Fall 2020

C E L E B R AT I N G O U R S TUDENTS’ SUCCESS CMA PPE Relief On the Bright Side Fall 2020

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VOLUME 68, NUMBER 3 • SEPTEMBER 2020

PICTURED ABOVE: PPE VOLUNTEERS POSE FOR THE CAMERA AFTER A LONG DAY.

9 PRESIDENT'S MESSAGE 12 IN THE NEWS 18 CMA PPE RELIEF 28 ON THE BRIGHT SIDE 41 ON THE OTHER SIDE 46 PRACTICE NEWS AND RESOURCES 50 PUBLIC HEALTH UPDATE

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PRESIDENT Hyma Jasti, MD PRESIDENT ELECT Raghunath Reddy, MD TREASURER Cyrus Buhari, DO BOARD MEMBERS Sanjay Marwaha, MD, Shahin Foroutan, MD, Neelesh Bangalore, MD, Philip Cheng, MD, Benjamin Morrison, MD, Maggie Park, MD, Nguyen Vo, MD, Sujeeth Punnam, MD, Richelle Marasigan, DO, John Zeiter, MD

MEDICAL SOCIETY STAFF EXECUTIVE DIRECTOR Lisa Richmond MEMBERSHIP COORDINATOR Jessica Peluso ADMINISTRATIVE ASSISTANT Maria Rodriguez-Cook

SAN JOAQUIN PHYSICIAN MAGAZINE EDITOR Lisa Richmond EDITORIAL COMMITTEE Lisa Richmond, Hyma Jasti, MD MANAGING EDITOR Lisa Richmond CREATIVE DIRECTOR Sherry Lavone Design

COMMITTEE CHAIRPERSONS CMA AFFAIRS COMMITTEE Larry Frank, MD

CONTRIBUTING WRITERS Kimberly Smith, RD, Barb Alberson, MPH. Dawn Custer, MSW, Marisela Pineda, MPH

DECISION MEDICINE Kwabena Adubofour, MD MEDICAL EDUCATION PROGRAMS R. Grant Mellor, MD PUBLIC HEALTH COMMITTEE Maggie Park, MD

THE SAN JOAQUIN PHYSICIAN MAGAZINE is produced by the San Joaquin Medical Society

SCHOLARSHIP LOAN FUND Gregg Jongeward, PhD SUGGESTIONS, story ideas are welcome and will be reviewed

CMA HOUSE OF DELEGATES REPRESENTATIVES

by the Editorial Committee.

Robin Wong, MD, Lawrence R. Frank, MD James R. Halderman, MD, Raissa Hill, DO

PLEASE DIRECT ALL INQUIRIES AND SUBMISSIONS TO:

Richelle Marasigan, DO, Ramin Manshadi, MD

San Joaquin Physician Magazine

Kwabena Adubofour, MD, Philip Edington, MD

3031 W. March Lane, Suite 222W

Harpreet Singh, MD

Stockton, CA 95219 Phone: (209) 952-5299 Fax: (209) 952-5298 E-mail Address: lisa@sjcms.org MEDICAL SOCIETY OFFICE HOURS: Monday through Friday 9:00am to 5:00pm Closed for Lunch between 12pm-1pm

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EXECUTIVE DIRECTOR’S REPORT

CLOSE TO HOME

In early May, my husband, Mark and I no sooner uttered the words “we don’t personally know anyone with COVID” when we learned he had been exposed. As a first responder, he was tested right away; the kids and I soon after. As we awaited our results, we noticed we felt lightheaded and tired. Surely a psychosomatic reaction, we thought. No one would develop symptoms on the very day they were tested after exposure, right? Wrong!

Later that evening I had a fever, headache and chills and, by the next day, we learned we were both positive.

Surprisingly, our teenage children were negative. We quickly isolated in our bedroom, leaving our kids to run the household and take care of us for what felt like the longest 10 days of my life! Upon learning of our positive result, the initial feeling was fear. How would it affect us? Would we be one of those who ended up requiring hospitalization? Living in the same household with my children, but not being able to interact with them, was particularly challenging for this mom.

LISA RICHMOND

The mental anguish caused by COVID was just as bad for us, if not worse than the physical symptoms.

The next 7-10 days were a roller coaster. While Mark only experienced headache, muscle aches and fatigue, I seemed to have every symptom on this list, except shortness of breath (thankfully), including a persistent fever. While lying in bed reflecting on this surreal experience, we realized many things. First and foremost, we wish we had purchased that super comfortable Temperdic mattress we’ve always wanted. Secondly, sharing a TV with your spouse 24/7 comes with its challenges. My husband was about to start the third World War II documentary on Netflix, when one of my SJMS board physicians pointed out that we could be streaming on all our devices (how had I not already thought of this?). Shout out to Dr. Morrison! Turns out a little mindless Bravo TV on my iPad was just what the doctor ordered :) We were grateful for the outpouring of concern from physicians. Each had advice to offer and we took ALL of it! My Amazon account was on fire ordering everything from vitamins/minerals to boost our immune systems to the pulse oximeter suggested by our personal physician, Dr. Tso. It brought us so much peace of mind knowing our oxygen saturation levels and heart rates remained stable. In my opinion, everyone should have one in their household “just in case” during this pandemic.

