Q3/Q4 Bulletin: Partners in Health - Focus on Santa Clara County Public Health Department

Official Magazine of the Santa Clara County Medical Association

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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

Officers

President | Clifford Wang, MD

President-Elect | Anlin Xu, MD

Secretary | Danielle Pickham, MD

Treasurer | Anh T. Nguyen, MD

Immediate Past President | Cindy Russell, MD

VP-Community Health | Lewis Osofsky, MD

VP-External Affairs | Christine Doyle, MD

VP-Member Services | Randal T. Pham, MD VP-Professional Conduct | Gloria Wu, MD

SCCMA Staff

Chief Executive Officer | April Steger, CAE Deputy Director | Erin Henke, CAE Physician Engagement Associate | Angelica Cereno Governance and Advocacy | Emily Coren Facility Manager | Paul Moore

SCCMA COUNCILORS

El Camino Hospital of Los Gatos | Shahram S. Gholami, MD

El Camino Hospital | Fahd Khan, MD

Good Samaritan Hospital | Krikor Barsoumian, MD

Kaiser Foundation Hospital - San Jose | David Hensley MD

Kaiser Permanente Hospital | Joshua Markowitz, MD

O’Connor Hospital | David Cahn, MD

Regional Medical Center | Kenneth Phan, MD

Saint Louise Regional Hospital | Kevin Stuart, MD

Santa Clara Valley Medical Center | Patricia Salmon, MD Stanford Health Care/Children’s Health | Sam Wald, MD

A Message from the President

Public Health and Summer to Fall Action

by Clifford Wang, MD SCCMA President

This issue of The Bulletin highlights the tremendous work our local public health department has undertaken and its role in a healthy society. We are fortunate to have an outstanding public health department in Santa Clara County led by Dr. Sara Cody, Health Officer and Public Health Director, and her staff which navigated us through the uncertain waters and waves of COVID-19, MPOX, and now possibly polio.1 We have had one of the lowest death rates for COVID-19 as a county in the U.S. that is associated with a high population vaccination rate. We applaud their Herculean efforts.

At the same time, the pandemic showed us that our public health system is a patchwork with significant variability among local and state public health departments that is underappreciated, underorganized, and underfunded.2 The governance and alignment of federal, state, and local agencies is not consistent or standardized and the activities performed vary. The CDC does not have authority to compel states to act and only about 3% of our healthcare expenditures

goes to funding public health which has led to a workforce crisis and lack of a modern database system. Our public health department is nationally accredited but many in the U.S. are not. The Commonwealth Fund Commission issued a report in June this year called “Meeting America’s Public Health Challenge” that recommended an overhaul of the U.S. public health system.3

It recommends establishing an undersecretary for public health at the U.S. Department of Health and Human Services to oversee and coordinate a national public health system, develop a modern information technology system, and provide adequate funding paired with standardized outcomes. In addition, there should be greater connections between health care systems and public health as well as more engagement with community partners in decision-making. If we are to improve overall health in the U.S and respond to the next crisis, we need a more coordinated and integrated public health network that is adequately funded.

The Santa Clara County Medical Association (SCCMA) has been busy this summer planning

We had over 100 students apply from 13 high schools and were able to accept 50 for the program this September.

and beginning our Stanford-SCCMA (SSTEM) transformative experience in medicine program for underserved high school students in the County. This work is in line with our effort to improve diversity in the healthcare workforce by reaching out earlier in the pipeline and inspiring young students to consider a career in medicine or health care. We had over 100 students apply from 13 high schools and were able to accept 50 for the program this September. We will have another opportunity with students in the Spring next year. The students had the opportunity to learn from different specialists about their career and participate in interactive sessions from dissections of a sheep’s brain or heart, suturing, and delivering a baby with a simulation model. I want to thank Angelica Cerano, our physician engagement associate, for organizing this program, the Stanford Medical Student Association including Wasan Kumar, and the SCCMA physicians who donated their time to meet and teach the students including Dr. Cindy Russell, Dr. Anh Nguyen, Dr. Anlin Xu, Dr. Sam Wald, and Dr. Gloria Wu.

SCCMA has been quite active on the legislative advocacy side this Summer. Physicians are facing more than 8.42% in payment cuts in 2023 and the cost of operating physician practices has gone up with the cost of rent and staffing in the Bay Area, and Medicare payments lag nearly 40% behind inflation.4 We know this impacts timely access to primary and specialist care for patients. In addition, a 2021 AMA survey found that 93% of physicians reported care delays due to unnecessary prior authorization requirements and 90% said it had a negative impact on patient clinical outcomes.5 We met with Congresswomen Zoe Lofgren’s staff and Congresswoman Anna Eshoo to advocate for stopping the Medicare payment cuts through the HR 8800 bill, “Supporting Medicare Providers Act of 2022” and prior authorization reform through the HR8487/S 3018 bill “Improving Seniors Timely Access to Care Act”. We also supported the Inflation Reduction Act which helps reduce unsustainable high drug costs for our patients. At the state level, we wrote a letter of opposition to California state senators for AB 2236 that would allow optometrists to be certified to perform various surgical procedures without the appropriate level of training and spoke to Governor Newsom directly. We were also in attendance with the Governor when he signed SB1338, the “CARE court Act” that creates a civil court which allows adults with severe mental illness and substance use disorders who do not have

decision making capacity to get medical treatment and housing and empowers loved ones and front-line responders to help. Finally, we wrote a letter to Dr. Miguel Cardona, U.S. Secretary of Education, to consider allowing the Federal Public Student Loan Forgiveness program to apply to California and Texas physicians who meet the requirements and would otherwise qualify if it were not for state laws that prohibit private non-profit hospitals from directly employing physicians.

We also welcomed two newly appointed SCCMA Council members – Dr. Patricia Salmon and Dr. Fahd Kahn. Dr. Salmon will be the representative for Santa Clara Valley Medical Center (SCVMC). She is currently chief of the division of endocrinology and president-elect of the medical staff at SCVMC. Dr. Fahd Kahn is a neurosurgeon who started the California NeuroInstitute and will be representing El Camino Hospital on the Council. I want to thank Dr. Hal Morrison from SCVMC for his service on the Council.

Dr. Donaldo Hernandez from our District VII was inaugurated

In October, the CMA House of Delegates was held in person in Los Angeles and the major topics for discussion included Physician Workforce, Health Care Policy Reform, and Mental Health (informational) along with a special panel discussion on “Understanding the Climate Health Crisis and How California Physicians Can Make an Impact.” Dr. Donaldo Hernandez from our District VII was inaugurated as the new CMA President. We also enjoyed our SCCMA Annual Awards Gala on Friday, December 9th at the Westin in San Jose. It was great to celebrate with so many of you who attended.

Warm regards and be well, Clifford Wang, MD

President, Santa Clara County Medical Association

References:

1. Ledford H, Spate of Polio Outbreaks Worldwide Puts Scientists on Alert, Nature, August 22, 2022, 609, 20-21, doi: https://doi.org/10.1038/d41586-022-02233-6

2. Wallace M, Sharfstein JM, The Patchwork U.S. Public Health System, January 6, 2022, N Engl J Med, 386:1-4, DOI: 10.1056/NEJMp2104881

3. Commonwealth Fund Commission on a National Public Health System, Meeting America’s Public Health Challenge: Recommendations for Building a National Public Health System That Addresses Ongoing and Future Health Crises, Advances Equity, and Earns Trust (Commonwealth Fund, June 2022). https://doi. org/10.26099/snjc-bb40

4. CMA Medicare Physician Payment and Access to Care Survey, August 29, 2022, https://www.cmadocs.org/Portals/CMA/files/public/CMA%20Medicare%20 Physician%20Survey%20-%20final%20(2022).pdf

5. 2021 AMA Prior Authorization Physician Survey, https://www.ama-assn.org/system/ files/prior-authorization-survey.pdf

Physicians are facing more than 8.42% in payment cuts in 2023 and the cost of operating physician practices has gone up with the cost of rent and staffing in the Bay Area, and Medicare payments lag nearly 40% behind inflation.

as the new CMA President.

Membership Insider

CMA HOD Recap

The California Medical Association (CMA) House of Delegates (HOD) met in person from October 21st to the 23rd to convene the 151st Annual Session at the JW Marriott LA Live in Los Angeles. SCCMA is part of the District VII Delegation and was pleased to have 26 Delegates and Alternates in attendance. The major issues addressed at this meeting were: Physician Workforce, including recommendations for expanding training for abortion care in California, and protections for California physicians from civil and criminal liability related to abortion services and reproductive care; Health Care Reform, including establishing a new, ongoing revenue source to increase Medi-Cal provider reimbursement rates to meet or exceed Medicare rates; and Mental Health recommendations that support the continued expansion of the behavioral health workforce, training and expanding financial incentives for behavioral health providers practice in underserved and streamlining the financing and payments for mental health services. The full text of the major issue reports can be found at: https://www.cmadocs.org/hod/issues.

A very well-attended pre-HOD session on climate change was led by Dr. Ashley McClure, co-founder of Climate Health Now, a group of members of the California health community who advocate for climate action through a health and equity framework. Physicians who would like to participate can learn more at https://climatehealthnow.org/.

SCCMA Annual Meeting

SCCMA held its virtual Annual Meeting on November 30th. Dr. Tanya Spirtos, CMA Presidentelect and past SCCMA President, spoke to attendees about Realizing Equity and Access to Healthcare, including updates on advocacy related to increasing Medicare rates, access to reproductive healthcare, providing legal protections for clinicians who provide abortion care, and petitioning for California physicians to have access to loan forgiveness programs from which they were previously excluded.

In addition, the election of 2023 SCCMA officers and councilors was held. Congratulations to the following newly elected officers and councilors:

2023 OFFICERS

Dr. Gloria Wu - President-elect

Dr. Randal Pham – Secretary

Dr. Anh Nguyen – Treasurer

Dr. Ken Yew - VP of Community Health

Dr. Christine Doyle - VP of External Affairs

Dr. Sam Wald - VP of Member Services

Dr. Lewis Osofsky - VP of Professional Conduct

2023 COUNCILORS

Dr. Reena Bhargava - Kaiser Santa Clara Dr. Fahd Khan - El Camino Hospital

Dr. CK Park - Good Samaritan Hospital

Dr. Patricia Salmon - Santa Clara Valley Medical Center

Dr. Laurice Yang - Stanford

2022

The Santa Clara County Medical Association (SCCMA) hosted the 144th Annual Awards Gala at the Westin Hotel in downtown San Jose on Friday, December 9. Nearly 150 physicians, special guests, and partners joined SCCMA to honor distinguished physicians that have made a positive difference in medicine, medical education, community, and the association.

RECAP GalaANNUAL SCCMA AWARDS

his presidential speech and introduced SCCMA 2023 president, Anlin Xu, MD, of South Bay Allergy and Asthma.

After two years, physician members were reunited to enjoy the evening with a reception to network before the program and dinner. California Medical Association (CMA) president, Donaldo Hernandez, MD, was the guest speaker for the night. Outgoing president, Clifford Wang, MD, received recognition for his service as SCCMA 2022 president from California Senator Dave Cortese, and Santa Clara County Supervisor Otto Lee, as well as U.S. Congresswoman Anna Eschoo, U.S. Congressman Jimmy Panetta, California Assemblymember Evan Low, and California Senator Josh Becker. Dr. Wang delivered

Dr. Xu is an allergy and asthma specialist in a private practice. She is a fellow of the American Academy of Allergy, Asthma, and Immunology, American College of Allergy, and Immunology and the American Allergy and Asthma Group. At SCCMA, she has served as councilor and president-elect. With leadership experience as president and CEO of the South Bay Allergy and Asthma Group and Regional Director of BASS Medical Group, Dr. Xu aims to enhance member services and bring a sense of revival after physician burnout due to COVID-19.

Dr. Xu received her undergraduate degree in Molecular Biology and Biochemistry from University of Pittsburgh, and her MD from the University of Pittsburgh School of Medicine. She completed her internship and residency in Internal Medicine at Yale University and later UC Davis.

Nearly 150 physicians, community leaders, and allies, attended SCCMA Awards Gala at the Westin Hotel in downtown San Jose

She completed her fellowship in Allergy, Asthma, and Immunology from the joint fellowship program at UCSF and Stanford University.

Awardees included Efren Rosas, MD, Joshua Markowitz, MD, and Ashok Krishnaswami, MD of The Permanente Medical Group, Kenneth Blumenfeld, MD of the Palo Alto Medical Foundation, Krikor Barsoumian, MD, and Citizen’s Award recipients, Eric Rosenblum and Gina Adriano. The late Fidelia Y. Butt, MD of Kaiser Santa Clara was honored as the recipient of the prestigious Robert D. Burnett, MD Legacy Award for her extraordinary clinical and humanitarian work in medical mission trips providing pro bono surgical care around the world, co-founding the Asian American Caner Support Network

(AACSN), and running the free medical clinic for CityTeam’s homeless shelter in San Jose before she lost her battle to cancer in April 2022.

SCCMA would like to thank our members, special guests, and Dr. Hernandez for their support of the event and of SCCMA. Special thanks to our event sponsors: Physicians Medical Group, ProAssurance, Cooperative of American Physicians, Kaiser Permanente, Stanford Medicine, Valley Water, AMBA, Bank of America, Legacy Wealth Advisors, Meriwest Mortgage, and Stanford Medicine Children’s Health. The Annual Awards Gala is the best opportunity to reconnect at the biggest event of the year. We hope to see you at the next SCCMA Annual Gala!

CMA President, Donaldo Hernandez, MD was the guest speaker for the night addressing physician workforce and initiatives CMA plans for 2023.

2022

Outgoing president, Dr. Wang, passes the gavel to 2023 SCCMA president, Dr. Xu

SCCMA CEO April Steger presents Dr. Wang with a plaque of recognition for his service as SCCMA 2022 president

SCCMA Past Presidents at the Annual Awards Gala Senator Dave Cortese presents certificate to Dr. Wang

SCCMA past presidents are joined with CMA president elect, Dr. Spritos, CMA president, Dr. Hernandez, and Senator Dave Cortese.

FOCUS ON SANTA CLARA COUNTY PUBLIC HEALTH DEPARTMENT

SCCMA was pleased to collaborate with the Santa Clara County Public Health Department on this issue of The Bulletin. We have longenjoyed a solid partnership with the department and were pleased to have the opportunity to highlight their work in protecting the public health interests of our County.

We’d like to thank the following individuals for their contributions to this issue of The Bulletin:

DR. SARA CODY: Health Officer and Public Health Director

DR. SARAH RUDMAN: Deputy Health Officer and Infectious Disease and Response Branch Director

DR. MONIKA ROY: Assistant Health Officer and Communicable Disease Controller

MICHAEL BALLIET: Deputy Director; Operations

RHONDA MCCLINTON-BROWN: Deputy Director; Strategy, Policy and Planning

GRACE MEREGILLANO: Maternal Child and Family Health Branch Director and Director of Public Health Nursing Services

JENNEFER YOON: Assistant Director of Pharmacy Services

KATHY LE: Public Health Pharmacy Supervisor

MARITZA RODRIGUEZ: Senior Manager, Racial Health Equity Program

CHARISSE FELDMAN: Nurse Manager and Maternal Child and Adolescent Health Director

EVELYN TIRUMALAI: Program Manager, California Children’s Services

RICK GARCIA: Public Health Nurse Manager, Communicable Disease Prevention and Control Program

ANNE MARIE SANTOS: Public Health Manager, Regional Nursing Services

EMMA MENDEZ: Nurse Manager, California Children’s Services

ALISON SIKOLA: Public Health Nurse Manager, COVID Prevention and Control Program

TARA KOMAR: Communications Officer, Pandemic Emergency Response Unit

AARON GROFF: Communications Officer, Public Health

THE ROLE OF PUBLIC HEALTH

In March 1603, William Shakespeare was at the pinnacle of his career as a playwright. His theater troupe was in high demand, his writing was prolific, and he was becoming a very wealthy man.

Then, in April, the plague hit. Again.

Bubonic plague, also known as the Black Death, had ravaged Europe for hundreds of years at this point. It was a truly horrifying disease, causing gangrene in the extremities (thus the black in the Black Death, referring to literally rotting tissue), as well as painful buboes on the lymph nodes that would swell until they burst, causing excruciating pain.

Needless to say, when the plague reemerged in April 1603, officials tried hard to reduce its spread by isolating patients into plague hospitals, restricting ships to port, and – sadly for Shakespeare –shutting down theaters.

No one knew at the time that the plague was caused by diseased fleas, who would bite humans and infect them. In the absence of scientific data, local leaders did their best to protect their citizens, becoming the first (albeit not particularly effective) public health officials.

Fast forward several centuries to today’s public health departments. Medical knowledge, epidemiology, multidisciplinary teams, and technology have advanced the field of public health by leaps and bounds, ensuring that public health decisions are data-driven and focused on equity (see Why Racial and Health Equity Matters on page 15) For the County of Santa Clara Public Health Department (SCCPHD), that means a dedication to its mission and vision of protecting and improving the health of the local community, ensuring that everyone thrives in healthy and safe communities.

“Our goal is just like the goal of a physician taking care of an individual patient—we work to keep people as healthy and safe as possible. It’s just that our patient is the whole population,” says Dr. Sara Cody, SCCPHD Health Officer. “Our tools are a bit different, and our focus is on changing systems and policies to prevent illness, but our goals are really the same.”

What does Public Health do?

To be sure, disease identification, control and prevention remain a primary function of modern public health, which was made clear during the recent COVID-19 (see COVID response on page 18) and Mpox (see Mpox Response on page 21) outbreaks. But the public health mandate has also expanded beyond that critical goal. Since its founding, for example, the PHD has created programs that:

• Support healthy choices related to nutrition, exercise, and tobacco

• Prevent and reduce the effects of chronic diseases like diabetes and cancer

• Advocate for Black maternal health equity

The range of programs reflects a modern understanding of

how health is achieved – it cannot simply be placed upon the individual to make good choices. Instead, health is a function of many different yet overlapping systems, like our environment (clean air and water), city planning (ensuring neighborhoods have grocery stores, parks, and walkable neighborhoods), and healthcare (providing accessible and affordable services in hospitals and neighborhood clinics).

With this understanding in mind, the County of Santa Clara Public Health Department (SCCPHD) organized itself into five branches that work together to ensure optimal community health:

1. Maternal, Child, and Family Health. This branch is focused on improving the health and well-being of women, infants, children, and adolescents residing in the County, especially those most at risk of poor health outcomes. Programs include the Women, Infants and Children (WIC) program to support nutrition, California Children’s Services (CCS) to care for children with special healthcare needs, and many public health home visiting programs.

2. Infectious Disease and Response. Although the public mostly associates public health with new outbreaks like COVID, the core of most Public Health departments’ activity is dealing with often mundane, endemic diseases like TB, flu, foodborne illnesses and sexually transmitted infections. It is this branch of SCCPHD that doctors in SCCMA will interact with the most.

3. Healthy Communities. The goal of the Healthy Communities Branch is to prevent chronic conditions; build healthy, safe, and peaceful communities; and address social and economic factors leading to poor health outcomes. Programs include violence prevention, active and safe transportation, climate change, healthy food and beverage initiatives, diabetes collaborative initiative, healthy aging, oral health, tobacco-free communities, and the COVID-19 community engagement and resiliency hubs.

