March 2013

SAN FRANCISCO MEDICINE J O U R NA L O F T H E S A N F R A N C I S C O M E D I CA L S O C I E T Y

Local Leaders in Health Care

Philanthropy

Why and How Physicians Become Advocates Public Health Advocacy Medical Volunteerism in San Francisco

Plus: Highlights from the 145th SFMS Annual Dinner VOL. 86 NO. 2 March 2013

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IN THIS ISSUE

SAN FRANCISCO MEDICINE March 2013 Volume 86, Number 2

Local Leaders in Health Care Philanthropy

FEATURE ARTICLES

MONTHLY COLUMNS

10 Giving Back: Why Physicians Become Community Activists

Dexter Louie, MD, JD, and Carol A. Lee, JD

4

Membership Matters

7

President’s Message Shannon Udovic-Constant, MD

11 Philanthropy on Many Fronts: Public Health from a

Community Foundation Perspective

Sandra R. Hernandez, MD

13 Medical Volunteerism: Helping Out in Your Own Backyard

Paul J. Turek, MD, FACS, FRSM 15 Environmental Health Advocacy: The New Public Health

Paradigm, Your Patients, and You

Michael Lerner, PhD

16 A Catalyst for Change: The California HealthCare Foundation

Mark D. Smith, MD, MBA

18 Operation Access: A Unique Vehicle for Medical Philanthropy

Ellen Kaufman

9

Editorial Gordon Fung, MD, PhD, and Steve Heilig, MPH

29 Hospital News

30 In Memoriam

Nancy Thomson, MD

31 New SFMS Members

SPECIAL FEATURE 23 Highlights from the SFMS Annual Dinner

19 Hippocratic Philanthropy? Lessons from International Health

Kevin Starr, MD, and Steve Heilig, MPH 21 Physicians as Fund-Raisers: A Talk with Martin Brotman, MD

Editorial and Advertising Offices: 1003 A O’Reilly Ave., San Francisco, CA 94129 Phone: (415) 561-0850 e-mail: adenz@sfms.org Web: www.sfms.org Advertising information is available by request.

MEMBERSHIP MATTERS Activities and Actions of Interest to SFMS Members

Become a Champion of Medicine and Participate in the April 16 Legislative Leadership Conference Join SFMS for the CMA Legislative Leadership Conference on April 16, 2013, at the Sacramento Convention Center. Members have the unique opportunity to gain advocacy training and network with colleagues throughout California at this annual event.

The morning includes a short legislative advocacy training and presentation from key legislative leaders. Attendees will go to the Capitol in the afternoon to meet with legislators on health care issues. The meetings will be scheduled and coordinated by SFMS. This event is offered at no cost to SFMS members. Please email SFMS at membership@sfms.org or call (415) 561-0850 if you would like to attend.

SFMS/CMA Joins Amicus Briefs Challenging Proposition 8 and the Defense of Marriage Act

On February 28, the SFMS and CMA joined the AMA and dozens of other health care organizations in filing an amicus brief with the US Supreme Court challenging California’s Proposition 8, which denies state recognition of same-sex marriages. Tomorrow, a similar brief will be submitted challenging the Defense of Marriage Act, which denies benefits to same-sex partners of federal employees.

“CMA strongly supports efforts to reduce health care disparities among members of same sex households, including measures to afford such households equal rights and privileges to health care, health insurance and survivor benefits,” said CMA President Paul Phinney, MD. “We also recognize that denying civil marriage contributes to worse health outcomes for gay and lesbian individuals, couples and their families.”

The brief states that the listed Amici—which includes leading associations of psychological, psychiatric, medical and social work professionals— have sought to present an accurate and responsible summary of the current scientific and professional knowledge concerning sexual orientation and families relevant to this case.

These briefs were filed based on policy passed at last year’s House of Delegates:

Date Adopted: 10/15/2012 | Status: Adopted Resolved #1 | That CMA support efforts to reduce health care disparities among members of same-sex households including minor children Resolved #2 | That CMA support measures providing same-sex households with the same rights and privileges to 4 5

San Francisco Medicine March 2013

health care, health insurance, and survivor benefits afforded to opposite-sex households Resolved #3 | That CMA recognize that denying civil marriage contributes to poorer health outcomes for gay and lesbian individuals, couples and their families.

Support SFMS Members at the June 15 Prostate Cancer Run/Walk

SFMS members Seck Chan, Edward Collins, Robert Kahn, Ira Sharlip, Rodman Rogers, Stuart Rosenberg, and Lawrence Werboff of Golden Gate Urology will be hosting the Zero Prostate Cancer Run/Walk at Crissy Field on June 15, 2013.

The goal of the event is to help educate and create awareness about prostate cancer. The Zero Prostate Cancer Run is a premier men’s health event, having now been held in thirty two cities throughout the U.S. This is the first time the event will be held in San Francisco. For more information, please visit www.zeroprostatecancerrun.org/sanfrancisco.

Choosing Wisely Expands List of Overused Tests and Treatments

The American Board of Internal Medicine, as part of its “Choosing Wisely” campaign, expanded the number of medical societies recommending caution before certain tests and procedures are ordered. The new recommendations include: • Waiting 6 weeks to do imaging for low back pain, unless red flags are present.

• Avoiding elective, non medically indicated inductions of labor between 39 weeks and 41 weeks.

• Not requiring annual Pap tests in women ages 30 to 65.

• Steering clear of ordering antibiotics for adenoviral conjunctivitis.

For more information about the expanded Choosing Wisely list, visit http://bit.ly/15yQaI7.

CMA Files Request for En Banc Review to Stop Medi-Cal Cuts

On January 28 the California Medical Association (CMA) filed a request for an en banc review by the Ninth Circuit Court of Appeals to stop the State of California from implementing a 10 percent cut to Medi-Cal provider reimbursement rates.

Last month, a three-judge panel of the Ninth Circuit ruled that the state could move forward with the rate cuts, passed by the Legislature in the spring of 2011, despite an earlier district court ruling that found that the cuts would irreparably harm the millions of patients who rely on Medi-Cal for health care. CMA and the other plaintiffs in the CMA et al. v. Douglas et al. case are now requesting a rehearing from the full Ninth Circuit Court of Appeals. www.sfms.org

March 2013 If the state moves forward with these cuts, access to care will be devastated, not only for existing Medi-Cal patients but also the 900,000 kids moving from the Healthy Families program into Medi-Cal in 2013 and the millions of patients who will be newly eligible for Medi-Cal under the Affordable Care Act in 2014.

Volume 86, Number 2

Join SFMS and expert practice management consultant Debra Phairas in our practice management seminar series for physicians and office managers.

EDITORIAL BOARD Editor Gordon Fung, MD, PhD Obituarist Nancy Thomson, MD Stephen Askin, MD Erica Goode, MD, MPH Toni Brayer, MD Shieva Khayam-Bashi, MD Linda Hawes Clever, MD Arthur Lyons, MD

Editor Gordon Fung, MD, PhD Managing Editor Amanda Denz, MA Copy Editor Mary VanClay

SFMS On-Site Seminars

Recipe for Financial Success March 28 from 12:00 p.m. to 1:45 p.m. # Revenue + $ Expense = # Physician Income. This new workshop will teach participants critical skills in analyzing profit/loss statements, accounts receivable ratios and staffing patterns, and how to access specialty comparison norms.

Physician Practice Options: Self-Employment vs. Group Affiliation April 11 from 12:00 p.m. to 1:45 p.m.

With the ever-evolving health care, there are many practice opportunities for physicians to consider, including solo practice, merge with others to form a bigger group, foundation/ACO model, and more. This workshop will present a balance discussion of options and issues for physicians to consider before making these practice decisions.

Lunch is included for both seminars. The cost is $69/each for SFMS/ CMA members and their staff; $139/each for non-members. Questions or to register, please contact Posi Lyon, plyon@sfms.org or (415) 561-0850 extension 260.

SFMS OFFICERS President Shannon Udovic-Constant, MD President-Elect Lawrence Cheung, MD Secretary Man-Kit Leung, MD Treasurer Roger S. Eng, MD Immediate Past President Peter J. Curran, MD SFMS STAFF Executive Director Mary Lou Licwinko, JD, MHSA Associate Executive Director for Public Health and Education Steve Heilig, MPH Associate Executive Director for Membership Development Jessica Kuo, MBA Director of Administration Posi Lyon Membership Coordinator Lauren Estrada

Complimentary Webinars for SFMS Members

CMA offers a number of excellent webinars that are free to SFMS members. Members can register at www.cmanet.org/events.

• March 20: EHR Selection: Top 10 Tips for Success. 12:15 p.m. to 1:15 p.m.

• March 27: Successful Medi-Cal Provider Enrollment for Physician Providers. 12:15 p.m. to 1:15 p.m.

• April 3: Strategic Planning From Vision to Action • 12:15 p.m. to 1:15 p.m.

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BOARD OF DIRECTORS Term: Jan 2013-Dec 2015 Charles E. Binkley, MD Gary L. Chan, MD Katherine E. Herz, MD David R. Pating, MD Cynthia A. Point, MD Lisa W. Tang, MD Joseph Woo, MD

Term: Jan 2011-Dec 2013 Jennifer H. Do, MD Benjamin C.K. Lau, MD Keith E. Loring, MD Ryan Padrez, MD Terri-Diann Pickering, MD Adam Schickedanz, MD Rachel H.C. Shu, MD

Term: Jan 2012-Dec 2014 Andrew F. Calman, MD John Maa, MD Edward T. Melkun, MD Justin V. Morgan, MD Kimberly L. Newell, MD Richard A. Podolin, MD Elizabeth K. Ziemann, MD

CMA Trustee: Shannon Udovic-Constant, MD AMA Delegate: H. Hugh Vincent, MD AMA Alternate: Robert J. Margolin, MD

March 2013 San Francisco Medicine

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California Medical Association’s Legislative Leadership Conference

State Capitol Sacramento

April 16, 2013

Training: How to Speak to your Legislator and Current Policy & Legislation Put your training into ACTION! Visit your Legislator on April 16th

California Medical Association Legislative Leadership Conference

For more information, please contact Yna Shimabukuro, Center for Government Relations 916.444.5532 or yshimabukuro@cmanet.org

7

San Francisco Medicine March 2013

www.sfms.org

PRESIDENT’S MESSAGE Shannon Udovic-Constant, MD

Physician Advocacy and Philanthropy Philanthropy is an effort undertaken by an individual or organization based on an altruistic desire to improve human welfare. Medicine and health care certainly fit that description. In addition to cash donations to causes I deem important, my “philanthropic” efforts have largely centered on advocacy.

