October 2016

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

POLITICS AND MEDICINE WHAT TO EXPECT ON NOVEMBER’S BALLOT

Move the Soda Tax Forward | Pass the Tobacco Tax Adult Use of Marijuana | Guns: Yes on Proposition 63 PLUS: SFMS LEADERSHIP ELECTION INFORMATION VOL.89 NO.8 October 2016

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IN THIS ISSUE

SAN FRANCISCO MEDICINE

October 2016 Volume 89, Number 8

Politics and Medicine FEATURE ARTICLES 11 Let’s Take the First Step: My Two Cents on the Soda Tax

Lawrence Cheung, MD 13 Proposition 56: Big Tobacco Aims Its Guns to Kill

California Tobacco Tax

Stanton Glantz, PhD 15 Safety for All: Yes on Proposition 63

Shannon Udovic-Constant, MD

17 Clearing Some Smoke: The Adult Use of Marijuana Act

(Proposition 64)

David E. Smith, MD and Steve Heilig, MPH 28 Legalizing Marijuana: An Argument for Medical Neutrality

John Maa, MD

MONTHLY COLUMNS 4

Membership Matters

7

President’s Message Richard Podolin, MD

9

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

21 In Memoriam

32 Medical Community News 33 Classified Ads 34 Upcoming Events

SFMS 2016 Leadership Election Information, Pages 18 to 31

Editorial and Advertising Offices: 1003 A O’Reilly Ave. San Francisco, CA 94129 Phone: (415) 561-0850 Web: www.sfms.org

MEMBERSHIP MATTERS Activities and Actions of Interest to SFMS Members

Hold the Date! SFMS Annual Gala The 2017 SFMS Annual Gala will be held on Friday, January 27, 2017, at the Asian Art Museum in San Francisco. PresidentElect Man-Kit Leung, MD, will be installed as 2017 SFMS President. Watch for your invitation in the mail in December and make sure to return your RSVP card promptly. If you have any questions, please contact Posi Lyon at (415) 561-0850, extension 260.

CMS Makes Major MACRA Implementation Announcement

Andrew Slavitt, Acting Administrator of the Centers for Medicare and Medicaid services (CMS), announced in a blog posting that CMS heard concerns expressed by the AMA and other physician organizations about the proposed start date for performance reporting by physicians under the new payment systems created by the MACRA. CMS announced that the final MACRA regulation will exempt physicians from any risk of penalties if they choose one of three distinct MIPS reporting options in 2017, in addition to the option of participating in an advanced APM: 1) Full-year reporting that begins on January 1; 2) Partial year reporting for a reduced number of days; and 3) A “test” option under which physicians can report minimal amounts of data. Physicians who report in 2017 may be eligible for bonus payments in 2019, depending on which option they choose.

Those who opt for full-year reporting will be eligible to receive a “modest positive payment adjustment;” those who choose partial year reporting will be eligible for a “small positive payment adjustment.” Physicians who choose the “test” option will not be subject to any payment adjustments. Qualified participants in advanced APMs will be eligible for five percent incentive payments in 2019. To view the blog posting, visit https://blog.cms. gov/2016/09/08/qualitypaymentprogram-pickyourpace/.

Letter from Surgeon General on Opioid Epidemic

A letter was recently sent from the Surgeon General to nearly 2.3 million physicians and other health care providers regarding the opioid epidemic. SFMS urges physicians to respond to the Surgeon General’s call to action on safe prescribing education, access to treatment for opioid use disorder, and compassionate care without stigma. A copy of the Surgeon General’s letter may be viewed at http://bit.ly/2cqq2ae.

Seamless Conversion to Medicare Advantage

Some questions have been raised about recent press coverage on plans enrolling new Medicare beneficiaries in Medicare Advantage without the beneficiary’s knowledge. The American Medical Association (AMA) raised concerns and a number of questions with senior officials at the Centers for Medicare and 4

Medicaid Services (CMS). This policy was developed a number of years ago by Congress and pre-dates Medicare Advantage.

The intention was to ease the pathway for low-income people with disabilities who were covered by Medicaid to remain in their same plan as they became dually eligible for Medicaid and Medicare, due either to their disability or their age. The policy is now having an impact on patients in commercial or exchange plans, and it is apparent from the CMS responses that the agency’s policies are still evolving to address the unintended consequences of the policy. To view the Q&A with CMS, visit http:// bit.ly/2cz3KXv.

New CMA Resource Clarifies Prohibitions on Balance Billing Medi-Medi Patients

The California Medical Association (CMA) often receives questions from physician members regarding the ability to collect the twenty percent that Medicare does not cover when the physician is not a Medi-Cal provider, but provides services to MediMedi (Medicare/Medi-Cal) patients. Both state and federal laws provide broad protections to such individuals and prohibit billing a Medi-Cal patient in most circumstances. Running afoul of these laws can put you at risk of a CMS audit and sanctions. CMA has created a new resource on this topic, “Ask the Expert: Billing MediMedi Patients,” free to members at www.cmanet.org/ces.

Have You Received a Request to Confirm Provider Directory Information from BetterDoctor?

CMA has received an increasing number of inquiries over the past few weeks from practices concerned about the validity of requests for information from a company called BetterDoctor.

SB 137, the new provider directory accuracy law, took effect July 1. The new law requires payors to ensure that their physician directories are accurate and up-to-date. BetterDoctor is a vendor working on behalf of 10 plans on a pilot project to ensure the accuracy of their physician directories, as required under the new law. Practices are encouraged to respond to the information requests, as the law also requires physicians do their part to keep their information up-to-date. The ten plans included in the pilot are AltaMed, Anthem Blue Cross, Blue Shield of California, CareMore, Health Net of California, Humana, LA Care, Molina Healthcare, SCAN and Western Health Advantage. There may also be other pilot programs taking place on behalf of other payors that utilize other vendors. For more information about physicians’ obligations under SB 137, see CMA’s new resource, “What Physicians Need to Know to Avoid Penalties Under the New Provider Directory Accuracy Law” at http://www.cmanet.org/resourcelibrary/detail/?item=what-physicians-need-to-know-to-avoid.

SAN FRANCISCO MEDICINE OCTOBER 2016 WWW.SFMS.ORG

ICD-10 Grace Period Ended October 1 Physicians are reminded that CMS’s one-year grace period for ICD10-coded claims came to an end on October 1, 2016. As of that date, providers are required to use the correct degree of specificity in their coded claims. There are more than 7,400 changes across the entire ICD-10 code set for this next year, including 2,305 new ICD-10-CM (diagnosis) codes and 3,836 new ICD-10-PCS (procedure) codes. These figures are dramatically higher than previous years, and physicians should review all sections of the guidelines to fully understand all of the rules and instructions needed to properly code their claims. Though the ICD-10 grace period ended on October 1, CMS said providers will still be allowed to use “unspecified” codes when they are warranted and there is no other option. Probably the most important step clinicians can take to prepare for these ICD-10 updates is to document patient diagnoses with precision. In addition, be sure to review the Local Coverage Determination (LCD) and National Coverage Determination (NCD) medical necessity policies for coding changes.

CMA’s Practice Manager Tip of the Month

Make the most of appeals by knowing your rights. Thanks to a CMAsponsored California law, payors are required to have a fast, fair and costeffective appeal process to resolve provider disputes. Familiarize yourself with the most common types of denials, underpayments and partial payments and learn how to most effectively respond using CMA’s “Know Your Rights: Quick Guide for Appeals.” Learn more at http://cal.md/kyr-series.

JOIN OR RENEW YOUR MEMBERSHIP TODAY! When you join the San Francisco Medical Society, you join more than 1,800 members in San Francisco who are actively protecting the practice of medicine and defending public health. Working together with you, SFMS unites physicians to champion health care initiatives and innovation, advocate for patients, and serve our local medical community, including physicians of all specialties and practice modes. We cannot do this alone.

Join SFMS/CMA Today to Receive 15 Months of Membership for the Price of 12 - Starting October 1, 2016, new members who join paying full 2017 dues, will receive the remaining months of 2016 membership for free. Join today to start receiving your benefits. Visit www.sfms.org/ membership for more information about SFMS membership and benefits, or to join online.

Renew Your Commitment to Medicine; Renew Your SFMS Membership Today - Make sure you continue to receive the benefits of SFMS and CMA membership by renewing today. Full dues-paying members enjoy a 5% Early Bird Discount* if your renewal is received by December 15, 2016. There are three easy ways to renew your dues: 1. Mail/fax your completed renewal form when you receive it in the mail; 2. Renew online at www.sfms.org with your credit card; or 3. Enroll in Easy Pay Automatic Dues Renewal Plan** (quarterly installments) by contacting SFMS at (415) 561-0850 or membership@sfms.org.

*5% Early Bird Discount applies to 2016 full dues-paying members only who are renewing at the same level for 2017; renewal form and payment must be received by December 15, 2016. **Easy Pay Automatic Dues Renewal Plan (quarterly installments) is available to full dues-paying members only; renewing members receiving the Early Bird Discount are not eligible for Easy Pay. WWW.SFMS.ORG

October 2016 Volume 89, Number 8 Editor Gordon Fung, MD, PhD Managing Editor Steve Heilig, MPH Production Editor Amanda Denz, MA Copy Editor Amy LeBlanc, MA EDITORIAL BOARD Editor Gordon Fung, MD, PhD Obituarist Erica Goode, MD, MPH Michel Accad, MD Erica Goode, MD, MPH Stephen Askin, MD Shieva Khayam-Bashi, MD Payal Bhandari, MD Arthur Lyons, MD Toni Brayer, MD John Maa, MD Chunbo Cai, MD David Pating, MD Linda Hawes Clever, MD SFMS OFFICERS President Richard A. Podolin, MD President-Elect Man-Kit Leung, MD Secretary John Maa, MD Treasurer Kimberly L. Newell, MD Immediate Past President Roger S. Eng, MD SFMS STAFF Executive Director and CEO Mary Lou Licwinko, JD, MHSA Associate Executive Director, Public Health and Education Steve Heilig, MPH Associate Executive Director, Membership and Marketing Erin Henke Director of Administration Posi Lyon Membership Coordinator Ariel Young BOARD OF DIRECTORS Term: Jan 2016-Dec 2018 Charles E. Binkley, MD Katherine E. Herz, MD Todd A. LeVine, MD Raymond Liu, MD David R. Pating, MD Monique D. Schaulis, MD Winnie Tong, MD

Term: Jan 2014-Dec 2016 Benjamin L. Franc, MD Benjamin C.K. Lau, MD Ingrid T. Lim, MD Keith E. Loring, MD Ryan Padrez, MD Rachel H.C. Shu, MD Paul J. Turek, MD

Term: Jan 2015-Dec 2017 Steven H. Fugaro, MD Brian Grady, MD Todd A. May, MD Stephanie Oltmann, MD William T. Prey, MD Michael C. Schrader, MD Albert Y. Yu, MD CMA Trustee Shannon Udovic-Constant, MD AMA Delegate Robert J. Margolin, MD AMA Alternate Gordon L. Fung, MD, PhD

OCTOBER 2016 SAN FRANCISCO MEDICINE

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PRESIDENT’S MESSAGE Richard Podolin, MD

Prescriptions and Pain in the Pocketbook In August 2015, Turing Pharmaceuticals acquired Daraprim (pyrimethamine), a drug approve by the Food and Drug Administration (FDA) in 1953 that is still the standard of care for treating toxoplasmosis.

The patent on Daraprim had expired, but the market was small and no generic alternative was being produced. Overnight, Turing Pharmaceuticals raised the price more than five thousand percent, from $13.50 to $750 per tablet. For many patients, that raised the cost of treatment to several hundred thousand dollars. Martin Shkreli, the thirty-two-year old former hedge fund manager who founded Turing, became the poster boy for greed in the pharmaceutical industry, but he was not alone. For example, Marathon Pharmaceuticals acquired Isuprel (isoproterenol) and Nitropress (nitroprusside) in 2013 and increased the prices on both four hundred percent. Valient Pharmaceuticals then acquired the drugs from Marathon and immediately increased the cost of Isuprel an additional five hundred twentyfive percent and Nitropress two hundred twelve percent. An investigation by Reuters found that in the five years between 2011 and 2016, four of the top ten drugs by annual sales sold in America had price increases of more than one hundred percent and another six had increases of more than fifty percent.

