October 2008

VOL.81 NO.8 October 2008 $5.00

SAN FRANCISCO MEDICINE JOURNAL OF THE SAN FRANCISCO MEDICAL SOCIETY

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CONTENTS SAN FRANCISCO MEDICINE October 2008 Volume 81, Number 8 Politics and Medicine: The Election Issue FEATURE ARTICLES

MONTHLY COLUMNS

Information: Where Each Presidential Candidate Stands on Health Care

4 On Your Behalf

10 Barack Obama on Health Care

5 Upcoming SFMS Events

14 John McCain on Health Care

6 Executive Memo Mary Lou Licwinko, JD, MHSA

Debate: Tobacco Funds for UC Research 16 No More Tobacco Funds for the World’s Greatest University Steven Fugaro, MD, and Steve Heilig, MPH

7 President’s Message Steven Fugaro, MD, and Steve Heilig, MPH

17 A Note about Academic Freedom and Research Funding Michael T. Brown

9 Editorial Mike Denney, MD, PhD

Debate: Healthy San Francisco

30 Classified Ads

18 Time to Stop Opposition and Pitch In Steve Heilig, MPH, and Philip R. Lee, MD

32 Hospital News

19 Healthy San Francisco Fails the Affordability Test Kevin Westlye Debate: The Benitez Case 20 One Physician Believes Doctors Have the Right to Choose Who To Treat Steve Askin, MD 21 The Gay Lesbian Medical Association Shares Its Views Joel Ginsburg, JD, MBA SFMS 2009 Election Section 22 2008 Slate of Candidates 23 Candidate Biographies and Policy Statements

Editorial and Advertising Offices • 1003 A O’Reilly, Ave, San Francisco, CA 94129 • Phone: 415.561.0850 ext.261 • Email: adenz@sfms.org Web: www.sfms.org • Subscriptions: $45 per year; $5 per issue Advertising information is available on our website, www.sfms.org, or can be sent upon request.

www.sfms.org

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october 2008 San Francisco Medicine The width is 3.5 by 4” high CALL Kae with any questions or concerns 415-567-5888

ON YOUR BEHALF

October 2008 Volume 81, Number 8

A sampling of activities and actions of interest to SFMS members Editor Mike Denney Managing Editor Amanda Denz Copy Editor Mary VanClay

Notes from the Membership Department

Cover Artist Amanda Denz Editorial Board Chairman Mike Denney Obituarist Nancy Thomson Stephen Askin

Shieva Khayam-Bashi

Toni Brayer

Arthur Lyons

Linda Hawes Clever

Terri Pickering

Gordon Fung

Ricki Pollycove

Erica Goode

Kathleen Unger

Gretchen Gooding

Stephen Walsh

SFMS Officers President Steven H. Fugaro President-Elect Charles J. Wibbelsman Secretary Gary L. Chan Treasurer Michael Rokeach Editor Mike Denney Immediate Past President Stephen E. Follansbee SFMS Executive Staff Executive Director Mary Lou Licwinko Director of Public Health & Education Steve Heilig Director of Administration Posi Lyon Director of Membership Therese Porter Director of Communications Amanda Denz Board of Directors Term: Jan 2008-Dec 2010

Jordan Shlain

George A. Fouras

Lily M. Tan

Keith Loring

Shannon Udovic-

William Miller

Constant

Jeffrey Newman

Term:

Thomas J. Peitz

Jan 2006-Dec 2008

Daniel M. Raybin

Mei-Ling E. Fong

Michael H. Siu

Thomas H. Lee

Term:

Carolyn D. Mar

Jan 2007-Dec 2009

Rodman S. Rogers

Brian T. Andrews

John B. Sikorski

Lucy S. Crain

Peter W. Sullivan

Jane M. Hightower

John I. Umekubo

Donald C. Kitt CMA Trustee Robert J. Margolin AMA Representatives H. Hugh Vincent, Delegate Robert J. Margolin, Alternate Delegate

Have you moved or changed your contact information? In August, SFMS sent out a database update mailing to the entire membership. This annual mailing is an important means of ensuring that you receive all communications from your Medical Society, and it also provides SFMS with information to keep its database as up to date as possible. If you haven’t returned yours, take a moment to do so now.

San Francisco Medical Society members are now able to pay their dues online.

If you haven’t tried this new and convenient way to renew your membership, visit www. sfms.org to give it a try. If you have any questions or problems, contact Therese Porter in the Membership Department at (415) 561-0850 extension 268 or tporter@ sfms.org.

The San Francisco Medical Society’s Nutcracker Night—a popular, family-friendly performance and reception event—has been scheduled for Friday, December 26. Details on seating and pricing coming soon!

The first annual SFMS/UCSF student mixer on September 25 was an enormous success. The first- and second-year students appreciated the opportunity to speak with practicing physicians, and a good time was had by all. The students intend for this to be an annual event, so there will be future chances to participate in this exciting opportunity to connect with the future of the profession.

The African American Health Disparities Project is asking the San Francisco Medical Society to help provide support to Dr. Nadine Burke. Dr. Burke runs the Bayview Child Health Center and is working on some Saturday sessions as part of the orientation process for foster families. For the next training she needs someone who can speak in Spanish for about two-and-a-half hours on childhood illnesses. There may be other opportunities in the future. If you are

San Francisco Medicine october 2008

interested, contact Michael Huff, director of the African American Health Disparities Project, at mhuff@aahdp.org.

Physicians Urged to Carefully Review Blue Cross Contract Amendment Physicians contracted with Blue Cross of California were recently notified of the insurer’s intent to amend its Prudent Buyer contract to include Anthem’s Select PPO product, effective January 1, 2009. CMA reminds physicians that before signing a health plan contract or contract amendment, it is important to know what value it will bring to your practice. Physicians do not have to accept bad contracts or contracts that are not mutually beneficial.

The addendum in question requires contracted physicians to always refer Anthem Select PPO members to other participating Select PPO providers, unless they have obtained authorization to refer out of network. Physicians should be aware that the underlying Prudent Buyer contract authorizes Blue Cross to unilaterally lower the physicians’ fee schedule as a penalty for referring to out-of-network providers. For this reason, it is important for physicians to determine if colleagues you frequently refer to, and those who refer to you, participate in the Select PPO network.

The addendum also requires physicians, in the event they refer patients to a nonparticipating provider, to ensure that the referred-to physician abides by the terms of the agreement.

If you do not want to participate in the Select PPO network, you must notify Anthem Blue Cross in writing no later than December 1. Opt-out notices should be sent via certified mail with return receipt to Anthem Blue Cross, Attn: Select PPO Contract Processing, 2121 North California Blvd., 7th Floor, Walnut Creek, CA 94596.

See www.cmanet.org for more information, including a copy of the proposed addendum and CMA’s analysis of the Blue www.sfms.org

Cross Prudent Buyer contract. You may also contact Aileen Wetzel at (916) 551-2037 or awetzel@cmanet.org to learn more.

SFMS Member Jane Hightower Publishes New Book on Mercury Jane M. Hightower, MD, longtime SFMS member and internal medicine physician in San Francisco, published a landmark study that brought the issue of mercury in seafood to national attention in 2002. She now follows that up with her latest book, Diagnosis: Mercury. In 2000 Dr. Hightower began to notice a pattern of similar symptoms in several of her patients who shared only an appetite for certain types of fish. The quest to discover the source of these symptoms led her to mercury, a poison that has been plaguing victims for centuries and is now showing up in seafood. This discovery only led her to further questions.

Her quest to get to the bottom of the issue is documented in her new book. It is now available online and in bookstores.

www.sfms.org

Job Opening

SFMS Seminar

There is currently an opening for a Cultural and Linguistic Competency Program Administrator at the Institute for Medical Quality. Position Summary: Responsible for the administration of the Cultural and Linguistic Competency Program, which is funded primarily by the California Endowment. The position is responsible for refining and expanding the CLC Program, creating sustainable technical assistance for continuing medical education, providing training opportunities to the health care communities in California, and promoting a national model of excellence for the implementation of cultural and linguistic competency into continuing education.

For more information about this job and the application process, please contact Jill Silverman, MSPH, President and CEO of the Institute for Medical Quality, at (415) 882-5169.

November 4, 2008 “MBA� for Physicians and Office Managers 9:00 a.m. to 5:00 p.m. (8:40 a.m. registration/continental breakfast) This one-day seminar is designed to provide critical business skills in the areas of finance, operations, and personnel management. $250 for SFMS/CMA members and their staff ($225 each for additional attendees from same office); $325 for nonmembers.

Advance registration is required. Please contact Posi Lyon at plyon@sfms.org or (415) 561-0850 extension 260.

Local Event October 23, 2008 Hope for the Uninsured: Operation Access 15-Year Anniversary and Volunteer Celebration San Francisco Presidio, 6:00 p.m. to 8:00 p.m. An event for medical professionals who volunteer with Operation Access (OA), a San Francisco-based nonprofit that provides donated outpatient surgical and specialty care to uninsured, low-income Bay Area residents.

Drinks, dinner, and a program with keynote speakers and OA surgeon cofounders Drs. Doug Grey and William Schecter.

Invitation only.

For more information, please contact communications@operationaccess.org.

october 2008 San Francisco Medicine

SFMS Election 2009 Executive Memo Mary Lou Licwinko, JD, MHSA

SFMS Supports Proposition A

T

he first proposition on the San Francisco ballot this November is a general obligation bond measure to provide approximately $888 million to rebuild San Francisco General Hospital and Trauma Center (SFGH). Passage of Proposition A will provide the funds to construct a new main building for SFGH that will meet modern seismic standards and keep our community’s only Level 1 Trauma Center open.

State law requires hospitals to meet specific seismic standards in order to withstand a major earthquake. The San Francisco Department of Public Health commissioned a study in 2000 that indicated that the main building at SFGH has significant seismic deficiencies.

Because of the number of deficiencies, the City concluded that the building should be rebuilt as opposed to trying to seismically

San Francisco Medicine october 2008

upgrade it. If the facility does not meet seismic standards, it faces closure by 2013 and San Francisco will lose its only public hospital as well as its trauma center.

The list of the ways in which SFGH serves the community is impressive. It provides care for the majority of residents who are on public insurance and provides more charity care than any other hospital in San Francisco. It is the only Level 1 Trauma center in the region. It has been on the cutting edge of HIV/AIDS care since the early 1980s. It is the hub of San Francisco’s recent universal health care initiative. It is also the only hospital in the City equipped to handle large numbers of patients following an earthquake or other disaster.

Unlike the Laguna Honda Hospital bond measure, which turned out to be too little for the job proposed, the bond measure for SFGH has been thoroughly researched and vetted. Also, unlike Laguna Honda, the time between the passage of the measure and the actual building is only about two years, in order to keep construction costs in line with current estimates.

Proposition A has wide support from Mayor Newsom, all eleven members of the Board of Supervisors, Democrats, Republicans, labor, and the Chamber of Commerce. However, in order for it to pass, Proposition A must get a “yes” vote from two-thirds of those who vote on the measure. This is significant number to reach. The San Francisco Medical Society is supporting Proposition A to keep SFGH open, and we urge you to do the same.

www.sfms.org

president’s Message Steven Fugaro, MD, and Steve Heilig, MPH

Fighting the Good Fight

T

he SFMS has a long history of taking policy positions on matters of health import, dating back to our Society’s early years in the 1800s when it led an effort to help get narcotics addicts out of opium dens and into treatment (such as it was at that time). So it was with interest that your elected leadership considered a somewhat similar proposal this year—see the note on California Proposition 5 below. In general, we are selective about the proposals we “take sides” on, and we rely as much as possible on evidence-based arguments, consulting with medical specialty organizations where possible and relevant.

Also on the local level, we have been actively involved with the crucial need to rebuild San Francisco General Hospital (see below) and with recent antitobacco efforts. Tobacco restrictions constitute a topic on which the SFMS also has a long record of advocacy, including taking a leading role in the proactive ban on smoking in restaurants in the 1990s, ahead of the rest of the state.

Currently, two antitobacco policies are in the works. San Francisco’s ban on the sale of tobacco products in pharmacies was passed by the Board of Supervisors after much testimony, including that of SFMS representatives.

However, the Walgreen’s chain has filed suit to block this policy, alleging that it is unfair to their pharmacy operations. While the legal technicalities are no doubt important, we feel the value of the policy,

­ hich removes America’s most lethal product from stores ostensibly w devoted to healthy products, is a good one. The new policy has received much positive attention around the nation and may serve as a model for other areas. We hope it is upheld and are looking into ways to further support that goal. Boston, too, is currently considering a similar ordinance regarding the sale of cigarettes. The city’s public health commission gave preliminary approval last week to regulations banning tobacco sales on college campuses and at drugstores.

The issue of exposure to secondhand tobacco smoke, which research continues to show is more dangerous than feared even a few years ago, continues to call for more restrictive policies on where smokers can light up. A package of such restrictions has been hammered out by the Board of Supervisors and is being revised to reflect some of the more technical enforcement issues at this time. On this front, unfortunately, San Francisco has fallen somewhat behind some other municipalities, and we hope our elected officials will see the wisdom of keeping us in the forefront of antitobacco policy. Again, SFMS representatives have testified and written to local officials on these policies and will continue to do so as indicated.

Thus we hope San Francisco’s physicians will agree that these are worthy efforts and will feel represented by the San Francisco Medical Society, not only on important issues of medical practice but on the public health front as well.