As the State Government Affairs co-chair for the California American Academy of Pediatrics and a representative to the CMA’s Council on Legislation, I am very involved in all healthrelated legislation that arises in California, especially as it pertains to children, adolescents, and the physicians who care for them.

In 2004 I became involved in advocacy efforts to curb access by children to violent video games when I was asked to participate in a press conference regarding Leland Yee’s Assembly Bill 1793, to require video game retailers to post signs regarding the video game rating system. With former SFMS President George Fouras, a child psychiatrist, I spoke on the importance of limiting violence in children’s and adolescents’ lives. This bill passed.

Then, Leland Yee wrote AB 1179 to ban the sale or rental to those under age eighteen of any video games that “depict serious injury to human beings in a manner that is especially heinous, atrocious, or cruel.” This legislation passed and was signed into law in 2005 by then-Governor Schwarzenegger.

Unfortunately, the makers of videogames challenged the bill, stating that this was a First Amendment issue. As a pediatrician, I disagree; we have precedents protecting our young, vulnerable children from obscenity such as pornography.

Many of us believe that the evidence is there for violence in videogames having the same status, but the Supreme Court did not agree and struck down the California law, stating that the industry-imposed voluntary rating system is adequate.

Seven years passed between the first press release that I was involved in and the 2011 Supreme Court ruling. I was disappointed that the efforts I had made on this issue did not result in a more gratifying victory. But an important effect is that this issue has received a lot of attention in the media. Parents do understand the concerns. I hope that more parents are restricting use of violent videogames for their children. A resource to help to do this is CommonsenseMedia.org, a nonpartisan, not-for-profit organization that provides information for families regarding content of all media.

Recent events have brought the issue of violence front and center. The Sandy Hook Elementary School shooting in Connecticut was heartbreaking. With parents around the country, I struggled with how and what to tell my two young children.

How do you explain something so unexplainable? As I read everything I could in the days following the shooting, I realized it was because I wanted to try to understand why. I want www.sfms.org

to understand not only as a mother but also as a pediatrician.

There is an ongoing debate about the role of guns in our society. President Obama directed Vice President Biden to hold hearings on the topic to inform the administration how best to limit future tragedies. One of the sessions included violence in the media. In the end, Vice President Biden recommended that Congress give $10 million for the CDC to study gun violence, including possible links to violent video games and media images. This will be a political battle; my advocacy efforts are not over.

Violence is a public health issue. Many physicians have been urging a public health approach to violence for many years. After the recent shooting, the AMA, along with fifty other organizations and medical societies, sent a letter to President Obama, the House, and the Senate, offering their expertise on this issue. The letter urged more mental health services and strengthening the assault weapons ban.

On January 16 the president released his plan to reduce gun violence. He calls for a new, national, safe, and responsible gun ownership campaign. In addition, there is acknowledgment of the importance of improved mental health services.

A large number of the proposals also call for funding to the CDC to look at violence as we would any other issue that kills members of our society.

A quote from Martin Luther King, Jr., seems fitting of the need for action: “This is no time to engage in the luxury of cooling off or to take the tranquilizing drug of gradualism.” I hope that another seven years don’t pass without some action to protect children from consequences of violence. There are many organizations involved in this work—the SFMS, AMA, CMA, AAP, National Physicians Alliance, and Moms Demand Action for Gun Sense in America. Hopefully this time real progress can be attained.

I urge you to pursue your own advocacy on the issues of your choice, because philanthropy, directly translated, means “love of mankind.”

March 2013 San Francisco Medicine

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EDITORIAL Gordon Fung, MD, PhD, and Steve Heilig, MPH

Philanthropy and Health, from Local to International “I gave at the office”—that’s the stereotypical, and stereotypically less-than-candid, response of the successful and busy person when asked for donations to worthy causes.

In medicine giving at the office is perhaps more common, and even more unavoidable, than in most any other profession.

Patients might need more care than their insurance—should they have any—will allow; the days (and nights) are full of overtime, voluntary, extended obligations. One gets used to that. But beyond such norms, many physicians are still compelled to give yet more of themselves in many ways.

The word “philanthropy” means “love of humanity”—a rather vague and lofty definition. But in action, according to the dictionary, that “love” translates into “altruistic concern for human welfare and advancement, usually manifested by donations of money, property, or work to needy persons, by endowment of institutions of learning and hospitals, and by generosity to other socially useful purposes.” Note that education and health care are the two leading examples there.

How to decide how, where, and to whom to direct our philanthropic concern and resources? Needs are endless in this world, and as the Bible warns, “The poor you will always have with you.” Prioritization is thus inevitable (even for billionaires!). One way some experienced philanthropists prioritize is by using legendary psychologist Abraham Maslow’s concept of a hierarchy of needs. Under this theory, the most basic needs include food, shelter, health, and some measure of safety against accidents and violence. Just above that come such needs as financial security and education.

Next come friendship, family, intimacy, self-esteem, respect of self and others, and ultimately “self-actualization” via creativity, ethical pursuits (including, yes, philanthropy), and so forth. From the food bank and free clinic to the opera, in operative terms.

Many of us who have pursued the healers’ arts decide that helping the disadvantaged is our primary goal, and that health needs are our preferred focus. The basic questions then often become utilitarian: How to advance the greatest good for the greatest number, with what we can share? What do we, in giving, wish to promote most? In what way? How to ensure that our money, time, and skills have maximum impact? How important are tax benefits? How “political” in our giving are we comfortable being? How much recognition, if any, do we want or need, ranging from the “pure” altruism of anonymous donations to having our name on a building (the “edifice complex,” as some wags have labeled it)?

In this issue of San Francisco Medicine, those and other issues are addressed by expert example. We are proud to present an all-star roster of authors, including leaders in the www.sfms.org

many forms of health care philanthropy, both local and international. Former SFMS president Dexter Louie and Carol Lee of the CMA’s Foundation explore why and how physicians have and can practice true philanthropy, even while still practicing medicine. Current SFMS President Shannon Udovic-Constant relates how her own volunteerism has taken her deep into policy advocacy on behalf of patients and the public. Sandra Hernandez, our city’s former public health director, who has headed San Francisco’s largest community foundation for more than a decade, describes her path of leadership in large systems, health and otherwise, and what she has learned in targeting resources for maximum impact.

Mark Smith describes his work with the statewide powerhouse California Health Care Foundation. Urologist Paul Turek explains how he became an active volunteer at a local clinic, despite his initial “I’m too busy” reflexive response.

Ellen Kaufman of Operation Access updates us on how that worthy organization, started by two local surgeons who saw a need they could help alleviate, continues as a great success and inspiration. Michael Lerner, a Macarthur fellow, outlines his many innovative efforts in environmental health, including a major project launched at the SFMS. Kevin Starr and Steve Heilig distill lessons in maximizing impact in the complex world of international projects. And longtime Sutter Health leader Martin Brotman wades into the tricky waters of how to enlist patients in supporting health services, including hospitals, so that all may benefit.

Also in this issue is expanded photographic coverage of the SFMS’s annual dinner, which was extremely well attended and received. The camaraderie across specialties, hospitals, and ages made for a gathering like few others in these evermore specialized times. The featured speaker, Dean Catherine Lucey of UCSF, outlined the important “Choosing Wisely” project she has led and which was featured in the previous issue of this journal.

We trust that you will enjoy and be inspired by this issue of our journal, and that you will join us in thanking all our authors for their contributions—all of them charitably donated, we should add!

March 2013 San Francisco Medicine

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Local Leaders in Health Care Philanthropy

Giving Back Why Physicians Become Community Activists Dexter Louie, MD, JD, and Carol A. Lee, JD The CMA Foundation’s success depends upon the commitment of the physician community in order to achieve our goals. And the passion you bring to medi-

cine is just what the CMA Foundation is looking for. Together, with your involvement, we can truly make the kind of difference you strive to make every day.

As a physician, you have a job like no other. At the end of the day, you don’t just dwell on the burden of paperwork and meetings. Rather, you can think about the mother who will finally be able to sleep tonight, because of the treatment you prescribed her coughing toddler. And the scared husband who hid pain in his wrist from his wife for a month, just so she wouldn’t worry. You laugh about the girl who was so ticklish you struggled to get the stethoscope near her. These are the people you help every day and think about every night.

You see patients as individuals who seek your expertise.

And your patients know this. They trust you above all others to hear their problems, heal their bodies, and soothe their worries—no matter how big or small. They confide in you.

These relationships are special.

Every day is different. And so is every patient, problem, and treatment. Nothing can keep you from caring about your patients.

After all, they depend on you to keep them healthy and to heal them when necessary.

ber or mentor who was key to their development of the belief that involvement with their community was part of what they should do. In particular, many minority physicians develop their commitment to community and helping others before choosing to become a physician. As a result, they brought a belief in community service when they chose to be physicians.

A number of physicians also shared the importance of a physician mentor in their lives, someone who encouraged and supported their community health efforts. The mentor was seen as someone who provided encouragement and a listening ear and who shared his experience and values in these efforts.

Giving back is central to physicians who are involved with their communities. A recurring sentiment

was expressed by a number of physicians who felt a strong desire to give back to their communities because of the opportunities given to them. A number of older physicians also expressed the sentiment that community involvement provided the public a chance to see physicians outside of their offices, involved in efforts that did not directly benefit them. While these physicians are experiencing significant stress in dealing with changes in health care, they continue to see medicine as a calling and understand their roles as advocates for community as well as for individual health.

Medical training, until recently, has not had any real focus on how the community and culture impact the way individuals make health decisions.

In addition to your clinical work, many of you have gone outside the four walls of your office, or clinic, or hospital, to devote substantial time to being involved in efforts to improve the health of your communities.

Research tells us that Californians want physicians to be their primary source of information about health care. This gives physicians a unique opportunity to directly impact the long-term health of their communities. Through a partnership with the CMA Foundation and their own desire to improve community health, physicians are becoming “community champions.”

The CMA Foundation has conducted extensive focus groups to determine whether there is a set of characteristics or qualities associated with physicians who are “community champions.” Key messages from the focus groups include the following:

Nor did medical training provide physicians with awareness of broader health issues as often perceived by a community, such as safe streets or quality schools. The students indicated that any of these types of experiences that they had were the result of volunteering their time, not part of their academic curriculum.

Many participants identified the presence of a family mem-

Continued on page 12 . . .

Life experience plays a major role for those physicians involved with community health efforts.