4. Department of Environmental Health. Although the Department of Environmental Health had been operated separately from the Public Health Department for almost 30 years, it has recently been folded back under the umbrella of Public Health. The change recognizes that community health is intertwined with environmental health, particularly with the ongoing climate crisis.

5. Science, Epidemiology, Informatics, and Improvement. If you see a dashboard full of data on the Public Health website, it’s the work of this newly formed branch. The data scientists in this branch ensure that all the other branches have the information they need to make informed decisions about policies and programs.

How can physicians work with Public Health?

Many of the physicians in SCCMA already do interact with SCCPHD on a regular basis because they are part of the County of Santa Clara Health System. The health system includes not only the Public Health Department but also:

• Behavioral Health Services

• Hospitals and clinics (Santa Clara County Valley Medical Center, O’Connor Hospital, St. Louise Regional Hospital, Valley Health Center Morgan Hill, and Valley Health Center San Jose)

• Emergency Medical Services Agency

• Custody Health Services Department

Together, these entities serve as a safety net of mental and physical health services for all residents in Santa Clara County. However, physicians outside of the County, as well as others, also provide critical information for Public Health, which is why the SCCPHD works so closely with key partners to achieve its mission and goals.

Partnerships with professional organizations like the SCCMA, the California Department of Public Health, and community-based organizations provide the opportunity for information sharing, collaboration, understanding, and actions to improve the local community’s health.

How Public Health Supports Hospitals, Providers, and the Community

SCCPHD offers direct support to clinicians and health care entities in a range of ways from capacity building and training to case management of certain patients and conditions. Below are just some of the programs and services that SCCPHD manages.

Communicable Disease Control

SCCPHD receives disease reports from providers on all diseases required to be reported under Title 17, SS 2500 of the California Health and Safety Code (see Communicable Disease Reporting on page 25). Depending on the urgency, CD Prevention & Control

will connect with providers to obtain additional information, support them in clinical decision-making, and collaborate with them on preventing further spread of diseases like measles, meningococcal disease, shigella or any other communicable disease. SCCPHD also collaborates with hospital epidemiologists to support investigation of healthcare acquired infections and hospital outbreaks, to better protect patients and healthcare staff.

Sexual Health and STIs

Public Health’s Sexual Health and Harm Reduction Program (SHHRP) can locate syphilis and HIV records reported to any County in California to assist in diagnosis and treatment recommendations. They’re also able to help locate patients through databases and field visits, and facilitate disclosure of sensitive results to patients and their partners using allowances in privacy regulations not available to health care providers.

The Positive Connections Program provides short-term case management for people living with HIV who need help accessing insurance coverage, health care, and additional supportive services . Finally, health educators are available to bring in-service trainings directly to clinics and providers by submitting a request on any of the above-linked pages.

Tuberculosis Prevention & Control1

In addition to investigating exposures in the home and in congregate settings, the TB Prevention and Control Program provides case management and directly observed therapy to patients with active tuberculosis, assisting the healthcare

“SCCMA has been a wonderful partner to public health over the years,” says Health Officer and Director of Public Health Dr. Sara Cody. “It’s really important that physicians know and understand the work that we do and can collaborate with us whenever it makes sense.”

Source: County of Santa Clara Public Health Department (November 2022),

provider with medication compliance and successful completion of treatment.

Emergency Preparedness

SCCPHD works with hospital and clinical leadership to ensure readiness for public health and other emergencies that may impact clinical care settings by helping to review plans, share best practices, support exercises to detect gaps in preparedness, and link to funding and other resources.

Public Health Laboratory2

The Santa Clara County Public Health Laboratory is a member of the Laboratory Response Network and is a Biosafety Level 3 facility, allowing it to perform diagnostic and research assays not available to clinical labs, such as testing ticks for Lyme disease, bats for rabies, or clinical specimens for measles or viruses causing Ebola, to name but a few.

California Children’s Services3

California Children’s Services (CCS) is a case management program for certain pediatric conditions or diseases that are chronic, disabling, or life threatening. CCS provides authorizations for diagnostic and treatment services, medical case management, equipment, and physical and occupational therapy services to children 21 years of age or under, diagnosed with certain medical conditions.

Nurse-Family Partnership

The Nurse-Family Partnership Program (NFP) is an intensive home visitation program for low-income first-time mothers. A Public Health Nurse is paired with a pregnant first-time mother, who is followed from pregnancy, through the infant’s delivery, and until the child is age two years old.

4

Black Infant Health Program

The Black Infant Health (BIH) Program strives to improve poor birth outcomes and health disparities in maternal and infant health. Research shows that black women are at higher risk for various pregnancy-related complications such as preterm birth, low birth weight babies, and infant mortality. The BIH Program addresses contributing factors such as chronic stress, social isolation, and racial inequities. The program helps reduce stress, build resilience, promote healthy behaviors, and increases social supports.

Clinic to Community Program

Strategies that connect community-based prevention programs with clinical services help ensure that people with or at high risk of chronic diseases have access to the resources they need. SCCPHD has several Clinic to Community programs that provide seamless links to community resources, such as walking programs, park engagement activities, smoking cessation, intimate partner violence, diabetes prevention, and nutritional support programs.

Program Links

1. https://publichealth.sccgov.org/disease-information/tuberculosis-tb-information-residents

2. https://publichealth.sccgov.org/services/public-health-laboratory

3. https://publichealth.sccgov.org/services/california-childrens-services-ccs

4. https://publichealthproviders.sccgov.org/programs/blackinfant-health

5. https://covid19.sccgov.org/dashboard-wastewater

Health Officer on Call

The team of Public Health physicians rotate on call to provide 24-7 coverage to respond to clinicians with public health emergencies such as suspected cases of botulism or needs for rabies prophylaxis. During business hours, the team can be reached at (408)-885-4214, option 3, and on nights, weekends, and holidays, the Health Officer on call can be reached through the County Communications dispatcher at (408)-998-3438.

Wastewater Partnership5

In addition to clinical partnerships and support for providers, SCCPHD has also had key academic and research collaboration with academic hospitals and clinical entities. One example is the collaboration with researchers from Stanford University to evaluate wastewater from the four major sewersheds serving Santa Clara County residents for SARS-CoV-2. These data have provided invaluable insight into the level of disease transmission in our County in a way that is more robust, and not subject to changes in testing and reporting practices.

Wastewater data have complemented other sources of surveillance data, and ultimately proved to be more reliable, enabling SCCPHD to make more emphatic recommendations about COVID safety. The research collaborators are now testing wastewater for additional pathogens such as Monkeypox (mpox), Influenza A and Respiratory Syncytial Viruses.

Shaping Policy

Finally, SCCPHD advises on public health policy with input from community partners and stakeholders, including physicians and other medical providers. Public health policy aims to establish laws, regulations, guidance, and social actions that improve the health of populations. SCCPHD also works diligently to pass policies that improve the built environment and reduce access to factors that serve as risks for healthy populations. Examples of such policies include the prohibition of the sale of tobacco products, smoke-free facilities, car seat laws, development of parks, authorization of mixed-use space that promotes walking and community cohesion, restrictions on concentrations of fast-food restaurants in specific geographic areas, and access to products to reduce harm due to substance abuse and sexual practices. Providers have an opportunity to have a profound impact on the health of their patients by serving as advocates and collaborators in public health policy.

Source: County of Santa Clara Public Health Department

WHY RACIAL AND HEALTH EQUITY MATTERS

In East San José, residents experience more violence and trauma than elsewhere in Santa Clara County. The community, which is 55 percent Latinx and 33 percent Asian, struggles with higher rates of hospitalizations due to assaults and firearms and higher rates of violent crimes, such as intimate partner violence. Experiencing violence and trauma, especially multiple forms of violence over a long period of time, is a significant contributor to poor health and life outcomes, ranging from heart disease and diabetes to increased risk for eating disorders, substance abuse, depression, and anxiety.

To understand why residents of East San José experience higher levels of violence and associated poor health outcomes, one must understand the history of the community and the evolution of multiple social determinants of health. Social determinants are conditions in the environment where people are born, live, learn, work, play, worship, and age that affect a wide range of health and quality-of-life outcomes, either positively or negatively. Addressing the social determinants of health to achieve health equity is at the core of public health work -- and is also an enormous challenge.

“Health equity means that all people have equal opportunity to be healthy; to achieve health equity is to ensure equal access to opportunities for education, employment, housing, transportation, and healthcare,” says Maritza Rodriguez, Senior Manager overseeing the County’s Racial Health Equity Program. “Historical legacies, structures, and systems have excluded many groups, especially people of color and low-income communities, from full and equitable access to these fundamental building blocks for health. Thus, public health must work for racial equity to achieve health equity.”

Public health departments assess which communities are experiencing what health disparities, then evaluate the underlying social determinants that may be driving these disparities, and ultimately work to address the inequities to alleviate the disparate health outcomes. The County of Santa Clara Public Health Department (SCCPHD) created the Racial Health Equity Program to help organize this work.

The Racial Health Equity Program is rooted in the belief that everyone deserves the same opportunities to achieve optimal health, regardless of race. When people are allocated the resources, care, and opportunities they need to thrive, everyone can benefit, racial disparities can resolve, and health equity is achieved. This program manages several community-based initiatives that make an impact at the local level, including policy change, redistribution of resources and critical partnerships.

Violence Prevention

One key Racial and Health Equity initiative is SCCPHD’s partnership with the East San José PEACE (Prevention Efforts Advance Community Equity) program. The PEACE partnership is made up of East San Jose residents and organizations dedicated to building a healthy, peaceful, and empowered community by preventing and addressing violence and trauma.

SCCPHD’s Violence Prevention Program serves as the coordination and backbone team supporting PEACE’s community partners. Although she serves as PEACE’s Co-Chair, Public Health Officer Dr. Sara Cody notes that, in fidelity to the model of community-driven change, neither she nor the department are decision-making authorities.

“The Public Health Department provides strategy, guidance, and alignment to the group, but we take a back seat to the experience and expertise of community members and leaders who set the direction and emphasis,” Cody says. “We use what’s called a distributed leadership model to make sure that decisions are made across the partnership.”

Accordingly, residents serve in PEACE workgroups and make decisions on funding allocation and strategies they want to implement.

Social determinants of public health gathered from the U.S. Department of Health and Human Services, Barhii Framework and Kaiser Family Foundation

Source: County of Santa Clara Public Health Department

“Health equity means that all people have equal opportunity to be healthy; to achieve health equity is to ensure equal access to opportunities for education, employment, housing, transportation, and healthcare,”

This community-based approach encourages the residents to be involved in decisions that meet their needs and improve their communities. Some of the community-led interventions include activities to address housing displacement, intimate partner violence, gun safety, resident-led peace-building, and youth leadership development.

The PEACE partnership is one of many programs that the County’s Public Health Department administers as part of its mission to eliminate the root causes of unequal health outcomes through focusing on racial and health equity. “It’s the moral responsibility of public health professionals to meet the needs of the community in a culturally responsive way,” says Rodriguez. The American Public Health Association has made health equity

“Like every other organization facing a once-in-a-lifetime pandemic, there are ways in which we could have improved our Public Health response to COVID,” said Deputy Director Michael Balliet. “But by centering racial health equity in our response, I believe that we were able to dramatically reduce unequal health outcomes in our most affected communities.”

Cost of Gun Violence in Santa Clara County

one of its foundational principles. They argue that “obstacles to health must be removed, such as poverty, discrimination, and their consequences, such as powerlessness and lack of access to quality education. Failing to make progress harms us all.”

Equity During the COVID-19 Pandemic Health inequities become dramatically apparent during health emergencies like the COVID-19 pandemic. The onset of the pandemic quickly magnified deep-rooted and systemic issues -- like high-density housing, high levels of service jobs, and poverty -- that perpetuated health disparities in communities like East San Jose and South County. SCCPHD’s Racial Health Equity team realized that they needed to act fast to rectify the inequities in these neighborhoods.

The team reached out to over 100 community partners to better understand the impacts of COVID and the shelter-in-place order. They discovered that multiple organizations in East San José were experiencing an influx of requests for resources and services from the community.

In response to the most impacted communities’ needs, the County internally reorganized and quickly began providing:

• Free COVID-19 testing at local community centers

• Mobile testing teams that provided culturally and linguistically appropriate customer service

• Drop-in vaccine clinics for those who had difficulty setting up a specific appointment time

• Technological support and paper options for COVID testing in settings where residents did not have access to a computer or internet

• Multiple language options for different populations and literacy levels.

• Communication emphasizing that access to services did not depend on immigration status

No issue better illustrates health inequities than the level of gun violence in communities of color. Gun violence is a public health crisis and has become a leading cause of premature death through suicide, domestic violence, and intra-community violence. However, through a public health approach, gunrelated injuries and death can significantly be reduced.

In August 2022, SCCPHD published the “Cost of Gun Violence in Santa Clara County” report. This report provides an economic analysis of direct costs associated with firearm injury and death across a continuum of public and private sectors, including healthcare, criminal justice, emergency response, mental health, and employers. Indirect costs such as victim loss of wages and lost quality of life are also included. To find other resources on injury and violence prevention, see the Health Data Reports section in SCCPHD’s website at publichealth.sccgov.org/healthinformation/health-data.

How Providers Can Play a Part in Achieving Racial Health Equity

What keeps people healthy extends much beyond clinical care. There are four ways providers can enhance patient care by utilizing a racial equity lens. First, providers have a unique role in promoting health equity by understanding and considering the social and economic determinants of health that impact the health of individuals, families, and communities. Second, providers can ensure that patients are seamlessly connected and linked to supportive community resources. Third, providers can engage in cultural humility training and institutional practices to better understand unconscious bias, stereotypes, and attitudes in caring for patients. And last, physicians have a position of power and can also serve as advocates and champions to hold society accountable for structural changes in the environment and social conditions that act as barriers to achieving health.

“It’s the moral responsibility of public health professionals to meet the needs of the community in a culturally responsive way”

“by centering racial health equity in our response, I believe that we were able to dramatically reduce unequal health outcomes in our most affected communities.”

This map shows which parts of the County are most affected by poverty. If someone were to overlay a similar map showing incidences of diabetes, gun violence, poverty, or COVID on the same map, we would see the highest prevalence in all the same areas. These are also the same areas with fewer farmer’s markets and grocery stores, but an abundance of liquor stores and tobacco retail outlets.

Source: County of Santa Clara Public Health Department (August 2022)

COUNTY OF SANTA CLARA PUBLIC HEALTH DEPARTMENT’S COVID RESPONSE

Bay Area residents all remember where they were when their lives changed on March 16, 2020. It was the day that six counties issued a shelter-in-place order that closed all but essential businesses and activities to slow the spread of the novel coronavirus, SARS COV-2. It was the beginning of a years-long battle against COVID-19 that is still being fought today.

The County’s COVID response program activated hundreds of County employees as Disaster Service Workers while simultaneously calling on more than 500 representatives from community partner organizations, including volunteers and employees from the California Department of Public Health (CDPH), students, ethicists, and city employees. It was a huge operation that included data monitoring and analysis, case and contact investigations at an unprecedented scale, outreach and education, strategic planning, detailed logistics, and round-theclock emergency response communications, while utilizing the full legal authority of the Public Health Officer in unprecedented ways given the threat to health and safety.

In the 32 months since then, the program has slowly transitioned from an all-hands-on-deck emergency response to a sustainable COVID Prevention and Control Program housed within the

County of Santa Clara Public Health Department’s (SCCPHD) Infectious Disease & Response Branch. This transformation has involved creating and maintaining dedicated teams focused on Disease Investigation, Education and Outreach, Data and Surveillance, as well as the continued deployment of the Mobile Response Team to reach marginalized groups with little access to healthcare. The program has formed lasting partnerships with schools, higher education and universities, skilled nursing facilities, places of worship, and other stakeholders in the community through this process.

SCCPHD has needed to remain agile and flexible to respond to rapid changes throughout the COVID-19 pandemic. This effort involves trying to meet current needs while simultaneously anticipating what needs might look like three months to a year from now. Input from healthcare providers has been invaluable during the pandemic, providing SCCPHD with real-time stories from the frontline that have helped inform their response, serve the community, and address health disparities and inequities.

Public Health strives to arm healthcare providers with the tools, resources, and information they need to serve patients directly. A patient’s own medical provider is often the most important person in their health decision-making. SCCPHD aims to give physicians a variety of tools to help their patients fight COVID, including vaccine delivery to provider locations, information about vaccination that they can share with patients,

Source: County of Santa Clara Public Health Department (February 2022)

updated guidance on boosters and treatments, and information on what to anticipate in the coming months with variants and other infectious diseases that often peak in the fall and winter.

COVID Communications

In addition to working directly with providers, SCCPHD also routinely updates the media and provides current, local guidance on its website covid19.sccgov.org. The County’s COVID site often expands beyond what is offered by CDPH or the Centers for Disease Control and Prevention (CDC), including:

• Patient education material in non-English languages

• Local infection and vaccination statistics

• Local wastewater data

• Public health orders that are unique to the County

The website also has a section dedicated to healthcare providers at publichealthproviders.sccgov.org. This site provides comprehensive and accessible tools and resource guides for

healthcare providers to support their patients with vaccination information, testing locations, guidelines for isolating when exposed to COVID, and referrals to community services.

Frequently asked questions from community health providers:

• How does the local public health department’s guidance differ from CDC and CDPH?

• What are the reporting requirements for providers with patients who test positive for COVID?

• How can I access treatments and medications for my patients?

• How can I order vaccines for my own practice?

Answers to these questions and others can be found on Public Health’s COVID webpage for providers: publichealthproviders. sccgov.org/diseases/covid-19

Ensuring Equity for All

Beginning in 2020, SCCPHD provided support services to people in quarantine, such as meal delivery, laundry service, transportation to medical services, and rental assistance if needed. Additionally, the County worked diligently with the jail and custody systems to reduce the incarcerated population to minimize person-to-person contact and with businesses with COVID outbreaks to slow the spread of the virus. SCCPHD also partnered with community residents and cross-sector partners to provide outreach and education to build awareness and dispel myths, fear, and misinformation. Drive-through and athome vaccine clinics were established to support people with disabilities, and clinics were offered in places where people felt most comfortable and safe, such as churches, schools, community service sites, and workplaces. SCCPHD continues to provide residents with essential resources, for example, hotel placements for COVID-positive unhoused people who need support to isolate to avoid spreading COVID.

The Future of COVID

As much as everyone would like it to be over, COVID and its evolving variants will remain with us for years, to come. In addition to relying on its strong relationships with the provider community, SCCPHD will also continue developing new partnerships, methods, and tools to reduce the harm that COVID has caused.

Wastewater Monitoring

SCCPHD provides multiple dashboards that the public can easily access to find data about COVID infections; vaccination status by age, gender, and race; and more.

One innovative approach SCCPHD has used for staying informed is through wastewater monitoring. Working with Stanford and the four water treatment facilities in Santa Clara County, SCCPHD has developed one of the most robust systems in the country to monitor wastewater for levels of COVID transmission and track the prominence of new variants. These data have allowed the department to see a surge or emergence of a new variant days, or even weeks, ahead of when reported case data would show the same. And, given that many people are now using home antigen tests rather than PCR tests, many cases are unreported so the wastewater trends provide a more accurate indication of level of virus circulating in the community and attendant exposure risk.