SFMS POSITIONS ON VOTER INITIATIVES San Francisco Initiative Proposition A: SAN FRANCISCO GENERAL HOSPITAL REBUILD The SFMS strongly urges a “yes” vote for Proposition A, which will provide funding for the necessary rebuild of San Francisco General Hospital.

While undeniably expensive, San Francisco General is also utterly essential to San Francisco’s health and is our only center for trauma care. Furthermore, it provides stability for our public health and hospital networks, as well as serving as a center of excellence for medical training and research, and more.

See the SFMS-authored “pro” argument in your voter’s information packet for more details.

California State Initiatives Proposition 4: WAITING PERIOD AND PARENTAL NOTIFICATION BEFORE TERMINATION OF MINOR’S PREGNANCY The SFMS strongly urges a “no” vote on Proposition 4. This proposal www.sfms.org

has already been defeated repeatedly by California voters and is opposed by all relevant medical groups as a counterproductive, onerous, and dangerous intrusion into medical privacy and the personal lives of young women at a difficult time in their lives.

Proposition 5: NONVIOLENT DRUG OFFENSES. SENTENCING, PAROLE, AND REHABILITATION The SFMS urges a “yes” vote on Proposition 5 (also known as NORA).

This proposal allocates more funding for nonviolent drug arrestees, in line with previous state policy that diverts drug abusers from imprisonment to more effective and less costly treatment options. The relevant medical specialty society, the California Society of Addiction Medicine, has studied such policies and strongly urges approval of this initiative.

october 2008 San Francisco Medicine

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SFMS Election 2009 Editorial Mike Denney, MD, PhD

Politics as Usual

I

n 1887, Ambrose Bierce, bon vivant, Civil War veteran, curmudgeon, writer of wit and cynicism, and known as “Wickedest Man in San Francisco,” was hired by William Randolph Hearst to be an editor and columnist for the San Francisco Examiner newspaper. In addition to his short stories about the Civil War, his 1891 novel Soldiers and Civilians, and his columns with contemptuous verbal assaults against politics, Bierce’s writings include many perverse, laconic, and acerbic definitions of words that were assembled into a book, The Devil’s Dictionary.

Bierce: Politics—A strife of interests masquerading as a contest of principles. The conduct of public affairs for private interests.

In this issue of San Francisco Medicine, in addition to pages filled with information about candidates currently seeking political office within the San Francisco Medical Society, we offer some opinions about a few of the current political issues that affect the practice of medicine. In keeping with our policy of balanced and fair reporting and to enable scrutiny of the accuracy of the statements, we assembled contrasting articles on opposite pages, offering our readers the opportunity to experience opposing views, each written carefully in reasonable arguments, using only pure logic.

Bierce: Logic—The art of thinking and reasoning in strict accordance with the limitations and incapacities of the human misunderstanding.

Of course, there are many kinds of logic. Informal logic is represented by the Socratic Method, as formalized by Plato, and entails a dialectic conversation in which an answer to an irrelevant question is always followed by another irrelevant question until the confused speaker is forced to contradict himself, thus reducing his argument to absurdity.

Bierce: Absurdity—A statement of belief manifestly inconsistent with one’s own opinion.

Formal logic, on the other hand, was practiced by Aristotle in the form of syllogism, a method in which two propositions that share a common phrase form a premise, which is followed by a conclusion based upon a proposition that involves the two unwww.sfms.org

related phrases in the premise—all in a calculated effort to reach clear understanding.

Bierce: Understanding—A cerebral secretion that enables one having it to know a house from a horse by the roof on the house.

Throughout history, philosophers have introduced additional forms of reasoning and argument, including propositional logic, modal logic, predicate logic, multivalued logic, paraconsistent logic, and intuitionistic logic. All of these constructs and mental manipulations of facts and opinions seek to offer, beyond doubt, PROOF. Bierce: Proof—Evidence having a shade more of plausibility than unlikelihood.

A recent philosophy of human reasoning is called mathematical logic, a development of late nineteenth-century Positivism, in which it can be demonstrated conclusively that mathematics and logic are, indeed, one and the same thought process, and they can be similarly expressed by complicated formulas written with chalk upon blackboards. This is all very clear, except that in the early twentieth century Bertrand Russell and others discovered that mathematics inherently contains a paradox that always spirals recursively to infinity. This was later formalized by mathematician Kurt Godel in his Incompleteness Theorem, which states that mathematics proves that mathematics will always be incomplete and paradoxical. Thus, using mathematical logic, it can be inferred that logic proves that logic will always be incomplete and paradoxical. Thus, we have the latest concept, fuzzy logic.

Syllogistically, then, one can say that political arguments prove that political arguments will always be incomplete, paradoxical, and fuzzy. Therefore, political arguments must always end in some kind of compromise.

Bierce: Compromise—Such an adjustment of conflicting interests as gives each adversary the satisfaction of thinking he has got what he ought not to have, and is deprived of nothing except what was justly his due.

october 2008 San Francisco Medicine

Politics and Medicine

Barack Obama on Health Care Where Does the Democratic Candidate Stand?

Reprinted from www.barackobama.com Editor’s Note: In light of the upcoming presidential election, we at San Francisco Medicine thought our readers would benefit from learning exactly where each candidate stands on health care. The following article is exactly what appears on Barack Obama’s website under “Health Care.”

The Problem Millions of Americans are uninsured or underinsured because of rising medical costs: Forty-six million Americans—including over eight million children—lack health insurance, with no signs of this trend slowing down.

Health care costs are skyrocketing: Health insurance premiums have risen four times faster than wages over the past six years.

Too little is spent on prevention and public health: The nation faces epidemics of obesity and chronic diseases as well as new threats of pandemic flu and bioterrorism. Yet despite all of this, less than four cents of every health care dollar are spent on prevention and public health.

Barack Obama’s Plan Quality, Affordable, and Portable Coverage for All Obama will make available a new national health plan to all Americans, including the self-employed and small businesses, to buy affordable health coverage that is similar to the plan available to members of Congress. The Obama plan will have the following features: Guaranteed eligibility. No American will be turned away from any insurance plan because of illness or pre-existing conditions.

Comprehensive benefits. The benefit package will be similar to that offered through Federal Employees Health Benefits Program (FEHBP), the plan members of Congress have. The plan will cover all essential medical services, including preventive, maternity, and mental health care.

Affordable premiums, co-pays and deductibles.

Subsidies. Individuals and families who do not qualify for Medicaid or SCHIP but still need financial assistance will receive an income-related federal subsidy to buy into the new public plan or purchase a private health care plan.

Simplified paperwork and reined-in health costs.

Easy enrollment. The new public plan will be simple to enroll in and provide ready access to coverage.

Portability and choice. Participants in the new public plan and the National Health Insurance Exchange (see below) will be able to move from job to job without changing or jeopardizing their health care coverage.

Quality and efficiency. Participating insurance companies in the new public program will be required to report data to ensure that standards for quality, health information technology, and administration are being met.

• National Health Insurance Exchange The Obama plan will create a National Health Insurance Exchange to help individuals who wish to purchase a private insurance plan. The Exchange will act as a watchdog group and help reform the private insurance market by creating rules and standards for participating insurance plans to ensure fairness and to make individual

10 San Francisco Medicine october 2008

coverage more affordable and accessible.

Insurers would have to issue every applicant a policy and charge fair and stable premiums that will not depend upon health status.

The Exchange will require that all the plans offered are at least as generous as the new public plan and have the same standards for quality and efficiency. The Exchange would evaluate plans and make the differences among the plans, including cost of services, public.

• Employer Contribution Employers that do not offer or make a meaningful contribution to the cost of quality health coverage for their employees will be required to contribute a percentage of payroll toward the costs of the national plan. Small businesses will be exempt from this requirement and will receive a new Small Business Health Tax Credit that helps reduce health care costs for small businesses.

• Support for Small Businesses Barack Obama will create a Small Business Health Tax Credit to provide small businesses with a refundable tax credit of up to 50 percent on premiums paid by small businesses on behalf of their employees. This new credit will provide a strong incentive to small businesses to offer high-quality health care to their workers and help improve the competitiveness of America’s small businesses.

• Mandatory Coverage of Children Obama will require that all children have health care coverage. Obama will expand the number of options for young adults to get coverage, including allowing young people up to age twenty-five to continue www.sfms.org

coverage through their parents’ plans.

• Expansion of Medicaid and SCHIP Obama will expand eligibility for the Medicaid and SCHIP programs and ensure that these programs continue to serve their critical safety-net function.

• Flexibility for State Plans Due to federal inaction, some states have taken the lead in health care reform.

The Obama plan builds on these efforts and does not replace what states are doing.

States can continue to experiment, provided they meet the minimum standards of the national plan.

Lower Costs by Modernizing the U.S. Health Care System • Reducing Costs of Catastrophic Illnesses for Employers and Their Employees Catastrophic health expenditures account for a high percentage of medical expenses for private insurers. The Obama plan would reimburse employer health plans for a portion of the catastrophic costs they incur above a threshold if they guarantee such savings are used to reduce the cost of workers’ premiums.

• Helping Patients Support disease management programs. Seventy-five percent of total health care dollars are spent on patients with one or more chronic conditions, such as diabetes, heart disease, and high blood pressure.

Obama will require that providers that participate in the new public plan, Medicare, or the Federal Employee Health Benefits Program (FEHBP) utilize proven disease management programs. This will improve quality of care, give doctors better information, and lower costs.

Coordinate and integrate care. Over 133 million Americans have at least one chronic disease, and these chronic conditions cost a staggering $1.7 trillion yearly.

Obama will support implementation of programs and encourage team care that will improve coordination and integration of care of those with chronic conditions.

Require full transparency about quality and costs. Obama will require hospitals www.sfms.org

and providers to collect and publicly report measures of health care costs and quality, including data on preventable medical errors, nurse staffing ratios, hospital-acquired infections, and disparities in care. Health plans will also be required to disclose the percentage of premiums that go to patient care as opposed to administrative costs.

• Ensuring Providers Deliver Quality Care: Promote patient safety. Obama will require providers to report preventable medical errors and support hospital and physician practice improvement to prevent future occurrences.

Align incentives for excellence.

Both public and private insurers tend to pay providers based on the volume of services provided, rather than the quality or effectiveness of care. Providers who see patients enrolled in the new public plan, the National Health Insurance Exchange, Medicare, and FEHBP will be rewarded for achieving performance thresholds on outcome measures.

Comparative effectiveness research.

Obama will establish an independent institute to guide reviews and research on comparative effectiveness, so that Americans and their doctors will have the accurate and objective information they need to make the best decisions for their health and well-being.

Tackle disparities in health care.

Obama will tackle the root causes of health disparities by addressing differences in access to health coverage and promoting prevention and public health, both of which play a major role in addressing disparities. He will also challenge the medical system to eliminate inequities in health care through quality measurement and reporting, implementation of effective interventions such as patient navigation programs, and diversification of the health workforce.

Insurance reform. Obama will strengthen antitrust laws to prevent insurers from overcharging physicians for their malpractice insurance and will promote new models for addressing errors that improve patient safety, strengthen the doctorpatient relationship, and reduce the need for malpractice suits.

• Lowering Costs Through Investment in Electronic Health Information Technology Systems Most medical records are still stored on paper, which makes it hard to coordinate care, measure quality, or reduce medical errors and which costs twice as much as electronic claims. Obama will invest $10 billion a year over the next five years to move the U.S. health care system to broad adoption of standards-based electronic health information systems, including electronic health records, and will phase in requirements for full implementation of health IT. Obama will ensure that patients’ privacy is protected.

• Lowering Costs by Increasing Competition in the Insurance and Drug Markets: The insurance business today is dominated by a small group of large companies that has been gobbling up their rivals. There have been over 400 health care mergers in the last ten years, and just two companies dominate a full third of the national market.

These changes were supposed to make the industry more efficient, but instead premiums have skyrocketed by over 87 percent.

Barack Obama will prevent companies from abusing their monopoly power through unjustified price increases. His plan will force insurers to pay out a reasonable share of their premiums for patient care instead of keeping exorbitant amounts for profits and administration. His new National Health Exchange will help increase competition by insurers.

Lower prescription drug costs. The second-fastest-growing type of health expense is prescription drugs. Pharmaceutical companies are selling the exact same drugs in Europe and Canada but charging Americans more than double the price. Obama will allow Americans to buy their medicines from other developed countries if the drugs are safe and prices are lower outside the U.S. Obama will also repeal the ban that prevents the government from negotiating with drug companies, which could result in savings as high as $30 billion. Finally, Obama will work to increase the use of generic drugs in Medicare, Medicaid, and FEHBP and prohibit big-name drug companies from keeping generics out of markets.

october 2008 San Francisco Medicine 11

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Fight for New Initiatives • Advance the Biomedical Research Field As a result of biomedical research, the prevention and early detection and treatment of diseases such as cancer and heart disease are better today than any other time in history. Barack Obama has consistently supported funding for the National Institutes of Health and the National Science Foundation. Obama strongly supports investments in biomedical research, as well as medical education and training in health-related fields, because it provides the foundation for new therapies and diagnostics. Obama has been a champion of research in cancer, mental health, health disparities, global health, women and children’s health, and veterans’ health. As president, Obama will strengthen funding for biomedical research and better improve the efficiency of that research by improving coordination both within government and across government/ private/nonprofit partnerships. An Obama administration will ensure that we translate scientific progress into improved approaches to disease prevention, early detection, and therapy that is available for all Americans.

