiration abortion care, we focused on making sure it is part of our regular schedule of services – which required training more clinicians to conduct these procedural abortions in addition to the other preventive care they are already providing.

Integrated providers are advanced practice clinicians (APCs) working primarily as a sexual and reproductive health care provider. They undergo a training process to learn aspiration abortion up to 13.6 weeks gestational age, the current state limit for APCs.

We’ve established this approach and trained 10 APC providers, in addition to those at our other standard procedural abortion sites. Being able to give more patients the option of receiving an aspiration abortion at the health center, rather than the multi-day and follow-up appointment medication abortion that we offer at all of our sites, is a more convenient and appropriate option for some patients.

For example, a patient who has only a small window of time for an abortion because of a need to return to work immediately or provide childcare, may not be best served by a medication abortion. A patient who needs a workup for an ectopic pregnancy or is having symptoms, such as bleeding, which require immediate attention, is also not a good candidate for medication abortion.

In the old, stigmatized approach to abortion care, this kind of patient could only be seen at the health center during a very limited time, likely requiring travel. But the integrated aspiration abortion program means that the APC has been trained in this care and can now provide the procedure immediately, either at the patient’s regular PPMM sexual reproductive health site or at one of our nearby health centers. This removes barriers that would once have made abortion care inaccessible for some patients – even in a strong reproductive-rights state like California.

Because our affiliate is so large, patients with extenuating circumstances have more options for care when providers can see them on a same-day basis for their abortion. These adjustments have been profound for our staff and patients. It has normalized abortion care not only for our patients in our regular ser-

Dr. Laura Dalton

vice regions, but also for those who have come to us from abortion-ban states.

Part of our philosophy has been to re-evaluate the standard of providing care, which has been focused on health center workflow and patient volume. The traditional model was based on having a particular space in the health center as well as dedicated staff – including medical assistants, registered nurses, advanced practice clinicians and physicians – to maximize efficiency and patient-access.

ment available. This patient also wasn’t going to be able to follow up with our health care staff for continued care because she needed to be back home very quickly, so a medication abortion wasn’t going to be appropriate for her.

However, because of our integrated abortion-care system, we quickly and seamlessly referred this patient to another of our nearby health centers where a clinician was able to provide procedural abortion before she needed to fly home.

But what does this really mean for the patient?

Consider the dilemma of a woman who wants an abortion at 12 weeks of pregnancy and who has a full-time job, another young child to care for, no access to a car every day and lives in an “abortion desert” that is more than 100 miles from the nearest abortion care. This restricted schedule for availability sends the message that abortion care isn’t regular, such as an appointment for contraception or a well-woman checkup.

Patients in nearby abortion-ban states who can afford to come California for an abortion – and, of course, thousands can’t afford it – often face even more hurdles to receiving care here because of the very restricted time they have to travel and, possibly, be away from their jobs or other children.

For example, in April a patient traveled from Texas to one of PPMM’s Sacramento health centers to have an abortion on a day when we did not have an abortion appoint-

Abortion care is health care.

The clinician at that health center, who completed aspiration-abortion training last year, said that our system of integrated care has involved procedures for ruling out severe complications. Therefore, she does not have to send patients to a hospital, where they may or may not get treatment they need. She added, “We are keeping patients out of the emergency department who don’t need to be there.”

As abortion providers in California continue to protect and promote reproductive rights for all who live here – and travel here – it is more important than it’s ever been to de-stigmatize this care by expanding availability in our state.

Even during the critical shortage of providers nationwide, including in Santa Clara County, PPMM is continuing to train clinicians to proudly provide more access to this service, treating it no differently than the essential sexual reproductive health care and family medicine we provide to thousands every day. This is what de-stigmatizing abortion looks like.

The message should be loud and clear in California: Abortion care is health care.

For more information about PPMM and to see the annual impact report, go to www.ppmarmonte.org

BY: BEVERLEY WHITE-MACKLIN, SHILPA JOSHI, TONYA ROBINSON, KAMILAH DAVIS, KENISHA MAKAU, AND KITTY ZHOU

Remember Serena Williams’ story: The renowned tennis champion described mistreatment while delivering her oldest child in a California hospital. Suffering a pulmonary embolism, she had to advocate to receive life-saving treatment after initially being dismissed by hospital staff (Williams, 2022). The connection between racism and health inequities, long recognized by African/African Ancestry people themselves, is becoming increasingly better understood in the United States.

Data paint a clear picture. There are a wide range of health conditions affecting both mom and baby for which we see African/African Ancestry people more disproportionally impacted. In Santa Clara County, African/African Ancestry mothers and infants have the highest rates of preterm birth, infant mortality, and severe maternal morbidity compared to other racial/ethnic groups (Santa Clara County Public Health Department, n.d. -a; n.d. -b).

Across California, African/African Ancestry women are three to seven times more likely to die from pregnancy-related causes than Asian/Pacific Islander, Hispanic, and White women (California Department of Public Health, Maternal, Child and Adolescent Health Division, 2023). Severe maternal morbidity includes unexpected and potentially life-threatening complications from labor and delivery that result in significant short- or long-term health consequences. From the local to national level, data show a worsening trend. Since 2018, the number of African/African Ancestry mothers experiencing life-threatening complications during their pregnancies in Santa Clara County has more than doubled (California Department of Public Health, n.d.; California Department of Health Care Access and Information, 2024).

There is an urgency for our health systems, communities, and individu-

als to work towards improving these health outcomes. Public Health works with partners across the county to create a village to wrap around expectant and new moms, but patients still need to know this help is available. Doctors can take proactive measures, such as making culturally appropriate referrals for additional, specialized care, and health and wellness connections for nutrition, exercise, and stress management. This is how we can save lives. Equity = Quality Care = Better Outcomes.

What Does Racism Have to Do With It?

Health disparities affecting African/ African Ancestry women and infants appear to be less dependent on age,

economic status, or education. To put it simply, the typical effects of Social Determinants of Health, such as income, education, place of residence, social class, etc., don’t apply here because the longstanding effects of structural racism override these [Social Determinants of Health] protective effects. Poor birth outcomes persist even when African/African Ancestry women have a pregnancy at an optimal age, have a high income, or are well-educated (California Department of Public Health, 2021).

Anti-Black racism has systemically harmed the health of African/African Ancestry people throughout the United States’ history. American chattel slavery and subsequent discriminatory policies

and practices in the United States over the past 150 years are the critical context shaping current racial health disparities (California Department of Public Health, Maternal, Child and Adolescent Health Division, 2023). In Santa Clara County, 20% of African/African Ancestry mothers reported experiencing racism often over their lifetime, which was the highest percentage compared to other racial/ethnic groups and higher than the county’s overall percentage (California Department of Public Health, 2024).

Black Infant Health Program: Have

You Heard?

Doctors and other health care professionals can help address these long-standing inequities by referring patients to services available in Santa Clara County. A word from their trusted doctor can make all the difference.

Black Infant Health (BIH) is a state pro-

gram that arrived in Santa Clara County in 1991 to improve African/African Ancestry infant and maternal health and decrease disparities in birth outcomes. The primary focus is on African/African Ancestry mothers and babies. To complement and support the work of BIH, Public Health added the Role of Men (ROM) and the Perinatal Equity Initiative (PEI).

How Can Black Infant Health Support African/ African Ancestry Pregnant or Postpartum Patients?

Like you, Public Health cares about your patients and making sure they receive the best possible health outcomes. Black Infant Health provides continuity of care, supporting patients during their pregnancy until their infants’ first birthday. Participants have access to a home-visiting Public Health nurse, culturally affirming prenatal and postpartum health education classes (i.e., stress management, nutrition, breastfeeding, and labor and delivery), 1:1 support, and incentives. Additionally, BIH seamlessly connects participants to needed services, such as affirming behavioral health services to address perinatal mood disorders like anxiety and/or depression.

Black Infant Health services are free for eligible patients and there are no in-

come/insurance requirements or restrictions. Language support is provided to all clients/patients, including Ethiopian and Eritrean staff language capacity, Amharic, and Tigrinya languages.

Black Infant Health’s Impact

Black Infant Health participants experience significant health benefits. Upon completion of the program, participants across California between 2015-2018 experienced: 35% decrease in depressive symptoms, 38% increase utilization of stress management techniques, 60% decrease in no practical and emotional support present, 45% decrease in food insecurity, 51% reported reduction in their smoking utilization (California Department of Public Health, 2022). One BIH alumni shared, “[Black Infant Health] gave me the keys I needed to redefine myself as a mom and to be more graceful with myself. When we go out into the world as moms, we’re judged all the time. As Black moms, we face many underlying negative assumptions and stereotypes. We’re in a constant state of proving ourselves. In Black Infant Health, we were welcomed into a space where the underlying assumption was that we were already more than enough.” Pediatrician Rhea Boyd, MD/MPH

Role of Men

Role of Men provides fathers, expectant fathers, or men contemplating fatherhood with tools to adapt, improve, support family dynamics, and support pregnant moms. Participants receive 1:1 support and can take part in six-week workshops based on 24/7 Dad curriculum, an evidenced-based program developed by the National Fatherhood Initiative (n.d.), with a focus on being positive role models.

How Does the Perinatal Equity Initiative Support Our Local African Ancestry Community?

Understanding that racial disparities in birth outcomes are a systemic issue that involves many factors beyond the individual level, the Perinatal Equity Initiative was created to complement BIH through interventions that address multiple levels of our system.

PEI partners with Roots Community Health Center – a community-based organization providing an array of culturally congruent health services to Santa Clara County residents of African/African Ancestry – to implement several interventions to the local community free of cost, including preconception health promotion, maternal health navigation, and doula services.

Perinatal Equity Initiative Impact

Since July 2023, 100% of Women of Wellness participants who attended all 48 sessions reported feeling supported and using something they learned during their participation. Additionally, all personal support services participants reported a supportive relationship with their provider, an increased ability to advocate for being advocates for themselves, and using something they learned

during their participation. The doula program has served at least 85 clients since its inception, April 2023.