When Mylan acquired EpiPen in 2007, pharmacies paid less than one hundred dollars for a two-pen set. By July 2013, pharmacies paid $264.50. In May, 2015, Mylan raised the price seventy-five percent to $461, and one year later raised it again to $608.61, setting off a public backlash. Perhaps the specter of a pharmaceutical company profiteering on an emergency medication that saves the lives of children struck a common chord.

An online petition: “Stop EpiPen Price Gauging,” gathered more than eighty thousand signatures in forty-five days and over one hundred twenty thousand letters were sent to Congress.

Pharmaceutical companies offer discounts to large purchasers and most have some form of patient assistance program. Still, many patients without prescription coverage find the expense prohibitive, and even insured patients are being asked to absorb a growing share of their medication costs while their insurance premiums rise due, in part, to higher drug prices. For the past five years, overall spending on drugs has risen faster than physician visits or hospitalization. In a recent Kaiser Family Foundation poll of health care priorities for the President and Congress, seventy-six percent of respondents selected “making sure that high cost medications are affordable for those who need them” as their top priority, making it the top priority overall. In second place was “government action to lower prescription drug prices.”

In California, the failure of two modest bills illustrates the WWW.SFMS.ORG

difficulty of achieving a legislative solution. AB 463, introduced

by Assembly member David Chiu (D-San Francisco) would have required drug makers to provide justification for the cost of any drug for which a year of treatment exceeded ten thousand dollars. It was withdrawn when it did not have enough votes to get out of committee. Senate Bill 1010 (Hernandez D-West Covina), which was supported by the CMA, required pharmaceutical companies to give two months’ notice to state programs such as MediCal and the California Public Employees’ Retirement System (CalPERS) when they planned to raise the price of a drug by more than ten percent, to justify the price increase, and to provide previous price increase information. Senator Hernandez withdrew the bill when amendments were inserted that would have significantly weakened its provisions.

Amazingly, Hillary Clinton and Donald Trump agree on two approaches to reducing drug costs. Both propose allowing Americans to import drugs from other countries and allowing Medicare to negotiate drug prices. To date, Hillary Clinton has put forward a more comprehensive plan, which includes, among other provisions, requiring insurance companies to cap out-of-pocket prescription drug expense to two hundred fifty dollars per month, eliminating corporate write-offs for direct to consumer advertising, and prohibiting “pay for delay” arrangements that keep generics off the market.

Proposition 61, The Drug Price Relief Act, will be on the ballot in November. It would mandate that MediCal and other state programs pay no more for medications than the price negotiated by the Department of Veteran Affairs (VA). Proponents believe it would save the state approximately $5.7 billion over ten years, but opponents note many problems. The VA is able to negotiate low prices because it serves a small, discrete population and its beneficiaries are veterans. If Proposition 61 passes, drug manufacturers are likely to increase the prices offered to the VA, and may decline to negotiate contracts with MediCal and other state programs, making needed drugs more difficult to prescribe. It would also invalidate many of the drug discounts previously negotiated, possibly increasing drug costs. The CMA opposes this measure. We welcome input from our members.

Dr. Podolin is a cardiologist at St. Mary’s Medical Center where he has been chief of the medical staff. Connect with him via the SFMS LinkedIn Group or send him an email at podolin@sfms.org.

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SAN FRANCISCO MEDICINE OCTOBER

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

In Search of Evidence-Based Politics Politics can be a dirty business, and even a dirty word to many health professionals. Some of us even claim to be “allergic” to political issues due to temperament and training.

And exposure to the political world often breeds more inflammation than immunity, as scientific and other facts are too often buried by other factors—especially money, the “mother’s milk of politics.” But engage on that battlefield we must, out of both self-interest and, especially, for the benefit of patients and the public’s health.

In the hopes of rising above some of the dirtier aspects of the legislative game, the state ballot initiative option was created. Here issues can be brought directly to the voters. But this process seems to have run amok—there are seventeen initiatives on the November ballot. The SFMS and CMA examine and take positions on those relevant to medicine and public health; here are those of most note.

Proposition V (San Francisco Soda Tax): The anti-Prop V brochures now arriving almost daily in our mailboxes call this a “grocery tax” while never mentioning soda. No doubt educated voters are shocked to read in the fine print that such mailers are almost wholly paid for by the sugary beverage industry. They’ve learned well from Big Tobacco. Much research now ties consumption of soda to many health problems, starting with kids. Even a small tax has now been shown to decrease consumption, and the funds can be used for further health efforts. Read SFMS past-president Lawrence Cheung’s thoughts in this issue.

Prop 52 (Hospital Fee for Healthcare Services:) California hospitals currently pay a Medi-Cal fee, which is then matched by the federal government, to help pay for healthcare services for low-income children. This is a bargain for a very worthy cause and this makes that program permanent.

Proposition 56 (California Tobacco Tax): “Big Tobacco” is going all-out to defeat this much-overdue $2/pack tax raise, spending upwards of $20 million to defeat it. In a way, this is an unintended, perverse endorsement of the tax—the tobacco industry knows it will work to discourage smoking and put funds into anti-tobacco efforts, which also work. Plus this includes e-cig/vaping products, a crucial step. For any reader who knows anything about tobacco and health, we likely need not say more, but read leading anti-tobacco expert Stan Glantz’s more detailed analysis herein.

Proposition 63 (“Safety for All”/Gun policy): CMA endorses this Gavin Newsom-spearheaded proposal, and SFMS agrees. Gun violence is a signature epidemic in the United States, with our exceedingly high rates of gunshot injury and WWW.SFMS.ORG

death, both from others and from suicides. Guns in the home raise these risks; the more guns in a community the more gun harm there is, and so on. But gun-related research has been blocked by the gun lobby for years, since they rightly suspect it will undermine so many of their arguments. Nobody expects the policies in Prop. 63 to end these harms, but they will very likely help. Read SFMS past-president Shannon Udovic-Constant’s article herein for more.

Proposition 55: Extends an existing tax on wealthiest Californians—who earn over $250k and couples earning over $500k—for another twelve years. This was endorsed as the funds are used to fund both education and health programs.

On other proposals, the SFMS voted to join CMA in opposing Proposition 60, which would mandate condoms in “adult” films; it was deemed, even by many who might otherwise support the idea, a counterproductive and deceptive proposal. On Proposition 64 (Marijuana Legalization), the endorsement of this proposal by the CMA was a big coup for this initiative, as health issues are a primary concern here. However, the SFMS Executive Committee still harbored doubts and our Medical Society took no position. One other proposal, Proposition 61, seeks to lower high pharmaceutical costs. This is obviously a topic of great concern and a worthy goal, but again, organized medicine is divided over the details, with CMA feeling it is a “wrong prescription.” The SFMS had not taken a position as of our deadline here, but will still consider doing so.

That’s the roster for this year. We must note that many of the CMA policies guiding these endorsements originated at least in part from the SFMS delegation to the CMA; we have a long and successful history of sparking forward-thinking policies there, many of which eventually are translated into actual public polity (four just last year—on physician-assisted dying, POLST, reimbursement for end-of-life counseling, and overuse of antibiotics in agriculture). In each proposal, we seek to institute what might be called “evidence-based” politics.

None other than Plato wrote:“One of the penalties for refusing to participate in politics is that you end up being governed by your inferiors.” San Francisco, fortunately, has been blessed with some of the best public servants around.

But we’ll leave you with this thought: What if anybody elected to public office was required to take a solemn oath to “Do No Harm”?

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Politics and Medicine

LET’S TAKE THE FIRST STEP My Two Cents on the Soda Tax Lawrence Cheung, MD In November, San Francisco residents will once again have a chance to enact public policy that will have a significant direct impact on the health of our city population. Proposition V will allow San Francisco to

levy a one-cent-per-ounce tax on sugar sweetened beverages.

According to the non-partisan Office of the Controller, this tax will result in a revenue of seven and a half million dollars in 2017-2018 and fifteen million dollars in 2018-2019. This revenue will go towards the General Fund. A Sugary Drinks Distributor Tax Advisory Committee would be formed, for ten years, to evaluate the impact of the tax on beverage prices, consumer purchasing behavior, and public health. This committee would make recommendations to the Mayor and the Board of Supervisors on the effectiveness of the tax.

A similar effort in 2014 called for a two-cent-per-ounce tax on sugar sweetened beverages with tax revenue directly earmarked for specific public health initiatives. This effort was narrowly defeated even though it garnered fifty-six percent of the vote because it required a super majority of sixty-seven percent due to the specific allotment of tax revenue. Campaign finance analysis showed that the American Beverage Association (the lobbying arm of the soda industry) spent more than nine million dollars to defeat this tax.

During that same year, Berkeley mounted a successful campaign in its fight against American Beverage Association and became the first city in the country to approve a one-cent-perounce tax on sugar sweetened beverages. These divergent paths of our cities allowed for what amounts to a case-control study of the effect of this tax. A study from University of California (UC) Berkeley showed a twenty-one percent decrease in soda consumption in poor and minority neighborhoods in Berkeley after the implantation of the tax, while a four percent increase in consumption was seen in San Francisco and Oakland during this same time.

This UC Berkeley study corroborates trends seen in Mexico after its government adopted a one-peso-per-liter sales tax on sugar-sweetened beverages in 2014. A study conducted jointly

by Mexico’s federal health agency, Instituto Nacional de Salud Publica, and University of North Carolina at Chapel Hill showed a twelve percent decline of sugar sweetened beverage sales by the end of 2014. Not surprisingly, while the decline was seen in all socio-economic groups, the decline was greatest in the lower socio-economic groups.

Critics of the sugar sweetened beverage tax (essentially the American Beverage Association) argue that the tax is a regressive tax that unfairly targets the low socio-economic population.

Most deceptively, the campaign ads against the tax refer to it as an “unfair grocery tax.” The fact is that the soda industry has, for WWW.SFMS.ORG

years, targeted minority and lower socio-economic population, which has resulted in a dramatic increase of sugar sweetened beverage consumption in that vulnerable population. The two case studies of Berkeley and Mexico demonstrate conclusively that the tax can and does lead to a significant impact in modulating the behavior of sales and consumption of sugar sweetened beverages.

It also appears true that the impact is greatest amongst the lower socio-economic population.

It may take many years for researchers to determine the true impact of the sugar sweetened beverage tax on obesity and diabetes. But like any journey, this one on controlling the national epidemic of obesity and diabetes will need to begin with the first step. Let’s educate our friends, family and patients on the importance of this tax. Let’s follow Berkeley and Mexico’s examples on sound public health policy.

Lawrence Cheung, MD, is a dermatoligist in solo private practice with volunteer teaching responsibility at UCSF. He is a past-president and longtime member of the SFMS and is currently running again to be a delegate to the CMA House of Delegates.

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Politics and Medicine

PROPOSITION 56 Big Tobacco Aims Its Guns to Kill California Tobacco Tax Stanton Glantz, PhD Public health and medical advocates have been working to increase California’s tobacco tax—one of

the nation’s lowest—by two dollars by sponsoring Proposition 56, the California Healthcare, Research, and Prevention Tobacco Tax Act of 2016 on this November’s ballot. Proposition 56 allocates most of the revenue to pay for expanded medical services for poor people through MediCal in California. More importantly, it includes crucial funds to reinvigorate California’s aggressive and effective, but fading, tobacco control and research programs.

Aggressive Efforts Work, Big Tobacco Fights Back

Health advocates had to go to the trouble and expense of putting this on the ballot because tobacco companies dominate the legislature. Despite thirty-five attempts in the last thirty-four years, the legislature has raised the tobacco tax only once since 1967 (a measly two cents for breast cancer research). With a tax of just eighty-seven cents per pack of cigarettes, California, the country’s most populous state, ranks thirty-seventh among the states in its tobacco tax. California’s cigarette tax is so low that even with a two dollar increase it would still only rank only ninth.

So far, Philip Morris and RJ Reynolds have coughed up thirty six million dollars to create “No on 56—Stop the Special Interest Tax Grab. Major Funding by Philip Morris USA Inc. and RJ Reynolds Tobacco Company, with a Coalition of Taxpayers, Educators, Healthcare Professionals, Law Enforcement, Labor, and Small Businesses.”