• Fight AIDS Worldwide There are 33 million people across the planet infected with HIV/AIDS. As president, Obama will continue to be a global leader in the fight against AIDS. Obama believes in working across party lines to combat this epidemic and recently joined Senator Sam Brownback (R-KS) at a large California evangelical church to promote greater investment in the global AIDS battle.

• Support Americans with Disabilities As a former civil rights lawyer, Barack Obama knows firsthand the importance of strong protections for minority communities in our society. Obama is committed to strengthening and better enforcing the Americans with Disabilities Act (ADA) so that future generations of Americans with disabilities have equal rights and opportunities. Obama believes we must restore the original legislative intent of the ADA in the wake of court decisions that have rewww.sfms.org

stricted the interpretation of this landmark legislation.

Barack Obama is also committed to ensuring that disabled Americans receive Medicaid and Medicare benefits in a lowcost, effective, and timely manner. Recognizing that many individuals with disabilities rely on Medicare, Obama worked with Senator Ken Salazar (D-CO) to urge the Department of Health and Human Services to provide clear and reliable information on the Medicare prescription drug benefit and to ensure that the Medicare recipients were protected from fraudulent claims by marketers and drug plan agents.

• Improve Mental Health Care Mental illness affects approximately one in five American families. The National Alliance on Mental Illness estimates that untreated mental illnesses cost the U.S. more than $100 billion per year. As president, Obama will support mental health parity so that coverage for serious mental illnesses are provided on the same terms and conditions as other illnesses and diseases.

• Protect Our Children from Lead Poisoning More than 430,000 American children have dangerously high levels of lead in their blood. Lead can cause irreversible brain damage, learning disabilities, behavioral problems, and, at very high levels, seizures, coma, and death. As president, Obama will protect children from lead poisoning by requiring that child-care facilities be lead-safe within five years.

• Reduce Risks of Mercury Pollution More than five million women of childbearing age have high levels of toxic mercury in their blood, and approximately 630,000 newborns are born at risk every year. Barack Obama has a plan to significantly reduce the amount of mercury that is deposited in oceans, lakes, and rivers, which in turn would reduce the amount of mercury in fish.

thinking, feeling, language, and the ability to relate to others. As diagnostic criteria broaden and awareness increases, more cases of autism have been recognized across the country. Barack Obama believes that we can do more to help autistic Americans and their families understand and live with autism. He has been a strong supporter of more than $1 billion in federal funding for autism research on the root causes and treatments, and he believes that we should increase funding for the Individuals with Disabilities Education Act to truly ensure that no child is left behind.

More than anything, autism remains a profound mystery with a broad spectrum of effects on autistic individuals, their families, loved ones, the community, and education and health care systems. Obama believes that the government and our communities should work together to provide a helping hand to autistic individuals and their families.

Barack Obama’s Record • Health Insurance In 2003, Barack Obama sponsored and passed legislation that expanded health care coverage to 70,000 kids and 84,000 adults.

In the U.S. Senate, Obama cosponsored the Healthy Kids Act of 2007 and the State Children’s Health Insurance Program (SCHIP) Reauthorization Act of 2007 to ensure that more American children have affordable health care coverage.

• Women's Health Obama worked to pass a number of laws in Illinois and Washington to improve the health of women. His accomplishments include creating a task force on cervical cancer, providing greater access to breast and cervical cancer screenings, and helping improve prenatal and premature birth services.

• Support Americans with Autism More than one million Americans have autism, a complex neurobiological condition that has a range of impacts on october 2008 San Francisco Medicine 13

Politics and Medicine

John McCain on Health Care Where Does the Republican Candidate Stand?

Reprinted from www.johnmccain.com Editor’s Note: In light of the upcoming presidential election, we at San Francisco Medicine thought our readers would benefit from learning exactly where each candidate stands on health care. The following article is exactly what appears on John McCain’s website under “Health Care.”

John McCain Believes the Key to Health Care Reform Is to Restore Control to the Patients Themselves. We want a system of health care in which everyone can afford and acquire the treatment and preventative care they need. Health care should be available to all and not limited by where you work or how much you make.

Families should be in charge of their health care dollars and have more control over care.

Care, Making It Easier for Individuals and Families to Obtain Insurance. An important part of his plan is to use competition to improve the quality of health insurance with greater variety to match people’s needs, lower prices, and portability.

Families should be able to purchase health insurance nationwide, across state lines.

John McCain Will Reform the Tax Code to Offer More Choices Beyond Employer-Based Health Insurance Coverage.

While still having the option of employerbased coverage, every family will receive a direct refundable tax credit—effectively, cash—of $2,500 for individuals and $5,000 for families to offset the cost of insurance.

Families will be able to choose the insurance provider that suits them best and the money would be sent directly to the insurance provider. Those obtaining innovative insurance that costs less than the credit can deposit the remainder in expanded Health Savings Accounts.

John McCain Proposes Making Insurance More Portable. Americans need insurance that follows them from job to job. They want insurance that is still there if they retire early and does not change if they take a few years off to raise the kids.

John McCain Will Encourage and Expand the Benefits of Health Savings Accounts (HSAs) for Families. When families are informed about medical choices, they are more capable of making their own decisions and often decide against unnecessary options. Health Savings Accounts take an important step in the direction of putting families in charge of what they pay for.

Making Health Insurance Innovative, Portable, and Affordable

A Specific Plan of Action: Ensuring Care for Higher-Risk Patients

John McCain Will Reform Health

John McCain’s Plan Cares for the

Straight Talk on Health System Reform A “Call to Action” John McCain believes we can and must provide access to health care for every American. He has proposed a comprehensive vision for achieving that. For too long, our nation’s leaders have talked about reforming health care. Now is the time to act.

Americans Are Worried About Health Care Costs. The problems with health care are well known: It is too expensive and 47 million people living in the United States lack health insurance.

John McCain’s Vision for Health Care Reform

14 San Francisco Medicine october 2008

Traditionally Uninsurable. John McCain understands that those without prior group coverage and those with pre-existing conditions have the most difficulty on the individual market, and we need to make sure they get the high-quality coverage they need.

John McCain Will Work with States to Establish a Guaranteed Access Plan.

As President, John McCain will work with governors to develop a best practice model that states can follow—a Guaranteed Access Plan, or GAP—that would reflect the best experience of the states to ensure these patients have access to health coverage.

One approach would establish a nonprofit corporation that would contract with insurers to cover patients who have been denied insurance and that could join with other state plans to enlarge pools and lower overhead costs. There would be reasonable limits on premiums, and assistance would be available for Americans below a certain income level.

John McCain Will Promote Proper Incentives. John McCain will work with Congress, the governors, and industry to make sure this approach is funded adequately and has the right incentives to reduce costs such as disease management, individual case management, and health and wellness programs.

A Specific Plan of Action: Lowering Health Care Costs John McCain Proposes a Number of Initiatives That Can Lower Health Care Costs. If we act today, we can lower health care costs for families through commonsense initiatives. Within a decade, health spending will comprise twenty percent of our economy. This is taking www.sfms.org

an increasing toll on America’s families and small businesses. Even Senators Clinton and Obama recognize the pressure skyrocketing health costs place on small business when they exempt small businesses from their employer-mandate plans.

Cheaper Drugs: Lowering Drug Prices. John McCain will look to bring greater competition to our drug markets through safe reimportation of drugs and faster introduction of generic drugs.

Chronic Disease: Providing Quality, Cheaper Care for Chronic Disease. Chronic conditions account for three-quarters of the nation’s annual health care bill.

By emphasizing prevention, early intervention, healthy habits, new treatment models, new public health infrastructure, and the use of information technology, we can reduce health care costs. We should dedicate more federal research to caring for and curing chronic disease.

Coordinated Care: Promoting Coordinated Care. Coordinated care—with providers collaborating to produce the best health care—offers better outcomes at lower cost. We should pay a single bill for high-quality disease care which will make every single provider accountable and responsive to the patients’ needs.

Greater Access and Convenience: Expanding Access to Health Care. Families place a high value on quickly getting simple care.

Government should promote greater access through walk-in clinics in retail outlets.

Information Technology: Greater Use of Information Technology to Reduce Costs. We should promote the rapid deployment of twenty-first-century information systems and technology that allow doctors to practice across state lines.

Medicaid and Medicare: Reforming the Payment System to Cut Costs. We must reform the payment systems in Medicaid and Medicare to compensate providers for diagnosis, prevention, and care coordination. Medicaid and Medicare should not pay for preventwww.sfms.org

able medical errors or mismanagement.

Smoking: Promoting the Availability of Smoking-Cessation Programs. Most smokers would love to quit but find it hard to do so. Working with business and insurance companies to promote availability, we can improve lives and reduce chronic disease through smoking-cessation programs.

State Flexibility: Encouraging States to Lower Costs. States should have the flexibility to experiment with alternative forms of access, coordinated payments per episode covered under Medicaid, use of private insurance in Medicaid, alternative insurance policies, and different licensing schemes for providers.

Tort Reform: Passing Medical Liability Reform. We must pass medical liability reform that eliminates lawsuits directed at doctors who follow clinical guidelines and adhere to safety protocols. Every patient should have access to legal remedies in cases of bad medical practice, but that should not be an invitation to endless, frivolous lawsuits.

Transparency: Bringing Transparency to Health Care Costs. We must make public more information on treatment options and doctor records, and require transparency regarding medical outcomes, quality of care, costs, and prices.

We must also facilitate the development of national standards for measuring and recording treatments and outcomes.

ing services to assist consumers in handling their programmatic responsibilities.

Setting the Record Straight: Covering Those with Pre-Existing Conditions

MYTH: Some claim that under John McCain’s plan, those with pre-existing conditions would be denied insurance.

FACT: John McCain supported the Health Insurance Portability and Accountability Act in 1996 that took the important step of providing some protection against exclusion of pre-existing conditions.

FACT: Nothing in John McCain’s plan changes the fact that if you are employed and insured, you will build protection against the cost of any pre-existing condition.

FACT: As President, John McCain would work with governors to find the solutions necessary to ensure those with pre-existing conditions are able to easily access care.

Combating Autism in America John McCain is very concerned about the rising incidence of autism among America’s children and has continually supported research into its causes and treatment.

Confronting the Long-Term Challenge John McCain Will Develop a Strategy for Meeting the Challenge of a Population Needing Greater Long-Term Care.

There have been a variety of state-based experiments, such as Cash and Counseling or the Program of All-Inclusive Care for the Elderly (PACE), that are pioneering approaches for delivering care to people in a home setting. Seniors are given a monthly stipend which they can use to hire workers and purchase care-related services and goods. They can get help managing their care by designating representatives, such as relatives or friends, to help make decisions.

It also offers counseling and bookkeepoctober 2008 San Francisco Medicine 15

Politics and Medicine

Tobacco Funds for U.C. Research No More Tobacco Funds for the World’s Greatest University Steven Fugaro, MD, and Steve Heilig, MPH “Until we have a nuclear war, the tobacco industry will continue killing more people than any other man-made cause.”

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hat was the startling but true statement made by a researcher at a recent UCSF conference titled “It’s about a Billion Lives.” And it’s sadly true, for all the well-established reasons about tobacco being both addictive and lethal and because the tobacco industry has long done whatever it can to get more people smoking, especially young ones, all over the world.

Which made it all the more distressing to learn that the University of California, Los Angeles, accepted $6 million from tobacco giant Philip Morris for the otherwise worthy purpose of studying nicotine addiction. This came as part of a Philip Morris research program that, since 2000, has supported 470 research proposals in sixty American medical schools. As part of this effort, in 2006–2007, the University of California received twenty-three grants for a total of $16 million in Philip Morris funding.

UCLA researchers and officials, and even the U.C. Regents, seem to be participating in a strong bit of willful denial about what this really means. UCLA officials do admit “the idea for the study of teenagers and monkeys originated with Philip Morris.” But then comes this astounding quote from UCLA’s vice-chancellor for research: “I have no idea why Philip Morris decides to fund this antismoking research, but they do. As long as we do not feel that we are interfered with and that the research is done with the highest intentions, what’s in the mind of the funder is irrelevant.”

With all due respect, that is scientifically and ethically naïve. Such a state-

ment could have been made with some validity—due to lack of information—a generation or so ago. Now we know, from decades of research and disclosure of tobacco industry documents, and in other fields such as pharmaceutical marketing, that the source of funding and the motives actually make a big difference. The differences come in terms of outcome of the actual research, behavior of clinicians and others who read and are influenced by it, marketing activities of the profit-motivated funders, and more.

These influences are found even when there is no outright mention of the funder’s name—that’s one of the little mysteries of human motivation and the altering of it, and the tobacco and other industries seem to know as much or more about that than anyone else.

This is why, after numerous embarrassments, most leading scientific and medical journals have adopted much stricter “conflict of interest” disclosure policies, with source of funding for research being the main reason for that. It’s also why a rapidly growing number of professional schools and entire universities also have stricter policies, including many banning such funding outright.

Philip Morris’s spokesman avers they have “no intention of using the results or teenagers’ brain scans to develop more addictive cigarettes. We would never do that.”

The problem is that they already have, as shown by long and lethal evidence proving otherwise.

The tobacco industry’s now-defunct Tobacco Institute was a lobbying arm disguised as a research center, and it finally closed when that became clear to everyone.