Source: County of Santa Clara Public Health Department (December 2022)

The Changing Nature of COVID

Persistent waves of COVID continue to ebb and flow within the local community. It’s challenging to continually ask the community to adjust to changing recommendations and protocols, which is why healthcare providers play such an important role. Though SCCPHD makes data-driven recommendations across the entire population, healthcare providers have direct conversations with their patients and can consider an individual’s health history, work circumstances, family care needs, and other factors that may influence how strictly they need to comply with those recommendations. Healthcare providers have the opportunity to take general guidelines and apply them in a more nuanced way with individual patients.

Long COVID

The Lancet recently released a study with a foreboding statement about Long COVID: “After recovery from acute COVID-19, a substantial proportion of patients continue to experience symptoms of a physical, psychological, or cognitive nature. These long-term sequelae of COVID-19 have been

Source: County of Santa Clara Public Health Department (December 2022), covid19.sccgov.org/wastewater

described as the next public health disaster in the making.”1

Moreover, the CDC estimates that as many as 1 in 5 people who get COVID will suffer from Long COVID effects ranging from brain fog and a loss of smell to gastrointestinal distress and cardiac problems. Some patients seem to improve after time while others end up so disabled that they can no longer work.

We still have much to learn about Long COVID and how they it will affect Americans one, five, and ten years into the future. Since COVID-19 continues to evolve, often unpredictably, healthcare providers can help by keeping SCCPHD updated on what they are encountering in their practice, sharing questions they are receiving from their patients, identifying what services patients are having difficulty accessing and what information gaps are still prevalent.

Footnote:

1. “Persistence of somatic symptoms after COVID-19 in the Netherlands: an observational cohort study - The Lancet”

WHEN A NEW HEALTH THREAT EMERGES: THE PUBLIC HEALTH RESPONSE TO MPOX

Gabriél sits on the examination table at the clinic, the white tissue paper crinkling underneath him, waiting for the doctor to come into the urgent care clinic he found online. He doesn’t want to be here; doctors make him nervous. But, he’s had a rash on his abdomen and inner thighs for a week, and it’s not going away. He’s heard about a new disease going around among his friends who attended Pride celebrations in San Francisco. Remembering past encounters with providers, he’s worried about how the doctor will react if he mentions this concern.

The doctor enters, smiles at Gabriél, and introduces himself as he looks over the chart: 25-year-old male, Latino, law student, no prior health history or medications on record, normal vitals, complaining of one week of evolving rash and headache. Eyeing the umbilicated rash and suspecting monkeypox or mpox, the doctor pauses after the HPI and says, “I always ask patients a bit about their sexual history ... What genders are your sexual partners?”

Gabriél sighs and thinks, “I’m so glad he asked…”

Source: County of Santa Clara Public Health Department (July 2022)

Normalizing Conversations About Sexual Health

Even when presenting symptoms don’t necessarily indicate a possible sexually transmitted infection, healthcare providers can normalize conversations about sexual health with their patients. Normalizing sexual health topics has a huge range of benefits beyond mpox risk assessment, prevention, and treatment. By having open conversations and using respectful language, physicians can create an opportunity for trust and open dialogue during that individual patient encounter. The County of Santa Clara Public Health Department (SCCPHD) offers training and resources for healthcare providers to learn how to have these sensitive conversations. For some providers, it's something they became comfortable with a long time ago. For others, it can be worth an update to better understand how people are talking about their behavior and sexuality.

Physicians have a significant role in shaping conversations among providers and other staff in their practices as well as being a trusted voice in their community. Talking respectfully about sexual health in all contexts, even outside of a clinical practice, provides opportunities to help decrease the stigma related to sexual health and disease transmission, which has been shown to enhance overall sexual health and related health and safety concerns.

Tips:

• Ask patients how they identify with respect to their own gender and sexual orientation.

• Ask patients about the genders of their sex partners.

• Ask what sexual behaviors they participate in. Use terms that are clear and technically accurate regardless of someone’s identity, e.g., “Do you have insertive or receptive anal sex? Insertive or receptive vaginal sex?”

• Use clinically accurate and affirming language. Using the terms patients use to describe themselves can indicate that you have heard and respect what they’ve shared with you.

• Offer multiple options when discussing reducing risk of STIs or unintended pregnancy, acknowledging that everyone should have access to all options that work for them.

• Help patients feel comfortable when their activities, identity or risk factors change. Help them feel comfortable approaching their provider to request information.

SCCPHD’s Role in Mpox

There are 211 probable and confirmed cases of mpox reported in Santa Clara County, as of December 21, 2022. SCCPHD plays four major roles in the County’s mpox response:

1. Create data collection systems to analyze the prevalence of mpox in Santa Clara County. SCCPHD interacts closely with healthcare providers to gather information from patients diagnosed with or who have had possible exposure to mpox for epidemiological studies and to prevent spread. SCCPHD is equipping healthcare providers and the community with information and updated research discoveries – this includes processing information from the state and Centers for Disease Control and Prevention (CDC) and working with local healthcare providers.

2. Set up testing mechanisms to confirm mpox cases and develop guidelines for isolation, treatment, and vaccination eligibility – Santa Clara County provided a key testing site in the early stages of the mpox response, and later became one of the sites offering access to treatment with the antiviral, Tecovirimat (TPOXX).

3. Activate the emergency infrastructure to vaccinate the most vulnerable immediately and re-distribute vaccine to local healthcare providers.

4. Collaborate with community organization partners who have been instrumental in connecting priority populations to information about prevention, testing, and treatment as well as connecting eligible individuals to appointments.

How Did COVID Help with Mpox Response?

Much of the infrastructure that was developed within the County during the COVID-19 pandemic is being used for the

To request training for your staff or yourself, go to publichealthproviders. sccgov.org/diseases/sexuallytransmitted-infections and fill out the form at the bottom of the page. For a comprehensive STI toolkit, scan the QR code with your mobile device and download the PDF.

response to mpox. Close working relationships with large health centers, chief medical officers and pharmacy directors have streamlined mpox response to quickly provide vaccines and treatments to healthcare providers. Early on, SCCPHD, with support from local partner organizations, was able to vaccinate close to 600 patients in two mass vaccination events within a week.

In fact, SCCPHD was an early resource across the Bay Area for mpox testing and resources. Samples across the region were sent to the Public Health Laboratory which had the early ability to test for mpox. SCCPHD was also leveraging current wastewater sampling capabilities first used during the COVID pandemic to track traces of mpox in wastewater. This served as a guide for where the County could be seeing the virus in local communities.

“In fact, SCCPHD was an early resource across the Bay Area for mpox testing and resources.”

Monkeypox (mpox) is a viral zoonosis (a virus transmitted to humans from animals) with symptoms similar to those seen in the past in smallpox patients, although it is clinically less severe. With the eradication of smallpox in 1980 and subsequent cessation of smallpox vaccination, mpox has emerged as the most concerning orthopoxvirus for public health. Prior to 2022, mpox primarily occurred in central and west Africa, often in proximity to tropical rainforests or after exposure to exotic animals, including a range of rodents and non-human primates. However, in late 2021 and through 2022, Mpox was seen to spread person-to-person throughout parts of the world that previously had seen little Mpox, with disproportionate impact to men who have sex with men and novel identification of spread during sexual contact. Mpox often presents as a rash or lesion that may be located on or near the genitals or anus and could be on other areas like the hands, feet, chest, face, or mouth, and can include a fever, swollen lymph nodes, exhaustion, muscle aches, headaches or respiratory symptoms.

In this current outbreak, mpox is primarily spreading through prolonged skin-to-skin contact, especially sexual and other intimate contact. As is the case in other jurisdictions across the state, country, and other affected countries affected by the current outbreak, airborne transmission has not been observed. Anyone can get mpox, although it happens to be primarily impacting sexual and social networks of gay and bisexual men.

Activities that may increase a person’s risk for contracting mpox may include having sex or direct physical contact with multiple or new partners, attending crowded parties or clubs where sex is occurring on-premises, or having direct physical contact with someone who is feeling sick or has a rash. Taking steps to avoid prolonged skin-on-skin contact can reduce the risk of getting mpox.

Speaking with patients about mpox (monkeypox)

Saying something like:

Anyone can get mpox Mpox is primarily spread by prolonged skinon-skin contact (hugging, kissing, sex) or, more rarely, sharing items (bedding, clothing, towels) with someone who has symptoms I need to ask some more specific questions, including any recent sexual history, to provide potential recommendations Feel free to ask for clarification at anytime "

Recommended Questions

Have you been to a crowded event with non-fully clothed people?

How would you describe your recent sexual history?

In the last few weeks, do you remember having prolonged skin-on-skin contact (hugging, kissing, sex) with someone who has new or unexplained rash, sores, or flu-like symptoms?

Currently, do you have a new or unexplained rash, sores, or flulike symptoms?

Cu�tura� Humi�ity Tip

Share something about yourself related to mpox misconceptions/bias or a subject you have difficulty talking about

Source: County of Santa Clara Public Health Department (December 2022)

Source: County of Santa Clara Public Health Department

“From quick inquires and guidance regarding sexually transmitted infections history and treatment to collaboration, guidance, and mobilization of resources regarding a number of emerging infectious diseases and outbreaks such as mpox, our public health colleagues from Santa Clara County have been vital and pivotal in providing resources, time, energy and effort to help clinicians such as myself care for my patients in their time of need. I grateful to work with them,” says Dr. Joe Cooper, Associate Medical Director, AIDS Medicine at PACE Clinic.

As it does for the COVID pandemic, the County Public Health Pharmacy acts as the liaison between the California Department of Public Health (CDPH) and SCCPHD. The mpox Response Team coordinates allocation and re-distribution of mpox vaccine and treatment. They also are a clinical resource for Santa Clara County healthcare providers and support the Public Health Officers with clinical information regarding vaccines, treatments, and eligibility criteria.

Common Questions

The most common questions from providers when it comes to mpox treatment, vaccine and clinical assistance are logistical (e.g., storage and handling) or related to access. SCCPHD also receives clinical questions related to new Emergency Use Authorizations (EUAs), what documentation is required to be a vaccine or Tecovirimat (TPOXX) provider, what recommendations are there to minimize waste, and how to get five doses out of the vaccine vial for intradermal injection. Providers are encouraged to request access to provide treatment and vaccine to eligible patients.

Answers to these questions and others can be found at: https://publichealthproviders.sccgov.org/diseases/monkeypoxresources-providers

Mpox Vaccination

The JYNNEOS vaccine is approved for the prevention of smallpox and mpox. It is the primary vaccine being used at this time during the mpox outbreak in the U.S. When properly administered before an exposure, vaccines are believed to be effective at protecting people against mpox. When administered after an mpox exposure, vaccination within 4 days may help prevent the disease, and vaccination between 4 and 14 days after exposure may decrease the severity of disease. The JYNNEOS vaccine is recommended as a two-dose regimen with the second dose able to be scheduled at least 28 days after the first. There is currently sufficient County supply to provide two doses to all those who self-identify as meeting current criteria.

Providers can request JYNNEOS vaccine and administer it to their patients. Many large healthcare systems have received vaccine doses throughout the response to vaccinate their own eligible patients. With an improved vaccine supply now available, providers and pharmacies are encouraged to request and receive vaccine -- they may contact medicalsupply@phd. sccgov.org to inquire about becoming a vaccine provider.

Many people testing positive for mpox have recently had new or multiple sex partners, so vaccination for eligible individuals with new sex partners is especially encouraged. Individuals meeting eligibility criteria are encouraged to ask their own doctor about vaccination. For anyone who experiences barriers in accessing vaccination, please call (408) 792-3720.

Treatment Options

TPOXX is currently FDA-approved for the treatment of smallpox but may be prescribed for the investigational treatment of mpox following under CDC’s EA-IND Protocol or a provider’s local IRB process. CDC currently encourages enrollment of TPOXX-eligible patients into the National Institute of Allergy and Infectious Diseases (NIAID) funded clinical trial to evaluate the effectiveness and side effects of TPOXX (stomptpoxx.org/ stompsites). However, providers should not delay appropriate prescribing and treatment if patients may have difficulty reaching the nearest study site, which is Zuckerberg San Francisco General Hospital.

As of November 18, 2022, in Santa Clara County, TPOXX is available at Kaiser Santa Clara, Kaiser San Jose, the County of Santa Clara Health System and at Stanford. If patients are a part of these health systems, they can access TPOXX treatment. If a patient is uninsured, they can be referred by calling Valley Connections at 1-800-334-1000. If they are insured but not through Kaiser or the County health system, then they can be referred through Stanford’s referral center.

Equitable Vaccine and Treatment Redistribution

A comprehensive logistical effort is underway for mpox vaccine and treatment redistribution, including making sure both are redistributed efficiently and equitably. Vaccines and treatment for mpox are currently stored in the U.S. Strategic National Stockpile. From there, the products are allocated to each state’s Public Health Department, which are then allocated to their respective counties. SCCPHD accepts their allocation from the State and redistributes it amongst local providers, including larger health systems. The redistribution process requires SCCPHD to work closely with providers to ensure they can store and handle the vaccine and treatment appropriately. Providers must also be able to document usage and wastage, which is then shared by SCCPHD with CDPH. Providers sign an agreement to be a mpox Vaccine and TPOXX provider. Public Health supports these providers with onboarding, resources, and information.

SCCPHD also works hard to ensure that the vaccine and treatments in Santa Clara County are being distributed equitably. The SCCPHD team works closely to interview providers to get a better understanding of their utilization and capacity, and for what populations they are providing care. The Public Health Officers, the pharmacy team, the Science Branch, and the community outreach team look at patient data for those being treated and vaccinated and use demographic and geographic information to assess outreach needs.

COMMUNICABLE DISEASE

REPORTING

When County of Santa Clara Public Health Department (SCCPHD) Deputy Health Officer Dr. Sarah Rudman read the report at 4 p.m. on a Saturday afternoon, her first thought was gratitude for the diagnosing provider. The provider had grown up in Ukraine and remembered her mom, a nurse, telling her about the cases of measles she’d seen over and over again. It was her mom’s voice in her head that helped her recognize Koplik’s spots on the young patient’s throat, ask about travel and measles vaccination status, and know to keep other staff out of the exam room while she looked for the emergency number to contact Public Health on a weekend.

Thanks to this quick thinking by the physician, Dr. Rudman was able to work with her and the County Public Health Laboratory to coordinate collection and testing of a measles PCR specimen over the weekend and ensure appropriate notifications to exposed contacts before individuals at high risk returned to work or school on Monday.

Healthcare providers and other individuals and organizations are required to report communicable diseases like measles, as well as outbreaks and certain conditions, to their local health department. This requirement is mandated by Title 17 of the California Code of Regulations and falls under exemptions to the Health Information Portability and Accountability Act (HIPAA) such that patient consent is not required for reporting. Subsection 2500 specifies which diseases are reportable by the diagnosing provider and how quickly they need to be reported.

Not all diseases require the urgent phone call needed for measles, but timely and complete reporting is often key in the ability to prevent life-threatening outcomes. For example, appropriate identification and reporting of syphilis in a pregnant patient can ensure treatment is complete more than 30 days before delivery, preventing an expensive and potentially harmful 10-day admission to the neonatal intensive care unit for the neonate to be treated with IV penicillin.

As SCCPHD investigates the spread of diseases and develops protocols to stop transmission, healthcare providers – whether they work in a hospital setting or an outpatient clinic – are an invaluable first line of defense against communicable disease spread by ordering tests, delivering care, providing initial isolation or prevention messages, and informing Public Health of diagnoses in their local communities.

Currently, there are over 80 reportable diseases. Some diseases are immediately reportable by telephone while others should

be reported within one working day or one week. A current list of reportable diseases and the required reporting timeframe is maintained by the California Department of Public Health (CDPH). Providers are required to report to the county where the patient resides, which may be different than the county in which the provider works. However, if a communicable disease could be causing an outbreak with local spread in Santa Clara County, even if the case patients live elsewhere, SCCPHD wants to know.

Reporting Resources

SCCPHD has an extensive provider reporting website at publichealthproviders.sccgov.org/reporting with many resources and reporting forms. Confidential Morbidity Reports (CMRs) should be as complete as possible, including:

• Demographic information

• Date the diagnosis is made

• Relevant medical records such as a history and physical

• Any specialist notes

• Copies of relevant lab results

Data from these reporting forms are used for statistics on mortality, morbidity, health behavior, and health outcomes which aid the development of public health policies and programs.

When a healthcare provider reports an exposure via telephone, public health officials can provide infection control guidance and facilitate additional testing resources, in addition to launching sometimes time-sensitive disease control actions available only to governmental public health departments.

The California Reportable Disease Information Exchange, or CalREDIE, is a secure system that CDPH has implemented for electronic disease reporting and surveillance. The purpose of CalREDIE is to improve the efficiency of surveillance activities and the early detection of public health events through the

collection of complete and timely surveillance information on a statewide basis. This allows for 24/7/365 reporting and receipt of notifiable conditions.

SCCPHD and CDPH have access to disease and laboratory reports in near real-time for disease surveillance, public health investigation, and case management activities. Healthcare providers can set up an account to report diseases themselves, or they can delegate this to a staff member in their organization or practice.

Prompt Reporting is Essential

Prompt reporting of communicable diseases allows the Communicable Disease program to initiate appropriate public health actions as soon as possible. For instance, if Public Health gets a report of Shigellosis or Salmonellosis in a person who works in a high-risk occupation like food handling, they can investigate and restrict them from returning to work to help stop further transmission. Similarly, if a physician diagnoses a case of measles and reports it to Public Health, then SCCPHD can start an investigation to identify susceptible contacts and offer them post exposure prophylaxis.

“Some common mistakes when reporting cases include submitting a CMR form with no lab result, a missing phone number or a missing address.”

If you are uncertain what to send to Public Health, err on the side of too much information. When public health officials do not have enough information, they must contact various hospitals or other healthcare providers and request medical records, which can delay the investigation and cost valuable time in preventing further transmission.

Common Reporting Mistakes

Some common mistakes when reporting cases include submitting a CMR form with no lab result, a missing phone number or a missing address. Those errors make it complicated for Public Health to take immediate action because it takes time to find out where patients live and how to get in contact with them. Other times, they receive forms that are handwritten rather than typed, rendering them illegible. Healthcare providers may also rely on the commercial or public health laboratories to report the test results. However, this assumption delays data reporting because those labs may not know about symptoms or other tests that may have been ordered – they are just reporting the one positive test result.

One common question from healthcare providers is whether something is reportable. If uncertain, SCCPHD suggests providers call the department to ask. It’s better that SCCPHD be notified and be able to decipher what is considered a reportable

case. They can also help the provider find and complete the correct form to accurately report information.

The Future of Communicable Disease Reporting

The CalREDIE reporting system owned and operated by the State is expected to undergo redesign in the coming years, with a plan to improve ability for providers and even patients to enter data directly via web portals. As healthcare providers have moved almost universally to electronic health record systems, Public Health has worked with state and local partners to examine ways to streamline and automate communicable disease reporting.