The “No” campaign, as usual, is not what it appears to be. To date, not a penny has come from “taxpayers, educators, health care professionals, law enforcement, labor or small businesses.”

The only reason Philip Morris and RJ Reynolds include their names in the committee name is that California law requires top donors—in this case the only donors—be identified.

And what is the cigarette companies’ leading argument against the California initiative?

They complain, “Prop 56 allocates just thirteen percent of new tobacco tax money to treat smokers or stop kids from starting.” And “If we are going to tax smokers another $1.4 billion per year, more should be dedicated to treating them and keeping kids from starting.”

This is, of course a hypocritical argument. They know full well that spending even more on tobacco control will cost big tobacco even more profit.

How Do They (And We) Know That?

In 1988, health advocates successfully defended another initiative, Proposition 99, which allocated five cents of the twenty-five-cent tax to support the largest, most aggressive and WWW.SFMS.ORG

effective tobacco control campaign ever done. Unlike past government campaigns, it did not focus on kids or smokers. The California Tobacco Control Program directly confronted big tobacco and educated the public about secondhand smoke nicotine addiction. It focused on the nonsmoking majority to reinforce the nonsmoking social norm.

And the results were stunning: Smoking dropped so fast between 1989 and 1997 that 58,900 deaths from heart disease were prevented. And eleven thousand cases of lung cancer were prevented by 1999. By 2009, the reductions in smoking had saved Californian citizens, taxpayers and businesses $134 billion in health care costs. It also cost big tobacco $28.5 billion in lost sales.

Tax Increase Needed to Help Smokers and Nonsmokers Alike

Since 1988, inflation has eroded the value of the five cents a pack that Proposition 99 allocated to California’s tobacco control program. Proposition 56 is the opportunity to restore lost ground on tobacco control programs. According to the California legislature’s nonpartisan Legislative Analyst, Proposition 56 provides one hundred thirty-five million dollars to anti-tobacco education and fifty million dollars to research, restoring eightyfive percent of the programs’ purchasing power. These resources, combined with the price increase that will accompany the tax, will cut smoking.

Smoke-Free Society Is In Reach

In 2014 only 11.7 percent of Californians smoked, and among them, two-thirds (sixty-five percent) were smoking ten cigarettes or less daily, with one-third (thirty-seven percent) not even smoking every day.

If voters see through Philip Morris and RJ Reynolds’ hypocritical campaign and vote yes on Proposition 56, they will reinvigorate the state’s tobacco control program. The bottom line?

California could become the first state to reach former Surgeon General C. Everett Koop’s vision of a smoke-free society.

Stanton Glantz, PhD, is professor of medicine at the University of California, San Francisco, and president of the Council of University of California Faculty Association.

An original extended version of this article can be read at https://theconversation. com/big-tobacco-aims-its-guns-to-kill-california-tobacco-tax-63750.

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Politics and Medicine

SAFETY FOR ALL Yes on Proposition 63 Shannon Udovic-Constant, MD In the United States, deaths attributable to gun violence—including suicides, accidents, homicides, mass shootings and acts of terrorism—outnumber ve-

hicle deaths in twenty-one states and the District of Columbia.

For the first time on record, Americans are as likely to die by gunshot as in a traffic accident. Americans are ten times more likely to be killed by guns than residents of any other developed nation.

As physicians, we see the effects of gun violence in the death or injury of our own patients and the anguish in the family that is left behind to grieve for their loved one. This firsthand knowledge of the true toll that gun violence takes is the reason that physicians have been strong advocates for policy to prevent gun violence. In fact, CMA has had policy on gun violence dating back to 1965. The advocacy of physicians with groups such as the Brady campaign and Moms Demand Action has led to some gun violence prevention policy measures nationally and even tighter ones in California.

Yet, it is not enough. In the past two days, I read about a woman and two children being shot in the Bay Area, and another mother wrote about her sadness about our California schools now having lock down drills in case of an active shooter on campus, which prompted her school aged daughter to ask, “Mom, why would someone want to shoot kids?”

Then, there are the even more dramatic examples of this issue. Sandy Hook happened and Congress did not act. Orlando happened and Congress did not act. There have continued to be no federal funds going to the Centers for Disease Control and Prevention for gun violence research for the past twenty years.

This has prompted California to continue to be at the forefront of policy aimed at reducing the harm that gun violence inflicts. In August, the University of California (UC) President Janet Napolitano announced that she plans to establish the UC Firearm Violence Research Center at UC Davis. This will be accomplished using a five million dollar, five-year appropriation from the Legislature. The goal is to pursue gun violence as a public health problem in the same way that automobile accidents were in the past. The research around automobile deaths led to enhanced safety features on cars, and also on the road, with a significant decrease in deaths from automobile accidents.

The research around gun violence that would be conducted by this center would have the goal to design effective prevention programs and policies to reduce death and injury.

Also in California, we moved forward on further gun safety when at the end of July the Legislature put forward enhanced gun legislation that Governor Brown signed. This new law imposes background checks for the purchase of ammunition and WWW.SFMS.ORG

new licensing for those who sell ammunition.

There are other policies that can continue to advance the safety of our patients. This November, voters in California can act to help our state take an even bigger leap forward in the fight against gun violence by voting to support Proposition 63, the Safety for All initiative. It includes six main provisions. It will: • Treat ammunition sales like gun sales, requiring ammunition purchasers to undergo a background check and ammunition sellers to obtain a state license (this overlaps with the law that Governor Brown signed in July); • Create a clear process for convicted criminals who are prohibited from possessing firearms to relinquish their guns; • Ban possession of ammunition magazines holding more than ten rounds; • Require the reporting of lost or stolen firearms; • Require the state to report prohibited individuals to the federal National Instant Criminal Background Check System (NICS); and • Clarify a previous initiative (2014’s Proposition 47) to ensure that the theft of any gun is a felony.

California voters support the components of this initiative.

A field poll conducted of California voters in 2016 found that fifty-six percent favored outlawing large-capacity magazines and eighty percent support background checks for those buying ammunition.

I appreciate the ability to be involved in advocacy in order to promote policy that will improve the health and safety of my patients outside of our office walls. Proposition 63 is an initiative that makes sense and will have a positive effect. Please vote yes and talk about it with your family and friends to ask for their vote in favor of Prop. 63 too. I hope that in the future our children will no longer need to have lockdown drills in school, and that I can read the paper and not read about senseless shooting deaths in our community.

Dr. Udovic-Constant is a pediatrician at Kaiser-Permanente, a past-president of the SFMS, and a trustee of the California Medical Association.

OCTOBER 2016 SAN FRANCISCO MEDICINE

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s L S ice t c CA YERnciscoal Pra O L LO n FraMedic Sa nd P g a n EMFeatusripitals o

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UCSF Millberry Conference Center 500 Parnassus Ave, San Francisco

Refreshments and hors d’oeuvres provided by the SFMS For detailed event information, including a list of confirmed exhibitors, please visit http://www.sfms.org/Membership/StudentResidents.aspx

EVENT OPEN TO ALL UCSF, CPMC, ST. MARY’S, AND KAISER PERMANENTE SF RESIDENTS AND FELLOWS

Politics and Medicine

CLEARING SOME SMOKE The Adult Use of Marijuana Act (Proposition 64) David E. Smith, MD, and Steve Heilig, MPH The California Medical Association (CMA) has endorsed Proposition 64, the Adult Use of Marijuana Act (AUMA). The SFMS has remained neutral. The AUMA is

thus controversial—although that should surprise few.

Under AUMA, adults aged twenty-one and over will be allowed to possess marijuana and grow small amounts at home for personal use. Sale of marijuana will be legal and highly regulated to protect consumers and kids, and it will be taxed.

The CMA’s endorsement is not due to support of marijuana use. To the contrary, CMA supports the ever-growing evidence that cannabis smoking is a bad idea for young people, with deleterious impacts on neurodevelopment and other adverse behavioral effects, including dependence if not outright addiction.

Unsurprisingly, then, the primary opposition to legalization is that it might increase teen use. But fortunately, use does not seem to rise with liberalization of marijuana laws. A Lancet sampling of over one million adolescents in forty-eight states concluded, “The results of this study showed no evidence for an increase in adolescent marijuana use after the passage of state laws permitting use of marijuana for medical purposes . . . Concerns that increased marijuana use are an unintended effect of state marijuana laws seem unfounded.” Adolescent use nationwide is actually on a long downward trend, including in states that have legalized. We expect that in California—where it seems few have problem finding it now—this would hold true.

The AUMA is at best seen as a harm-reduction proposal.

The “drug war” has clearly failed on most counts, including deterring use and dealing with addiction. The primary harm from the drug war is exposure to the criminal system. Every minute in the U.S., somebody is arrested for cannabis—about fifty thousand each year in our state. There is much racial injustice involved in arrests, prosecutions, and prison sentences. The “prison-industrial complex” thrives on drug arrests, and thus representatives of law enforcement and incarceration are often the most outspoken against any lessening of punitive drug laws.

The California Legislative Analyst predicts AUMA will save the state tens of millions of dollars annually in reduced taxpayer costs—and raise up to one billion dollars in new tax revenues annually, much to be used for teen drug prevention and treatment, training law enforcement to recognize driving under the influence of drugs, protecting the environment from the harms of marijuana cultivation, economic development in communities impacted by marijuana prohibition, and more.

Some informed critics have warned of the cannabis industry emulating “big tobacco” in pushing pot to young people.

We do share that concern. In states that have legalized, there are concerns regarding increased driving under the influence of cannabis, and of emergency department visits due to overWWW.SFMS.ORG

doses, particularly from ingested “edibles.” For these and other reasons, members of Lieutenant Governor Gavin Newsom’s Blue Ribbon Commission on Marijuana Policy are recommending some tighter regulations to be instituted should Prop. 64 pass.

And Newsom reports that his own wife was initially opposed to AUMA, but has become supportive after seeing some of the evidence summarized above—mainly that youth use will still be illegal and marketing to them prohibited, with the bulk of tax funds generated going towards sounder cannabis education and treatment.

University of California San Francisco Professor Donald I. Abrams, MD, Chief of the Hematology-Oncology Division at San Francisco General Hospital and leading cannabis researcher says, “This measure is first and foremost a public health measure. It will fundamentally change California’s approach to dealing with marijuana, generating necessary resources to improve public health, allowing for more clinical research, and strengthening the physician-patient relationship.”

The CMA called for “rescheduling” and legalization, regulation, and taxation of cannabis in 2001. CMA President Steven Larson, MD, MPH, a longtime anti-tobacco advocate, says of AUMA, “We oppose smoking marijuana or ingesting marijuana for nonmedicinal reasons. But we’re not so naïve to think it’s not going to happen . . . the harm reduction in adolescents outweighs the risk.” He adds, “Right now, medicinal marijuana is terribly abused and misused and puts physicians in the middle.” He notes that much of the bogus “medical” market should wither with legalization, and concludes, “the California Medical Association believes the Adult Use of Marijuana Act is a comprehensive and thoughtfully constructed measure that will allow state officials to better protect public health by clarifying the role of physicians, controlling and regulating marijuana use by responsible adults, and keeping it out of the hands of children.”

David Smith, MD, (left) is founder of the Haight-Ashbury Free Medical Clinics, a past president of the American Society of Addiction Medicine, and has been medical director of treatment centers for cannabis abuse and dependency. Steve Heilig (right) is with the SFMS and served on both the CMA’s task force on cannabis policy and Lt. Governor Newsom’s Commission on Marijuana Policy. They are co-editors of a recent issue of the Journal of Psychoactive Drugs titled “Cannabis in California: Science, Policy, Prevention, Profits, and Perils.”

OCTOBER 2016 SAN FRANCISCO MEDICINE

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SLATE OF CANDIDATES SFMS 2016 Election Pursuant to the San Francisco Medical Society Bylaws Article X Section 2—Nominations, the Nominations Committee renders in writing the following slate of candidates for the 2016 SFMS election. This slate was read at the September 12, 2016 General Meeting, at which time the SFMS President called for additional nominations from the floor.