Now Philip Morris, under similar pressure, has abandoned the particular research pro-

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gram UCLA participated in, but more such funding is expected from it and other “Big Tobacco” companies.

U.C. researchers and officials should know all this and act accordingly. Saying that they “monitor” such funding carefully, while no doubt true, is not enough. The U.C. Regents should adopt and adhere to a strict U.C.-wide policy that does not allow for any tobacco funding of research at this great tax-supported university system. Until that occurs, the evidence will keep showing us that money can buy just about anything, including denial.

Steven Fugaro, MD, is president of the San Francisco Medical Society and works in private practice in San Francisco. Steve Heilig, MPH, is the Director of Public Health Education for the San Francisco Medical Society.

www.sfms.org

Politics and Medicine

Tobacco Funds for U.C. Research A Note about Academic Freedom and Research Funding Michael T. Brown

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moking is unhealthy and addictive. Tobacco-related diseases impair the quality of life of people who smoke—and the lives of those around them—and are all too often fatal. The enormous health care costs associated with tobacco drain billions of dollars from our country every year.

As the state’s public research institution, the University of California has for decades conducted extensive research to better understand, prevent, and treat tobacco-related diseases. It would not be unreasonable, then, given its demonstrated commitment to improving the health of all Californians and people around the world, that U.C. would prohibit its scientists from accepting research funding from tobacco companies.

Yet there is another important principle involved, one at the heart of the excellence, vitality, and integrity of every great research university—the necessary freedom of scholars to explore, exchange, and express their ideas; to teach and conduct research free of inappropriate restrictions. This fundamental tenet applies whether the constraints are political pressures, administrative bans, or the ulterior motives of funders.

In this instance, the scrutiny of motives was heightened when a federal court concluded in 2006 that the tobacco industry had, in the past, used its funding support to manipulate research for its own ends.

Recognizing the real health dangers of tobacco and past tobacco company practices, the University of California has chosen to protect the essential academic freedom of its researchers in declining to ban research funding from tobacco companies, but also to establish a review process of funding proposals that ensures the integrity www.sfms.org

of its research.

The University did not reach this position lightly or in haste.

The faculty of the ten-campus system has deliberated long—dating back several years—and carefully on the question of research funding from tobacco companies.

In 2004, the faculty’s university-wide Academic Council and Assembly both adopted resolutions opposing restrictions on research funding sources, concluding that a ban on funding from a particular industry source—not just tobacco companies—could impair academic freedom.

The following year, the U.C. Board of Regents took up the issue after a federal court ruled that the major tobacco companies had engaged in a decades-long campaign to hide the dangers of tobacco and smoking. The Regents asked the faculty to evaluate whether the court decision provided an appropriate basis for instituting a ban on accepting funding from tobacco companies or their agents.

By nearly two-to-one margins, the Academic Council and Assembly passed a new resolution in fall 2006 advising that “grave issues of academic freedom would be raised” if the Regents were to deviate from longstanding U.C. policies and seek to prevent faculty members from accepting research funding based solely on the source of funds. The Academic Council further explained that “policies such as the faculty code of conduct are already in place on all campuses to uphold the highest standards and integrity of research.”

In 2007, the Regents considered a proposal (Resolution 89) to institute a university-wide ban on accepting research funding from the tobacco industry and asked for the faculty’s assessment. The Academic

Council and Assembly voted overwhelmingly against the proposed ban.

As a culmination of those deliberations, the Regents took what they considered a prudent and balanced approach to the debate, approving a policy that, while wisely not banning research funding from tobacco companies, established specific monitoring procedures around those research funding activities.

The Regents exhorted researchers to exercise the utmost care to assure that research adheres to the highest scientific and ethical standards, including vigilance to keep any funder from directing or controlling the outcome of their research or the dissemination of its results. As a safeguard, the Regents required that proposals be evaluated by a scientific review committee of faculty and approved by the campus chancellor before they are submitted for funding from the tobacco industry.

To help monitor tobacco funding system-wide, the Regents required an annual report summarizing the number of proposals reviewed and funded, along with a description of each proposal.

In reaching what some consider a measured approach, the Regents and faculty affirmed that academic freedom must be preserved. Bans based upon judgments about the funding source or speculations about how the research might be used fundamentally interfere with a faculty member’s freedom to carry out a research program.

Michael T. Brown, a U.C. Santa Barbara professor of counseling/clinical/school psychology, was Chair of the university-wide Academic Senate for the ten-campus University of California system last year.

october 2008 San Francisco Medicine 17

Politics and Medicine

Healthy San Francisco Time to Stop Opposition and Pitch In Steve Heilig, MPH, and Philip R. Lee, MD

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an Francisco is implementing a new program to provide access to health care for all its residents.

The Healthy San Francisco program was designed by a broadly composed group of experts and interest groups, and thus far implementation, which began in July, is proceeding successfully. One important obstacle remains to be overcome, however—a lawsuit by the Golden Gate Restaurant Association to stop the new program because of our proposal to mandate contributions by businesses with more than twenty employees.

That legal challenge continues but has not been successful to date.

A recent survey of small businesses statewide, in fact, showed that this local lobby may not truly represent its own constituency. The survey of 506 employers by Small Business for Affordable Healthcare showed that 80 percent of small-business owners believe that employers should pay at least some amount for their employees’ health care, and that smaller but significant numbers reaching around half of those surveyed favor proposals to require contributions to a pool for health coverage, including specific proposals to require from 4 percent to 7.5 percent of payroll expenses for this purpose.

Our local program may thus turn out to be a bargain for local businesses. State and federal lawmakers are now in a relative frenzy of “universal health” policy making that might result in mandatory health care proposals for employers. But the lack of true progress on those fronts means that we should not hold our collective breath about achieving such solutions soon.

Locally, beginning with a Mayorappointed Universal Healthcare Council,

San Francisco health care and business leaders sought to design a program that exempted truly small businesses, did not require onerous costs for those who were affected, and provided access to good care, mostly via existing health care resources.

The program will cost approximately $200 million annually, about half of that from existing funds and the rest from new sources, such as the employer contributions.

Enrollees will be eligible for primary and preventive care, including prescription medications, mental health services, and much more—but not dental care, organ transplants, and some other services, as some lines had to be drawn.

The San Francisco Board of Supervisors and the mayor—a former local restaurant owner—fully endorse the local program.

More than 80 percent of businesses of all sizes already provide for health coverage.

Employers were at the table from the start, including the San Francisco Chamber of Commerce, and they vocally endorsed the concept of providing universal access while differing on the issue of mandated contributions.

The Healthy San Francisco program, however, is going forward, with about 28,000 patients enrolled to date. Implementation is guided by another broad-based committee (and SFMS Past President Gordon Fung, MD, represents the Medical Society there).

The program, and San Francisco, will be best served by a more cooperative approach.

The program is not perfect, but, as many have remarked, “the perfect is the enemy of the good.” The owners of some businesses now opposed to the program might find that their bottom line will be better served when all their employees have access to care, as they may see less absenteeism due to health

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issues, more loyalty among employees, and even more support from customers. Many employers will likely pass much or all of the cost along to consumers; one estimate is that this program could add approximately 40 cents to the price of a sandwich or burrito.

We think health coverage is worth that.

San Francisco is poised to become the first city in the nation to actually implement what virtually everyone agrees is a good and morally important concept: universal access to at least some minimal level of health care. The lawsuit challenging Healthy San Francisco has been unsuccessful so far and is widely seen as counterproductive. It’s time for everyone to be on board.

We thus strongly feel that the Golden Gate Restaurant Association should withdraw its unpopular and shortsighted lawsuit and let the Healthy San Francisco program take full effect. All the money that will likely be wasted on legal fees could certainly go to better purposes—such as, perhaps, helping business owners provide for access to health services. Again, we think most would agree that is a worthy goal.

Steve Heilig is with the San Francisco Medical Society and served on the Mayor’s Universal Healthcare Council, which first designed Healthy San Francisco. Philip R. Lee is chancellor emeritus of UCSF and former U.S. Assistant Secretary of Health and was the first chair of the San Francisco Health Commission.

The views expressed here are their own.

For information about the Healthy San Francisco program itself, see http://www. healthysanfrancisco.org.

A previous version of this article originally appeared in the San Francisco Chronicle.

www.sfms.org

Politics and Medicine

Healthy San Francisco Healthy San Francisco Fails the Affordability Test Kevin Westlye

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he Golden Gate Restaurant Association has always supported Healthy San Francisco. The program provides coordination of service through San Francisco’s public and nonprofit clinic systems, providing health care for the uninsured. In particular, the computer coordination and medical home for each resident improve speed of service, leading to improved patient outcomes.

What we do not support is an employer mandate that provides no real reform in slowing down the outrageous costs of a failing health care system. Simply assigning individual small businesses the cost because the City can no longer afford it is not reform and will not fix the delivery system. Small business simply can’t afford the cost, especially in January 2010 when the three-year cap on escalation of fees expires and the hourly cost will increase by roughly 50 percent. The monthly cost of health care for a full-time employee under the mandate is currently $304. In January of 2010 the cost will rise to roughly $456 per month. Without the cap on annual escalation of fees, there is no end in sight to future costs.

San Francisco officials have stated the employer mandate is required to prevent employers from “dumping” employees into the clinic system. They have provided no data to support this claim. We simply do not believe that any employer who can currently afford to provide health care will stop providing the coverage and send their employees into the clinic system. Employers have been able to “dump” into the system for years and yet have not done so. The real health care issue is containing the escalation of cost so employers who currently provide coverage can continue to afford www.sfms.org

the benefit.

We have proposed a quarter-cent county sales tax to fund the shortfall in the funding of HSF. This affordable alternative would be paid for by business to business, resident, and tourist sales tax dollars. This alternative would not break the back of many small businesses and would allow the City to fully fund the program. We polled San Francisco residents to see if they would support this funding alternative. More than 70 percent supported the idea.

It is not progressive to drive small business out of San Francisco when a legal, affordable, and sustainable funding mechanism can fund HSF. After all, the people have already supported a quarter-cent sales tax for education and for transportation.

Opponents say sales tax is regressive. We say the sales tax proposal is reasonable and by far the best alternative. Spending subject to sales tax for a minimum-wage employee earning $20,000 per year would be minimal.

Consider that a third of such an employee’s income goes to rent and another third to food, leaving a third of his spending subject to sales tax. His tab: $17 per year. Individuals with higher expendable incomes would pay a larger share, as would tourists visiting San Francisco.

The legislation has another problem to overcome. There is no employee mandate and there is an entire category of uninsured who are 21 to 34 years old. The even have a name: the young immortals. Many work full-time but do not take their employeroffered health care because they would have to pay $50 per month to participate. If their employers paid into HSF, why would these employees suddenly decide to spend the same money for clinic care after passing on medical, dental, and vision coverage? Their

coverage would only be in the geographical limits of the City, while the coverage they would be passing on would be good within the entire country. As a category, they would not change their health care to take advantage of significantly reduced benefit.

Universal health care coverage is good for America. Until the leaders in Washington address the failing health care system, we should not accept flawed local legislation and consider it reform. The outrageous profits of the insurance and pharmaceutical companies need to be addressed as part of the solution.

The ordinance was ruled illegal in federal court. The City was granted a stay order allowing the employer mandate to be implemented during the appeal at the Ninth Circuit Court of Appeals. Hearings for the appeal were completed April 17. There is no specific timeline for the ruling.

Kevin Westlye is Executive Director of the Golden Gate Restaurant Association.

october 2008 San Francisco Medicine 19

Politics and Medicine

The Benitez Case One Physician Believes Doctors Have the Right to Choose Whom to Treat Steve Askin, MD

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n August 18, 2000, religious rights of physicians collided with the rights of a lesbian patient before the California Supreme Court, and the physicians came out on the short end. Here’s how it happened. Miss Guadalupe Benitez and her longtime partner came to see Dr. Christine Brody to obtain assistance in becoming pregnant. After discussion with Dr. Brody, according to the patient, the doctor told her that at some point an intrauterine insemination may be needed, and that she could not do the procedure herself. She cited the religious reasons that she would not do the procedure on a lesbian. Instead, another physician from the group would do it. Dr. Brody then proceeded to manage the case, ordering fertility medication and instructing Benitez in self-insemination at home per vagina. This took place in 1999.

She did not become pregnant, so intrauterine insemination was recommended. For a number of reasons, none of the physicians at the North Coast Women’s Care Medical Group in Vista (near San Diego) were able to perform intrauterine insemination at that time, so she was referred to a physician at another clinic.

The insemination was performed but was unsuccessful. However, she underwent in vitro insemination and gave birth to a boy, now age six, and later to twin girls, now age three. Apparently she received good care with a good result. Then in 2001 she sued Dr. Brody, Dr. Douglas Fenton, and the medical group, citing the Unruh Act, the state’s civil law that bans discrimination in businesses that serve the public. Since the case began, the doctors stated in subpoenas that they would not inseminate any unmarried woman, regardless of sexual orientation.

The state now bans discrimination based on

marital status but did not do so when the suit was filed. The case took several turns, but in 2003 as it was heading for trial, Benitez’s lawyers asked the trial court judge to rule that the doctors could not raise a religious liberty defense at the trial. The judge made this ruling and the doctors appealed. On December 2, 2005, the justices ruled that there was enough evidence that the doctors’ religiously based refusal to treat Benitez was based on her marital status, not her sexual orientation; the physicians should not be able to raise that defense.