10 San 11 SanFrancisco FranciscoMedicine Medicine March March2013 2013

Physicians at all stages of their training and practice were vocal about what working in and with their communities has taught them. Many

shared experiences that helped them learn patience and understanding. They felt they acquired better listening skills. Those with the greatest experience also described their learning about “not being in charge.” They shared that this was something they had not learned in medical school. Working with community and patient groups required them to understand more how groups work, how to be a member of a team, and that community health efforts took time.

www.sfms.org

Local Leaders in Health Care Philanthropy

Philanthropy on Many Fronts Public Health from a Community Foundation Perspective Sandra R. Hernandez, MD One of the most important but elusive missions in our nation has been that of assuring safe and affordable health care delivery to the poor, uninsured, and underinsured, while also assuring a fun-

damentally sound public health system. When I left the San Francisco Department of Public Health, where I had served for almost fifteen years—first as a house officer at SFGH and later culminating as its Director—I was witnessing systematically less spending on the public’s health and on prevention in general.

As a primary care trained internist whose early years were immersed in the AIDS epidemic, I decided it was time to work intensely on the two ends of the continuum, getting more people better access to primary health services while trying to better understand and thereby influence factors that drive demand for care.

I had learned a lot from my days as the director of the department’s AIDS Office. Namely, I came to fully understand the power of community engagement, advocacy, and the selfdetermination and effectiveness of residents, neighbors, and ordinary people. The lessons learned specifically from trying to create needle-exchange programs when there was such compelling supportive data and such an urgency to abate new infections was immensely instructive.

My first real venture outside of the medical care system came in 1996, when we undertook a comprehensive study of repeat high-cost users of SFGH’s emergency room. What was clear was that while our ER interventions worked, our discharge planning didn’t. Many of these folks were effectively homeless, or would lose access to housing when we admitted them. We would discharge them to a local SRO hotel with a voucher only to see them return a week or so later, having had no follow-up. We realized that we needed a much better post-hospital care plan. Later we got funding from the Robert Wood Johnson Foundation to run a pilot of what later became the Direct Access to Housing program, which was modeled after evidence-based supportive housing. The Health Department became a housing provider and began to wrap services around these clients in a way that not only met their wound care and their psychiatric care but that also created a community where residents with complex social and health needs could find a stable home.

Not long afterward, we felt that we needed to look at our www.sfms.org

emergency pre-hospital care system. Given that San Francisco is both a city and a county, the Department of Public Health had under its roof both the paramedic department and the Emergency Medical Services agency that is meant to monitor and regulate it. As we looked at best practices. it became clear that a merger of the Paramedic Unit into the Fire Department would decrease response time and create a much more efficient pre-hospital response system. We received funding from another local philanthropy to do the research. Today the delivery system is in the Fire Department, and DPH oversees the entire county system, both public and private. This made it clear that the DPH was providing the public health role, or regulation, quality, and oversight.

Working for an amazing group of volunteer and appointed health commissioners, I would listen—first as health officer and later as health director—to public testimony at semimonthly commission meetings. There a member of the public would routinely testify about the department’s need to look at the issue of childhood lead poisoning. I would listen and take notes, and finally one day I decided to look deeply into our lead screening program, only to find—well, that we really didn’t have a program. There were many good reasons, of course, and we later addressed many of the obstacles that impeded routine screening. The lesson, again, was about citizen engagement and advocacy. It was also a lesson in how important the built environment and place are in contributing to health risks and ultimately to health outcomes.

When I left the DPH some fifteen years ago, it was to take over as the CEO of the San Francisco Foundation (TSFF). The foundation’s mission was fundamentally focused on place, with an emphasis on underserved neighborhoods and communities in the five Bay Area counties (San Francisco, San Mateo, Marin, Alameda, and Contra Costa). It was an opportunity to work with grassroots leaders and advocates as well as leading business leaders and committed philanthropists who also wanted to be catalytic in making the region stronger and the neighborhoods healthier.

Perhaps the signature example of this good will, common vision, and sense of the possible was the amazing groups of business leaders, health system leaders, health philanthropic leaders, union leaders, and patient advocates who came together over several months to redesign San Francisco’s fragmented health care safety net. Driven by data and using consumer research done by partnering philanthropies, Healthy San Francisco leveraged the San Francisco Health Plan’s infrastructure to create a rational and financially sustainable medical home for more than 50,000 uninsured San Francisco

Continued on the following page . . .

March 2013 San Francisco Medicine

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Philanthropy on Many Fronts Continued from the previous page . . . residents. As significant as that was, we now of course welcome the even greater opportunity of making the national Affordable Care Act a reality in California and assuring that we effectively reach all the communities and residents who stand to benefit from this historic expansion of health insurance benefits through Covered California, our state health exchange.

TSFF’s environment program has partnered with the State Metropolitan Transit Agency to invest in affordable housing, open space, child care, and fresh food venues in places where public transit can replace the need for cars and thus reduce urban sprawl and the consummate negative health outcomes.

The foundation’s work on poverty alleviation, job training, and asset building is perhaps some of the most “downstream” of all our work in the sense that it recognizes and is addressing the profound connection between family poverty and stress, violence, despair, and preventable morbidity. The Bay Area, like the State of California, is a region of great contrasts. Since the devastating housing and financial crisis of 2008, the contrasts have only become more exacerbated— and yet here too we are embracing the great complexity of assuring the ongoing development of affordable housing. In partnership with Lennar Corporation, a leading homebuilder, TSFF is supporting the implementation of a community benefit agreement to assure that residents in SF’s District 10 have access to job training and jobs while Lennar redevelops the former Bayview Shipyard into Candlestick Point, a 702-acre redevelopment project of which 320 acres will be open space and parks. The project will also generate 12,000 permanent jobs. Here, again, the foundation is focused deeply on built spaces, with a specific goal of engaging residents to assure that communities fully benefit from the economic engines and investments of corporations large and small.

As a physician with a deep commitment to public health, my path through philanthropy to date has taken me deep downstream from a primary care clinic or even from the challenges encountered in implementing comprehensive needle exchange programs as part of HIV prevention in the 1980s.

Today’s challenges are different, but no less complex or compelling. The value of a public health orientation is in the ability to see holistically that harnessing the incredible diversity of people and ideas across sectors is incumbent upon us all. I am also deeply aware and appreciative of the work, stamina, and passion of our civic leaders. Be they volunteer leaders, civil servants, corporate leaders, or citizen activists, one does not serve the mission of public health without a deep and profound optimism.

Since my early days in philanthropy, I have worked with some of the most generous, intelligent, civic-minded, and creative people in this region. My optimism is further fueled by the younger generations of leaders who see the intersections between what we build, how we live, how we plan, and how we act with regard to future generations. They are running city agencies, leading advocacy organizations, running student organizations, and developing businesses that seek to 12

San Francisco Medicine March 2013

grow the economy while assuring that a social mission is fully realized. I have had not one routine day while on this journey.

I travel in crowds and try to find the points where we can accelerate the scaffolding of human development and wellness.

Sandra R. Hernandez, MD, is the CEO of the San Francisco Foundation and an assistant clinical professor at the UCSF School of Medicine. She also maintains an active clinical practice at San Francisco General Hospital in the AIDS clinic and is on the Board of Blue Shield of California. She is former director of public health for the City and County of San Francisco. See www.sff.org for more information.

Giving Back Continued from page 10 . . .

Although viewed as the group with the most time to spare, retired physicians were often reluctant to become involved in activities drawing on their clinical expertise. While a few volunteered in

community free clinics, most were reluctant to do so, citing liability concerns and not being current with the standard of medical practice. Several retired physicians suggested that the county medical society could serve as the local job resource bank for physicians interested in volunteering in the community and sharing their interests and skills. In this way communities could match their needs with these physician’s interests and availability.

The CMA Foundation welcomes additional physician champions to carry out our mission.

Dexter Louie, MD, JD, is a thirty-five-year member of the SFMS and CMA, and immediate past president of the CMA Foundation Board, as well as a past president of the SFMS. Carol A. Lee is the president and CEO of the CMA Foundation.

THE CMA FOUNDATION PROJECTS • Champions for Health • AWARE (Alliance Working for Antibiotic Resistance Education) • California Medicine and Public Health Initiative • Carlo Joseph Geraldi Medical Student Scholarship: • Cervical Cancer/HPV Project • Diabetes Quality Improvement Project • Ethnic Physician Organization Project • Medical Student Community Leadership Grant Program • Obesity Prevention Project • Prescription for Wellness • Women’s Health Initiative

See www.thecmafoundation.org for more information.

www.sfms.org

Local Leaders in Health Care Philanthropy

medical volunteerism Helping Out in Your Own Backyard Paul J. Turek, MD, FACS, FRSM I remember the day she asked me. It was during a busy cystoscopy clinic at the Veterans Affairs Hospital. There were veterans in half-buttoned medical gowns

meandering all around. And there was Janet Reilly, oblivious to the setting, plopped down in one of the small consult rooms with a rather large smile on her face. “Hi, Paul,” she said. “I really need you to help me get medical professionals, especially retired ones, to volunteer in a free clinic.”

I’m Too Busy!

The first thing to cross my mind was: How could I possibly add more to my schedule? My days at UCSF were chock-full of teaching, research, grants, clinics, committees, and travel. And then there was the young family. As an academic surgeon, I was already spinning at high rpm, barely holding things together, and the time was nearing for my promotion to full professor.

But her dream was clear. She wanted to start a volunteerpowered, free clinic for the working uninsured in San Francisco—a population of about 63,000 at the time. It would be based on the national Volunteers in Medicine Model (VIM), of which some 70-plus prior clinics had already been started around the country. But this would be the first such clinic in a major city, making it a major logistical challenge.

I e-mailed her back later that same day and said, “Count me in.”

Although I have always been interested in medical volunteerism, this was not exactly how I pictured myself getting involved as an experienced professional. During training, I had volunteered in fantastically needy and faraway places like Dakar, Senegal, and always imagined going back to the third world again when I could offer more expertise and wisdom. But Janet’s proposal was different: It awakened me to the opportunities to help in my own backyard. And that’s why her offer was so compelling to me. I didn’t have to fly sixteen hours to another continent and leave my family for weeks at a time to help others.

Volunteering is possible in smaller, less disruptive doses, nearer to home.

It’s really the same giving feeling, just spread evenly over everyday life rather than sparingly and in jolts.

The Clinic by the Bay

Since opening in November 2010, the Clinic by the Bay has come a long way. Its mission is “to understand and serve, with dignity and respect, the health and wellness needs of the medically underserved in the San Francisco Bay Area.” As a dedicated medical home for the working uninsured, it provides comprehensive care that includes mental health, dental screenwww.sfms.org

ing, and a general medical exam, all at the initial visit. Through a growing network of medical partnerships, it provides clinical laboratory tests, X-rays, and quality specialty care and surgical procedures. Most important, volunteer providers see patients for visits of forty-five minutes or longer, and there is little to no paperwork and no insurance forms to worry about! When was the last time that you truly enjoyed a twelve-minute patient visit? Honestly, during my training, this is the way that I always imagined that medicine should be practiced: old-school care delivered in a paperless way, with edgy EMR technology and among smiling volunteers. As is often said at the Clinic, “We practice the art of medicine, not the business of health care.”