2017 Officers | Term 2017

For SFMS President-Elect John Maa, MD For SFMS Secretary Brian Grady, MD For SFMS Treasurer Kimberly L. Newell, MD (Incumbent Treasurer) For SFMS Editor Gordon L. Fung, MD, PhD, FACC, FACP (Incumbent Editor) SFMS Board of Directors Term: 2017-2019 Seven candidates to be elected to the SFMS Board of Directors: David T. Duong, MD, PhD Alexander B. Geng, MD Robert A. Harvey, MD, FACS, MBA (Incumbent Director) Dawn D. Ogawa, MD Ray Oshtory, MD, MBA Justin P. Quock, MD, FACP Dennis Song, MD, DDS Joseph W. Woo, MD

SFMS Nominations Committee

Term: 2017-2018 Four candidates to be elected to the SFMS Nominations Committee: Kamal S. Ghei, MD Gary Y. Huang, MD Erica M. Metz, MD Robert J. Purchase, MD

SFMS Young Physicians Section (YPS) Alternate to the California Medical Association House of Delegates Term: 2017 Meghan D. Gould, MD Jaclyn (Jakki) Taub, DO

For SFMS Delegation to the California Medical Association House of Delegates Term: 2017-2018 The candidates receiving the highest number of votes will serve as Delegates; the rest will be Alternate Delegates or on the wait list. The President-Elect automatically becomes one of the Delegates according to the SFMS Bylaws: Lawrence Cheung, MD, FAAD, FASDS (Incumbent Delegate) Mihal L. Emberton, MD, MPH, MS (Incumbent Delegate) Gordon L. Fung, MD, PhD, FACC, FACP (Incumbent Delegate) Pratima Gupta, MD (Incumbent Alternate) John Landefeld, MD Robert J. Margolin, MD (Incumbent Alternate) Kelly Pfeifer, MD Richard A. Podolin, MD, FACC (Incumbent Delegate) Andrea M. Wagner, MD (Incumbent Delegate) Amy E. Whittle, MD (Incumbent Alternate)

NOTES 2016 President-Elect, Man-Kit Leung, MD, automatically succeeds to the office of President.

2016 President, Richard A. Podolin, MD, FACC, automatically succeeds to the office of Immediate Past President.

Member voting will take place ONLINE ONLY. In order to place your vote, we must have your email address in our database.

Please provide us with your email address if we don’t already have it by emailing plyon@sfms.org.

Paper ballots are NO LONGER mailed. Please look for a special email from SFMS on October 24 with detailed information regarding the online voting process, as well as the link to the online ballot.

Your email vote must be cast by 5 PM, Monday, November 14, 2016.

Please see candidate biographies and statements on the following pages.

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SAN FRANCISCO MEDICINE OCTOBER 2016 WWW.SFMS.ORG

CANDIDATE BIOGRAPHIES President-Elect

Secretary

Treasurer KIMBERLY L. NEWELL, MD

BRIAN GRADY, MD

JOHN MAA, MD

Incumbent Treasurer

General Surgery

Urology

Pediatrics

Current Job Positions and Hospital and Teaching Affiliations

Chair, University of California Office of the President Tobacco Related Disease Research Program; Marin General Hospital, General and Trauma Surgery; Chair of the American Heart Association Western States Affiliate Advocacy Committee. Selected as (415) Top Doctor by Marin Magazine, a San Francisco SuperDoctor in 2012 and 2013, and the 2016 American Heart Association (AHA) Physician Volunteer of the Year.

Urologist, Golden Gate Urology; active medical staff member at California Pacific Medical Center (CPMC) and CPMC/St. Luke’s, St. Mary’s Medical Center, St. Francis Memorial Hospital, and Seton Medical Center.

Pediatrician, Kaiser Permanente; AssociateClinical Professor, UCSF.

Secretary, 2016; Board of Directors, 20122015; Executive Committee, 2014-2016/20122013; AMA, 1991-present; CMA Specialty Society Delegate and Member of the Subcommittee on Professional Liability; Awarded SFMS David Perlman Award for Excellence in Medical Journalism in 2013; San Francisco Medicine Magazine Editorial Board, 2012-present.

SFMS Board of Directors, 2014-Present; Liaison from St. Luke’s Medical Staff to the SFMS; SFMS Executive Committee, 2015-2016. CMA Council on Health Professions and Quality of Care, 2016.

SFMS: Treasurer 2016; Secretary 2015. Board of Directors 2012-2014; Executive Committee, 2014-present; Nominations Committee, 2010-2011.

Past President, American College of Surgeons (ACS) Northern California Chapter; Recipient of the 2013 ACS Ellenberger Award for Excellence in State Advocacy; Nominated for the White House “Champion of Change for Prevention and Public Health” 2013; Named a “Top 20 people making a difference in healthcare in America” 2009; Current Member of AHA Board of Directors and Past President, San Mateo, 2004-2005; Commendation for Tobacco Control Advocacy by the San Francisco Board of Supervisors in 2014; Recipient of the California Chronic Care Coalition 2016 Star of Advocacy Award.

Currently serving as the Chief of Surgery Department, CPMC/St. Luke’s campus; Secretary/Treasurer Medical Executive Committee (MEC) Seton Medical Center; former president of the CMA Resident Physician’s Section.

Having trained at University of California, San Francisco (UCSF), worked in the community at San Francisco General Hospital (SFGH) and at several private practice offices, and now in practice at Kaiser San Francisco, I have had experience with a range of medical settings and care delivery systems in this city. I have held several local and regional leadership positions at Kaiser Permanente, including Chief Healthcare Innovation Office, Chief of Physician Health and Wellness, Emerging Leaders Program, Department Technology Lead, and Continuing Medical Education (CME) Coordinator.

I would be honored to serve as SFMS President-Elect with the vision to improve the overall health of the public in San Francisco by leading scientific, public policy, and research efforts to strengthen the future practice of medicine, and promote quality patient care through advocacy in City Hall and Sacramento.

I am proud and excited to be a part of the process of growing the voice of physicians. Our profession and our patients need advocacy now more than ever, here at the local level and beyond. I am honored for the opportunity to serve.

More than ever in these turbulent times, physicians must work to shape how medicine evolves so we can continue to take exemplary care of our patients and attain professional satisfaction. I would be honored to continue to help lead this group of committed physician leaders for the benefit of the entire community.

SFMS/CMA Committees or Offices

Additional Relevant Experience

Why Are You Interested in Serving?

WWW.SFMS.ORG

Bios continued on the following page.

OCTOBER 2016 SAN FRANCISCO MEDICINE

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CANDIDATE BIOGRAPHIES Editor

Board of Directors DAVID T. DUONG, MD, PHD

GORDON L. FUNG, MD, PHD, FACC, FACP

ALEXANDER B. GENG, MD

Incumbent Editor

Also Candidate for CMA Delegation

Cardiovascular Diseases

Urology

Radiation Oncology

Current Job Positions and Hospital and Teaching Affiliations

Clinical Professor of Medicine, UCSF Medical Center; Director of Cardiac Services at UCSF Medical Center at Mount Zion; Director of Asian Heart & Vascular Center; Director of Electrocardiography Laboratory at Moffitt-Long Hospital.

Urologist in private practice; Active medical staff member at California Pacific Medical Center, Saint Francis Memorial Hospital, and St. Mary’s Medical Center.

I currently serve as the Medical Director of the CyberKnife Radiosurgery Center at Saint Francis Memorial Hospital and serve on faculty for the Radiation Oncology Residency Program at California Pacific Medical Center.

SFMS Editor, 2011-present; Executive Committee, 2011-present; Past President. CMA: Delegate since 2000 (Chair since 2014); Member of Council of Scientific Affairs 2004-present; Institute for Medical Quality (IMQ) Surveyor since 1994.

SFMS Nominations Committee, 2016-2017.

None.

Currently serve on Board of Directors of Saint Francis Memorial Hospital and on Board of Directors of Saint Francis Foundation.

Member of California delegation, American Society for Radiation Oncology (ASTRO) Advocacy on Capitol Hill - lobbying for oncology specific issues including patient access, preserving independence of physician practice, and improving efficiency of electronic medical records. Physician Advisory Panel member: Doximity.

SFMS leads the way in shaping health policy for the City of San Francisco and for the State of California. Our collective efforts are needed to navigate the changing currents of health care in America. I would be honored to represent my colleagues and serve on the SFMS Board of Directors. Together, we must work to improve the health of our patients and our practices.

With my background in engineering, I bring a unique perspective on how technology influences healthcare delivery. My practice in radiation oncology is heavily impacted by changes in technology. Together, with the SFMS, I hope to bridge the gap between physician needs and technology through local and Capitol Hill lobbying efforts.

SFMS/CMA Committees or Offices

Additional Relevant Experience

Why Are You Interested in Serving?

Communications, education, and learning are the jobs of the editor. Over the past five years I have learned much more about the topics and issues facing the clinicians in practice in the community as well as academics. Working with the SFMS staff, Editorial Board, and Executive Committee and keeping the communication channels open with the membership and other interested parties that interface with SFMS through San Francisco Medicine has been one of the highlights of my involvement with SFMS. In a sense, San Francisco Medicine, our awardwinning journal, is one of the oldest still-viable forms of social media used by the physician community serving San Francisco Bay Area. I truly cherish my time on the board and look forward to serving as your editor for 2017.

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SAN FRANCISCO MEDICINE OCTOBER 2016 WWW.SFMS.ORG

IN MEMORIAM DAWN D. OGAWA, MD

ROBERT A. HARVEY, MD, Incumbent Director

Plastic and Reconstructive Surgery

The Doctor has left the building!

Obstetrics and Gynecol-

ogyAffiliations Current Job Positions and Hospital and Teaching Solo practice of Plastic and Reconstructive Surgery in San Francisco for more than twentyfive years. For the past three years President of the Medical Staff at Saint Francis Memorial Hospital. For the preceding seven years, Chief of Surgery at Saint Francis. Chair of Medical Executive Committee at Saint Francis. Medical staff at CPMC and an active applicant to rejoin the medical staff at St. Mary’s Medical Center.

Practicing Obstetrician and Gynecologist, 2008-present; Chief of Patient Health Education, Assistant Chief of Obstetrics and Gynecology Kaiser Permanente San Francisco; Volunteer Clinical Faculty at UCSF, 2008-present; San Francisco Gynecology Society Member; American Congress of Obstetricians and Gynecologists (ACOG) Resident Lobby Day Leader, 2012-present.

Medical Staff Liaison to SFMS Board from Saint Francis Memorial Hospital, 2014-2016.

SFMS Nominations Committee, 2016-2017.

SFMS/CMA Committees or Offices

Additional Relevant Experience

Saint Francis Memorial Hospital Board of Trustees, 2013-present. Current Secretary of the Board, member of the Executive Committee, and Chair of the Community Advisory Committee of the Board which focuses on the Tenderloin Health Improvement Project. Certified Physician Executive (CPE) by the American Association for Physician Leadership.

Master of Business Administration (MBA).

Through my training at UCSF, as a member of the SF Gynecological Society, and as a practicing physician at Kaiser Permanente, I know many physicians across medical centers and across specialties. Knowing this community of doctors will make me a valuable member of the Board of Directors. It is critical that our voice is heard here at City Hall and in Sacramento as policy decisions are made.

As doctors, the main focus of our work is to provide excellent medical care to our patients. Part of any success in this involves working with and caring for our colleagues, support staff, and ourselves. The SFMS provides an excellent path to help care for all of these stakeholders. I welcome the opportunity to expand this in the future.

I am impressed by the work SFMS has done to improve the overall health of residents in San Francisco and California through political action. I would welcome the opportunity to be more involved in this work as a member of the Board of Directors.

Why Are You Interested in Serving?

Xavier Barrios, MD Xavier Barrios passed on September 7, 2016, at the age of eightyeight. He was surrounded by his loving family and friends.

Xavier was born on February 11, 1928, in El Paso, Texas. After graduating the University of Texas at El Paso at the age of nineteen, he excelled in medical school at the University of Texas at Galveston.

Xavier headed north to St. Mary’s Hospital in Milwaukee, WI where he completed his medical internship and chose to specialize in ear, nose and throat medicine. He married his wife Ann, a nurse, and moved to San Francisco.