Then Benitez’s lawyers appealed to the California Supreme Court. On August 18, 2008, the court decided that physicians who have religious objections against treating lesbians in certain instances must treat them nevertheless. Judge Joyce Kennard said doctors who have religious objections to a particular treatment or procedure must refuse to perform it on all patients but can’t selectively reject gays or lesbians. Lawyers for the doctors said they were considering an appeal to the U.S. Supreme Court. A supporter called the ruling a strike against religious freedom. Judge Kennard said the physicians have the option of referring to another physician at the same clinic. This makes no sense. In this case the patient received excellent care in another clinic.

And what about the solo practitioner? To whom could he refer?

The Supreme Court did order a trial to consider whether Christian doctors were allowed to refuse to inseminate Benitez because she was unmarried. We may see more activity in the courts. Meanwhile we can consider whether the fertility doctor has any rights as to what he or she must do. Dr. Elena Gates, a UCSF ethicist, says fertility doctors struggled when insemination technology

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first became available with the question of who should be allowed to receive treatment, and it was first limited to married couples.

While these restrictions have lowered over time, fertility doctors often feel responsible for the children they help bring into the world and do not want to introduce children into unhealthy family situations.

My reaction to all this is that forcing physicians to do anything rubs me the wrong way. They should be treating patients of their free will. The patient is better off with a willing doctor. As to freedom of religion, even doctors have that right. I believe the physicians in this case are sincere in their beliefs. Otherwise why would they go through so much grief? I think it’s a shame that the state medical society (the CMA), which was supporting doctors, switched sides, giving in to gay-lesbian pressure. This is more about activists pushing their agenda than about correcting any problem or addressing any harm done—there was none.

Steve Askin, MD, is a retired physician and longtime member of the SFMS.

www.sfms.org

Politics and Medicine

The Benitez Case The Gay and Lesbian Medical Association Shares Its Views Joel Ginsburg, JD, MBA

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n 1999, Lupita Benitez, a lesbian in a long-term relationship, was denied an infertility treatment by her doctors at the North Coast Women’s Care Medical Group in San Diego. Benitez has polycystic ovarian syndrome and needed intrauterine insemination to create her family.

Benitez’s physicians were the only ObGyn providers offered by her health plan.

They accepted payment and provided a variety of health services to her for nearly a year. However, they refused to perform the insemination because she was a lesbian, stating that their religious beliefs—they are conservative Christians—gave them the right to withhold care from Benitez that they routinely provided to heterosexual patients.

With the help of Lambda Legal, a national legal advocacy organization, Ms. Benitez sued the physicians. The crux of the issue was whether California’s civil rights laws contain an exemption for religious health care providers. The Gay and Lesbian Medical Association (GLMA) provided scientific expertise in the form of amicus briefs and helped raise awareness about the case. In August 2008, the California Supreme Court ruled unanimously that no such exception exists and that health care providers engaging in commerce in the state must follow the state’s antidiscrimination laws regardless of their religious beliefs.

If you find this ruling hard to accept, here are some things I’d ask you to think about.

First, this case has no impact on doctors’ rights to decline to perform abortions or certain other procedures for which exceptions have been created by the state legislature. In this case, however, the doctors, members of a for-profit group practice, www.sfms.org

were willing to perform the specific procedure, but not for certain people of whom they disapproved. It continues to be legal for health care providers to refuse to perform specific procedures, so long as they don’t perform them for anyone.

Second, it’s important to acknowledge the impact of discrimination. Many studies have shown that discrimination leads to “minority stress,” which is associated with a wide range of negative effects on health and wellness. The federal government has recognized that lesbian, gay, bisexual, and transgender (LGBT) people experience real health disparities, just as other minority populations do. There is substantial evidence that many of these health disparities are related to minority stress.

Third, some have argued that patients are not harmed if they are referred to other providers. In some cases, the burden on the patient may seem small, such as if another provider is available nearby. However, there is a significant dignitary injury in being refused services that are being provided to other people because one is seen as sinful or somehow unworthy. Also, the alternative offered is rarely of equivalent quality, price, and convenience. Finally, such treatment may lead patients to avoid care, resulting in delayed diagnosis of disease.

Fourth, people have long invoked sincerely held religious beliefs to justify discrimination, such as with laws prohibiting interracial marriage. Legislatures have recognized the negative effects of discrimination on society and simply outlawed it, and courts have found no constitutional right to engage in business in a discriminatory way that violates valid statutes.

Discrimination in health care is real, and it’s a danger to people’s health. In 1994,

the Gay and Lesbian Medical Association conducted a study that found that 88 percent of LGBT physicians surveyed had heard their medical colleagues disparage LGBT patients, and 52 percent had directly witnessed substandard care or denial of care to LGBT patients. We are now conducting a new physician study in partnership with the AMA. I hope that these data will show a substantial reduction in negative attitudes vis-à-vis LGBT patients over the past fifteen years.

Unfortunately, these issues do continue to arise. Just last year, for example, a Miami hospital prevented a woman in Florida from being by the side of her dying partner, telling her that she was “in an antigay state.”

I think that many, if not most, health care professionals understand that practicing their art without discriminating against certain classes of people—even if they don’t agree with or fully accept those people—is related to the principle to “do no harm.” I look forward to the day when as a society we will have evolved to the point that health care professionals no longer defend discrimination based on sexual orientation, gender identity, and other nonmedically relevant factors. In the meantime, I’m sure glad I live in California.

Joel Ginsberg’s experience includes management consulting (CompassPoint, Arthur Andersen), political appointments (the INS, the White House, USIA), the U.S. Congress (Senator Kennedy, Representative Lynn Schenk), and law (Katten Muchin). His JD/MBA is from U.C. Berkeley and his undergraduate degree from the University of Chicago. He cochairs the Advocacy Committee of the Commission to End Health Disparities and serves as Vice President of Access Institute, which provides low-cost mental health services in San Francisco.

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SFMS Election 2009 Nominations Committee Report 2008 Slate of Candidates Pursuant to the SFMS Bylaws Article X Section 2 - Nominations, the Nominations Committee renders in writing the following slate of candidates for the 2008 SFMS election. This slate was read at the September 8, 2008, General Meeting, at which time the SFMS President will call for additional nominations from the floor. The following are this year’s candidates:

2009 Officers

For a one-year term For President-Elect: Michael Rokeach, MD For Secretary: George A. Fouras, MD For Treasurer: Gary L. Chan, MD For Editor: Myron K. (Mike) Denney, MD, PhD (Incumbent Editor)

For SFMS Board of Directors Seven to be elected for a three-year term, 2009-2011 Jeffrey Beane, MD Andrew F. Calman, MD Lawrence Cheung, MD Peter James Curran, MD Roger Eng, MD Thomas H. Lee, MD * Richard A. Podolin, MD Rodman Shelton Rogers, MD * * Incumbent Director

For Nominations Committee Four to be elected for a two-year term, 2009–2010 Lisa Dana, MD Jerome A. Franz, MD Marybeth Mulcahy, MD Joseph Woo, MD

For Solo/Small-Practice Group Forum Delegate Two-year term, 2009–2010 Eric Tabas, MD (Incumbent Delegate)

For Solo/Small-Practice Group Forum Alternate Delegate Two-year term, 2009–2010 Eric H. Denys, MD

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For SFMS Delegation to the CMA House of Delegates The four candidates receiving the highest number of votes will serve as delegates for a two-year term, 2009–2010. The next five will be alternate delegates. The President-Elect automatically becomes the fifth delegate.

Lawrence Cheung, MD Peter James Curran, MD Roger Eng, MD ** George A. Fouras, MD ** Steven H. Fugaro, MD * Gordon L. Fung, MD * Robert I. Liner, MD ** William A. Miller, MD ** E. Ann Myers, MD * Shannon Udovic-Constant, MD * H. Hugh Vincent, MD * Joseph Woo, MD * Incumbent Delegate ** Incumbent Alternate NOTES: 2008 President-Elect Charles J. Wibbelsman, MD, automatically succeeds to the office of President.

2008 President Steven H. Fugaro, MD, automatically succeeds to the office of Immediate Past President.

www.sfms.org

SFMS Election 2009 FOR PRESIDENT-ELECT

our own families. Organized medicine remains the most effective vehicle to protect the values of our medical practices and the quality of our professional lives. I am excited about the future of SFMS, and I would like to continue being a part of the Society’s leadership. I am offering my candidacy for President-Elect, and I ask for your support once again.

MICHAEL ROKEACH Specialty: Emergency Medicine Membership: SFMS/CMA 1990 SFMS: Treasurer 2008, Secretary 2007, Director 2001–06, CPMC Medical Staff Liaison 2006–08 SFMS Committee Appointments: Executive 2006–08, PAC Consultant 2008, PAC Board 2002–08 (Chair 2003–08), Medical Review and Advisory 2000–08, Nominations 2003 CMA: Alternate Delegate 2002–03 Related Medical Affiliations: Vice Chief of Staff, CPMC 2006–08; Medical Staff Treasurer, CPMC 2004–05; Medical Executive Committee, CPMC 1992–2004; Chair, MEC Nominating Committee 1997–2000; Chair, Risk Management Committee, CPMC 1990–98; Quality Performance and Improvement Committee, CPMC 1992–present; Executive Committee, San Francisco Emergency Physicians Association, Ambulatory Services PI Committee, CPMC 1998–present; Chair, Sutter Emergency Department Directors Group 2003; Representative, EMS Clinical Advisory Committee 1990–2002; National and California Chapters, American College of Emergency Physicians 1988–2007 Medical School: University of Miami 1973 Hospital Affiliation: Active: CPMC Policy Statement: It has been an honor and a pleasure serving on the San Francisco Medical Society Board of Directors, as SFMS Treasurer and Secretary, and as Chair of the PAC. I wish to continue as an officer by becoming your President in 2010. I can think of no better way to invest in our patients and ourselves than through an organized San Francisco medical community.

To that end, I will represent the best interests of all practicing physicians in San Francisco, irrespective of your hospital model or practice model. The Medical Society must continue to address the many issues that challenge our ability to meet the needs of our patients and

FOR SECRETARY

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As a physician working in the San Francisco Department of Public Health, I am keenly aware of how state policies, especially regarding MediCal/Medicare, affect our patients, both public and private. In addition, it is likely that further scope-of-practice issues will be introduced in the next legislative session. I will work hard to bring these issues to SFMS and to ensure that our views are carried to CMA. It is my firm belief that we must work together, regardless of specialty, to present a united message regarding patient care and our ability to practice medicine.

FOR TREASURER

GEORGE A. FOURAS ALSO CANDIDATE FOR DELEGATION Specialty: Child and Adolescent Psychiatry Membership: SFMS/CMA 1996, AMA 1987–90/1995–present SFMS: Director 2003–08 SFMS Committee Appointments: Executive 2003–08, SFMS PAC 2004–08 (Chair 2007–08), Physician Membership Services 2003–08, Nominations 2008, Psychiatric Services 1996–2006, Fellowship/Wellness 2006 CMA: Alternate Delegate 2000–02/2007–08; California Psychiatry Association Specialty Delegate to Young Physicians Section, CMA 1996–99 Related Medical Affiliations: President, Northern California Regional Organization of Child and Adolescent Psychiatry 2000 (President-Elect 1999); Chair, California Psychiatric Association Child and Adolescent Committee 2000–present; Medical Director, Foster Care Mental Health Program, City and County of San Francisco 1995–present Other: Board-Certified in General Adult Psychiatry 1999 Medical School: Ohio State University 1990 Hospital Affiliation: Courtesy: SFGH Policy Statement: I am honored to be nominated for a position as Secretary, and for the HOD Delegation. It has been a great experience being part of the Delegation and a member of the Board of Directors. I hope to be able to continue to serve the SFMS in the new role of Secretary.

GARY L. CHAN Specialty: Internal Medicine Membership: SFMS/CMA 1981 SFMS: Secretary 2008, Director 2002–07, St. Francis Memorial Hospital Medical Staff Liaison 2005–08 SFMS Committee Appointments: Executive 2006–08, Nominations 2007, Information Technology 2006, Health Care Foundation of San Francisco Board 2005–06 CMA: Alternate Delegate 2008–09; Solo/SmallGroup Practice Forum Alternate 2006–07 Related Medical Affiliations: Assistant Medical Director, Brown & Toland 1990–present; Utilization Management Advisor, Blue Shield 1984–99 Medical School: Tufts University 1976 Hospital Affiliation: Active: St. Francis, CPMC; Courtesy: St. Mary’s Teaching Appointments: Clinical Associate, UCSF Policy Statement: I have been active on the SFMS Board for the past five years. I would be pleased to serve as a Delegate from San Francisco to the CMA and to serve as your Treasurer.

Thank you for offering me that opportunity. I have been practicing internal medicine here in San Francisco for the past twenty years and have witnessed vast changes in medicine. I have

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SFMS Election 2009 firsthand knowledge of how the managed care system has evolved and of the pressures placed on the system by providers, insurers, employers, and, lastly, consumers. There has been a large disconnect between the goals and wishes of all parties concerned. There needs to be more active education on how the current system works or doesn’t work. Only then can we begin to lay the groundwork to fix it for the benefit of both physicians and patients, who have been mostly afterthoughts. There is a major crisis in health care today. The costs are going through the roof as the benefits and reimbursements diminish.

Only through our organized voices can physicians play a role in changing our current system for the better. SFMS must provide a forum for getting our voices heard. I hope to represent these concerns in the coming years. Thank you for your vote.

