Central Valley Physicians Winter 2017

Winter 2017

t n e m e L I F E T I M E AaCcH I E V E MENT v e i h e m i t e f i l generous • focused • passionate • pioneers

T H A T S E N T R I P P L E S A C R O S S T H E VA L L E Y

FMMS Annual Installation and Awards Gala

‘ECMO’ Greatly Improving Patient Outcomes House of Delegates

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800.356.5672 CAPphysicians.com/quote Winter 2017

VOLUME 2, NUMBER 1 • WINTER 2017

Cover photo by James Ramirez

{FEATURES}

10 14 18 22 26 32 46 Winter 2017

AN EYE ON EDUCATION

{DEPARTMENTS}

ABOVE THE STANDARD

12 FMMS ANNUAL INSTALLATION 48 PUBLIC HEALTH UPDATE:

CENTRAL CALIFORNIA BLOOD CENTER ‘ECMO’

Greatly Improving Patient Outcomes

HOUSE OF DELEGATES LIFETIME ACHIEVEMENT

Elimination of TB

44 CLASSIFIEDS 50 CMA AND FMMS BIG WINS

At the Ballot Box

52 PHYSICIAN PROFILE

Dr. John Thompson

52 IN MEMORIAM

Robert Mills, MD

PHYSICIAN-ASSISTED DEATH

CENTRAL VALLEY PHYSICIANS

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Letter From The Executive Director

HAPPY NEW YEAR! I cannot believe 2016 is already over. It was such a good year for the Medical Society; we grew membership by 20 percent, provided 35 hours of Continuing Medical Education (that is twice as many hours as the year before), and held our first fundraiser supporting the Fresno Madera Medical Society Scholarship Foundation. Those are just few on the list of accomplishments in 2016. I can’t tell you how much I enjoyed working with Dr. Hemant Dhingra. He kept me on my toes and NICOLE BUTLER provided a never-ending list of ideas and support. I want to thank him for all of his time and energy that he provided, and I am glad to have him on the board for one more year.

The medical society is launching into the new year with a new president, Dr. Alan Kelton, and some new board members, Drs. Uma Swamy and Alfred Valles. Our main goals will stay the same; membership growth and retention, and continue to grow membership benefits. If you are interested in becoming a member of the medical society, now is the time! We have launched a new monthly payment plan with automated monthly payments that make your membership affordable and easy to maintain. For more information on this, or to become a member, you can go to www.fmms.org, or call me directly.

I know there has been a lot of talk about a CME cruise to Alaska and I am happy to announce that the cruise is finalized and we are now accepting reservations through our travel agent.

Please see page 5 for more information. Our goal for these CME vacations is to provide them once a year to different locations. I would like to encourage those who are interested in taking a vacation to Alaska join us in July; it will be educational, informative and not to mention fun!

Finally, I am happy to introduce our new events coordinator, Nicole Tenorio. Yes, another Nicole in an office of three people, but I could not pass up on the experience Nicole would bring to the organization. Last year we hosted over 20 events; everything from monthly office manager forums to CME events, major fundraisers, and family movie nights. This year we will be planning just as many events and Nicole will be overseeing most of them. Personally, I am thrilled to have her as part of the FMMS team and I am looking forward to taking our events to the next level.

I hope everyone had a great Holiday and cheers to 2017!

Nicole Butler can be reached by phone at (559) 224-4224 or by e-mail at nbutler@fmms.org.

Thank you,

Nicole Butler Executive Director Fresno Madera Medical Society

PRESIDENT Alan Kelton, MD PRESIDENT-ELECT Trilok Puniani, MD VICE PRESIDENT Cesar A. Vazquez, MD TREASURER Alan Birnbaum, MD PAST-PRESIDENT Hemant Dhingra, MD BOARD OF GOVERNORS Christine Almon, MD, Jennifer Davies, MD, Joseph Duflot, MD, William Ebbeling, MD, Don Gaede, MD, David Hadden, MD, Christina Maser, MD, Katayoon Shahinfar, MD, Roydon Steinke, MD, Janae Barker, DO, Uma Swamy, MD, A.M. Aminian,Alfred Valles CENTRAL VALLEY PHYSICIANS EDITOR Don Gaede, MD MANAGING EDITORS Nicole Butler EDITORIAL COMMITTEE Don Gaede, MD - Chair, Alan Birnbaum, MD - Associate Editor, Ranjit S. Rajpal, MD, Hemant Dhingra, MD, Roydon Steinke, MD, Cesar Vazquez, MD, Nicole Butler CREATIVE DIRECTOR www.sherrylavonedesign.com CONTRIBUTING WRITERS Alan Birnbaum, MD, Don Gaede, MD, Jennifer Seita, Alan Birmbaum, MD, Erin Kennedy, Malissa Rose, Jay Lewis, Marylisa Russell, Christopher Staub, Frederick Elmore, MD CONTRIBUTING PHOTOGRAPHERS Nicole Butler, Tomas Ovalle, James Ramirez CENTRAL VALLEY PHYSICIANS is produced by Fresno Madera Medical Society PLEASE DIRECT ALL INQUIRIES AND SUBMISSIONS TO: Central Valley Physicians 1040 E. Herndon Ave., Suite 101 Fresno, CA 93720 Phone: 559-224-4224 • Fax: 559-224-0276 Email Address: nbutler@fmms.org MEDICAL SOCIETY OFFICE HOURS: Monday through Friday 9 a.m. to 5 p.m.

MEDICAL SOCIETY STAFF Executive Director, Nicole Butler CMA HOUSE OF DELEGATES REPRESENTATIVES Alan Kelton, MD, A.M. Aminian, MD, Patrick Golden, MD, Brent Kane, MD, Ranjit Rajpal, MD, Oscar Sablan, MD, Roydon Steinke, MD, Toussaint Streat, MD, Don Gaede, MD ALTERNATES Trilok Puniani, MD, Naeem Akhtar, MD, Praveen Buddiga, MD, William Carveth, MD, Trilok Puniani, MD, Swarnpal Sekhon, MD *Automatic Delegate

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Winter 2017

Fresno Madera Medical Society CME Cruise to Alaska

Book Now Save

$200

July 22, 2017

7-day Cruise Sailing from Seattle, WA Aboard the Ruby Princess

Fresno Madera Medical Society is hosting its first Continuing Medical Education while cruising Alaska.

Earn up to 12 hours of CME while enjoying the cruise with Family, Friends, and Colleagues.

Please join us and book by March for the discount.

Inside Cabin - Starting at $3213 per couple includes Port Taxes & Registertion Fees

Outside Cabin - Starting at $4413 per couple includes Port Taxes & Registertion Fees

Balcony Cabin - Starting at $5113 per couple includes Port Taxes & Registertion Fees

Limited cabins available for 3rd and 4th guest in the same stateroom -- call to inquire

For more information or to book now contact Air KingTravel & Tours at 1.888.565.5050 or by email at nita@airkingtours.com CME $295 for Physicians - $225 for Physician Assistants, Nurse Practitioners, Nurses & Others Target Audience: Physicians, Physician Assistants, Nurses, Nurse Practitioners

A message from our Editor > Don H.Gaede, MD

Let’s Do the Write Thing

ABOUT THE AUTHOR ­ Dr. Gaede is a Fresno native and is boardcertified in Internal Medicine and specializes in Vascular Medicine, with an expertise in the treatment of varicose veins, circulation problems, blood clots, and advanced techniques using ultrasound and sclerotherapy.

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It will be a hard act to follow.

Alan Birnbaum, editor of this publication for the past two years, is completing his term. He will remain on as Assistant Editor, and join the FMMS executive team as Secretary/Treasurer.

His editorials have always been well written and a pleasure to read.

He has eloquently advocated for passage of Prop 46 (preservation of MICRA), and Prop 56 (the two dollar cigarette tax that will help increase Medi-Cal reimbursement). He has pleaded that government regulations allow physicians to “cook more and measure less” so that we can take that extra five minutes with our patients—those minutes that can turn a rushed visit into a meaningful interaction for both our patients and ourselves. He has asked us to raise our voices to our legislators about these important

issues.

We physicians write a lot. We write medical histories of our patients, we write notes to our colleagues, and we (ugh) write to pharmacies and insurance companies. Some of us write letters to the editor or columns in the newspaper, and some write letters to our members of Congress, so it is in our best interest to learn to write better.

We have a long and honorable history of writing, and writing well. Hippocrates started it off around 400 BC with that famous Oath. St. Luke followed up with a best-selling book in the New Testament. Michael Servetus was the first European to correctly describe the pulmonary circulation, but his religious writings so infuriated both Catholics and Protestants that he was burned at the stake, along with

Winter 2017

his books—for extra kindling. that they had actually got to know this patient/person, More recent physician writers include Anton as a living, breathing human being.

Chekhov, Sir Arthur Conan Doyle, Oliver Wendell I spoke with Mike about this. He said he usually tries Holmes, John Keats, Somerset Maugham, Richard to include something about the patient’s occupation Selzer, Lewis Thomas, Deepok Copra, Oliver Sacks, (present or former) in his medical history. This not Michael Crichton, Robin Cook, Khaled Hosseni, only adds a human touch to the medical history, but Charles Krauthammer, and Atul Gawande. I left out when the patient shows up again months later, the hundreds of other physician writers, but you get my patient’s personal information helps bring trigger Saul’s point—many of us have a real knack for writing.

I met Atul Gawande at Do you enjoy writing? Good—because our medical this year’s CMA leadership profession needs you. Our CVP magazine is always conference, and asked him how he became such a looking for well-written, timely articles. And our patients good writer. His answer: and political representatives need to hear from you.

“I just started writing.” He began with writing a blog about his experiences as a physician, which later evolved into writing articles for memory of the clinical information.

New Yorker magazine. He then went on to write some I write an occasional newsletter for my patients. of my favorite books, like The Checklist Manifesto, and The newsletter serves as a way to educate them about Being Mortal. recent medical research, or about new procedures Can a patient’s medical history be celebrated as offered in my office. I have been pleasantly surprised a good piece of writing? I think it can, because in at the positive feedback I get from my patients. I make essence, we are writing a story about our patients. But an extra effort to make the newsletters interesting our EMR systems conspire with our ever-increasing and sometimes humorous to read, since as Oscar documentation requirements to turn our medical Hammerstein wrote, “just a teaspoon of sugar makes histories into robotic, dry descriptions that do not the medicine go down . . .” come close to telling a good story. When I attempt to Do you enjoy writing? Good—because our medical read a medical history filled with disjointed, soulless profession needs you. Our CVP magazine is always phrases generated by drop-down menus and copy and looking for well-written, timely articles. And our paste, I fear that the robots have already taken over. patients and political representatives need to hear from In an article in the 2009 American Journal of you.