Here are some interesting facts about the Clinic by the Bay: Since November 2010, we have tripled our capacity and completed more than 4,200 visits. We now handle 240 visits per month and see patients during the day and an evening a week. Our patients are largely (more than 85 percent) ethnic minority adults, and 60 percent do not speak English as a primary language. We currently have more than 100 active volunteers, and about 70 volunteers help at the clinic each month.

Among them, 20 are licensed care providers who work alongside 26 nurses. Seventy-four percent of our volunteers have been with the clinic for six months or more. Clinic volunteers have logged in more than 17,000 hours of service to date, representing $675,000 in services. The clinic has received nearly $2 million in private and corporate funding and nearly $1 million in in-kind donations of goods and services. We are not an official member of the Healthy SF network, but we work cooperatively with Healthy SF and the Department of Public Health.

Continued on the following page . . .

March 2013 San Francisco Medicine

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Medical Volunteerism Continued from the previous page . . .

The Power of Volunteering Since I became involved during the clinic’s planning stages in 2007–2008, I have never looked back. As a founding board member and chair of the Medical Advisory Board, my involvement has only deepened with time. Recently, the clinic celebrated its second anniversary as a fully functioning free clinic in San Francisco’s Excelsior district. In the middle of a dramatic and lingering recession, we have become, in car talk, a small and underpowered but well-oiled machine. And one that is completely privately funded. Notably, during this critical and challenging time of growth, the little-clinic-that-could has also made a little history. As observed by Aaron Hurst in The Chronicle of Philanthropy, we have become an innovative nonprofit by relying on pro bono help “not just to keep the lights on but to go from good to great.”1 Indeed, almost half of our life-breathing “support” comes from professionals of all walks of life, including doctors, nurses, pharmacists, accountants, lawyers, and businessmen and women. When reduced to simple math, this means that 89 cents of every donated dollar goes straight to care.

Why Me?

Paul J. Turek is director of the Turek Clinic (www.TheTurekClinic.com), a men’s health clinic in San Francisco. He is a former professor of urology, obstetrics, and gynecology at the University of California, San Francisco, and held the Academy of Medical Educators Endowed Chair in Urology. He is an active clinician and recognized international authority on men’s health issues. A member of the SFMS, Dr. Turek maintains an active blog at www.TurekonMensHealth.com.

References Hurst A. Pro bono help can do far more for nonprofits than save money. The Chronicle of Philanthropy.

November 11, 2012. http://philanthropy.com/article/

Skilled-Volunteers-Can-Help/135644/ http://theturekclinic.com/clinic-by-the-bay-freeclinic-healthcare-dr-paul-turek/

Physician Volunteer Opportunities at Clinic By The Bay

1) Volunteer at the clinic for a minimum of 4 hours per month.

2) Participate in our Physician Advisory Panel that allows clinicians at CBTB to get real-time, over the phone advice once or twice a month.

Contact info@clinicbythebay.org for more informa-

Why did I become, and why do I remain, involved with Clinic by the Bay? Honestly, because it feels good to give back in an understated, everyday way. And because each of the following matters greatly to me: providing the gift of better health, giving back in my own backyard, helping fellow citizens in an incredibly fundamental way, making the community a better place, doing what I love to do, coming home to my family with a big A REGISTRY smile on my face.

Tracy Zweig Associates

A Limerick for Clinic by the Bay

Inspired by what we have done and how far we have come, I gave this poem as a toast at the second anniversary celebration of the clinic at Credo Restaurant last fall.

Chant it to the tune “If I Only Had a Heart” from The Wizard of Oz: You can while away the hours, conferring with the flowers, consulting with the rain. . . .

Or you can feel so much better, enclosing check and letter, to the Clinic by the Bay. You could be an empty kettle, sit back and always settle, and never get involved. . . .

Or you could be kind-a-human, act a bit like Harry Truman, and help our clinic evolve.

You could also be a Lincoln, and do a lot of thinkin, by volunteering today. . . .

You’d feel more sentimental, fulfilled, romantic, and gentle, at Clinic by the Bay.

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San Francisco Medicine March 2013

INC.

&

PLACEMENT

FIRM

Physicians

Nurse Practitioners ~ Physician Assistants

Locum Tenens ~ Permanent Placement V oi c e : 8 0 0 - 9 1 9 - 9 1 4 1 o r 8 0 5 - 6 4 1 - 9 1 4 1 FA X : 8 0 5 - 6 4 1 - 9 1 4 3

tzweig@tracyzweig.com w w w. t r a c y z w e i g . c o m

www.sfms.org

Local Leaders in Health Care Philanthropy

Environmental Health Advocacy The New Public Health Paradigm, Your Patients, and You Michael Lerner, PhD Why should you, as a physician, care about the role environmental factors play in the health of your patients? Why should it matter to you as a priority of any

kind? I would suggest three reasons: First, understanding how chemicals and other environmental factors affect your patients may enable you to offer sound, science-based recommendations for treatments and prevention-oriented lifestyle changes.

Second, understanding these issues can make you a better advocate for sound, science-based lifestyle and public health measures in your specialty and in your community.

Third, when physicians and allied health professionals come together to support the new public health paradigm, they are often the decisive voice in achieving genuine progress for public health.

In 1999, a small group of funders formed the Health and Environmental Funders Network. HEFN believed that health professionals and patient advocates would represent a decisive voice on environmental health promotion as disease prevention policies and practices.

Specifically, HEFN sought to bridge the gap between environmental funders and health funders. Today, foundations are investing an estimated $100 million into the environmental health philanthropy field.

One watershed in environmental health philanthropy was the publication in 1996 of Our Stolen Future, by Theo Colborn, Dianne Dumanoski, and Pete Myers, which put the threat of endocrine-disrupting chemicals on the public health agenda.

EDCs can affect human health throughout the life cycle at extremely low doses in critical windows of vulnerability. We now know that EDC effects are in some instances heritable. Bisphenol A, which is in plastics and can linings, has emerged as the poster child for EDCs, driving awareness of the whole field.

One of the earliest projects of environmental health funders was support for Health Care Without Harm—an international campaign for environmentally responsible health care.

Funding HCWH was entirely congruent with the view that the health sector was one of the most important sectors to move forward toward the new public health. HCWH was followed by comparable initiatives in other industrial sectors.

Major efforts were also launched in science media and communications (Environmental Health News), in state policy work (the SAFER campaign), in national policy work (Safer Chemicals, Healthy Families), in the chemical sector (Coming Clean), in international treaty work (the International Persistent Organic Pollutants Elimination Network), and in many other arenas.

Environmental justice funders made powerful contribuwww.sfms.org

tors to the environmental health and justice movement.

Funders of women’s environmental health issues also made a central contribution.

The achievements of environmental health philanthropy have been substantial. The REACH chemical regulations in the European Union introduced a precautionary approach to chemical management in one of the world’s largest markets.

Precautionary approaches to chemical management are now law in many states across the country. The Stockholm Convention was the first global treaty to ban twelve of the world’s most toxic chemicals. Green chemistry is a growing field of chemical research. Endocrine-disrupting chemicals are recognized as a potent health threat. The industrial sector market campaigns are driving entire industrial sectors toward safer chemical policies.

As part of this burgeoning field of environmental health, the Collaborative on Health and the Environment (CHE) was launched at a meeting at the San Francisco Medical Society on March 21, 2002. Its purpose was to bring the revolution in environmental health science to the patient and health professional communities that represent health-affected disease groups.

A two-day conference at Commonweal followed the San Francisco Medical Society meeting. CHE’s consensus statement recognized that: 1. We have an epidemic of chronic disease in this country.

2. Seventy percent of these diseases are preventable.

3. Investing in prevention as well as treatment is not only prudent but necessary.

4. Identifying and reducing environmental toxicants related to these diseases is essential.

5. Taking precautionary action is important.

Today, CHE has 4,500 partners in 50 states and 79 countries. Eighteen working groups and listservs discuss science, cancer, fertility, learning disabilities, autism, neurodegenerative diseases, diabetes-obesity, asthma, healthy aging, and more.

CHE’s motto is “science and civility.” We share and discuss the new environmental health science in civil and respectful ways. CHE doesn’t do advocacy—but thousands of its partners bring CHE science and scientists into campaigns and policy work on health promotion and disease prevention.

While CHE sustains a principal focus on chemical contaminants, the revolutionary developments in endocrinedisruption science, low-dose effects, and epigenetics require a broader frame.

Continued on page 17 . . .

March 2013 San Francisco Medicine

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Local Leaders in Health Care Philanthropy

A Catalyst for Change The California Health Care Foundation Mark D. Smith, MD, MBA The California HealthCare Foundation (CHCF) focuses its efforts on some of the most intractable problems in health care delivery and financing—im-

proving quality of care for people with chronic disease; reducing barriers to efficient, affordable care for the underserved; promoting greater transparency and accountability; and supporting implementation of health reform in California.

Based just across the Bay in Oakland, our nonprofit philanthropy uses strategic grants, program-related investments, demonstration projects, and nonpartisan research and analysis to improve the health care safety net, encourage adoption of new technologies, inform policy makers, and enlighten future health care leaders. Seeking to fulfill the promise of better health care for all Californians, CHCF supports ideas and innovations that improve quality, increase efficiency, and lower the costs of care.

Established in 1996, CHCF has about $700 million in assets and has paid out more than $500 million to support its programmatic work. There are limits to what any philanthropy can do.

While it isn’t possible to buy better health care for even a small percentage of Californians or build a new system from scratch, CHCF can serve as a catalyst for change by supporting great ideas and innovations that need help getting off the ground. Following are a few examples of how we play the role of catalyst for change.

Skill-Building and Networking for Health Care Leaders

Nearly all successful professionals who play a leadership role in California’s health care system subscribe to the “it takes a village” philosophy. CHCF’s Health Care Leadership Program transforms today’s clinicians into tomorrow’s leaders. Up to thirty physicians, nurses, dentists, pharmacists, and other health care professionals are selected annually for this part-time, two-year fellowship. Led by nationally recognized health care and leadership development experts from the UCSF Center for Health Professions and the UCLA Anderson School of Management, fellows broaden their management skills while gaining insights into the trends and challenges facing health care in California. Alumni become part of a network that continues to collaborate, develop its skills, and profoundly influence health care delivery in California.

Using Technology to Expand Access to Care

When CHCF was founded, the application for Medi-Cal was longer than twenty pages, and it was only for one program. Today, One-e-App is an innovative Web-based system that provides an efficient, one-stop approach to enrollment in a range of public and private health, social service, and other support programs.