FOR EDITOR

MYRON K. (MIKE) DENNEY, MD, PhD (Incumbent Editor) Specialty: Psychosomatics/General Surgery Membership: SFMS/CMA 2002, American College of Surgeons 1967 SFMS: Editor 2006–08 SFMS Committee Appointments: Executive 2006–08, Editorial Board 2002–08 Medical School: University of Michigan 1959 Teaching Appointments: Adjunct Faculty, Holistic Health Education, John F. Kennedy University; Integrative Health and Healing, California Institute of Integral Studies; Depth Psychology, Pacifica Graduate Institute Policy Statement: I am honored to be nominated for another term as Editor of the Journal of the San Francisco Medical Society. It has been pleasurable and rewarding to serve for the past three years. As this Journal is an advocate for physicians and patients, my editorials have focused upon underlying meanings and transcendent dynamics of economic, political, scientific, ethical,

spiritual, and personal issues that confront both healers and the afflicted. I will dedicate myself to the ongoing quality of our publication as it continues to explore new and deeper perspectives of the art and science of medicine.

JEFFREY BEANE Specialty: Geriatrics, Hospice and Palliative Medicine Membership: SFMS/CMA 1998 Related Medical Affiliations: American Geriatrics Society, American College of Physicians, and American Academy of Hospice and Palliative Medicine; Member, Ethics Committee and Physicians’ Well-Being Committee at Kaiser Permanente Medical School: UC Davis 1981 Hospital Affiliation: Active: TPMG Policy Statement: Our profession needs an organized, unified voice in order to exert physician leadership in health care policy. I have a particular interest in health care delivery for frail, chronically ill patients. I am excited by the opportunity to improve end-of-life care in our community as provided by the recent passage of AB 3000 (Wolk), which establishes the POLST form (Physician Orders for Life-Sustaining Treatment) as the equivalent of a prehospital DNR, and I look forward to SFMS providing leadership in establishing the POLST form as the standard of care across all settings in San Francisco.

1982 CMA: Ophthalmology Subspecialty Delegate 2002–08, House of Delegates Insurance & Reimbursement Reference Committee D 2004–07 (Chair 2007) Related Medical Affiliations: Chief of Ophthalmology, CPMC-St. Luke’s; Associate Examiner, American Board of Ophthalmology; Medical Expert, Medical Board of California; St. Luke’s IRB 1996–2003 Other: American Academy of Ophthalmology Executive Council 2003–08; Health Policy Committee 2004–08; Legislative Key Contact 2000–08; California Academy of Ophthalmology VP 1998–99, 2005–06, and CFO 2004–05; California Medicare Carrier Advisory Committee 1996–2004 Medical School: UCSF 1989 (MD-PhD) Hospital Affiliation: Active: CPMC-St. Luke’s, UCSF, SFGH; Courtesy: CPMC, St. Mary’s, Seton Teaching Appointments: UCSF, Associate Clinical Professor of Ophthalmology and Family & Community Medicine Policy Statement: For me, advocacy has been a natural outgrowth of fifteen years of practicing in a low-income area. I authored successful CMA and AMA resolutions to allow drug importation from Canada and to direct Medicare negotiations with pharmaceutical companies (reversing AMA policy), and I improved early detection of childhood disabilities. I recently helped organize physicians in a successful effort to resist the closure of CPMC-St. Luke’s Hospital.

I have also worked for many years on Medicare reimbursement policy at the state and national levels. In these difficult economic times, I will be a tireless advocate for fair payments to physicians and for access to health care for our most vulnerable citizens.

ANDREW F. CALMAN Specialty: Ophthalmology Membership: SFMS 1993, CMA 1982, AMA

LAWRENCE CHEUNG ALSO CANDIDATE FOR DELEGATION Specialty: Dermatology

FOR BOARD OF DIRECTORS

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SFMS Election 2009 Membership: SFMS/CMA 2005, AMA 2005 SFMS Committee Appointments: SFMS PAC Board 2007–08, Physician Membership Services Committee 2006–08 Related Medical Affiliations: Fellow, American Academy of Dermatology; Fellow, American Society for Dermatologic Surgery; Member, Society of Investigative Dermatology Medical School: Columbia University College of Physicians and Surgeons 1998 Hospital Affiliation: Active: St. Mary’s, Chinese Hospital Teaching Appointments: Assistant Clinical Professor of Dermatology, UCSF Policy Statement: As a recent graduate who started my own solo practice in the city two years ago, I have gained a deep appreciation for the San Francisco Medical Society. Beyond the camaraderie of colleagues, the Society has provided a wealth of resources to me as a practicing physician. I soon became active in the Society because I wanted to ensure that it remains a valuable resource for other physicians. I joined the Membership Committee because I felt that a robust membership base is critical for the Society on many levels. From the number of delegates at the CMA to the legitimacy of representing San Francisco physicians in areas of patient advocacy and health care policy, membership is the backbone of the Society. I also became active in the Political Action Committee because I feel that California is a pioneer in many areas of health initiatives, and San Francisco is one of the cities leading these changes. I believe that only by actively engaging in the political process can we ensure positive outcomes for both our patients and our profession. I am truly honored to have been nominated to run for the SFMS Board of Directors and the CMA Delegation, and I hope to be able to serve the Society in those capacities.

PETER JAMES CURRAN ALSO CANDIDATE FOR DELEGATION www.sfms.org

Specialty: Cardiology Membership: SFMS 2007, CMA 2005 SFMS Committee Appointments: Membership Services 2007–08 Related Medical Affiliations: Director of Cardiac Rehabilitation, St. Mary’s Medical Center Medical School: Loma Linda University 1994 Hospital Affiliation: Active: St. Mary’s, St. Francis, CPMC Policy Statement: I appreciate the nominations to the SFMS Board of Directors and CMA House of Delegates. It is an exciting year to be involved in health care politics. I see opportunities in practicing in a city known for tolerance and diversified practice settings. These include building camaraderie in our medical society that will, hopefully, translate into a larger membership base. Opportunities also include being an advocate for positive change in patient care, such as basic care for all and health prevention rather than bending to the whims of special interest groups and third-party payers. Most important, I want to listen to what is important to physicians who live and serve in San Francisco.

ROGER ENG ALSO CANDIDATE FOR DELEGATION Specialty: Radiology Membership: SFMS 2003, CMA 1995, AMA 1995 CMA: Alternate Delegate 2008; Board of Trustees 1997–98, 2003–07; Delegate/Alternate Delegate 1995–present; Young Physicians Section, Chair 2001–02 CMA Appointments: Committee on Nominations 1997–98, 2003–07; IT Committee, Chair 2004–08; Radiologic Technology Certification Committee 2004–present; Long-Range Planning Committee 2003–07; Chair, CMA Website Taskforce Subcommittee 2006–07; Health Care Finance Technical Advisory Committee 2004; Committee on Medical Service 1998–99 AMA Offices: AMA Delegate 1996–97, AMARPS Delegate 1995–97, AMA-YPS Delegate

1998–99 (Vice Chair, CMA YPS delegation) Related Medical Affiliations: Chief of Radiology, Chinese Hospital 2003–present; President, Golden Gate Radiology Medical Group 2006– present; Chinese Hospital, Medical Executive Committee 2004–present; Chinese Community Health Care Association Information System Physician Advisory Committee, 2006–present; Chinese Hospital, Nominations Committee, Chair 2007–present; Eastman Kodak Healthcare Information System Physician Advisory Board 2005–present; American College of Radiology, Councilor 2008–present; California Radiological Society, Executive Committee 2008–present Medical School: George Washington University 1991 Hospital Affiliation: Active: Chinese Policy Statement: As a native San Franciscan, I am honored to be nominated to the SFMS Board of Directors. I feel that my involvement at the statewide level as well as participation in three other county medical societies has given me valuable exposure to new ideas and initiatives. I hope to bring these ideas to our medical society to help make it an ever-stronger voice for our patients and community. My core belief is that organized medicine is here to serve our patients in arenas (legislative and community outreach) in which we are unlikely to succeed as individual physicians. This also includes helping our physician members in all facets of their practices, so that they can concentrate their energies on their primary mission: patient care.

THOMAS H. LEE (Incumbent Director) Specialty: Internal Medicine Membership: SFMS/CMA 2002, AMA 1994 SFMS: Director 2006–08, Young Physician Representative to Board 2003–05 SFMS Committee Appointments: Executive 2006–08, SFMS PAC Board 2003–08 (Vice Chair 2005–08), Membership Services 2007–08, Information Technology (Chair 2006), Editorial

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SFMS Election 2009 Board 2003–06, Web Page Oversight 2004–05 CMA: Alternate Delegate 2005–08 Medical School: University of Washington 1994 Hospital Affiliation: Active: CPMC, Saint Mary’s Teaching Appointments: UCSF Policy Statement: As a younger physician interested in improving care delivery systems, I believe that SFMS plays an important role in bridging policy with the practice of medicine.

Clinical practice can, at times, be isolating, and it is rewarding to share a common passion for improving the care of our patients outside the exam room. I believe that SFMS best serves the community as a unified voice for patient and physician advocacy. To that end, I would like to continue efforts in membership recruitment and retention, forums for education and discussion, and the development of solutions that support improved regional coordination of care.

RICHARD A. PODOLIN Specialty: Cardiovascular Diseases Membership: SFMS/CMA 1991 Related Medical Affiliations: Chief of Staff, SMMC; Delegate to the CMA, California Chapter of the American College of Cardiology; Associate Chief, Department of Cardiovascular Medicine and Interventional Cardiology, SMMC Medical School: Stanford University 1979 Hospital Affiliation: Active: St. Mary’s Policy Statement: As physicians, both the legitimacy and the strength of our role in the development of health care policy derive from our deep understanding of and commitment to quality care. We are in a time of great challenge.

Resources are limited and the need to expand health care services is acute. At the same time, we cannot maintain high-quality care in this community unless we can safeguard reimbursements and provide a practice environment that will attract and sustain excellent physicians in

both primary and specialty practices. As a member of the SFMS Board, I will work to promote these goals.

RODMAN SHELTON ROGERS (Incumbent Director) Specialty: Urology Membership: SFMS/CMA 2000 SFMS: Director 2006–08 CMA: Alternate Delegate 2008–09, Solo/SmallPractice Forum Alternate Delegate 2005–06 Related Medical Affiliations: American Urological Association Medical School: University of Oklahoma 1995 Hospital Affiliation: Active: CPMC, Saint Mary’s Policy Statement: I am honored to be nominated to serve another three years on the Board of Directors. Like most young people, I entered medicine wanting to contribute to the health of individual patients as well as to make scientific advancements in my discipline. Accomplishing this requires more than the action of one individual. It is dependent on the culture of those who provide care and conduct research, as well as the choices made by the individuals and institutions paying for such care. I believe that the San Francisco Medical Society is a good way to participate in the community for both patient and physician advocacy so that we may influence the choices of the other partners in health care.

Membership: SFMS/CMA 2007 Medical School: Georgetown University 1996 Hospital Affiliation: Active: UCSF, CPMC Policy Statement: I am pleased to be considered for the Nominations Committee of the San Francisco Medical Society. I consider it an honor to take part in the selection of the leaders of this group. Our voice in San Francisco is only heard because of the excellent work of our colleagues.

Thank you.

JEROME A. FRANZ Specialty: Internal Medicine/Geriatrics Membership: SFMS/CMA 1983, AMA 1983 SFMS: Director 2000–04, Saint Luke’s Medical Staff Liaison 1999 SFMS Committee/Board Appointments: Nominations 2005–06, HCFSF Board 1999–06, Executive Committee 2003, Managed Care Committee 1998–2001 Related Medical Affiliations: Director, Saint Luke’s Hospital Board 1997–2005; Director, CPMC Board 2006–08 Medical School: UC Davis 1977 Hospital Affiliation: Active: Saint Luke’s, Chief of Staff 2005–08; Courtesy: CPMC Teaching Appointments: Associate Professor of Clinical Medicine, UCSF Department of Family and Community Medicine; School of Nursing Department of Community Health Systems Policy Statement: Four years on the board of San Francisco Medical Society have shown me the value of its voice for our medical community. I hope to increase its presence and representation from the South of Market area. The plans to rebuild St. Luke’s offer an opportunity to expand our medical staff and its influence in the city.

FOR NOMINATIONS COMMITTEE LISA DANA Specialty: Pediatrics

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SFMS Election 2009

MARYBETH MULCAHY Specialty: Emergency Medicine Membership: SFMS/CMA 2007 Related Medical Affiliations: American College of Emergency Physicians; California College of Emergency Physicians; San Francisco Environmental Protection Agency; Chief, KPSF Emergency Department, 2002–07; President, KPSF Professional Staff Association 2006–08; Fellow, American College of Emergency Physicians; KPSF Hospital Quality and Utilization Executive Oversight Committee; Credentials and Privileges Committee; Resource Utilization Committee; Regional Education Chair Peer Group; Chair, Disaster Committee Medical School: University of Arizona 1991 Hospital Affiliation: Active: TPMG Policy Statement: I recently served a term as Chief of the Kaiser San Francisco Emergency Department and also as President of the Kaiser San Francisco Medical Center Professional Staff Association. These incredible experiences confirmed my belief that individual commitment and involvement in medical politics are key to our continued success and to the health and well-being of our society. With that in mind, I am honored to be nominated to serve on the SFMS Nominations Committee. Your support is truly appreciated.