Medicine, Drs. Siegler and Adelman put it this way: I would like to see a group of us physicians write short “Because charts have become capacious warehouses pieces on various medical topics for consumption by of disorganized, irrelevant, or erroneous data, the story our central valley community; these articles could be of the patient and the patient’s illness is no longer easy posted regularly on the FMMS website. Who knows, to read or likely to be read. In a most compelling and it could even evolve into a regular column in the perhaps unintended way, we are witnessing the ‘death’ Fresno Bee, similar to the “Ask the Doctors” feature of the health record narrative, as many of us have that appears there now. Such a column would be good known it.” advertising for our medical society, and good medical But when I think about a well-written medical information for our patients. history, two Fresno physicians come to my mind: Interested? You know where to find me.

Michael Saul (intensivist) and John Slater (retired Don Gaede, MD neurosurgeon). Their medical histories were You can reach Dr. Gaede at drveinmd@gmail.com consistently interesting to read, and left me with a sense

Winter 2017

CENTRAL VALLEY PHYSICIANS

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President Report > Alan Kelton, MD

Holiday Greeting To All!

ABOUT THE AUTHOR ­ ­ ABOUT THE AUTHOR AlanDr. Kelton, MD, is board and Ronald Morton is acertified board-certified specializes in Internalwho Medicine.

He in earned his ophthalmologist practiced medical degree from University of Nevada’ Bakersfield for over 30 years and is s School of Medicine wasCounty awarded the a past presidentwhere of thehe Kern Outstanding StudentHe in Internal Medicine Medical Society. is currently retired and and the Endorcine Society Medical Student enjoys traveling with his wife of 46 Achievement Award. He completed residencies years, Ingrid. at University of Utah School of Medicine and UCSF Fresno. Dr. Kelton enjoys camping, visiting Yosemite and spending time with his family.

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Holiday greetings to all! I am looking forward to this next year as the President of the FresnoMadera Medical Society. It is an honor to represent and lead our organization.

Different than our national election, the process for advancing candidates in the society is a sober and rational process. This is important for there are many issues that the president should understand before assuming the position. We are the Central California Blood Center, we have a non-profit foundation, a separate scholarship foundation and we are a member society of the CMA. We send delegates to the CMA and have the opportunity to have members advance to important positions in the CMA, such as when Dr. Ranjeet Rajpal was elected Chair of the President’s Council two years back. Still going, Dr. Rajpal this year was

elected as CMA trustee for District 6. Great work, Ranjeet.

The 2016 election of the President of the United States was quite a spectacle. The election and its aftermath led many to feel separated from those on the opposing political side. Many have felt a sense of loss and confusion. There are those that fear a loss of the ACA or changes to the ACA. There are others who feel that change is desperately needed. Even hospital administrators are questioning the future, looking twice at current expenditures and gazing into a crystal ball to divine the future of the healthcare market.

It is quite easy to choose one side or the other, call your political opponent evil or greedy or maybe evil and greedy and then be done for the day. In healthcare this does not work, it does not help.

Designing a system without

Winter 2017

critique leads to errors predictable a victory. Let us keep our common If you are opposed in your efforts, to the critic, but not the engineer. ground and speak our common ask this doctor what the society Designing a systems that is language as change is made. needs to do for them, and when not dynamic will lead to failure We as physicians are uniquely answered, recruit that physician to without a doubt. Closing debate qualified to speak on behalf of join and take the lead on their issue to opponents will not strengthen our patients and to comment on of concern. the healthcare changes that will healthcare access and provision.

I am proud to be part of a group come.

We do not have different goals just that honors the physicians chosen Sometimes, when talking about different approaches and different for 2016’s award banquet: Drs healthcare or the ACA it is not viewpoints. Please be civil in your Robert Libke, Alex Moir, Andre so easy to look for the common thoughts and discussions with Minuth, Morton Rosenstein for ground. Please do, I am sure that physicians who seem to be on the lifetime achievement and Dr. Chris you can find it. I have yet to find other side.

Perkins for special projects. Please a physician who does not want I spoke of our “impossible also be proud of the Society for affordable care and affordable tasks” at the annual awards and what it represents and for what insurance for patients. I have yet installation dinner for the Fresno it can do. Please this year add to to find a physician who does not Madera Medical society. This your impossible tasks in order to desire for care for those who are year, I will ask you to add to help us be better this year. truly in need. I have yet to find a your impossible list. Please ask physician who does not want ready someone to join us at the Society. access to well-equipped and wellInvite a non-member to an event. staffed facilities for those who need the greatest in life saving care. I have yet to find a physician who would deny care Assisted Living • Memory Care to a visitor to our great country. I would challenge you to find the physician Scrooge, knowing you will not.

We do not need to stand across a fence or police barrier to find our common ground. The ground is here beneath our feet, the common Resident focused care that you will be proud to recommend. thoughts in our brains and the common feelings Personalized care plan • Incontinence Program in our hearts. There will Medication management including injections • Purposeful activity programs be change to the ACA, Nurse on-site 7 days a week • Diabetic Wellness Program there will be change to Medi-Cal and there will be changes (as always) in 5605 N Gates Ave • Fresno, CA 93722 our practices. Changes 559-682-3114 would have been needed oakmontoffresno.com even if the Republican candidate had not staged RCFE #107206882 TOURS AVAILABLE DAILY!

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Eye On Education > Steven Fogg

DR. STEVEN FOGG:

An Eye On Education

ABOUT THE AUTHOR ­ Alan M. Birnbaum, MD, is Board Certified in Adult Neurology and is with Spruce Multispecialty Group. Dr. Birnbaum is currently Medical Director of the Saint Agnes Medical Center Stroke Program and a Board Member of Fresno Madera Medical Society.

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On November 8, 2016, Dr. Steven Fogg won a seat on the sevenmember Clovis Unified School Board with a whopping 71 percent of the vote. The Fresno ophthalmologist easily defeated administration-favored former Board member Scott Troescher. I recently phoned Dr. Fogg to talk about his win.

“I’ve always been interested in public service” he allows. While a Brigham Young University undergraduate during the 1970’s, he made an unsuccessful run for Student Body President. In 1985, he lost his bid for a Clovis City Council seat. Over the three decades, Dr. Fogg has practiced in an eyecare group founded by his father, Gary Fogg, MD. Dr. Fogg considered running a few years ago, but found any decision difficult. Then, “I had several patients come up to me” asking, ’Have you ever thought of being on the School Board?’”

The 2016 CUSD dress code controversy proved one stimulus.

Dr. Fogg’s wife attended and spoke at a January meeting on the topic, and returned home that night feeling that she had made a difference in keeping the dress code, only to become irked come April when that decision was reversed. Finally, on the very last day to file, Dr. Fogg realized, “I think that’s just what I need to do,” his wife chiding him as he filed papers barely by the deadline: “Don’t lose this time!”

Of the four Districts voting in 2016, Dr. Fogg’s was the only one lacking an incumbent, while every single incumbent was challenged. With ten candidates running for the four positions, this was the first contested election in at least ten years. “We felt like the Board wasn’t holding up what they should be doing.”

Again, the core issue was the dress code: “they f lipped their vote.”

Dr. Fogg felt that in the Board responding to ACLU and other

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legal pressures, they had done the right thing but had not communicated that well to parents.

Dr. Fogg felt he could do better to promote community dialogue. “As a physician, that’s what we do all day long.

That’s what we get paid to do, explain the complex yet make it simple.” He found it very moving that Fresno-Madera Medical Society offered to contribute to his campaign, which he declined. “I wanted this to be all mine, though I felt a lot of support from my fellow physicians. I was very moved by that.”

His family now finds Clovis Unified a district with more strengths than weaknesses. “We love it. We don’t think there’s a better place to raise a family anywhere.” He contrasts today’s CUSD with the Bullard district where he completed his own secondary education.

Circa his 1980 graduation, Bullard High School “was fantastic but over the years a lack of support from Fresno Unified allowed it to deteriorate.”

Dr. Fogg regards the Clovis emphasis on athletics and extracurricular activities such as forensics “extremely important,” emphasizing that what you do outside the classroom becomes great training for life, even critical; just as important as what you do in the classroom.

Dr. Fogg also supports CUSD expanding its vocational education offerings, for those whom college may not be the best plan. Next year the district will start a track in “Medical Health Careers” with courses to include “Clinical Anatomy and Physiology” and “Introduction to Emergency Medical Response.”

Beyond what CUSD does for collegebound students, “they have probably the finest Special Education program in the state.” His youngest child of five, a son graduating this spring, has been challenged by learning disabilities yet motivated to persist “because he wants to play football,” with support staying in

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We felt like the Board wasn’t holding up what they should be doing. general education classes. While proud of his four older children, his youngest’s graduation will be a highlight of his life. He looks forward to personally handing him his diploma.

Dr. Fogg seems unconcerned by the change in national administration from Democratic to Republican, with an orthopedist and neurosurgeon joining the Trump Cabinet. If anything, school vouchers favored by incoming Secretary of Education Betty DeVos may provide additional funding for a District that has always made “it very easy for families who are motivated to come into the district.”

As to District challenges, he observes that Clovis Unified is suffering from his own success, becoming huge—the 14th largest in California. Resultant growing pains mean that Board policies of twenty years ago no longer suffice. However, recruitment does remain favorable. Teachers will come and teach in CUSD for less money due to its orderly student population.

Dr. Fogg starts his four-year term as a Board Trustee highly satisfied with his children’s education. His motivation includes “payback,” repaying their education not just by his taxes, but also by personal commitment. He asks colleagues to copy his example: “I hope that physicians will step up and support these kids.”

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Fresno Madera Medical Society’s

Annual Installation and Awards Gala

Save the Date for the 2017 Installation and Awards Gala: Friday, November 17

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Fresno Madera Medical Society’s annual installation and Awards Gala was attended by more than 200 physicians and guests. The event took place on Friday November 18 at Fort Washington Country Club.

Lifetime Achievement Awards were honored to Drs. Robert Libke, Andre Minuth, Morton Rosenstein and Alex Moir. The Special Project Award was honored to

Dr. Christopher Perkins for his work on the Art of Life Cancer Foundation.

New officers were announced during the installation ceremony – President Dr. Alan Kelton, President-Elect Dr. Trilok Puniani, Vice President Dr. Cesar Vazquez, Secretary/Treasurer Dr. Alan Birnbaum and Immediate Past President Dr. Hemant Dhingra.

Photos by James Ramirez

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BY MALISSA ROSE

To qualify for the prestigious Boston Marathon, experts say to try to run faster than the set standard for each age group to get first dibs when registering. Throughout his life, Jesus Rodriguez, MD, has always aimed past the standard, and in doing so, he has not only achieved a Bostonqualifying time for the 2018 race, but he has used that same determination to inspire many adolescents to pursue careers in the field of medicine.

For the past ten years, the Kaiser Permanente Fresno Family Medicine physician has mentored Sunnyside High School students as a part of the Doctors Academy program affiliated with the University of California, San Francisco-Fresno Latino Center for Medical Education and Research.

The program, which started at Sunnyside High School in 1999, encourages educationally disadvantaged students to focus on careers in health and medicine. >>

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Winter 2017

“My passion is to get the youth involved and to look at careers in medicine as an option,” he says. “The sooner we start allowing students to have it in their mind that it is possible, than the more likely they are to pursue it.”

Dr. Rodriguez says although California’s population is over 50 percent Latino, only four to five percent of physicians are Latino.