Join the Perinatal Equity Working Group

Are you interested in working collaboratively with Public Health to reduce these disparities for your patients and others across Santa Clara County? The Perinatal Equity Working Group convenes perinatal healthcare staff (and other vital stakeholders in reducing health disparities) to support anti-racist and equity-promoting practices at the organizational level. The goal is to develop and implement actionable strategies to reduce racial disparities in birth outcomes and improve birthing experiences for African/African Ancestry families. PEI staff regularly present to hospital groups (i.e. at staff meetings and grand rounds) and other relevant stakeholder groups to discuss the resources available for PEI participants and increase awareness of this continuing issue.

Perinatal Equity Conference

On April 12, 2024, Public Health’s Perinatal Equity Initiative and Black Infant

2024 Perinatal Equity Conference

Health Program co-hosted the second Santa Clara County Perinatal Equity Conference. This year, the conference welcomed just under 400 attendees and featured speakers with a variety of expertise relevant to Black maternal health. Ninety-seven conference attendees received 3.5 continuing education (CE) contact hours. Recordings are available on the #DeliverBirthJustice YouTube channel (YouTube 2024).

How to Get Involved:

To refer your patients to Black Infant Health, visit sccphd.org/BIHInterest (for patients or providers) or sccphd.org/BIHClientReferral (for providers). To refer eligible patients to preconception health education or our doula program, visit our sccphd.org/PEIServices. To refer to the Role of Men program, call 669-287-6918.

Providers in Santa Clara County can also contribute to birth equity by establishing authentic and equitable partnerships with local organizations supporting the African/African Ancestry community.

• Champion change within your organization and identify other staff members who share a commitment to addressing racism and considering joining the Perinatal Equity Initiative Working Group.

• Seek education and actively challenge implicit biases. Racism by nature is pervasive and has been

woven into each of our society’s institutions, including, and especially, the institution of medicine (recommended read: Medical Apartheid by Harriet A. Washington Killing the Black Body by Dorothy Roberts, and Birthing Justice by Alicia Bonaparte, Julia Chinyere Oparah, and Alexus Roane; additional resources can be found on our take action page at https://deliverbirthjustice.org/ take-action). While hospitals are mandated by law to participate in implicit bias training, often implemented via virtual modules, this is by no means a one-anddone solution. Read articles, listen to podcasts, take courses, and attend conferences, especially those that uplift the voices of those with lived experience.

• Listen to, trust, and urgently respond to the concerns of African/ African Ancestry patients.

• Advocate for policy and system changes that align with evidence-based recommendations to promote and maintain optimal maternal-child health. Visit https://deliverbirthjustice. org/take-action for more calls to action.

References:

• California Department of Health Care Access and Information. (2024). 2016-2022 Patient Discharge Data

• California Department of Public Health. (n.d.). Maternal, Child, and Adolescent Health Division. https://www.cdph.ca.gov/ Programs/CFH/DMCAH/Pages/ default.aspx.

• California Department of Public Health. (2021). Perinatal Equity Initiative Profile. https://www. cdph.ca.gov/Programs/CFH/ DMCAH/CDPH%20Document%20 Library/Communications/Pro-

file-PEI.pdf.

• California Department of Public Health. (2022, November 22). Program evaluation: Intermediate outcomes among prenatal group model participants. https:// www.cdph.ca.gov/Programs/ CFH/DMCAH/BIH/Pages/ Data-Brief-Intermediate-Outcomes-2015-2018.aspx.

• California Department of Public Health. (2024). 2016-2018 Maternal and Infant Health Assessment (MIHA) survey.

• California Department of Public Health: Maternal, Child and Adolescent Health Division. (2023). Centering Black Mothers in California: Insights into racism, health, and well-being for Black women and infants. https://www. cdph.ca.gov/Programs/CFH/ DMCAH/CDPH%20Document%20 Library/Centering-Black-Mothers/ Centering-Black-Mothers-Report-2023.pdf.

• National Fatherhood Initiative. (n.d.) 24:7 Dad. https://www. fatherhood.org/program-24-7-dad

• Santa Clara County Public Health Department. (n.d.-a). California Integrated Vital Records System (CALVRS), 2000-2022 California Comprehensive Birth File

• Santa Clara County Public Health Department. (n.d.-b). California Integrated Vital Records System (CALVRS), 2015-2021 California Comprehensive Death File.

• Williams, S. (2022). How Serena Williams saved her own life. ELLE. https://www.elle.com/life-love/ a39586444/how-serena-williamssaved-her-own-life/

• YouTube: #DeliverBirthJustice (2024). https://www.youtube.com/ channel/UCBL-pVvYaeEKhAZ8iEaBDsw

Full data story from Public Health

Why I Am No Longer Chief Medical Officer

BY SANTOSH PANDIPATI, MD

Co-Founder & Chief Health Officer, Lōvu Health

Originally published in Lōvu Health2 and Medium3 December, 2023

My original journey into medicine was not dissimilar from that of millions of my colleagues: I viewed medicine as a means to help people achieve a better human existence. When bodies fall into disrepair, physicians are there to right the ship, to reset the course. Through glamorized blockbuster drugs and risky but rewarding surgery we obliterate tumors, replace hearts, and correct metabolic imbalances. We can now even cure genetic conditions such as sickle cell anemia through gene editing. These spectacular successes fuel an abundance of fictional and non-fictional televised stories of heroic saviors of patients snatched from death’s grasp. Such is the sexy appeal of modern medicine.

As a maternal-fetal medicine physician I too revel in this existence. I sweep in at the final hour to make lifesaving decisions for patients and their families — decisions that amount to no less than ensuring the continuity of humanity through one mother and baby at a time. The self-reinforcing ego boost is so compelling, so invigorating, and so addictive that it often is sufficient to fuel a 3 to 4-decade long career despite numerous long nights, extraordinarily difficult conversations, and not insignificant medico-legal risks.

However, many physicians are not purely acute interventionists like trauma surgeons or interventional cardiologists. Maternal-fetal medicine involves a great deal more than rescue cervical cerclages and emergency c-sections; to the contrary, much rests on mitigating risk through preventive measures such as screening fetal ultrasounds, genetic testing, risk factor assessments for preeclampsia, gestational diabetes, preterm birth and other complications, guided monitoring and judicious use of medications, as well as potentially advising patients to terminate or avoid pregnancy altogether. None of these are acutely heroic, but rather measured interventions.

Evident to me, mid-career and with the perspective of look-

ing beyond short-lived ego boosts, is that many smaller events lead up to these momentous final decisions. These smaller events are consequential, but more importantly, modifiable and influenceable — and all too often fall outside the purview of “traditional” medicine that is ensconced within the four walls of a clinic or a hospital. What happens before conception, not just from nutrition, cardiovascular health, and pelvic floor strength, but also from a lifetime of environmental exposures, income, societal prejudices and so much more, directly impacts much of what occurs in pregnancy, childbirth, and the years beyond. Twenty-three years into being a licensed physician, with an estimated 40,000+ individual patient encounters under my belt, looking upon a vast history of these smaller individual events as well as larger societal conditions, I can definitively state that we are deeply unhealthy as individuals, and collectively as societies. Even worse, doctors have diminishing capability to bend the narrative arc.

This is because medicine is about intervention when there is sickness and injury. Medical doctors are trained to think as such: to restore equilibrium where there is newfound disequilibrium. We stand ready in emergency rooms, in clinical offices, in radiology centers, and in surgical theaters to do just this. But health stands in contradistinction to medicine. Health is about maximizing the human condition by maintaining and strengthening equilibrium. It is about more than simply vital

Santosh Pandipati, MD

signs and blood tests — it is about social context and environment, about relationships and freedom, about access and empowerment, about education and prevention. Health diminishes the need for medicine. Certainly at times one needs medicine to restore health, but many times one needs much more than that, for health exists along a continuum and is a process of resilience-building, not a fixed state of being. This perspective makes every moment an opportunity for change and improvement.

Medicine in the United States, and ever increasingly in the world at large, finds itself in a conundrum. Medicine is and will always be there. There will always be a major role for standing upright those who have fallen. But individuals and the societies they comprise are ailing rapidly, falling into disrepair. As people fall ever more frequently into disequilibrium, societies call upon medicine to play a greater and greater role, but this comes at tremendous cost. Fixing disrepair is always more expensive than maintaining a state of repair.

health.

MEDICINE IN THE UNITED STATES, AND EVER INCREASINGLY IN THE WORLD AT LARGE, FINDS ITSELF IN A CONUNDRUM. MEDICINE IS AND WILL ALWAYS BE THERE.

Apart from birth and death, pregnancy itself is one of the most inexplicable — and nothing short of spiritual — events in a human being’s life. Those of us who lack a uterus stand on the sidelines, witnesses to this remarkable phenomenon, just as when I was to my wife’s three pregnancies. In medical school, after a brief foray with rehab medicine, I wanted to become an interventional cardiologist. I envisioned forcing open clotted arteries and restoring blood flow to ischemic myocardium; in so doing I would tell families I saved their loved ones from the clutches of death. I would be a hero in a white cape. But nothing prepared me for my obstetrics rotation when my hands directly held emerging life from the womb. I was irrevocably changed. I abandoned cardiology in favor of working to support patients who found themselves taking on the burden of continuing the life of our species.

The health startup community, and the investors backing founders, has largely doubled down on medicine over health. This makes sense. There is a lot of innovation to be had, and a lot of money to be made. Individuals and their societies will pay large sums of money to fix ailing and injured bodies. But more and more of us are falling ill, and due to neglect of health in its most holistic form, disadvantaged groups of people fall into illness disproportionately more than others. Health startups often ignore solutions for these groups as compensation tends to be significantly less, if even existent at all, in caring for them.

Adding insult to injury, there are not enough doctors, nurses, and allied health professionals to deal with rising rates of calamity. There is not enough money to go around. And simply spending large sums to stand upright the fallen, without addressing the root causes of why they fell in the first place, does not lead to real prosperity or innovation, but rather to insidious societal decline. In a better world many of these dollars would be spent elsewhere. In our efforts for convenience we build and grow carelessly. We neglect our well-being for instant gratification. And we build financial rewards for doing the easy work, but not the hard work. This gross misalignment between financial success and human success will go on to cause immense damage if left uncorrected. I have seen this occur in women’s health — especially pregnancy

Pregnancy is all about dynamic equilibrium and resilience. Fusion of egg and sperm unleashes a nearly indefatigable life force that compels a mother’s body to nourish a primordial ball of pluripotent cells. Every organ system, mind included, in maternal biology adapts, and must continue to adapt, as the next generation grows, develops, and eventually is birthed. At no point is there rest, at no point is there stasis. And just as shortly after a rocket launches, there is no more a dangerous time for those on the ground or for those aloft than after birth. It is an incredible demand that leaves no one unaltered — mother, child, and family. In the context of excellent health it is akin to a gyroscope — steady, upright, and difficult to throw off balance. But in the context of poor health a myriad array of adverse forces destabilize and compromise the entire process.