As Xavier developed his private medical practice in the city, he also quickly developed a well-deserved reputation as an incredibly kind and gentle physician whose bedside manner was second only to his surgical skill. He took great pride in his role as head of Ear, Nose & Throat medicine at St. Mary’s Hospital and serving on the staffs at St. Luke’s Hospital and longgone Children’s Hospital (now CPMC). He also served as President of the San Francisco Medical Society and on numerous boards and committees including at the CMA and AMA. He routinely treated people regardless of their ability to pay. His mantra was that he was here to serve his fellow man. This dedication to relieving the suffering of others earned him the prestigious St. Thomas More Award for Distinction in Public Service from the University of San Francisco in 1972. He continued his practice for the next three decades in The Mission serving an ethnically diverse population until retiring in 2011.

His passions were his family, his Forty Niners, his Giants, his Warriors, his Texas Longhorns and his Cal Bears. Xavier is survived by his children Bill, Jim and Patricia, grandchildren Kathleen, Jacob, Isabelle, Zach, Carlos and Ella.

Nieces and nephews David, Ricky, Denni, Missy, Diane, Debby, Terry, Ron and Scott will miss their Tio Xavier, but know that he is serenading all the angels (and anyone else who will listen) with his guitar and singing!

Reprinted from Legacy.com

Bios continued on the following page.

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OCTOBER 2016 SAN FRANCISCO MEDICINE

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CANDIDATE BIOGRAPHIES Board of Directors JUSTIN P. QUOCK,

RAY OSHTORY, MD, MBA

Orthopedic Spine Surgery

MD, FACP

Medical Oncology

DENNIS SONG, MD, DDS

Oral and Maxillofacial Surgery (American Dental Association)

Current Job Positions and Hospital and Teaching Affiliations

Solo, Private Practitioner for seventeen years. Chief, Department of Internal Medicine, Chinese Hospital, January 2014-present. Privileges at St. Francis Memorial Hospital, Saint Mary’s Medical Center, CPMC and Chinese Hospital.

Oral and Maxillofacial Surgeon, Private Practice; Associate Clinical Professor, UCSF Oral and Maxillofacial Surgery; Vice Chief, Dental Division, General Surgery, California Pacific Medical Center; Active Staff, California Pacific Medical Center; Courtesy Staff, St. Mary’s Medical Center; Chief of Radiography Services, American Association of Dental Maxillofacial Radiographic Technicians (AADMRT) Online School.

SFMS Nominations Committee, 2015-2016.

None.

Board Member, SFMS Political Action Committee (PAC).

I am vice-president and board member of Northern California Orthopedic Society. I currently serve as a member of the New Technology Committee and Orthopedic Quality of Care committee at CPMC. I have served on the Capital and Budget Committee and on the nominations committee for the Chairman of the Department of Orthopedics at St. Luke’s Hospital.

Past Interim Medical Director for Chinese Community Healthcare Association (IPA), January-July 2014, December 2015-January 2016; Physician Representative, Chinese Hospital Association Board of Trustees, January 2013-January 2014; Board of Trustees, Chinese Community Healthcare Association (IPA), January 2002-January 2008.

2015 President, San Francisco Dental Society (SFDS); Past Chair of SFDS Membership, New Dentist, Program Development Committees; Current/Past Service on SFDS Membership, Legislative, Finance, Community Dental Health, Program Development, Nominating, and New Dentist Committees; Representative to House of Delegates, California Dental Association; Board Member, SFDS PAC; Member, General Surgery Quality of Care Committee, CPMC.

As stewards of our patient’s health we are also stewards of our profession. Being part of leadership, I believe I can better inform my colleagues about pertinent practice changing issues so that they can remain more focused on why they became doctors.

The SFMS is forward-thinking and at the forefront of organized medicine representing physicians and public health interests. My unique background in organized dentistry, leadership, private practice, academia, hospital care, and business brings a different experience and perspective to the membership. I would be honored to serve in this position.

Solo private practice; privileges at CPMC, St. Luke’s, Seton, and St. Francis hospitals.

SFMS/CMA Committees or Offices

Additional Relevant Experience

Why Are You Interested in Serving?

A community is only as strong as its leadership.

Today, more than ever before, doctors need charismatic and influential leaders to fight for the needs of our patients and colleagues. As a member of the Nominations Committee for the last two years, I have helped to elect several such leaders to SFMS. Now that those duties have concluded, I would be honored to further serve the Society as a board member to continue our tradition of advocacy and service.

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SAN FRANCISCO MEDICINE OCTOBER 2016 WWW.SFMS.ORG

SFMS Nominations Committee JOSEPH W. WOO,

KAMAL S. GHEI,

MD

MD

GARY HUANG, MD

Former Director

Emergency Medicine

Internal Medicine

Child and Adolescent Psychiatry, Adult Psychiatry, Pediatrics

Current Job Positions and Hospital and Teaching Affiliations

Hospitalist at Saint Francis Memorial Hospital for last ten years. I work with a large national multi-specialty group (CEP America).

Newly appointed staff at Saint Mary’s Medical Center.

I’m currently practicing as a child, adolescent, and adult psychiatrist and serving as an Assistant Chief of the Psychiatry Department at Kaiser Permanente San Francisco. I have served as a Volunteer Clinical Faculty at UCSF teaching medical student and residents.

SFMS Board of Directors, 2010–2015.

None.

None.

Former Medical Director Chinese Hospital ER; Former Chief of Medical Staff, Chinese Hospital.

Currently serve on the Associates Board at Saint Francis Memorial Hospital. Member of multiple committees at Saint Francis Memorial Hospital (Quality Assurance & Improvement committee, Medical Care & Evaluation committee, Psychiatric Patient care committee). Actively involved in maintenance and operation of Hospitalist program with focus on optimizing inpatient utilization to efficiently deliver high quality care.

I trained in a combined residency program in Pediatrics, Adult Psychiatry, and Child/Adolescent Psychiatry. I learned about the medical home in pediatrics and looked at ways to integrate mental health services and provide excellent care to families. I currently serve on multiple committees at Kaiser including Behavioral Health Quality Performance Improvement Committee, Regional Pediatric Chronic Pain Workgroup, Service Liaisons Committee, and Physician Health and Wellness Committee including Physician Mentoring Program.

Over the last ten years, I have met many physicians from various specialties in many hospitals. Some of these talented physicians have skills and attributes that would be well suited for San Francisco Medical Society. I would welcome the opportunity, as a member of the Nominations Committee, to assist in finding and recruiting physicians that are the right fit for positions within San Francisco Medical Society.

I would be honored to serve on the Nominations Committee to identify and recruit a diverse group of leaders for the San Francisco Medical Society. I look forward to the opportunity to work together with primary care physicians and specialists to improve the overall health of residents in SF and California.

Staff Physician, Chinese Hospital Emergency Room (ER); Chief Executive Officer, Asian American Medical Group; Medical Director, Chinese Community Healthcare Association.

SFMS/CMA Committees or Offices

Additional Relevant Experience

Why Are You Interested in Serving?

The importance of organized medicine cannot be underemphasized. I was in the middle of the recent controversies in the Chinese Community health system. The subsequent support by SFMS/CMA has made it clear to me that we must remain united and continue to exert our collective influence. Currently, I find myself in a unique position in my career: practicing physician, administrator, and prior Board member. I look forward to the opportunity to serve and humbly ask for your vote.

Bios continued on the following page.

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OCTOBER 2016 SAN FRANCISCO MEDICINE

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CANDIDATE BIOGRAPHIES SFMS Young Physicians Section (YPS) Alternate to the CMA House

SFMS Nominations Committee ERICA M. METZ,

ROBERT J.

MEGHAN D.

MD

PURCHASE, MD

GOULD, MD

Internal Medicine

Orthopedic Surgery

Pediatrics, Primary Care

Current Job Positions and Hospital and Teaching Affiliations

Regional Medical Director for Transgender Health, Kaiser Permanente, Northern California; Primary Care Physician, Department of Adult and Family Medicine, and Co-founder/ Clinical Director, Gender Pathways Clinic, Kaiser Permanente San Francisco Medical Center.

Primary care pediatrician at Golden Gate Pediatrics; newborn rounding privileges at CPMC; Volunteer Clinical Instructor at UCSF; Pediatric Preceptor for second-year medical students.

SFMS/CMA Committees or Offices

Orthopedic surgeon in private practice. Hospital-based clinic as well as a traditional private office. Active medical staff member at Saint Francis Memorial Hospital and CPMC. Medical director of Shoulder Surgery at Saint Francis Memorial Hospital.

None.

None.

SFMS Nominations Committee, 2015-2016.

Throughout my career, I have embraced physician leadership positions. Early in my career at Kaiser, I spearheaded the effort to increase operating room efficiencies. Since moving to the Bay, I have served as a board member of the Northern California Orthopedic Society, coordinated their annual convention, held a position on a patient care committee for a highly regarded malpractice insurer, and served on the Quality Committee at CPMC. I currently serve as the Medical Director of Shoulder Surgery at Saint Francis Memorial Hospital.

Lobbied for the California Health Insurance Reliability Act (SB 840) in Sacramento, 2006, as a member of American Medical Student Association (AMSA).

Participation with SFMS (and groups like it) is vital to shaping an environment that allows us to deliver care in a professional and compassionate way. This is true of doctors from all specialties. By participating in this committee, I hope to lead by example as well as encourage other subspecialists to participate.

In the role of YPS alternate, I aspire to become a more knowledgeable and effective advocate for young physicians and their patients. As a pediatrician, I will advocate for policies on health prevention and medical practice, including gun control, access to early childhood education, and efficient delivery of health care.

Additional Relevant Experience

My work to create a comprehensive program of clinical and surgical services for transgender patients at Kaiser Permanente requires collaboration with physicians across many diverse disciplines of practice and health care administration, as well as engagement with colleagues in community, university, and managed care settings. These experiences have allowed me to build strong connections in San Francisco as well as a honed sense of the qualities necessary for leadership.

Why Are You Interested in Serving?

The field of medicine is rapidly evolving, and identifying physician leaders to represent our collective voices is crucial to our ability to shape our health care system. I would be honored to participate in the recruitment of leaders for the San Francisco Medical Society.

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SAN FRANCISCO MEDICINE OCTOBER 2016 WWW.SFMS.ORG

SFMS Delegation to the California Medical Association House of Delegates

JACLYN (JAKKI) TAUB, DO

Obstetrics and Gynecology

LAWRENCE CHEUNG, MD, FAAD, FASDS

MIHAL L. EMBERTON, MD, MPH, MS

Incumbent Delegate

Incumbent Delegate

Dermatology

Family Medicine

Current Job Job Positions Positions and and Hospital Hospital and and Teaching Teaching Affiliations Affiliations Current

Associate Physician, Kaiser Permanente San Francisco - Mission Bay Office.

Solo private practice with volunteer teaching responsibility at UCSF.

Adult and Family Medicine Senior Physician, The Permanente Medical Group; Clinical Teaching Faculty, UCSF.

SFMS: Board Consultant, 2016; Immediate Past President, 2015; President, 2014, President-Elect, Treasurer, Secretary, Board of Directors, Political Action Committee, Membership Committee. CMA: House of Delegates and current member of the Council on Science and Public Health. AMA: Delegate At Large representing the CMA.

Delegate to CMA House, 2015-2016; Alternate Delegate, 2013-2014.

I have been very active at the local level (SFMS), state level (CMA) and national level (AMA) on a variety of issues including preserving modes of practice (specifically solo and small group) as well as public health policy (tobacco control, soda, obesity epidemic and health care disparity).

When my wife was denied health coverage in 2008 by my employer, despite my Public Policy Masters in Public Health, it took six weeks of emotional collaboration with multiple stakeholders, both in the hospital and community, before we were finally granted spousal benefits. This experience has stimulated my passion for social justice and also prompted my participation on multiple LGBTQ and Diversity Committees, where I continue to refine leadership and advocacy skills.

SFMS was an invaluable organization for me when I started my solo practice eleven years ago and continues to be a resource for me today. The Society serves as my only local advocate and the CMA serves as my only state advocate in matters of public health, patient safety, and physician advocacy. With the looming changes occurring in the profession of medicine, I feel that it is not just a privilege but a duty to make the Society a relevant organization for future San Francisco physicians.

I would like to continue to improve the practice of medicine and the delivery of care from the policy side, where changes can improve the overall health of Californians as well as the lives of physicians. It is an honor to represent my SF colleagues in the House of Delegates.

SFMS/CMA Committees or Offices

None.

