February 2014

official publication of SDCMS february 2014

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Contents

Volume 101, Number 2

MANAGING EDITOR: Kyle Lewis EDITORIAL BOARD: Theodore M. Mazer, MD, James Santiago Grisolía, MD, Robert E. Peters, PhD, MD, David M. Priver, MD, Van C. Johnson, MD, Roderick C. Rapier, MD MARKETING & PRODUCTION MANAGER: Jennifer Rohr SALES DIRECTOR: Dari Pebdani ART DIRECTOR: Lisa Williams COPY EDITOR: Adam Elder SDCMS BOARD OF DIRECTORS OFFICERS PRESIDENT: Robert E. Peters, PhD, MD PRESIDENT-ELECT: J. Steven Poceta, MD TREASURER: William T-C Tseng, MD, MPH (CMA Trustee) SECRETARY: Mihir Y. Parikh, MD IMMEDIATE PAST PRESIDENT: Sherry L. Franklin, MD (CMA Trustee)

features LOCAL RED CROSS AND KEY COMMUNITY AND BUSINESS LEADERS STRIVE TO PREPARE SAN DIEGO

BY THE AMERICAN RED CROSS SAN DIEGO/IMPERIAL COUNTIES CHAPTER

18

departments

20

4 Calendar • Welcome New & Rejoining Members! • Poetry and Medicine • And More …

Introduction Healthcare Needs: How San Diego Physicians Can Help

22 How the WIC Program Works With Prepare San Diego 23

ed Cross Blood Services and R Prepare San Diego

24 How to Donate Blood in San Diego 24

“San Diego Young Marine of the Year” Hosts Blood Drive

26

A Salute to the Red Cross Service to the Armed Forces Program

28

ed Cross Support at Every Stage of R Military Life

29

8

New Options for Health Insurance Coverage for Your Practice and Employees

BY the CALIFORNIA MEDICAL ASSOCIATION

10

How to Better Define an Office Manager’s Job for a Possible Search

BY GEORGE CONOMIKES

12

Each Moment Matters

BY HELANE FRONEK, MD, FACP, FACPH

14

AT-LARGE ALTERNATE DIRECTORS Karl E. Steinberg, MD, Phil Kumar, MD, Samuel H. Wood, MD, Elaine J. Watkins, DO, Carl A. Powell, DO OTHER VOTING MEMBERS COMMUNICATIONS CHAIR: Theodore M. Mazer, MD (CMA Vice Speaker) YOUNG PHYSICIAN DIRECTOR: Edwin S. Chen, MD RESIDENT PHYSICIAN DIRECTOR: Jane Bugea, MD RETIRED PHYSICIAN DIRECTOR: Rosemarie M. Johnson, MD MEDICAL STUDENT DIRECTOR: Jason W. Signorelli OTHER NONVOTING MEMBERS YOUNG PHYSICIAN ALTERNATE DIRECTOR: Renjit A. Sundharadas, MD RESIDENT PHYSICIAN ALTERNATE DIRECTOR: Erin Whitaker, MD RETIRED PHYSICIAN ALTERNATE DIRECTOR: Mitsuo Tomita, MD SDCMS FOUNDATION PRESIDENT: Stuart A. Cohen, MD, MPH CMA PAST PRESIDENTS: James T. Hay, MD (AMA Delegate), Robert E. Hertzka, MD (Legislative Committee Chair, AMA Delegate), Ralph R. Ocampo, MD CMA TRUSTEE: Albert Ray, MD (AMA Alternate Delegate) CMA TRUSTEE (OTHER): Catherine D. Moore, MD CMA SSGPF Delegates: James W. Ochi, MD, Marc M. Sedwitz, MD CMA SSGPF ALTERNATE DELEGATES: Dan I. Giurgiu, MD, Ritvik Prakash Mehta, MD AMA ALTERNATE DELEGATE: Lisa S. Miller, MD

BY THE DOCTORS COMPANY

34

Physician Marketplace Classifieds

29

36 ICD-10 Webinar Series in 2014

2 february 2014

AT-LARGE DIRECTORS Jeffrey O. Leach, MD (Delegation Chair), Karrar H. Ali, MD, Kosala Samarasinghe, MD, David E.J. Bazzo, MD, Mark W. Sornson, MD (Board Representative), Peter O. Raudaskoski, MD, Vimal Nanavati, MD (Board Representative), Holly B. Yang, MD

Disconnect From Malpractice Risks by Following These Telephone Triage Tips

The Service to the Armed Forces Legacy Partnering in International Services

GEOGRAPHIC AND GEOGRAPHIC ALTERNATE DIRECTORS EAST COUNTY: Venu Prabaker, MD, Alexandra E. Page, MD, Jay P. Mongiardo, MD (A: Susan Kaweski, MD (CALPAC Treasurer)) HILLCREST: Gregory M. Balourdas, MD, Thomas C. Lian, MD (A: Sunny R. Richley, MD) KEARNY MESA: Jason P. Lujan, MD, John G. Lane, MD (A: Anthony E. Magit, MD, Sergio R. Flores, MD) LA JOLLA: Geva E. Mannor, MD, Wayne Sun, MD (A: Lawrence D. Goldberg, MD) NORTH COUNTY: James H. Schultz, MD, Eileen S. Natuzzi, MD, Michael A. Lobatz, MD (A: Anthony H. Sacks, MD) SOUTH BAY: Reno D. Tiangco, MD, Michael H. Verdolin, MD (A: Elizabeth Lozada-Pastorio, MD)

Opinions expressed by authors are their own and not necessarily those of San Diego Physician or SDCMS. San Diego Physician reserves the right to edit all contributions for clarity and length as well as to reject any material submitted.

Not responsible for unsolicited manuscripts. Advertising rates and information sent upon request. Acceptance of advertising in San Diego Physician in no way constitutes approval or endorsement by SDCMS of products or services advertised. San Diego Physician and SDCMS reserve the right to reject any advertising. Address all editorial communications to Editor@SDCMS.org.

All advertising inquiries can be sent to DPebdani@SDCMS.org. San Diego Physician is published monthly on the first of the month. Subscription rates are $35.00 per year. For subscriptions, email Editor@SDCMS.org. [San Diego County Medical Society (SDCMS) Printed in the U.S.A.]

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/////////briefly ///////////////////noted ////////////////////////////////////////////////////////////////////// calendar SDCMS Seminars, Webinars & Events SDCMS.org

For further information or to register for any of the following SDCMS seminars, webinars, workshops, and courses, email Seminars@SDCMS.org.

Covered California: How to SHOP for Health Insurance for Your Practice (webinar) FEB 19: 12:00pm–12:30pm ICD-10 Implementation: Chapters 1, 2, 3 (webinar) FEB 19: 12:15pm–1:15pm Cal MediConnect From a Billing Perspective (seminar/webinar) FEB 27: 11:30am–1:00pm C.U.R.E.S. Sign-up Event FEB 28: 9:00am–5:00pm ICD-10 Implementation: Chapters 4, 5, 6 (webinar) MAR 5: 12:15pm–1:15pm Covered California: What You Need to Know to Inform Your Patients (seminar/webinar) MAR 6: 12:00pm–1:00pm Media Training (workshop) MAR 8: 8:00am–12:00pm ICD-10 Implementation: Chapters 7, 8, 17 (webinar) MAR 19: 12:15pm–1:15pm Certified Medical Compliance Officer (course) MAR 24, 31, APR 7, 14, 28, MAY 5, 12, 19, JUN 2, 9, 16, 23: 10:00am–11:30am

Cma Webinars CMAnet.org/events Transitioning Your Practice: Retiring, Selling, or Buying a Practice FEB 19: 12:15pm–1:15pm Personal Belief Exemptions to Required Immunizations: A New Role for Physicians FEB 20: 12:15pm–1:15pm Fraud and Abuse: Dangers and Defenses FEB 26: 12:15pm–1:15pm

get in touch HIPAA Security Risk Analysis: How to Make Sense of This Requirement MAR 5: 12:15pm–1:15pm

Your SDCMS and SDCMSF Support Teams Are Here to Help!

SDCMS Contact Information 5575 Ruffin Road, Suite 250, San Diego, CA 92123

Community Healthcare Calendar

To submit a community healthcare event for possible publication, email KLewis@ SDCMS.org. Events should be physician-focused and should take place in or near San Diego County.