WE CONNECT PATIENTS WITH REAL HUMAN BEINGS WHO MATCH THEIR CULTURE AND COMMUNITY, AND WHO WALK A SIMILAR LIFE PATH.

Over nearly three decades since medical school I have seen rising rates of obesity, diabetes, hypertension, and mental affliction. But I have also seen rising rates of environmental harms, from microplastics and chemical pollutants to rising heat to more extreme climatic events to

worsening air pollution, and to increasing socioeconomic disparities leading to greater and greater challenges for patients to seek and receive care. I have seen disinformation and misinformation spread faster than doctors and medical institutions can stamp out, from computer to phone to unwitting patient. With patients and their families presenting to pregnancy more often with neglected health, chronic illness, and basic misunderstandings and distrust of the “healthcare” system — some deserved

— it should come as no surprise that pregnancy complications are on the rise.

Victims themselves, clinicians succumb to the same calamities afflicting their patients, from falling income and rising debt to over-emphasis on work over self-health. I myself was burning out. Feeling less and less meaning in treating ever more frequent and repetitive problems among my patients, I was admittedly fatigued from decades of the same without fundamentally bending the overall arc towards improvement. Just as with the unacceptable worsening of outcomes for pregnant persons, so too does society face unacceptable shortages, mental illness, and burn out for the healers of society1.

Born from this angst, L ōvu restores equilibrium to clinicians and to patients. With our Continuously Connected Wellness™ model we shatter an archaic 90-year old rigid care paradigm that limits care providers and pregnant persons in lieu of a personalized approach that restores freedom and health to individuals. Via an AI-empowered human navigation and technology platform we monitor and assess women from pre-conception through 2 years postpartum, filling the gap between doctor visits, yielding novel insights into maternal health that previously were impossible to obtain. We connect patients with real human beings who match their culture and community, and who walk a similar life path. In so doing we restore human connection and create bonds that extend beyond cold, dispassionate medical care into warm, compassionate, insightful health education, coaching, and guidance. Through gentle nudges that reinforce the doctor’s care plan more effective change is possible. The result: strengthening healthful behaviors while reducing the need for in-office visits and medical interventions. Through Continuously Connected Wellness ™ L ōvu detects illness earlier than previously possible, giving doctors and midwives the chance to intervene before more serious harm occurs. But we don’t stop there: we recognize that we are not alone in our desire to restore health and to slice through access barriers for essential services so as physical, social, and emotional needs arise we connect patients and their families to best-in-class technologies and service platforms in our first-inkind mom’s marketplace. The end result is an improved mother, baby, and family who can remain healthy for the longterm — a perfect ratio of health with medicine.

to heal societies as well, as the health of an individual cannot exist in the absence of health of her greater society. As the remarkable Krishnamurti wrote in Commentaries on Living:

“Is society healthy, that an individual should return to it? Has not society itself helped to make the individual unhealthy? Of course, the unhealthy must be made healthy, that goes without saying; but why should the individual adjust himself to an unhealthy society? If he is healthy, he will not be a part of it. Without first questioning the health of society, what is the good of helping misfits to conform to society?”

WE CAN FOOL OURSELVES INTO THINKING WE ARE OK, WHEN IN FACT WE MAY BE IGNORING BLARING WARNING SIGNS ALL AROUND US.

Collectively we ignore dynamism in favor of rigidity and overly controlled circumstances. We ignore real world evidence at our own peril, force-fitting overly controlled and contrived studies for all patients from all walks of life, calamitously ignoring women, their pregnancy journeys, and their overall life journeys. We can fool ourselves into thinking we are ok, when in fact we may be ignoring blaring warning signs all around us. But so many of us are blind to these signals, suffering a lack of information and practical guidance, left struggling to amalgamate insights for ourselves but never truly knowing if they are valid. Nothing less than the health, prosperity, and longevity of our species is at risk. And so it’s time to start healing the ruptures in society, ruptures resulting from misapplication and unintended consequences of technology, from having left large swathes of people behind in the interest of making a fast buck, from chasing wealth for wealth’s sake.

At L ōvu we recognize that life is dynamic, not static, that meaningful life is resilient life, that healthy lives lead to healthy societies. We are not just a business to exact a return, but rather to effect a transformation in the wellbeing of one patient at a time, one family at a time, collectively yielding a better humanity for all. As we look to a New Year we unequivocally recognize that it’s time to set aside a Chief Medical Officer in favor of a Chief Health Officer.

References:

1. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2812960

2. https://medium.com/e-l%C5%8Dvu-health

3. https://medium.com/e-l%C5%8Dvu-health/why-i-am-nolonger-chief-medical-officer-9a21f3777f04

This is just a start, for it’s time to heal not just individuals, but

Legislative Advocacy Day 2024

Our SCCMA team sent twenty-seven physician and resident participants to Sacramento to meet with our legislative ofﬁces.

On April 10th, 2024, the Santa Clara County Medical Association participated in the CMA’s 50th Legislative Advocacy Day. It was a huge success. Our SCCMA team sent twenty-seven physician and resident participants to Sacramento to meet with our legislative offices. We had ten legislative meetings in one day, including meetings with the offices for Assemblymembers Berman, Kalra, Lee, Low, Pellerin, and Rivas, as well as Senators Becker, Cortese, Laird and Wahab. In some of our meetings, we were joined by colleagues from neighboring county medical societies where our legislative districts overlapped.

Our group convened at the Sheraton Grand Sacramento Hotel with hundreds of other physicians, residents, and medicals students from throughout California in the morning before heading to our meetings with our local representatives. Physicians were lobbying their legislators in support of CMA’s priority issues, including Medi-Cal rate increases, Prior Authorization and the Physicians Make Decisions Act protecting physician oversight of AI in medical decision making.

The key messages that were shared with legislators were:

Protect Access to Care: Preserve Quality Health Care for All Californians by Maintaining Last Year’s Historic Budget Agreement for Medi-Cal Providers

• We must uphold last year’s agreement to invest in the Medi-Cal system and provide physicians with the certainty they need to treat more patients.

• California has the largest Medi-Cal program in the county, serving nearly 15 million people—a number that

has consistently grown over the last decade. California needs to ensure that it has the health care workforce to treat these patients.

• Last year, California reached a historic budget deal that would invest billions of dollars in the Medi-Cal system, and it is important for the Legislature to uphold its promise by investing these funds as intended.

• With growing inflation and the recent pandemic related to health care delivery systems, current Medi-Cal reimbursement rates don’t come close to covering the cost of a routine medical visit.

• To meet California’s goal of universal access to health care coverage, it must provide equitable funding to strengthen the overall health system and ensure enough providers to meet the demand for patient care.

• Our organization is committed to supporting policies that better fund Medi-Cal and ensure that health insurance actually means access to health care.

Senate Bill 516 (Skinner) Prior Authorization: Patient-Centered Care: Prior Authorization Reform

• It’s time to share your story! Please provide your or your patient experiences with prior authorization! The key to getting this done will require the issue to remain at the forefront of the Legislature’s work!

• To do this, we need you to emphasize that despite all the “work” that health plans are doing to “fix” the prior authorization issue.

• Tell a story about your patients who have not gotten the care they need or have had to stop taking medications because the health plan attached a prior authorization to it or denied it.• Share a gripping story about how long you were on the phone trying to get a necessary or urgent treatment approved by a health plan and how many patients you could have seen in that time.

Media reports have begun documenting insurers practice of denying necessary care to patients to boost heath plan profit margins (The New York Times, ProPublica, NPR, Calmatters). This is an imbalance that puts profit margins over treating patients has contrib-

Meeting with Senator Laird at the Swing Space during Legislative Advocacy Day with with the Santa Cruz Monterey Medical Association

uted to delayed patient care, worse health outcomes, administrative burdens on physicians and clinicians, and increased health care costs.

Senate Bill 1120 (Becker) Health Care Coverage: Utilization Review: Physicians Make Decisions Act

• Without the Physicians Make Decisions Act, patients could have essential medical services denied by artificial intelligence (AI) when being used for utilization review by health insurers.

• AI has been and will continue to be an essential tool in improving health care access and affordability for patients, but physicians must have oversight of critical

utilization review decisions to ensure the best health outcomes for our communities.

• This bill is necessary because, as leaders in the health care delivery system, we want to be proactive in guaranteeing that no patient’s health condition or diagnosis is missed due to AI.

• This bill provides essential guardrails to allow us to continue successfully integrating AI into our health care system.

• SB 1120 provides protection for patients from AI-generated rejections of medical services.

Thank you to our physician leaders for their participation and advocacy!

Dr. Somersille with Assemblymember Berman

Assemblymember Pellerin together with the Santa Cruz Monterey Medical Association

Meeting with Senator Wahab’s Legislative Health Aide, Carson Knight together with the Alameda-Contra Costa Medical Association

Senator Becker meets with CEO Marc Chow, CMA President Dr. Tanya Spirtos, Dr. Carol Somersille, Dr. Seema Sidhu, and Dr. Cindy Russell

Meeting with Assemblymember Lee’s Legislative Director Andrew White with the Alameda-Contra Costa Medical Association

CURRENT OPINION Pregnancyoptionscounseling

SarahN.OwensandJadeM.Shorter

PurposeofReview

Thisarticlereviewskeyaspectsofpregnancyoptionscounseling,andhighlightshowinappropriate counselingcancreatebarrierstotimelyandsafeabortioncare.