JOSEPH WOO ALSO CANDIDATE FOR DELEGATION Specialty: Emergency Medicine Membership: SFMS/CMA 2005 SFMS: Chinese Hospital Medical Staff Liaison 2007–08 Related Medical Affiliations: Chinese Hoswww.sfms.org

pital Chief of Medical Staff 2005–08, Chinese Community Health Plan Board of Directors 2006–08 Medical School: Medical College of Wisconsin 1991 Hospital Affiliation: Active: Chinese Policy Statement: I am honored to have this opportunity to serve and participate in the election process of our medical society. While I am a relatively new member, I have learned a great deal attending our Board meetings as my hospital’s liaison. Sometimes going to the meetings seems burdensome as our days are already so busy, but then I am always encouraged and renewed when I see such passionate, intelligent, and caring people gathered together to further our common goals. I look forward to being a part of the nominations committee.

Francisco that is accessible to all San Francisco physicians. It provides us a community beyond our individual situations. The Society is the principal voice of medicine for our community, our patients, the world of politics, and the media.

Through SFMS, we have the potential to lead and shape medicine and the issues pertinent to our physicians and our patients. In particular, I look forward to representing the ideas and issues of solo and small-group practices in San Francisco to the CMA, as I have been in solo practice for twenty-three years.

FOR SOLO/SMALL-PRACTICE GROUP FORUM ALTERNATE DELEGATE

FOR SOLO/SMALL-PRACTICE GROUP FORUM DELEGATE

ERIC TABAS (Incumbent Delegate) Specialty: Obstetrics and Gynecology Membership: SFMS/CMA 1987 SFMS: Treasurer 2000, Director 1995–99 SFMS Committee Appointments: Finance/Investment Committee 1999–2008 (Chair 2000); SFMS Services, Inc., Board 1997–2001 (Secretary/Treasurer 1999); Executive 1998–2000; Nominations 1997; Legislative 1988–92 CMA: Solo/Small-Practice Group Forum Delegate 2006–08 Medical School: Northwestern 1980 Hospital Affiliation: Active: CPMC, Saint Mary’s, Saint Francis; Courtesy: Davies, Mount Zion, UCSF Teaching Appointments: Assistant Clinical Professor of Obstetrics/Gynecology, UCSF Policy Statement: I want to continue to serve San Francisco physicians as SFMS Delegate to CMA’s Solo/Small-Group Practice Forum. I believe that SFMS is the only organization in San

ERIC H. DENYS Specialty: Neurology Membership: SFMS/CMA 1976 SFMS: UCSF Association of Clinical Faculty Consultant 2000 SFMS Committee Appointments: Tripartite 1999–2001 CMA Committee Appointments: Council on Scientific Affairs 2007; Specialty Advisor, Cal Advantage 1996; Scientific Advisory Panel on Neurology 1992–94 (Chair 1994) Related Medical Affiliations: Secretary/Treasurer, Association of California Neurologists 2006; President, San Francisco Neurological Society 2001–02; President, Association of Clinical Faculty, UCSF 2000; Member, Ethics Committee, CPMC 1986 Medical School: University of Leuven, Belgium 1966 Hospital Affiliation: Active: CPMC; Courtesy: UCSF, Mt. Zion Teaching Appointments: Associate Clinical Professor in Neurology, UCSF Policy Statement: I have accepted the invitation to become Alternate Delegate for the Solo/Small Practice Forum. I may not seem the most likely candidate because I am at the end, not the be-

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SFMS Election 2009 ginning, of my career after thirty-two years in San Francisco. However, all these years, as well as my involvement in both local and national organizations, have given me a perspective on how changes in health care have affected individual and small-group practices. Since 1980 I have been involved in numerous capacities in the American Association of Electrodiagnostic Medicine, and I was President of the Association of the Clinical Faculty at UCSF and of the San Francisco Neurological Society. Individual practitioners are facing enormous challenges because of the power the for-profit health insurance companies are wielding. Small groups will only survive if they can find a form of practice that sets them apart from large groups. It will be a challenge. There can be no divisiveness among us. I will need your input in order to chart the course for you. I look forward to your collaboration.

FOR CMA DELEGATION LAWRENCE CHEUNG ALSO CANDIDATE FOR BOARD. See biography under “For Board of Directors.”

PETER JAMES CURRAN ALSO CANDIDATE FOR BOARD. See biography under “For Board of Directors.”

ROGER ENG (Incumbent Alternate) ALSO CANDIDATE FOR BOARD. See biography under “For Board of Directors.”

Policy Statement: I appreciate the opportunity to serve on the SFMS Delegation this year and my nomination for next year. I plan on using my past experience at the CMA House of Delegates and Board of Trustees to support our alreadycapable delegation to the best of my ability. I look forward to working with the rest of our delegation to advance the causes of our SFMS within CMA. GEORGE A. FOURAS (Incumbent Alternate) ALSO CANDIDATE FOR SECRETARY. See biography under “For Secretary.”

ties such as Brown & Toland with various IPAs and specialty groups in San Francisco. I welcome the opportunity to serve the San Francisco Medical community as a Delegate to the California Medical Association from SFMS and to work closely with Dr. Stephen Follansbee, the head of the SFMS delegation for 2008.

STEVEN H. FUGARO (Incumbent Delegate) Specialty: Internal Medicine Membership: SFMS/CMA 1986 SFMS: President 2008, President-Elect 2007, Treasurer 2006, Director 2003–05 SFMS Committee Appointments: Executive 2006–08, Finance 2006–08 (Chair 2006), SFMS PAC Board 2005–08, Information Technology 2006, Nominations 2004 CMA: SFMS Delegate 2007–08 Related Medical Affiliations: American College of Physicians, Society of General Internal Medicine Medical School: Yale University 1981 Hospital Affiliation: UCSF, Mt. Zion Teaching Appointments: Associate Clinical Professor of Medicine, UCSF Policy Statement: I have practiced privately, full-time, in internal/primary care medicine for the last seventeen years and before that was employed by UCSF for eight years as a general internist and clinician-educator. This varied employment background enables me to appreciate both the vast changes that have occurred in medicine in the previous two decades as well as the various challenges confronting physicians today in academic medicine, managed care, and private practice. As the current President of SFMS, I have become acutely aware of the critical role played by the San Francisco Medical Society in influencing medical care and medical policy at the local, state, and national levels. The Medical Society has been able to accomplish this via its CMA Delegation and its recognized role as the leader of organized medicine in our city. This year alone there have been critical legislative battles involving Medicare, MediCal, and the scope of medical practice. There are a number of important issues that we as a Medical Society will need to confront over the next year—issues such as primary-care physician shortages, fair billing for noncontracted physicians in the ER setting, and the relationship between managed care enti-

28 San Francisco Medicine october 2008

GORDON L. FUNG (Incumbent Delegate) Specialty: Cardiovascular Diseases Membership: SFMS/CMA 1985 SFMS: Consultant 2008, Immediate Past President 2007, President 2006, President-Elect 2005, Director 1999–2000/2002–04, Secretary 2001 SFMS Committee/Board Appointments: Executive 2000–07; SFMS Finance/Investment 1998–2006; PAC 2005–08; Professional Relations and Ethics 1997–2008; Judicial 2005–08; Services, Inc., Board 1995–2005 (President 1999–2005; Secretary/Treasurer 1996–98); Nominations Committee 2000–01; Editorial Board 1995; Insurance and Managed Care Mediation 1995–96 CMA: SFMS Delegate 2005–08, Specialty Society (Cardiology) Delegate 2002–06, Alternate 2001, Delegate 2001 CMA Committee Appointments: Medical Staff Survey Steering Committee 1998, Medical Staff Survey 1995 Related Medical Affiliations: American College of Cardiology, California Chapter, President and Governor 2006–09; Chair, Membership Committee 2002–06; Member, National Board of Directors, American Heart Association 1999–2001; President, California Affiliate, American Heart Association 1996–98; Member, Executive Committee, Council on Clinical Cardiology, AHA; Medical Director, ECG Lab, UCSF 2001–present; Director of Cardiac Services, UCSF Medical Center at Mount Zion 2001–present; President, San Francisco Division, American Heart Association 2004–06 Medical School: UCSF School of Medicine www.sfms.org

SFMS Election 2009 1979 Hospital Affiliation: Active: UCSF; Associate: Chinese Hospital, Saint Francis Memorial Hospital, St. Mary’s Hospital, CPMC Teaching Appointments: Clinical Professor of Medicine, UCSF 2006–present; Associate Clinical Professor of Medicine 1998–2006 Policy Statement: I am honored to be nominated for the SFMS Delegation to the CMA House of Delegates. Over the past several years, the challenges of practicing medicine in San Francisco and California have caused many physicians to consider early retirement and/or leaving the field entirely. Regardless of hospital affiliation, mode of practice, or specialty, this organization pulls together the energy and expertise of all physicians to support physicians and quality health care for all San Franciscans. I strongly believe that all physicians need to be a part of this team effort to support each other in an organized manner.

Only by volunteering to be part of the solution can we succeed in medicine. I look forward to working with you and for you.

screening at eleven to fourteen weeks, Fetal Medicine Foundation.

Policy Statement: I became a member of the SFMS/CMA in order to join others who want to do their part to make a difference in the way physicians use their individual and collective influence to improve the health and well-being of patients. This is both idealistic and self-serving, since professional improvement enhances the quality of our own working lives and also because, eventually, we all become patients. Impressed with the personalities of the members of the SFMS and with the diligent work expended by its delegation at the HOD meetings, I wanted to be a participant as well as an observer at those meetings. As something of a student of the history of medicine on the Pacific Coast, I know that it can take time for wise policies to evolve.

Best evidence-based practice can only evolve with dedicated leadership. I’m pleased and feel honored to be able to join the SFMS delegation, working toward our perceptions of wise policy and best practice.

ROBERT I. LINER (Incumbent Alternate) Specialty: Obstetrics and Gynecology Membership: SFMS/CMA 2004 CMA: Alternate Delegate 2008, Attendee House of Delegates 2006–07 Related Medical Affiliations: Diplomat, ACOG; American Institute of Ultrasound in Medicine Medical School: University Rochester 1970 Hospital Affiliation: Retired from hospital affiliations Teaching Appointments: Clinical Faculty and Temporary Director, OB/GYN at Mt. Zion Hospital (retired); Assistant Clinical Professor (temporary), UCSF at Highland General Hospital (retired) Current Practice (1988–present): Private practice in prenatal diagnosis, diagnostic ultrasound (obstetrical and gynecologic), and genetic amniocentesis. Certified to perform ultrasound

WILLIAM A. MILLER (Incumbent Alternate) Specialty: Internal Medicine Membership: SFMS/CMA 2002 SFMS: Director 2007–10, St. Luke’s Medical Staff Liaison 2006–08 SFMS Committee Appointments: Nominations 2007–08 Related Medical Affiliations: St. Luke’s Hospital Chief Medical Executive and Immediate Past Chair, Department of Medicine Medical School: University of Arizona College of Medicine 1991 Hospital Affiliation: CPMC, St. Luke’s Teaching Appointments: Associate Professor, Touro University Policy Statement: We all know that health care policy is of major interest at both the state and national levels. In the efforts to reduce health care spending and the subsequent battle to divide

www.sfms.org

up the shrinking health care dollar, it is crucial that physicians have dynamic representation in the government process. I wish to serve the local community of doctors by representing us at the state level through the California Medical Association’s House of Delegates.

E. ANN MYERS (Incumbent Delegate) Specialty: Endocrinology Membership: SFMS/CMA 1989, AMA 1980 SFMS: Consultant 2006–08, Immediate Past President 2005, President 2004, President-Elect 2003, Secretary 2002, Director 1998–2001, Saint Mary’s Medical Staff Liaison 1999–2001 SFMS Committee Appointments: SFMS PAC 2003–08, Physician Membership Services 2003–08 (Chair 2003), Executive 2002–05 (Consultant 2006–08), Judicial 2003–06, Local Health 1995–2006, Fellowship/Wellness 2006, Finance 2004, Chiefs of Staff 2003–04, Nominations 1999/2001–02/2005 CMA: Delegate 2001–08, Alternate Delegate 1999–2000 Related Medical Affiliations: Board, American Diabetes Association, Golden Gate Chapter 1989, California Affiliate 1996–97 Medical School: Creighton University 1976 Hospital Affiliations: Active: CPMC, Saint Mary’s Policy Statement: Banding together, we defeated the Medicare cut in physician reimbursement, and we must monitor that it does not use a change in the RVU or another measure to effect an actual cut. Additionally, there is much more to deal with, from onerous authorization requests to clinically restrictive PFP policies and draconian raises in Medicare costs to our patients (including planned increases in Part D)—and, now, another threat to MediCal. We must foster strong coalitions with our legislators, other medical associations, and the public to protect our practices and medical care. These and other issues affect all types of medical practices,

october 2008 San Francisco Medicine 29

SFMS Election 2009 from solo to the largest practice models, and all disciplines in medicine. The SFMS delegation has successfully put forward changes in public health and in policy and reimbursement. My belief and commitment to the vital need we have to band together and speak for all constituents in the house of medicine is deeper now than ever before. We must unite to demand that payers reimburse hospitals and health professionals so that closures, program cutbacks, and personnel and physician shortages stop. I will foster the growing public and political awareness so that physicians, patients, and the public can work together to strengthen our future health. If elected, I will work with you on behalf of our patients and medicine.