Based on a platform originally funded by CHCF, One-e-App streamlines the application process through one electronic appli16 17

San Francisco Medicine March 2013

cation that collects and stores information, screens and delivers data electronically, and helps families connect to needed services.

One-e-App is in use in a growing number of counties throughout California. As the state transitions to health care reform, CHCF is supporting the use of a further customized One-e-App to support enrollment and eligibility determination for participants in the Healthy San Francisco low-income health program, as well as for low-income health programs in Alameda, San Mateo, and Santa Cruz counties.

Supplying Data to Support Good Decisions

Health care delivery, like politics, is local. How medical care is organized, delivered, and financed in California varies by region. To better understand these differences, CHCF commissions dozens of nonpartisan studies each year. One example is a recent series of reports on the six large and diverse regional state markets, including the San Francisco Bay Area. Among the findings were that Bay Area health care providers weathered the economic downturn comparatively well, with hospital systems showing strong financial performance, where county and smaller safetynet hospitals continued to struggle. Health reform and other developing trends are expected to tamp down revenues in coming years, and hospital seismic construction projects underway raise concerns about ability to pay debt obligations in the face of declining income. The complete report is available for free download at www.chcf.org.

Examining Medical Care Variation

In 2005, CHCF brought together researchers from the Dartmouth Atlas of Health Care (CHCF is one of several funders) and leaders at different University of California hospitals to explore findings that similarly ill patients at UCLA spent significantly more days in the hospital, in intensive care, and had more physician visits than patients at UCSF. Did more care translate into more lives saved—was the variation warranted? Following this meeting, CHCF supported a collaboration of researchers from the five UC hospitals and Cedars-Sinai (which has doctors affiliated with UCLA) in an effort to take a case-by-case look at data on heart failure patients and find out what was behind the variations in care. While the answers turned out to be complex, participants agreed that hospitals must develop a culture that provides aggressive treatment when warranted and approved by the patient and family, and ensure that patients and families were aware of all options available to them, including palliative care alongside curative care, when aggressive care was clearly unwanted or unwarranted.

The University of California/Cedars-Sinai coalition continues to work on innovative approaches to better manage patients www.sfms.org

and was recently granted nearly $10 million from the Agency for Healthcare Research and Quality to continue its efforts.

Investing in Innovation

Beyond a robust grants program, CHCF has embarked on an ambitious effort to help transform health care delivery through the CHCF Health Innovation Fund, which supports business models with the potential to significantly lower the cost of care or improve access to care. CHCF is investing $10 million in medical and health care devices, technologies, and services over three years.

Among the projects receiving funding is CareInSync, which offers a proprietary mobile platform that allows care teams to collaborate on patient transition plans to expedite discharges and reduce readmissions. Research has demonstrated that hospital readmission rates can be reduced by improving discharge planning; coordinating care between settings; and enhancing coaching, education, and support for patient self-management. However, the quality improvement interventions most commonly used by providers are paper-based and have proven difficult and costly to implement, scale, and sustain over time.

CHCF invested in CareInSync because real-time, structured communication and coordination between providers is essential to improving the quality of patient care transitions from the hospital to the community while reducing overall costs. With support from CHCF, CareInSync will enhance its products and expand operations throughout California and the nation.

Encouraging EHR Use

Small medical practices are under tremendous pressure as they struggle to maintain financial stability while improving patient care. CHCF funded a two-year, $1.5 million initiative called Small Practice eDesign to develop a prototype infrastructure and tools that support the adoption, integration, and meaningful use of electronic health records (EHRs) for small practices in Tulare County. Tulare County is one of the poorest counties in the nation, is a federally designated primary care shortage area, and has the highest prevalence of diabetes in California. The lessons learned from and the tools developed for the Small Practice eDesign project can help small medical practices throughout the state as they wrestle with implementation of electronic practice management systems.

These examples—just a few of the many projects supported by the foundation—show that CHCF’s strength is providing the spark and the support to bring disparate parties together, contribute nonpartisan research and analysis, support development of skills for improved effectiveness, and help build a structure to search for solutions. We think this is what being a catalyst is all about.

Environmental Health Advocacy Continued from page 15 . . .

Chemicals are only one harmful ingredient of the “environmental health soup” to which we are exposed. Other ingredients include income disparities; psychosocial stressors; climate change; infectious disease vectors; nutrition/food; radiation; and newer threats including biotechnology, nanotechnology, EMF, and synthetic biology.

Good science on how chemical contaminants work in real life inevitably requires acknowledging other stress vectors.

Hence CHE came to embrace complexity theory, or what we also call the “ecological paradigm of health.”

We now know that different people develop the same epidemic diseases for different reasons. There is no single path to cancer, infertility, learning disabilities, asthma, autism, or hundreds other environmentally related conditions.

For this reason, the new public health movement—a frame that may be better than the environmental health and justice movement—requires recognition of complexity theory, or the ecological paradigm of health.

The bad news about the complex causal web of morbidity and mortality is there is no silver-bullet fix. The good news is that any meaningful reduction in environmental threats to human health—or increase in health-supportive factors— will likely strengthen health promotion, resiliency, and disease prevention across a wide range of conditions.

The new public health paradigm—based on the premise of causal complexity—raises awareness that an extraordinary array of efforts to improve public health—promoting better diet, fitness, air and water quality, food safety, green building practices, school lunches, safe streets, income disparities, and much more—are partners in improving the lives and health of your patients and our families.

Despite the challenges facing the new public health movement, the issue won’t go away. We can’t be healthy people on a sick planet. In every corner of the globe, women and men are fighting local battles against pesticides, polluting industries, and every other form of environmental contamination.

The great and enduring struggles—for peace, for the environment, and for justice—may never be won once and for all. But while we will never complete the struggle, we can also never turn away from doing our part.

Michael Lerner is the president of Commonweal and board chair of Smith Center for Healing and the Arts in Washington, D.C. He is a cofounder of HEFN, Health Care Without Harm, and the Collaborative on Health and the Environment. For more information, visit www.commonweal.org.

Mark D. Smith, MD, MBA, has been president and chief executive officer of the CHCF since its formation in 1996. A board-certified internist, Smith is a member of the clinical faculty at UCSF and an attending physician at the Positive Health Program for AIDS Care at SF General Hospital. He is a member of the Institute of Medicine (IOM) and was appointed to chair the IOM committee on “The Learning Health Care System in America,” a two-stage consensus study that began in January 2011 and issued a report in September 2012. For more information, visit www.chcf.org. www.sfms.org

March 2013 San Francisco Medicine

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Local Leaders in Health Care Philanthropy

Operation Access A Unique Vehicle for Medical Philanthropy Ellen Kaufman More than twenty years ago, Operation Access founding surgeons William Schecter, MD, and Douglas Grey, MD, attended a meeting of the Northern

California Chapter of the American College of Surgeons at which the challenge of providing surgical care to the uninsured was discussed. Drs. Schecter and Grey recognized that while many low-income, uninsured people could access primary care at a public or community clinic, if and when someone needed a surgical procedure, finding care was difficult—if not impossible.

As physicians, they believed that providing care to all patients in need was part of their professional responsibility, and they proceeded to meet every week to explore options for meeting the challenge.

Recognizing that it was easier for medical professionals to volunteer overseas than in their own communities, Drs. Schecter and Grey concluded that the good will and energy of physicians and others who traveled abroad could be harnessed to benefit the underserved right here at home. They began to build a care model based on the philanthropic impulse of local clinicians and, through the West Bay Hospital Conference, reached out to local hospital CEOs to propose that they provide operating rooms and surgical equipment on a rotating basis, enabling volunteer physicians and nurses to donate low-risk outpatient surgical procedures. The reception was polite. There was conceptual agreement with the principle. But it took a lot of time and a lot of work to move from vision to implementation.

Joined by Dr. Paul Hofmann, then an executive with a nonprofit Northern California health care system, they fielded a multidisciplinary team of management, legal, and hospital volunteers to develop a business plan for the nascent organization. The team spent hundreds of hours outlining the process of care: Who would be served? How would they be referred and screened? How would they be matched with appropriate physicians?

Focusing on low-income, uninsured workers and the selfemployed who fell through the cracks, Drs. Schecter, Grey, and Hofmann and their volunteer team set up an administrative structure to screen patients from referring community clinics for financial eligibility and medical comorbidities and to connect them with surgeons and their partner hospitals. They solved the problems of credentialing, liability, and quality assurance by limiting volunteers’ service to their own hospitals and using the credentialing and quality assurance programs in place rather than creating another process. The volunteers provided their own malpractice insurance.

After two years of preparation, Drs. Grey and Schecter recruited their professional friends and launched a “pilot” surgery day at Kaiser-Permanente San Francisco, at which fifteen vol18 19

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unteers cared for five patients. Since that first surgery day, OA volunteers have cared for more than 10,000 Bay Area residents in Alameda, Contra Costa, Marin, San Francisco, San Mateo, and Sonoma counties.

Drs. Schecter, Grey, and Hofmann, who have remained actively engaged with OA, created an enduring structure that enables medical professionals to efficiently and effectively embody their values. Their vision has inspired clinicians throughout the Bay Area to donate their time and skills to benefit the low-income, uninsured population in our community and to make a difference in the lives of their neighbors.

Today, more than 1,100 physicians, nurses, and support staff volunteer in conjunction with thirty-three medical facilities to serve approximately 1,700 patients a year. Each volunteer is motivated by his or her personal values, but the underlying humanitarian impulse to help others is shared by all.

“I’ve always believed that we in health care are blessed with skills that are so universally valued and so easy to give away. I’m impressed by the enthusiasm with which volunteers give up their free time to do what they do best, expecting nothing in return.”

—Andrew Moyce, MD, retired

To date, more than $80 million in clinical services have been provided without charge to more than 10,000 patients. Formally recognized and supported by the American College of Surgeons, Operation Access has encouraged replication of its model in other parts of the country.

Predictably, patients are profoundly grateful for the care that they receive. In the absence of insurance and financial resources, many patients resign themselves to coping with pain and/or physical limitation and only dream of what their lives might be like if their health problems were resolved. The volunteers who have followed in the footsteps of Drs. Grey and Schecter have restored dignity and hope to thousands of people by enabling them to secure or return to work, often in physically demanding jobs; to care for their families; and to live without pain or physical limitation.

“It is difficult to express my gratitude for the help all of you provided without my eyes smarting or my chin trembling. . . . I am grateful not just for myself. I am grateful for all of those you have assisted. There is not one patient who doesn’t realize the value you each make on their behalf.”

—Peter, Operation Access patient, March 2011 Ellen Kaufman is the development and communications officer of Operation Access. Visit www.oerationaccess.org for more. www.sfms.org

Local Leaders in Health Care Philanthropy

Hippocratic Philanthropy?