Independent from the automated process by which laboratories provide results related to reportable diseases to SCCPHD, the California Department of Public Health has begun pilot testing “electronic Case Reporting” in which electronic health records can automatically send certain information about reportable diseases, bypassing or simplifying the need for healthcare providers to manually submit information. As these projects progress, and other data streams become usable for communicable disease monitoring, SCCPHD continually looks for ways to reduce the reporting burden on healthcare provider organizations.

When public health officials do not have enough information, they must contact various hospitals or other healthcare providers and request medical records, which can delay the investigation and cost valuable time in preventing further transmission.

The CalREDIE reporting system owned and operated by the State is expected to undergo redesign in the coming years, with a plan to improve ability for providers and even patients to enter data directly via web portals.

Referring Patients to County of Santa Clara Public Health Department Programs

One of the best ways that physicians and other healthcare providers can be of service to their patients is by referring them to places that can provide them with additional help, resources, and care.

The County of Santa Clara Public Health Department (SCCPHD) has about 40 programs designed to serve the needs of residents and communities within the County. While some are specific to certain diseases or medical conditions, others are focused on racial health equity, like the County’s Juntos Initiative, which encourages physical activity in park settings with a prescription from a healthcare provider. The goal of the initiative is for families to explore parks in the County of Santa Clara, participate in park hikes, and become familiar and comfortable in park settings.

“Going out and being active in nature as a community has been such a powerful health intervention for my patients and their families,” says Dr. Laurie Bostick Cammon. “These outings have helped improve the mental and physical health of these families in ways I never could have imagined before starting this partnership.”

Referrals for Families

The Maternal, Child & Family Health Branch provides care and services across the lifespan, including during pregnancy, to infants, children, and teens, and to adults and seniors. Public Health nurses follow clients who are experiencing highrisk pregnancies. They also coordinate care for infants with complicated health needs, such as being born prematurely, with congenital anomalies or perinatal substance abuse. Children who have safety or neglect concerns, and high-risk children and youth can also be referred for case management services.

Below are just some of the Maternal, Child & Family programs that providers can refer their patients to:

• Black Infant Health: Black Infant Health provides education emphasizing the importance of early and continuous prenatal care, well-child check-ups, breastfeeding, and timely and complete immunizations to ensure babies are born healthy and grow into healthy children. Eligible participants are pregnant or post-partum Black women or fathers with a child under six months of age. Providers can refer eligible patients to www.sccbih.org.

• Pregnancy and Parenting: The Pregnancy and Parenting Referral Line promotes healthy living for mothers and their families via resources and referrals for reproductive health, family planning, pregnancy, birth defects, infants, children, and teens. Santa Clara County residents are eligible, and providers can refer them by calling 1 (800) 310-2332

• Women, Infants and Children: The Women, Infants, and Children (WIC) Supplemental Nutrition Program provides food and breastfeeding support to low-income families with young children. Eligible patients are pregnant people or new parents who have had a child (or pregnancy loss) in the past six months, as well as parents and caregivers of children under 5. Providers wishing to make a referral can have their patients call WIC at (408)-792-5101 or text (888)-413-2698.

• California Children’s Services: The Department’s California Children’s Services (CCS) program provides statemandated medical, physical, and occupational therapy and coordinating support to low-income families whose children have chronic or debilitating medical conditions. The medical staff at CCS can authorize diagnostic, treatment, and case management services for the patient. Santa Clara County is also an independent county for CCS, meaning they are able to make more requests for care decisions in their own facility without relying on the State for review and determination. Providers can fill out a form at https://publichealthproviders. sccgov.org/programs/california-childrens-services-ccs or call (408) 793-6200.

• Public Health Nurse Home Visiting: Many of the above programs include the option for Public Health Nurses to visit a patient in their home. If you feel like your patient would benefit from these visits, but you aren’t sure which program would fit them best, a good place to start is to contact the Referral Center at (408) 494-1500 or phnreferrals@phd.sccgov. org. Referrals are handled by a referral coordinator who is a nurse. The referral coordinator will provide information and connect you or your patients to appropriate programs and services offered by SCCPHD.

Referrals Specific to Disease or Infections

One of the most common referral needs is for tuberculosis (TB). The Tuberculosis Prevention and Control program investigates and supports follow up of any patient suspected of having TB. Providers can refer to the TB program by calling (408) 792-1381. Please note that this is a different number from the one providers must call to report TB.

For more detailed information about SCCPHD’s many referral programs, go to www.publichealthproviders.sccgov.org. There, providers will find resources on reporting requirements, diseases and programs, and links for making referrals to specific programs. If there is a question about the outcome of a referral, the provider can always contact the program for an update.

When to Refer Patients

If there are any questions about when the appropriate time is to refer a patient, providers are encouraged to call sooner rather than later. For providers within the County’s Valley Health System, SCCPHD can accept public health nursing referrals through their electronic health record, HealthLink, as well as ongoing communications.

What Information to Provide (at a minimum)

1. Provide the name and contact number of the client 2. The particular concern that the provider has, and 3. The best way to contact the provider.

Referral coordinators may reach out to the provider to get more information about the client’s needs so they can best connect them to appropriate programs and services. The faster providers can return calls and emails, the faster their patients can be referred to and access appropriate services. Public Health programs are available to Santa Clara County residents. Before making a referral, providers should confirm that the patient’s address is within the County.

If a provider is unsure of what program their patient is eligible for, it is best to include as many details as possible in the communication and the program will review the information and select the program which best meets their needs. It is a case-by-case scenario and sometimes there might be a waitlist for specific services, depending on the capacity of the team. However, no one is refused services. If an individual doesn’t meet certain eligibility criteria, referrals to other programs or resources within Santa Clara County are provided.

Referral coordinators may reach out to the provider to get more information about the client’s needs so they can best connect them to appropriate programs and services.

Just a few examples of SCCPHD programs and how to refer patients

Source: County of Santa Clara Public Health Department, publichealthproviders. sccgov.org

House of Delegates

CMA ELECTS NEW OFFICERS AND ESTABLISHES POLICY ON MAJOR HEALTH CARE ISSUES

The California Medical Association (CMA) recently convened its 151st annual House of Delegates (HOD) meeting in Los Angeles. During the first in-person meeting of the HOD since the pandemic, more than 500 California physicians gathered to debate and establish broad policy on current major issues that have been determined to be the most important issues affecting members, the association and the practice of medicine.

The association also installed its new officers, including new CMA President Donaldo Hernandez, M.D., an internist who is one of the longest-serving hospitalists in Santa Cruz County.

The major issues the delegates focused on this year were:

Physician Workforce: Our state is facing a physician shortage that has reached crisis proportions, and the COVID pandemic has placed additional pressure on an already strained system. And, as California continues to grapple with longstanding workforce challenges, the Dobbs decision is creating new ones, particularly for medical students and residents in states that restrict or ban abortion services. The delegates discussed policies to expand and strengthen the physician workforce so that every patient has timely access to affordable, quality care.

Health Care Reform: In 2019, the Healthy California for All Commission was formed and charged with developing a plan to move our state toward a unified financing system for health care delivery. CMA’s commitment to universal access remains steadfast, but CMA strongly believes that the health care system must be funded in a way that is sustainable, so that health care coverage is not simply an empty promise and that all patients have equal access to quality care. The delegates discussed and debated a set of principles to ensure that any health care reforms will delivery highquality, affordable and evidence-based care to all.

Mental Health: Over the last five years, California has committed to investing billions of new dollars into improving mental health services for all Californians across all delivery systems. The scope of these investments is sweeping, and implementation of many of the initiatives, along with growing the state’s mental health workforce, will take years to accomplish. Delegates heard from Diana Ramos, M.D., the newly appointed California Surgeon General and longtime CMA member and delegate about California’s efforts to improve and expand mental health care.

Elections

Santa Cruz Internist Donaldo Hernandez, M.D., Takes Office as CMA’s 154th President

Santa Cruz internist and hospitalist Donaldo M. Hernandez M.D., FACP, was installed as CMA’s 154th president.

“As we emerge from the mire that was the pandemic, I think it’s clear that we cannot go back to the system that existed before the world shut down,” said Dr. Hernandez. “Business as usual left too many behind, left too many gaps, and left too many of us asking, ‘Is this what I signed up for?’”

Dr. Hernandez has long been a tenacious agent for change, and as president his goal is to position CMA at the forefront of change and innovation.

“I believe that an energized and engaged physician community is the best path toward a reimagined and integrated care delivery system, insulated from political gamesmanship and special interests,” said Dr. Hernandez. “A system that focuses on relationships –particularly the core relationship between patient and physician – is the solution for affordable and equitable care delivery.”

“Physicians are the only segment of the care delivery infrastructure that swore a sacred oath to uphold a values-based construct as we care for our fellow humans. Adherence to that oath positions us to truly lead the necessary transformation of health care. The path forward must be physician-led and patient-focused.”

Born in Southern California, Dr. Hernandez received his undergraduate degree from the University of California, Berkeley; his medical degree from the University of California, San Diego; and completed his internal medicine residency, and a fellowship in general internal medicine at Harbor-UCLA Medical Center in Torrance.

Dr. Hernandez is one of the longest-serving hospitalists in Santa Cruz County and is currently a shareholder in the Palo Alto Medical Foundation, considered one of the highest quality hospital medicine programs in Central and Northern California.

Dr. Hernandez has been a member of CMA and the Santa Cruz County Medical Society (SCCMS) since 2003.

Prior to joining the CMA Executive Committee as President-Elect, he was elected to two terms as SCCMS president, then served on the CMA Board of Trustees for 10 years, representing the geographically and ethnically diverse District 7, which includes Monterey, Santa Cruz, San Benito, Santa Clara and San Mateo counties. He has also served since 2016 as chair of CMA’s Justice, Equity, Diversity and Inclusion Committee.

House of Delegates

Donaldo Hernandez, M.D., CMA President

Elections

Redwood City ob-gyn Tanya Spirtos, M.D., Becomes CMA President-Elect

Redwood City ob-gyn Tanya W. Spirtos, M.D., was named CMA president-elect. She will serve on the CMA Executive Committee in that role for one year before being installed as president at the conclusion of next year’s annual meeting.

Dr. Spirtos is a board-certified obstetriciangynecologist in full-time practice in a group of six physicians, now part of foundation model Packard Medical Group/Stanford Medicine. She is also on the active medical staff of El Camino Hospital and Sequoia Hospital.

Dr. Spirtos earned her undergraduate degree at the University of Chicago and her medical degree at Northwestern University Medical Center. She completed her residency at Los Angeles County Medical Center/University of Southern California and is a fellow of the American Congress of Obstetricians and Gynecologists.

She was a member of the Board of Trustees of Sequoia Hospital Systems from 2003-07 and served on the Community Board of Directors of Sequoia Hospital from 2007-15. She has also been an adjunct clinical faculty of Stanford University Medical School since 1995, with an academic appointment as adjunct clinical assistant professor from 2006-14.

Since 2010 she has served at the Arbor Free Clinic with Stanford medical students and has been recognized for exemplary contributions in teaching. Despite this—and her participation on various health boards—she receives 100% of her compensation from patient care.

Dr. Spirtos has been a member of the CMA and American Medical Association (AMA) since 1985,

and is a member of both the San Mateo County Medical Society and Santa Clara County Medical Association—the latter of which she served as president from 2005-06. She was elected to the CMA Board of Trustees in 2009 and continues to serve on the CMA delegation to the AMA. Since 2016, she has served on the CMA Executive Committee, first as vice speaker of the House of Delegates, then as speaker.

She lives with her husband, Elias Eleftheriades, in Redwood City, where they are both active in the Greek community and culture. Her children, Michael and Alexandra, born in 1989, have grown up surrounded by the practice and profession of medicine.

Alex is currently an ob-gyn resident at the University of Texas Southwestern Medical Center in Dallas; Mike is a practicing lawyer with Cleary Gottlieb Steen and Hamilton in New York City in the division of mergers and acquisitions.

Los Angeles Family Medicine Physician

Jack Chou, M.D., Elected CMA Speaker of the House

Los Angeles family physician Jack Chou, M.D., was elected the new speaker of the CMA House of Delegates. He previously served three years as vice speaker.

Dr. Chou has split his clinical time between primary care, urgent care and hospitalist duties at Kaiser Baldwin Park Medical Center since 1999. He has been the physician-in-charge for the Family Medicine Department at Kaiser Baldwin Park Medical Center, Family Medicine Medical Office Building since 2006. Dr. Chou became the Chief of Service of the Family Medicine Department in July 2018, overseeing five medical office locations.

Dr. Chou is a partner of the Southern California Permanente Medical Group (SCPMG) and is the Regional Chair for Health Information Management and Regional Co-Chair for Scanning Oversight Committee at SCPMG.

Since medical school, Dr. Chou has embraced leadership at all levels – local, state and national. Dr. Chou has been a member of CMA and the Los Angeles County Medical Association (LACMA) since 1992 and he has been an AMA member since 1996.

Dr. Chou has served as a member of the CMA House of Delegates since 2001. He was elected to represent LACMA on the CMA Board of Trustees in 2010 and served on the CMA Council on Ethical Affairs from 2011 to 2016. Dr. Chou is also active in his local, state and national specialty societies, including serving as president and speaker of the California Academy of Family Physicians Congress of Delegates.

Dr. Chou was raised in a small rural town in Taiwan and later earned his Bachelor of Science in biology from the University of Miami, Florida, and his medical degree from the University of Southern California. He completed his family medicine residency at Kaiser Permanente Woodland Hills.

Dr. Chou and his wife, Kathy, are proud parents of twin daughters, Sarah and Samantha, and son, Nathan. He spends most of his free time dedicated to traveling with his family as part of his children’s education.

San Francisco Dermatologist Lawrence Cheung, M.D., Elected CMA Vice-Speaker

San Francisco physician Lawrence Cheung, M.D., was elected the new vice-speaker of the CMA House of Delegates.

Dr. Cheung has been a dermatologist in solo private practice for 17 years. As a part of his practice, Dr. Cheung conducts and serves as principal investigator for clinical trials. He also serves as a volunteer dermatology preceptor at St. Mary’s Medical Center in San Francisco.

Dr. Cheung has been a member of the CMA Board of Trustees since 2020, after having previously served as chair of the CMA House of Delegates District VIII Delegation and as a member of the CMA Council on Science and Public Health. He also previously served on the Board of Directors for San Francisco Health Plan as a mayoral-appointed San Francisco County Commissioner.

Dr. Cheung has been a member of CMA and the San Francisco Marin Medical Society since 2006. He is also a member of the American Medical Association, the American Academy of Dermatology and the American Society for Dermatological Surgery.

Elections

Awards and Honors

Ferndale Physician Donald Baird, M.D., Receives CMA’s Plessner Award

Ferndale family physician Donald Baird, M.D., received CMA’s most prestigious award, the Frederick K.M. Plessner Memorial Award. The award honors the California physician who best exemplifies the ethics and practice of a rural country practitioner.

Dr. Baird has served indigent and underserved patients in Humboldt and Del Norte counties for 46 years. He has enjoyed a full-time practice in primary care, which once included OB and

pediatrics, but is now primarily focused on adults with subspecialty interest in psychiatry including bipolar disorder, schizophrenia and autism.

“During multiple attempts at retirement I've done some volunteer work in the third world, which has been very rewarding, but I also realized we have our own needs right here in this community,” said Dr. Baird.

Tanya Spirtos, M.D. President-Elect

Donaldo Hernandez, M.D. President

Sergio R. Flores, M.D. Vice-Chair, Board of Trustees

Shannon Udovic-Constant, M.D. Chair, Board of Trustees

Jack Chou, M.D. Speaker of the House

Robert E. Wailes, M.D. Immediate Past President

Lawrence Cheung, M.D. Vice-Speaker of the House

Dr. Baird also serves as medical director of hospitalist services at a critical access rural hospital in the far north coastal California community of Fortuna (near Eureka), surrounded by the natural beauty of 1,000-yearold redwood forests.

“In a community like we have right here, so many patients actually still don’t even have physicians, so the willingness of a person who could easily have retired long ago to not only continue practicing but enjoy doing it (staying late, going in on his days off, covering for physicians who are ill, demonstrating a type of genuine regard for humanity) means more to a community like this than I think most people could ever know,” said colleague (and patient) Galen W. Pettey, P.T. “Because without people like him there are so many people who are underserved or unserved.”

Dr. Baird also became Humboldt County Public Health Officer in 2012. In that role, he worked closely with Humboldt County Public Health Department staff to obtain accreditation by the National Public Health Accreditation Board in 2016, making Humboldt the first California county of its size to achieve this status. Dr. Baird has a reputation not only as a gifted clinician, but also as a team player and someone who truly cares about the health of his community.

“The way he talks about the community and the way we discuss things about our concerns for the community have always really shown me that he really does love where he lives and he really cares about this community,” said Katie Hanson from the Humboldt County Public Health Department.

He worked tirelessly alongside the Humboldt County Department of Health and Human Services staff and community partners and took an active role in disaster preparations for the county, including providing mutual aid to other counties during devastating fires. Most recently, he triaged patients to determine who couldn’t go without power during the countywide PG&E planned power outages.

Dr. Baird is a native of Portland, Maine, and a graduate of Dartmouth University and The Medical College of Virginia at Virginia Commonwealth University. He served his medical residency in family practice and community health at the University of Minnesota at Minneapolis, where he also received a master's degree in health care education.

Learn more about Dr. Baird in our video profile: youtu.be/pBB5csfKoVg

Awards and Honors

Chico Family Physician Dannielle Harwood, M.D., Receives CMA’s Physician Health and Well-Being Award

Butte County family physician Dannielle Harwood, M.D., has received the Gary S. Nye Award for Physician Health and Well-Being. The award honors a CMA member who has made significant contributions toward improving physician health and wellness.

Dr. Harwood was recognized for her commitment to and passion for helping fellow and future physicians find success, fulfillment, happiness and well-being in pursuit of their noble profession. Most notably, she has gone above and beyond to uplift a community devastated by the Camp Fire tragedy and the COVID-19 pandemic.

After the devastation of the Camp Fire, the deadliest and most destructive wildfire in California's history, and the most expensive natural disaster in the world displacing more than 45,000 people, Dr. Harwood became increasingly more active in the Butte-Glenn Medical Society (BGMS).

BGMS sponsored Dr. Harwood's enrollment in the UC Davis Physician Wellness fellowship in 2020, ultimately being named BGMS’s first Chief Wellness Officer. In that role, she has stepped up to lead programs that are essential for the wellness of BGMS members and staff, as well as the medical community at large.

“[These programs are] the backbone of Butte-Glenn Medical Society's efforts to heal our community and sustain us through the pandemic and even more devastating fires that continue to plague Butte-Glenn areas,” said Kristy Bird MaKieve, BGMS executive director.

Dr. Harwood’s initiative and passion are admirable as she mentors female physicians and is committed to improving the wellness of her physician colleagues and bringing back the joy of medicine.

Awards and Honors

Glenn County Pediatrician Joanne Reid, M.D., Receives CMA’s Compassionate Service Award

Glenn County pediatrician Joanne Reid, M.D., received the Compassionate Service Award, created in 2015 to honor CMA member physicians who best illustrate the association’s commitment to community and charity care.