“The more outreach we do and the more we can encourage the youth, especially from underserved minority populations, the better we will be able to serve California as a whole,” he says. “Once I greet my patients in Spanish, I immediately see them smile and an entire relaxation of their physical being overcomes them because they know they are going to be able to express themselves better, which leads to overall better care.”

Dr. Rodriquez, his brother and mother came to the United States from Mexico when he was just six years old. Raised in

a single-parent home, he spent many summers working as a farm laborer to help provide. His mother emphasized the importance of education and pushed him to be the best he could be so that he didn’t have to live a life like she did.

By the third grade, teachers noticed Dr. Rodriguez’ love for Science and Math and placed him on a more accelerated learning path. He quickly became a top student in his school.

During his junior year of high school, he was selected as one of only 20 students in California to attend an exclusive, 5-week residential program for low income students with the Stanford Medical Youth Science Program.

Once there, Dr. Rodriguez realized his love for medicine.

The curriculum involved completing a hospital internship and attending workshops and lectures conducted by Stanford faculty and medical professionals. Dr. Rodriguez’ internship assignment was to assist in the hospital’s morgue. He discovered a fascination for the autopsy process to learn not only why the person passed away but how it could have been prevented.

Fueled by his new-found passion to help others through

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medicine, he then graduated from Madera High School as the class valedictorian, attended Stanford University, earned his medical degree from the University of Washington and completed residency training at University of California, San Francisco-Fresno.

Originally wanting to be a pediatrician, Dr. Rodriquez learned to appreciate the broad scope of care that could be provided as a family medicine physician while he completed rotations throughout the Valley during residency. Once he graduated, he decided to stay in the Valley to continue to provide care for the underserved and try to inspire disadvantaged youth just as he was inspired many years ago.

In addition to mentoring Doctors Academy students, Dr. Rodriguez enjoys helping members of the community combat chronic disease.

“I am a big proponent of spreading health education to as many people as I can,” he says.

He has been a guest speaker on many Spanish television and radio programs, he’s provided health screenings at various community events, and is an active board member for the American Heart Association’s Central Valley division. In this role, he plans to focus on the need to educate Latino women about heart health and will work closely with the Consulate of Mexico in Fresno.

In the fall, Dr. Rodriguez also donates his time and services to provide school sports physicals at local high schools.

“While I’m there, I take advantage of the opportunity to ask the students of their plans after high school,” he says. “I try to encourage them to continue their education and even consider a career in the medical field or in physical therapy.”

Throughout the years, Dr. Rodriguez has kept in touch with many of the students he’s mentored and is happy to report that almost all of them have pursued careers in medicine, nursing or physical therapy.

“I think it’s rewarding that some part of me was there to help them continue their efforts and encourage them along the way because it’s a hard road,” he says. “Even if they find that medicine is not for them, as long as they keep exploring and trying to find their way and not give up – that’s when we know we’ve done our job.”

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Central California > Blood Center

Central California Blood Center

First in State to Offer Innovative Platelet Product

BY CHRISTOPHER STAUB

Central California Blood Center (CCBC) is poised to become the first blood center in California to offer recently FDA-approved psoralen-treated platelets to its hospitals.

Cerus Corporation (Concord, California), received FDA approval to market its Intercept pathogen reduction system for platelets in the United States in December 2014, after several years of successful experience with it in Europe.

Currently, only Cerus has a US-approved pathogen reduction method for treating blood products. As of today, 19 US blood centers are producing psoralen-treated platelets with 40 other centers having signed contracts with Cerus to begin in 2017.

CCBC expects to start producing these platelets in late January, at least several months to years ahead of other California blood centers. Standard platelet products will continue to be produced. Production numbers of psoralentreated platelets in Fresno will be determined by hospital demand.

For many years, blood centers have been required to perform a bacteria screening test on all platelet pheresis products collected from volunteer donors to reduce the risk of a contaminated transfusion. In spite of this effort, studies reported that cases of bacterial sepsis still occur following platelet transfusion, notably after day three of platelet storage.

The risk has been calculated to be about 1:250 platelet receiving patients.

In response, the FDA issued a Draft Guidance for Industry, Bacterial Risk Control Strategies for Blood Collection

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Winter 2017

Winter 2017

CENTRAL VALLEY PHYSICIANS

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Central California > Blood Center

ORDER YOUR 2017 PHYSICIAN PICTORIAL DIRECTORY You can still order your 2017 edition of the Fresno-Madera Medical Society Pictorial Directory.

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Directory

Physician members of FMMS will automatically receive a complimentary copy of the directory. Additional directories can be purchased for the following rates:

Physician Member Non-Member

$20 $30

Directories will be delivered or mailed directly to the physician’s address as shown in the membership data base.

Hospitals, governmental agencies, businesses and individuals do not qualify for the member rate.

Sales tax and shipping are included in the price.

To purchase or for additional information, please call 559-224-4224 ext. 110.

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Establishments and Transfusion Services to Enhance the Safety and Availability of Platelets for Transfusion (March 2016) which proposes to require either hospitals to employ an additional bacteria detection test for platelet products older than 3 days, or use a pathogen-reduced platelet. When the FDA upgrades this to a Final Guidance, one can expect demand for psoralen-treated platelets to dramatically increase as pathogen reduction represents a more proactive approach for not only protection against bacterial or viral contamination, but also protection against emerging infections (ie. Zika, chikungunya, dengue and others) to which there now exists no blood donor screening test.

The Intercept method is designed to be performed in blood centers under controlled cGMP conditions. It involves the addition of a photoactive psoralen compound, called amotosalen HCL. Psoralens are found naturally in foods such as limes, celery and parsnips.

Amotosalen was found to yield at least a 4 log reduction in a broad range of pathogenic viruses and bacteria while maintaining the functional properties of platelets and plasma. Following the addition of amotosalen to the collected platelet bag, the product is then exposed to an ultraviolet light source. When it encounters a pathogen, or a donor T-cell, the amotosalen penetrates it and docks between the DNA or RNA amino acid base pairs. The ultraviolet light then assures crosslinked bonding which blocks replication, transcription and translation. A final step in the Intercept treatment of the platelet product involves removing residual amotosalen and its photoproducts with a compound adsorption device. The final platelet and plasma storage containers appear similar to standard platelet and plasma products.

The data on Intercept demonstrates that the process blocks donor T-cell’s ability to promote transfusion associated Graft-vs-Host Disease (TAGVHD) in recipients by crippling more base pairs of T-cell DNA than does the standard blood irradiation process. For this reason, the AABB’s 30th edition of Standards for Blood Banks and Transfusion Services accepts pathogen reduction technology as an acceptable means of preventing TAGVHD. Psoralen-treated platelets represent a new and proactive approach to providing a safer platelet, free from the risk of bacterial contamination, TAGVHD and emerging pathogens. Use of psoralen-treated platelets will preclude the need by blood center and hospital to do costly bacterial detection testing and thereby make platelets available to patients sooner after collection. They will also preclude the need to irradiate and CMV test platelet products prior to transfusion. The cost of psoralen-treated platelets will be comparable to that of irradiated, CMV screened platelets.

Christopher Staub, MT(ASCP)SBB, is the Chief Operating Officer at Central California Blood Center in Fresno since January 2016, and is a Director on the Board of America’s Blood Centers. He is a frequent contributor to ABC Newsletter and other blood industry publications.

Winter 2017

The California Medical Association and the Fresno Madera Medical Society

MONTHLY PAYMENT PLAN

TOGETHER, WE ARE STRONGER. It’s through a strong membership foundation that CMA remains a dominant force in health care, leading the charge on several fronts, including the following: Continuously defending the Medical Injury Compensation Reform Act (MICRA) Advocating for specialty scope of practice that protects patients , including decreasing youth smoking and passing a landmark immunization law Other benefits of membership include professional, personal and practice resources, which commonly dues. Learn more at www.cmanet.org/groupdiscounts.

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e

ECMO > Improving Patient Outcomes

‘ECMO’ TEAM

BY MARY LISA RUSSELL

G R E A T L Y I M P R O V E S PATIENT OUTCOMES A special, high-level care medical team gives patients with life-threatening respiratory or cardiac failure a new hope for life, and it’s been critical for saving patients over the last few months at Community Regional Medical Center (CRMC).

Last August, after months of planning and preparation, the new extracorporeal membrane oxygenation (ECMO) medical team was launched at CRMC in partnership with UCSF Fresno. The team was created by the pulmonary critical care division under Dr. Timothy Evans’ leadership. Dr. Evans is a UCSF faculty member and medical director of the CRMC medical intensive care units. >>

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ECMO > Improving Patient Outcomes

“We needed this team and technology to save lives,” said Dr. Timothy Evans. “It was necessary for our patients so we developed this team, protocol and infrastructure to manage these critically ill patients. This is the only place in the Valley with the resources to do it.”

ECMO is a cardiopulmonary bypass technique that provides long-term breathing and heart support. Clinicians place the ECMO catheters into arteries or veins and the patient is usually on a ventilator while being monitored by a specially trained critical care team.

The ECMO machine pumps and oxygenates a patient’s blood outside their body, much like a heart-lung by-pass machine. Blood pumps through the catheters oxygenating a patient’s blood and taking out carbon dioxide before warming the blood to body temperature as it is pumped back into the patient. This allows the organs to rest and heal.

While the technology has been used for some time, it’s the medical team approach and the accreditation by Extracorporeal Life Support Organization (ELSO) that makes it one-of-a-kind in the region, says Dr. Evans.

ECMO team member and UCSF faculty Eyad Almasri, MD, agrees.

“The collaboration between UCSF Fresno and CRMC gave us an advantage on this team approach. Having available staff and educational infrastructure allowed us to introduce ECMO

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based on guidelines and best available evidence,” he said.

Dr. Almasri said being a part of the ELSO registry gives the program legitimacy and transparency. But most important, he said, it gives the team the necessary tools to arrange for next steps if needed (transplant or other advanced therapy.)

This specialized team approach is something Dr. Michael Peterson, chief of medicine, UCSF and associate dean, UCSF Fresno, said is needed for a higher level of care.

“ECMO is an important new tool in our ability to care for the critically ill patient, but the technology requires unique expertise and 24-hour access to highly trained clinicians,” Dr. Peterson said. “We are very fortunate at UCSF Fresno and CRMC to have developed such a skilled team to deliver this level of care to the people living in our region. This new technology clearly saves lives and we are excited to have it available now.”

Besides a standardized approach and wiser management of resources, Dr. Almasri said the most important aspect since the ECMO team’s inception is seeing better patient outcomes.

“Above all, that’s the most important.”

For example, the ECMO team treated 24-year-old Maggie Noel who was transferred from a nearby county to CRMC for a higher level of care for severe pneumonia. The clinicians immediately determined she would not survive the night without maximum cardiopulmonary support, so the team was activated and she was placed on ECMO for 21 days. One

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physician team member even cancelled his vacation to stay with the patient throughout her treatment.

Noel, who came into CRMC in the most critical of conditions, said the team and the technology saved her life. “I wouldn’t be here today without them,” she said.

And the number of patients they can now save because of the team is growing, according to the Dr. Almasri.