Lessons from International Health

“Philanthropy” is defined as “altruistic concern for human welfare and advancement, usually manifested by donations of money, property, or work”—in

other words, well-intentioned giving. But good intentions aren’t enough to keep us out of trouble. In philanthropy, as in the clinical practice of medicine, the foremost principle should be, “First, do no harm.”

Haiti provides a sobering example of aid gone wrong. Three years ago an earthquake shattered a nation already at the top of the misery index. The international response seemed heartening at first, involving vast amounts of money, personnel, and pledges.

The result? What has been called a disastrous response to disaster, a “Republic of NGOs” (nongovernmental organizations) with hundreds of uncoordinated aid groups tooling around with too little positive effect, hundreds of thousands of Haitians still in tents, actual increases in disease in some cases, waste of untold millions of dollars, broken trust among donors and Haitians— and no end in sight. The harm comes from the opportunity wasted, from what might have been if money had been used more wisely.

Philanthropy can cause harm in myriad ways: by wrecking local economies with giveaways; by undercutting local efforts and institutions, by creating dependency, by enabling corruption—it’s a long list. The end result of all of them, though, is the failure to create lasting change for the better. Philanthropy that fails to create sustained impact raises hopes and dashes them; it suppresses the emergence of better solutions and wastes the opportunities presented by crisis.

In international health funding, we’ve done far too many things that didn’t work, for far too long. Our obvious failures have played into the hands of Tea Party politicians intent on cutting foreign aid—which represents a paltry less-than-one percent of the nation’s budget as it is. We need to get it right. For those considering support for or work with international development and health projects, here are a few ideas on how to assure that money and effort leads to real impact in a way that “does no harm”: Get clear on what you’re setting out to accomplish. Focus on impact, not activities, and know exactly what that impact is to be. That is what defines your mission, and it should be the driver of everything you do. A lack of clarity about the mission is where a lot of efforts go wrong. You can see in the typical mission statement, too often just a collection of verbiage about “empowerment,” “capacity-building,” and “sustainability”—buzzwords and activity lists without a focused sense of outcomes. We like to use something we call “the eight-word mission statement,” which includes only a verb, a target population, and an outcome that implies something to measure. Why eight words? It’s long enough www.sfms.org

Kevin Starr, MD, and Steve Heilig, MPH

to be specific and short enough to force clarity. Save kids’ lives in Uganda. Rehabilitate coral reefs in the Western Pacific. Prevent maternal-child transmission of HIV in Africa. Get Zambian farmers out of poverty. These statements tell us exactly what the organization has set out to accomplish, in very concrete terms. Only with that clarity can you hope to efficiently get to impact.

It’s all about behavior change. Real impact comes from behavior change, from someone doing something differently.

Lasting change comes from people continuing to do that thing differently. Mothers need to feed their kids the right foods. Local doctors need to give the right treatment. Officials need to keep doing their jobs. If you’re not changing behavior in a lasting way, nothing you do will last. If, say, your mission is to ensure that kids are well nourished, you know you can’t feed them forever—who needs to do what to make sure that the right foods get to the kids most at risk in the right way? When we are designing or evaluating a program, we make a list of those behaviors and think through each one in terms of whether the organization is going to be able to set things up so that they happen in a lasting way.

Treat the beneficiaries as customers. Funders and NGOs too often tend to think of aid recipients as recipients, which leads to grotesque asymmetries of power and the assumption that we know best what they need. If we see them instead as “customers” whose perceptions of our value can make or break us as “companies,” we’re going to pay a lot more attention to what they want and what they have to say. We’re going to seek to understand them and will work to develop the channels for feedback that help us serve them better. We won’t do dumb things because they’ll tell us they’re dumb, and they’ll let us know early on when unintended consequences emerge. Whether we like to see it this way or not, aid and development are industries, and they long been serving the wrong masters.

Measure, improve, then measure again. Companies stay in business because they continually measure their profits and constantly fiddle with their operations and products to maximize those profits. Aid organizations should do the same with impact.

You can’t improve what you don’t measure, and this is the single biggest failing of the aid and development industry: Good quality-impact measurement is not the norm, nor is constant quality improvement based on good data.

Measuring impact isn’t always easy, but it’s always doable and it’s always necessary. We start with the mission, because you can’t know what to measure until you know exactly what you’re trying to accomplish (that’s why we want such a tight and clear mission statement). The keys, then, are to do the following: (1) Measure the right thing—a good mission statement implies what outcome indicator(s) is best. (2) Get good numbers—get

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Hippocratic Philanthropy Continued from the previous page . . . baseline and follow-up data with good methods that show a change. (3) Show that it was you—attribution is as important in development as it is in clinical trials; you need to compare to something, to create some kind of counterfactual.

And once you measure impact (and operations and behavior), you must use that information to improve what you do, not just to write a report to headquarters. Smart businesses do this all the time, but it isn’t something we see nearly enough of in the development world. We shouldn’t give money to anyone who’s not measuring their own impact, nor to those who don’t use high-quality data to drive decision making.

Fund smart. Give money to those who have the most impact, not those who’ve simply done the most activities. Don’t worry about overhead, worry about cost-effectiveness—what it cost them to save a life, get a family out of poverty, assure decent housing, or whatever mission they’ve set themselves to (and don’t fund anyone whose mission isn’t clear to you). If the organization is good at what they do, give them unrestricted money—be supportive, not directive. Meddlesome funders often think they know more than those who actually do the work, and they burden them with tedious due-diligence requirements and constant looking over their shoulders. Often it can seem like foundation staff just need to justify their jobs. But in the business world, if you were to invest in a company for profit, you wouldn’t tell the management they had to make a product of your choosing, restrict the number of vehicles they purchased, or expand operations into a new country. Why should we do any differently in the nonprofit sector? What is important is the impact per donor dollar: the cost per child’s life saved from disease or death, per family out of poverty, per island species saved from extinction, and so on. The real experts are the people you are funding.

Help, and let, them do what they know.

You don’t have to be a development expert to be a smart funder. What it comes down to is this: Look for organizations that treat the poor and disadvantaged with the respect and attentiveness that a good business gives to its customers, and for those that run their operations in the same way that good businesses run its operations. Imagine that you are an investor who is seeking not profits but a lasting bright future for the world’s hardest hit, and treat your donor dollar with the same thought and care that you would your own retirement plan. That’s your best chance to both do good and “do no harm.”

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Karen Fong MD

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Kathleen Low NP

Kevin Starr directs the Mulago Foundation (mulagofoundation.org) and the Rainer Arnhold Fellows Program (rainerfellows.org), which support high-performance organizations worldwide. A graduate of UCSF, Starr practiced medicine for twenty years. He blogs at the Stanford Social Innovations Review at http://www.ssireview.org/bios/kevin_starr. Steve Heilig is on the staff at SFMS and at Commonweal, a health and environmental research institute. He has worked on health projects in Africa, Asia, and South America and has been a consultant to numerous foundations and other organizations.

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www.sfms.org

Local Leaders in Health Care Philanthropy

Physicians as Fund-raisers A Talk with Martin Brotman, MD

This month we sat down to talk fund-raising with Martin Brotman, MD, senior vice president for education,

research, and philanthropy at Sutter Health, a not-for-profit network of community hospitals. Dr. Brotman was the founding president of Sutter’s West Bay Region and is a practicing gastroenterologist. Over the years, Dr. Brotman has responded to a number of similar questions from both his physician and administrative colleagues about fund development and the added value of physician involvement, and he has shared his views here.

Why are physicians reluctant to raise funds for their chosen medical center, when they know it’s valuable to their patients?

The reasons are multiple and complex. Some will hesitate to become involved because they’re concerned that at a time of rising overhead, declining reimbursement, and uncertainty about the future of health care, they will be expected to give a major gift. This is a legitimate concern, since they often entered practice with a large debt, have a family to support, started earning at a later age than friends in other professions, and face increasing competition. . . . Others will be reluctant because physicians are trained to know the limits of their knowledge and capabilities (that’s why they use consultants). They have no experience in fund-raising, fear that a question or push back from a potential donor will leave them like a fish out of water, opening and closing their mouths with nothing coming out in response. Others may have had bad experiences with overly aggressive fund-raisers and consider it undignified to ask for money. Many feel they “give at the office,” through serving patients with limited or no ability to pay and serving as volunteers on committees. Others may be asked to raise funds for projects of no interest to them, such as asking a cardiologist to raise funds for specialized obstetrics needs. Others will plead they have no time, but the busiest do find time when the cause is right.

What motivates patients to give, and how is that motivation relevant to physician fund-raising?

The motives obviously vary, but the most common ones are personal, positive experiences as a patient; concern for personal health and fear of “anonymity” when in need; gratitude to the physician and the medical center, and desire to express their gratitude in a meaningful way; a grateful grandparent; prestige, including visibility at events, naming opportunities; business strategic plans, such as vendor gifts; medical/scientific interest; true altruism, as in the anonymous donor. Almost all of these motivations link directly to physician-patient relationships. www.sfms.org

Some physicians express concern that it isn’t ethical for them to solicit their own patients for funds, and that it will interfere with the doctor-patient relationship. Do you believe it is unethical?

Despite the Council on Ethical and Judicial Affairs of the American Medical Association’s concern about direct solicitation of patients by physicians1, I believe it is ethical and appropriate for physicians to provide their patients with opportunities to improve health care for themselves and many, many others in need. I do not believe there is a conflict of interest; the patient will often point out there is a mutuality of interest. First, the physician is asking nothing for him- or herself. Second, patients often seek opportunities to thank their physicians and see a gift in honor of their physician as a way of expressing their gratitude. Third, more than 80 percent of philanthropy in the United States comes from individuals. Our patients are the most appropriate ones to ask for support. In my experience, the majority are flattered and pleased to be asked. Additionally, the physician’s interests at the medical center are most likely to appeal to the patient. But it is very important to avoid asking the patient at the wrong time or in the wrong place.

What is the wrong time? What is the right place?

The principles are: (1) Do not discuss a gift with the patient when he/she is most vulnerable, such as during an acute illness. (2) Arrange a visit (preferable) or a call with the patient for the purpose of describing the need, and inform the patient of the purpose of your visit or call. (3) Meet in a “neutral” site, not in the patient’s office, preferably not in your office or the hospital; the patient’s home or a restaurant would be fine. (4) Make it clear to the patient that if he/she is not interested in making a gift, then that decision must have no impact on your doctor/patient relationship. If the patient fears it will have a negative impact, then you would prefer not to have the gift discussion.

You pointed out that physicians are often inexperienced and fear saying the wrong thing or not having effective responses to patient’s questions or concerns. Outline the “anatomy” of a request for us.