RecentFindings

AccesstosafeabortionservicesintheUnitedStatesisincreasinglyconstrained.Onewaytocombatthis hostileenvironmentistoensurethatindividualspresentingforcareearlyinpregnancyhaveaccessto comprehensiveandunbiasedpregnancyoptionscounseling.Thereareunfortunatelymanybarriersto individualsreceivingadequatepregnancyoptionscounseling,andmarginalizedgroupsexperience disproportionateeffectsofinappropriatecounseling.Researchshowsthatindividualsdesireappropriate pregnancyoptionscounselingwhenseekingearlypregnancycare,andthatprovidersoftenserveasa barriertothiscare.Providermiseducationandoppositiontopregnancyoptionscounseling,particularlyas itconcernsabortioncare,createschallengesanddelaysforpeopleseekingabortionservices.Crisis PregnancyCentersusemisinformationtofurtherthesebarrierstoappropriatecare.

Summary

Nondirectiveandpatient-centeredpregnancyoptionscounselingisstandardofcare.Peopleseeking pregnancyoptionscounselingdesireanddeservecomprehensiveandaccurateinformation.Providersmust notserveasbarrierstosafeandappropriatecare.Increasingnondirectivepregnancyoptionscounseling research,education,andtrainingiscrucialtoensuringaccesstosafeandappropriateabortioncare.

Keywords counseling,patient-centeredcare,pregnancyoptions

INTRODUCTION

Pregnancyoptionscounselingcanbedefinedasa formofcounselingthatprovidespatientswithinformationandsupportregardingpregnancy,usuallyin thesettingofanunintendedpregnancy[1].Unintendedpregnancyiscommonworldwide.However, accordingtostudiesbytheGuttmacherInstitute, unintendedpregnancyissignificantlymoreprevalentintheUnitedStatesthaninotherdeveloped countries[2].Nearlyhalf(45%or2.8million)of the6.1millionpregnanciesintheUnitedStateswere unintendedin2011[2,3].Giventhisexceptionally highpercentageofunintendedpregnancies,options counselingisakeypartofreproductivehealthcarefor peopleintheUnitedStates.However,manydisparitiesexistinprovidermiseducationandpatientaccess toclearandappropriatepregnancyoptionscounseling.Pregnancyoptionscounselingshouldincludea patient-centereddiscussionthathighlightsallpregnancyoptions,includingabortionservices,parenting,andadoption.Providersshouldprovideeffective andnonjudgmentaloptionscounselingthatappropriatelydiscussestherisksandbenefitsofeachoption

basedontheirpatient’spreferencesandindividualizedhealthstatus.

VARIATIONSINPREGNANCYOPTIONS COUNSELING

Nondirectiveandpatient-centeredpregnancy optionscounseling

Allpregnantpeopledeservecompleteandunbiased counselingregardingtheirpregnancyoptionsand informationonhowtoobtainsafeandappropriate reproductivehealthcare.Healthcareprovidersplaya crucialroleinensuringthatpregnantpeopleare

DepartmentofObstetricsandGynecology,StanfordUniversitySchool ofMedicine,Stanford,California,USA CorrespondencetoJadeM.Shorter,MD,MSHP,DepartmentofObstetricsandGynecology,StanfordUniversitySchoolofMedicine,453 QuarryRoad,MC5317,PaloAlto,CA94304,USA. Tel:+14157869112;e-mail:jshorter@stanford.edu CurrOpinObstetGynecol 2022,34:386 – 390 DOI:10.1097/GCO.0000000000000823

KEYPOINTS

Nondirectivepregnancyoptionscounselingisaterm forpatient-centered,comprehensive,andaccurate counselingthatincludesallpregnancyoptions, includingabortion,parentingandadoption.

Providersshouldprovideadequatepregnancyoptions counselingorrefertheirpatientstoan appropriateprovider.

Patientsdesireclearandcomprehensivepregnancy optionscounselingandhaveanimprovedexperience whenreceivingcounselingonallpregnancyoptions.

Therearemanybarrierstopregnancyoptions counseling,andmarginalizedgroupsareatgreatest riskfrominappropriateandfalsepregnancy optionscounseling.

CrisisPregnancyCentersincreasebarriersto appropriatepregnancyoptionscounselingandcreate delaystosafeabortioncare.

givenevidence-basedandunbiasedinformationon allpregnancyoptions.Thisalsoincludesappropriate referralstopursuethedesiredoption.Thisprincipleis definedasnondirectivepregnancyoptionscounseling[4].Patient-centeredcareisanimportant approachtohealthcareandhasbeendefinedas respectfulcarethatisresponsivetopatientpreferences,needsandvaluesandensuresthatthepatients’ valuesguideallclinicaldecisions[5].Pregnancy optionscounselingshouldbeundertakenusinga patient-centeredapproachandshouldincludeall optionsincludingabortion,adoption,andparenting [6&].TheAmericanAcademyofFamilyPhysicians, AmericanCollegeofNurse-Midwives,American CollegeofObstetriciansandGynecologists(ACOG), andtheAmericanAcademyofPediatricshaveall independentlyproducedguidelinesonproviding informationandreferralsforprenatalcare,adoption services,andabortionservicestopregnantpatients [7–10].Eachoftheseguidelinesfocusonthenotion thatitisourprofessionalandethicalobligationto provideunbiasednondirectivecounselingonall availablepregnancyoptionsormakeatimelyreferral toanotherproviderifunabletoprovideappropriate counselingduetopersonalbeliefs[11].TheserecommendationsarealsoendorsedbytheCentersfor DiseaseControlandPreventionandtheOfficeof PopulationAffairs[12,13].

Acrucialaspectofpregnancyoptionscounselingistheabilitytoprovidemedicallyaccurate informationaboutthevariousoptionsthatexist foranindividualseekingcare.Inastudydoneacross sixfacilitiesinMichiganandNewMexico,patients

wereinterviewedabouttheirexperienceswithlong distancetravelforabortioncare[14].Theauthors identifiedinformation-relatedbarrierstoabortion careaccessincludingagenerallackofreproductivehealthrelatedknowledgeand/orunhelpfulnesson thepartofthehealthcareproviders[14].The authorsconcludedthatinaccuratemedicalinformationandinappropriatereferralscanserveaskey barrierstoobtainingsafeabortioncare.Similar inappropriatereferralswerereportedinaUnited Statessurveyof567publiclyfundedfamilyplanning facilities[13].Thisstudyfoundthatproviderswere significantlymorelikelytoprovidepatientswithan adoptionreferral,whenrequested,thanareferralto abortionservices,whenrequested.Furthermore, healthdepartmentsandcommunityhealthcenters werelesslikelytoreferforrequestedabortionservicescomparedwithcomprehensivereproductive healthcenters[13].Thesestudiesdisplaytheimportanceofreproductivehealthcareprovidersand facilitiesdiscussingallavailablepregnancyoptions, andprovidingpatientswithreferralstoanappropriateserviceinatimelyandgeographicallyfeasible manner.

Oppositiontopregnancyoptionscounseling

ThestandardofcarerecommendedbyACOGfor pregnancyoptionscounselingincludesreferralin casesofpersonalobjectiontotheseservices.A studyperformedinaNebraskaclinicsurveyedcliniciansabouttheirreferralpracticesforvariousreproductivehealthscenarios,includingabortion.This studyfoundthatfewcliniciansfacilitatedadequate referralsforabortionsservicesandthat15%of cliniciansprovidedmisleadingreferralsforabortioncare[15].Theseinappropriatereferrals includedcrisispregnancycenters,adoptionservicesonly,ortoanotherproviderwhodoesnot provideabortioncare.Similarfindingswere depictedinastudythatlookedatabortionreferrals amongsthealthandsocialserviceproviders. Approximately18%ofprovidersreferredpatients toacrisispregnancycenterorsimilarorganization thatencouragescontinuationofthepregnancy, and7%ofprovidersdirectlyencouragedtheirclienttocontinuethepregnancy[16].Furthermore, accordingtoasummaryofsevenarticleslookingat providerperspectivesandpracticesrelatedtoabortionreferrals,approximatelyonethirdofrespondentsdonotreferpatientsforabortionservices,and asmanyasoneinsixprovidersreportedactive dissuasionofabortioncare[17].Thisgapincare isunacceptableonthepartofreproductivehealthcareproviders.Manyprofessionalorganizations, includingtheAmericanCollegeofObstetricians

andGynecologists,supportpatientsbeingreferred forcomprehensiveandevidence-basedcareregardlessoftheopinionsoftheirprovider[7,10,12,18]. Providersshouldnotimposetheirpersonalbeliefs uponpatientsnorhinderpatientsseekingnecessaryandsafeabortioncare.

Theimportanceofpregnancyoptions counselingeducationandtraining

Apotentialsolutiontoimprovingpregnancy optionscounselingamongstprovidersisthrough medicaleducationandtraining.TheAssociation ofProfessorsofGynecologyandObstetricsstates thatnondirectivepregnancyoptionscounselingis anecessarycomponentofmedicaleducation[19]. Despitethisrecommendation,pregnancyoptions counselingisrarelyincludedinU.S.preclinical medicaleducation[1].Interventionstoaddressthis gapinmedicaleducationhavebeenshownto improvemedicalstudent’sabilitytoprovidepregnancyoptionscounseling.Arecentstudyfound higherscoresonapregnancyoptionscounseling ObjectiveStructuredClinicalExaminationamong medicalstudentswhowererandomizedtoapreexamination2-hpregnancyoptionscounselingnarrativemedicineworkshop[1].

Improvingeducationandtrainingaroundpregnancyoptionscounselinghasthepotentialto addressprovider-basedbarrierstoappropriatepregnancyoptionscounselingandabortionreferrals. Onestudyfoundthatanabortion-referraltraining sessionforproviderssignificantlyincreasedprovider’swillingnesstoprovideareferraltoabortion carefrom50%to80%[16].Inastudylookingat patientexperienceswithpregnancyoptionscounseling,10%ofpatientsreportedthattheirprovider discussedalloptions,whichincludedabortion, adoption,andparenting.Providerswhodiscussed alloptionsweremorelikelytohavereceived optionscounselingtraining[6&].Implementation ofpregnancyoptionscounselingeducationand trainingsessionscouldimprovepregnancyoptions counselingandincreasethefrequencyofabortion referralsamongstproviderswhowerepreviously reluctantoropposedtothiscounseling.Improvementsinstudentandprovidereducationaround pregnancyoptionscounselingandabortioncare canincreaseaccesstotimelyandsafepregnancy careforpatients.Educationandtrainingonpregnancyoptionscounselingshouldbebasedonthe principlesofpatient-centeredcareandshareddecision-making.Thesetenetswillallowprovidersto counselpatientsonpregnancyoptionscenteredon safeandappropriatecareratherthanpersonal beliefsandstigma[17].