CTEPH: State of the Art 2014 — A Multidisciplinary Symposium FEB 28–March 1 (www.ccmmeetings.com) The Future of Genomic Medicine VII MAR 6, 7 (www.scripps.org/ events/the-future-of-genomicmedicine-vii-march-6-2014) The SDCMS Foundation’s 2nd Annual Aces for Health Golf Tournament MAR 13 (taking place at the Del Mar Country Club; benefitting Project Access, which provides healthcare to those who need our help most; foursome: $1,000; individual players: $300; sponsorship opportunities available; contact (858) 565-7930 or visit www.sdcmsf.org/golf) 19th Annual Primary Care in Paradise MAR 24, 25, 26, 27 (www.scripps.org/events/ primary-care-in-paradisemarch-24-2014) 29th Annual New Treatments in Chronic Liver Disease MAR 28, 29, 30, 31 (www. scripps.org/events/newtreatments-in-chronic-liverdisease-march-28-2014) Brain Injury Rehabilitation Conference MAY 16, 17 (www.scripps. org/events/brain-injuryrehabilitation-conferencemay-16-2014)

T (858) 565-8888 F (858) 569-1334 E SDCMS@SDCMS.org W SDCMS.org • SanDiegoPhysician.org CEO • EXECUTIVE DIRECTOR Tom Gehring at (858) 565-8597 or Gehring@SDCMS.org COO • CFO James Beaubeaux at (858) 300-2788 or James.Beaubeaux@SDCMS.org DIRECTOR OF ENGAGEMENT Jennipher Ohmstede at (858) 300-2781 or JOhmstede@SDCMS.org DIRECTOR OF MEMBERSHIP SUPPORT • PHYSICIAN ADVOCATE Marisol Gonzalez at (858) 300-2783 or MGonzalez@SDCMS.org DIRECTOR OF RECRUITING AND RETENTION Brian R. Gerwe at (858) 300-2782 or at Brian.Gerwe@SDCMS.org DIRECTOR OF MEMBERSHIP OPERATIONS Brandon Ethridge at (858) 300-2778 or at Brandon.Ethridge@SDCMS.org DIRECTOR OF COMMUNICATIONS AND MARKETING • MANAGING EDITOR Kyle Lewis at (858) 300-2784 or KLewis@SDCMS.org OFFICE MANAGER • DIRECTOR OF FIRST IMPRESSIONS Betty Matthews at (858) 565-8888 or Betty.Matthews@SDCMS.org LETTERS TO THE EDITOR Editor@SDCMS.org GENERAL SUGGESTIONS SuggestionBox@SDCMS.org

SDCMSF Contact Information 5575 Ruffin Road, Suite 250, San Diego, CA 92123 T (858) 300-2777 F (858) 560-0179 (general) W SDCMSF.org EXECUTIVE DIRECTOR Barbara Mandel at (858) 300-2780 or Barbara.Mandel@SDCMS.org project access PROGRAM DIRECTOR Francesca Mueller, MPH, at (858) 565-8161 or Francesca.Mueller@SDCMS.org RESOURCE DEVELOPMENT DIRECTOR Kristina Starkey at (858) 565-7930 Kristina.Starkey@SDCMS.org Patient Care Manager Rebecca Valenzuela at (858) 300-2785 or Rebecca.Valenzuela@SDCMS.org Patient Care Manager Elizabeth Terrazas-Olivera at (858) 565-8156 or Elizabeth.Terrazas@SDCMS.org Office Manager Liz Brave at (858) 300-2789 or at Liz.Brave@SDCMS.org IT PROJECT MANAGER Victor Bloomberg at (619) 252-6716 or Victor.Bloomberg@SDCMS.org IT PROJECT MANAGER Rob Yeates at (858) 300-2791 or Rob.Yeates@SDCMS.org

4 february 2014

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There is a vitality, a life force, an energy, a quickening, that is translated through you into action, and because there is only one of you in all time, this expression is unique. And if you block it, it will never exist through any other medium and will be lost.

— Leo Tolstoy, Russian writer (1828–1910)

”

SAN DI EGO PHYSICIAN.org 5

/////////briefly ///////////////////noted ////////////////////////////////////////////////////////////////////// Erratum

SDCMS-CMA Membership

Welcome New and Rejoining SDCMS-CMA Members!

New Members Maria T. CarriedoCeniceros, MD Family Medicine San Diego • (619) 662-4103

Susanna J-A Park, MD Reproductive Endocrinology San Diego (858) 794-6363

Jack G. Copeland, MD Cardiothoracic Surgery La Jolla • (858) 657-7086

Kari L. Purcott, MD, FACOG Obstetrics and Gynecology Oceanside (619) 278-3300

Robert B. Eisenberg, MD Urology La Mesa (619) 697-2456

Rebecca A. Samuels, DO Internal Medicine Escondido (760) 745-1551

Lewis R. Greenstein, MD Anesthesiology Escondido (858) 673-6100

Nicole Tremain, MD Internal Medicine Escondido (760) 745-1551

Melissa N. Kagnoff, MD Neurology Cardiff by the Sea (619) 582-2595

Ryan B. Viets, MD Diagnostic Radiology La Mesa (619) 460-2770

Rejoining Members Samuel A. Bozzette, MD Infectious Disease San Diego (619) 929-4313 David W. Brunsting, MD Internal Medicine Poway (619) 472-1000 Franklin Galef, MD Internal Medicine Vista (760) 806-5820 Joshua K. Greenstein, MD Nephrology Escondido (760) 745-1551 Emmet W. Lee, MD Internal Medicine Escondido (760) 745-1551

Brian W. Meyerhoff, MD Internal Medicine Escondido (760) 745-1551

www.SanDiegoSafePrescribing.org The No. 1 cause of unintentional deaths in San Diego County is from drugs, with almost one person a day dying in our county from this preventable cause.

The San Diego and Imperial County Prescription Drug Abuse Medical Task Force is a coalition of medical leaders who have joined efforts to reduce deaths and addiction due to prescription drugs. The task force includes pain specialists, internal medicine physicians, emergency physicians, psychiatrists, dentists, pharmacists, hospital administrators, health department administrators, and our local DEA. The task force also includes broad health partners, including Kaiser Permanente, Scripps Health, Sharp HealthCare, UC San Diego Health System, Palomar Health, and the Community Clinics. The task force encourages all medical practitioners to use the materials provided at www.

SanDiegoSafePrescribing.org to improve patient care.

6 february 2014

In the Nov. 2013 San Diego Physician issue’s “My Journey in the World of Medicine” article, the author, Carlos J. Sanchez, MD, who joined SDCMSCMA in 1974, was identified as retired.

Dr. Sanchez is in fact still a practicing physician. Our sincere apologies to Dr. Sanchez.

affordable care act

Surviving the First Months of Covered California: A Tip Sheet for Physicians On Jan. 1, 2014, California’s health benefit exchange, Covered California, began providing health coverage to more than 400,000 patients statewide. With that figure expected to grow by the end of the 2014 open enrollment period, it is critical that physicians and their staff know what to expect. To that end, the California Medical Association (CMA) has published a tip sheet, “Surviving the Second Month of Covered California,” available free to SDCMS-CMA members. To receive this tip sheet, members can email Membership@SDCMS.org.

Become an SDCMS Featured Member!

SDCMS features member physicians for their noteworthy accomplishments in these pages. If you would like to be considered for our next “Featured Member” spotlight, please email Editor@SDCMS. org. Thank you for your membership in SDCMS and CMA!

/////////////////////////////////////////////////////////////////////////////////////////////////// poetry and medicine

Touched Are the days of the personal physician numbered? Will the patient of the future simply type in his complaints, submit his blood to an analytic chip and expose his organs to ultrasound and X-ray? Will his diagnosis and treatment be delivered by machine or the machine’s human mouthpiece? Perhaps. Driven by “efficiency,” drive-throughsuper-high-tech medicine will be one possible tomorrow. But the variety show of human experiences — only some of which we construe as symptoms — will likely defy satisfying computerized analysis. And the innate need for connection will not go away, particularly when pain and dread are involved.

In this day of brassy press releases Touting nuclear scans and gene sequencing, There remains an ancient, quiet communion Between doctors and patients.

In an act part ritual and part practical, They unclothe themselves as before no one else And we touch them. We lay our hands on their Bodies: trembling, tender, blistered, broken.

Defenseless and confessional, they speak The vulnerable truth on the other side of nakedness.

Here’s how I explain it to the medical students: Not cold-blooded like a thief checking for doors ajar Not hot-blooded like a lover seeking to excite But warm-blooded, like a grandmother checking the cheek Of her youngest grandchild for fever and fear.

The examining hands do more than probe On behalf of the inquisitive brain.

As bridges between two human souls They send as well as receive.

While the right hand is feeling for the liver’s edge The left hand is on the patient’s shoulder Closing a circuit of reassurance & safety.

Without fanfare or even conscious awareness The patient feels not just examined But also touched.

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— Daniel Bressler, MD, FACP SAN DI EGO PHYSICIAN.org 7

Covered California

There is no minimum number of enrollees in a particular plan, as there are in many commercial plans. begin offering health insurance plans to employers with 100 or fewer eligible employees, for coverage effective Jan. 1, 2016. Employers can enroll in Covered California’s SHOP throughout the year. Unlike the Covered California marketplace for individuals, there is no designated open-enrollment period for businesses, giving employers the option to enroll either according to their current policy’s renewal date or by another effective date of their choosing.

by the California Medical Association (CMA)

Tax Credits for Small Businesses Small-employer practices may qualify for a tax credit to help offset their contribution to their employees’ premium. There are two phases of tax credits. Starting in 2010 and lasting through tax year 2013, there is a tax credit for businesses with fewer than 25 fulltime-equivalent employees who are paid an average annual salary of less than $50,000.

During this first phase, qualifying employers can receive a tax credit of up to 35% of premium expenses (25% for nonprofits).

Starting in 2014, the maximum tax credit increases to 50% (35% for nonprofits) and is available for a total of two consecutive years. Generally, businesses with 10 or fewer full-time-equivalent employees and yearly wages averaging less than $25,000 will qualify for the highest credits. To qualify for any tax credit, employers must contribute at least 50% of employees’ premium costs. To learn more about tax credits, please consult the “Small Business Tax Credit” fact sheet, which is available at www.CoveredCA.com.

The federal Patient Protection and Affordable Care Act (Affordable Care Act) created a number of provisions to encourage more employers to offer health insurance to their employees. Those provisions include making insurance more affordable and easier to purchase. Small businesses, including physician practices, have excellent access to a range of health plan choices, all available on a single bill and managed on a single online platform.