In the beginning, we felt hesitant to share our experience as we found some people avoided us, afraid we may still be contagious. It was a very isolating feeling. Since then, we have realized it is important to share our story to bring awareness to the prevalence of the virus and so that we can support friends as they navigate the COVID positive path with their families. We have now been recovered for months and have “robust” antibodies, leading us to donate convalescent plasma to help others in need. We feel so lucky to have made it through this experience with relative ease compared to many who have had much more serious battles with COVID-19.

Thank you to our amazing healthcare workers on the frontlines taking care of those critically ill patients every day. We appreciate your unwavering dedication to our community!

Please stay safe and healthy,

Lisa Richmond

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A message from our President > Hyma Jasti, MD

Certainity In Uncertain Times As the coronavirus pandemic continue to impact the humankind, more layers of the crisis are being uncovered. Originally, COVID was thought to impact all population equally, especially the elderly. However, not all people have the resources to access testing, or the time to go to free exiting testing facilities. Perhaps there are issues of trust with a healthcare system in populations that were perceived as failed medical institutions in the past. Multiple health systems like Kaiser Permanente, Community Medical centers, Dignity Health and Public Health are currently working individually to track cases through a COVID ambulatory surveillance program, with risk factors determining level of follow-up and care. Based on this effort, we know that 70% of cases are in communities of color. Most recent census data in San Joaquin County show that our population is about 50% people of color, which show that COVID does not affect the country or the county equally.

Another view of the situation is through an economic lens: COVID is exposing and deepening economic crises. People are losing their jobs or being exposed to the virus at their jobs, and mental health is declining as their anxiety deepening. We already have a wealth of research on how lower SES (Socio Economic Status) affects health outcomes.

It is correlated to increased heart disease, mental health, substance use disorders, and many other problems. There are complex ways and reasons for SES associated to race.

Lack of insurance and health literacy, and now, fear of going to a hospital compound the issues. The economy of the entire world is suffering, and San Joaquin has felt its fair share of the repercussions. The economic instability and uncertainty are most notable for the most vulnerable in society.

ABOUT THE AUTHOR Hyma Jasti, MD is the current president of San Joaquin Medical Society and the Chief of Adult & Family Medicine for the Central Valley Area for The Permanente Medical Group

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So, what can we do as health care professionals to help each one of our patients without judging them? We should ask all our patients these questions consistently: How have you and your family been impacted by COVID? Keep questions open ended: Any changes in income? Any trouble paying for food or rent? Familiarize yourselves with potential answers and resources to offer to those who answer yes to any of these questions. We must continue to strive towards holistic health, because every little thing we do helps our patients and their families. Reinforce the importance of correctly wearing a mask and maintaining social distancing. Reassure them that this too will pass, and that you are on their healthcare team in the meantime. Much is uncertain, but we know that we’re in this together.

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The heroes among us.

As valued partners and dedicated professionals, our health care providers and staff can be relied upon to do their best for our patients every day. But right now, as we manage COVID-19, our people are going above and beyond to ensure we meet the needs of our patients and the safety of our community.

To all our providers and staff, for what you do today and every day, we thank you.

St. Joseph’s Medical Center I St. Joseph’s Behavioral Health Center I Mark Twain Medical Center Dignity Health Medical Foundation

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In The News

IN THE

NEWS

Providing staff, physicians, and patients with relevant & up to date information

honor the previously selected Young Physician and Lifetime Achievement Award recipients, Drs. Philip Cheng and Peter Garbeff on Sunday, June 6, 2021. More details to follow next year.

Richelle Marasigan, DO & Hyma Jasti, MD SJMS Installs New President, Hyma Jasti, MD In July, minus the pomp and circumstance of the usual annual dinner, Richelle Marasigan, DO quietly passed the gavel to Hyma Jasti, MD. Dr. Jasti is the Chief of Adult & Family Medicine for the Central Valley Area for The Permanente Medical Group. She has served on the board since 2018 and is active on the Bridge to Medicine and Decision Medicine committees. This is the first time in the 146-year history, that there have been back to back women presidents. SJMS is grateful to Dr. Marasigan for her service and leadership, particularly as we entered the challenging times of COVID-19 pandemic.