Additional Relevant Experience

I have been on several committees in my residency program to help improve patients’ experience, such as improving the bereavement process and also emergency simulation drills and training. I would like to get more involved with the political aspects of healthcare.

Why Are You Interested in Serving?

As a relatively new physician, I am eager to learn more about how I can help shape the future of healthcare. I would love the opportunity to learn from the SFMS leadership and create improvements in the care of our community and for ourselves.

WWW.SFMS.ORG

Bios continued on the following page.

OCTOBER 2016 SAN FRANCISCO MEDICINE

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CANDIDATE BIOGRAPHIES SFMS Delegation to the California Medical Association House of Delegates PRATIMA GUPTA,

GORDON L. FUNG, MD, PHD, FACC, FACP

JOHN LANDEFELD, MD

MD Incumbent Alternate

Delegation Chair; Incumbent Delegate

Also Candidate for Editor

Cardiovascular Diseases

Obstetrics and Gynecology

Internal Medicine Resident

Current Job Positions and Hospital and Teaching Affiliations

Internal Medicine - Primary Care resident (PGY-1) at UCSF-SFGH.

SFMS/CMA Committees or Offices

Kaiser Permanente Senior Physician; Volunteer Assistant Professor at UCSF; Medical Director St. James Infirmary (free clinic in SF for sex workers and transgender individuals).

Additional Relevant Experience

SFMS PAC 2016; Alternate Delegate to CMA House of Delegates, 2015-2016.

None.

Vice-Chair of the San Francisco Democratic County Central Committee; American College of Ob/Gyn District IX Legislative Committee member; Board of Directors of California Family Health Council; Member of SF Mayor’s Anti-Human Trafficking Taskforce; former member of Board of Directors for Physicians for Reproductive Choice and Health.

Prior to medical school, I was a political organizer working on Barack Obama’s first presidential campaign. During medical school, I spent a year as a non-voting board member of LifeLong Medical Care, a community health center in the East Bay. I have also conducted public health and health policy research on topics including digital health, patient safety, social determinants of health, and the health of marginally housed individuals.

As San Francisco’s first-ever elected medical doctor, I believe that health and public service extend beyond the doors of my clinic and hospital. The social determinants of health such as education, nutrition, transportation, and environment must be incorporated into our priorities at SFMS and CMA. Physician advocacy is an important part of my medical philosophy, as I consistently use my voice as a physician to fight to ensure reproductive rights for all men and women in the U.S. and abroad. In addition, I am committed to cultivating and empowering others to achieve success.

Through my many years of medical training and practice, I have mentored many undergraduate and medical students, residents, and colleagues.

My mentorship approach involves a discussion around the individual’s goals (both immediate and long term), envisioning the best and worst case scenarios, and making a roadmap about how to achieve success. I like to continue to do regular check-ins with my mentees to explore their path, their strategy, and allow them to stray as long as they continue to keep their end goal in sight. We must be our own support network.

As an intern in internal medicine building a career in public health and primary care, I am eager to bring a Primary Care Physician trainee’s perspective on front-line care in safety net settings to service at SFMS.

See bio under “Editor”

Why Are You Interested in Serving?

I ask for your support to represent you at the California Medical Association House of Delegates (HOD). San Francisco is a unique community that has a finely honed process to make a significant impact in health policy at the local, state, and national levels. We have also been rising to the challenge of working within the new format of the CMA for year-round resolutions and a shortened HOD. Your delegation over the years has demonstrated success in developing and supporting resolutions that have impacted key areas of our practice, from environmental health issues to public health issues with healthy lifestyles and neighborhoods to streamlining the way for patients to get their prescriptions. No one person can have the expertise required in all these areas. So the collaborative/team effort to bring these issues to the CMA and many to the AMA requires all members of the delegation to pitch in. I look forward to working with this team of delegates to bring San Francisco’s expertise and issues to the state and the nation.

26

SAN FRANCISCO MEDICINE OCTOBER 2016 WWW.SFMS.ORG

ROBERT J.

RICHARD A. PODOLIN,

KELLY PFEIFER, MD

MARGOLIN, MD

MD, FACC

Incumbent Alternate

Incumbent Delegate

Internal Medicine and Geriatrics

Family Medicine

Cardiology

CurrentJob JobPositions Positionsand andHospital Hospitaland andTeaching TeachingAffiliations Affiliations Current

Primary Care Practice in Internal Medicine; Chief, Division of Internal Medicine at CPMC; Vice Chief of Staff of the Medical Staff at CPMC; Chair of the Credentials Committee at CPMC; Board of Directors, Medical Insurance Exchange of California; Associate Clinical Professor, UCSF.

SFMS/CMA Committees or Offices

AMA: Delegate to the House of Delegates.

CMA: Past Member of the Board of Trustees, Past Chair of the Audit Committee, Chair of CALPAC. SFMS: Past President, Past Chair of the Delegation.

Director, High-Value Care, California Health Care Foundation (CHCF): lead team focused on improving and integrating care of addiction and mental illness, expanding access to palliative care, piloting an electronic Physician Orders for Life Sustaining Treatment (POLST) registry, and improving maternal health. Also volunteer in community clinics and as Associate Professor, UCSF Family and Community Medicine.

I am in private practice with one partner (Remo Morelli, MD) and affiliated with St. Mary’s Medical Center.

None.

SFMS: President, 2016; President-Elect, 2015; Secretary, 2014; Board of Directors, 20092013; Executive Committee, 2012-2016; Nominations Committee, 2009 CMAS; Delegate to CMA House, 2015-2016; Alternate Delegate, 2014. Additionally, for many years I served as delegate to the CMA from the California Chapter of the American College of Cardiology.

I lead health policy work in collaboration with leaders in the California Department of Public Health and Health Care Services. I co-lead the CHCF clinical leadership program and work closely with its alumni network across the state. I recently served as the Chief Medical Officer for San Francisco Health Plan and led a group of public health plan Care Management Organizations (CMOs). I have a strong grasp of local and statewide policy issues affecting the practice of medicine.

I served as Chairman of the Quality Committee at St. Mary’s Medical Center for four years, and then as Chief of Staff for four years. I have been President of the San Francisco Heart Association and a District Councilor for the California Chapter of the American College of Cardiology. For two years I served as Chairman of the Board of the St. Mary’s Medical Center Foundation, and currently, I serve as Chairman of the Community Board of St. Mary’s Medical Center.

My role at CHCF is dedicated to advancing meaningful, measurable improvements in the California health care delivery system— especially for those not well-served by the status quo. It would be an honor to represent San Francisco values and help the CMA be a strong, positive force for change.

In this period of fundamental change in our health care system, physicians need to align to advocate for their profession, their patients, and their community. The strength of the SFMS and the CMA will directly affect the viability of medical practice and the vitality of health care in San Francisco.

Additional Relevant Experience

I have spent much of the past twenty years in leadership roles in our medical society and the CMA.

Why Are You Interested in Serving?

I have greatly enjoyed my role as your CMA delegate for the past twenty years. I believe I have the experience, perspective, energy, and desire to continue to advocate for physicians and their patients and thus ask that you reelect me to serve on your CMA delegation.

Bios continued on the following page.

WWW.SFMS.ORG

OCTOBER 2016 SAN FRANCISCO MEDICINE

27

CANDIDATE BIOGRAPHIES SFMS Delegation to the California Medical Association House of Delegates ANDREA M. WAGNER, MD

AMY E. WHITTLE, MD

Incumbent Delegate

Emergency Medicine

Incumbent Alternate

Pediatrics

Current Job Positions and Hospital and Teaching Affiliations

Director of Outside Hospital & Emergency Operations and Emergency Prospective Review Program (EPRP) for Northern California; Staff Physician, Emergency Medicine, Kaiser Foundation Hospital, San Francisco.

SFMS/CMA Committees or Offices

Assistant Clinical Professor of Pediatrics, University of California, San Francisco; Medical Director, Multidisciplinary Assessment Clinic; Medical Director, San Francisco Medical-Legal Partnership, both at Zuckerberg San Francisco General; Course Director, Physician in Community & Behavior and Development rotations, UCSF Pediatric Residency.

Delegate to CMA House, 2015-16; Alternate Delegate, 2012-2014.

Alternate Delegate to CMA House, 20152016; SFMS Nominations Committee, 20142015.

Board of Directors, California Chapter of the American College of Emergency Medicine, June 2006–June 2012; Counselor, American College Emergency Physicians, 2006-2015; Committee Member, Government Affairs Committee California American College of Emergency Physicians (ACEP), 2006-2016.

I served as State Governmental Affairs Committee Representative for Chapter 1 of the California American Academy of Pediatrics (AAP) from 2011-2016. This committee determines advocacy priorities and then reviews state legislation relevant to these areas and determines AAP advocacy strategies. I am also co-chair of the Chapter 1 AAP-CA Advocacy Committee, which coordinates advocacy around pediatric health policy issues at the local, state, and national levels.

Additional Relevant Experience

Why Are You Interested in Serving?

I would like to continue in my role in the SFMS delegation to the CMA House of Delegates. We play a critical role for our Medical Society in crafting and promoting policy resolutions. Thank you for your support.

28

My prior experience in advocacy led me to become interested in serving as a delegate to the CMA House of Delegates. My past experience in evaluating legislation and policy will serve me well in the task of reviewing resolutions and helping to form the SFMS positions.

LEGALIZING MARIJUANA An Argument for Medical Neutrality John Maa, MD

The SFMS Executive Committee has voted to take no position on Prop. 63, after careful reflection on both the merits and the pitfalls of the legalization of the adult use of marijuana.

The Committee recognized strong arguments to both endorse and oppose Prop. 63, and the final vote to stay “neutral” was a reflection that neither side convincingly dominated. A neutral position on AUMA was also adopted by the California Chapter of the American Academy of Pediatrics, the California Chapter of the American Society of Addiction Medicine, and the California Grower’s Association (the state’s cannabis trade association).

Ultimately, the fate of state marijuana legalization attempts may be a legal one for the courts to decide, rather than a ballot decision made by voters. The Supremacy Clause of the U.S. Constitution places federal laws above state laws, and existing national laws prohibit the sales and use of recreational marijuana. The Federal Government can choose at any time to enforce existing federal marijuana laws in the states of Alaska, Colorado, Oregon and Washington, and any attempt by each state’s Attorney General to interfere would likely be overruled. Other court challenges loom. In 2015, the states of Nebraska and Oklahoma filed a joint lawsuit against the State of Colorado for the costs related to smuggling, traffic violations, and law enforcement among others related to cross border effects of Colorado’s legalization of marijuana. Though the U.S. Supreme Court did not hear the lawsuit, one might anticipate that as more states legalize recreational marijuana use in the future, adjoining states may also file litigation and the U.S. Supreme Court will be required to weigh in on the matter.

In the interim, a key for public health is to protect children, and ensure that health safeguards to prevent overdoses, vehicular accidents, and to provide content labels for edibles are made available. A benefit if AUMA passes would be to expand the existing scientific understanding of the health benefits and harms of marijuana, and a mechanism should be contemplated to revise AUMA if scientific evidence accumulates that the cardiovascular and carcinogenic effects of marijuana are greater than currently realized. SFMS should be positioned to lead the way forward with CMA resolutions if this proves true, and to champion decriminalization as an alternative to legalization of recreational marijuana.

SAN FRANCISCO MEDICINE OCTOBER 2016 WWW.SFMS.ORG

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Member-only savings on office supplies and magazine subscriptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $500 Access to webinars and seminars ranging from business essentials for physicians, EHR adoption best practices, . . . $800 effective coding/billing strategies, and Medicare reporting compliance .

For a list of full member benefits, visit http://www.sfms.org/membership/membership-benefits/full-member-benefits.aspx.

NOVEMBER BALLOT RUNDOWN From the California Medical Association Reprinted from the CMA Capitol Insight, a biweekly column by veteran journalist Anthony York, reporting on the inner workings of the state Legislature.

California’s ballot has evolved into an impressive—and daunting—laundry list of policy proposals, running the gamut of fiscal and social policy.

While the seventeen measures on the ballot are not a statewide record, many of the state’s hot-button political issues—including health care, guns, criminal justice and environmental protection—will all be decided by voters this fall.