THEPATIENTPERSPCECTIVE

Patientpreferencesforpregnancyoptionscounselingdonotalwaysmatchtheprovider’sperspective andthecounselingprovided[6&].Thisisevidentin studiesshowingthatmanyprovidersrefertheir patientsonlytoprenatalcare[20]andoftendo notdiscussorreferforabortionservices[15,21]. Thediscrepancybetweenprovidercounselingand patientpreferencesintroducesunnecessarybarriers toreceivedpatient-centeredreproductivehealthcare.OnestudyoftwoU.S.abortionclinicsfound thatonly25%ofabortionpatientshadseentheir primarycareproviderregardingpregnancyoptions counseling.Thiswasinpartduetofearsofnotbeing supportedorconcernsaboutbeingjudged[14].

Astudysurveyedwomen’sperspectivesand preferencesaroundpregnancyoptionscounseling atanabortionandprenatalclinicinNebraska[22]. Mostwomensupportedofferingoptionscounseling toallpregnantwomenandnotedthatcomprehensiveandunbiasedinformationisanimportantcomponentofpregnancyoptionscounseling.Study participantsfeltthatcounselingshouldbetailored aperson’sownmedicalandsocialcircumstances andexpressedtheimportanceoftreatingthe patient’smedicalneedsbeyondpregnancy.Women whowereplanningtocontinuetheirpregnancyalso voicedopennesstoreceivingpregnancyoptions counselinganddidnotthinkthatthiscounseling wouldbeoffensive[22].

Thelackofappropriatepregnancyoptions counselinghasalsobeenshowntoeffectpatient’s healthcareexperiences.AstudyconductedintheUS southaimedtoevaluatetheassociationbetween comprehensivepregnancyoptionscounseling, whichincludesadiscussionofabortion,adoption, andparenting,andpatientreportedexperiencewith counseling[6&].Patientsexpressedadesirefor supportiveandnondirectivecounselingonallpregnancyoptions.Patientswhowerecounseledabout allpregnancyoptionsreportedamorepositive experience,definedasbeingmorelikelytorate thecounselingasexcellent.

BARRIERSTOTIMELYANDADEQUATE PREGNANCYOPTIONSCOUNSELING

Barriersformarginalizedgroups

ThemajorityofindividualsseekingabortionservicesidentifyasBlack,Hispanic,Asian,orPacific Islander,andreportlivingatorbelowthefederal povertylevel[23].Marginalizedgroupsmorelikely tofacebarrierstoaccessingadequateabortioncare [7].Forexample,peoplewithlowincomeshave beenfoundtoexperienceincreasedwaittimes,lack

ofappointments,anddifficultyfindingaprovider whenseekingabortioncare[24].Transgendermen andgender-diverseindividualshavereportedchallengesinaccessingabortionservicesduetodiscriminationandmistreatment[25].Moreresearchis neededtounderstandtheexperiencesofthese marginalizedpopulationsandthecounselingthey receivewhenseekingreproductivehealthcare.

Geographicalbarriers

Geographyalsocreatesdisparitiesinoptionscounselingavailability.Morethanhalfofwomeninthe UnitedStatesnowliveinstateswithlawshostileto abortionrights;definedasstatesthathaveatleastfour typesofmajorabortionrestrictionsinplace[13].Most ofthesestatesareMidwesternwithlargeswathsof ruralareas.Onestudyhighlightedthechallengesthat publiclyfundedfamilyplanningfacilitiesfacein providingabortionreferrals.Thesefacilitiesexpress willingnesstoprovideabortionreferralsupon request,howeverthereisalackofqualityinformation aboutnearbyproviders,andinmanyruralareasthere areoftennolocalabortionproviderstowhom patientscanbereferred[13].Furthermore,lawsalone caninfluencetheinformationgiventoaperson seekingabortion.AccordingtotheGuttmacherInstitute,18statesmandatethatindividualsbegiven counselingbeforeanabortionthatincludesinformationonatleastoneofthefollowing:theallegedlink betweenabortionandbreastcancer,theabilityofa fetustofeelpain,orlong-termmentalhealthconsequencesofabortioncare[26].Forpatientstraveling significantdistancesfortime-sensitiveabortions, accurateinformationaboutabortionsoptionsand locationofservicesiscritical.

Crisispregnancycenters

Crisispregnancycentersportraythemselvesas healthclinicsthatofferallpregnancyoptions.However,theydonotofferabortionservicesandoften deterindividualsfromseekingcare[27].Notonlydo theyincorrectlypresentthemselvesasalegitimate reproductivehealthcarecenterthatprovidescomprehensivecare,buttheyalsooftenpresentindividualswithfalseandinaccuratemedicalinformation [7].Thestandardofcareforpregnancyoptions counselingisnondirectivepregnancyoptionscounseling[14].Crisispregnancycentersthreatenthis standardbyprovidingmisleadingreproductive healthcareresources.Theseresourcesareoftenantiabortionandcontainareligiousperspective[14]. Thiscancausepatientsmajordelaysinreceiving timelyandsafeabortioncare[7].Suchbarriersalso contributetoracialandsocioeconomichealth

disparities.Inasurveyofapproximately2500reproductive-agewomeninOhio,13.5%ofrespondents reportedalifetimeprevalenceofeverattendinga crisispregnancycenter.Crisispregnancycenter attendancewashigheramongwomenofBlack, non-Hispanicrace/ethnicityandcurrentlyinthe lowestsocioeconomicstatus.

Crisispregnancycenterwebsitespurposelylack clearcommunicationonwhethertheyprovideabortionservices.Thisoftenincitesconfusionamongst individualsseekingabortioncare.Across-sectional surveyofapproximately1000womenfoundthat 85%ofparticipantsfailedtocorrectlyidentifyat leastonecrisispregnancycenterafterbeingpresentedwithmultiplecrisispregnancycenterwebsites[28&].Theinabilitytocorrectlyidentifyacrisis pregnancycenterwasfoundtobeassociatedwitha lowhealthliteracyscore.Thisindicatesthatindividualswithdecreasedknowledgeaboutabortion andlowhealthliteracymaybemoresusceptibleto thedeceptionofcrisispregnancycenters,whichcan leadtodelaysinappropriateabortioncare.Dueto thedangersofmisinformationandunethicalpractices,onJune26,2018,theSupremeCourtofthe UnitedStatesissuedarulingonaCalifornialawthat requiredlicensedcrisispregnancycenterstopost informationaboutaffordableabortionandcontraceptionservices.Thelawalsorequiredunlicensed crisispregnancycenterstodisclosethattheywere notlicensedmedicalclinics[27,29].

CONCLUSION

Nondirectiveandpatient-centeredpregnancy optionscounselingisstandardofcare.Therecent literatureisclearthatallindividualsseekingabortion caredeservetobeappropriatelycounseledabout everypregnancyoptionincludingabortion,parentingandadoptionusingashareddecision-making approach.Whetherbylaworpublishedguidelines, it’salsonowastandardthatreproductivehealthcare providershaveanobligationtoprovidefactualand comprehensivepregnancyoptionscounselingto theirpatientsorrefertoanappropriateprovider. Inappropriatepregnancyoptionscounselingand misinformationexacerbatereproductivehealthcare disparitiesamongpatientoutcomesandexperiences. Improvingpregnancyoptionscounselingeducation andtrainingwillimprovegapsinknowledgeand increaseaccesstosafeandtimelyabortioncare.

Acknowledgements

None.

Financialsupportandsponsorship

None.

Conflictsofinterest

Therearenoconflictsofinterest.

REFERENCESANDRECOMMENDED READING

Papersofparticularinterest,publishedwithintheannualperiodofreview,have beenhighlightedas: & ofspecialinterest && ofoutstandinginterest

1. RivlinK,WesthoffCL.Navigatinguncertainty:narrativemedicineinpregnancy optionscounselingeducation.PatientEducCouns2019;102:536–541.

2. UnintendedpregnancyintheUnitedStatesGuttmacherInstitute.2019. Availableat:https://www.guttmacher.org/fact-sheet/unintended-pregnancyunited-states.

3. FinerLB,ZolnaMR.DeclinesinunintendedpregnancyintheUnitedStates, 2008–2011.NEnglJMed2016;374:843–852.

4. HasstedtK.Unbiasedinformationonandreferralforallpregnancyoptionsare essentialtoinformedconsentinreproductivehealthcareGuttmacherInstitute.Availableat:https://www.guttmacher.org/gpr/2018/01/unbiased-information-and-referral-all-pregnancy-options-are-essential-informed-consent[cited2018].

5. BakerA.Crossingthequalitychasm:anewhealthsystemforthe21st century.BritishMedicalJournalPublishingGroup;2001.

6. & NobelK,AhrensK,HandlerA,HoltK.Patient-reportedexperiencewith discussionofalloptionsduringpregnancyoptionscounselingintheUS South.Contraception2022;106:68–74.

Thisstudydemonstratestheimportanceofincorporatingpatient-centeredcarein medicaltrainingonpregnancyoptionscounselingandsupportscomprehensive pregnancyoptionscounselingasbestpractice.

7. AmericanCollegeofGynecologists’CommitteeonHealthcareforUnderservedWomenACoO,Gynecologists’Abortion,TrainingExpertWorkG. Increasingaccesstoabortion:ACOGCommitteeOpinion,Number815. ObstetGynecol.2020;136(6):e107–e115.

8. HornbergerLL,CommitteeOnA.Diagnosisofpregnancyandprovidingoptions counselingfortheadolescentpatient.Pediatrics2017;140:2017–2273.

9. AmericanCollegeofNurse-Midwives.Accesstocomprehensivesexualand reproductivehealthcareservices.http://www.midwife.org/acnm/ﬁles/ ACNMLibraryData/UPLOADFILENAME/000000000087/Access-to-Comprehensive-Sexual-and-Reproductive-Health-Care-Services-FINAL-04-1217.pdf.ReviewedandRevisedOctober2016.AccessedJuly27,2022.