Covered California’s Small Business Health Options Program (SHOP) is specifi-

Why Buy Through SHOP? Medical practices may find conveniences they would not access through traditional commercial plans. Covered California’s SHOP policies allow employers to easily compare a variety of plans, select the premium contribution and level of coverage they would like to provide, and determine if dependent coverage is available. Employees are then free to choose from among the plans within that tier; there is no minimum number of enrollees in a particular plan, as there are in many commercial plans.

New Options for Health Insurance Coverage For Your Practice and Employees

8 february 2014

cally designed for small businesses with 1–50 eligible employees. This marketplace will allow employers to compare a number of qualified, competing health insurance plans from private insurance companies.

Through Covered California’s SHOP, small businesses will be able to offer different plans to their employees, something that few small employers have been able to do easily until now.

For 2014 and 2015, SHOP policies are available for businesses with 1–50 eligible employees. In 2015, Covered California will

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Practice Management

How to Better Define an Office Manager’s Job for a Possible Search Office Manager Responsibilities Profile

by George Conomikes, CEO, Conomikes Associates Inc. 10 february 2014

In a group practice, different physicians can have varied perceptions of the job of the office manager, which can pose problems when the group is recruiting for a new office manager. The following “Office Manager Responsibilities Profile” is a useful tool that allows each involved physician to provide input.

How to Use the Office Manager Responsibilities Profile Be sure that all physicians complete their profile scoring. For each of the 26 tasks listed, add all the submitted scores. Upon completing the tallies, those tasks that, in the voting of the physicians, add up to the larger scores have greater weight and stronger priorities than those tasks with lesser numbers. The result is a consensus based on the contributions of each involved physician.

Note that other tasks can be added or subtracted to this listing depending on your own practice’s preferences. For some

Office Manager Responsibilities Profile Survey Instructions: To the left of each task listed below, mark your score based on your valuation of that task. Use the following guideline:

3 = Very Important 2 = Important 1 = Somewhat Important 0 = Not Important

Personnel Management: Supervising and directing the work of all employees Independent performance review of all support staff Termination of nonphysician staff Creating job expansion opportunities for personnel Recruiting, selecting, and training nonphysician staff Physician Liaison and Reporting: Participate in perpetuating and ensuring practice growth Identifies, recommends, and implements practice needs: staffing, services, equipment, and facilities Physician/management meetings: establishes agenda in consultation with physicians; prepares data for meeting; contributes to decision-making Responsible for executing projects/changes as directed by the physicians at management meetings Interprets management reports/explains non-normal reports to physicians Ensures that reports to government agencies are on time/liaison with accountant and attorney Fee analysis, survey, and review with recommendations to physicians Negotiates fees and contract terms with major plans Practice Marketing: Practice marketing with patients, referring practices, local businesses, and industry Networking to find out what other practices are doing re: state-of-the-art

practices the investigation and adoption of a new electronic medical record system can be included in the survey. New priorities as well can replace existing ones, e.g., investigation of a possible surgery center.

The advantage to the group of using this office manager responsibilities profile is that the physicians can agree upon a priority of needs, which can then be shared with the newly hired manager.

Mr. Conomikes heads Conomikes Associates, a nationally recognized medical practice consulting firm based in San Diego, which has undertaken more than 1,200 onsite assignments with practices. The firm’s Medical Office Placement Service is endorsed by SDCMS. Mr. Conomikes can be reached at conomikesg@ conomikes.com or at (858) 720-0379.

Financial Management: Preparation of annual budget Manages practice within budgetary guidelines Determines economic aspects of equipment, facility, and new service decisions Responsible and accountable for billing and collection activities Maintains overhead and collection percentages within (best practice) industry standards Responsible for negotiating equipment leases and best prices for supplies (business and medical) Facilities and Equipment: Responsible for facilities and premises management If practice relocates or establishes new location, dealing with architect, contractors, and property management Investigates new equipment and facility needs Self-development: Attends managerial-level and other educational programs.

Possible membership in MGMA (local and/or national) and specialty management groups Subscribes to management publications

SAN  DI EGO  PHYSICIAN.org 11

Personal & Professional Development

I recently listened as a friend expressed her frustrations with her roommate, who often encouraged behavior and ideas that were in conflict with my friend’s values. In an attempt to “look on the bright side,” I remarked that since their lease was coming to an end in a few months, my friend wouldn’t have to endure the situation much longer.

Is this how we want to spend the moments of our lives — just enduring them and wishing they would pass quickly?

Just before this, I received a note from a dear friend. He told me about the wonderful things his children were doing and the happiness of his family. “Life is very, very good in all the important ways,” he wrote. This person had previously suffered with health problems, occupational stress, and other concerns. Were those times of his life any less precious or important than the happier times he was now living?

As the Palestinian poet Naomi Shihab Nye writes:

Before you know what kindness really is you must lose things, feel the future dissolve in a moment like salt in a weakened broth.

What you held in your hand, what you counted and carefully saved, all this must go so you know how desolate the landscape can be between the regions of kindness …

Before you know kindness as the deepest thing inside, you must know sorrow as the other deepest thing.

Each Moment Matters

by Helane Fronek, MD, FACP, FACPh

It’s commonly accepted that the surest way to “spoil” a child is to give him everything he wants, so he never develops an appreciation for anything he has. It’s why psychologist John Rosemond, PhD, encourages us to give our children healthy doses of “Vitamin N” by telling them “no” on a regular basis. In the same way, running from the discomforts — the less-than-perfect episodes in our lives — deprives us of appreciation for the happier times as well as the opportunity for growth, learning, and the strength that comes from knowing we can live and thrive in spite of, and sometimes because of, our challenges.

It would have been better had I asked my friend what she’s learning from living with someone so different: about finding common ground, opening her mind to other ideas, accepting people for who they are. And, more importantly, what she’s finding out about herself: what she knows to be true about life, whether she judges those who are different, how to have compassion when others’ ideas conflict with her own, and where she finds the courage to maintain her own convictions in the face of pressure to change and fit in.

Each moment in our lives matters — the difficult ones as well as the happy ones. While we prefer the latter, it’s possible that the challenging times form the foundation that allows us to enjoy and appreciate those happier moments. It also gives us the confidence that we can make those difficult times worthwhile and meaningful. So, in what ways does this moment matter to you?

Dr. Fronek, SDCMS-CMA member since 2010, is a certified physician development coach, certified professional co-active coach, and assistant clinical professor of medicine at the UC San Diego School of Medicine. You can read her blog at helanefronekmd.wordpress.com.

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Risk Management

Disconnect From Malpractice Risks

by Following These Telephone Triage Tips 14 february 2014

By SDCMS-endorsed The Doctors Company — For more patient safety articles and practice tips, visit www.thedoctors.com/ patientsafety.

Miscommunication is one of the

most common causes of adverse patient events in the physician’s office setting. Telephone triage, a critical part of the patient’s overall care and management, presents a significant area of liability exposure.

Implementing an effective telephone triage system can improve physician-patient communication, confidence, service, satisfaction, and care. It can also reduce emergency medicine department (EMD) visits.

Telephone triage guidelines require accurate assessment without the benefit of a face-toface encounter. For this reason, only licensed professional staff with appropriate training should provide assessments. Patients should be informed in writing about situations that are appropriate for telephone advice.

To avoid some of the risks of telephone triage: • Develop policies and protocols for licensed professional staff to follow. These policies and protocols should: »» Require that licensed professional staff check with the doctor first if there is any doubt about proper instructions or advice. »» Instruct licensed professional staff not to give advice beyond their competence.

• Develop written protocols for staff members who take initial calls but who are not RNs or mid-level practitioners.

These written protocols should: »» Include specific examples of questions to ask the caller, such as: ♦♦ Whom am I speaking to? (Find out whether or not you are speaking with the patient.) ♦♦ What is the reason for your call?

(Use the caller’s own words to describe the situation.) ♦♦ What medications are you taking? What are the dosages and frequency, and how are they administered? ♦♦ Is there anything else you would like me to know? »» Outline the types of calls to either refer immediately to licensed professional staff or to schedule for an office appointment. »» Instruct non-licensed office staff to never practice medicine over the phone.

• Train all staff members to refer a call to the physician immediately if the patient has an urgent or emergent need.

• Document all calls in which medical information or advice is provided. Documentation should include the date, time, patient’s name, name of caller/relationship to patient, complaint/concern/ question, and advice given.

• Document critical negative information that helped determine the advice that was provided. Examples: “Mother stated the child has no fever, no lethargy, or neck stiffness,” and “Mother stated the child has a good appetite and is taking fluids.”

• Establish a reasonable timeframe in which non-urgent calls are expected to be returned. If possible, build time into the physician’s schedule to return calls.

Inform patients when they can expect a return call.

• Review telephone procedures and protocols with staff periodically to ensure that inquiries are being appropriately managed.

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SAN DI EGO PHYSICIAN.org 15 CAP_1402.indd 1

2/5/13 11:13 AM

Natural Disasters & Human Emergencies

Local Red Cross and Key Community and Business Leaders Strive to Prepare San Diego

By The American Red Cross San Diego/Imperial Counties Chapter

16 february 2014

TABLE OF CONTENTS

18

Introduction

20

Healthcare Needs: How San Diego Physicians Can Help

22

How the WIC Program Works With Prepare San Diego

23

Red Cross Blood Services and Prepare San Diego

24

How to Donate Blood in San Diego

24

“San Diego Young Marine of the Year” Hosts Blood Drive

26

A Salute to the Red Cross Service to the Armed Forces Program

28

Red Cross Support at Every Stage of Military Life

29

The Service to the Armed Forces Legacy

29

Partnering in International Services

»

SAN DI EGO PHYSICIAN.org 17

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T

he American Red Cross San Diego/Imperial Counties Chapter is one of the most trusted community service organizations in education, preparation, and response to natural disasters and human emergencies.