First, do your homework. Before the visit, you should have a good idea about the patient’s interests, the medical center’s prioritized needs related to those interests, and the patient’s ability to give. Philanthropy professionals have sophisticated tools that will provide the background information needed regarding gift capacity. Always have a number in mind and a

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Physicians ad Fund-raisers Continued from the previous page . . . number of needs from which the patient can choose. Also, inform yourself regarding the variety of ways the patient can give: cash, IRA, appreciated securities, planned gift, etc.

At the visit, remain consistently collegial, appreciative and responsive. To become impatient or to confront, to become argumentative or coercive would be inappropriate, selfdefeating, and could cross the line into offending the patient and damaging the doctor-patient relationship.

Introduce the topic by stating that you are aware of opportunities at the medical center to improve care for them, their family and friends, and many others whom they do not know.

Explain how a gift from them to an area of interest to you will make a difference, such as a new mammography suite, a new cardiac laboratory, neurosurgical instruments, etc.

Pause from time to time for questions, watch patient comments and body language for signals of interest.

Finish your presentation, go back to that area where you saw interest, then present a specific request: “I hope you will be able to make a gift of X so that we can provide Y for our patients.”

Stop there; do not bid against yourself if the patient is silent. They will respond. If they say no, you can say, “Is it that you are not interested in this area of need, or is my proposal more than you are able to consider?” If it appears to be a current cash flow problem, offer the option of a gift over three to five years or a planned gift from their estate.

Always reach a conclusion—at the least, seek permission to ask again in the future, or a specific date for a second visit, or an offer to send additional requested detail and talk again. In my many decades of fund-raising, I have never had a patient express resentment of my request. Most have been pleased to examine the opportunities. Even those who say no have expressed appreciation for my spending the time with them to educate them.

“Physician fund-raiser” is not an oxymoron. It is an ethical, needed, and effective activity that enhances patient care.

In these increasingly difficult times, when our medical centers are starved for capital and the operating funds essential to ensuring state-of-the-art care, we can make a difference, and we should.

Do you and the staff in your office of education, research, and philanthropy at Sutter Health have any resources that you have found particularly helpful for those interested in learning more about philanthropy in general and fund-raising in particular?

We have just completed a fairly extensive examination of research, materials, and faculty involved in philanthropy in the United States for a curriculum we are developing for our physicians, executives, and board members on this subject. Below are a few of the resources that we find particularly informative, as well as several gateways to research and studies in philanthropy: We Make a Life by What We Give, Richard Gunderman, MD, PhD. Gunderman is a professor of radiology, pediatrics, medical education, philosophy, liberal arts, and philanthropy at Indiana University.

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• This site summarizes research conducted on philanthropy at the Indiana University Center of Philanthropy (IUCP). Included are results of the 2012 Bank of America Study of High Net Worth Philanthropy conducted with IUCP and the 2011 Study of High Net Worth Women’s Philanthropy and the Impact of Women’s Giving Networks: http://www. philanthropy.iupui.edu/research-by-category.

• This site provides you with a copy of the Executive Summary of the Giving USA 2012 annual report: http://store. givingusareports.org/2012-Giving-USA-The-Annual-Reporton-Philanthropy-for-the-Year-2011-Executive-Summary-P43. aspx. Association for Healthcare Philanthropy, www.ahp.org.

• Stanford Social Innovation Review, www.ssireview.org.

• The Chronicle of Philanthropy, http://philanthropy.com/ section/Home/172.

I hope these thoughts will persuade other physicians to become involved. They will find it to be a rewarding experience!

Martin Brotman, MD, is the first senior vice president for education, research, and philanthropy at Sutter Health, a notfor-profit network of community hospitals. He was the founding president of Sutter’s West Bay Region. Previously he served at Sutter’s major West Bay affiliate, California Pacific Medical Center, as chief of gastroenterology, director of education, chairman of the Department of Medicine, and president and CEO. Brotman is a fellow of the American College of Physicians and American Gastroenterological Association. He is a clinical professor of medicine at the University of California, San Francisco. He maintains a small, private practice in gastroenterology and internal medicine in San Francisco.

Reference 1. Report of the Council on Ethical and Judicial Affairs (CEJA). Subject: Physician Participation in Soliciting Contributions from Patients. CEJA Report 7-A-04.

Welcome New SFMS Members!

SFMS is pleased to welcome the following physicians and physicians-in-training to membership with the medical society. With your membership, you will join more than 1,600 members championing the cause of San Francisco physicians and their patients.

Physicians

Christopher H Cheng, MD | Emergency Medicine Dzung Cao Do, MD | Emergency Medicine Faranak Fiedler, MD | Family Medicine Patricia Jean Galamba, MD | Family Medicine Catherine Mary Mallouh, MD | Psychiatry Glenn Strome, MD | Diagnostic Radiology

Residents

Jervis Yau, MD | Orthopaedic Surgery

www.sfms.org

More than 160 physicians, physicians-in-training, and supporters/partners of the SFMS celebrated 145 years of physician advocacy and camaraderie with the SFMS at our Annual Dinner.

Held at the Concordia-Argonaut Club on January 31, 2013, the event marked SFMS’ 145th year as the only physician association that advocates for physician and patient rights in San Francisco. The SFMS represents more than 1,600 physicians and physicians-in-training of all specialties, and works to improve the health of all San Franciscans by providing support and education to physicians and patients.

Event highlights included the installation of Shannon Udovic-Constant, MD, a pediatrician at Kaiser Permanente San Francisco, as the 2013 SFMS President; and the featured presentation from Catherine R. Lucey, MD, professor of medicine

www.sfms.org

and vice dean for education at the UCSF School of Medicine, on the Choosing Wisely Campaign.

SFMS would like to thank our members, sponsors, and special guests Senator Mark Leno, Assemblymember Phil Ting, Supervisor David Chiu, Supervisor Eric Mar, CMA President Paul Phinney, and Dr. Catherine Lucey for their support of this event and the medical society.

Pictured below: SFMS 2013 officers from left to right.

Gordon Fung, editor; Lawrence Cheung, presidentelect; Shannon Udovic-Constant, president; Pete Curran, immediate-past-president; Man-Kit Leung, secretary; Roger Eng, treasurer.

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Top left: Senator Mark Leno with SFMS executive director Mary Lou Licwinko Top right: Kaiser San Francisco physician-in-chief Robert Mithun with assemblymember Phil Ting Middle left: Meg McNamara, Catherine Lucey, Shannon Udovic-Constant, Shannon Thyne Middle right: Lawrence Cheung, supervisor David Chiu, Man-Kit Leung Bottom left: Ashley and Paul Turek Bottom right: UCSF students Arezu Haghighi and Jerome Atputhasingam

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www.sfms.org

Top left: CMA president Paul Phinney, Rob Margolin, and Robin Harris Middle left: Peter Curran, Shannon Udovic-Constant Bottom left: Robert Owen, Stephen Follansbee

www.sfms.org

Top right: Past SFMS presidents Hugh Vincent and Ann Myers with UCSF student Bryan Iorgulescu Middle right: Colleen Geiger, Pedro Aceves-Casillas, Sean Bourke Bottom right: Kaiser Permenante San Francisco physicians

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Left: Katherine Herz, Kimberly Newell, Diana Bojorquez Below Right: Supervisor Eric Mar Bottom right: Shannon Udovic-Constant reads a proclamation from state senator Leland Yee honoring immediate-pastpresident Peter Curran Below left: Heather Bennett, Adam Schickedanz Bottom left: Medical director of the San Francisco EMS Agency John Brown, UCSF resident Dina Wallin, and UCSF student Gabriel Prager

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www.sfms.org

Robert Margolin, MD was recognized for his dedication to organized medicine and ten years of service as the SFMS representative to the CMA board of trustees at the annual dinner. Here’s his reflection on his tenure: “I had the great pleasure of serving as your trustee on the CMA board these past ten years. The position required that I help run an organization representing 35,000 physicians and their millions of patients. Representing San Francisco meant bringing its generally more ‘liberal’ views to the board. In recent years, we were leaders in the successful RICO lawsuits, which began to curb the abusive practices of health plans toward physicians. During the debate on Obama’s Accountable Care Act, CMA helped craft the guidelines used by AMA to shape the discussion to optimize its effectiveness.

We wrote the standards for ACOs, which were later adopted by the AMA and which helped us force CMS to revise their regulations and make them far friendlier for physicians. We fought for additional funding for mentally ill patients, against cuts for physicians’ MediCal payments, optimizing child vaccination rates, and maintaining increased Medicare funding for locations with higher practice expenses. For the past four years I served as chair of CMA’s audit committee, assuring that the organization’s financial operations were sound. I am certain that Shannon Udovic-Constant will serve us well in new her role as trustee. I wish her well.” Pictured above: Udovic-Constant, president (left), giving award to Margolin (right)

The David Perlman Award for Excellence in Journalism Every year the editorial board of our award-winning journal, San Francisco Medicine, presents the David Perlman Award for Excellence in Medical Journalism to an outstanding contributing writer. The award is named in honor of David Perlman, the longtime science journalist for the San Francisco Chronicle, who has provided the Bay Area with outstanding science and medical journalism for more than forty years.

This year the editorial board honored Dr. John Maa. Dr. Maa is an esteemed general surgeon and professor at UCSF and a member of the SFMS board of directors. John began his career of publishing outside of the surgical literature at the top—with the New England Journal of Medicine, where he wrote about his own mother’s death and the need for reform of some policies and practices. He has continued such writing, authoring fine pieces in the SFMS journal. Most recently he authored a review on an important health policy book for the San Francisco Chronicle; that review appeared in the January/February issue San Francisco Medicine. John has also been a leader in the antitobacco battle, with his attempt to get an accurate recount of the tobacco tax measure vote in California last June. His efforts there continue.

The SFMS was pleased to present him the David Perlman Award for Excellence in Medical Journalism! Pictured above: Gordon Fung, editor (left), giving award to John Maa (right)

At this year’s Annual Dinner Catherine R. Lucey, MD, of the Choosing Wisely initiative, addressed SFMS members in the keynote speech. Lucey is a professor of medicine and vice dean for education at the UCSF School of Medicine, where she oversees undergraduate medical education, graduate medical education, continuing medical education, faculty development, educational research, and instructional technology.

A graduate of the honors program in medical education at Northwestern University, Dr. Lucey completed her internship and residency in internal medicine at the University of California, San Francisco Medical Center. She then served as chief resident in internal medicine at the San Francisco General Hospital. Her career as a clinician-educator has spanned twenty-five years and five different academic institutions.