10. AmericanCollegeofGynecologists.ACOGCommitteeOpinionNo.385 November2007:thelimitsofconscientiousrefusalinreproductivemedicine. ObstetGynecol2007;110:1203–1208.

11. BerglasNF,WilliamsV,MarkK,RobertsSCM.Shouldprenatalcareproviders offerpregnancyoptionscounseling?BMCPregnancyChildbirth2018;18:384.

12. GavinL,MoskoskyS,CarterM, etal. Providingqualityfamilyplanning services:recommendationsofCDCandtheU.S.OfﬁceofPopulationAffairs. MMWRRecommRep2014;63(RR-04):1–54.

13. HebertLE,FabiyiC,HasselbacherLA, etal. Variationinpregnancyoptions counselingandreferrals,andreportedproximitytoabortionservices,among publiclyfundedfamilyplanningfacilities.PerspectSexReprodHealth2016; 48:65–71.

14. KavanaughML,JermanJ,FrohwirthL.It’snotsomethingyoutalkaboutreally’: informationbarriersencounteredbywomenwhotravellongdistancesfor abortioncare.Contraception2019;100:79–84.

15. HomaifarN,FreedmanL,FrenchV.She’sonherown’:athematicanalysisof clinicians’commentsonabortionreferral.Contraception2017;95:470–476.

16. O’DonnellJ,HoltK,NobelK,ZurekM.Evaluationofatrainingforhealthand socialserviceprovidersonabortionreferral-making.MaternChildHealthJ 2018;22:1369–1376.

17. ZurekM,O’DonnellJ.Abortionreferral-makingintheUnitedStates:ﬁndings andrecommendationsfromtheabortionreferralslearningcommunity.Contraception2019;100:360–366.

18. SwartzendruberA,EnglishA,GreenbergKB, etal. Crisispregnancycenters intheUnitedStates:lackofadherencetomedicalandethicalpractice standards;ajointpositionstatementoftheSocietyforAdolescentHealth andMedicineandtheNorthAmericanSocietyforPediatricandAdolescent Gynecology.JPediatrAdolescGynecol2019;32:563–566.

19. TheAssociationofProfessorsofGynecologyandObstetrics,APGOmedical studentobjectives,11thed.2019.Availableat:https://cdn.ymaws.com/ apgo.site-ym.com/resource/resmgr/apgo-11th-ed-mso-book.pdf.

20. WhiteK,AdamsK,HopkinsK.Counselingandreferralsforwomenwith unplannedpregnanciesatpubliclyfundedfamilyplanningorganizationsin Texas.Contraception2019;99:48–51.

21. HoltK,JaniakE,McCormickMC, etal. Pregnancyoptionscounselingand abortionreferralsamongUSprimarycarephysicians:resultsfromanational survey.FamMed2017;49:527–536.

22. FrenchVA,SteinauerJE,KimportK.Whatwomenwantfromtheirhealthcare providersaboutpregnancyoptionscounseling:aqualitativestudy.Womens HealthIssues2017;27:715–720.

23. JermanJ,JonesRK,OndaT.CharacteristicsofU.S.abortionpatientsin2014 andchangessince2008.2016.Availableat:https://www.guttmacher.org/ sites/default/ﬁles/report_pdf/characteristics-us-abortion-patients-2014.pdf.

24. FosterDG,BiggsMA,RalphL, etal. Socioeconomicoutcomesofwomen whoreceiveandwomenwhoaredeniedwantedabortionsintheUnited States.AmJPublicHealth2018;108:407–413.

25. LightA,WangLF,ZeymoA,Gomez-LoboV.Familyplanningandcontraceptionuseintransgendermen.Contraception2018;98:266–269.

26. Anoverviewofabortionlaws:GuttmacherInstitute.2022.Availableat: https://www.guttmacher.org/state-policy/explore/overview-abortion-laws

27. BorreroS,FrietscheS,DehlendorfC.Crisispregnancycenters:faithcenters operatinginbadfaith.JGenInternMed2019;34:144–145.

28. & SwartzJJ,RoweC,TruongT, etal. Comparingwebsiteidentiﬁcationforcrisis pregnancycentersandabortionclinics.WomensHealthIssues2021; 31:432–439.

Thisoriginalresearcharticleexploresthechallengesindividualsfaceincorrectly identifyingcrisispregnancycenterwebsites,whichcanleadtodelaysaccessto timelyandsafeabortionservices,especiallyforindividualswithlowhealthliteracy.

29. ParmetWE,BermanML,SmithJA.TheSupremeCourt’scrisispregnancy centercase–implicationsforhealthlaw.NEnglJMed2018; 379:1489–1491.

Vice President Harris’s Reproductive Freedoms Tour

On January 22, the 51st Anniversary of Roe v. Wade, Vice President Kamala Harris embarked on a nationwide tour aimed at supporting reproductive freedoms1. The journey began with an event in Wisconsin, marking a pivotal moment in the ongoing fight for women’s rights. The tour, spearheaded by Vice President Harris, seeks to shed light on the detrimental impact of abortion bans while amplifying the voices of those affected. She urges Congress to restore the protections afforded by Roe v. Wade and emphasizes the importance of grassroots activism and civic engagement in safeguarding fundamental freedoms. She highlights the collective power of the American people in upholding reproductive rights, citing victories in various states where voters overwhelmingly supported freedom of choice. Harris asserts, “To truly protect reproductive freedoms, we must restore the protections of Roe v. Wade, “Because, you see, what the United States Supreme Court took, Congress can put back in place.” Her call to action underscores the need for legislative measures that uphold individuals’ autonomy over their bodies.

Moines, Iowa, who courageously shared the challenges faced by patients seeking abortion care. Harris condemns the efforts of legislators and reaffirms that freedom includes the right to make decisions about one’s own body.

The tour, spearheaded by Vice President Harris, seeks to shed light on the detrimental impact of abortion bans while amplifying the voices of those affected.

The campaign is still going strong. Vice President Harris stated, “everything is at stake,” referring to the upcoming November elections.3 The campaign announced they would hold more than 50 events in battleground states to mark the second anniversary of the Supreme Court’s decision on Dobbs v. Jackson.3 They aim to remind voters that Trump and his appointed Supreme Court judges are responsible for overturning the federal legal right to abortion.5 Her advocacy underscores the urgency of protecting reproductive freedoms for all individuals, regardless of geography or circumstance.

Voices from Santa Clara County: Uniting for Reproductive Justice

The campaign announced they would hold more than 50 events in battleground states to mark the second anniversary of the Supreme Court’s decision on Dobbs v. Jackson.

The Reproductive Freedom Tour is not merely a political campaign but a call to action. The tour’s itinerary includes visits to various states where legislation has been introduced or passed that restricts reproductive healthcare options. Harris has used these visits to engage with local communities, meet with healthcare providers, and hear directly from individuals impacted by these laws. In recounting the stories of individuals impacted by restrictive abortion laws, she reflects on the stigma and misinformation surrounding reproductive healthcare. She amplifies voices from healthcare professionals, like a nurse in Des

In the wake of recent developments in reproductive rights, leaders from Santa Clara County are rallying behind a shared commitment to safeguarding women’s health and autonomy.4 Supervisor Cindy Chavez and Supervisor Otto Lee, alongside Paul Lorenz, CEO of Santa Clara Valley Medical Center Hospitals and Clinics, underscore the importance of solidarity and action in the face of threats to reproductive freedom. Santa Clara County supports reproductive justice, in solidarity with communities nationwide. The support for reproductive health is visible locally.2 Supervisor Cindy Chavez emphasizes California’s role as a sanctuary for reproductive rights.4 While acknowledging the state’s secure status, she warns against complacency, urging Californians to remain vigilant and engaged in the broader fight for women’s rights nationwide. Chavez calls upon individuals to leverage their voices, time, and

resources to support candidates and causes aligned with the protection of reproductive freedoms and civil rights for all.

Supervisor Otto Lee shares a personal reflection on the Supreme Court’s recent decision, expressing profound concern for the implications on women’s health and well-being.4 As a husband and father of three daughters, Lee underscores the critical importance of reproductive rights in safeguarding the health and dignity of women and girls. He voices a commitment to fighting for reproductive justice, both within Santa Clara County and beyond, recognizing the disproportionate impact of restrictive policies on marginalized communities.

Paul Lorenz reaffirms the commitment of the County of Santa Clara Health System to provide access to comprehensive reproductive care, including abortion services.4 Recognizing the potential influx of individuals seeking care from areas with restricted access, Lorenz underscores the county’s role as a beacon of reproductive rights. He emphasizes the inherent human right to access reproductive healthcare without fear or stigma, pledging continued support for all individuals in need of services.

References

1. https://www.whitehouse.gov/briefing-room/statements-releases/2023/12/19/vice-president-kamala-harris-launch-

es-reproductive-freedoms-tour/

IN NOVEMBER

2. https://www.whitehouse.gov/briefing-room/speeches-remarks/2024/01/22/ remarks-by-vicepresident-harris-tokick-off-nationwide-fight-for-reproductive-freedomstour-big-bend-wi/#:~:text=We%20are%20winning.,a%20 little%20%E2%80%94%20by%20overwhelming%20margins.

3. https://apnews.com/article/harris-biden-trump-abortion-rights-debate-election-5ad83af956a401897552a8fdf3a0cacd

4. https://news.santaclaracounty.gov/news-release/county-santa-clara-supports-efforts-make-reproductive-freedom-constitutional-right

After a long day of seeing patients and interacting with medical staff, it is always nice to unwind with good company and great food when the weather is nice. On Thursday, June 27, the Santa Clara County Medical Association (SCCMA) hosted the annual Summer Social at Meso Restaurant in Santana Row. The social event was free for all members. Members including physicians of all specialties, young physicians, retired physicians, and physician leadership mingled at the trendy restaurant while enjoying Mediterranean food and libations.

Exciting raffle prizes like gift cards to Meso Restaurant and one single occupancy room admission to the Wellness Retreat in August were given throughout the evening. The lucky recipient of the single occupancy room admission to the Wellness Retreat was Raymond Chan, MD of Santa Clara Valley Medical Center (SCVMC). After discovering a calendar conflict, he graciously gifted his raffle prize to An Thi Vo, MD, from SCVMC. She is the Wellness Committee Chair for Valley Homeless Healthcare Program. As an extra optional activity, attendees were invited to play an ice breaker game that encouraged conversation. Many attendees were able to befriend other physicians with similar interests and experiences.