Many people believe they know all the 130-plus-year-old organization has to offer, but you might be surprised to learn about the many sides it has, especially in the San Diego region. The Red Cross is a not-for-profit organization that depends on volunteers and the generosity of the American public to perform its mission.

With the public’s ongoing support, the Red Cross provides lifesaving preparedness training, disaster relief services, and 24-hour emergency services to deployed military personnel and their families, as well as nutritional counseling through its Women, Infants, and Children (WIC) program. Vital blood services are also a core component of the nonprofit’s operations.

18 february 2014

The organization has also recently spearheaded the launch of a lofty effort called Prepare San Diego. This four-year regional resiliency initiative brings together key community and business leaders from the region to create a sustainable network that encourages preparedness, carries out response and recovery plans, and strives for resiliency in the face of disaster, meeting all aspects of the disaster lifecycle.

As background, Prepare San Diego in its original form was developed by the San Diego/Imperial Counties Chapter of the Red Cross following the devastating 2007 wildfires that ravaged the region. Prepare San Diego combined the power of awareness with education and outreach

in order to effectively mobilize residents to take action to become prepared. The Red Cross relied largely on traditional, grassroots community education methods to inspire residents to take action and cascade it to their community. The chapter targeted vulnerable populations (low- to moderate-income individuals, youths, seniors, refugees, and monolingual individuals). From 2008 to 2012, the Red Cross reached nearly 600,000 residents to raise broad community awareness about the risks facing this region and the need to get prepared.

The Red Cross and Competitive Edge Research developed the Emergency Preparedness Index (EPI) in 2010 to help gather more detailed data to measure the initiative. The EPI measures preparedness across a spectrum and can detect movement in specific communities and demographics, as well as identify key drivers and barriers. The index found that only 7% of households in San Diego County reported having a “very comprehensive plan” and were prepared for a disaster.

While the initial effort was successful and partner support was high, the Red Cross recognized it alone could not make the kind of impact that is needed to truly get our region prepared for the next disaster.

In 2013, the Red Cross experienced a leadership change and Tony Young became CEO. Young is a former San Diego city councilman and city council president. Under his leadership, knowledge about, and connections within the region, the Prepare San Diego initiative took on a much broader meaning, both internally and externally. Not only is the Red Cross collaborating and breaking down silos internally, the organization recognized it alone could not reach goals of preparing one-third of the population without the help of key partners and organizations.

A combination of these factors led to a renewed version of Prepare San Diego: a community-wide initiative driven by the Red Cross to help prepare the San Diego region for hu-

Prepare San Diego is a four-year regional resiliency initiative that brings together key community and business leaders from the region to create a sustainable network that encourages preparedness, carries out response and recovery plans, and strives for resiliency in the face of disaster, meeting all aspects of the disaster lifecycle.

man emergencies and disasters. This phase of Prepare San Diego builds upon the broad community awareness developed during phase one and offers a more holistic approach to fostering a prepared region by involving all aspects of the disaster lifecycle: prepare, response, and recovery. Prepare San Diego is a single integrated program that brings the entire community together, shoulder to shoulder, to make preparedness a priority.

Last September, during National Preparedness Month, the Red Cross, along with key partners, formally announced Prepare San Diego. A key goal with the initiative is to facilitate a cultural shift to increase individual, organizational, and business preparedness, and, with that, one million people in San Diego County will make an emergency plan, build a disaster kit, or get trained to effectively respond.

“Research has told us that only 7% of households in San Diego County are prepared for a disaster — that’s not good enough,” says Young.

“Much of my life has been about San Diego and making it a better place to live, work, and play. We must look at everything through a preparedness lens, and it’s yet to happen as a collective effort until now.”

Several key community and business leaders are behind Prepare San Diego, including names like Interim Mayor Todd Gloria, councilmembers Mark Kersey and Marti Emerald, county supervisors Ron Roberts and

Dave Roberts, former mayor Jerry Sanders, the Chamber of Commerce, and entities like County Office of Emergency Services, San Diego Gas & Electric (SDG&E), San Diego State University, KPBS, and the Economic Development Corporation (EDC), among others.

“SDG&E has long been an advocate of safety and emergency preparedness, and is a supporter of the American Red Cross and many other entities in the region,” says David L. Geier, vice president of electric operations for SDG&E. “This is the right time for a region-wide leadership initiative of this kind, and we’re proud to be part of it.”

In addition to a preparedness goal, Prepare San Diego rounds out the full disaster lifecycle with goals for response and recovery. From the response standpoint, several other key entities have their own goals under the initiative — largely first responders and the County Office of Emergency Services, among others.

For the Red Cross, a key response goal is to increase the region’s ability to feed, shelter, and care for those impacted and displaced by human emergencies and disasters. Broken down for the Red Cross, this means being able to shelter 25,000 San Diego County residents, serving 200,000 meals per day, and having more than 4,000 event volunteers available to assist after a major disaster.

From a recovery standpoint, the collective goal is to strengthen the

SAN DI EGO PHYSICIAN.org 19

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Healthcare Needs: How San Diego Physicians Can Help

region’s post-disaster recovery infrastructure and economic resiliency.

Businesses throughout the San Diego region need to be able to return to a pre-disaster state as quickly as possible in order to assist with regional recovery.

“With disasters and other emergencies, it’s not ‘if’ but rather ‘when’ it will strike,” says Jerry Sanders, CEO of the San Diego Regional Chamber of Commerce. “We must work together to ensure successful, long-term recovery and reduce economic impact. I applaud the American Red Cross and all other partners who are behind Prepare San Diego.”

A pivotal component of the initiative is the steering committee, comprised primarily of members of the Senior Red Cross Business Council. This committee will review and evaluate the progress of the initiative, inform future directions, and disseminate findings and progress to key stakeholders within the region to ensure Prepare San Diego is responsive to the needs of the entire region.

Native San Diegan and philanthropist Malin Burnham is also a supporter of the initiative. “Prepare San Diego is the kind of forward and collaborative thinking our region

20 february 2014

needs,” says Burnham. “The importance of teamwork is key to meeting a large goal like preparing one million people. I believe San Diego can do it.”

While the initiative is region-wide, the organization is putting extra efforts into seven carefully chosen, laser-focused communities during the first year of the initiative, including San Marcos, Ramona, Rancho Bernardo, University Heights, City Heights, Broadway Heights, and San Ysidro. Many of these communities have already stepped up to help get people prepared, like Broadway Heights and City Heights, including things like spearheading fire canvassing events to provide information and tools for their neighbors to make emergency evacuation plans for their homes. Having the Red Cross train groups to provide community disaster education programs to local groups, schools, etc., is also a great way to get involved.

The laser-focused communities will be reevaluated this summer, and new focus areas for September 2014 through August 2015 will be chosen. If you know of an area for extra focus, please contact Curt Luthye at curt.luthye@redcross.org or at (858) 309-1302.

The Red Cross stresses that one entity alone cannot make these goals happen. Key business, government agencies, nonprofits, educational institutions, and tribal entities all play pivotal roles. However, one area available for more collaboration with the Prepare San Diego initiative is within the healthcare arena.

While several hospitals are involved with emergency management and other countywide disaster plans in general, the more work and collaboration with each other, the better off and more prepared we will all be.

Young challenges all healthcare personnel to get on board to help strengthen the San Diego region to be prepared and ready for the next big thing. He stresses we cannot wait until the next devastating wildfire or earthquake hits and says there are a variety of ways to get involved.

“Even starting with your own places of business can make an impact on truly preparing San Diego,” says Young. “At the Red Cross we had to start internally to ensure our own staff and volunteers are practicing what we preach. All have taken at least one step in preparedness, either by getting a disaster kit, making an emergency plan, or getting trained to assist others during emergencies or disasters, with several spanning all three. Preparedness is contagious.”

Young stresses there is also a need for physicians and others in the medical field to be part of the Steering Committee and Business Council for the initiative. For more information about Prepare San Diego and how to get involved, visit www. preparesandiego.org or contact Curt Luthye at curt.luthye@redcross.org, (858) 309-1302.

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How the Red Cross Women, Infants, and Children (WIC) Program Works With Prepare San Diego One critical way Prepare San Diego will reach some of San Diego’s most hard-to-reach communities is through its Women, Infants, and Children (WIC) program. This nutrition and breastfeeding program assists more than 35,000 families each month at 19 locations throughout San Diego County. WIC provides checks for healthy foods, nutrition education, breastfeeding support, and referrals to community resources for low-income pregnant women, infants, and children. The program plays a pivotal role in Prepare San Diego by providing classes for 18,000 families between January and September 2014 that will focus on helping families get prepared for a disaster or emergency. Classes will be offered both at WIC offices and online. Additionally, WIC will educate families about Prepare San Diego through social media messages, community outreach, and in-office materials.

A key message WIC is communicating to families is the fact that breastfeeding can be lifesaving in an emergency due to several factors: It’s always available, it’s safe, it protects the baby’s health, and it keeps both mother and baby calm during otherwise stressful situations. “There is a vital need to support breastfeeding, especially in the early days of an emergency. … Death rates among children less than 5 years old

22 february 2014

Breastfeeding can be lifesaving in an emergency due to several factors: It’s always available, it’s safe, it protects the baby’s health, and it keeps both mother and baby calm during otherwise stressful situations.