“Once the ECMO team is activated, we quickly communicate, review data and determine eligibility and indication,” said Dr. Almasri. “Once we identify the candidate, we escalate the call and include the surgeon, OR staff, house supervisor and perfusionist.”

Dr. Almasri said the care is delivered in collaboration with the critical care team, nursing staff, physical therapy, respiratory therapy, dietitians, social workers and more.

ECMO team member Mohamed Fayed, MD, is a UCSF pulmonary critical care fellow and part of the founding ECMO team. When he first came to CRMC in 2014, he helped save the life of a pregnant mother and her baby. This case inspired him to be part of developing the ECMO team at CRMC and work with his mentor Dr. Evans, where he assists in the decision making and management efforts.

“The multidisciplinary team approach in these cases has made a big difference in selection and outcome compared to the previous process,” Dr. Fayed said. “Also, centers like ours,

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that are accredited, usually have better outcomes.” In fact, Dr. Fayed said he’s seen as much as 75% improvement in outcomes for patients.

Cardiothoracic Surgeons Shams Khwaja and John Lin are also critical ECMO team members who are responsible for placing the cannula (thin tube) into the artery or vein of the patient. Their role is vital as cannula placement has a major impact on the patient’s outcome. Dr. Khwaja and Dr Lin also are involved in the decision making for the intervention.

“Patients requiring ECMO often are very complex and sick.

Bringing both surgical and critical care disciplines together gives patients the best chance for a meaningful recovery,” said Dr. Lin. Dr Fayed said every ECMO team member is essential including non-physician staff.

“Respiratory therapy is needed to manage the ventilator and a perfusionist manages any technical issue with the machine,” he said. “From the nursing staff who manages medication or fluid status, to the physical therapists mobilizing patients, each team member plays a big part in the team’s success.”

This well-orchestrated team effort has brought great results to patients throughout the Valley, according to ECMO team members.

“It’s all about what is best for the patient – and this team makes it happen,” Fayed said.

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Winter 2017

2016 HOUSE OF DELEGATES CALIFORNIA MEDICAL ASSOCIATION DELEGATES DISCUSS MAJOR ISSUES AND ELECT OFFICERS AT ANNUAL MEETING More than 500 California physicians convened in Sacramento for the 145th Annual Session of the California Medical Association (CMA) House of Delegates, October 15-16, 2016, at the Sacramento Convention Center. This meeting marks the end of the first year of CMA’s new governance reforms and the first time the delegates have reconvened since they approved the reforms at last year’s House of Delegates (HOD).

Under the new system of governance, proposed policies are considered on a quarterly basis, with online testimony throughout the year. The HOD still meets annually, but the delegates now establish broad policy on current major issues affecting members, the association and the practice of medicine. The major issues discussed this year are listed on the following page. >>

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MACRA:

As the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is implemented over the next several years, the CMA will be working hard to ensure it is workable for practicing physicians and improves patient care. The CMA House of Delegates discussed various recommendations to guide CMA’s policy on this issue.

MAINTENANCE OF CERTIFICATION: CMA supports the highest

standards for licensure that are based on education, training, experience and ethical criteria. In a sometimes heated debate, delegates discussed various models and proposals regarding maintenance and recertification of specialty board certification, including alternative approaches.

OPIOIDS:

The issue of opioid-related misuse, abuse and overdose continues to be a major policy issue at the federal, state and regional levels. The delegates discussed various strategies and policies to promote prescribing controlled substances safely and effectively to relieve pain, while simultaneously reducing the risk of prescription medication misuse, addiction and overdose.

PHYSICIAN BURNOUT:

Recognizing that it is the responsibility of the medical community to identify risk factors for and appropriately respond to signs of physician burnout, the CMA House of Delegates explored strategies to preserve the physical and mental well-being of physicians.

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ACA CHANGES:

Beginning in 2017, states can request a five-year renewable exemption on key coverage provisions within the Affordable Care Act, including those related to benefits and subsidies, the exchanges, and the individual and employer mandates. The CMA House of Delegates discussed various recommendations related to a possible Section 1332 waiver for California.

FIVE-YEAR PUBLIC HEALTH PLAN: For many decades, CMA has taken an active role

in championing notable and successful public health policy campaigns that promote healthy practices and behaviors.

Continuing its commitment to public health, the CMA House of Delegates developed strategies to prevent and treat chronic disease and supports healthy and safe communities, focusing on the following areas: adult and childhood obesity, tobacco use, pain, behavior health disorders, violence and infectious disease.

Before debating the issues, the delegates heard from experts in each major issue area, and for the first time continuing medical education (CME) credit was offered for these educational sessions. Final reports detailing the actions taken by the delegates are posted at www.cmanet.org/hod.

Winter 2017

NEW PRESIDENT OF CMA PROMISES TO RESTORE VALUE TO THE PROFESSION Ruth Haskins, MD, was installed as CMA’s 149th president. In her address to the delegates, she promised that in the face of the big changes taking place in health care and the overarching administrative burdens that have been placed on physicians, she would bring back value to the profession of medicine during her year as president.

“For most of us, being physicians is not something we do’, it is something we ‘are,’ she said. “ We need to be valued for the sacrifices we have made to earn our professional titles. We dedicated years of our lives for our education and training – giving up social events, missing holidays.”

“We need to be valued for what we give up every day as we try our best to remain passionate about our work,” she said. “The responsibility of life and death decisions, compounded by administrative burdens often feels overwhelming.”

“The public needs to know how much we’d rather be touching our patients than stroking our electronic medical record keyboards; how much we’d rather be enjoying family time or exercising than completing charts at home every evening. We need to be valued for the hours of time we spend agonizing over details about our patients’ health and the business of our practice: time we will never be compensated for.”

Dr. Haskins, an ob-gyn practicing in Folsom, has been a member of CMA and the Sierra Sacramento Valley Medical Association for 23 years.

She served on the CMA Board of Trustees from 2013-15 and as chair of the CMA Council on Legislation from 2010-13.

Dr. Haskins is a U.S. Air Force veteran who began active duty while enrolled in the University of Pittsburgh School of Medicine. She completed her residency in Obstetrics and Gynecology at the David Grant USAF Medical Center at Travis Air Force Base before transferring to the Illinois-based Scott Air Force Base Medical Center, where she later became chair of the department of obstetrics and gynecology.

Dr. Haskins progressed to the rank of major in the military and was involved in the readiness campaign for Operation Desert Storm and Desert Shield in the early 1990s. The strength of her loyalty to her country is only matched by her passion for her hometown heroes, the Pittsburgh Steelers. Her fervor for sports and appreciation of great teamwork feeds into her enthusiasm for restoring the joy and value of the practice of medicine.

“California’s physicians are fortunate to have a champion for health care on their side,” said outgoing CMA President Steve Larson, MD, MPH. “Dr. Haskins brings energy and enthusiasm into everything she does, and I know she’ll provide the leadership needed to help tackle the health care challenges facing California.”

Winter 2017

THE PUBLIC NEEDS TO KNOW HOW MUCH WE’D RATHER BE TOUCHING OUR PATIENTS THAN STROKING OUR ELECTRONIC MEDICAL RECORD KEYBOARDS.

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House of Delegates > 2016

2016-2017 EXECUTIVE COMMITTEE Joining Dr. Haskins on the Executive Committee are:

Theodore M. Mazer, MD

Tanya Spirtos, MD

Robert E. Wailes, MD

Lee T. Snook, Jr., M.D

David H. Aizuss, MD

Steven E. Larson, M.D

President-Elect: Theodore M. Mazer, MD, was elected president-elect and will serve in this capacity for one year, taking office as president during next October’s annual meeting. Dr. Mazer is a board-certified otolaryngologist who has been working in a small, solo practice in San Diego for more than 25 years. A CMA member since 1988, Dr. Mazer served on the association’s Board of Trustees from 2002 to 2010, speaker of the house from 2013 to 2016, and has chaired various committees, including those focusing on medical services and access to specialty care.

Speaker of the House: Lee T. Snook, Jr., MD, a Sacramento pain management specialist, was elected Speaker of the House. A CMA member since 1985, Dr. Snook has served as chair of the CMA Worker’s Compensation Technical Advisory Committee and as a member of CMA’s Board of Trustees. Dr. Snook has served as vice speaker of the CMA House of Delegates since 2011.

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Vice Speaker of the House: Tanya Spirtos, MD, a Redwood City obgyn was named Vice Speaker. Dr. Spirtos has been a member of CMA since 1985, serving on the CMA Board of Trustees since 2009 and on the CMA delegation to the American Medical Association.

Chair of the Board: David H. Aizuss, MD, an ophthalmic surgeon from Los Angeles, will be returning as chair of the CMA Board of Trustees, a position he has held since 2014. Dr. Aizuss, a CMA member since 1981, previously served as vice chair of the board from 2011-2014, and is a former president of the Los Angeles County Medical Association and the California Academy of Eye Physicians and Surgeons.

Vice Chair of the Board: Robert E. Wailes, MD, a pain specialist and board-certified anesthesiologist from Encinitas, will be returning as vice chair of the Board of Trustees, a position he has held since 2014. Dr. Wailes, a CMA member since 1982, has served

as president of the San Diego County Medical Society and represents the American Academy of Pain Medicine at the American Medical Association.

Immediate Past President: Steven E. Larson, MD, a board certified internist and infectious disease specialist from Riverside, will serve one last year on the Executive Committee as immediate past president. Dr. Larson, a CMA member since 1980, is the current CEO and chairman of the board of Riverside Medical Clinic and is also a delegate to the American Medical Association, serving as vice chair of the Pacific Rim Delegation.

Full bios for the Executive Committee members are available at www.cmanet. org/about/cma-governance.

Winter 2017

Free to FMMS/CMA Members!

This month’s Office Manager’s Forum is held on Wednesday, January 25, 2017 from Noon to 1:30 p.m. at Fresno Madera Medical Society. Event includes complimentary lunch and presentation.

LEGAL UPDATES: KEEPING YOUR PRACTICE COMPLIANT An overview of changing employment and healthcare laws in 2017.

January 25, 2017 - Noon to 1:30 p.m.

Mr. Jamison’s 30 plus years of law practice encompass a wide variety of trial practice in business disputes, land use issues, insurance litigation and healthcare litigation. He has represented hospitals and physicians in a wide variety of healthcare disputes that include, among others, government obligations for indigent care, physician discipline, and closed departments.

Mr. Littlewood practice is focused on employment and complex civil litigation. Bill has practiced in the Fresno community since 2002, joining Dowling Aaron’s Employment Law and Business Litigation Practice Groups in 2015. Bill has more than 16 years of litigation experience handling all facets of legal matters in the state and federal courts, at both the trial and appellate court levels.

Office Mangers of Fresno Madera Medical Society Members are always FREE and Office Managers of Non-Members are FREE for first event ($20 thereafter).

Registration required, call (559) 224-4224 ext. 110 or email info@FMMS.org.