Holiday Party Cancelled Unfortunately, SJMS has cancelled the annual holiday party, which was scheduled in December. They tentatively plan to

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Calling All Mentors!

Do you worry about who will take care of your patients when you retire? Are you looking for a meaningful way to give back to your community? If so, look no further, SJMS is currently recruiting volunteers to join our Bridge to Medicine (BTM) committee. BTM guides high achieving students (high school & college) along their academic journey so that they have the best chance of being accepted to medical school and ultimately return to practice in our community.

The committee is meeting virtually, via Zoom, every other month and consists of physicians (working & retired), alliance members and even a local professor. Most importantly, you don’t need to be an expert! We have committee members with a wide array of skill sets and resources, so you are never alone. For more information please contact Lisa Richmond at 952-5299 or Lisa@sjcms.org.

Michael Schrader, Health Plan of San Joaquin CEO - Leading for ongoing preventative care and COVID-era collaborations When Michael Schrader became CEO in May of 2020, he brought to Health Plan of San Joaquin (HPSJ) over 20 years of extensive managed care executive experience, including Medi-Cal and Medicare for Dual Eligible Individuals (i.e., Dual Eligible Special Needs Plans – or D-SNPs, and

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association of all 16 local, not-for-profit health plans providing access to critical, comprehensive healthcare services for low-income populations enrolled in Medi-Cal. LHPC provides an active platform to share best practices, even more valuable during the pandemic crisis. He also is a board member of the California Association of Health Plans.

CAHP is a statewide association representing 46 public and commercial health plans providing coverage to more than 26 million Californians.

Michael Schrader a combined Medicare and Medicaid plan – in California known as Cal MediConnect). Schrader has a deep, careerspanning commitment to providing access to quality health care for vulnerable communities. Assuming leadership during the unprecedented COVID-19 pandemic, Schrader, who has a track record of supporting employee engagement and career development, has let dedicated HPSJ staff know he appreciates their continuing rise to the occasion – even as most continue to work remotely and without missing a beat – to serve members, providers, and community.

While responsible for continued operations to serve Medi-Cal members and promote their ongoing preventative health care, he and his HPSJ team are working closely with public health officials and local leaders to help keep both HPSJ members and the community safe during the pandemic.

HPSJ COVID-related initiatives range from support for testing and follow-up care for vulnerable homeless and farm worker populations, to extending hospital capacity by adjusting oxygen at home for earlier COVID patients’ discharge. HPSJ is now collaborating with the State to help conceive a possible long-term care benefit at home that could eventually provide another support for HPSJ members and COVID-taxed hospital systems. Ongoing community communication initiatives include the multimedia COVID-19 outreach/education campaign Step Up! Help Restore Our Community, introduced in summer; it continues along with direct and broad communication efforts that leverage public health and community organization efforts.

Schrader also is a leader at the state level. He is chair of Local Health Plans of California (LHPC), the statewide

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On the Road to More Safe Reopening –Well Child Outreach, A Provider/Health Plan of San Joaquin Campaign This is just one of our COVID-era partnerships, here targeted to parents with children at risk due to gaps in immunizations and regular office visits. From HPSJ’s outbound calls, to this bi-lingual mailing encouraging parents to work with their doctor while practicing COVID safety, to support for practices re-orienting for safe reopening – Provider Services Representatives and other HPSJ employees are working closely with practices and clinics as they prepare and maintain their spaces for safe reopening.

This Well Child/Immunizations Campaign will continue into fall, and include outdoor community education, advertising, social media, and messaging for HPSJ members – for example, in the member newsletter (FOCUS) and on the HPSJ member website https://www.hpsj.com/coronavirus/.

STAND Receives $1.8 Million Grant from Dignity Health Homeless Health Initiative Dignity Health recently provided a Homeless Health Initiative Grant to Stocktonians Taking Action to Neutralize Drugs (STAND) for $1.8 million, in partnership with San Joaquin County Whole Person Care (WPC). With this funding, STAND will be able to provide permanent housing for those most in need in our community.

“Dignity Health’s Homeless Health Initiative grant program is an extension of our organization’s long standing commitment to serving those most vulnerable among us, including the unhoused,” said Don Wiley, president and CEO of St. Joseph’s Medical Center. “Through this collaboration between multiple partners, we are able to address both the social support and housing needs in our community, through this sustainable model.”

This grant will enable STAND to build four units

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In The News

IN THE

NEWS

Providing staff, physicians, and patients with relevant & up to date information

New Class of Residents at St. Joseph’s Medical Center on its existing property and to purchase and rehabilitate three additional units to permanently house the homeless.

The seven units will house a minimum of 16 individuals experiencing homelessness.

In addition to the $1.8 million from Dignity Health, WPC will be contributing up to $560,000 to the project.