SHANNON UDOVIC-CONSTANT (Incumbent Delegate) Specialty: Pediatrics Membership: SFMS/CMA 2001 SFMS: Director 2007–09 SFMS Committee Appointments: SFMS PAC 2006–08, Medical Review and Advisory 2002–present CMA: Alternate Delegate 2007–08 CMA Committee Appointments: Young Physicians Section Executive Committee, At-Large Member 2003–05 Related Medical Affiliations: AAP State Government Affairs chapter representative; AAP chapter Board, Alternate Member-atLarge 2003 Medical School: UC Berkeley/UCSF Joint Medical Program, MS 1996, MD 1998 Hospital Affiliation: Active: Kaiser Permanente Teaching Appointments: Assistant Clinical Professor, UCSF Department of Pediatrics Policy Statement: As individual physicians in San Francisco, we can directly affect the health and well-being of our own patients. The power of organized medicine is that physicians across all specialties can have a voice to address the

broader health care issues facing patients and their physicians through improved access to care, appropriate reimbursements, public health programs, and effective health care legislation.

In my previous and upcoming visits to the House of Delegates, I have brought forth resolutions to protect physician prescribing data. I have asked and plan to continue to ask colleagues for their ideas for resolutions to help further the interest of San Francisco physicians. I welcome the opportunity to continue to serve the SFMS.

H. HUGH VINCENT (Incumbent Delegate) Specialty: Anesthesiology Membership: SFMS/CMA/AMA 1972 SFMS: Board Consultant 1993–present, Immediate Past President 1993, President 1992, President-Elect 1991, Director 1982–90 SFMS Committee Appointments: Medical Review and Advisory 1975–present, SFMSPAC Board 1991–96 (Chair 1995–96/Consultant 1997–present), Health Care Foundation of San Francisco Board 1999–2004, Managed Care 1998–2001, Membership Services 1986–89 (Chair 1994–95)/1994–2001, Nominations 1994–95 (Chair 1994–95)/2000–01, Judicial 1993–99, Anesthesia Section Chair 1975–90 CMA: Trustee 1997–2003, Delegate 1991–97 (Chair 1993–96)/2003–08, Alternate Delegate 1985–90 CMA Board Committees: Nominations 1997– 2003, Medical Services 1997–2002, Finance 1999–2003, Bylaws 2001–03 CMA Committee Appointments: Council on Legislation 1996–97, Speaker’s Advisory 1993– 96, Rules 1994–95 (Chair 1995), Solo Practice TAC 1993–94 (Chair), Governance 10-94 TAC 1994, CalPAC Board of Directors 1995–2001 (Executive Committee 1999–2001) AMA: Delegate 1996–2008 (Vice Chair 2000–04, Chair 2004–08); Alternate Delegate 1994–95; Council on Long-Range Planning and Development 2008–12; House Select Oversight

30 San Francisco Medicine october 2008

Committee 2001; Reference Committee C, A-95, I-95, A-01; Cal-C Committee Chair 1995–96; Resolutions Committee 1995–2000 Related Medical Affiliations: Saint Francis Physicians Medical Group/CHW Bay Area Physicians Medical Group 1995–2000 (President/CEO), Saint Francis Memorial Hospital Board of Trustees 1990–96/2000–09 (Secretary 1994–95, Chair 2001–03, Executive Committee 1992–2007), Catholic HealthCare West Bay Area Board of Directors 1996–01, CHW Strategic Planning Committee 2001–05 Medical School: UCSF 1968 Hospital Affiliation: Active: Saint Francis Policy Statement: My purpose in medical politics continues to be to further the agenda and goals of California physicians and their patients. As a Delegate to our CMA House, I take part in the debate of those issues which will go for national action. My involvement in that process gives me deeper understanding of the issues and better ability to successfully promote them at the national level. I ask for your continued support and particularly for your input on issues important to California physicians.

JOSEPH WOO ALSO CANDIDATE FOR NOMINATIONS COMMITTEE See biography under “For Nominations Committee.”

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hospital news Chinese

Joseph Woo, MD

Our thanks to Dr. Dexter Louie for the important work he has been doing to combat obesity. Dr. Louie, an ENT doc by trade, is well known to schools all over the Bay Area for giving talks on obesity, and he was instrumental in eliminating soft drinks in favor of healthier alternatives in those facilities. As many of you know, the California Association of Health Plans and the CMA Foundation have collaborated to create a set of tool kits that address the prevention and effective management of overweight children, adolescents, adults, and bariatric surgery patients. Dr. Louie not only represented the Chinese Community Health Plan but was cochair of this Obesity Tool Kit Expert Panel.

On October 13, Chinese Hospital hosts its Fourteenth Annual Charity Golf Tournament, held at the beautiful Olympic Club in San Francisco. The Olympic Club played host to the U.S. Open in 1955, 1966, 1987, and 1998, and it will host again in 2012. It certainly is a thrill to walk in the footsteps of Jack, Arnold, and Tiger. This event is expected to raise more than half a million dollars to benefit our community and is made possible through the hard work of Cochairs Ed Lee (City Administrator) and Rose Pak. The Chinese Hospital Medical Staff and Board of Trustees are proud to honor Dr. Sum P. Lee at our Thirty-Fifth Annual Award on November 21 at the St. Francis Hotel. Each year the medical staff chooses an honoree who has made a significant contribution to the Chinese community. Dr. Lee is dean of the medical school at the University of Hong Kong and professor of gastroenterology at the University of Washington. As our Education Chair, Dr. Mai-Sie Chan, would say, “This is not just any Lee, it’s Sum Lee!” We are honored to have him, and my thanks to Dr. Chan for securing such a distinguished guest.

Kaiser

Robert Mithun, MD

With the presidential election season upon us, many people are paying more attention to politics at the national, state, and local levels.

While we may be engaged and interested in politics, it is sometimes hard to see how what goes on in Washington, D.C., or Sacramento or our local city hall has to do with medicine.

After all, most of what goes on in politics seems to have little relevance for the practicing physician, right? Well, actually, no.

With the rate of health care inflation outpacing the overall rate of inflation, there is more pressure on employers, purchasers, and policy makers to focus efforts to address the high cost of health care. As we saw in California, policy makers and other stakeholders (including Kaiser Permanente and other health care organizations) engaged in a yearlong process to try and achieve a universal health reform agreement to extend coverage to the uninsured. At the federal level, the leading presidential candidates have articulated broad health reform proposals to address cost and access challenges.

These efforts to address coverage and cost in health care inevitably lead to some very difficult choices about how best to use health care spending. Physicians are often widely perceived to be well paid and therefore inevitably become the targets for cost cutting.

For many reasons, it is important for physicians to be involved in the legislative process and to serve as resources on clinical issues and the economic reality of caring for our patients. Our efforts to reach out to policy makers impact the profession and, ideally, result in more balanced and thoughtful debate.

32 San Francisco Medicine october 2008

Saint Francis

Wade Aubry, MD

Let me begin by recognizing Catholic Healthcare West’s President and CEO Lloyd Dean for being recognized as one of our Nation’s Top 100 Powerful People in Healthcare, as polled by Modern Healthcare weekly news. Mr. Dean joins a long list of prominent and influential people who are changing the face of health care. This year he ranked number fifty-seven, a jump up from number seventy-three in 2007. Mr. Dean can also be credited as a coarchitect in the Healthy San Francisco program, whose goal is to provide 80,000 residents with a medical home to improve quality of care. Last year Mr. Dean and CHW released a “health security index,” which assessed the nation’s public on feelings about health care and health care reforms. Mr. Dean is the current Chairman of the Board of Trustees of the Catholic Health Association.

Here at Saint Francis we are very pleased to announce that our Bothin Burn Center has successfully completed the American Burn Association/ American College of Surgeons requirements for triannual reverification. Our Burn Center remains the only independently verified center in the Bay Area, and this speaks strongly to the commitment and level of care that we provide burn patients.

Congratulations to our Medical Team, including Medical Director Clyde Ikeda, MD; Jeffrey DeWeese, MD; Michael Kulick, MD; and Thomas Harries, MD. In addition to this verification, the American College of Surgeons Commission on Cancer (ACoS) surveyed our Cancer Care Program and we received reaccreditation for another three years. Our program was recognized for commendation in five areas. Thanks and congratulations to Gerald Schall, MD, and John Meyer, MD, for their guidance and leadership. In this election season, with health system reform once again a major issue on the domestic agenda, I would like to recognize Hugh Vincent, MD, longtime medical staff member in the Department of Anesthesia, for his tireless efforts as CMA delegate to the AMA House of Delegates. www.sfms.org

Hospital News St. Mary’s

Richard Podolin, MD

This election season, health care is one of the topics on the hot button list for people across the country. It’s a complex, multifaceted issue worthy of thoughtful conversation and debate. St. Mary’s Medical Center, as a member of Catholic Healthcare West (CHW), is participating in the national debate through CHW’s executive leadership and public policy advocacy. A call for comprehensive health care reform is a primary focus of CHW’s efforts to influence public policy.

At the local level, the Sister Mary Philippa Health Center recently implemented the Healthy San Francisco program. The Center will be a “medical home” for eligible program participants, many of whom already benefit from access to its services. Established in 1923, expanded and dedicated to Sr. Mary Philippa in 1966, the Sr. Mary Philippa Health Center is the clinical expression of St. Mary’s commitment to provide direct services to the poor and disenfranchised.

Another topic in the news lately is palliative care. A study published in the Archives of Internal Medicine (September 8, 2008) found that palliative care programs not only save money but result in better patient care. As a Catholic hospital, St. Mary’s Medical Center has always embraced the spiritual dimension to life. In early 2008, a newly remodeled Palliative Care Room opened, providing patients and their loved ones with kitchen and electronic amenities, a sleeper bed, and a recliner. The Palliative Care Consult Team includes physicians, registered nurses, pharmacists, social workers, specialty therapists, and chaplains who collaborate to provide comprehensive management of the physical, psychological, social, and spiritual needs of patients facing complex and progressive illnesses.

In all endeavors, St. Mary’s Medical Center remains true to its mission to deliver compassionate, high-quality, affordable health services and to partner with the community to improve the quality of life. www.sfms.org

UCSF

Veterans

Elena Gates, MD

Diana Nicoll, MD, PhD, MPA

The majority of general internists and pediatricians are not comfortable serving as primary care providers for young adults with complex chronic illnesses that originate during childhood, a new UCSF and University of Michigan study finds.

Researchers found that the health care these patients receive as children is not necessarily matched in adulthood. Megumi Okumura, MD, lead author of the paper and assistant professor in pediatrics at UCSF, says, “My goal is to improve care for young people with childhood-onset chronic diseases and give them the services they need to have productive lives.”

UCSF Children’s Hospital celebrated children and their families at the thirteenth annual Pediatric Transplant Picnic held late this summer in San Rafael. Attending were about 200 children who have had transplants, children who are awaiting transplants, their families, and their organ donors. The picnic featured a costume contest, music, dancing, face painting, kayaking, and piñatas. UCSF pediatric nurse practitioner Chris Mudge organizes the annual picnic. “It’s like gardening,” says Mudge of pediatric transplantation. “You pull out the weeds that don’t work and then you put in something new that does.”

People who have discussed their end-of-life care wishes with family, friends, and physicians before they are in need of such care are much more likely to have taken the next step of filling out an advance directive, according to a study led by researchers at UCSF and the San Francisco V.A. Medical Center. “Planning for end-of-life care is a process that involves many individual steps, including a lot of thought and discussion,” observes lead author Rebecca Sudore, MD, a staff physician at SFVAMC and an assistant professor of medicine at UCSF. “As physicians and policy makers, we need to do everything we can to facilitate discussions about end-of-life care between patients, family and friends, and physicians.”

Urologic surgeons at the San Francisco V.A. Medical Center (SFVAMC) recently performed a robotic-assisted laparoscopic partial nephrectomy, the first such operation in the city of San Francisco or anywhere in the V.A. health care system.

A partial nephrectomy is the removal of a tumor and repair of the kidney, which allows complete tumor excision and pathologic analysis of the tumor type, grade, and stage. While partial nephrectomy surgery is widely practiced, it’s traditionally performed through a relatively large incision under or next to the ribs, which can result in postoperative pain and a slow recovery.

Laparoscopic partial nephrectomy allows the procedure to be done through small incisions, using special instruments and a video screen. It is technically challenging and not suitable for all small tumors. The SFVAMC surgical team used its vast experience in robotic-assisted laparoscopy and prostate cancer surgery to apply roboticassisted surgical techniques to the procedure.

The team uses a DaVinci robot, requiring only a one-centimeter keyhole incision. This minimally invasive surgery reduces the chance of infection and improves the precision of tumor resection and kidney repair, especially when the tumor is in a location that is challenging to reach with standard laparoscopic instruments.

As more kidney tumors are detected at small sizes due to widespread use of abdominal CT scans and ultrasounds, the hope is that roboticassisted surgery will enable more patients with small kidney tumors to enjoy the faster recovery offered by laparoscopy.

The surgical team included Dr. Badri Konety, the chief of urology at SFVAMC, and Drs. Marc Dall’Era, Matt Cooperberg, and Tom Chi. The surgical nursing team was Arsenio Villarimo, Thelma Vetvitoon, Allyson Kuppens, and Criselda Navarro.

october 2008 San Francisco Medicine 33

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