Dr. Reid runs the only rural health clinic in Glenn County. As the only access to care for Glenn County parents with sick babies, children and adolescents, she often has 40-60 patient visits in a day. Although she lives 30 minutes away in Chico, Dr. Reid knew that a rural health clinic was much more needed in Willows. She has served the community of Willows and all of Glenn County since 2002.

“Dr. Reid is deeply committed to and embraces the importance of human welfare and human dignity in her rural community of Willows,” said Kristy Bird MaKieve, executive director of the Butte-Glenn Medical Society and CEO of Healthy Rural California. “Although she could practice anywhere, she is steadfast to the needs of the most vulnerable and broken in a small rural town with few resources and endless hardship, many who are frequently unable to pay for medical care.”

During the COVID-19 pandemic, Dr. Reid’s clinic rose to the needs of the community to become a COVID-19 vaccination clinic when there were few, if any, options. She also helped distribute PPE across Glenn County and to neighboring medical practices as well.

“Dr. Reid is a critical member of our community’s fight to make a difference, to turn the tide, and to be the bright light for youth to have a healthier and higher quality of life,” said MaKieve.

Dr. Reid was also one of the first members on the board of Rural Healthy California and served as an advisor to the Chico Community Prevention Coalition as it formed in the wake of the Camp Fire.

Dr. Reid attended the University of Michigan where she earned a Bachelor of Science of Chemical Engineering, graduating Cum Laude in 1981. She earned her medical degree from Wayne State University School of Medicine in Detroit, Michigan, 1985. Dr. Reid completed her pediatric residency at University of Chicago Hospitals and Clinics and at William Beaumont Hospital in Michigan in 1989.

Awards and Honors

Sacramento Senator and Pediatrician Richard Pan, M.D., Receives CMA Speaker’s Recognition Award

California Senator and pediatrician Richard Pan, M.D., received the 2022 Gary Krieger Speaker’s Recognition Award. The recipient of this award is hand-selected by the CMA Speaker of the House for remarkable contributions to CMA and its House of Delegates.

Dr. Pan has been a member of CMA and the Sierra Sacramento Valley Medical Society since 1999. In addition to serving organized medicine as a CMA trustee and delegate, in 2010 Dr. Pan was elected to serve in the California legislature and has spent the past 12 years working tirelessly to improve the lives of Californians.

Dr. Pan has been a catalyst for positive change in the community, creating innovative educational programs, expanding access to health care for children and bringing people together to address community priorities.

TIME magazine called Dr. Pan a “hero” when he authored landmark legislation to abolish non-medical exemptions to legally required vaccines for school students, thereby restoring community immunity from preventable contagions. Dr. Pan also authored one of the most expansive state laws regulating health plans, eliminating denials for pre-existing conditions and prohibiting discrimination by health status and medical history.

He demands transparency and accountability in state health programs; holding hearings on reducing fraud, investigating poor access to dental care, and ensuring children with cancer and other serious conditions have access to pediatric specialty care. Dr. Pan provided leadership in enrolling families for health coverage, resulting in halving the number of uninsured in California. He also sponsored numerous health fairs providing resources including free glasses, dental screenings and vaccines.

Dr. Pan was also honored by his peers as he terms out of the California legislature. Watch their video tributes at youtu.be/2nxsj1T5KGg

Awards and Honors

Los Angeles Psychiatrist C. Freeman, M.D., Receives YPS Young at Heart Award

The CMA Young Physicians Section (YPS) named Los Angeles psychiatrist C. Freeman, M.D., the 2022 recipient of the YPS Young at Heart Award for her commitment to helping young physicians become tomorrow’s leaders.

“Dr. Freeman is a champion for medicine, young physicians and medical students,” said CMA trustee and YPS member Jerry Abraham, M.D., when announcing the award. “She is a valiant steward advancing our agenda of protecting patients and the profession of medicine; advancing public health including being a CMA climate health champion – a stalwart defender of physician health and wellness.”

Dr. Freeman is in solo private practice as an adult and geriatric psychiatrist and provides services in a community clinic affiliated with Barbour and Floyd Medical Associates and the primary care practice of William King Health Care Group via an integrated behavioral health model that she created.

Dr. Freeman has been a member of CMA, the Los Angeles County Medical Association (LACMA), and the American Medical Association since 2007, and has been a delegate to the CMA House of Delegates since 2009. Since 2015, she has represented the CMA Ethnic Medical Organization Section on the association’s Board of Trustees. She has also served on the CMA Council on Ethical Affairs, the CMA Diversity Technical Advisory Committee and the CMA Nominations Committee.

“As a woman physician of color, she continues to fight for small and solo physicians across the state of California, as well for ethnic and minority physicians,” said Dr. Abraham. “She continues to serve as a role model for us early career physicians and exemplifies our values to the utmost. We look forward to ongoing leadership and mentorship from Dr. C. Freeman in the many years to come.”

San Francisco Radiologist Roger Eng, M.D., Receives SSGPF Doctor of the Year Award

The CMA Solo and Small Group Practice Forum (SSGPF) gave San Francisco radiologist Roger Eng, M.D., its Doctor of the Year Award. This award is bestowed upon an individual who has gone above and beyond in efforts to represent the independent physicians of California.

“Dr. Eng's tireless efforts in championing causes to support the sustainability of solo and small group practices in California made him an ideal choice for being nominated for this year's award,” said SSGPF Chair Join Luh, M.D. “Over the years, I have marveled at how Dr. Eng keeps his hand on the pulse of what goes on in the California State Legislature, bringing

relevant issues to the attention of state medical organizations, like the CMA. His leadership skills are an asset to both CMA and its Solo and Small Group Practice Forum.”

Dr. Eng has been a member of CMA for 31 years, serving as a trustee and delegate, and is a past president of the San Francisco Marin Medical Society and the California Radiological Society. He earned his medical degree from George Washington University's School of Medicine & Health Sciences and earned a Master of Public Health from George Washington University's Milken Institute School of Public Health

Around the House

Around the House

Other News

CMA House of Delegates Approves New Community Health Centers Forum

The CMA House of Delegates approved the creation of a new Community Health Centers Mode of Practice Forum. The new delegation participated in its first meeting at this year’s House of Delegates in Los Angeles.

California’s 1,300 community health centers provide care for more than 5 million patients every year, and are a critical piece of our state’s health care safety net. They provide comprehensive, quality health care services, particularly for low-income, uninsured and underserved Californians, who might otherwise not have access to health care.

“As a member of CMA and a board member of the California Primary Care Association, I am excited that the community health center physician perspective will have its own forum within CMA’s governance structure,” said Rakesh Patel, M.D., Chief Executive Officer of Neighborhood Healthcare. “This forum will

empower community health center physicians to partner with the broader house of medicine to advocate for policies that support the health center model of care and expand access to care to our state’s most diverse communities.”

CMA’s other mode of practice forums include the Solo and Small Group Practice Forum, the Medium Group Practice Forum, the Large Group Practice Forum, the Very Large Group Practice Forum, the Academic Practice Forum, the Administrative Medicine Forum, the Government Employed Physicians Forum and the Hospital-Based Physicians Forum.

Membership in these forums is determined by each member’s self-selected mode of practice. Delegates for each forum represent their modes of practice by attending and actively participating in delegation caucus meetings and in the annual CMA House of Delegates.

CALPAC Sets New All-Time Fundraising Record

CMA’s Political Action Committee (CALPAC) shattered all previous fundraising records in its history for the third year in a row, raising $232,855 at CMA’s 151st House of Delegates. Donations to CALPAC are used to support candidates for office who share medicine’s priorities.

Join CALPAC Today!

Please join your colleagues in supporting CALPAC and help strengthen our political voice. Please visit calpac.org/donate to contribute to CALPAC. Different levels of support are available along with monthly options that make supporting the house of medicine easier than ever.

To pay via check , please make payable to CALPAC and send to: CALPAC, 1201 K Street, Suite 800, Sacramento, CA 95814.

For more information about CALPAC, visit calpac.org.

#CMAVoices:

What are the biggest issues facing health care?

At the 2022 CMA House of Delegates, physicians were asked: What’s the biggest issue facing health care today? See the Twitter thread using #CMAvoices to hear what your colleagues had to say.

What's your take? Tell us what you think the biggest issue facing health care today is and we will share your thoughts in our #CMAvoices video series.

Submit your video comments at bit.ly/cmavoices.

Staying Involved

Already have ideas for next year’s House of Delegates or want to continue the fight to support CMA? Even though HOD might be over, there are plenty of ways to stay involved and dedicated to CMA.

Grassroots Action Center

CMA boasts some of the best advocates and lawyers in the capital—but YOU are the most powerful advocate. As someone who serves on the front lines of health care delivery, elected officials and policymakers need to hear your voice to make informed policy, legislation and regulations. Visit cmadocs.org/grassroots to see how you can get involved.

Submit a Resolution

CMA is proud of its resolutions process because it preserves the value of each member's perspectives and experiences, and empowers physicians to shape the ever-changing health care landscape and ensure that CMA is speaking with its members’ voices in its advocacy.

From internal governance to ambitious statewide advocacy, every policy is crafted, reviewed and approved by the dedicated team of physician leaders that make up CMA's organizational structure. Visit cmadocs.org/ resolutions to submit a resolution.

Nominate Yourself or a Colleague

Members of CMA councils and subcommittees play crucial roles in shaping health care policy. You can find out more about available opportunities and awards at cmadocs.org/ nominations

AB 1954 (QUIRK):

PHYSICIANS

AND SURGEONS – TREATMENT AND MEDICATION OF PATIENTS USING CANNABIS

Status: Signed by Governor (Chapter 232, Statutes of 2022).

Assembly Bill 1954 originally would have prohibited physicians from denying treatment to a patient solely based on a positive drug test for tetrahydrocannabinol (THC). CMA successfully negotiated amendments stating that a physician shall not automatically deny treatment or medication to a qualified patient based solely on a positive drug screen for THC. This amendment restored a physician’s discretion for medical decision-making. The amendments ensure that physicians are protected from liability risk and continue to have the ability to make medical decisions for their patients.

designated surrogate decision-makers for the patient’s health care decisions, including when the patient is incapacitated or otherwise unable to personally designate a surrogate. CMA secured amendments that made the hierarchy suggestive and not mandatory, thereby addressing the liability concerns that initially existed with the bill.

SB 923 (WIENER): GENDER-AFFIRMING CARE Status: Signed by Governor (Chapter 822, Statutes of 2022).

2022 Legislative Wrap-Up

Senate Bill 923 initially would have required physicians and their staff to complete a one-time cultural humility course for the transgender, gender nonconforming and intersex (TGI) communities before they would be able to contract with a health plan to provide care. The provider or staff would be required to take the course again if a complaint was filed against the provider or their staff.

AB 2085 (HOLDEN): CRIMES – MANDATED REPORTERS

Status: Signed by Governor (Chapter 770, Statutes of 2022).

Assembly Bill 2085 originally required mandatory reporters, including physicians, to make a determination between “severe neglect” and “general neglect,” and required that they only report neglect deemed “severe.” CMA sought amendments to clarify that health professionals must have clear standards about mandatory reporting and that making an assessment between “general” and “severe” neglect should not be a part of their role.

CMA secured amendments to the bill that incorporated the TGI community into current physician continuing medical education cultural competency requirements and removed the contracting prohibitions in the bill.

SB 964 (WIENER): BEHAVIORAL HEALTH Status: Vetoed by Governor.

By Janice Rocco, CMA Chief of Staff

Amendments were taken to the bill focusing the measure on the definition of “general neglect” in the law rather than on an assessment of levels of neglect by mandatory reporters.

AB 2274 (B. RUBIO): MANDATED REPORTERS – STATUTE OF LIMITATIONS

In 2021, with emergency use authorization for COVID-19 vaccines, the hope was that the pandemic would end and life could go back to normal. Instead, it wasn’t until 2022 that the state legislature began moving back to something resembling business as usual.

Status: Signed by Governor (Chapter 587, Statutes of 2022).

Assembly Bill 2274 would have made it a continuing crime if mandated reporters, which includes physicians, did not report child abuse regardless of whether or not the failure to report was intentional. CMA secured amendments to instead extend the statute of limitations for a person to bring a lawsuit against a mandated reporter who did not report to five years from the date of the occurrence of the offense.

AB

Senate Bill 964 would have required the Board of Behavioral Sciences to analyze current law and provide recommendations to the legislature about actions it can take to increase the supply of behavioral health professionals and increase access to behavioral health services. The board would have to evaluate current scope of practice laws, licensing and clinical training requirements, and requirements for the renewal requirements for expired licenses. The bill ultimately would have required a report of the current behavioral health workforce and the state’s behavioral workforce needs. CMA successfully removed the review of current scope of practice laws.

AB 1375 (ATKINS): NURSING: NURSE PRACTITIONERS AND NURSE-MIDWIVES –ABORTION AND PRACTICE STANDARDS Status: Signed by Governor (Chapter 631, Statutes of 2022).

The state declaration of the COVID-19 State of Emergency remains in effect. The State Capitol is again open to the public, but even that has changed in ways that provide less access to legislators and their staff than was the case prior to the pandemic. The Capitol building is undergoing construction and legislators have moved their offices outside the Capitol. Committee hearings are being conducted in person again, though often with a hybrid phone-in option. Separate from the legislature, public meetings held by state departments and commissions have begun shifting back to a hybrid approach, so that we can be back in person again. These changes mean that we have adjusted and found new ways that we, as advocates, communicate with legislators and their staff.

In California, we had five legislative seats become vacant during the year, which meant five special elections to fill them. By the time each of these races had concluded, a total of five new Democrats had been sworn into office. With these additions, Democrats continue to have a supermajority in both the Assembly and the Senate.

2338

– DECISION MAKERS AND SURROGATES

Status: Signed by Governor (Chapter 264, Statutes of 2022).

The closing of the 2021–2022 legislative session also brought with it the end of an era for a well-respected member of the legislature. Senator Richard Pan, M.D., spent 12 years serving California in the legislature by focusing on improving the state’s health care system, fighting for patients and the practice of medicine. Though Dr. Pan has many legislative accomplishments, we are particularly grateful for his leadership during the COVID-19 pandemic, where his expertise was critical to our state on a daily basis.

(GIPSON): HEALTH CARE DECISIONS

Assembly Bill 2338 would have adopted a rigid, default hierarchy surrogate consent law in which family members and the people closest to a patient by kinship become

Senate Bill 1375 is intended to increase access to abortion services by trained nurse practitioners. However, as introduced, it would also have eliminated the transition to practice for Section 103 and Section 104 nurse practitioners, which is much broader and unrelated to abortion care. At CMA’s request, a number of amendments were adopted that removed our opposition. The bill was amended to include additional training safeguards for nurse practitioners performing aspiration abortions and to remove the sections of the bill that would have eliminated the transition to practice for nurse practitioners.

AB 1954 (QUIRK):

HEALTH CARE REFORM

PHYSICIANS

AND SURGEONS – TREATMENT AND MEDICATION OF PATIENTS USING CANNABIS

Status: Signed by Governor (Chapter 232, Statutes of 2022).

As the legislative year began, AB 1400, the single payer health care coverage bill, was before the State Assembly for a vote. That bill died in the Assembly at the end of January, which then shifted the discussion to other health care reform measures. The Governor’s Office of Health Care Affordability proposal from 2021 was back for discussion and debate, with the California Medical Association (CMA) fighting to prevent this broad measure from becoming an administrative burden for physician practices.

Assembly Bill 1954 originally would have prohibited physicians from denying treatment to a patient solely based on a positive drug test for tetrahydrocannabinol (THC). CMA successfully negotiated amendments stating that a physician shall not automatically deny treatment or medication to a qualified patient based solely on a positive drug screen for THC. This amendment restored a physician’s discretion for medical decision-making. The amendments ensure that physicians are protected from liability risk and continue to have the ability to make medical decisions for their patients.

AB 2085 (HOLDEN): CRIMES – MANDATED REPORTERS

Status: Signed by Governor (Chapter 770, Statutes of 2022).

Ultimately, we were successful in getting physician practices with fewer than 25 physicians exempted from both the data submission requirements and the cost targets that the state will develop. Similarly, we fought to prevent independent practice associations (IPAs) from being included as a way to impose cost targets and data submission requirements on smaller physician groups, ultimately seeing them removed from the bill. We were also able to get the Newsom Administration to commit to include $200 million in the state budget for grants to assist physician practices with implementation of some of the provisions in Office of Health Care Affordability legislation, such as a shift to alternative payment models.

STATE BUDGET

Assembly Bill 2085 originally required mandatory reporters, including physicians, to make a determination between “severe neglect” and “general neglect,” and required that they only report neglect deemed “severe.” CMA sought amendments to clarify that health professionals must have clear standards about mandatory reporting and that making an assessment between “general” and “severe” neglect should not be a part of their role.

Amendments were taken to the bill focusing the measure on the definition of “general neglect” in the law rather than on an assessment of levels of neglect by mandatory reporters.

AB 2274 (B. RUBIO): MANDATED REPORTERS – STATUTE OF LIMITATIONS

Status: Signed by Governor (Chapter 587, Statutes of 2022).

Assembly Bill 2274 would have made it a continuing crime if mandated reporters, which includes physicians, did not report child abuse regardless of whether or not the failure to report was intentional. CMA secured amendments to instead extend the statute of limitations for a person to bring a lawsuit against a mandated reporter who did not report to five years from the date of the occurrence of the offense.

AB 2338 (GIPSON): HEALTH CARE DECISIONS – DECISION MAKERS AND SURROGATES

Another victory in the health care reform space was achieved via the 2022–23 state budget. Continuing California’s commitment to achieving universal health care access, the $308-billion budget includes a phasedin system to provide full scope Medi-Cal coverage to all income-eligible Californians regardless of age or documentation status by January 1, 2024. This makes California the first state in the nation to expand its Medicaid program to provide full benefits to all eligible individuals—a critical step in our shared goal of ensuring that every Californian has access to quality health care. Many other CMA priorities and supported issues were addressed in the 2022–23 budget, including: a permanent extension of key Medi-Cal telehealth flexibilities implemented during the pandemic; full funding for the Prop. 56 Medi-Cal supplemental payments and graduate medical education funding programs; major investments in health care workforce development; $1.3 billion for health care worker retention pay; $700 million in equity and practice transformation payments; and $200 million for reproductive health and reproductive justice issues. (For more details on the state budget, see cmadocs.org/ budget-22-23.)

Status: Signed by Governor (Chapter 264, Statutes of 2022).

Assembly Bill 2338 would have adopted a rigid, default hierarchy surrogate consent law in which family members and the people closest to a patient by kinship become

MICRA

designated surrogate decision-makers for the patient’s health care decisions, including when the patient is incapacitated or otherwise unable to personally designate a surrogate. CMA secured amendments that made the hierarchy suggestive and not mandatory, thereby addressing the liability concerns that initially existed with the bill.

SB 923 (WIENER): GENDER-AFFIRMING CARE Status: Signed by Governor (Chapter 822, Statutes of 2022).

Senate Bill 923 initially would have required physicians and their staff to complete a one-time cultural humility course for the transgender, gender nonconforming and intersex (TGI) communities before they would be able to contract with a health plan to provide care. The provider or staff would be required to take the course again if a complaint was filed against the provider or their staff.