“There is a vital need to support breastfeeding, especially in the early days of an emergency.”

are generally higher than for any other age group … and non-breastfed infants are up to 20 times more likely to die.” (Diana D. Bienvenu, MD, FAAP, “Infant Feeding in Emergencies and Natural Disasters” PowerPoint presentation, 2008.) WIC will ensure all pregnant women and new moms have access to this vital information about breastfeeding during emergencies, and will continue to provide lactation support during local emergencies and disasters.

If your current entity also has a WIC program, please contact Ann Anderson, director of Red Cross WIC, at ann.anderson@redcross.org or (858) 309-1219 to discuss ideas on how to become a partner in the Prepare San Diego initiative.

Red Cross Blood Services and Prepare San Diego Every two seconds, someone in the United States needs blood. On average, the Red Cross must collect 15,000 pints of blood every day to meet the needs of patients at approximately 2,700 hospitals and transfusion centers across the country.

Last May, the American Red Cross officially opened its new Blood Services Center in the Kearny Mesa area of San Diego. The new Blood Services facility has allowed the Red Cross to expand its capability to collect and distribute lifesaving blood products to San Diego-area hospitals, a feat that certainly falls under the Prepare San Diego initiative.

From its new donor center in Kearny Mesa, the Red Cross is able to collect whole blood, platelets, double red cell and other specialty donations. The center also serves as a central hub for planning Red Cross community blood drives, recruiting blood donors and volunteers, and distributing nearly 50% of all blood products transfused in local hospitals. “The new Red Cross blood donor center is important for our community as a whole,” says Young.

“We encourage all who are eligible to donate blood at our new center. Just one pint of blood can save up to three lives.”

The Red Cross typically sees a decline in donations during the winter holiday season. Individuals can help the Red Cross and hospital patients recover from the lull in holiday donations and give the generous gift of blood or platelet donation. Blood donations are used to treat cancer patients, trauma victims, premature babies, and those living with chronic blood diseases each and every day — patients like Kelsey Harris. Kelsey — a star athlete, attentive student, and teenage driver — was on her way to school when she got into a serious accident. As a result of her injuries, Kelsey needed type O negative blood, the “universal” donor type. Kelsey’s sister, Kenzie, says, “Without the help from those donors, my sister might not be alive today.” Nearly all

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On average, the Red Cross must collect 15,000 pints of blood every day to meet the needs of patients at approximately 2,700 hospitals and transfusion centers across the country.

of Kelsey’s family members are type O negative donors, and they regularly give blood together. They are grateful for the donors who helped Kelsey make a recovery, and say it is their way of giving back.

Since 1898, the American Red Cross has proudly served the San Diego community. Through its state-of-the-art Disaster Operations Center and new life-saving Blood Donor Center, the Red Cross stands ready to meet the needs of San Diego and Imperial counties as the most trusted community service organization in blood collection, education, preparation, and response to natural disasters and human emergencies.

The Red Cross Biomedical Services offers a comprehensive suite of blood products and services to help with the treatment of patients in need. Blood products include red blood cells, platelets, plasma, whole blood, and granulocytes. Reference testing includes immunohematology, antibody investigations, IgA deficiency, neutrophil testing, platelet serology, molecular testing, and HLA testing. Clinical services include therapeutic apheresis; perioperative autologous cell salvage; HPC harvesting, freezing, and storage; therapeutic phlebotomy; autologous collections; and directed donor collections. For more information about any of the products and services the Red Cross offers, please visit www. redcrossblood.org.

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How to Donate Blood in San Diego The new blood services center is open three days a week on Mondays, Fridays, and Saturdays. Individuals interested in scheduling an appointment to donate at the new center can call (800) RED-CROSS [(800) 7332767] or visit www.redcrossblood. org/socal. Businesses or groups interested in coordinating a lifesaving blood drive may call (858) 712-1611.

For more information and to coordinate a local blood drive, contact Renell Asplin at (858) 652-2746 or at renell.asplin@redcross.org.

All blood types are needed to ensure a reliable supply for patients.

A blood donor card, driver’s license, or two other forms of identification are required at check-in. Individuals who are 17 years of age (16 with parental consent in some states), weigh at least 110 pounds, and are

in generally good health may be eligible to donate blood. High school students and other donors who are 18 years of age and younger also have to meet certain height and weight requirements.

“San Diego Young Marine of the Year” Hosts Blood Drive For more information and to coordinate a local blood drive, contact Renell Asplin at (858) 652-2746 or at renell.asplin@redcross.org.

Hilltop High School student Tito Pasto partnered with American Red Cross Blood Services to save lives.

On Nov. 27, 2013, the high school junior hosted a blood drive in Chula Vista where 25 pints of blood were collected. That amount can save the lives of up to 75 people.

“Although the need for blood in San Diego is constant, the demand is even higher during the holiday

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months,” says Carina Kagan, with Red Cross Blood Services in San Diego. “There is also a higher need for Latino blood donors. The timing of Tito’s blood drive was critical for our region.”

A high percentage of Latinos have type O blood, which can be transfused to patients of other blood types. Latino blood contains important antibodies that are unique to the Latino population. Additionally, many Latinos carry a rare antigen in their blood, which could save the lives of those who are in need. For these reasons, Latinos are in a position to save even more lives when they donate blood. According to the U.S. Census Bureau, Latinos make up about 31% of the population of San Diego County.

Pasto had high hopes that his fellow students at Hilltop High School, which has a high Latino population, would join the blood drive. “Students can help by just dedicating a small amount of time to donate blood, which will make a Project4:Layout 1

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huge impact and save many lives,” says 16-year-old Pasto, who has been helping the Red Cross with community blood drives since he was a young boy. More than 50 people showed up to support the blood drive.

“Staying involved in my community has always been one of my main objectives. I believe that because we are future leaders, it is our job to ensure our community is a suitable and proper place to live.” Pasto says.

Pasto’s dedication to community service has been reinforced through his involvement in San Diego Young Marines, an education and service program for boys and girls ages 8 through high school. The Young Marines focuses on building character, leadership, and a healthy, drug-free lifestyle. Pasto was recently named San Diego Young Marine of the Year and was invited to travel to Washington, DC, where he was recognized for his accomplishments.

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Hilltop High School student Tito Pasto partnered with American Red Cross Blood Services to save lives.

On Nov. 27, 2013, the high school junior hosted a blood drive in Chula Vista where 25 pints of blood were collected. That amount can save the lives of up to 75 people.

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A Salute to the Red Cross Service to the Armed Forces Program The American Red Cross San Diego/ Imperial Counties Chapter has been a vital part of the community since 1898 and is well known for disaster relief efforts. Yet most people don’t know that the organization’s roots can be found in its relief efforts for troops during the Spanish-American War. In a military region like San Diego, those roots thrive today through the chapter’s Service to the Armed Forces (SAF) program dedicated to serving the men and women in the U.S. Armed Forces, veterans, and their families. The SAF program also plays a critical role in the Prepare San Diego initiative, largely by ensuring military families are prepared for disasters or emergencies during deployment briefings the organization provides.

Communication and support lie at the heart of Red Cross services to the military. The congressional charter established in 1900 explicitly states that the Red Cross shall volunteer aid to the sick and wounded military during war, and serve as a medium of communication between the people of the United States and the armed forces. For example, during World War I, troops who were deployed would fill out a postcard upon arrival at their destination, which the Red Cross would mail to their families to notify them that their loved ones had arrived safely. Today, the Red Cross is able to locate military personnel and relay emergency messages in a matter of hours anywhere in the world, including ships at sea, embassies, and isolated military units.

Red Cross personnel form a global network through local chapters, military installations worldwide, and in forward-deployed locations in Kuwait, Afghanistan, Iraq, and Djibouti, Africa. Red Cross forward-deployed offices are embedded with the military and are a vital communication link. They aid with morale-building

26 february 2014

efforts by sponsoring activities such as barbecues and recreational events.

They also facilitate receipt of care packages from home to the service members. At military bases overseas, Red Cross personnel work with local communities and governments on initiatives such as health and safety programs, disaster preparedness awareness, and evacuation plans.

Emergency Communications Services The Red Cross Emergency Communications Services keep military personnel in touch with their families following the death or serious illness of an immediate family member, the birth of a service member’s child or grandchild, or when a family faces other emergencies. Twenty-four hours a day, 365 days a year, they relay urgent messages containing accurate, factual, complete, and verified descriptions of the emergency to service members stationed anywhere in the world, including on ships at sea, at embassies, and other remote locations.

The local Red Cross hosts one of four Red Cross emergency call centers where caseworkers verify information and relay information to the member’s command post, which is used in making decisions regarding contact with the family and emergency leave.

Communication and support lie at the heart of Red Cross services to the military. The congressional charter established in 1900 explicitly states that the Red Cross shall volunteer aid to the sick and wounded military during war, and serve as a medium of communication between the people of the United States and the armed forces.

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Sequoian Investments LLC (855) 390-5626 alex@sequ.com sequ.com

Mortgage Banking

BBVA — Daniel Schroeder (858) 356-2601 daniel.schroeder@bbvacompass.com bbvacompass.com

Personal Training

Gill’s Fitness (619) 299-1988 Training@gillsfitness.com gillsfitness.com

Pharmacy

University Compounding Pharmacy (619) 683-2005 ucprx.com

Placement Services

Tracy Zweig & Associates (800) 919-9141 tzweig@tracyzweig.com tracyzweig.com

Speech Recognition Solutions Medical Speech Solutions (888) 532-3311 sales@medicalspeechsolutions.com medicalspeechsolutions.com

Technology

Soundoff Computing (858) 569-0300 ofer@soundoffcomputing.com soundoffcomputing.com

SAN DI EGO PHYSICIAN.org 27

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Red Cross Support at Every Stage of Military Life New Recruits A new recruit’s first introduction to the Red Cross begins at the local processing center, where he or she can fill out an information card that is forwarded to the local Red Cross chapter. Then the Red Cross contacts the recruit’s family to let them know about available services to assist the recruit and family throughout their military service and beyond.