Winter 2017

Fresno Madera Medical Society 1040 E. Herndon, Suite 101 Fresno, CA 93720

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t n e m e L I F E T I M E AaCcH I E V E M ENT v e i h e m i t e f i l generous • focused • passionate • pioneers

T H A T S E N T R I P P L E S A C R O S S T H E VA L L E Y Story by Erin Kennedy Photos by James Ramirez

“Generous”, “intently focused”, “passionate about making a difference”, “pioneers who lead the way in medicine”, and “service to others” –

those were the words used to describe all five of the physicians honored by the Fresno Madera Medical Society with Lifetime Achievement honors and a Special Project Award for 2016.

T

wo were first in their field in Fresno County and continue to grow their specialty in the Valley, mentoring others to follow in their footsteps and serve patients here. One found his niche in rural healthcare, encouraging primary care practitioners to find a higher calling in small town medicine. Another found a life of service after medicine in doing volunteer civic work to help troubled children. And the special project honoree helps give cancer patients a voice through artistic expression.

All have left an indelible mark on our region. Their influence continues to spread like ripples in a pond. >>

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t

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Lifetime Achievement > 2016

DR. CHR ISTOPHER PER K INS

The Medical Society’s 2016 Lifetime Achievement Award winners include: Robert Libke, MD, the first infectious disease specialist in central California, who is teaching the next generation as chief of infectious disease for UCSF Fresno Andre Minuth, MD, the first nephrologist in the Fresno region and a retired UCSF Fresno internal medicine faculty member, who still staffs the UCSF Fresno renal clinic and represents medical views in the political arena Morton Rosenstein, MD, former Chief of Obstetrics and Gynecology at St. Agnes Medical Center, former Fresno County Grand Jury foreman, board member emeritus of the Central Valley Community Foundation and Fresno Regional Foundation Alex Moir, MD, who was Chief of Family and

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Community at UCSF Fresno before his death in December 2015, and also served as Chief of Medicine at the Selma District Hospital Christopher Perkins, MD, medical oncologist with California Oncology of the Central Valley, and founder of the Art of Life Cancer Foundation ‘Mr. Infectious Disease’ After a stint as a U.S. Air Force flight surgeon and a clinical instructor at UCLA, Dr. Robert Libke landed in the Valley in 1978 as a UCSF faculty member and the only specialist in infectious disease in the region. Through his nearly three decades with UCSF Fresno he’s trained more than 600 medical residents and convinced scores to join him in treating patients in Central California. His patients remember him as the guy who quietly figured out the most difficult diseases and his colleagues as the one they turn to for answers.

“For decades he was ‘Mr. Infectious Disease’ for Fresno,

Winter 2017

Family Tree > Growing Local Physicians

DR. MORTON ROSENSTEIN

rounding at all the hospitals, serving as Infection Control Officer, becoming the resource for Valley Fever for the region,” said Michael Peterson, MD, Associate Dean of the UCSF Fresno Medical Education Program and Chief of Medicine at UCSF Fresno. Dr. Libke has literally written the textbook chapters on Coccidioidomycosis (Valley Fever) that many medical students turn to.

“He has been just extraordinary – the work he put into the Valley and the breadth of what he did as a professional infectious disease specialist. In addition, he really loved and was committed to the academic environment,” Dr. Peterson praised.

Dr. Libke’s commitment to academics meant he’s chaired the academic review board that oversees all the UCSF research at Community Medical Centers for decades and he was fundamental in establishing the UCSF fellowship program in infectious disease in 2008, said Dr. Peterson. “I think his fellows would say he’s one of the smartest people they’ve ever worked with. He’s probably forgotten more in infectious disease then they

Winter 2017

are going to learn,” he added.

“Dr. Libke is someone who is really matter-of-fact about the huge encyclopedia of knowledge that he has and he kind of shares that knowledge with you in a way that you think ‘Of course it’s that,’” agreed Dr. Ivan Gomez, program director of the UCSF Fresno’s family and community medicine department and the Valley’s only pediatric HIV/AIDS specialist.

The second infectious disease specialist to arrive in Fresno, Dr. Herbert Boro, said he and Dr. Libke shared call duties for three decades and it was from Dr. Libke that he learned how to inject amphotericin B into the back of the neck, by cisternal puncture — which was the preferred way to treat Valley Fever patients in the 1980s.

In his typical low-key way, Dr. Libke gave him a crash course, having him watch one, then assist on a second.

“And then the third one he watched me do it. The fourth one he waited at the nurses station while I did it alone. . . out of the goodness of his heart he mentored me along,” said Dr. Boro.

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Where else but in the Army would a neurologist need to check the natural habitat of hyenas before making a diagnosis, or a plastic surgeon get to use her skills on secret service agents, or a pediatrician have the chance to conduct a yearlong health follow up of the Pentagon’s 9-11 survivors?

Listen to these physicians describe the advantages of serving their country while they were learning their craft and you’ll be ready to enlist too: no medical school debt, great benefits, good pay, access to work with top experts, international postings, no worries about billing patients and fascinating, exciting work. >> Dr. W. Eugene Egerton, a pediatrician with a specialty in adolescent medicine, was in charge of health care for West Point’s military academy cadets, headed the Army’s population health program and oversaw the “Pentagon Post-Disaster Health Assessment” after September. 11, 2001. Dr. Egerton, who was named Saint Agnes Medical Center’s Chief Medical Officer in Septemberember, signed up for better residency pay than he could get as a civilian, but stayed 23 years in the Army because he kept getting promoted to more interesting jobs.

Dr. Robin C. Hardiman’s military resume includes trauma surgery for victims of a major earthquake, casualties from the U.S.’s largest mass murder at the time and the crash of a U.S. Secret Service SUV. Hardiman, a plastic and reconstructive surgeon at Kaiser Permanente Fresno, has a special framed commendation from the Secret Service hanging in her office.

The frames hanging on the walls of Dr. Cong Z. Zhao’s University Neurology Associates office on the campus of Community Regional Medical Centers contain a photo of her in fatigues holding a machine gun from her basic training days and an aerial photo of the herringbone architecture of Landstuhl Regional Medical Center in Germany.

She calls her time at Landstuhl, the largest military hospital outside of the United States, “a very strange practice” that prepared her for any odd case that could come her way now.

D RCENTRAL . A NVALLEY D R EPHYSICIANS M I N U T H A N D H I S W I F E M A R Y J I M Winter E N E2017 Z

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Lifetime Achievement > 2016

Another infectious disease specialist, Naiel S. Nassar, MD, who was mentored by Dr. Libke after joining the UCSF Fresno internal medicine faculty in 2006, said, “I always ask his advice because no one is more politically savvy about what is going on in hospitals in this town than him.”

Dr. Nassar describes his mentor’s style as tireless and meticulous. “He never cuts corners. When you read the notes he leaves on patients they are amazingly complete.”

“Nobody can fill Dr. Libke’s shoes,” Dr. Nassar continued. “It’s not only that he’s extremely good at everything he does, it’s also that he’s extremely well-liked.

We always want Dr. Libke to be around taking care of patients and sharing his knowledge.”

Dr. Libke in his usual self-effacing way said the most rewarding part of his career has been “seeing the cadre of people doing infectious disease work now in Fresno.”

He added “How can you get an award for doing things that are rewarding? I don’t feel like I’ve done anything extraordinary.”

Passionate about politics Andre Minuth, MD, the Valley’s first nephrologist had a similar reaction: “I’m not the most deserving one by far, it’s just that I know I’ve outlived the ones who deserve it more.”

Roydon Steinke, MD, disagreed: “He did pioneering work in nephrology in Fresno. He started the first outpatient dialysis clinic in Fresno and he did some home dialysis which was considered quite radical at that time. He even served as a dialysis doctor on cruise ships allowing people who wouldn’t normally be able to go on cruises to go.”

Dr. Minuth also started the Fresno Nephrology Medical Group and grew it to 19 physicians.

Nephrologist Hemant Dhingra, a clinical professor at UCSF Fresno, also had high praise for his commitment to training the next generation of nephrologists. Despite being in his 80s, he continues to teach two days a week in the clinic at Community Regional Medical Center.

Anesthesiologist Virgil Airola met Dr. Minuth in his early instruction days when Dr. Airola was a medical student at Baylor College of Medicine in Houston, Texas, and took an elective in nephrology. Dr. Minuth was his attending fellow. Even early in his teaching career, Dr. Airola was impressed: “Andre was phenomenal. He let

me do everything that you could imagine. I got to work with patients in the hypertension clinic. He let me write prescriptions. He let me present the cases to him. Because I liked that rotation so much I asked the dean if I could do an extra two weeks.”

Described by his colleagues as a passionate and complex man, Dr. Minuth is known as much for his involvement in politics—including an unsuccessful run for Congress— as for his work with patients with kidney disease.

“Andre let us know in the medical community that politics is important. He convinced me to be a delegate to the California Medical Association,” said Dr. Steinke, an OB/Gyn in Fresno. “He mentored all of us younger delegates and taught us all about ‘Roberts Rules of Order’ and how to debate. He participated aggressively in debate and never shirked from controversies.”

During his congressional campaigning, Dr. Minuth had to seek support even from Democrats, joked Dr. Steinke.

“One of the interesting things he did was he got a haircut every two or three days in some obscure barbershop in a small town as a way to introduce himself to the community.”

Dr. Minuth’s unique views are partisan and often colored by his experience as a displaced person, Dr. Dhingra said. “He looks through a Republican glass,” Dr. Dhingra elaborated. “He’s well-read and he’s passionate about what he believes. One thing you don’t want to do is enter a discussion about being a Republican or a Democrat with him. That will be a two-hour discussion!”

Dr. Airola said he continues to be amazed at Dr. Minuth’s boundless energy and generosity in helping others, and in working to make a difference in medicine through politics. “Andre is a wizard. He’s always involved and always smiling. He helps energize any discussion.

When we interviewed state legislators or candidates for city council or county supervisor, Andre was asking the tough questions. He was advocating for his patients and for his fellow doctors…I don’t think he’ll ever retire” True public servant It has been in retirement that Morton Rosenstein, MD, really has made his mark on the Valley. “He had a solid career in obstetrics and gynecology, but since then he’s participated in so many facets of community service I’d have to print his CV to get all the details,” praised Dr. Boro who nominated him for the lifetime achievement award.

SAFE Opioid Prescribing The healthcare community in Central Valley has seen an increase in problems arising from the use of prescription pain management medications.

The Central Valley Opioid Safety Coalition has planned a lecture series that will raise the level of understanding of this critical issue. The 3-part lecture series includes topics about Understanding Pain, the Management of Chronic Pain, and Safe Prescribing.

September 21, 2016 - Understanding Pain - Completed November 9, 2016 - Management of Chronic Pain - Completed January 25, 2017 - Safe Prescribing

Wednesday, January 25, 2017

Roneet Lev, MD Emergency Medicine

Director of Operations Emergency Department, Scripps Mercy, San Diego

CME Dinner Event

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1.5 CME

January 25, 2017 - 6 PM Fort Washington Country Club 10272 N Millbrook Ave., Fresno, CA

the number of people who die everyday from prescription opioid overdose

Preregistration is required - No charge Please register online at www.fmms.org or by calling (559) 224-4224. Registration must be received by January 23 to be a guarantee participant.