Tax measures loom large this year, with Propositions 55 and 56. Prop. 55 would extend the state’s income tax rates on top earners, which were initially instituted in 2012 when voters approved Prop. 30. Prop. 56 would implement a new twodollar-per-pack increase of the levy on tobacco products to help raise money for Medi-Cal and other important health-related services. The tax is supported by the California Medical Association (CMA), Democratic mega-donor Tom Steyer, and the state council of the Service Employee International Union (SEIU).

This ballot has a little something for everyone—from taxes to transparency to new regulations for the porn industry. We’ve got price caps and bag bans, guns and cannabis, and that’s all before you get to any of the candidates for federal, state and local office.

Here is a rundown of the ballot proposals, broken down by subject matter:

HEALTH CARE Prop. 52 (CMA supports) would lock in hospital fees to

allow the state to draw down federal health care funds. While that is a non-controversial measure, another health-related proposal could be the most costly of the election fights this year.

And that’s saying something.

Prop. 61 (CMA opposes) would cap prices the state could pay on prescription drugs. The pharmaceutical industry has already raised more than sixty million dollars to fight the proposal. While the proponents will be massively outspent, the idea of price caps has polled well among California voters. CMA maintains that Prop. 61 would likely increase—not lower—state prescription drug costs. Legislative vehicles, like SB 1010, provide real reforms to protect consumers and lower drug costs.

Prop. 56 (CMA supports) falls into both the health care and tax categories. The measure would raise per-pack taxes on cigarettes and other tobacco products by two dollars to $2.87.

The money would be used to shore up Medi-Cal and provide other health care services.

TAXES

30

The larger tax measure is Prop. 55 (CMA supports), which extends the state’s higher income taxes for those earning more than five hundred thousand dollars per year. Billed as a way to fund schools, projections from the governor’s office show the state running future budget deficits if the measure is not approved.

EDUCATION

Despite opposition from Governor Brown, who has indicated that school bonds should be left to local governments, Prop.

51 would authorize nine billion dollars in state borrowing to dedicate to school construction projects. The proposal has bipartisan support, with major funding coming from developers, as well as backing from education groups.

Prop. 58 (CMA supports) would overturn Proposition 227, the “English Only” initiative passed by state voters in 1998.

The fact that this is not a hot-button issue this cycle is a sign of just how much has changed in California politics over the last two decades.

ENVIRONMENT

The two environmental proposals on the ballot are tied to the legislature’s passage of a ban on single-use plastic bags in 2014. Many local governments have already passed similar bans, and more than half of all Californians live in places that have local bag bans in effect.

Prop. 67 would overturn the statewide ban, while Prop.

65 would require grocery stores to direct paper bag sale proceeds toward environmental fund instead of allowing stores to pocket the money. Grocers were a major backer of the 2014 legislation, and Prop. 65 is seen largely as political retribution from the plastic-bag industry.

PUBLIC SAFETY Prop. 57 is the criminal justice reform package backed by

Governor Jerry Brown. The measure would allow for earlier parole for non-violent offenders and give judges more latitude in deciding whether or not to try juvenile offenders as adults.

Prop. 60 would require adult film actors to wear condoms during sex while filming.

Prop. 63 (CMA supports) is the gun-control measure backed by Lieutenant Governor Gavin Newsom. Newsom, who is a candidate for governor in 2018, has been heavily engaged on the guns issue and is a staunch supporter of the cannabis legalization initiative.

Backed by the California Academy of Preventive Medicine and others, Prop. 64 (CMA supports) would regulate and control the cultivation and use of non-medical cannabis. The proposal would raise up to one billion dollars in taxes for state and local governments, according to a fiscal analysis of the proposal.

DEATH PENALTY

SAN FRANCISCO MEDICINE OCTOBER 2016 WWW.SFMS.ORG

Californians will have two chances to vote on the death penalty this fall.

Prop. 62 ends the death penalty in California, making life imprisonment with no parole the strongest possible sentence.

This would be a smidge of poetic justice for students of California history, since the death penalty issue was among the most controversial in Jerry Brown’s first stint as governor. The issue led to the electoral defeat of three of Brown’s state’s Supreme Court justices, including Rose Bird.

Prop. 66 would preserve capital punishment and attempt to speed up judicial review of death penalty cases.

GENERAL GOVERNMENT Prop. 53 (CMA opposes) would change the law to require

voter approval for state revenue bonds of two billion dollars or more. The measure, backed by wealthy Central Valley agribusiness executive Dean Cortopassi, is seen as an effort to stifle Governor Brown’s plan to build two massive new tunnels to divert water from the Sacramento-San Joaquin River Delta to Southern California. The water project is one of the major legacy infrastructure projects being pushed by the governor.

Prop. 54 Backed by wealthy Republican donor Charles Munger Jr., this measure would change the way the state legislature does businesses. The proposal is an effort to end the lastminute writing of legislation, requiring any bill to be in print for seventy-two hours before it is approved by state lawmakers.

CAMPAIGN FINANCE Prop. 59 holds no legally binding authority. The measure

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is simply a way for Californians to voice their displeasure about Citizens United, the Supreme Court decision that paved the way for increased corporate participation in electoral politics. This measure urges the court to reconsider that decision, and change our nation’s campaign finance laws.

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MEDICAL COMMUNITY NEWS SPMF

Robert Osorio, MD, FACS

When booking a vacation, most of us would review several websites and compare the cost and convenience of a given airline and the cost and amenities of hotels. The cost of health care continues to rise, and a greater portion of payment responsibility is being shifted to patients through higher deductibles and co-pays. This is making patients, employers, commercial insurers, and the government increasingly focus on a similar value equation for health care: Value=Quality/Cost.

It is increasingly important for organizations such as Sutter Pacific Medical Foundation to prove our relative value by demonstrating high quality and low cost. The Centers for Medicare & Medicaid Services and commercial insurers already have instituted a portion of payment based on “pay for performance.”

As part of Sutter Health, we use a dashboard internally to identify opportunities for performance improvement and also to transparently demonstrate value for our patients and community. Quality metrics may differ for a hospital setting and those that relate to the ambulatory care setting. With regard to hospitals, reduction of avoidable readmission, reduction of Cesarean sections, prevention of catheter associated infection, sepsis management, and appropriate length of stay are some measures being monitored.

In the ambulatory setting, appropriate preventive care such as screening for breast and colon cancer, and childhood and adult immunizations are important, as well as chronic disease management of patients with cardiac disease and Diabetes Mellitus. Generic medication prescribing and avoidance of unnecessary antibiotics are areas of focus.

As physicians, we are aware of a wide range of costs for lab tests and various imaging studies such as magnetic resonance images (MRIs), computed tomography (CT) scans, and mammograms. There has often been no demonstrable quality benefit that justifies the cost difference. Increasingly, this will be a focus of attention.

32

SFVAMC

C. Diana Nicoll, MD, PhD, MPA

The San Francisco VA Medical Center (SFVAMC) serves as a tertiary referral center for the VA’s Sierra Pacific Network, which includes facilities in San Francisco, Sacramento, Fresno, Palo Alto, Las Vegas, Reno and Honolulu.

The VA divides the surgical services of its facilities into three tiers of operative complexity: complex, intermediate and advanced ambulatory. SFVAMC is a complex service organization that provides over fifty percent of the complex surgical case volume in the Network.

There are twelve surgical specialties: General, Cardiac, Vascular, Thoracic, Orthopedic, Oral/ Maxillofacial, Plastics, Neurological Surgery, Urology, Podiatry, Otolaryngology and Ophthalmology. All of the surgical staff are recruited jointly with the surgical departments at UCSF and all hold UCSF faculty appointments.

The SFVAMC serves Veterans up to the Oregon border and referrals come from the entire western region because of the availability of highly specialized services. For instance, San Francisco was the first VA to offer deep brain stimulation for movement disorders and was one of the first VAs to offer transcatheter-aortic valve replacement cardiac surgery.

In addition to the complexity, volume and variety of surgical care offered, the quality of surgical care is high. The VA Surgical Quality Improvement Program (VASQIP) has been foundational in the development and measurement of surgical quality metrics. SFVAMC uses clinically acquired data that is reviewed through the national VASQIP program to determine risk-adjusted morbidity and mortality outcomes. In addition, thirty day readmission, fourteen day admission after outpatient procedures, critical incidents, and efficiency measures are collected, analyzed and reviewed quarterly.

The SFVAMC was a low outlier in the VA nationally for mortality (the risk adjusted rate of death was lower than predicted) in 2015. This is notable given the complexity of the procedures performed and the high acuity of the patients.

Kaiser Permanente Maria Ansari, MD

Many health care professionals are familiar with the Healthcare Effectiveness Data and Information Set (HEDIS) quality measures defined by the National Committee for Quality Assurance (NCQA).

As the NCQA states, HEDIS “is a tool used by more than ninety percent of America’s health plans to measure performance on important dimensions of care and service.

Because so many plans collect HEDIS data, it’s possible to compare the performance of health plans on an ‘apples-to-apples’ basis.”

In the outpatient setting, the HEDIS quality measures represent a wide range of care delivery—from preventive cancer screening to heart attack and stroke prevention to pediatric immunizations to management of asthma to fracture prevention in at-risk older women, and many more. Kaiser Permanente, including the San Francisco Medical Center, routinely leads in performance on multiple HEDIS measures.

To use the example of preventive cancer screening, in the regions served by our health plan, Kaiser Permanente is number two for screening of cervical cancer, number three in screening for breast cancer and in the top tenth percentile for colorectal cancer screenings. At the San Francisco Medical Center, nearly ninety percent of women who are due for cervical and breast cancer screening are screened on-time. More than eighty percent of men and women are screened on-time for colorectal cancer screening. These high screening rates have resulted in early detection and improved outcomes.

In order to achieve high quality population health, we must continually innovate systems to support efficient, effective care delivery. We rely on a wide variety of levers—including evidence based medicine, our organization’s integrated model of care, technology, and physician extenders working at the top of their scope—to ensure our members enjoy excellent health throughout their life span.

SAN FRANCISCO MEDICINE OCTOBER 2016 WWW.SFMS.ORG

CLASSIFIED ADS Saint Francis Robert Harvey, MD, MBA, CPE

The overuse of opioids is reaching epidemic levels nationwide. According to the Centers for Disease Control, as many as one in four people receiving prescription opioids long term in a primary care setting struggles with addiction. Locally, Dignity Health Saint Francis Memorial Hospital’s Phoebe Cowles Center for Comprehensive Pain Treatment is responding with a holistic approach to preventing opioid dependency. While opioids can play a role in helping a patient manage pain, there are nonpharmacologic therapies that allow the patient to be less reliant on medication. Using a multidisciplinary approach, the Center focuses on the whole person—body and mind—not just the pain. With the addition of psychologist Israel Rosales, PhD, who specializes in the treatment of chronic pain along with posttraumatic stress disorder and depressive and anxiety disorders, the Center offers cognitivebehavioral therapy, biofeedback, and mindfulness training to help patients reduce their pain more effectively. Dr. Hoyman Minx Hong, medical director of the Phoebe Cowles Center for Comprehensive Pain Treatment, believes in conservative management techniques for treating pain and therefore incorporates exercise recommendations into his treatment plans. The Center also includes Dr. Hoyland Hong, physiatrist; Dr. Christopher Keys, anesthesiologist; and Dr. Susan Anzalone, neurologist, who identify the optimal and appropriate treatment plan to help patients manage their pain, increase function, and improve their quality of life. Many state-of-the-art pain management techniques are used in conjunction with the latest diagnostic technology, including nerve blocks, spinal cord stimulator implants, epidural steroid injections, rhizotomy, plasma disc decompression, intradiscal electro-thermal therapy (IDET), spinal column stimulators, and medication pumps. It is the hope that through patient and physician education, proper medication dosing and monitoring, and integrative treatment options, we can help turn the tide on the opioid epidemic while still helping patients return to an active lifestyle.

WWW.SFMS.ORG

St. Mary’s

Robert Weber, MD

Dignity Health St. Mary’s Medical Center welcomes Pamela Lindemoen as our new hospital president. Pamela comes to Dignity Health from Kaiser Permanente, where she served as vice president of hospital operations for the Northern California region. In this role, Pamela led transformational work for twenty-one medical centers, twenty-five thousand staff and physicians, and more than three million patients. During her tenure at Kaiser, Pamela worked hand-in-hand with hospital administrative teams and physician executives to successfully implement the organization’s strategic goals and leverage national best practices to achieve and exceed quality, service, and affordability targets.