Active Duty at Home and Abroad Another cornerstone of the Red Cross SAF mission is to educate deploying military members and their families about Red Cross services. This is done through attending pre-deployment briefings, resource fairs, and other gatherings. For example, the team gave a pre-deployment briefing to the 3rd Battalion, 5th Marines at Camp Pendleton in Oceanside. There were numerous young families and expectant mothers in attendance, who especially found comfort in learning about emergency communications services.

The team also had the privilege of hosting an information table during a Family Day Cruise on the USS Peleliu, where many families from the same battalion heard the Red Cross message for the first time. Finally, on the day they set sail, the team was on the dock distributing Hug-A-Hero dolls to deploying servicemen and women to give to their children.

Thanks to a generous grant from Wal-Mart and Operation Hug-A-Hero, the Red Cross locally has distributed more than 1,000 dolls imprinted with photos of deploying parents to their children.

28 february 2014

Families can also take advantage of the Coping With Deployments workshop, which prepares them to navigate the challenges of serving at home while their loved one is deployed.

This course is designed to increase resilience in the family and provides psychological first aid for managing stress and difficult emotions.

Coming Home and Re-entry The Red Cross continues to be a visible source of support to the troops and families when the deployed family member returns home. The Red Cross attends reunion events, where they set up a canteen vehicle for refreshments and participate in making signs to welcome the troops.

Through the emergency call centers, caseworkers refer families and military members struggling with re-entry to community resources, financial assistance, and support programs. The Red Cross also provides Reconnection Workshops presented in partnership with Wal-Mart.

Current topic areas include stress and trauma, depression, building communication, managing anger, and other topics critical to reunion adjustment.

Support for Veterans Red Cross volunteers serve in VA

Families can also take advantage of the Coping With Deployments workshop, which prepares them to navigate the challenges of serving at home while their loved one is deployed.

medical centers throughout the country to transport patients to and from treatment sessions, deliver magazines, books, and comfort items to patients, provide companionship and personal services, raise funds to support veterans, and more. The local Red Cross has more than 130 licensed medical professionals who volunteer in area military hospitals. At the Navy Medical Center San Diego, volunteers work with the Army’s Wounded Warrior Battalion. Volunteers also capture veterans’ stories about their military experiences for The Veterans History Project. This is a partnership with the Library of Congress whose mission is to capture and preserve this rich part of our history for future generations.

The Red Cross, in partnership with the Veterans Crisis Line, assists veterans and active-duty military with suicide intervention. This partnership has become a vital resource at a critical juncture in the lives of our servicemen and women in crisis. The Veterans Crisis Line team responds to calls concerning veterans. Calls concerning active-duty members are immediately routed to the Red Cross, which can locate the service member and work with his or her command or local authorities to provide intervention. The Red Cross also provides claims support to veterans.

however, through Red Cross efforts, he was granted leave. This veteran never had the chance to thank the Red Cross until 40 years later.

The ability to serve our military families is made possible through community support. Thanks to partners, Red Crossers are available around the clock, 365 days a year to assist the men, women, and families who dedicate their lives to military service.

The Service to the Armed Forces Legacy The Service to the Armed Forces team members are part of a tremendous legacy that dates back to the Spanish-American War. They form a worldwide network that serves all branches of the military and their families throughout their lives. What one SAF volunteer may have done for a service member decades ago continues to make a difference today and in the future. A San Diego family assistance coordinator discovered this while attending a conference for mental health professionals. One of the presenters was a veteran who paused to thank the Red Cross for helping him return to his dying father during the height of the Vietnam War. His Army platoon was engaged in the battle of Hamburger Hill, and his command would not release him;

Partnering in International Services Thanks to partners, Red Crossers are available around the clock, 365 days a year to assist the men, women, and families who dedicate their lives to military service.

The American Red Cross is one of more than 180 Red Cross and Red Crescent societies worldwide that are devoted to alleviating human suffering wherever it is found. As a national society, the American Red Cross works within this framework to help provide services for the world’s most vulnerable people. The American Red Cross works with our

BOB DESIMONE, MBA, CPA

THE DOCTORS INSURANCE AGENCY CA AGENT #0722131

215 S. Highway 101, Ste. 117 Solana Beach, CA 92075 bdesimone@tdia.com (800) 464-2986 (858) 345-1370 Fax (858) 345-1376

“think SDCMS FIRST!” Start by contacting SDCMS at (858) 565-8888 or at SDCMS@SDCMS.org.

SAN DI EGO PHYSICIAN.org 29

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partner Red Cross and Red Crescent societies in more than 30 countries to support projects in disaster management and emergency health. The San Diego/Imperial Counties Chapter supports efforts to reconnect families separated by international disasters, as well as to educate the public about international humanitarian law. The Red Cross’ work within these groups throughout San Diego County is yet another avenue by which the organization gets in front of communities to teach them how to be prepared for disasters and emergencies.

Restoring Family Links In San Diego, Ms. Simone Hedstrom wrote in regarding her experience with local Red Crosser Mariana Vasconcelos. Ms. Hedstrom spent years wondering about her father before they were a family and began a soulsearching journey. Here’s an excerpt of her story: “During WWII, my dad was a European POW in Germany. When

30 february 2014

I learned about the role of the Red Cross in helping prisoners as they were liberated from German camps, I turned to the San Diego/Imperial Counties Chapter of the Red Cross.

In an interview, Mariana Vasconcelos, local Red Cross representative, emphasized the role and the mission of the association. The Red Cross, she said, provides assistance to families separated internationally by armed conflict, disaster, or humanitarian emergencies. Restoring Family Links (International Tracing) services are a core requirement for all chapters, and include tracing (locating missing family members), sending Red Cross messages in areas where there’s not a postal system, Holocaust and World War II tracing and documentation, among other services.

We met at my house, we talked, and I told her what I knew. And she left, saying she would get back to me soon. … A couple months passed, and then one morning I had a call — she had something for me. Her visit was

Those interested in trying to find a loved one can contact the local Red Cross chapter.

for me a joyful and emotional moment as she gave me the documents.

Obtaining information from my father’s military and POW records helped shed light on his past and helped me understand that part of his life that he never talked about.

I even discovered names of people who inquired about him after the war, people who were part of his life!

Exploring my dad’s past has been for me a journey to wholeness and understanding. Now able to connect some of the dots, I plan sometime in the future on retracing some of his footsteps.”

Those interested in trying to find a loved one can contact the local Red Cross chapter. These searches are free of charge, but are complex and can take a year or more to find results.

For more information about the local Red Cross, please visit www. redcross.org/sandiego or connect with the nonprofit via social media on Facebook, YouTube, and Twitter.

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classifieds PHYSICIAN POSITIONS WANTED LOOKING FOR SURGICALLY RELATED OPPORTUNITIES: I am a semi-retired general surgeon seeking part-time or per diem surgically related opportunities in the San Diego area. I have taken mandatory retirement from our multispecialty group partnership at Kaiser Permanente, San Diego, am in excellent health, and plan to continue active practice for at least the next few years. Surgical assisting and office or clinic duties would be very acceptable. I am board certified in general surgery and an active member of the American College of Surgeons. I have over 30 years of general surgical and laparoscopic experience in a busy practice. Email me at mravden@ earthlink.net. [197] PHYSICIAN POSITIONS AVAILABLE INTERNAL MEDICINE PHYSICIAN, NORTH SAN DIEGO COUNTY: Private practice internal medicine group in North San Diego County seeks BC/BE internist for full-time outpatient internal medicine practice. This is an excellent opportunity to practice with a well-established group of internists. Email CV to dgosejohan@ncim.net. [190] INTERNAL MEDICINE — PRIVATE PRACTICE, PART-TIME OPPORTUNITY **LIFE / WORK BALANCE**: Unusual and exceptionally attractive private practice IM opportunity in beautiful North San Diego County. Stable, long-term, parttime, outpatient position in a highly regarded group practice with >30 years in the community.

Collegial, single-specialty group, exceptional office staff, and very high quality patient care set this far apart from many other situations. Office location is easily accessible from anywhere in the county. Multiple scheduling options available, making this a very attractive option for any physician who wishes to work exclusively part-time or who wishes to combine this with other job opportunities. Outstanding way to experience the best of private practice! Please email CV to portofino3@aol.com or call (619) 248-2324. [186] LOOKING FOR ENERGETIC OPHTHALMOLOGISTS: The UCSD Student-Run Free Clinic Project is looking for energetic ophthalmologists who love teaching to volunteer their time to act as attending physicians at the Ophthalmology Free Clinic. Attendings would have the choice to volunteer at two different clinic sites: the First Lutheran Church in Downtown San Diego and/ or Baker Elementary School. Both clinics are four hours long, are held monthly, and provide services to the uninsured patient population of San Diego. Monthly commitment is not required.