Accreditation Statement: The Fresno Madera Medical Society (FMMS) is accredited by the Institute for Medical Quality/California Medical Association (IMQ/CMA) to provide continuing medical education for physicians.

Credit Designation Statement: FMMS designates this live activity for a maximum of 1.5 hours AMA PRA Category 1Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Lifetime Achievement > 2016

“It goes way beyond medical practice, but it is driven by a heartfelt interest in the welfare and the health of a community,” Dr. Boro said. “And his influence spans anywhere from the foster parents organization to establishing the Value Care HMO in Fresno in the 1980s, to helping young adults who are in trouble with the law.”

After 40 years in medicine, which included founding the Women’s Healthcare of Central California medical group, Dr. Rosenstein said he was eager to give back to his community in other ways so he volunteered first for the Fresno County Grand Jury and became foreman during his second year. His investigations there led to a deep interest in foster children and to his work with the then struggling Fresno Regional Foundation. He became an ad hoc CEO of the foundation and then board chairman and continues in a role as a board member emeritus.

While on the grand jury in 2003 and 2004, Dr. Rosenstein found that Fresno County’s 2,800 foster children were moved an average of 4.8 times, that social workers were inadequately trained and many didn’t make the required visits to the children under their supervision, and that the various agencies charged with foster care didn’t really talk to each other.

“The foster care system needed a lot of work and support,” said Dr. Rosenstein who volunteered for the county’s newly formed Foster Care Oversight Committee and chaired the advisory group for 10 years. “The committee was responsible for getting a lot of improvement in getting foster kids to go on to secondary education.”

Those connections in education led Dr. Rosenstein to help establish Focus Forward in 2005.

The community benefit organization works with youth in the Fresno County juvenile justice and foster care systems to provide access to clothing, cultural arts, mentoring, higher education, and scholarships.

Dr. Boro described his friend as “humble and low-key.” He explained, “Dr. Rosenstein is a very thoughtful person, and he doesn’t contribute with bombast and excitement, but rather with solid responses to problems and problem-solving. He

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CENTRAL VALLEY PHYSICIANS 39

completed leadership courses from three different organizations and brought those skills back to the Valley.”

Dr. Rosenstein said that lending his organizational and leadership skill has been a “super rewarding” way to spend his retirement. “To be able to really give back to your community is important. I’d really like to encourage you all to find an interest in some community organization and donate some of your time and your knowledge and skills to make our community a better place.”

Role model for family physicians Alex Moir, MD, definitely left the communities where he worked “a better place,” say the colleagues who worked with him. Dr. Moir, Chief of Family and Community Medicine at UCSF Fresno, was on a family vacation in Canada when died in a skiing accident on Dec. 19, 2016, at the age of 53.

His greatest legacy was in epitomizing the traditional

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small town doctor and modeling that for his students. It was his character—not his achievements— that people remember and miss.

“Dr. Moir was a special kind of doctor especially in the 21st century,” said Dr. Peterson, Associate Dean of UCSF Fresno where Dr. Moir spent his entire 20-year career.

“He was really the true family and community physician.

He really cared about more than the patients in front of him; he really cared about the larger community. It was especially noteworthy that he was a transplant to the Valley but he fell in love with the Valley.”

Dr. Moir’s patients would often opt to wait weeks to be seen by him rather than get an earlier appointment with someone else, said Dr. Gomez. ” Selma is kind of a small town and whenever we would go into town to a restaurant to eat lunch, he knew everybody by their first name. He was really a fantastic role model to try to emulate.”

Arlin Venturina, MD, who worked with Dr. Moir for

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DR. ANDRE MINUTH AND HIS WIFE MARY JIMENEZ

14 ½ years agreed: “Dr. Moir’s patients adored him. He was sincere and he was genuine. That was something he instilled in the residents he worked with. When the waves were rocky he was our anchor; we knew we were going to okay. He also knew how to make you feel appreciated.”

Self-effacing and completely unflappable is how Alex Sherriffs, MD, a UCSF family and community medicine faculty member and geriatrics specialist, described his former colleague. “He was so humble but he could make everyone he encountered feel important, feel empowered.

He was always calm in the midst of a storm, and because of that it was always hard to tell by looking at him whether things were going well or not well. He was very steady.

He was very persistent. He had a huge commitment to increase access in the Valley, to get physicians to stay in the Valley, and particularly to work in underserved and rural areas.”

Dr. Moir’s approach to medicine continues to live on

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in the students he mentored. “All of us remember the physicians who taught us,” Dr. Peterson said. “We all take a little piece of them into our careers, and so the fact that Dr. Moir really set the kind of tone and example that he did, for many decades to come the healthcare that happens in this Valley is going to be tied directly to the model that he provided for his trainees and the people he worked with.”

Healing through Creative Expression In the same way that Dr. Moir’s example has created ripples of commitment to rural medicine, Oncologist Christopher Perkins said the program he founded has created “a great ripple effect” with multiple generations being touched by better understanding and compassion for all those affected by cancer.

Dr. Perkins had a long history of medically caring for cancer patients through their most difficult challenges but

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41

Lifetime Achievement > 2016

he wanted to do even more for the emotional well-being and spirit of his patients. “’Art of Life’ started in 2007 with one mission to inspire people affected by cancer to connect and heal through creative expression,” explained Janell Higton, Executive Director of the Art of Life Cancer Foundation and practice administrator of California Oncology of the Central Valley.

“Dr. Perkins’ greatest joy was seeing his patients grow during life’s most difficult moments. And he found that while partnering local survivors with artists, they were able to tell their stories in a way they were never able to express before, with words

and focus on what the cancer had taught them about life.”

Dr. Perkins said his patients light up when they talk about their experience with the “Art of Life” program. “I’ve heard everything from ‘I learned that I wasn’t alone; to ‘This empowered me to be more in control of my life,’” Dr. Perkins said during an interview by his foundation staff. “A lot of patients can’t even put it into words, they just cry. They’ve expressed very deep, profound emotions about their experience…There is an immeasurable effect on the world through these patients as they become more intact individuals.”

The program, which started with

30 cancer survivors from Perkins’ practice, has been expanded to include any cancer patient or survivor, no matter what stage of cancer and no matter where they were treated. So far, more than 500 have teamed up with local artists to share their cancer journey and the insights they learned. And in 2015, the Art of Life Cancer Foundation broke ground on a 3-acre healing garden in Fresno’s Woodward Park.

“The healing garden was inspired by survivors but is truly meant for anyone that’s going through a difficult times,” Higton said. “The healing garden reminds us to be still, to celebrate life, to love openly, to always remember and to fight on …

I think this transcends cancer.”

The mark left by this year’s Fresno-Madera Medical Society INC. honorees on the Valley transcends far beyond A REGISTRY & PLACEMENT FIRM the direct care they provided to patients: they mentored others in their specialties, they Nurse Practitioners ~ Physician Assistants encouraged research, and they used politics and social service to truly improve the health and welfare of our region. The ripples of their impact reaches far throughout our region.

Tracy Zweig Associates Physicians

Locum Tenens ~ Permanent Placement Voice: 800-919-9141 or 805-641-9141 FAX: 805-641-9143

tzweig@tracyzweig.com www.tracyzweig.com

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Winter 2017

Do you know What, When and How to Report Child Abuse?

FREE ONLINE COURSE! 

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Guidelines for questionable situations Learn definitions, requirements & expectations Recommended for ALL healthcare providers Course developed by the Child Abuse Prevention Center Approved for 1.25 AMA PRA Category 1 Credits™ / CE credits Course available 24/7 Register NOW at: Winter 2017

http://www.imq.org/education/caprrc.aspx CENTRAL VALLEY PHYSICIANS

43

CL

DS

F I S IE S A

FOR RENT POSITIONS AVAILABLE Medical Consultants Needed for Fresno Field Office This is an excellent opportunity to help your community and to obtain valuable experience. The Department of Consumer Affairs, Division of Investigation, Health Quality Investigation Unit is seeking well-qualified individuals to be a Medical Consultant for the Fresno Field Office.

Are you interested in being an integral part of the Medical Board of California enforcement process? Do you have the ability to conduct interviews, exercise sound judgment in reviewing conflicting medical reports and preparing opinions, analyzing problems, and taking appropriate action?

Interested individuals must submit an application for examination.

Paste this link into your web browser for additional information and instructions: (https://jobs.ca.gov/JOBSGEN/5CACC. PDF).

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CENTRAL VALLEY PHYSICIANS

If you have any questions please contact Herbert Boro, MD, F.A.C.P. with the Health Quality Investigation Unit in Fresno at (559) 447-3045 or by Email at herbert. boro@mbc.ca.gov.

Family/ General Practice Physician Needed A multi-disciplinary organization is looking for a FP/GP/DO/Medical Director for our Fresno medical office. Candidates must have an active CA license.

As a member of our team you will enjoy a Monday-Friday workweek, no weekends, late nights, or hospital calls. Part time and full time available!!

Medical or Business office space Medical office space, 1331 square and 1319 feet. Many new exterior improvements.

1046 and 1060 E. Shields Ave. Contact Shannon Mar, (559) 999-6165 or smar@guarantee.com

FOR SUBLEASE Class A Medical Office Space, approximately 1500 square feet.

1781 East Fir Avenue, Suite 102, available 7/1. Rent: $2250 plus security deposit. Contact Robert at (559) 800-7476 or administration@cvphysiatry.com

Benefits include 401K, health, dental and vision insurance.

Great-pay, potential to bonus by performance criteria and protocol. 100% employer paid malpractice.

For immediate consideration please submit your CV by email to matt@ firsthealthmedical.com or by fax to (559) 435-3462.

If you would like to submit a listing to our Classifieds, contact nbutler@ fmms.org. Listings are free for members with reasonable rates for nonmembers.

Winter 2017

MEET NICOLE Nicole Tenorio Joins Fresno Madera Medical Society New Marketing/ Event Coordinator My name is Nicole Tenorio and I’m the new Marketing/ Event Coordinator for the Fresno Madera Medical Society. I will be working to develop and coordinate relevant educational and social workshops/ events for physicians, their offices and residents.

My background includes over 4 years of experience in event coordinating and most recently was the director of a local event venue.

With only two weeks under my belt in this position, we hit the ground running

Promoting the science and art of medicine, the care and well-being of patients, the protection of the public health and the betterment of the medical profession.

with our first every Family Movie Night in which we partnered with Fresno PACE to provide gifts for senior citizens.

Thank you all for coming out and for your donations, it was a huge success!

The following day we organized, wrapped, and sent off nearly 300 gifts to seniors who might not have received any Christmas gifts this season.

I can’t say enough how honored I feel to be working with an organization that impacts the community in such positive ways. Let’s just say, it was the perfect way to start off in a new position. For the members I have met - thank you for such a warm welcome, and I look forward to meeting the members I have yet to meet!

If you have any questions about any upcoming events or have a suggestion of event you would like to do please don’t have hesitate to contact me at (559) 224-4224 ext.

118 or email me at ntenorio@fmms.org.