They will be working with patients that are receiving services and are ready to transition to living independently, to help them obtain tenant and project based vouchers from the Housing Authority of San Joaquin County. The vouchers will cover the cost of monthly rent for each unit, support Dignity Health selected STAND to receive this grant because this project helps both the medically vulnerable population identified by Whole Person Care and creates permanent solutions through shared housing.

St. Joseph’s Behavioral Health Center Offers New Medication Management & Stabilization Services

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St. Joseph’s Behavioral Health Center is now offering a new Outpatient Medication Management Clinic. This new service provides patients with education and counseling regarding psychiatric medications and medication compliance.

Using a holistic approach, St. Joseph’s providers help patients attain the skills necessary to enhance the quality of their lives and achieve and maintain the best possible reduction in symptom severity. Patients will also receive referrals to other programs or providers as appropriate.

Patients can call 209.938.0831 to learn more and register.

St. Joseph’s Welcomes New Class of Residents This summer, St. Joseph’s Medical Center welcomed 35 new residents to its Graduate Medical Education Program. After

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completing a safe and physically distanced orientation, the residents began their first rotations in July.

"With all that we can point to that is troubling in this world, the opportunity to contribute to the education of this diverse and talented group of professionals is both a tremendous responsibility as well as a source of deep joy and inspiration for those of us blessed to be a part of Graduate Medical Education at St. Joseph's Medical Center," said Scott Neeley, MD, Vice President and Chief Medical Officer at St. Joseph’s.

St. Joseph’s launched its Graduate Medical Education Program in 2018 and currently has a total of 70 residents serving in five programs.

St. Joseph’s Hosts COVID-19 Community Webinars St. Joseph’s has started offering monthly webinars to provide information on health topics that are pertinent to the community. These webinars are free and open to all.

In response to the COVID-19 pandemic, the first two webinars have focused on educating the community on COVID-19 prevention and treatment and on encouraging community members to not delay seeking emergent care.

Video recordings of the webinars are available to view at StJosephsCares.org. To be informed of upcoming webinars, please email SJMCinfo@DignityHealth.org.

Dameron Hospital acquires new state-ofthe-art robotic surgical system Dameron Hospital has just acquired the latest da Vinci Xi Robotic Surgical System from Intuitive Surgical, Inc. The da Vinci Surgical System brings the most advanced robotic and computer technology to surgeons and patients in the area. This system enables physicians to perform complex operations through tiny incisions with enhanced precision, dexterity and control, with the benefit of a high-definition, three-dimensional vision system.

“Even during these challenging times, we believe this was an important investment into our community that will give patients access to the highest levels of surgical excellence right here in Stockton,” said Dameron Hospital Board President Bill Trezza. “Increasing healthcare systems’ overall capabilities and capacity to care for patients in our community is something that our board is passionate about.

Bringing Dameron online with robotic surgery was the right

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Tarig Samarkandy, MD & Alan Sabino, MD thing to do during this time of extraordinary community need.”

“This is the most advanced robotic surgery system now available in Stockton,” says Tarig Samarkandy, MD, a Stockton general surgeon who is a fellowship-trained expert in robotic surgery and chair of Dameron’s Robotics Committee. “It enhances our ability to perform minimally invasive procedures on a broader range of patients with different surgical needs. From the patient’s perspective, receiving a minimally invasive procedure results in less postsurgical pain and blood loss, a shorter hospital stay, quicker recovery and faster return to normal daily activities. Our new surgical capabilities at Dameron deliver a real benefit to our community and will enhance the quality of patients’ lives.”

“The addition of the da Vinci System to Dameron Hospital is one component of our strategic plan to make a positive impact on the health of those who live in San Joaquin County and the surrounding areas” says Daniel Wolcott, President of Dameron Hospital and Adventist Health Lodi Memorial Hospital. “We understand the many benefits this will have on our patients’ lives because we have been using this system at Lodi Memorial for the past five years and the results have been excellent. It also provides an attractive option for surgeons with a preference for robotic surgery and this may help us attract more medical expertise to the area.”

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In The News

IN THE

NEWS Bader Ghalyoun, MD, joins Pacific Heart and Vascular as new Interventional Cardiologist Bader Ghalyoun, MD, recently joined Pacific Heart and Vascular (a service of Dameron Hospital) as its new Interventional Cardiologist. With close to 20 years of experience, Dr. Ghalyoun focuses his practice in the areas of cardiac catheterization, Echocardiography, Electrocardiography, and Nuclear Cardiology. Dr. Ghalyoun is a graduate of the University of Jordan School of Medicine in Amman, Jordan. He held his internal medicine residency at the Mount Sinai School of Medicine, Saint Joseph’s Medical Center, in Paterson, New Jersey, where he also conducted his general cardiology and interventional cardiology fellowships.