When the year began, the expectation was that CMA’s focus in 2022 would be working to defeat the socalled “Fairness for Injured Patients Act” (FIPA) ballot initiative that had qualified for the November 2022 ballot. The ballot initiative, if it had passed, would have eviscerated the protections of California’s Medical Injury Compensation Reform Act (MICRA). After Californians Allied for Patient Protection (CAPP), led by CMA CEO Dustin Corcoran, negotiated a legislative deal with FIPA proponents, Assemblymember Eloise Gómez Reyes put that legislative deal into AB 35, the MICRA Modernization Act. Just 16 days later, Governor Newsom signed the bill into law and FIPA proponents removed their initiative from the ballot. This historic agreement prevented a costly ballot fight and ushered in a new and sustained era of stability around malpractice liability.

CMA secured amendments to the bill that incorporated the TGI community into current physician continuing medical education cultural competency requirements and removed the contracting prohibitions in the bill.

MEDICAL BOARD

CMA aggressively fought AB 2060 (Quirk), which would have created a public member majority on the Medical Board of California. We were able to kill this bill in its first house.

SB 964 (WIENER): BEHAVIORAL HEALTH Status: Vetoed by Governor. Senate Bill 964 would have required the Board of Behavioral Sciences to analyze current law and provide recommendations to the legislature about actions it can take to increase the supply of behavioral health professionals and increase access to behavioral health services. The board would have to evaluate current scope of practice laws, licensing and clinical training requirements, and requirements for the renewal requirements for expired licenses. The bill ultimately would have required a report of the current behavioral health workforce and the state’s behavioral workforce needs. CMA successfully removed the review of current scope of practice laws.

At the same time, CMA sponsored legislation— AB 1636 by Assemblymember Akilah Weber, M.D. —to preserve the integrity of the medical profession by ensuring physicians convicted of sexual assault with a patient lose their license with no ability for it to be reinstated. This bill removes the medical board’s discretion to give or reinstate the license of a physician or surgeon who lost their license due to sexual misconduct with a patient. This bill would also deny a physician’s and surgeon’s license to an applicant who has been or is required to register as a sex offender.

HEALTH IT

AB 1375 (ATKINS): NURSING: NURSE PRACTITIONERS AND NURSE-MIDWIVES –ABORTION AND

PRACTICE STANDARDS

Status: Signed by Governor (Chapter 631, Statutes of 2022).

CMA had three significant victories addressing health information technology issues. The passage of AB 852 (Wood) eliminates administrative burdens associated with complying with California’s electronic prescribing mandate. AB 32 (Aguiar-Curry) permanently ensures parity in reimbursement for telehealth services provided through Medi-Cal managed care plans, so that this reimbursement reform lasts beyond the public health emergency. Finally, SB 1419 (Becker) helps physicians comply with the new federal information blocking rule and protects patients’ sensitive medical information.

Senate Bill 1375 is intended to increase access to abortion services by trained nurse practitioners. However, as introduced, it would also have eliminated the transition to practice for Section 103 and Section 104 nurse practitioners, which is much broader and unrelated to abortion care. At CMA’s request, a number of amendments were adopted that removed our opposition. The bill was amended to include additional training safeguards for nurse practitioners performing aspiration abortions and to remove the sections of the bill that would have eliminated the transition to practice for nurse practitioners.

REPRODUCTIVE RIGHTS

In June, the U.S. Supreme Court decision in Dobbs v. Jackson Women’s Health caused shockwaves on a national

AB 1954 (QUIRK): PHYSICIANS AND SURGEONS – TREATMENT AND MEDICATION OF PATIENTS USING CANNABIS

Status: Signed by Governor (Chapter 232, Statutes of 2022).

scale, as access to reproductive health care services was stripped away from millions of Americans overnight. CMA and other organizations had begun planning for this reality in late 2021 by forming the Future of Abortion Council to develop legislative and budget proposals to ensure that access to abortion care would not be denied in California once the court overturned Roe v. Wade This year, 15 reproductive health care bills were signed into law by Governor Newsom, including bills meant to strengthen protections for physicians and other health care providers from civil or criminal actions that could arise in other states if providers treat patients from outside California. Additionally, $200 million was included in the 2022–23 state budget to expand access to reproductive health care, including abortion.

Assembly Bill 1954 originally would have prohibited physicians from denying treatment to a patient solely based on a positive drug test for tetrahydrocannabinol (THC). CMA successfully negotiated amendments stating that a physician shall not automatically deny treatment or medication to a qualified patient based solely on a positive drug screen for THC. This amendment restored a physician’s discretion for medical decision-making. The amendments ensure that physicians are protected from liability risk and continue to have the ability to make medical decisions for their patients.

ADMINISTRATIVE BURDENS

AB 2085 (HOLDEN): CRIMES – MANDATED

designated surrogate decision-makers for the patient’s health care decisions, including when the patient is incapacitated or otherwise unable to personally designate a surrogate. CMA secured amendments that made the hierarchy suggestive and not mandatory, thereby addressing the liability concerns that initially existed with the bill.

SB 923 (WIENER): GENDER-AFFIRMING CARE

Status: Signed by Governor (Chapter 822, Statutes of 2022).

Senate Bill 923 initially would have required physicians and their staff to complete a one-time cultural humility course for the transgender, gender nonconforming and intersex (TGI) communities before they would be able to contract with a health plan to provide care. The provider or staff would be required to take the course again if a complaint was filed against the provider or their staff.

REPORTERS

Status: Signed by Governor (Chapter 770, Statutes of 2022).

CMA sponsored SB 250 (Pan) to reduce administrative burdens from health plans’ prior authorization requirements and ensure that patients get the care they need, when they need it. This bill was strongly opposed by the health plans and although it passed the Senate, it fell short in the Assembly Appropriations Committee.

CMA secured amendments to the bill that incorporated the TGI community into current physician continuing medical education cultural competency requirements and removed the contracting prohibitions in the bill.

Assembly Bill 2085 originally required mandatory reporters, including physicians, to make a determination between “severe neglect” and “general neglect,” and required that they only report neglect deemed “severe.” CMA sought amendments to clarify that health professionals must have clear standards about mandatory reporting and that making an assessment between “general” and “severe” neglect should not be a part of their role.

SCOPE OF PRACTICE

Amendments were taken to the bill focusing the measure on the definition of “general neglect” in the law rather than on an assessment of levels of neglect by mandatory reporters.

AB 2274 (B. RUBIO): MANDATED REPORTERS – STATUTE OF LIMITATIONS

Status: Signed by Governor (Chapter 587, Statutes of 2022).

Another big fight this year was CMA’s work with the California Academy of Eye Physicians and Surgeons to oppose AB 2236 (Low), which would have allowed optometrists to perform certain surgical procedures without the same training as ophthalmologists. This bill was hard-fought in the legislature and was the last bill to pass the Assembly before midnight on the final night of the legislation session, when it eventually received the 41st vote it needed for passage. Even though this bill narrowly made it out of the legislature, Governor Newsom heard from hundreds of physicians and vetoed it to protect patients, issuing a strong statement about the inadequacy of its training requirements.

Assembly Bill 2274 would have made it a continuing crime if mandated reporters, which includes physicians, did not report child abuse regardless of whether or not the failure to report was intentional. CMA secured amendments to instead extend the statute of limitations for a person to bring a lawsuit against a mandated reporter who did not report to five years from the date of the occurrence of the offense.

LOOKING BACK AT A BUSY SESSION

By the time the Governor’s bill final signing period for the 2021–22 legislative session ended, Governor Newsom had signed 997 bills into law and vetoed 169 bills. On the following pages, you will find summaries of many of the key bills that CMA was involved with in 2022.

AB 2338 (GIPSON): HEALTH CARE DECISIONS

– DECISION MAKERS AND SURROGATES

Status: Signed by Governor (Chapter 264, Statutes of 2022).

Assembly Bill 2338 would have adopted a rigid, default hierarchy surrogate consent law in which family members and the people closest to a patient by kinship become

For more details on the major bills that CMA followed this year, visit cmadocs.org/legwrap2022. Subscribe to CMA’s free biweekly Newswire and stay informed on CMA’s legislative efforts and other issues critical to the practice of medicine at cmadocs.org/subscribe

SB 964 (WIENER): BEHAVIORAL HEALTH

Status: Vetoed by Governor.

The California Medical Association (CMA), working to empower physicians to lead and transform the health care system, recently welcomed Stuart Thompson, J.D., as its new Senior Vice President. In that role, he will lead the association’s government relations and political operations efforts.

“Stuart’s impressive record of success inside the halls of government and across California’s political landscape will be a great asset as we navigate rapid changes in our health care delivery system and look for opportunities to improve the health of all Californians by helping people get timely, high-quality care,” said CMA CEO Dustin Corcoran. “We have a big year ahead of us and Stuart’s deep understanding of health care policy, and the legislative and regulatory agencies in California, will position CMA as an even greater force in the health care advocacy space.”

Senate Bill 964 would have required the Board of Behavioral Sciences to analyze current law and provide recommendations to the legislature about actions it can take to increase the supply of behavioral health professionals and increase access to behavioral health services. The board would have to evaluate current scope of practice laws, licensing and clinical training requirements, and requirements for the renewal requirements for expired licenses. The bill ultimately would have required a report of the current behavioral health workforce and the state’s behavioral workforce needs. CMA successfully removed the review of current scope of practice laws.

AB 1375 (ATKINS): NURSING: NURSE PRACTITIONERS AND NURSE-MIDWIVES –ABORTION AND PRACTICE STANDARDS

Status: Signed by Governor (Chapter 631, Statutes of 2022).

Thompson has over 15 years of legislative, government and legal experience in California, most recently serving as the Chief Deputy Legislative Secretary in Governor Gavin Newsom’s administration. Having already served as Associate Director of Government Relations at CMA for five years prior to joining the Newsom administration, Thompson’s wealth of experience advocating on behalf of physicians and the patients they serve makes him uniquely suited for the role.

Senate Bill 1375 is intended to increase access to abortion services by trained nurse practitioners. However, as introduced, it would also have eliminated the transition to practice for Section 103 and Section 104 nurse practitioners, which is much broader and unrelated to abortion care. At CMA’s request, a number of amendments were adopted that removed our opposition. The bill was amended to include additional training safeguards for nurse practitioners performing aspiration abortions and to remove the sections of the bill that would have eliminated the transition to practice for nurse practitioners.

“This is a pivotal time for health care in our state and I am thrilled to join CMA’s lobbying team to advance meaningful, measurable improvements in California’s health care delivery system,” said Thompson. “By bridging the gap between policymakers and medical professionals, we can achieve a health care system that delivers for all Californians.”

SPONSORED BILLS

AB 1954 (QUIRK): PHYSICIANS AND SURGEONS – TREATMENT AND MEDICATION OF PATIENTS USING CANNABIS

AB 32 (AGUIAR-CURRY): TELEHEALTH

Status: Signed by Governor (Chapter 232, Statutes of 2022).

Status: Signed by Governor (Chapter 515, Statutes of 2022).

Assembly Bill 1954 originally would have prohibited physicians from denying treatment to a patient solely based on a positive drug test for tetrahydrocannabinol (THC). CMA successfully negotiated amendments stating that a physician shall not automatically deny treatment or medication to a qualified patient based solely on a positive drug screen for THC. This amendment restored a physician’s discretion for medical decision-making. The amendments ensure that physicians are protected from liability risk and continue to have the ability to make medical decisions for their patients.

Assembly Bill 32 ensures parity in reimbursement for telehealth services provided through Medi-Cal managed care plans, adds flexibility for providers to enroll patients in certain Medi-Cal programs remotely, and requires the Department of Health Care Services to complete an evaluation to assess the benefits of telehealth in Medi-Cal by July 2025.

AB 1636 (WEBER): PHYSICIAN LICENSURE OR REVOCATION – SEXUAL MISCONDUCT

Status: Signed by Governor (Chapter 453, Statutes of 2022).

AB 2085 (HOLDEN): CRIMES – MANDATED REPORTERS

Status: Signed by Governor (Chapter 770, Statutes of 2022).

Assembly Bill 1636, by Assemblymember Akilah Weber, M.D., protects patients and maintains confidence in the medical profession by ensuring physicians convicted of sexual misconduct have their license revoked and cannot acquire or have a license reinstated. This bill removes the Medical Board of California’s ability to give a license to or reinstate a physician who lost their license due to sexual misconduct with a patient.

designated surrogate decision-makers for the patient’s health care decisions, including when the patient is incapacitated or otherwise unable to personally designate a surrogate. CMA secured amendments that made the hierarchy suggestive and not mandatory, thereby addressing the liability concerns that initially existed with the bill.

bill because it is narrowly tailored to apply only to those egregious instances in which a licensee is acting with malicious intent or clearly deviating from the required standard of care while interacting directly with a patient under their care. To be clear, this bill does not apply to any speech outside of discussions directly related to COVID-19 treatment within a direct physician patient relationship.”

SB 923 (WIENER): GENDER-AFFIRMING CARE Status: Signed by Governor (Chapter 822, Statutes of 2022).

AB 2132 (VILLAPUDUA): TUITION FOR MEDICAL SERVICE PILOT PROGRAM

Senate Bill 923 initially would have required physicians and their staff to complete a one-time cultural humility course for the transgender, gender nonconforming and intersex (TGI) communities before they would be able to contract with a health plan to provide care. The provider or staff would be required to take the course again if a complaint was filed against the provider or their staff.

Status: Held in Assembly Higher Education Committee.

Assembly Bill 2132 would have created a pilot program, administered by the California Student Aid Commission, to identify and select individuals from diverse, underrepresented communities to fund their education from community college/undergraduate school through completion of their medical residency program.

CMA secured amendments to the bill that incorporated the TGI community into current physician continuing medical education cultural competency requirements and removed the contracting prohibitions in the bill.

The individual would have been required to commit to practicing in medically underserved areas after completing their residency program.

SB 964 (WIENER): BEHAVIORAL HEALTH Status: Vetoed by Governor.

AB 2522 (GRAY): PUBLIC HEALTH WORKFORCE LOAN REPAYMENT PROGRAM

AB 2055 (LOW): CONTROLLED SUBSTANCES

– CURES DATABASE

Assembly Bill 2085 originally required mandatory reporters, including physicians, to make a determination between “severe neglect” and “general neglect,” and required that they only report neglect deemed “severe.” CMA sought amendments to clarify that health professionals must have clear standards about mandatory reporting and that making an assessment between “general” and “severe” neglect should not be a part of their role.

Status: Held in Assembly Appropriations Suspense Committee.

Amendments were taken to the bill focusing the measure on the definition of “general neglect” in the law rather than on an assessment of levels of neglect by mandatory reporters.

AB 2274 (B. RUBIO): MANDATED REPORTERS – STATUTE OF LIMITATIONS

Status: Signed by Governor (Chapter 587, Statutes of 2022).

Assembly Bill 2055 would have rehoused the state’s prescription drug monitoring program – the Controlled Substance Utilization Review and Evaluation System (CURES) database – from the Department of Justice to the California State Board of Pharmacy. CURES should be managed with the primary goals of improving patient care and public health, and as such it should be administered by an entity whose mission and policies focus on the use of the database by health care providers and research experts.

Assembly Bill 2274 would have made it a continuing crime if mandated reporters, which includes physicians, did not report child abuse regardless of whether or not the failure to report was intentional. CMA secured amendments to instead extend the statute of limitations for a person to bring a lawsuit against a mandated reporter who did not report to five years from the date of the occurrence of the offense.

AB 2098 (LOW): PHYSICIANS AND SURGEONS – UNPROFESSIONAL CONDUCT

Status: Signed by Governor (Chapter 938, Statutes of 2022).

AB 2338 (GIPSON): HEALTH CARE DECISIONS

– DECISION MAKERS AND SURROGATES

Status: Signed by Governor (Chapter 264, Statutes of 2022).

Assembly Bill 2098 provides that the dissemination of misinformation or disinformation related to COVID-19 by a physician to their patient constitutes unprofessional conduct. The bill clarifies that the medical board may take action if a licensee provides misinformation that departs from the applicable standard of care or did so with malicious intent or the intent to mislead.

Assembly Bill 2338 would have adopted a rigid, default hierarchy surrogate consent law in which family members and the people closest to a patient by kinship become

The governor issued a statement in conjunction with his signature on the bill, which read in part: “I am signing this

Status: Held in Senate Appropriations Committee. Assembly Bill 2522 sought to create a dedicated loan repayment program for the state’s public health workforce. There are currently no existing retention or recruitment loan repayment programs for non-licensed public health personnel.

SB 250 (PAN): HEALTH CARE COVERAGE

Status: Passed Senate. Held in Assembly Appropriations Committee.

Senate Bill 964 would have required the Board of Behavioral Sciences to analyze current law and provide recommendations to the legislature about actions it can take to increase the supply of behavioral health professionals and increase access to behavioral health services. The board would have to evaluate current scope of practice laws, licensing and clinical training requirements, and requirements for the renewal requirements for expired licenses. The bill ultimately would have required a report of the current behavioral health workforce and the state’s behavioral workforce needs. CMA successfully removed the review of current scope of practice laws.

AB 1375 (ATKINS): NURSING: NURSE PRACTITIONERS AND NURSE-MIDWIVES –ABORTION AND PRACTICE STANDARDS

Status: Signed by Governor (Chapter 631, Statutes of 2022).

Senate Bill 250 would have comprehensively reformed the prior authorization process by requiring that physicians be included in the development and updating of plan utilization management criteria; requiring plans to create a prior authorization exemption program that allows physicians who are practicing within the plan’s criteria 90% of the time to get a blanket exemption for one year from the plan’s prior authorization requirements; and giving a treating physician who does not have a prior authorization exemption the right to have an appeal of a denial be conducted by a physician in the same or similar specialty.

Senate Bill 1375 is intended to increase access to abortion services by trained nurse practitioners. However, as introduced, it would also have eliminated the transition to practice for Section 103 and Section 104 nurse practitioners, which is much broader and unrelated to abortion care. At CMA’s request, a number of amendments were adopted that removed our opposition. The bill was amended to include additional training safeguards for nurse practitioners performing aspiration abortions and to remove the sections of the bill that would have eliminated the transition to practice for nurse practitioners.

SB 1419 (BECKER): HEALTH INFORMATION

Status: Signed by Governor (Chapter 888, Statutes of 2022).

Senate Bill 1419 helps California physicians comply with the federal information blocking rule. In spring 2021, the federal 21st Century Cures Act final rule took effect. That rule has had unintended consequences for patients and physicians regarding sensitive medical information.

SB 1419 improves quality of care by guaranteeing that physicians and patients have all the information needed for integrated health care.

AB 1954 (QUIRK): PHYSICIANS AND SURGEONS – TREATMENT AND MEDICATION OF PATIENTS USING CANNABIS

Status: Signed by Governor (Chapter 232, Statutes of 2022).

This bill provides patients with the right to receive results of their imaging scans in written or oral form, the same protection currently provided to lab results. It also provides enhanced protection for sensitive medical information, as defined by the Confidentiality of Medical Information Act.

Additionally, this bill provides a framework for application programming interfaces by incorporating the requirements of the Interoperability and Patient Access final rule for state-regulated health plans and insurers.