CONTRACT RENEGOTIATIONS Making Your Business Case When submitting a request to open up a contract renegotiation discussion, best practice is to present a “business case” as to why the payor wants to keep your practice in the network. Failure to present a business case often results in a quick reply from the payor indicating that they are not in a position to renegotiate at this time. To prevent the “auto-reply,” the California Medical Association (CMA) suggests you be thoughtful in your renegotiation request.

To help physicians prepare for negotiations or renegotiations, CMA has created a contracting resource. CMA members can obtain a free copy at www.cmanet.org/resource-library or by calling (800) 786-4CMA.

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CENTRAL VALLEY PHYSICIANS

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Physician-

death: MY VIEW

FREDERICK ELMORE, MD

46

“Do what’s right!” Those words were first spoken to me in 1972 by my friend and fellow first surgery resident Dr. Coleman Arnold. In context, Coleman was saying do what’s right for the patient. This simple phrase became the maxim for our four years of residency and, for me, my subsequent 38 years of private medical practice. Should my patient have an operation? Should it be done now? Should I be the one to do it? As I pondered questions such as these, I would always come back to “do what’s right” (for the patient).

But how do we know what is right? God has created within each of us an inherent sense of right and wrong. This is present in all people in all cultures. You may think of it as our conscience, or that little voice that nags at us when we prepare to do something that we inherently know is wrong. Christians know it as the Holy Spirit living within us. “And I will ask the Father, and he will give you another Counselor (i.e. the Holy Spirit) to be with you foreverthe Spirit of truth.” (John 14:16-17) Our patients entrust their very lives to us. They expect and trust that as their physicians we will do what is right for them every time and in every circumstance. When a physician encourages or participates in an act of euthanasia, whether the physician directly terminates the patient’s life or indirectly assists the patient in committing suicide, then that physician violates the very trust that is so essential in a physician-patient relationship. Might not a patient ask us: “How can I trust that you will do all you can to heal me, to save my life if you are also willing to kill me, to take my life?”

Included in the Hippocratic Oath is the following statement: “I will neither give a deadly drug to anyone if asked for it, nor will I make a suggestion to this effect.” Hippocrates was a 5th century Greek physician and is known as “The Father of Medicine”. The Hippocratic Oath is one of the oldest binding documents in history and its principles have guided the practice of medicine for centuries. Its foundational principle is that physicians are to cure and relieve suffering without injuring the patient (primum non nocere: first do no harm). Most physicians pledge this oath upon graduation, but even if they do not, the principle still applies and should

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Winter 2017

-assisted guide their practice. Make the moral choice and do what’s right.

Euthanasia unequivocally violates this fundamental principle. Facilitating in the death of a patient, whether direct or indirect, can never be described as doing no harm, no matter the circumstances. One can use all manner of euphemisms focusing on the relief of pain and the lessening of suffering, but ultimately euthanasia results in the death of another human being from unnatural causes. The American Medical Association has affirmed its stance opposing physician-assisted suicide in its Code of Ethics adopted at the June 2016 National Convention.

There is a rising tide of voices in this country encouraging physicians to accept and even participate in euthanasia: asking us to take that irreversible first step down the slippery slope. We must turn away from this assault on our profession. Why? Because our acceptance of euthanasia in any form is dangerous. This danger exists on four different levels: 1. There is danger to the physician. Humans inherently anguish over the death of another person. Anyone who accidentally kills another person in a motor vehicle accident often anguishes over this death for the rest of their life.

Soldiers, who are trained to kill, return from combat changed by the experience, often manifesting post-traumatic stress disorder. Ask a soldier to talk about what he or she has seen and done on the battlefront, and usually the memory is too painful for them to talk about. A physician’s participation in euthanasia can create the same painful memories. And some physicians will take advantage of this power if vested in them. Here in California, after recent passage of a bill allowing physician-assisted suicide, a physician has come out of retirement and now offers his services to assist patients in killing themselves for a cash fee of two thousand dollars.

Remember Jack Kevorkian, the “Doctor of Death”?

2. There is danger to the patient. The Christian Medical Dental Association states that the Netherlands, Belgium, and Switzerland now allow physician‑assisted euthanasia

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for non-terminal illnesses, including treatable psychiatric disorders such as depression and schizophrenia. And there are cases reported when the euthanasia “treatment” did not succeed as planned, causing additional serious medical complications for the patient.

3. There is a danger to the family. In situations where the family decides it is too inconvenient or too expensive to continue taking care of grandmother, do they then decide to end her life? What if one family member arranges for grandmother’s “suicide” without informing the rest of the family? Families have been permanently destroyed over this issue.

4. There is danger to society. It is indeed a slippery slope when laws are enacted which establish a hierarchy of net worth for individuals in our society. First the terminally ill are deemed of no value. Then the old and the infirm.

Who is next, the mentally ill? Babies with birth defects?

It is an historical fact that euthanasia of the mentally ill, intellectually disabled, and handicapped was already well established in Germany and Austria before Adolf Hitler ascended to power. That this practice was already familiar to the populace of these countries greatly facilitated their acceptance of Hitler’s “Final Solution” which led to the killing of almost six million Jews.

Fellow physicians, is euthanasia what we really want for the once noble healing profession of medicine? More importantly, is this what our patients really want from us?

I challenge all of us to listen to that voice within us, telling us that voluntarily ending the life of another person is both morally wrong and dangerous. Yes, we can and we should provide all manner of compassionate care for every patient with all the myriad of resources at our disposal. And yes, this should be provided early in the course of an illness, not just for terminal care. But please, let us disavow euthanasia in any and all circumstances. Let us make the moral choice and let us do what’s right for our patients. Consider what God has to say to us in Genesis 9:5b: “And from each man too, I will demand an accounting for the life of his fellow man.”

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Public Health

Update

Elimination of TB through targeted testing of high risk individuals

Ken Bird, MD Public Health Officer • Fresno County Department of Public Health

Last year in Fresno County, 40 cases of tuberculosis (TB) were identified among county residents. As of November 28, 53 individuals have been diagnosed with the illness, including a local high school student.

This number is considerably lower than the 102 cases reported in 2004, but the fairly steady decline in numbers from 2004 to 2012 (when 35 cases were reported) has stabilized and slightly reversed itself in recent years.

While this infectious illness is not endemic in this country as it is in many parts of the world, and while the incidence

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Winter 2017

nationally continues to slowly decrease, we do not seem to be anywhere near its elimination in the U.S., which is defined by the Centers for Disease Control and Prevention’s Division of Tuberculosis Elimination as fewer than one case per million population.

TB control in this country is accomplished through four activities which include: 1. P rompt identification and adequate treatment of persons that have active disease.

2. P rompt and complete identification of individuals who have been exposed to someone with TB disease, evaluation for TB infection or TB disease in these individuals, and treatment of either infection or disease if found.

3. S creening of all individuals for TB infection risk and testing of those that are known to be at higher risk for infection with TB or at higher risk for developing TB disease if infected.

4. A pplication of control measures in high-risk settings.

FCDPH released a Health Information1 notice to local providers on November 2, 2016 recommending that providers screen all patients for risk for TB infection and test those patients determined to be at higher risk according to tools available from the California Department of Public

There are an estimated 2.1 million persons in California with latent TB infection. For approximately 5-10 percent of those infected, the immune system will not be able to contain the infection, and replicating TB bacteria will cause illness (active TB disease).

The Fresno County Department of Public Health (FCDPH) works closely with local healthcare providers in identifying and treating individuals with TB disease, and with local healthcare facilities in applying control measures in high risk settings. The department works in large part on its own in identifying, evaluating, and treating contacts to individuals with TB disease. These measures are well established and quite effectively implemented in our county, and little can be done to improve their efficacy other than maintaining a higher degree of suspicion of TB for all patients presenting with respiratory or systemic symptoms.

The same cannot be said, however, for the process of screening for TB infection risk, and elimination of TB in this county, this state, and this country depends on its full implementation.

Recently, the United States Preventive Services Task Force, recognizing the importance of this activity, recommended screening for latent TB infection (LTBI) in populations at increased risk, which includes persons who were born in, or are former residents of, countries with increased TB prevalence, as well as persons who live in, or have lived in,

Winter 2017

high-risk congregate settings (such as homeless shelters and correctional facilities).

There are an estimated 2.1 million persons in California with latent TB infection. For approximately 5-10 percent of those infected, the immune system will not be able to contain the infection, and replicating TB bacteria will cause illness (active TB disease). Worse, among the millions in California with TB infection, most are not aware they are infected, but deserve to know and to have an opportunity to prevent disease from occurring.

Health for both adults2 and children3.

On December 08, 2016, FCDPH issued the recommendation to all jurisdiction school districts that all students new to their respective districts be screened as to risk for TB infection using a screening tool jointly approved by the California Department of Public Health (CDPH) and the California Tuberculosis Controllers Association (CTCA). It is further recommended that students found to be at risk for infection be tested for LTBI. Patients and students thus identified, tested, and found to have TB infection should be offered treatment for the infection once TB disease is ruled out by appropriate examination, which would include chest x-ray (and sputum studies as necessary). This LTBI treatment can now be offered as a nine month course of daily isoniazid, a four month course of daily rifampin, or a twelve week course of weekly isoniazid plus rifapentine. This regimen currently requires directly observed therapy as a best practice.

The tools and the knowledge to eliminate TB in our community, and our state, are available to us, but we have to use them.

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CMAWINS BIG AT THE BALLOT BOX

CALIFORNIA VOTERS MADE HEALTH CARE A PRIORITY

Election Night 2016 was one for the history books. Once again, the California Medical Association (CMA) and Fresno Madera Medical Society took on tough fights and prevailed. We won all of our statewide ballot measure endorsements, including three local initiatives in the Bay Area.

Together, we voted to: • Invest in Medi-Cal. (Yes on Prop. 56, 55 and 52)

• Save lives, reduce smoking rates and prevent thousands of children from starting in the first place. (Yes on Prop. 56) • Triple the funding for California’s anti-smoking programs.

(Yes on Prop. 56)

• Prevent an increase in state prescription drug costs, as well as preserve patient access to medications. (No on Prop. 61)

• Provide more essential services like medical check-ups, immunizations, prescriptions and dental/vision care for 13 million low-income Californians, including seven million children.

(Yes on Prop. 52)

• Protect public health and clarify the role of physicians in controlling and regulating the adult use of cannabis.

(Yes on Prop. 64)

• Strengthen California’s ability to prevent gun violence.

• Reduce sugar intake to prevent diabetes and obesity. (Yes on Measures V (San Francisco), HH (Oakland) and O1 (Albany))

• Break down barriers and removed outdated bilingual education mandates to better reflect California’s diverse society. (Yes on Prop. 58) • Ensure critical infrastructure projects – including hospitals and medical facilities – aren’t subject to delays or loss of local control.

(No on Prop. 53)

(Yes on Prop. 63) 50

CENTRAL VALLEY PHYSICIANS

Winter 2017

ELECTION 2016

BY THE NUMBERS Looking ahead In the coming months, we’ll work to ensure the new revenue reaches the communities most in need of access to health care and improved services.