Following his fellowships, Dr. Ghalyoun worked as a hospitalist for Three Rivers Hospital in Grants Pass, Oregon; Camden Clark Medical Center, in Parkersburg, West Virginia; and the Charleston Area Medical Center in Charleston, West Virginia. He has authored numerous research publications, holds many professional memberships and is board certified by the American Board of Internal Medicine.

Providing staff, physicians, and patients with relevant & up to date information

Bader Ghalyoun, MD

HAVE SOMETHING TO SHARE? Send your files to lisa@sjcms.org one month prior to publication (February 1st for the Fall issue, May 1st for the Fall issue, August 1st for the Fall issue and November 1st for the Fall issue).

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PPE RELIEF

CMA DISTRIBUTES T WO - MONTH S U P P LY O F F R E E P P E T O M O R E THAN 40K C ALIFORNIA PHYSICIANS

BY JACO B GR EENS T EI N

Since the onset of the COVID-19 pandemic, lack of personal protective equipment (PPE) has compounded the hardships for medical practices and hindered their ability to provide care for Californians. To alleviate the strain on practices and improve patient access to care, the California Medical Association (CMA) mobilized with its local county medical societies, the state of California and Altais to bring more than 45 million pieces of PPE— including medical-grade masks, gloves and gowns— to physicians free of charge, so that they can safely provide care for California residents.

From the beginning, the need was urgent, and the demand was clear. CMA jumped into action, reaching out to California’s Office of Emergency Services to see what it would take to quickly get PPE into the hands of physicians. >>

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The result was an unprecedented project— in both scale and complexity—requiring an exceptional level of logistical planning, execution and collaboration between CMA, local county medical societies and several logistical partners.

This was an entirely new operation for CMA, setting up a statewide distribution system for essential equipment that the state of California was struggling to get into the hands of physicians who desperately needed it. The CMA team, led by Mike Steenburgh— vice president of membership, marketing and component relations—got to work, rallying county medical societies and reaching out to Pride Industries, a Roseville-based non-profit that specializes in supply-chain management.

Together, they established a statewide distribution network that took materials

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from state warehouses, repackaged them

societies embarked on a three-week-long series

into individual kits for medical practices and

of traveling distribution events to put PPE

loaded the material on trucks to be distributed

directly into the hands of physicians across the

at dozens of drive-through events across the

state.

state—sponsored by health care services company Altais.

The demand for the product was

On Monday, July 27, 2020, the PPE distribution events kicked off at the Rose Bowl in Pasadena. Staff arrived just after sunrise

overwhelming. Within days of reaching out

to scope out, plan and unload the dozens of

to physicians across the state, nearly 10,000

pallets of PPE and equipment necessary to

small and medium-sized physician practices

ensure a safe and effective drive-through event.

signed up to secure free PPE. To fulfill these

Soon after, volunteers began to arrive onsite to

requests, CMA and its component medical

help complete set up. Hours before the events

an affiliate of

We’re delivering the same comprehensive medical and social care to seniors – remotely, in their homes.

THOUGH THE WORLD HAS CHANGED, our commitment to the health and well-being of our participants has never been stronger. We’ve rapidly shifted to a model of care we’re calling HomePACE, deploying 4G LTE tablets to all participants to help them stay connected to our medical team and stay engaged through games and social activities.

When in-person care is required, it’s done by a single caregiver in the home whenever possible, minimizing potential exposures to Covid-19.

We continue to enroll new participants, helping keep seniors healthy and thriving while also physically distanced to prevent the spread of the virus.

For more information about our program, visit stocktonpace.com.

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even began, cars started lining up by the dozens as physicians who

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had been up against

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insurmountable supply chain issues could hardly believe there would be enough PPE

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to fulfill the need.

Each box distributed included 1,600 nitrile

out at drive-through distribution events, and

examination gloves, 320 N95 respirators,

more than 6,600 boxes were directly shipped to

90 isolation gowns, 40 face shields and 800

practices who needed equipment but could not

surgical masks. In addition to a box of PPE,

attend their local events.

physicians were given a 20-bottle case of 500ml hand sanitizers, when available.

Although the thousands of PPE kits will

Event teams worked tirelessly in an assembly-line fashion checking reservations, guiding traffic, loading PPE and thanking

not permanently solve PPE issues for medical

physicians for their hard work. At roughly 45

practices, the infusion of a roughly two-

lb. for a box of PPE, volunteers loaded nearly

month supply of masks, gloves and gowns was

half a million pounds into physicians’ cars over

welcome relief for thousands of physicians who

three weeks, sometimes loading for a near full

simply could not secure the equipment they

eight-hour day in 100+ degree weather.

needed through traditional channels.