CO-SPONSORED BILLS

Assembly Bill 1954 originally would have prohibited physicians from denying treatment to a patient solely based on a positive drug test for tetrahydrocannabinol (THC). CMA successfully negotiated amendments stating that a physician shall not automatically deny treatment or medication to a qualified patient based solely on a positive drug screen for THC. This amendment restored a physician’s discretion for medical decision-making. The amendments ensure that physicians are protected from liability risk and continue to have the ability to make medical decisions for their patients.

AB 2085 (HOLDEN): CRIMES – MANDATED REPORTERS

AB 1608 (GIPSON): COUNTY OFFICERS –CONSOLIDATION OF OFFICES

Status: Signed by Governor (Chapter 770, Statutes of 2022).

Status: Passed Assembly. Held on Senate Floor. Assembly Bill 1608 would have eliminated the ability of a county board of supervisors to consolidate the offices of the sheriff and the coroner. The bill would have also required counties that currently consolidate those offices to separate the roles. The intent behind the bill was to retain physician autonomy and prevent forensic pathologists from being pressured to change their cause of death determinations due to pressure from a sheriff/coroner in order to reduce any indications of law enforcement misconduct.

Assembly Bill 2085 originally required mandatory reporters, including physicians, to make a determination between “severe neglect” and “general neglect,” and required that they only report neglect deemed “severe.” CMA sought amendments to clarify that health professionals must have clear standards about mandatory reporting and that making an assessment between “general” and “severe” neglect should not be a part of their role.

Amendments were taken to the bill focusing the measure on the definition of “general neglect” in the law rather than on an assessment of levels of neglect by mandatory reporters.

PRIORITY SUPPORT BILLS

AB 2274 (B. RUBIO): MANDATED REPORTERS – STATUTE OF LIMITATIONS

AB 35 (REYES): CIVIL DAMAGES – MEDICAL MALPRACTICE

Status: Signed by Governor (Chapter 17, Statutes of 2022).

Status: Signed by Governor (Chapter 587, Statutes of 2022).

Assembly Bill 2274 would have made it a continuing crime if mandated reporters, which includes physicians, did not report child abuse regardless of whether or not the failure to report was intentional. CMA secured amendments to instead extend the statute of limitations for a person to bring a lawsuit against a mandated reporter who did not report to five years from the date of the occurrence of the offense.

Assembly Bill 35, the MICRA Modernization Act, implements the compromise that was negotiated between CAPP and the proponents of the “Fairness for Injured Patients Act” ballot proposition. The bill extends the longterm predictability and sustainability of the state’s medical malpractice laws and settles a decades-long divide on the issue. After the bill was signed, FIPA proponents withdrew their ballot measure, avoiding a million-dollar fight.

AB 2338 (GIPSON): HEALTH CARE DECISIONS

– DECISION MAKERS AND SURROGATES

Status: Signed by Governor (Chapter 264, Statutes of 2022).

Assembly Bill 2338 would have adopted a rigid, default hierarchy surrogate consent law in which family members and the people closest to a patient by kinship become

AB 852 (WOOD): ELECTRONIC PRESCRIBING

Status: Signed by Governor (Chapter 518, Statutes of 2022).

designated surrogate decision-makers for the patient’s health care decisions, including when the patient is incapacitated or otherwise unable to personally designate a surrogate. CMA secured amendments that made the hierarchy suggestive and not mandatory, thereby addressing the liability concerns that initially existed with the bill.

SB 923 (WIENER): GENDER-AFFIRMING CARE Status: Signed by Governor (Chapter 822, Statutes of 2022).

Assembly Bill 852 gives physicians more flexibility in complying with California’s electronic prescribing mandate. This bill exempts low-volume prescribers (many of them retired or semi-retired physicians who maintain a license), prescribers in areas of natural disasters, and prescribers who are granted a waiver based on extraordinary circumstances. These new exceptions also track with exceptions in the Medicare program.

Senate Bill 923 initially would have required physicians and their staff to complete a one-time cultural humility course for the transgender, gender nonconforming and intersex (TGI) communities before they would be able to contract with a health plan to provide care. The provider or staff would be required to take the course again if a complaint was filed against the provider or their staff.

AB 1242 (BAUER-KAHAN, BONTA AND GARCIA): REPRODUCTIVE RIGHTS –PROTECTIONS FOR PATIENTS AND PROVIDERS

Status: Signed by Governor (Chapter 627, Statutes of 2022).

CMA secured amendments to the bill that incorporated the TGI community into current physician continuing medical education cultural competency requirements and removed the contracting prohibitions in the bill.

SB 964 (WIENER): BEHAVIORAL HEALTH Status: Vetoed by Governor.

Assembly Bill 1242 protects those performing, aiding in the performance of or obtaining an abortion from arrest and prohibits law enforcement from cooperating with or providing information to those outside of California regarding lawful abortion. This bill went into effect immediately when it was signed into law on September 27, 2022.

AB 1666 (BAUER-KAHAN): ABORTION – CIVIL ACTIONS

Status: Signed by Governor (Chapter 42, Statutes of 2022).

Senate Bill 964 would have required the Board of Behavioral Sciences to analyze current law and provide recommendations to the legislature about actions it can take to increase the supply of behavioral health professionals and increase access to behavioral health services. The board would have to evaluate current scope of practice laws, licensing and clinical training requirements, and requirements for the renewal requirements for expired licenses. The bill ultimately would have required a report of the current behavioral health workforce and the state’s behavioral workforce needs. CMA successfully removed the review of current scope of practice laws.

Assembly Bill 1666 enacts legal protections from civil and criminal liability for clinicians that provide abortions to patients who reside in other states with hostile abortion laws. These protections include precluding liability for any of the following “crimes” in other states: aiding or abetting in the inducing of an abortion; receiving or seeking an abortion; and performing and inducing an abortion. This bill went into effect immediately when it was signed into law on June 24, 2022.

AB 1375 (ATKINS): NURSING: NURSE PRACTITIONERS AND NURSE-MIDWIVES –ABORTION AND PRACTICE STANDARDS

AB 1797 (WEBER): IMMUNIZATION REGISTRY

Status: Signed by Governor (Chapter 631, Statutes of 2022).

Status: Signed by Governor (Chapter 582, Statutes of 2022).

Senate Bill 1375 is intended to increase access to abortion services by trained nurse practitioners. However, as introduced, it would also have eliminated the transition to practice for Section 103 and Section 104 nurse practitioners, which is much broader and unrelated to abortion care. At CMA’s request, a number of amendments were adopted that removed our opposition. The bill was amended to include additional training safeguards for nurse practitioners performing aspiration abortions and to remove the sections of the bill that would have eliminated the transition to practice for nurse practitioners.

Assembly Bill 1797 requires health care providers and other agencies, including but not limited to, schools, childcare facilities, Women, Infants, and Children service providers, health care plans, foster care agencies, and county human services agencies to disclose immunization information to local health departments and the California Department of Public Health (CDPH). The data includes disclosure of a new data point related to a patient’s or client’s race and ethnicity. This bill was part of the legislature’s broader “vaccine work group” legislative package.

AB 1954 (QUIRK): PHYSICIANS AND SURGEONS – TREATMENT AND MEDICATION OF PATIENTS USING CANNABIS

AB 2223 (WICKS): REPRODUCTIVE HEALTH

Status: Signed by Governor (Chapter 629, Statutes of 2022).

Assembly Bill 2223 clarifies the law to prevent anyone in California from being investigated, prosecuted, or incarcerated for ending a pregnancy or experiencing pregnancy loss.

Status: Signed by Governor (Chapter 232, Statutes of 2022).

Assembly Bill 1954 originally would have prohibited physicians from denying treatment to a patient solely based on a positive drug test for tetrahydrocannabinol (THC). CMA successfully negotiated amendments stating that a physician shall not automatically deny treatment or medication to a qualified patient based solely on a positive drug screen for THC. This amendment restored a physician’s discretion for medical decision-making. The amendments ensure that physicians are protected from liability risk and continue to have the ability to make medical decisions for their patients.

AB 2626 (CALDERON): MEDICAL BOARD OF CALIFORNIA – LICENSEE DISCIPLINE –ABORTION

Status: Signed by Governor (Chapter 565, Statutes of 2022).

AB 2085 (HOLDEN): CRIMES – MANDATED REPORTERS

Status: Signed by Governor (Chapter 770, Statutes of 2022).

Assembly Bill 2626 prevents state licensing boards from suspending or revoking the license of someone who performs an abortion in accordance with California law. Additionally, the bill prohibits the boards from taking an adverse action against an applicant or licensee that was disciplined in another state for performing an abortion if the abortion met the applicable standard of care for the procedure in California.

SB 866 (WIENER): MINORS – VACCINE CONSENT

Status: Passed Senate, but not taken up on Assembly Floor.

Assembly Bill 2085 originally required mandatory reporters, including physicians, to make a determination between “severe neglect” and “general neglect,” and required that they only report neglect deemed “severe.” CMA sought amendments to clarify that health professionals must have clear standards about mandatory reporting and that making an assessment between “general” and “severe” neglect should not be a part of their role.

Amendments were taken to the bill focusing the measure on the definition of “general neglect” in the law rather than on an assessment of levels of neglect by mandatory reporters.

AB 2274 (B. RUBIO): MANDATED REPORTERS – STATUTE OF LIMITATIONS

Senate Bill 866 would have allowed minors 15 years of age or older to consent to vaccines that the United States Food and Drug Administration and Advisory Committee on Immunization Practices have approved. Existing law allows minors 12 years of age or older to make certain medical decisions without parental consent, most notably as it relates to consenting to general medical care if the minor lives separately from their parents or legal guardians. Due to timing and vocal opposition, this legislation was not taken up for a vote on the Assembly floor.

SB 871 (PAN): PUBLIC HEALTH –IMMUNIZATIONS

Status: Signed by Governor (Chapter 587, Statutes of 2022).

Status: Held in Senate Health Committee.

Assembly Bill 2274 would have made it a continuing crime if mandated reporters, which includes physicians, did not report child abuse regardless of whether or not the failure to report was intentional. CMA secured amendments to instead extend the statute of limitations for a person to bring a lawsuit against a mandated reporter who did not report to five years from the date of the occurrence of the offense.

AB 2338 (GIPSON): HEALTH CARE DECISIONS

Senate Bill 871 would have added the COVID-19 vaccine to the list of required vaccinations before a pupil can be admitted into any private or public elementary or secondary school, childcare center, day nursery, nursery, family day care home or development center. The bill also would also have removed the personal belief exemption for the COVID-19 vaccination. This bill was part of the legislature’s broader “vaccine work group” package of legislation.

– DECISION MAKERS AND SURROGATES

Status: Signed by Governor (Chapter 264, Statutes of 2022).

Assembly Bill 2338 would have adopted a rigid, default hierarchy surrogate consent law in which family members and the people closest to a patient by kinship become

designated surrogate decision-makers for the patient’s health care decisions, including when the patient is incapacitated or otherwise unable to personally designate a surrogate. CMA secured amendments that made the hierarchy suggestive and not mandatory, thereby addressing the liability concerns that initially existed with the bill.

SB 883 (ROTH): UMBILICAL CORD BLOOD COLLECTION PROGRAM

Status: Signed by Governor (Chapter 604, Statutes of 2022).

Senate Bill 883 extends the University of California’s Umbilical Cord Blood Collection Program through January 1, 2026. Stored umbilical cord blood is a lifesaving resource that is used to treat more than 80 diseases such as leukemia, lymphoma and immune deficiency.

SB 923 (WIENER): GENDER-AFFIRMING CARE Status: Signed by Governor (Chapter 822, Statutes of 2022).

Senate Bill 923 initially would have required physicians and their staff to complete a one-time cultural humility course for the transgender, gender nonconforming and intersex (TGI) communities before they would be able to contract with a health plan to provide care. The provider or staff would be required to take the course again if a complaint was filed against the provider or their staff.

SB 1473 (PAN): HEALTH CARE COVERAGE

Status: Signed by Governor (Chapter 545, Statutes of 2022).

CMA secured amendments to the bill that incorporated the TGI community into current physician continuing medical education cultural competency requirements and removed the contracting prohibitions in the bill.

Senate Bill 1473 requires health plans to cover COVID-19 therapeutics consistent with current law related to coverage of COVID-19 testing and vaccinations, which was signed into law in 2021 through CMA-sponsored SB 510 (Pan). Additional provisions of the bill extend coverage for out-of-network cost-sharing for COVID-19 testing and vaccination to six months after the federal public health emergency expires.

SB 964 (WIENER): BEHAVIORAL HEALTH

SCA 10 (ATKINS): REPRODUCTIVE FREEDOM

Status: Vetoed by Governor.

Status: Signed by Governor (Chapter 97, Statutes of 2022).

Senate Bill 964 would have required the Board of Behavioral Sciences to analyze current law and provide recommendations to the legislature about actions it can take to increase the supply of behavioral health professionals and increase access to behavioral health services. The board would have to evaluate current scope of practice laws, licensing and clinical training requirements, and requirements for the renewal requirements for expired licenses. The bill ultimately would have required a report of the current behavioral health workforce and the state’s behavioral workforce needs. CMA successfully removed the review of current scope of practice laws.

Senate Constitutional Amendment 10 creates a pathway for California to constitutionally protect an individual’s right to reproductive freedom and to obtain health services, including abortion and contraception. Approved with a two-thirds vote of the legislature, the provisions of this bill became Proposition 1 on the November 2022 ballot, which passed with an overwhelming margin of support.

PRIORITY OPPOSE BILLS

AB 1278 (NAZARIAN): PHYSICIANS AND SURGEONS – PAYMENTS: DISCLOSURE: NOTICE

AB 1375 (ATKINS): NURSING: NURSE PRACTITIONERS AND NURSE-MIDWIVES –ABORTION AND PRACTICE STANDARDS

Status: Signed by Governor (Chapter 750, Statutes of 2022).

Status: Signed by Governor (Chapter 631, Statutes of 2022).

Senate Bill 1375 is intended to increase access to abortion services by trained nurse practitioners. However, as introduced, it would also have eliminated the transition to practice for Section 103 and Section 104 nurse practitioners, which is much broader and unrelated to abortion care. At CMA’s request, a number of amendments were adopted that removed our opposition. The bill was amended to include additional training safeguards for nurse practitioners performing aspiration abortions and to remove the sections of the bill that would have eliminated the transition to practice for nurse practitioners.

Assembly Bill 1278 requires physicians to provide each patient with a written or electronic notice about the federal Open Payments database at their initial office visit, and obtain a signature from the patient or a patient representative. This bill was introduced in 2021 and originally would have required physicians to provide each patient with detailed information about the physician’s personal receipt of gifts or funds from pharmaceutical companies, device manufacturers, etc., as reported by those entities in the federal Open Payments database on an annual basis. CMA sought amendments, and the bill was narrowed to a onetime, general notice to patients about the existence of the Open Payments database.

AB 1328 (IRWIN): CLINICAL LABORATORY TECHNOLOGY AND PHARMACISTS

Status: Held on Senate Floor.

AB 1954 (QUIRK): PHYSICIANS AND SURGEONS – TREATMENT AND MEDICATION OF PATIENTS USING CANNABIS

Status: Signed by Governor (Chapter 232, Statutes of 2022).

Assembly Bill 1328 would have created a scope infringement allowing pharmacists to order and perform over 1,400 Clinic Laboratory Improvement Amendmentsapproved tests, not limited to temperature, pulse and respiration. This bill would also have authorized a pharmacist to order and interpret any test results they ordered to “promote patient health.” CMA worked hard to seek amendments and ultimately stop the bill on the Senate Floor.

AB 1400 (KALRA): GUARANTEED HEALTH CARE FOR ALL

Status: Held on Assembly Floor.

Assembly Bill 1954 originally would have prohibited physicians from denying treatment to a patient solely based on a positive drug test for tetrahydrocannabinol (THC). CMA successfully negotiated amendments stating that a physician shall not automatically deny treatment or medication to a qualified patient based solely on a positive drug screen for THC. This amendment restored a physician’s discretion for medical decision-making. The amendments ensure that physicians are protected from liability risk and continue to have the ability to make medical decisions for their patients.

AB 2085 (HOLDEN): CRIMES – MANDATED

REPORTERS

Status: Signed by Governor (Chapter 770, Statutes of 2022).

Assembly Bill 1400, the California Guaranteed Health Care for All Act, would have created the CalCare program to administer and provide universal single payer health care coverage and a health care cost control system in the state. The bill contained minimal details regarding the administration of such a program.

AB 1785 (DAVIES): CALIFORNIA PARENTS’

BILL OF RIGHTS ACT

Status: Held in Assembly Education Committee.

Assembly Bill 2085 originally required mandatory reporters, including physicians, to make a determination between “severe neglect” and “general neglect,” and required that they only report neglect deemed “severe.” CMA sought amendments to clarify that health professionals must have clear standards about mandatory reporting and that making an assessment between “general” and “severe” neglect should not be a part of their role.

Assembly Bill 1785 attempted to create a “California Parents’ Bill of Rights” by making numerous technical and substantive amendments to various code sections. This bill would have undermined existing protections for health care decisions, and the resulting records, that a minor has a statutory right to make. In addition, the bill attempted to erode the ability of a school district to require certain immunizations.

Amendments were taken to the bill focusing the measure on the definition of “general neglect” in the law rather than on an assessment of levels of neglect by mandatory reporters.

AB 2274 (B. RUBIO): MANDATED REPORTERS – STATUTE OF LIMITATIONS

AB 2060 (QUIRK): MEDICAL BOARD OF CALIFORNIA

Status: Killed on Assembly Floor.

Status: Signed by Governor (Chapter 587, Statutes of 2022).

Assembly Bill 2060 sought to change the composition of the Medical Board of California to a public member majority and eliminate the licensee majority of the board’s disciplinary panels. This was the second consecutive legislative session that the Legislature sought this change to the board’s composition.

Assembly Bill 2274 would have made it a continuing crime if mandated reporters, which includes physicians, did not report child abuse regardless of whether or not the failure to report was intentional. CMA secured amendments to instead extend the statute of limitations for a person to bring a lawsuit against a mandated reporter who did not report to five years from the date of the occurrence of the offense.

AB 2338 (GIPSON): HEALTH CARE DECISIONS

– DECISION MAKERS AND SURROGATES

Status: Signed by Governor (Chapter 264, Statutes of 2022).

Assembly Bill 2338 would have adopted a rigid, default hierarchy surrogate consent law in which family members and the people closest to a patient by kinship become

AB 2080 (WOOD): HEALTH CARE CONSOLIDATION AND CONTRACTING FAIRNESS ACT OF 2022

Status: Held in Senate Health Committee.

designated surrogate decision-makers for the patient’s health care decisions, including when the patient is incapacitated or otherwise unable to personally designate a surrogate. CMA secured amendments that made the hierarchy suggestive and not mandatory, thereby addressing the liability concerns that initially existed with the bill.

SB 923 (WIENER): GENDER-AFFIRMING CARE Status: Signed by Governor (Chapter 822, Statutes of 2022).

Assembly Bill 2080 would have required any medical group, hospital, hospital system, health care service plan or pharmacy benefit manager to provide written notice to the Attorney General (AG) at least 90 days before agreeing to a merger, acquisition or change in control with another health care entity if the transaction had a value of $15 million or more. The bill would authorize the AG to consent to, give conditional consent to, or not consent to the agreement, and if the AG did not consent to the agreement, the transaction would be stopped.