The Summer Social also gave members the opportunity to speak with representatives from the legislative offices of Senator Cortese, Supervisor Otto Lee, Supervisor Evan Low, and Assemblymember Alex Lee. These encounters with representatives give everyone the chance to voice positions and concerns to our elected officials. SCCMA has built connections with elected officials and gives opportunities for members to interact with legislative offices for advocacy.

Doctors from different hospitals and modes of practice met, ate together, and became friends. By the end of the event, physicians lingered to grab dinner, lounged, and expressed their gratitude to SCCMA staff for such a fun event. The annual Summer Social is free for all Members. We hope you will be joining us next year!

Dr. Wu takes a selfie with SCCMA CEO, Marc Chow, Anh T Nguyen, MD, and Tara Sreekrishnan, Legislative Director (and Assembly Race AD-26 candidate) on behalf of Senator Cortese.

SCCMA President, Gloria Wu, MD, welcomes guests and introduces the event sponsor, Sherri Pattterson, and legislative representatives including Assembly Race AD-26 candidates Tara Sreekrishnan and Patrick Ahern.

The evening was perfect with pleasant weather, tasty food, and enjoyable libations.

Raffle Prize Winner: An Vo, MD

Past SCCMA President, Clifford Wang, MD, and Current SCCMA President pose for a picture at the Summer Social. The first Summer Social was established in 2022 under Dr. Wang’s leadership.

AI, Healthcare and Innovation Hybrid Event #2

The Santa Clara County Medical Association (SCCMA) hosted our second AI in Healthcare Hybrid Event on May 11th, 2024 at the SCCMA offices. We had a great turnout providing a series of twelve seven to ten minute presentations. Sixty people attended both online and in person. After everyone enjoyed a Silk Road themed breakfast, Dr. Wu kicked off the event with a warm welcome and a presentation discussing data analytics, and the possibilities that can come about when AI and healthcare meet. She spoke about Remote Patient Monitoring and Chronic Care Management. The message that she hoped the participants would get from the meeting was, “Be Empowered, Use AI.”

Dr. Brian Grady, a urologist from San Francisco, was the first presenter of the morning. Dr. Grady is a part of Golden Gate Urology and works for Sutter Health. He is the Past President of the San Francisco Marin Medical Society. He spoke about urology and AI, particularly in the health and equity space. Dr. Grady’s presentation focused on prostate cancer and how there is increased disparities in diagnosis for urological cancers among patients in minority populations particularly among black and brown patients. He emphasized the importance of early and frequent screening for minority men. AI can determine and suggest therapies which are appropriate for each case, with predictive models that lead to better patient outcomes.

Scott Bobo joined us by Zoom and discussed the basic concepts of AI and current applications. He presented information on publicly traded companies that are in the broader AI space and the successes these companies are experiencing. He then presented investment opportunities for the attendees.

Professor Israel Mendonca joined us live via Zoom all the way from Japan, with a presentation on Age Classification Based on Voice Identification. He introduced the concept of how smart home devices can use AI to provide age-appropriate answers to the person who asked a question.

Next, Dr. Yan Chow, who worked as a pediatrician with Kaiser for 20 years, provided a personal perspective on AI, Healthcare and Big Data. His perspective was shaped by being the healthcare lead for an intelligent automation company based in San

Jose. He presented data on how technology has evolved since the 1950’s. He observed that after 2022, there has been a focus on generative AI which takes large data sets and delivers specialized content through targeted channels. AI has potential but will need lots of clinical validation. He anticipates it becoming as important as the internet was in the past.

Dr. Kris Borrison, an OBGYN with Los Olivos Medical Group and the Medical Director of Robotic Surgery at Good Samaritan, presented the benefits of using ION with integrated 3D imaging and explained the benefits of robotic surgery. Dr. Borrison provided quantified data that included the reduced need for blood transfusions, decreases in complications, and reduction of readmissions. This presentation garnered excitement from participants and generated lively questions.

After a short break, Dr. Jagmohan Khaira, with Brown and Toland Experience, introduced Ambient AI Medical Scribing which uses AI and Natural Language Processing (NLP) technologies to automatically transcribee patient encounters during clinical visits. He feels that the benefits using Ambient AI Medical Scribing include increased accuracy, reduced administrative burden and improved patient care.

Dr. Leeda Rashid, MD, MPH, ABFM is from the San Francisco office of the Food and Drug Administration. She is a current hospitalist with Alameda County and she is a part of the Center for Device and Radiological Health (CDRH) Center of Excellence. The CDRH visions is to foster digital health focused on collaboration and to provide safe, high quality medical devices of public health to the world. She shared the vision that digital healthcare can enable to move healthcare from

Scott Bobo

Dr. Yan Chow

Dr. Kris Borrison

Dr. Jagmohan Khaira

Dr. Leeda Rashid

the clinic to the patient, helping patients to understand world physiology and behaviors leveraging computing power, sensors, connectivity, and software.

Jeff Hui with Jumpstart AI joined us via Zoom, and raised the interest of the physicians with his presentation on how Jumpstart AI could save providers a lot of time by creating videos for patient education. Jumpstart AI can produce videos with only 5 minutes of set up time, and patients can re-watch these videos whenever they have questions. Users can modify the script until the message is crystal clear reducing patient risk due to lack of clarity.

Gen AI engine summarizes patient participant, resident history, goals progress notes, behaviors, lab work and medications. It has private and secure ISO & HIPPA compliant messaging and integrates with many of the Emergency medical Records (EMRs) and Emergency Health records (EHRs).

Next, we watched a video submitted by Srinivas Rajgopal, who is the Principal at Arthur D Little (ADL) a management consulting firm in the healthcare and health science industry. He presented on generative AI and integration with human conversation. He demonstrated how generative AI can be used for customer support inquiries and automated data pre- processing. The software can report on KPI’s and summarize internal knowledge and produce different forms of outgoing communication such as publications, manuscripts, and marketing collateral. Another engaged question and answer session followed this presentation.

Ashwin Ramashwarmi, a candidate for Georgia State Senate in District 48, a cyber security specialist focusing on election security and law, submitted a pre-recorded video presentation. He earned his undergraduate in computer science from Stanford, a law degree from Georgetown, and his job with the government was to ensure election websites were secure. He worked with state and local governments to ensure they had the resources they needed in 2020, and the 2022 midterms. His message to physician members is that there is a calling for technical experts in the government sector. There is a need for cybersecurity professionals, to provide protection at all government levels. He encourages members to work in government and healthcare roles and collaborate with the private sector to deploy artificial intelligence tools responsibly.

Guru Tadiparti then introduced BlueSecures.ai. The Murphi

Jung Park, PhD, introduced Parakeet Health, an AI -powered answering service, using intelligent and compliant AI technology. Incoming calls are expensive, with staffing issues, missed calls, empathy fatigue, and is frustrating for patients due to long hold times, call routing and calls going unanswered. He shared three different demonstrations using the app, where the patients request was completed with patient satisfaction in just a few minutes.

CIPRA.ai, was the main sponsor of our event, and we ended the day with a presentation from Sujit Dey, Founder & CEO. of CIPRA.ai and a Professor at UC San Diego. About 10 years ago, they started building tools to help capture data. They created Digital Twins to be used with AI to capture the majority of the data not included in EHRs, and EMRs to solve problems in understanding what the top contributing factors are to hypertension and diabetes in patients. After various clinical trials, they began to commercialize the product through UC San Diego. CIPRA.ai outperforms standard and remote patient monitoring in monitoring the patient throughout their journey. They used artificial intelligence to generate specific recommendations and guidance for patient engagement. This supports physicians to provide precise care, and reverse and prevent chronic conditions. They have launched a hypertension and diabetes application that provides lifestyle guidance for patients.

All in all, it was a successful event! Great presentations were delivered, and even better conversations took place at this event. We ended the afternoon with lunch and participants stayed behind to engage in meaningful one-on-one discussions.

Jeff Hui

Srinivas Rajgopal

Guru Tadiparti

Jung Park, PhD

Sujit Dey

Protect Our Health Care

Problem – Our Health Care System is in Crisis:

California’s health care system is in crisis. In rural and urban communities alike, hospitals are delivery services. Emergency rooms are overcrowded. Patients cannot get in to see a doctor or specialist within a reasonable amount of time. Care for 15 million children, seniors, disabled

YES ON 35 Will Address Our Most Urgent Health Care Priorities

Prop 35 is supported by health care workers, physicians, community health centers, Planned Parenthood, health plans and emergency responders. The measure will address our most urgent health care priorities by securing dedicated, ongoing funding – without raising taxes on individuals – to protect and expand patient access to care. Yes on Prop 35 will:

+ Protect and Improve Care for all Patients.

Prop 35 will address our health care crisis by securing dedicated resources to protect and expand patient access to care at community health clinics, hospitals, emergency rooms, primary care, family planning, mental health providers and specialty care providers like cancer, cardiology and OB/GYN. Prop 35 will also

+ Ensure Dedicated Funding to Improve Care.

Prop 35 secures ongoing revenue by extending an existing tax on health insurance companies – without raising taxes on individuals –and dedicates these funds to protect and expand access to care for all Californians. Prop 35 permanently extends this revenue source that will otherwise expire in 2026.

+ Improve Health Care Access for the Most Vulnerable.

More than 15 million children, low-income families, seniors and persons with disabilities rely on Medi-Cal for their health coverage. But lack of adequate funding means Medi-Cal patients must wait months to see primary care doctors or cardiologists, cancer doctors, pediatric specialists or orthopedists. Prop 35 will ensure that the most vulnerable among us have equitable access to health care and get an appointment with a doctor or specialist when they need it.

+ Fund Health Care Worker Training.

Prop. 35 expands our state’s education and training programs to create a pipeline of health care workers and providers, including nurses, mental health providers, physician assistants, dentists and medical assistants.

+ Impose Strict Accountability.

Prop 35 prevents the state from redirecting these funds for non-health care purposes. And the measure requires that 99% of the revenues must go to patient care, capping administrative expenses at 1%. Lastly, the measure requires annual independent as intended.