Between July 27 and August 13, CMA and

When asked what this means to them, time and time again physicians relayed the hardship

county society staff and hundreds of volunteers

of trying to scour the internet for PPE,

from networks of friends, family, and local

often paying exorbitant prices for miniscule

schools and universities came together to

amounts, if they can even find it, just to keep

execute a campaign that had a profound impact

enough on hand to stay open on a day-to-day

on physicians and patients across the state.

basis. “Amazing,” “necessary” and “grateful”

Nearly 10,000 boxes of PPE were handed

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were among the words that resounded from

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event to event.

The San Joaquin Medical Society held their drive-through pick up event on August 7 at the

safely provide care to the residents of their communities.

Upon receiving the box of PPE for his

Health Plan of San Joaquin with assistance of

office, Dr. Kwabena Adubofour said “what

volunteers from HSPJ, St. Mary’s High School,

an amazing display of unfettered support

the San Joaquin County Sheriff’s Cadet and

for the clinicians of this community. A huge

Decision Medicine programs. Together,

thank you to the staff of the San Joaquin

they distributed 200 boxes of PPE, reaching

Medical Society and the California Medical

over 150 practices in their service areas of

Association for getting these much-needed

San Joaquin, Alpine, Amador and Calaveras

items signed, sealed and delivered to us. Now

counties. That means $1,000,000 worth of

let’s go stomp out COVID-19 and push back

PPE was given to local physicians, at no charge

pestilence.”

to them, to jumpstart and restart efforts to

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CMA and its component medical societies

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BECOME A MEMBER OF SJMS/CMA

Here are just some of the benefits ...

San Joaquin Medical Society Resources: • Annual Directory • Quarterly Magazine • • • •

Social Events Office Managers Forum Leadership Opportunities Patient Referrals

CMA Resources: • • • • • •

Legal Help Contract Analysis Billing Assistance Education Resources News Updates Practice Resources

• Member Discounts

Federal, State, and Local Advocacy: Dues support advocacy efforts to protect the profession of medicine and your patients

Serving the counties of San Joaquin, Calaveras, Alpine, and Amador

(209) 952-5299 www.sjcms.org 26

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continue to advocate for more resources for our state’s physicians.

“To say that physicians and health

P P E R E L I E F AT A GL ANCE

care are essential at this time is an

E V E N T S : 3 6 o v e r 15 d a y s

understatement, and PPE is an essential

PR AC TICE S RE ACHE D:

part of their ability to administer care,”

14 ,9 4 2

said CMA President Peter N. Bretan,

BOX E S DI S TRI B UTE D:

Jr., M.D. “CMA and its county medical societies are proud to work with the state to ensure that physicians of California can keep their practices open, and keep themselves and their patients safe.”

CMA and its component medical societies remain committed to distributing PPE across the state.

Remaining surplus is being shared with medical groups who did not qualify under the parameters of the initial program—which was limited to practices with fewer than 50 providers— and are struggling with securing adequate PPE supplies or experiencing

15 ,7 9 8

9,12 0 i n p e r s o n 6 , 678 b y m a i l

PPE DISTRIBUTED: 45,024,300 pieces

2 5 , 2 76 , 8 0 0 E x a m i n a t i o n Gloves

5,055, 360 N95 Respir ator s 1, 4 2 1, 8 2 0 I s o l a t i o n G o w n s 6 31,9 2 0 F a c e S h i e l d s

12 , 6 3 8 , 4 0 0 S u r g i c a l M a s k s ITE M S PE R BOX: 1, 6 0 0 n i t r i l e e x a m i n a t i o n gloves

320 N95 r espir ator s 90 isolation gowns 40 face shields

financial hardship because of the

800 surgical masks

increasing costs of PPE. Interested

VA L U E O F P P E

groups can contact CMA at

DISTRIBUTED:

memberservices@cmadocs.org to learn

T O TA L : ~$ 8 0 , 57 0 , 0 0 0

more.

P E R B O X : ~$ 5 , 0 0 0 I N DI V I DUA L BOX WE IG HT: 45 pounds

V O L U N T E E R S : 10 0 0 +

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ON THE BRIGHT S I DE C E L E B R AT I N G O U R S TUDENTS’ SUCCESS

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2020 HA S BEEN FULL OF VERY SERIOUS C H A L L E N G E S F O R O U R C O M M U N I T Y. E V E R YO N E I S L E A R N I N G T O A D A P T A N D O V E R C O M E T H E O B S TA C L E S P R E S E N T E D B Y C O V I D -19. yet to track down but have made a lot of progress! Currently, there are 19 students in medical school, 3 in residency and 1 practicing physician with another 230+ undergrads with science majors. Additionally, students have pursued ancillary health careers such as nursing, physical therapy and dentistry, which also expands access to quality healthcare for our community.