Dr. Lucey’s lucid presentation of the rationale and progress to date of the Choosing Wisely project was very positively received and prompted stimulating questions and dialogue. She praised the January/February edition of San Francisco Medicine on this topic as “fantastic” and noted that she looked forward to much more collaborative work with SFMS in this effort, which may include a major conference later this year.

www.sfms.org

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Congratulations Fifty-Year Members!

The SFMS honored two fifty-year members at the Annual Dinner, Leong Tan (pictured above left with wife) and Rolland Lowe (pictured above right). Drs. Lowe and Tan have made tremendous commitments to provide high-quality health care for the underserved and to improve health care delivery within the Chinese American community. The SFMS is honored to have had these two outstanding physicians as members for the past half of a century.

Leong Tan, MD

Dr. Leong Tan graduated from the University of Chicago Medical School in 1958. He practiced urology for three years at Chinese Hospital, followed by twenty eight years at Kaiser Permanente San Francisco Medical Center, where he retired as the chief of the urology Department in 1988. Dr. Tan has led a very active retirement: mentoring UCSF urology residents, volunteering as a consultant to the North East Medical Services (NEMS), and cofounding a foundation to support impoverished students in China.

Dr. Tan is a recipient of the 1991 UCSF William Smart Award for Excellence in Clinical Teaching and was honored as the volunteer of the Year by NEMS in 1990.

Rolland Lowe, MD

Dr. Rolland Lowe is a community doctor in the truest sense.

He has cared for some twenty-thousand patients in more than four decades of practicing medicine in San Francisco’s Chinatown.

Dr. Lowe was one of five Asian students admitted into UCSF’s medical school class of 1955, where he also completed his surgical residency. He was the first Chinese American SFMS President (1982) and the first Asian American president of the CMA (19971998), served as the chairman of Chinese Hospital, and helped put in place the Chinatown Community Health Plan. Additionally, Dr. Lowe has served on the board of the Chinese Cultural Foundation of San Francisco, which empowers and teaches Chinese American youths about their cultural heritage.

Dr. Lowe’s accolades are many: Among his awards are the UCSF Chancellor’s Award for Public Service, the California Wellness Foundation’s Champions of Healthy Diversity Award, the Association of Fundraising Professionals’ Lifetime Achievement Award in Philanthropy in 2008 and Lifetime Achievement Award in Community Building in 2011, and the Silver SPUR Lifetime Achievement Award.

He was also recognized as one of eleven philanthropic heroes in the 1999 White House Conference on Philanthropy and elected into the Berkeley Fellows. Dr. Lowe currently serves as chair of the Lawrence Choy Lowe Memorial Fund.

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Medical Insurance Exchange of California

www.sfms.org

HOSPITAL NEWS KAISER

SFVAMC

Chinese

Robert Mithun, MD

Diana Nicoll, MD, PhD, MPA

James K. Yan, MD

As part of Kaiser Permanente’s core mission, we not only strive to provide high-quality, affordable health care services but also to improve the health of our communities. By developing partnerships and pursuing collaborations with community organizations, we are able to provide financial resources through sponsorships and grants, as well as technical assistance and volunteers. Our volunteers range from clinical providers at community health fairs to nonclinical employees at such civic initiatives as Project Homeless Connect. By encouraging and fostering a culture of service, physicians and employees begin to integrate volunteering into their work lives.

We also host Operation Access several times a year, in which our hospital, along with thirtythree others, donates use of our operating and procedure rooms as well as supplies and medications. Kaiser Permanente medical staff volunteers provide procedural care for those who need surgery but don’t have health insurance or access to care. Over the past twenty years this program has treated 8,000 patients, many whom were able to return to work after their care. Our Kaiser Permanente medical center also provided more than $800,000 in 2012 to community-based organizations, safety net clinics, and the San Francisco Unified School District. In addition, the San Francisco Medical Center provides care for more than 3,000 Healthy San Francisco participants in the City’s health access program. Once a year in October, Kaiser Permanente asks our physicians and employees to donate to nonprofit organizations of their choice through our Community Giving Campaign. Additionally, there is a matching program that gives even greater incentive for donating during the campaign.

Last year in Northern California, physicians and employees donated more than $1,000,000 in October to nonprofit organizations. With the full implementation of the Affordable Care Act set for 2014, Kaiser Permanente will remain fully committed to its philanthropic efforts, which include medical and family assistance as well as care for those in subsidized programs. www.sfms.org

Most major VA Medical Centers throughout the country have nonprofit affiliate organizations. The San Francisco VA Medical Center (SFVAMC) has the Northern California Institute for Research and Education (NCIRE), more commonly known as NCIRE – The Veterans Health Research Institute. NCIRE is a congressionally established 501(c)(3) nonprofit organization whose sole mission and purpose is to facilitate and support the community of research clinicians and scientists at SFVAMC. Medical research in this arena focuses on current and emerging health needs facing veterans: cancer, cardiovascular disease, neurodegenerative disease, traumatic brain injury, and posttraumatic stress.

NCIRE’s annual budget is approximately $50 million, making it the largest of all VAaffiliated nonprofit research institutes in the country. More than 90 percent of NCIRE’s funding comes from the National Institutes of Health; the remaining funds come from other federal agencies (Department of Defense and National Aeronautics and Space Administration), foundations, corporations, and private donors.

NCIRE sustains a culture of philanthropy from private donors through Friends of Veterans Health Research, a growing cadre of business and community leaders dedicated to NCIRE’s mission: advancing veterans’ health through research.

To find out more about NCIRE and the research it supports, visit www.ncire.org.

Chinese hospital had its groundbreaking ceremony on December 10, 2012. Mayor Edward Lee and many members of the Board of Supervisors were present, along with Chinese Hospital board members. The Jackson Street thoroughfare was closed off for the occasion.

It was a historic moment, with symbolic gold shovels planted into the soil to symbolize the auspicious beginning. Lee; supervisors David Chu, Rose Pak, and Brenda Yee; former Mayor Willie Brown; and Dr. James K. Yan all spoke with heart and passion regarding Chinese Hospital. A hearty lunch followed the ceremony.

Chinese Hospital had its Christmas party celebration at the Grand Hyatt Regency on Stockton Street. It was a fun evening for all involved. We gave thanks for the many years of service of many hospital employees, especially Karen Chow, whose retirement from Chinese Hospital followed forty-five years on staff in various capacities. The evening included a spirited scavenger hunt.

Chinese Hospital medical staff wishes all a happy and safe year.

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CPMC

UCSF

Michael Rokeach, MD

Michael Gropper, MD

In Memoriam Nancy Thomson, MD

Denny Lee Tuffanelli

On November 1, 2013, all four campuses of CPMC will go live with the Electronic Health Record (EHR). More than 370 employees and physicians have been specially selected as Subject Matter Experts (SMEs). Their job: to make sure that the EHR meets the needs of our patients, clinicians, and other employees.

They come from all areas of our hospitals and will use their expertise to help create the EHR design for the entire WestBay Region, including CPMC. They will play a key role in an important step called “Validation”—identifying which work processes and work flows will need to change to accommodate the EHR, and how the EHR should be built to support more safe and efficient care processes.

Congratulations to Dr. Yuan-Da Fan, who was recently appointed chair of the Department of Obstetrics and Gynecology. He will serve a three-year term beginning February 2013. Special thanks to Dr. Elliott Main, who served as chair of the department for several years.

Researchers at the California Pacific Medical Center Research Institute report that low doses of curcumin, the main ingredient in the spice turmeric, reverses many of the major changes caused by exposure to bisphenol-A, also known as BPA. BPA exposure has long been thought to be a risk factor for developing breast cancer and other developmental changes, including fetal abnormalities. “This is the first study offering promise that the effects of BPA can be reversed in people,” said Dr. Shanaz Dairkee, PhD, lead author on the study. The study compared the effects of BPA alone and BPA with curcumin exposure in nonmalignant human breast cells. A report on the study is available at http://carcin.oxfordjournals.org/ content/early/2012/12/05/carcin.bgs379. abstract.

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At UCSF Medical Center and UCSF Benioff Children’s Hospital, we are the beneficiaries of generous support from people who care deeply about medicine, and who believe so strongly in the potential of UCSF that they invest in the medical center’s mission as partners. Through their generosity, they accomplish something the most dedicated and skilled caregivers and the most visionary scientists could not achieve on their own: They champion the future of medicine. Powerful physical evidence of this mission can be seen in the new children’s, women’s, and cancer hospitals that have risen on our Mission Bay campus and will open on February 1, 2015.

At Mission Bay, our benefactors are making possible a space where physicians and scientists in the vanguard of cancer medicine and women’s and children’s health will be able to partner in the best solutions for patients. And in hospital rooms, laboratories, and operating rooms—as well as behind the scenes—advanced patient safety protocols, efficient electronic records, and sophisticated technologies from robotics to imaging will make UCSF a model of modern healing.

Finally, we know that our philanthropic partners invest in a cause for more than the satisfaction of giving. They seek impact—a return that demonstrates and deepens the value of their investment. Building breakthrough hospitals at Mission Bay; integrating UCSF’s care and research enterprises; contributing to the prosperity of neighborhood, city, and region; championing health care solutions for the world—our philanthropic donors make a transformative impact that can be measured in many ways. They also know that their investment is one that offers returns for years to come—through new facilities that will set a standard of care and through discoveries that will shape medicine for future generations.

To learn more about UCSF Medical Center at Mission Bay and the role of our philanthropists in making it a reality, visit missionbayhospitals.ucsf.edu.

San Francisco Medicine March 2013

Dr. Denny Lee Tuffanelli was born in Pasadena on June 21, 1929, to the late George Tuffanelli and Augustine Amour and passed away peacefully, age 83, in Kentfield on February 3, 2013.

He graduated from Stanford University in 1951 and from Stanford University Medical School in 1955. He completed his internship at the University of Chicago in 1956 and served in France as captain in the U.S. Army in 1958. This was followed by a residency in dermatology at Mayo Clinic in 1963 and an Internal Foundation Fellowship residency at the L.A. County Hospital in 1963.

Tuffanelli joined Drs. Norman and John Epstein, practicing dermatologists in San Francisco, in 1963. He also served as a clinical professor emeritus at UCSF for thirty years. He was awarded the National Dermatology Foundation’s Clark W. Finnerud Lifetime Award for Teaching and Writing by a Clinician. He received the United Scleroderma Foundation’s Messenger of Hope Award and was named to the National Lupus Hall of Fame. He served as a vice president of the American Academy of Dermatology and president of the Pacific Dermatologic Association.

However, his primary focus was always his patients. He considered it his duty and privilege to care for them.

He is survived by his wife Sheila (née Howell), whom he had married in 1954; his sister Shirley Tuffanelli; five daughters; eleven grandchildren; and one great grandchild.

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