Senate Bill 923 initially would have required physicians and their staff to complete a one-time cultural humility course for the transgender, gender nonconforming and intersex (TGI) communities before they would be able to contract with a health plan to provide care. The provider or staff would be required to take the course again if a complaint was filed against the provider or their staff.

AB 2236 (LOW) OPTOMETRY: CERTIFICATION TO PERFORM ADVANCED PROCEDURES

CMA secured amendments to the bill that incorporated the TGI community into current physician continuing medical education cultural competency requirements and removed the contracting prohibitions in the bill.

SB 964 (WIENER): BEHAVIORAL HEALTH Status: Vetoed by Governor.

Status: Vetoed by Governor. Assembly Bill 2236 would have authorized optometrists to perform laser and surgical procedures on a patient’s eye if they met minimal education and training requirements, including performing 43 procedures on live patients. The bill failed to adequately educate optometrists to develop clinical competency and judgment to identify, manage and mitigate complications during surgery to prevent permanent damage to patients’ eyes and eyesight.

Senate Bill 964 would have required the Board of Behavioral Sciences to analyze current law and provide recommendations to the legislature about actions it can take to increase the supply of behavioral health professionals and increase access to behavioral health services. The board would have to evaluate current scope of practice laws, licensing and clinical training requirements, and requirements for the renewal requirements for expired licenses. The bill ultimately would have required a report of the current behavioral health workforce and the state’s behavioral workforce needs. CMA successfully removed the review of current scope of practice laws.

Echoing CMA’s concerns, Governor Newsom vetoed the bill with a statement indicating: “I am not convinced that the education and training required is sufficient to prepare optometrists to perform the surgical procedures identified. This bill would allow optometrists to perform advanced surgical procedures with less than one year of training. In comparison, physicians who perform these procedures must complete at least a three-year residency program.”

SB 920 (HURTADO): MEDICAL BOARD OF CALIFORNIA: INVESTIGATIONS: RECORD REQUESTS

AB 1375 (ATKINS): NURSING: NURSE PRACTITIONERS AND NURSE-MIDWIVES –ABORTION AND PRACTICE STANDARDS

Status: Held in Senate Business, Professions, and Economic Development Committee.

Status: Signed by Governor (Chapter 631, Statutes of 2022).

Senate Bill 920 sought to erode privacy protections for both patients and physicians by allowing Medical Board of California investigators to inspect records prior to requesting a subpoena for the records in order to establish good cause for further investigation. This was the second consecutive legislative session that the Legislature sought this change.

Senate Bill 1375 is intended to increase access to abortion services by trained nurse practitioners. However, as introduced, it would also have eliminated the transition to practice for Section 103 and Section 104 nurse practitioners, which is much broader and unrelated to abortion care. At CMA’s request, a number of amendments were adopted that removed our opposition. The bill was amended to include additional training safeguards for nurse practitioners performing aspiration abortions and to remove the sections of the bill that would have eliminated the transition to practice for nurse practitioners.

SB 1023 (HURTADO): HEALTH PROFESSIONS

AB 1954 (QUIRK): PHYSICIANS AND SURGEONS – TREATMENT AND MEDICATION OF PATIENTS USING CANNABIS

– TRAINING AND EDUCATION: BLUE RIBBON COMMISSION

Status: Held in Assembly Health Committee.

Status: Signed by Governor (Chapter 232, Statutes of 2022).

Senate Bill 1023 sought to create a Blue-Ribbon Commission on Strengthening our Health System by Transforming Medical Training and Education to Improve Patient Protection. The bill was a misguided effort to address broader concerns about the regulation of physicians and surgeons by the medical board. In particular, the bill sought to reconsider the evidentiary standard used in disciplinary cases. CMA was able to negotiate amendments with the author to refocus the bill on seeking information and reporting on methods to increase the number of diverse physicians entering the workforce, particularly in low-income and rural communities.

Assembly Bill 1954 originally would have prohibited physicians from denying treatment to a patient solely based on a positive drug test for tetrahydrocannabinol (THC). CMA successfully negotiated amendments stating that a physician shall not automatically deny treatment or medication to a qualified patient based solely on a positive drug screen for THC. This amendment restored a physician’s discretion for medical decision-making. The amendments ensure that physicians are protected from liability risk and continue to have the ability to make medical decisions for their patients.

AB 2085 (HOLDEN): CRIMES – MANDATED REPORTERS

SB 1467 (KAMLAGER): MATERNAL MENTAL HEALTH

Status: Held in Senate Health Committee.

Status: Signed by Governor (Chapter 770, Statutes of 2022).

Senate Bill 1467 sought to ensure that all biological mothers are offered maternal mental health care services or are screened appropriately for maternal mental health conditions. CMA expressed concern that the term biological mother may exclude a population of people that may be pregnant or become pregnant.

Assembly Bill 2085 originally required mandatory reporters, including physicians, to make a determination between “severe neglect” and “general neglect,” and required that they only report neglect deemed “severe.” CMA sought amendments to clarify that health professionals must have clear standards about mandatory reporting and that making an assessment between “general” and “severe” neglect should not be a part of their role.

CMA’s Council on Legislation took an oppose unless amended position and sought an amendment to change the term biological mother to birthing person. Instead, the bill failed to garner a hearing in its first committee.

ACA 11 (KALRA): TAXES TO FUND HEALTH CARE COVERAGE AND COST CONTROL

Amendments were taken to the bill focusing the measure on the definition of “general neglect” in the law rather than on an assessment of levels of neglect by mandatory reporters.

Status: Held in Assembly Rules Committee.

AB 2274 (B. RUBIO): MANDATED REPORTERS – STATUTE OF LIMITATIONS

Status: Signed by Governor (Chapter 587, Statutes of 2022).

Assembly Constitutional Amendment 11 was the companion funding mechanism for the single-payer health care system proposed under AB 1400 (Kalra, 2021), which the association took an oppose unless amended position on. ACA 11 would have raised the gross receipts tax, increased the employer and employee shares of the payroll tax, and increased the personal income tax on high earners. This bill was never referred out of the Assembly Rules Committee.

Assembly Bill 2274 would have made it a continuing crime if mandated reporters, which includes physicians, did not report child abuse regardless of whether or not the failure to report was intentional. CMA secured amendments to instead extend the statute of limitations for a person to bring a lawsuit against a mandated reporter who did not report to five years from the date of the occurrence of the offense.

AB 2338 (GIPSON): HEALTH CARE DECISIONS

– DECISION MAKERS AND SURROGATES

Status: Signed by Governor (Chapter 264, Statutes of 2022).

Assembly Bill 2338 would have adopted a rigid, default hierarchy surrogate consent law in which family members and the people closest to a patient by kinship become

SUCCESSFULLY NEGOTIATED BILLS

AB

1704 (CHEN): LIMITED PODIATRIC RADIOGRAPHY PERMITS

Status: Signed by Governor (Chapter 580, Statutes of 2022).

designated surrogate decision-makers for the patient’s health care decisions, including when the patient is incapacitated or otherwise unable to personally designate a surrogate. CMA secured amendments that made the hierarchy suggestive and not mandatory, thereby addressing the liability concerns that initially existed with the bill.

SB 923 (WIENER): GENDER-AFFIRMING CARE Status: Signed by Governor (Chapter 822, Statutes of 2022).

Senate Bill 923 initially would have required physicians and their staff to complete a one-time cultural humility course for the transgender, gender nonconforming and intersex (TGI) communities before they would be able to contract with a health plan to provide care. The provider or staff would be required to take the course again if a complaint was filed against the provider or their staff.

Assembly Bill 1704 adds health care professionals operating leg-only podiatric radiography equipment under the supervision of a licensed podiatrist to the list of individuals exempted from the existing requirements of state law regarding who is permitted to operate radiological equipment in California. It also tried to remove the CDPH Radiologic Health Branch’s authority to determine certification and move it to the Podiatric Medical Board of California. CMA was able to retain the certification authority within CDPH and provide more specificity related to the requirements to receive this permit.

CMA secured amendments to the bill that incorporated the TGI community into current physician continuing medical education cultural competency requirements and removed the contracting prohibitions in the bill.

AB 1809 (AGUIAR-CURRY):

NURSING FACILITY RESIDENT INFORMED CONSENT PROTECTION ACT OF 2022

Status: Vetoed by Governor.

Assembly Bill 1809 would have required informed consent be given by a skilled nursing facility resident before being prescribed and administered any psychotherapeutic medication. Additionally, the prescribing physician could be charged with criminal battery for not obtaining the consent from the resident. CMA secured amendments to narrow the drugs affected by the bill, remove the charge of criminal battery from the bill and to require only the relevant information about the prescribed medication be given to the resident for consent purposes.

AB 1896 (QUIRK): GAMETE BANKS

Status: Vetoed by Governor.

SB 964 (WIENER): BEHAVIORAL HEALTH Status: Vetoed by Governor. Senate Bill 964 would have required the Board of Behavioral Sciences to analyze current law and provide recommendations to the legislature about actions it can take to increase the supply of behavioral health professionals and increase access to behavioral health services. The board would have to evaluate current scope of practice laws, licensing and clinical training requirements, and requirements for the renewal requirements for expired licenses. The bill ultimately would have required a report of the current behavioral health workforce and the state’s behavioral workforce needs. CMA successfully removed the review of current scope of practice laws.

AB 1375 (ATKINS): NURSING: NURSE PRACTITIONERS AND NURSE-MIDWIVES –ABORTION AND PRACTICE STANDARDS Status: Signed by Governor (Chapter 631, Statutes of 2022).

Assembly Bill 1896 would have added notification requirements to gamete banks. Specifically, this bill attempted to require gamete banks to notify clients of the risk of inbreeding and steps to mitigate that risk. In addition, the banks would have been required to implement a secure process for tracking future sperm donations and sharing that information with other gamete banks. CMA staff successfully negotiated amendments that minimized this bill to being education-based only, while reducing the administrative burdens and liability risk that were originally part of the bill.

Senate Bill 1375 is intended to increase access to abortion services by trained nurse practitioners. However, as introduced, it would also have eliminated the transition to practice for Section 103 and Section 104 nurse practitioners, which is much broader and unrelated to abortion care. At CMA’s request, a number of amendments were adopted that removed our opposition. The bill was amended to include additional training safeguards for nurse practitioners performing aspiration abortions and to remove the sections of the bill that would have eliminated the transition to practice for nurse practitioners.

AB 1954 (QUIRK): PHYSICIANS AND SURGEONS – TREATMENT AND MEDICATION OF PATIENTS USING CANNABIS

Status: Signed by Governor (Chapter 232, Statutes of 2022).

Assembly Bill 1954 originally would have prohibited physicians from denying treatment to a patient solely based on a positive drug test for tetrahydrocannabinol (THC). CMA successfully negotiated amendments stating that a physician shall not automatically deny treatment or medication to a qualified patient based solely on a positive drug screen for THC. This amendment restored a physician’s discretion for medical decision-making. The amendments ensure that physicians are protected from liability risk and continue to have the ability to make medical decisions for their patients.

AB 2085 (HOLDEN): CRIMES – MANDATED REPORTERS

Status: Signed by Governor (Chapter 770, Statutes of 2022).

Assembly Bill 2085 originally required mandatory reporters, including physicians, to make a determination between “severe neglect” and “general neglect,” and required that they only report neglect deemed “severe.” CMA sought amendments to clarify that health professionals must have clear standards about mandatory reporting and that making an assessment between “general” and “severe” neglect should not be a part of their role.

Amendments were taken to the bill focusing the measure on the definition of “general neglect” in the law rather than on an assessment of levels of neglect by mandatory reporters.

AB 2274 (B. RUBIO): MANDATED REPORTERS – STATUTE OF LIMITATIONS

Status: Signed by Governor (Chapter 587, Statutes of 2022).

Assembly Bill 2274 would have made it a continuing crime if mandated reporters, which includes physicians, did not report child abuse regardless of whether or not the failure to report was intentional. CMA secured amendments to instead extend the statute of limitations for a person to bring a lawsuit against a mandated reporter who did not report to five years from the date of the occurrence of the offense.

AB 2338 (GIPSON): HEALTH CARE DECISIONS

– DECISION MAKERS AND SURROGATES

Status: Signed by Governor (Chapter 264, Statutes of 2022).

Assembly Bill 2338 would have adopted a rigid, default hierarchy surrogate consent law in which family members and the people closest to a patient by kinship become

designated surrogate decision-makers for the patient’s health care decisions, including when the patient is incapacitated or otherwise unable to personally designate a surrogate. CMA secured amendments that made the hierarchy suggestive and not mandatory, thereby addressing the liability concerns that initially existed with the bill.

SB 923 (WIENER): GENDER-AFFIRMING CARE Status: Signed by Governor (Chapter 822, Statutes of 2022).

Senate Bill 923 initially would have required physicians and their staff to complete a one-time cultural humility course for the transgender, gender nonconforming and intersex (TGI) communities before they would be able to contract with a health plan to provide care. The provider or staff would be required to take the course again if a complaint was filed against the provider or their staff.

CMA secured amendments to the bill that incorporated the TGI community into current physician continuing medical education cultural competency requirements and removed the contracting prohibitions in the bill.

SB 964 (WIENER): BEHAVIORAL HEALTH

Status: Vetoed by Governor.

Senate Bill 964 would have required the Board of Behavioral Sciences to analyze current law and provide recommendations to the legislature about actions it can take to increase the supply of behavioral health professionals and increase access to behavioral health services. The board would have to evaluate current scope of practice laws, licensing and clinical training requirements, and requirements for the renewal requirements for expired licenses. The bill ultimately would have required a report of the current behavioral health workforce and the state’s behavioral workforce needs. CMA successfully removed the review of current scope of practice laws.

AB 1375 (ATKINS): NURSING: NURSE PRACTITIONERS AND NURSE-MIDWIVES –ABORTION AND PRACTICE STANDARDS

Status: Signed by Governor (Chapter 631, Statutes of 2022).

Senate Bill 1375 is intended to increase access to abortion services by trained nurse practitioners. However, as introduced, it would also have eliminated the transition to practice for Section 103 and Section 104 nurse practitioners, which is much broader and unrelated to abortion care. At CMA’s request, a number of amendments were adopted that removed our opposition. The bill was amended to include additional training safeguards for nurse practitioners performing aspiration abortions and to remove the sections of the bill that would have eliminated the transition to practice for nurse practitioners.

In a year where the world was starting to return to “normal,” the California Medical Association (CMA) seized the opportunity to make big gains for physician practices in several areas, from modernizing crucial malpractice legislation, preserving reproductive rights and encouraging grassroots engagement. This year’s achievements include:

MICRA Modernization

Facing another statewide ballot proposition that would have effectively eliminated MICRA’s cap on non-economic damages, CMA and Californians Allied for Patient Protection seized an opportunity to end one of the longest running political battles in California. The legislative deal (AB 35), which modernizes MICRA while preserving its underlying principles, has ushered in a new and sustained era of stability around malpractice liability.

Reproductive Rights

After the Supreme Court’s Dobbs decision, CMA worked with the Future of Abortion Council to protect and expand access to reproductive health care in California, leading to 15 bills signed into law, $200 million in the state budget and the passage of Prop. 1 to enshrine abortion rights into California’s constitution.

Election Victories

CMA member Jasmeet Bains, M.D., joined the California Assembly as its third physician legislator, while incumbent assemblymembers Joaquin Arambula, M.D., and Akilah Weber, M.D., were re-elected. At the federal level, representatives Ami Bera, M.D., and Raul Ruiz, M.D., were re-elected to Congress. CMA also saw its ballot measure positions reflected in election results, including the rejection of Prop. 29 (dialysis clinic requirements) and passage of Prop. 31 (ban on flavored tobacco).

Federal Loan Forgiveness

The U.S. Department of Education overhauled the Public Service Loan Forgiveness Program, including the specific fix that CMA advocated for that will allow all eligible California physicians to receive loan forgiveness.

Health IT

Billing and Burdens

CMA recouped more than $1 million this year (nearly $40 million over 14 years) on behalf of physician members through direct payor interventions. CMA also stopped Cigna’s burdensome modifier 25 policy.

CMA achieved significant victories on health information technology issues by extending the COVID telehealth waivers into 2023; permanently extending key Medi-Cal telehealth payment parity; eliminating e-prescribing burdens (AB 852); and helping physicians comply with the new federal information blocking rule while protecting patients’ sensitive medical information (SB 1419).

2022 YEAR IN REVIEW

Grassroots Engagement

CMA saw unprecedented grassroots physician engagement, with nearly 4,000 messages sent to policymakers. These physician voices were key in helping to defeat AB 2060 (public member majority on Medical Board of California) and AB 2236 (allowing optometrists to perform surgical procedures).

Public Health Funding

CMA helped administer both the KidsVaxGrant ($22+ million) and COVID-19 Test to Treat Equity Grant ($59 million) programs, providing critical funding for community pediatric vaccinators, public health systems and community health centers.

Community Health Centers

CMA saw rapid membership growth among community health centers, resulting in an expansion of our mode of practice forums and House of Delegates representation.

Retention Payments

Universal Health Care

CMA successfully advocated for full-scope Medi-Cal coverage for all income-eligible Californians by January 1, 2024, making California the first state to expand its Medicaid program to provide full benefits to all eligible individuals regardless of age or documentation status.

Virtual Grand Rounds

CMA helped secure $1.3 billion in the state budget to provide retention bonuses for many of California’s physicians and other health care workers to stabilize the health care workforce. Visit cmadocs.org/year-in-review

CMA completed its 28th Virtual Grand Rounds webinar, providing critical COVID-19 continuing medical education to over 13,000 attendees while expanding topics to include other public health concerns such as long COVID, monkeypox and wildfire smoke.

In Memoriam

Paul Stuart Auerbach, MD

EMERGENCY MEDICINE; MEMBER FOR 3 YEARS

Founded and was a past president of the Wilderness Medical Society, and an author in the academic discipline of wilderness medicine

Rene Soriano Orquiza, MD RADIOLOGY; MEMBER FOR 11 YEARS

Completed fellowship in nuclear radiology at The Johns Hopkins Medical School, then served as an instructor in nuclear medicine; in his private practice in San Jose, he did not turn away patients even if they could not pay, and often accepted payment in the form of homemade foods at Christmastime

Frank D. Berry, MD OPHTHALMOLOGY; MEMBER FOR 46 YEARS

A centenarian, passing away at the age of 101; was the first chairman of the Medical Advisory Committee for the El Camino Hospital District in 1955; that committee began the work that led to the creation of El Camino Hospital, in Mt. View, CA

James Striebel, MD INTERNAL MEDICINE; MEMBER FOR 26 YEARS

Practiced internal medicine with Kaiser Permanente in Santa Clara for 33 years

Amul Jobalia, MD NEPHROLOGY; MEMBER FOR 13 YEARS

Chief of Nephrology at Santa Clara Valley Medical Center where he practiced medicine for 22 years; had a love for race cars, collected Hot Wheels, and had a great sense of humor and a dry wit; was a member of the National Kidney Foundation where he supported the organization in many ways

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CAPphysicians.com 800-252-7706

Sarah E. Scher, JD Chief Executive Officer

“We want to make sure that California’s finest physicians are properly protected.”