Health Plan of San Joaquin (HPSJ) has been a long-time supporter of the Decision Medicine program. Several years ago, they began to offer a scholarship to alumni of the program, which later grew to two recipients.

This year due to the cancellation of DM and their unwavering commitment to the program, HPSJ leadership elected to award an unprecedented number of scholarships totaling $24,000! All 12 student applicants were awarded a scholarship of either $3000 (HPSJ Health Careers Awardees) or $1,000 (HPSJ Extended Program Honorees).

HPSJ Chief Medical Officer Lakshmi Dhanvanthari, MD, said: “We believe that during this pandemic it is even more essential to offer tangible support and encouragement to nurture this next generation of healthcare professionals. Beyond these important financial resources, the six awardees receiving the full $3,000 scholarship will also have the benefit of a personal mentor from our professional HPSJ staff. The HPSJ mentors are eager to continue this program we started several years ago.”

As always, those who apply for the HPSJ Scholarship are also considered for SJMS’ Rick Halligan Memorial Scholarship, which was established in 2017 in memory of one of our most passionate volunteers. Rick was a Diagnostic Imaging Supervisor at San Joaquin General Hospital and served

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ON T H E B R I G HT S I D E

2020 has been full of very serious challenges for our community. Everyone is learning to adapt and overcome the obstacles presented by COVID-19.

At SJMS, we are passionate about “growing our own physicians “which is ref lected in our various programming including Decision Medicine, Bridge to Medicine and Scholarship Loan Fund. As mentioned in the last issue, Decision Medicine was yet another (temporary) casualty of the pandemic.

While we miss the students, we thought this was a perfect opportunity to brighten your day by highlighting their successes!

On an annual basis, we conduct a survey of past alumni of Decision Medicine via email and social media. We know there are many we have

“ D e c i s i o n Medicine strengthened my decision to become a physician, but more importantly to come back to San Joaquin Count y to give back to the communit y” SANAH NASSIMI

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Extraordinary

Grateful Empowering Inspirational Family

Unforgettable Inspiring

Transformative

Awe-inspiring

Awesome

as a site coordinator for the program. Inspired by HPSJ’s offered annually renewable educational loans (1-2 per year) generosity, SJMS followed suit by awarding six $1,000 for local students accepted into U.S.-accredited programs scholarships this year. leading to licensure as a Physician, Registered Nurse, Our Bridge to Medicine (BTM) mentoring program Nurse Practitioner or Physician Assistant. Recognizing continues to grow and the response from students illustrates the tremendous need for physicians in our community, the there is a great demand for our services. BTM “ M y b i g g e s t t a k e a w a y f r o m D e c i s i o n M e d i c i n e w a s guides high that no mat ter what, reaching my dreams is possible achieving students as long as I have the passion and the determination (high school & t o g e t t h e r e ” N A D I N E KO O C H O U college) along their academic journey so that they have the best chance of being admitted to medical Scholarship Loan Fund provides incentives to physician loan school and ultimately return to practice in our community. recipients who return to any of our service areas (Alpine, Currently, there are 70+ students being mentored by 15 Amador, Calaveras and San Joaquin counties) to practice. physicians, alliance members and a local college professor.

We invite you to learn more about all of these programs We are excited to announce we had two students accepted by visiting www.sjcms.org/programs. If you are interested to medical school this year! The committee celebrated by in serving as a volunteer mentor for Bridge to Medicine or gifting them their first stethoscope. would like more information, please contact Lisa Richmond For 58 years, SJMS’ Scholarship Loan Fund program has at Lisa@sjcms.org.

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ON T H E B R I G HT S I D E

C O N G R AT U L AT I O N S T O O U R 2 0 2 0 D M A L U M N I G R A D U AT E S !

A D R I A N A M O N R OY B i o l o g y UCL A

ALONDR A C AMARENA

Integrated Biology UC Berkeley HPSJ Health Career Scholarship FALL 2020

A N T H O N Y YA P Biology UC Davis

A R I A N A C H AV E Z

Biology San Joaquin Delta College SAN JOAQUIN PHYSICIAN

31

ARLEN SANCHEZ

A S H L E Y R I VA S

ASHLET VILL A

AQ SA NORE E N

Public Health UC Berkeley HPSJ Ex tended Program Scholarship Rick Halligan Memorial Scholarship

Life Sciences UC Davis

Biological Sciences UC Davis HPSJ Ex tended Program Scholarship Rick Halligan Memorial Scholarship

Data Science / Pre-Med University of San Francisco HPSJ Ex tended Program Scholarship Rick Halligan Memorial Scholarship