Harmeet Sachdev, MD, FAAN

MEMBERFEATURED

Harmeet Sachdev, MD, FAAN, is a board-certified neurologist who has been a member of the Santa Clara County Medical Association (SCCMA) for a total of 38 years. At 8-years-old, he was a curious and adventurous child who enjoyed playing with friends and family, including his grandpa. That was until one day, he couldn’t. His grandpa, once a vibrant man, was now chair-bound because of a stroke. He sat still throughout the day, unable to move one side of his body. He also could no longer speak.

Inspired by this and his uncle who started the first neurology program in North India, Dr. Sachdev began his medical journey at Punjabi University in India. After completing his studies, he continued his education at the University of South Wales, and also attended at Queen Square Institute of Neurology in London, England before doing his internship in Detroit, Michigan. Dr. Sachdev continued his neurology residency at Stanford University Medical Center and became Chief Resident of Neurology in 1980. Today, Dr. Sachdev is the Director of Comprehensive Stroke Center at Good Samarian Hospital.

“FOR DAYS, I WOULD JUST SIT ON THE FLOOR AND LOOK AT MY GRANDPA, WONDERING WHY THERE WASN’T SOMETHING THAT WOULD HELP HIM TALK AGAIN, TO LIVE AGAIN,” SACHDEV SAID. “THAT WAS THE START OF MY JOURNEY: A JOURNEY TO SOLVE THE MYSTERIES OF THE BRAIN.”

With a vivid memory, Dr. Sachdev can recall significant medical cases like a 49-year-old patient in 1996 who experienced a stroke and was paralyzed on his right side and was unable to speak. Being the first physician to render t-PA (tissue plasminogen activator) treatment for stroke in the San Jose area shortly after FDA approval, Dr. Sachdev helped his paralyzed patient gain back 90% mobility. Patient cases like this inspired Dr. Sachdev to establish the Stroke Awareness Foundation and Brain Attack Team. This was the beginning of the lifelong journey for Dr. Sachdev to take care of stroke patients.

Dr. Sachdev has been an advisor to the Stroke Awareness Foundation since 1999.

The Foundation (SAF) advocates for a policy to redirect emergency medical transportation in Santa Clara County so that all stroke victims will be transported directly to a Certified Stroke Center. This ground-breaking legislation, unanimously approved by the Santa Clara Board of Supervisors, was the first of its kind in California.

Their work was instrumental in helping local hospitals to become Certified Stroke Centers. There are currently 6 Primary Stroke Centers certified by the Joint Commission for Accreditation, 1 Comprehensive Capable Center as well as 3 Comprehensive Stroke Centers in Santa Clara County. In 2003, Dr. Sachdev helped Good Samaritan Hospital to become certified as one of the first 5 Primary Stroke Centers in the nation, and the first in Santa Clara County. Beginning in 2008, he helped Good Samaritan Hospital with the clot retrieval process thereby extending the time window from 3 hours to 6.5 hours and beyond. In order to care for the most complex stroke cases, he assisted in the dedication of the Neuroscience Critical Care Unit at Good Samaritan Hospital.

“TO SEE SOMEONE COMPLETELY PARALYZED, THEN DELIVER MEDICINE AND SEE THIS PERSON GET UP AND WALK AND TALK AGAIN, IT WAS LIKE,” HE SAID WITH A PAUSE. “IT WAS SOMETHING LIKE A MIRACLE. AND FROM THERE, THERE WAS NO GOING BACK.”

Outstanding Contribution in Community Service by the Santa Clara County Medical Association for improving the stroke care in Santa Clara County in 2006. He has participated in several national and international trials for new medications, treatments, and innovations designed to help bring the latest cutting-edge stroke care to the community of San Jose. In addition to his membership with SCCMA, he has also been an active member of the American Stroke Association, American Heart Association, Western States Consortium, Neurocritical Care Society, and the American Academy of Neurology, as well as being chosen as a Fellow of the Academy (FAAN) by his peers.

In 2013, the hospital became the first community hospital in the state of California, to be certified as a Comprehensive Stroke Center.

Dr. Sachdev also realized one of the biggest challenges was to educate the public on the symptoms and signs of stroke, which most people fail to recognize. Because treatment had to be rendered in a 3-hour window after a stroke, public education became the foremost requirement. The second challenge was to educate the EMS system, including paramedics and EMT’s. This would ensure the patient was brought to the appropriate stroke center for treatment.

With all of these accomplishments, Dr. Sachdev was recognized by his peers and given the award for

Dr. Sachdev continues to work aggressively in taking care of Stroke patients and continues his pursuit of educating fellow physicians, nurses, EMT’s, paramedics, hospital personnel, and the public at large, in order to improve the level of care provided to stroke victims in our community. In recognition of his services to helping improve the care of stroke patients in the community, he was awarded commendation by the City Council of San Jose in May of 2023. He presented his 24th annual stroke update at Good Samarian Hospital in May 2024.

In his free time, he enjoys spending time bonding with his 6 year old grandson and enjoying Bollywood music.

The best piece of advice Dr. Sachdev was given in his career was from the late Dr. Robert Armstrong: “If you never look, you will never find” which always encourages him to keep thinking and do the proper investigation and treatments for patients.

Dr. Sachdev and Good Samaritan being recognized by the San Jose City Council as leaders in stroke awareness and care on May 2, 2023.

Virtual Grand Rounds: Gender-Affirming Care

Hosted by CMA

July 9, 2024 | 12:00 PM to 1:00 PM

As gender-affirming care takes the spotlight on the national scene, with restrictions being placed on physicians’ ability to provide care in some states, what is the landscape in California? Please join us as we discuss gender health equity with leaders from the California Department of Public Health and physicians involved in gender-affirming care.

James Watt, M.D. will provide us with the current status of COVID-19 and other summer epidemiology updates.

2024 Health Equity Leadership Summit

Hosted by Physicians for a Healthy California

July 11, 2024

This event provides an opportunity for physicians, executives, advocates and allies to find community, engage in hands-on trainings and workshops, and hold in-depth conversations about how they are addressing the issue of health equity in California through their care of underserved communities throughout the state.

Attendees will leave feeling energized and inspired to continue their important work to improve the lives of all Californians. This event will take place at the Sheraton Grand in Sacramento. For more information, visit phcdocs.org/equity-summit.

Webinar: Workplace Violence Prevention in Ambulatory Care Setting

Hosted by CMA, Sponsored by The Doctors Company

July 30, 2024 | 12:15 PM – 1:15 PM

California employers, including in outpatient care/clinic settings, must adopt a workplace violence prevention plan under Senate Bill 553 (2023). SB 553 was passed to address the gap in industry settings that was not covered by existing regulations.

Workplace violence in ambulatory care settings has become increasingly prevalent due not only to factors that are common within all health care settings, but also to other factors that are unique to ambulatory care settings. Chronic and complex health conditions are treated more frequently in the outpatient settings, increasing the likelihood that patients and families may become increasingly frustrated.

This webinar is free to all interested parties.

Wellness Retreat

Hosted by SCCMA

August 16 – 18

To register for any of these events, please visit www.

sccma.org or scan the QR code

This Wellness Retreat is a three-day, two-night program at 1440 Multiversity, a 75-acre campus at Santa Cruz Mountains. Attendees will be immersed in a beautiful backdrop of nature as they unplug over the course of the weekend and participate in sessions aimed at delivering healing and supportive care.

Registration: $400 for single-occupancy room; $550 per pair in a double-occupancy room (all inclusive)

Webinar: Prescription for Success – Why Physicians Need Attorneys

Hosted by CMA

August 27, 2024 | 12:15 PM – 1:15 PM

Attorneys can play a crucial role in safeguarding physicians’ practices and careers. In this webinar, attendees will benefit from the expert guidance provided by California Medical Association (CMA) staff attorneys specializing in health care law. Don’t miss this opportunity to equip yourself with the knowledge and resources necessary to thrive in the modern health care landscape.

Book Club

Hosted by SCCMA

September 25, 2024 | 6:30 PM – 8:00 PM

This quarter, SCCMA Book Club will read “Kitchen Table Wisdom: Stories that Heal” by Rachel Naomi Remen, MD. Dr. Remen has been counseling those with chronic and terminal illness for more than twenty years. She is cofounder and medical director of the Commonweal Cancer Help Program in Bolinas, California, and is currently clinical professor of family and community medicine at the University of California at San Francisco School of Medicine.

Registration: Free for all SCCMA Members! Advanced Registration Required. Register by August 31.

We organize and mobilize the California health community to advocate for equitable systems-level climate action.

Who Can Join: Anyone who works in health! We welcome those involved in public health, clinical care services, community healing, health administration, health research, and development of healthcare products - including trainees, students, and those who have retired from these fields.

What We Do:

Education: Most of us didn’t learn about climate change and health in our training. We offer practical education in topics related to community organizing, climate health and equity impacts, and advocacy skills.

Trainings and Coaching:

CHN Speaks: Interested in talking to health colleagues about climate, health, and equity? Our CHN Speaks team offers personalized coaching so that anyone can give a climate-related talk to health colleagues.

Healthcare Sustainability Fellowship: We support members in a year-long fellowship to design and execute a healthcare sustainability project.

Action: We use the power of our collective health voice, in partnership with broad coalitions, to urge California policymakers towards climate action.

the date for our next

for Clean Air and Climate Action

Are you a health professional concerned about air pollution & climate change?

Climate change is already harming our health, from worsened ozone pollution due to warmer temperatures, to more frequent and intense wildfires producing dangerous particle pollution. Medical and health voices are critical to raising awareness of the overwhelming health burden caused by air pollution and climate change. We are looking for physicians, nurses, public health workers, respiratory therapists and other health professionals to join our efforts and speak out for stronger climate action.

Visit Lung.org/ClimateChangesHealth to take part in our growing Health Professionals for Clean Air and Climate Action community, where you can:

• Sign up for the Health Professionals for Clean Air and Climate Action monthly newsletter

• Share your story about why addressing climate change is critical to protecting public health

• Read stories from other health professionals around the country

• Sign our letters to urge policymakers to clean up dangerous air pollutants For more information, please contact Elise Wallis, MPH, Manager, Health Partnerships, at Elise.Wallis@Lung.org.

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