Malpractice is covered by UC Regents via a voluntary faculty appointment. For more information, please email SunnyDSmith@gmail.com. [185] SEEKING BC/BE INTERNIST FOR FULL-TIME POSITION: Private group practice in Escondido with excellent reputation for quality of care. EHR implemented. Complete benefit package and competitive salary. Partnership tract. Email CV to EIM2011SDP@gmail.com. [184] FULL-TIME OR PART-TIME URGENT CARE PHYSICIAN: Busy practice in El Cajon, established in 1982, seeks a full-time and/or part-time physician. Good hours (mostly 9:00am–5:30pm weekday shifts with some weekends from 9:00am–4:00pm and closed on major holidays)

plus good pay. Please send CV to jeff@eastcountyurgentcare.com or fax to (619) 442-2245. [161] PHYSICIANS WANTED FOR OUR GROWING ORGANIZATION: Full, part time, or per diem, flexible schedules available at locations throughout San Diego. A national leader among community health centers, Family Health Centers of San Diego is a private, nonprofit community clinic organization that is an integral part of San Diego’s healthcare safety net. Since 1970, our mission has been to provide caring, affordable, high-quality healthcare and supportive services to everyone, with a special commitment to uninsured, low-income, and medically underserved persons. Every member of our team plays an important role in improving the health of our patients and community. We offer an excellent, comprehensive benefits package that includes malpractice coverage, NHSC loan repay eligibility, and much, much more! For more information, please call Anna Jameson at (619) 906-4591 or email ajameson@fhcsd.org. If you would like to fax your CV, fax it to (619) 876-4426. For more information and to apply, visit our website and apply online at www.fhcsd.org [046] PRIMARY CARE JOB OPPORTUNITY: Home Physicians (www.thehousecalldocs.com) is a fastgrowing group of house-call doctors. Great pay ($140–$220+K), flexible hours, choose your own days (full or part time). No ER call or inpatient duties required. Transportation and personal assistant provided. Call Chris Hunt, MD, at (619) 9925330 or email CV to drhunt@thehousecalldocs. com. Visit www.thehousecalldocs.com. [037] PHYSICIANS NEEDED: Family medicine, pediatrics, and OB/GYN. Vista Community Clinic, a private nonprofit outpatient clinic serving the communities of North San Diego County, has opening for part-time, per diem positions. Must have current CA and DEA licenses. Malpractice coverage provided. Bilingual English/Spanish preferred. Forward resume to hr@vistacommunityclinic.org or fax to (760) 414-3702. Visit our website at www.vistacommunityclinic.org. EOE/ MF/D/V [912] SEEKING BOARD-CERTIFIED PEDIATRICIAN FOR PERMANENT FOUR-DAYS-PER-WEEK POSITION: Private practice in La Mesa seeks pediatrician four days per week on partnership track. Modern office setting with a reputation for outstanding patient satisfaction and retention for over 15 years. A dedicated triage and education nurse takes routine patient calls off your hands, and team of eight staff provides attentive support allowing you to focus on direct, quality patient care. Clinic is 24–28 patients per eight-hour day, 1-in-3 call is minimal, rounding on newborns, and occasional admission, NO delivery standby or rushing out in the night. Benefits include tail-covered liability insurance, paid holidays/vacation/sick time, professional dues, health and dental insurance, uniforms, CME, budgets, disability and life insurance. Please contact Venk at (619) 504-5830 or at venk@gpeds. sdcoxmail.com. Salary $ 102–108,000 annually (equal to $130–135,000 full-time). [778] PRACTICE FOR SALE EVER DREAM OF BEING YOUR OWN BOSS? Private practice internal medicine physician on the campus of Scripps Memorial La Jolla looking

To submit a classified ad, email Kyle Lewis at KLewis@SDCMS.org. SDCMS members place classified ads free of charge (excepting “Services Offered” ads). Nonmembers pay $150 (100-word limit) per ad per month of insertion.

34 february 2014

for board-certified internist to take over his practice when he retires. Currently sharing campus office space and overhead with another internist who will be continuing to practice. Exciting opportunity, as the campus is expanding and building a new state-of-the-art Cardiovascular Institute set to open in 2015. Various arrangements available. Please email nev@san.rr.com for information. [189] PRACTICE WANTED WE BUY URGENT CARE OR READY MED-CLINIC: We are interested in purchasing a preexisting urgent care or ready med-clinic anywhere in San Diego County. Please contact Lyda at (619) 4179766. [008] OFFICE SPACE / REAL ESTATE

CLASS “A” MEDICAL OFFICES, VISTA Upgrade to a new Class “A” medical office at no cost in TriCity’s leading outpatient health center. Collegial environment with more than 40 physicians in 15+ specialties. Strong primary care referral base. Fully renovated offices with today’s modern finishes. Close hospital proximity. Multiple sizes available ranging from 1200, 1600, 2400, 4000-5700.

For more information, including floor plans, please call Greg Petree at (858) 792-0696 x112 or visit www.vistamedicalplaza.com/ leasing

OPPORTUNITY IN EAST COUNTY (LA MESA): Jackson Drive at Fletcher Parkway. Beautiful physical and hand therapy clinic (2800 sq. ft.) has furnished office space available to lease. Space currently available is 700–850 sq. ft. on the first floor. Includes utilities, general office and kitchen supplies/expense, and cleaning service. The office is close to Sharp Grossmont Hospital, trolley and bus lines. ADA compliant space and plenty of parking. Contact Jeanette Barrack at jeanette@ rehabst.com or at (619) 251-2417. [201] OFFICE SPACE AND PRACTICE OPPORTUNITY BANKERS HILL / HILLCREST: Surgical office space available to share in newly renovated private medical office building. Beautifully updated building inside and out. Located in Bankers Hill / Hillcrest area just minutes to Scripps Mercy Hospital. Fully accredited ambulatory surgery center onsite that is also available for use. Ideal practice setting for part-time or full-time plastic surgeon, facial plastic surgeon, or ENT surgeon.

Shared office staff may be possible. Email KLewis@SDCMS.org for additional information. [200] LA JOLLA (NEAR UTC) OFFICE FOR SUBLEASE OR TO SHARE: Scripps Memorial medical office building, 9834 Genesee Ave. — great location by the front of the main entrance of the hospital between I-5 and I-805. Multidisciplinary group. Excellent referral base in the office and on the hospital campus. Please call (858) 455-7535 or (858) 320-0525 and ask for the secretary, Sandy. [127] OFFICE SPACE POWAY/RANCHO BERNARDO: Medical office space for lease, all or part. Up to 1,100SF. Great location in medical/dental complex in Poway, next to Pomerado Hospital (borders Rancho Bernardo). Open treatment areas and private treatment rooms, two bathrooms, waiting room/lobby, front office. Second floor.

Elevator/stair access. Beautiful view of the hills.

Ideal for medical, complementary / alternative medicine, physical therapy, chiropractic, acupuncture, massage / body work, etc. Patients / clients from Poway, Rancho Bernardo, Carmel Mountain, 4-S Ranch, Scripps Ranch, Escondido, Ramona, and surrounding areas. Contact Debbie Summers at (858) 382-8127 or at debjsummers1@yahoo.com. [195] SPACIOUS, NEWLY REMODELED 2ND FLOOR MEDICAL OFFICE SPACE FOR RENT IN THE KEARNY MESA AREA: Good space for patient care or for clinical research use. Easy access, lots of parking. Approximately 1500SF. Private physician office, 2 exam rooms, and nurse desk/work area. Shared reception area, patient waiting rooms, and lab. Contact Trudy Brass, Manager, Allergy and Asthma Medical Group and Research Center, at (858) 292-1144 or at trudybrass@allergyandasthma.com. [193] TORREY HILLS MEDICAL BUILDING: 4765 Carmel Mountain Rd., San Diego 92130: 1 space available; Suite 201; 1,120SF; rental rate: negotiable; max. contiguous: 3,449SF; sublease: yes; sublease expires Jan. 2018; available: now. Fully built-out medical office in new Class “A” building, Ample parking garage exclusive for tenants and patients. Patient drop area. Highly upgraded with upscale finishes/ exam rooms. Suites 201 and 202 may be combined for 3,449SF total. Located in growing commercial and residential area. New on/off ramps at Carmel Valley Rd. for immediate access to all of San Diego County. Outstanding exposure to adjoining retail center/community. Contact Gateway Financial Real Estate, James Pieri, Jr., at (619) 972-2214. [192] AMAZING PRIMARY CARE OPPORTUNITY IN OLD DEL MAR: Available suites with 1,000–6,000 sq. ft. of doctor-ready medical space located one block south of the Del Mar Plaza on Hwy. 101. Location boasts a 50-year medical office history.

Current primary care with over 12,000 patients is moving, providing the opportunity to coattail and capture a significant patient load. Building complex currently includes numerous specialists, PT, X-ray, and dentists. Parking is ample and lease rates are extremely competitive. Establish yourself in this proven location in the desirable community of Del Mar. Contact Richard at richcardow@yahoo.com or call (858) 755-2345 for more information. [183] LUXURIOUS / BEAUTIFULLY DECORATED DOCTOR’S OFFICE NEXT TO SHARP HOSPITAL FOR SUB-LEASE OR FULL LEASE: The office is conveniently located just at the opening of Highway 163 and Genesee Avenue. Lease price if very reasonable and appropriate for ENT, plastic surgeons, OB/GYN, psychologists, research laboratories, etc.