Originally from Minneapolis, Pamela led several health care organizations in Minnesota before joining Kaiser. She served as chief operating officer and executive vice president of operations for Courage Center (now known as Courage Kenny Rehabilitation Institute, part of Alina Health.) Also, as chief operating officer of the two-hospital North Memorial Health Care system, she successfully deployed a growth strategy across all service lines, including heart and vascular, oncology, and women’s services.

Pamela has a proven track record of profitable growth and excellence in operations, patient care, clinical quality, and physician and employee engagement. She has experience in all areas of a health care organization, including finance, human resources, facilities, and marketing, and is a natural fit to lead St. Mary’s into the future. In other news, the Sister Diane Grassilli Center for Women’s Health at St. Mary’s Medical Center now offers a five-day treatment program for breast cancer. This high-dose rate (HDR) brachytherapy treatment involves a temporary catheter implanted into the lumpectomy cavity allowing radiation to be delivered from inside the breast twice a day for five days. This technique ensures the maximum radiation dose is given to cancerous tissues, while minimizing exposure to the surrounding healthy tissue.

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I am 100% committed in assisting the new owner with all the support necessary to ensure a smooth transition. Please contact me for more information or to schedule a visit. Gail Altschuler, MD, (415) 3096258 or drgail@marinweightloss.com.

Practice for Sale–Phlebology –Vein and Cosmetic Dermatology, Walnut Creek - Revenue

$1.3 million on 4 MD days/week. Five exam rooms in 2500 square feet in beautiful building close to hospital, freeway, and mass transit. Great potential for growth and expansion. Owner willing to stay PT and mentor new owner in full range of non-surgical treatment techniques. Wide referral base of physicians and satisfied patients. Third-party appraisal available.

Offered at only $290,000. Contact Medical Practices USA for more information. (800) 576-935. info@MedicalPracticesUSA.com. www.MedicalPracticesUSA.com.

Ophthalmology Practice for Sale - Central Peninsula, San Francisco Bay - Comprehensive

Ophthalmology practice with emphasis on cataract surgery and glaucoma, and an optical dispensary. 2015 revenue $1.2 million, up 6% over 2014, on 3.5 seller MD days/week. Staff includes two part-time Optometrists, a dispensing optician and loyal supporting staff. Two local surgery centers nearby. Independent appraisal available. Offered at only $428,000.

Contact Practice Consultants for more information. 800-576-6935. info@ PracticeConsultants.com. www.PracticeConsultants.com.

Spacious 2,216 to 4,432 sq ft medical office available -

full-time to part-time. Four blocks from new Van Ness CPMC. 30% below current market value. Call (415) 673-4500.

OCTOBER 2016 SAN FRANCISCO MEDICINE

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UPCOMING EVENTS

Welcome New Members!

ACTIVE REGULAR MEMBERS

CMA President’s Reception and Awards Gala | October 15, 2016 | 6:00 p.m. to 10:30 p.m. | Sacramento

Memorial Auditorium, Sacramento | Contact Sadye Reish at (916) 551-2030 or sreish@cmanet.org for more information

SFMS Member Open House | October 20, 2016 |

5:00 p.m. to 7:00 p.m. | SFMS Office, 2720 Taylor Street, Suite 450, San Francisco | Come celebrate SFMS’s move to lively Fisherman’s Wharf! Meet the SFMS staff, take a peek at our new office space, and mingle with colleagues while enjoying light snacks and drinks. For further event details or to register, visit www.sfms.org/events.

ZERO Prostate Cancer Run/Walk San Francisco

November 12, 2016 | 9:00 a.m. | Lake Merced, San Francisco | For more information, visit www.zeroprostatecancerrun. org/sanfrancisco.

SFMS Annual Career Fair | November 15, 2016 | 5:00 p.m. to 8:00 p.m. | UCSF Millberry Conference Center | Join SFMS for our seventh annual Career Fair! This complimentary recruitment event is open to all SFMS residents, fellows, and San Francisco-based physician members of all specialties.

Last year, there were twenty-two Bay Area medical groups who exhibited at this event, including UCSF Medical Center, Kaiser Permanente, Stanford Hospital, as well as other local hospitals and community clinics. For further event details or to register, visit www.sfms.org/events.

Save the Date: SFMS Annual Gala | Friday, January 27, 2017 | 6:30 p.m. to 9:00 p.m. | Asian Art Museum, San Francisco | Join SFMS for our Annual Gala! Come together with many of San Francisco’s most influential stakeholders in the medical community to celebrate SFMS’ one hundred fortynine years of physician advocacy and camaraderie. Man-Kit Leung, MD will be installed as the SFMS President. Guests will be treated to an exquisite reception with elegant hors d’oeuvres and libations. Ticket information will be available online soon at www.sfms.org and invitations will be mailed in early December. If you have any questions, please contact Posi Lyon at (415) 561-0850 x260.

UPCOMING CMA WEBINARS Is Your Practice at Risk for a HIPAA Security Breach? | November 2, 2016 | 12:15 p.m. to 1:15 p.m.

| Free for members - www.cmanet.org/events | Medical practices are at increasing risk for Health Insurance Portability and Accountability Act (HIPPA) security breaches such as ransomware, or theft of electronic patient information.

Increased dependency on electronic health records and exchange of data with other providers, or staff turnover can compromise security. In this webinar, CMA’s HIPAA advisor, David Ginsberg, will discuss common threats and breaches, how to safeguard and strengthen your systems, and what to do if you have a breach.

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Aaron Clementi Baker, MD | Vascular Surgery Lailene Shu Lain Chin, MD | Internal Medicine Jimmy Choi, MD | Emergency Medicine Rebecca Adelaide Clendenin, MD | Psychiatry Amsalu Dabela-Biketi, MD | Diagnostic Radiology Susan Patricia Ehrlich, MD | Internal Medicine Michael Jordan Feldstein, MD | Orthopaedic Surgery Elizabeth Marie Gebis, MD | Psychiatry Alexander Bennan Geng, MD | Radiation Oncology Gabriela Gryczynski, MD | Internal Medicine Mitika Vinod Kanabar, MD | Family Medicine Gayatri Khanna, MD | Internal Medicine Stephanie Suhee Kim, DO | Family Medicine David Gary Klein, MD | General Surgery Rosana Lastra Castellucci, MD | Pediatrics Erin Ebbel Niemasik, MD | Obstetrics and Gynecology Yash Shravah, MD | Internal Medicine Loren Clifford Stolle, MD | Internal Medicine Brian Bernard Yurgionas, MD | Neurology HOUSE OFFICERS

Leny Abraham, MD | Internal Medicine Fouad Iba Al Adel, MD | Radiology Mansi Amin, MD | Pediatrics Mariam Amin, MD | Dermatology Davin Ashraf, MD | Ophthalmology Michelle Barton, MD | Psychiatry Daniah Beleford, MD, PhD | Medical Genetics Aislinn Bird, MD | Psychiatry Seth Blumberg, MD | Internal Medicine Jeffrey Allen Bonham, MD | Radiology Katie Bruksch, MD | Radiology Ekama Onofiok Carlson, MD | Dermatology Timothy Warren Chang, MD | Dermatology Roger C Cheng, MD | Neurology Paul Tinpo Cheung, MD | Internal Medicine Ramya Chitters, MD | Internal Medicine Henry Hanling Chow, MD | Radiology Rodrigo Cordero, MD | Internal Medicine Amanda Kristin Crawford, MD | Internal Medicine Naznin Daginawala, MD | Radiology Rachel Donaldson, MD | Internal Medicine Andrew Michael Figoni, MD | Orthopaedic Surgery Andrew Woods Francis, MD | Ophthalmology Ariel Franks, MD | Family Medicine Jennifer Funk, MD | Internal Medicine Bassem Wassim Ghali, MD | Hospitalist Lucy Han, MD | Hematology (Pathology) Jessica Stewart Hightower, MD | Radiology Lawrence House, MD | Anesthesiology Michael Adam Incze, MD | Internal Medicine Erin Alexandria Jones, MD | Adolescent Medicine (Pediatrics) Michael Jung, MD | Anesthesiology Mina Khorashadi, MD | Anesthesiology Donald Kim, DO | Radiology Katie Kinzer, MD | Radiology R Bryan Scott Klassen, MD | Internal Medicine Shona Lee, MD | Anesthesiology Nicholas Steven Leslein, MD | Radiology Felix Litvak, MD | Internal Medicine Shane Lloyd, MD | Radiation Oncology Paul Marano, MD | Internal Medicine

Debbie Martins, MD | Plastic Surgery Diana M Mina, MD | Nephrology Farshid Moussavi-Harami, MD | Pediatrics David Nery, MD | Internal Medicine Michael Orloff, MD | General Surgery Monica Parks, MD | Internal Medicine Purvi Jairam Parwani, MD | Cardiovascular Surgery Lauren Patrick, MD | Neurology Kesav Raghavan, MD | Radiology Jay Rajan, MD | Anesthesiology Vivek Ashok Rudrapatna, MD, PhD | Gastroenterology Eliah Shamir, MD | Hematology (Pathology) Sujay Kiran Sheth, MD | Radiology Molly Siegel, MD | Obstetrics and Gynecology Sunil Singh, MD | Interventional Cardiology Allanceson Smith, MD | Child and Adolescent Psychiatry Bryan Sofer, MD | Dermatology Jae Ho Sohn, MD | Radiology William Soulsby, MD | Pediatrics Misa Stroker, MD | Internal Medicine Christiana Tai, MD | Pediatrics Tianyi Tang, MD | Internal Medicine Jeremy Tanner, MD | Neurology E. Nicole Teal, MD | Obstetrics and Gynecology Justin Teng, MD | Radiology Clare Timbie, MD | Pediatrics Jesus Torres, MD | Emergency Medicine Ashley Tsang, MD | Family Medicine Lulu Tsao, MD | Internal Medicine Van Vu, MD | Family Medicine Jeremy Takashi Warshauer, MD | Endocrinology, Diabetes and Metabolism Bethany Ann Woomer, MD | Pediatrics Frances Wu, MD | Ophthalmology Susan Wu, MD | Radiation Oncology Clay Wu, DO | Internal Medicine Kendra Wulczyn, MD | Internal Medicine Edward Xu, MD | Internal Medicine Jina Maria Youn, MD | Neurology Albert Young, DO | Internal Medicine Joyce T Yuan, MD | Dermatology

SAN FRANCISCO MEDICINE OCTOBER 2016 WWW.SFMS.ORG

CMA/San Francisco Medical Society sponsored Health Insurance Program

Is your health insurance open enrollment soon?

Are your rates going up?

Want to shop?

Whether you are an individual policyholder or a member of a group health plan, it’s time to think about your health coverage for 2017. The open enrollment period for individual and family plans starts on November 1, 2016. Many practices have open enrollment periods for small groups on December 1 or January 1.

Did you know that you can get the right insurance though the CMA/San Francisco Medical Society sponsored Health Insurance program with Mercer? If you are covering yourself, or if you’re responsible for providing coverage for your family or employees, working with Mercer online or in person with a licensed agent, can get you the benefits you need, utilizing the physicians you want to see, at a price that fits your budget.

Working with the largest insurers in California, Mercer can help you determine what’s best for you.

Call today at 800-842-3761 or visit www.CountyCMAMemberInsurance.com.

Sponsored by:

Administered by:

Scan for more info

Mercer Health & Benefits Insurance Services LLC • CA Insurance License #0G39709

75547 (10/16) • Copyright 2016 Mercer LLC. All rights reserved. 777 South Figueroa Street, Los Angeles, CA 90017 800-842-3761 • www.CountyCMAMemberInsurance.com • CMACounty.Insurance.service@mercer.com

San Francisco Medical Society 2720 Taylor St, Ste 450 San Francisco, CA 94133

Find the best specialist for your patient with one call.

We make it easy to transfer and refer your patients to specialists at CPMC, part of the Sutter Health network. One call allows you to match your patients’ needs with the right specialist, notify admissions, get authorizations and more.

And we’re available 24/7, so you never have to wait to find the best possible care for your patients.

Referrals and Transfers 24/7 888-637-2762 cpmc.org