Voters sent a clear signal that they are willing to support investments in public health and that they are tired of Sacramento chronically underfunding health care. CMA’s alignment with voters further demonstrates our strength and ability to fight for physicians throughout the state and in all modes of practice.

$3 BILLION per year in new federal matching funds for Medi-Cal to serve elderly and low-income Californians.

(Yes on Prop. 52)

UP TO $2 BILLION per year to improve access to health care services, including Medi-Cal, for low-income children and their

And on the national front – there are more questions than answers, but one thing is clear: we could be facing a major shake-up.

How will the next Congress and Trump’s administration handle the Affordable Care Act? Rising drug prices? Medicaid expansion? Mega-mergers?

Regardless of what comes next, CMA will continue to keep California’s physicians in the driver’s seat on health care policy.

And we’re working ahead to 2018 to ensure the next Governor reflects our values, including the protection of MICRA and investments in public health.

families. (Yes on Prop. 55)

UP TO $1.7 BILLION (plus $1 billion in federal matching funds) for Medi-Cal. (Yes on Prop. 56)

SAVINGS OF $1.5 BILLION in costs for children’s health coverage by FY 2019-20.

(Yes on Prop. 52)

“I want to thank each of you for your support and

$350 MILLION

dedication to CMA. Your membership drives this

per year in support to state and

organization to excellence. Together, we stand stronger.”

local public hospitals.

(Yes on Prop. 52)

$20 MILLION Dustin Corcoran California Medical Association CEO

per year for public schools to enhance smoking cessation programs.

(Yes on Prop. 56)

Join or renew your membership today! www.cmanet.org/join VALLEY PHYSICIANS 51 Questions? Contact our Member Service Center at (800) 786-4262 CENTRAL or memberservice@cmanet.org.

Winter 2017

Physician Profile > Dr. John Thompson

PHYSICIAN

profile:

DR. JOHN THOMPSON

by Jennifer Seita

Palliative medicine and end of life care isn’t for everyone. It takes a special kind of healthcare provider to dedicate their focus to hospice and palliative care. Dr. John Thompson is one of those physicians.

Dr. Thompson has returned to UCSF Fresno as a Fellow in the Hospice and Palliative Medicine Program after completing his residency there in 2006. On why he chose the specialty of hospice and palliative medicine he simply said, “In a certain way, it seemed natural.”

He’s from a family of care providers; his mother was an LVN in an oncology unit in the 1970s and his sisters were both nurses. Throughout his life he bounced across the United States, living in a total of seven different states. Thompson knew he wanted an advanced degree in something – his mother assumed it would be in law – and at the urging of a counselor at his Sacramento community college, decided to focus on medicine.

He continued his education at University of Arizona, then Kansas City University School of Medicine and finally UCSF for his Family Practice Residency, where he met his wife, Virginia “Ginny” Thompson.

Dr. Thompson knew upon completion of his residency he wanted to specialize in hospice and palliative medicine, but thought it might be smarter to start working immediately to help pay off student loans. He worked in Family Medicine at Kaiser in Sacramento for nearly eight years, when he began to feel the pull for something more professionally fulfilling saying he “was definitely burning out on primary care.”

Dr. Thompson’s life steered into a new direction in 2013 when he woke up intubated in the ICU at UC Davis Medical Center after a terrible car accident. After a week in the hospital and months of rehabilitation to regain his ability to walk, he realized this was his opportunity to fulfill his desire to specialize in hospice and palliative care.

Palliative Medicine is an emerging niche in the healthcare industry due to the increasing clinical complexity of patients. Most people are familiar with hospice care, but palliative

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Winter 2017

medicine is still unclear, even to some in the industry. Palliative medicine is the management of chronic illness for those still actively treating their disease. Palliative care doctors work closely with the patient and their family to provide relief from symptoms, pain, physical stress and mental stress of a serious illness – whatever the diagnosis. On the other hand, hospice care is comfort care for patients in the last phases of an incurable disease.

Dr. Thompson’s personal and professional experiences have shaped who he is as a physician. He credits listening to his mother talk about the suffering of oncology patients and others at the end of life as part of what made him decide to go into palliative and hospice care. His work as a Patient Care Technician in the BMT/ Oncology unit as an undergraduate allowed him to see the totality of the patient experience, reinforcing his desire to pursue this specialty.

Each person has their own idea of what it means to live, and Dr. Thompson helps guide his patients through informed decisions as they approach the end of their journey.

Said Dr. Thompson, “My job is to talk with the patient and family, find out their goals and fill in the gaps for care. We align patient’s wishes with intensity of care or vice-versa. It sounds really morbid, but the best part of this job is hearing from a family after a ‘good’ death.”

Dr. Thompson is half-way through his fellowship and looks forward to completing his program. Although he’s open to options, he would like to return to The Permanente Group in Sacramento to finish his career.

Central California Available Medical Office BAKERSFIELD - David A Williams, Jason Alexander & Cameron Mahoney 10000 Stockdale Hwy. #102 Bakersfield, CA 93311 | Ph 661 631 3800 For Sale 8301 Brimhall - 7,500 sf 3535 San Dimas St. - 4,620 sf 820 34th St. - ±33,000 sf 3941 San Dimas #103 - 3,959 sf 8307 Brimhall - 27,000 sf Lease 820 34th St. - 7,500sf 9508 Stockdale Hwy - 2,443 sf 8307 Brimhall - 2,000 - 27,000 sf 3535 San Dimas - up to 4,620 sf 8301 Brimhall - 2,000 - 7,500 sf FRESNO - Bobby Fena, Michael Schuh & Beau Plumlee 7485 N. Palm Ave. #110 | Fresno, CA 93711 Ph 559 221 1271 For Lease 560 E. Herndon - up to 15,247 sf 1360 E. Herndon - 16,475 rsf www.colliers.com

Fresno Madera Medical Society

66th Annual Yosemite Postgraduate Institute March 24 - 26, 2017

Registration is now open - Call (559) 224-4224 ext. 118 for more information or visit www.FMMS.org

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Walk with a Doc Take a Step Towards Better Health Walk with a Doc is a FREE walking program for anyone who is interested in taking steps to improve their heart health.

Each walk is hosted by a friendly, local physician. In addition to numerous health benefits received just by walking, you will also get the chance to talk with a doc.

FRESNO

2016 SCHEDULE

MADERA

Where: San Joaquin River Where: Lions Town & Parkway & Trust Country Park- Pavilion 11605 Old Friant Rd 2300 Howard Rd Fresno, CA 93730 Madera, CA 93637 When: 3rd Saturday When: 1st Saturday Time: 8:30 am Time: 8:30 am Dates for Fresno Dates for Madera February 20 February 6 March 19 March 5 April 16 April 2 May 21 May 7 June 18 June 4 July 16 July 2 August 20 August 6 September 17 September 3 October 15 October 1 November 19 November 5 December 17 December 3 54 CENTRAL VALLEY PHYSICIANS

Join us for Walk with a Doc

For more information or questions, please call Winter 2017 (559) 224-4224 or visit www.fmms.org.

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In Memoriam > Robert Mills, MD

In Memoriam Robert Mills, MD

Robert Mills, MD 10/26/1918 – 12/20/2016

Robert passed away peacefully at home in Carmel with his wife Diane holding his hand as he slipped away.

The middle of three siblings he was born in Cleveland, Ohio of Canadian transplant parents, Roy C. Mills and Ida Rau Mills. He attended Cleveland schools, graduated from Ohio University in Athens, Ohio, and received his medical degree in 1946 from Case Western Reserve University in Cleveland. After four years of surgical residency in Minneapolis he spent two years as a surgeon in the Air Force in Arizona, followed by two years of specialty training in colorectal surgery. A Fellow of the American College of Surgeons, Robert set up a private medical practice in Fresno in 1955, retiring after thirty years in 1985.

Having played high school and college tennis he enjoyed participating in the sport throughout most of his adult life. Since his late 30s he held a special interest in working with local architects and builders in creating six personal homes over these many years in Fresno, Carmel and Indian Wells, CA. Blessed with mental acuity he maintained an interest in the latest technology and always looked forward to new horizons.

He and Diane married in Carmel in 1978, and upon his retirement in 1985 they relocated there to a home they were building. The next years were spent splitting their time between the sea in Carmel and the sun in the desert of Indian Wells.

Robert was predeceased by his sisters Evelyn Mills and Doris Mills Glenny, his son Robert J. Mills, Jr., his grandson Robert J. (Jeff) Mills, III and his former wife Lois Mills Knight.

He leaves behind his loving wife of 38 years Diane (nee Maliani), daughters Bonnie (Dr. Alan) Newhoff of Phoenix and Cynthia Mills of Fresno, grandchildren Melissa Mills, David Newhoff and Morgan Newhoff, two great grandchildren Jordan and Ryan, three nieces and a nephew.

With heartfelt gratitude to cardiologist Dr. Richard Gerber for over twenty years of expert care and to the nurses of the Hospice of the Central Coast for their compassion these last two weeks.

Dr. Robert Mills was a member of the Fresno Madera Medical Society for 40 years

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Fresno Madera Medical Society 1040 E. Herndon Ave., Suite 101 Fresno, CA 93720

PRSRT STD. U.S. POSTAGE

PAID

Permit No. 30 Fresno, CA

State of the Heart

Shawn’s compassion. Your hospital.

SAINT AGNES CARDIOLOGY SYMPOSIUM 2016 Saturday, April 23 • 8 a.m.-2 p.m.

Saint Agnes Medical Center, Shehadey Pavilion 1303 East Herndon Avenue • Fresno, California This symposium focuses on cardiovascular disease management and emerging paradigms in treating coronary and structural heart disease.

It will address practice gaps in disease management and provide education to improve patient outcomes.

Speakers Paradigms of Revascularization for Chronic Coronary Artery Disease Verghese Mathew, MD, FACC, FSCAI Consultant, Division of Cardiovascular Diseases and Department of Radiology Professor of Medicine, Mayo Clinic College of Medicine Protected PCI: Treating Complex Coronary Artery Disease in 2016 Anthony A. Hilliard, MD Assistant Professor of Medicine Director, Adult Cardiovascular Lab Loma Linda University International Heart Institute Invasive Management of Intractable Angina Gurpreet S. Sandhu MD, PhD Director, Dr. Earl Wood Cardiac Cath Lab, Mayo Clinic Like all our people, labor and delivery nurse Shawn Henson’s approach Transcatheter Mitral Valve Therapies to caring for new mothers and their babies is remarkable. She believes every birth is a miracle and makes Oluseun O. Alli, MD every new mother feel like her baby is the most Assistant precious ofProfessor them all. For it’s all about creating of Shawn, Medicine a memory that her patients can cherish.

The best part ofSchool her job?of Medicine University of Alabama at Birmingham Witnessing one of the most amazing moments in a person’s life.

Visit samc.com/maternity-services to view a video Preregistration of our new private rooms.is required • No charge

Please register online at www.samc.com. Registration must be received by April 16, 2016, to be guaranteed a participant syllabus. If you have questions or problems registering online, email medicaleducation@samc.com or call (559) 450-7566.

Registration at the door is dependent on space availability.

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