Please contact Mia at (858) 279-8111 or at (619) 8238111. Thank you. [836] SCRIPPS ENCINITAS CONSULTATION ROOM/ EXAM ROOMS: Available consultation room with two examination rooms on the campus of Scripps Encinitas. Will be available a total of 10 half days per week. Located next to the Surgery Center. Receptionist help provided if needed. Contact Stephanie at (760) 753-8413. [703] POWAY / RANCHO BERNARDO — OFFICE FOR SUBLEASE: Spacious, beautiful, newly renovated, 1,467 sq-ft furnished suite, on the ground floor, next to main entrance, in a busy class A medical building (Gateway), next to Pomerado Hospital, with three exam rooms, fourth large doctor’s office. Ample parking. Lab and radiology onsite. Ideal sublease / satellite location, flexible days of the week. Contact Nerin at the office at (858) 521-0806 or at mzarei@ cox.net. [873]

BUILD TO SUIT: Up to 1,900ft2 office space on University Avenue in vibrant La Mesa / East San Diego, across from the Joan Kroc Center. Next door to busy pediatrics practice, ideal for medical, dental, optometry, lab, radiology, or ancillary services.

Comes with 12 assigned, gated parking spaces, dual restrooms, server room, lighted tower sign.

Build-out allowance to $20,000 for 4–5 year lease. $3,700 per month gross (no extras), negotiable.

Contact venk@cox.net or (619) 504-5830. [835] SHARE OFFICE SPACE IN LA MESA JUST OFF OF LA MESA BLVD: 2 exam rooms and one minor OR room with potential to share other exam rooms in building. Medicare certified ambulatory surgery center next door. Minutes from Sharp Grossmont Hospital. Very reasonable rent. Please email KLewis@SDCMS.org for more information. [867] NONPHYSICIAN POSITIONS AVAILABLE / WANTED MEDICAL ASSISTANT WANTED FOR SPORTS/ REGENERATIVE MEDICINE PRACTICE (ENCINITAS): BA or BS preferred. Please reply with resume and letter of interest to ssbunyak@hotmail. com. [199] MEDICAL RECEPTIONIST NEEDED: Must be detailed-orientated and organized. Knowledge of all types of insurance (Medicare, Medi-Cal, HMO, PPO), knowledge of Allscripts PM and EHR is a plus! Bilingual English/Spanish. Duties: scheduling and confirmation of patient appointments; checking in and out of patients and processing co-pays, as well as onthe-spot referrals for a specialist/procedures; triage patient messages to physicians, which may include

medications or emergencies; prepare and maintain accurate medical record files and notes according to procedures; follow up with insurance companies for insurance eligibility and authorizations. Two years experience as a medical receptionist required! Fax resume to (760) 967-9010. [198] MEDICAL BILLER AND CODER: The ideal candidate will be a great communicator, with extensive experience in out-of-network billing and neurosurgery field. Will be able to set up in-house billing procedures as we transition from outsourced billing to in-house, and oversee all aspects of the billing cycle. Qualifications Required: 3–5 years experience in surgical and out-of-network billing a must; medical billing and coding certification required; ICD-10 coding certification or experience preferred; high computer literacy and experience with EMR systems required; knowledge of eClinical Works software preferred. Salary: 60K + incentive and benefits. Please send your resume, cover letter, and salary history to olgald@sdneurosurgery. com. [191] NURSE PRACTITIONER: Needed for house-call physician in San Diego. Full-time, competitive benefits package and salary. Call (619) 992-5330 or email drhunt@thehousecalldocs.com. Visit www. thehousecalldocs.com. [152] PHYSICIAN ASSISTANT OR NURSE PRACTITIONER: Needed for house-call physician San Diego. Part-time, flexible days / hours. Competitive compensation. Call (619) 992-5330 or email drhunt@thehousecalldocs.com. Visit www.thehousecalldocs.com. [038]

Place your ad here Contact Dari Pebdani at 858-231-1231 or DPebdani@sdcms.org

SAN DI EGO PHYSICIAN.org 35

Practice management

ICD-10 Webinar Series in 2014 SDCMS PHYSICIANS AND OFFICE STAFF: You are invited to sign up to view any of the webinars at right on ICD-10 coding. Before you view any of the webinars, though, you MUST watch a three-hour ICD-10 implementation orientation webinar, which you can view at your convenience. SDCMS also recommends that you view the five webinars that have already been recorded. Contact Jennipher Ohmstede at SDCMS at (858) 3002781 or at JOhmstede@SDCMS.org for additional information or should you have any questions. To register for any of the webinars at right, fill out this form and fax it back to SDCMS at (858) 569-1334.

2014 SCHEDULE OF ICD-10 CODING WEBINARS: Webinar #1 — February 5, 12:15pm–12:45pm ❚❚General Introduction for All Specialties ❚❚Coding Guidelines, Conventions, and Terms ❚❚Chapter 18: Symptoms, Signs, and Abnormal Clinical and Laboratory findings, not elsewhere classified

Webinar #5 — April 2, 12:15pm–12:45pm ❚❚Chapter 9: Diseases of Circulatory System ❚❚Chapter 10: Diseases of Respiratory System ❚❚Chapter 17: Congenital Malformations, Deformations, and Chromosomal Abnormalities

Webinar #2 — February 19, 12:15pm–12:45pm ❚❚Chapter 1: Infectious and Parasitic Diseases ❚❚Chapter 2: Neoplasms ❚❚Chapter 3: Blood and Blood Forming Organs and Certain Disorders Involving Immune Mechanism

Webinar #6 — April 16, 12:15pm–12:45pm ❚❚Chapter 11: Diseases of Digestive System ❚❚Chapter 14: Diseases of Genitourinary System ❚❚Chapter 17: Congenital Malformations, Deformations, and Chromosomal Abnormalities

Webinar #3 — March 5, 12:15pm–12:45pm ❚❚Chapter 4: Endocrine, Nutritional, and Metabolic Diseases ❚❚Chapter 5: Mental, Behavioral, and Neurodevelopmental disorders ❚❚Chapter 6: Diseases of Nervous System Webinar #4 — March 19, 12:15pm–12:45pm ❚❚• Chapter 7: Diseases of Eye and Adnexa ❚❚• Chapter 8: Diseases of Ear and Mastoid Process ❚❚• Chapter 17: Congenital Malformations, Deformations, and Chromosomal Abnormalities

NOTE: Before Viewing Any of These Webinars, You MUST View a Three-hour ICD-10 Implementation Orientation Webinar!

Have You Viewed The Three-hour ICD-10 Orientation Webinar Yet? YES ❏ NO ❏ MARK THE WEBINARS YOU WOULD LIKE TO REGISTER FOR: #1 ❏ #2 ❏ #3 ❏ #4 ❏ #5 ❏ #6 ❏ #7 ❏ #8 ❏

PHYSICIAN FULL NAME

ATTENDEE NAME / TITLE (if different)

TELEPHONE

EMAIL

36 february 2014

Webinar #7 — May 7, 12:15pm–12:45pm ❚❚Chapter 12: Diseases of Skin and Subcutaneous Tissue ❚❚Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue ❚❚Chapter 19: Injury, Poisoning, and Other Consequences of External Causes ❚❚Chapter 20: External Causes of Morbidity Webinar #8 — May 21, 12:15pm–12:45pm ❚❚Chapter 15: Pregnancy, Childbirth, and the Puerperium ❚❚Chapter 16: Certain Conditions Originating in the Perinatal Period ❚❚Chapter 21: Factors Influencing Health Status and Contact With Health Services

*

Fax Your Orientation Registration to (858) 569-1334

Special mortgage financing for physicians Our special home financing program is designed specifically to meet your needs as a busy physician for the purchase of your primary residence. s 'JOBODJOH BWBJMBCMF XJUI MPX EPXO QBZNFOU VQ UP SFลขJOBODFT XJUI IJHI MPBO UP WBMVFT BMTP BWBJMBCMF s 1SJWBUF NPSUHBHF JOTVSBODF JT OPU SFRVJSFE s 4JOHMF GBNJMZ IPNFT BSF FMJHJCMF 'PS EFUBJMT DPOUBDU

Daniel Schroeder

Senior Mortgage Banking Officer NMLS#633034 Daniel.Schroeder@bbvacompass.com 4180 La Jolla Village Drive Suite 530 La Jolla, CA 92037 Office (858) 356-2601

All loans subject to approval, including credit approval. Eligible properties must be located in Alabama, Arizona, California, Colorado, Central Florida, North Florida, New Mexico or Texas where BBVA Compass has a market presence. BBVA Compass is a trade name of Compass Bank, Member FDIC.

$5.95 | www.SANDIEGOPHYSICIAN.org

PRSRT STD U.S. POSTAGE

San Diego County Medical Society 5575 Ruffin Road, Suite 250 San Diego, Ca 92123

PAID DENVER, CO PERMIT NO. 5377

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radiology practice, a leaking fire suppression system destroyed a $1,000,000 1.5 tesla MRI. Make sure you’re covered.

In a Los Angeles

For decades, The Doctors Company has provided the highest-quality medical malpractice insurance. Now, the professionals of The Doctors Company Insurance Services offer the expertise to protect your practice from risks beyond malpractice. From slips and falls to emerging threats in cyber security—and everything in between. We seek out all the best coverage at the most competitive prices. So talk to us today and see how helpful our experts can be in preparing your practice for the risks it faces right now—and those that may be right around the corner.

Call our Los Angeles office at (800) 852-8872 today for a quote or a complimentary insurance assessment. n

Medical Malpractice

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Employment Practices Liability

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Workers’ Compensation Health and Disability

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Directors and Officers/Management Liability Errors and Omissions Liability

Property and General Liability

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CA License #0677182

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Billing Errors and Omissions Liability

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