ON T H E B R I G HT S I D E

C H A LY N VA L D E Z

D I E G O V I L L A N U E VA

CHRISTIAN L ABASAN

I SA B E L A OR TEG A OCHOA

Psychology U C L A HPSJ Health Career Scholarship

Biological Anthropology UC Davis

Global Disease Biology UC Davis HPSJ Ex tended Program Scholarship Rick Halligan Memorial Scholarship

Global Disease Biology UC Davis HPSJ Health Career Scholarship

I YO N N A J A C K S O N

KIANA MIK AMI

K E E LY KO S I E R

LUMIN OO

Nursing San Joaquin Delta College

Child & Adolescent Development San Francisco State University HPSJ Ex tended Program Scholarship Rick Halligan Memorial Scholarship 34

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Biology UCL A

Business Administration UC Ir vine

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ON T H E B R I G HT S I D E

MALIHA SHAHZAD

S A FA H A N D S A N A H N A S S I M I

N A D I N E KO O C H O U

SA RISH A JACOBS

Biological Sciences UC Davis HPSJ Health Career Scholarship

Biology Santa Clara University HPSJ Ex tended Program Scholarship Rick Halligan Memorial Scholarship FALL 2020

N e u r o b i o l o g y, P h y s i o l o g y & Behavior UC Davis

Pre-Human Biology & Society UCL A HPSJ Health Career Scholarship

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NOT PIC TURED AMIR BROOKS

Kinesiology Santa Barbara City College

J O N AT H A N Y E P I Z Pre-Nursing CSU Stanislaus

V I A N DA N GU Y E N

Biology Stanford University HPSJ Health Career Scholarship

“ I t a l l o w e d m e a g l i m p s e i n t o w h a t m y l i f e w o u l d l o o k like in the medical f ield and reaf f irmed that I want a c a r e e r i n m e d i c i n e ” A R I A N A C H AV E Z

MEDICAL SCHOOL ADMISSIONS

OLGA FRIAZ

College of Osteopathic Medicine Wes tern Univer sit y of Health Sciences De c i s io n M e dic in e 20 07

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C A R O LY N R I E B E R

Albany Medical College Scholar ship Loan Fund Bridge to Medicine M e n t o r : R . G r a n t M e l l o r, M D

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ON T H E B R I G HT S I D E

MARISSA REYES

UC Davis School of Medicine Scholar ship Loan Fund Bridge to Medicine M e n t o r : J o h n Z e i t e r, M D

R E S I D E N C Y M AT C H E S

VA N E S S A A R M E N D A R I Z , M D

KELSEY MILL AR, MD

D AV I D A R A I Z A , M D

PRECIOUS FORTES, MD

Sut ter Santa Rosa Family Medicine Program Decision Medicine 2005 Scholar ship Loan Fund

San Joaquin General Hospital Family Medicine Program Scholar ship Loan Fund

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UC Davis Or thopedic Surger y Program Scholar ship Loan Fund

UCL A Pathology Program Scholar ship Loan Fund

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Throughout the COVID-19 pandemic, providers have risen to the challenge, working to aid families and individuals who are experiencing hardships. Thank you for your innovation and commitment to support the health and well-being of our community!

888.936.PLAN (7526) | www.hpsj.com/COVID19 38

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WELCOME OUR NEW

CARDIOLOGIST

DR. MUHAMMAD CHOUDHRY “I aim to provide compassionate and comprehensive cardiovascular care to my patients as I would want for myself and my family members.” -Dr. Choudhry DR. CHOUDHRY’S BIO Dr. Choudhry graduated from All ama Iqbal Medical College in Lahore, Pakistan. He did his Internal Medi ci ne resi dency at Marshfield Clinic. After his residency he joined Indiana University as a Cardi ac Hospi talis t. Whil e there he worked extensively with pi oneers in the field of cardiovasc ul ar researc h. His path forward brought him to the University of Texas Medical Branc h (UTMB) where he s uccessfully completed his General Cardiology, Interventional Cardiology and Adv anced Heart Fail ure and Transplant fel lowship whil e also s erving as the Chi ef Interventional Cardi ol ogy fell ow. He has si nce earned medi cal li censes in Wisconsin, Indiana, Texas and Cali fornia. Dr. Choudhry is happily married and enjoys rai si ng their two daughters.

BOARD CERTIFICATIONS     

AMERICAN BOARD OF INTERNAL MEDICINE AMERICAN BOARD OF INTERNAL MEDICINE – CARDIOVASCULAR DISEASES NATIONAL BOARD OF ECHOCARDIOGRAPHY, SPECIAL COMPETENCE IN ADULT ECHOCARDIOGRAPHY (ASCeXAMI) REGISTERED PHYSICIAN IN VASCULAR INTERPRETATION (RPVI) CERTIFICATION BOARD OF NUCLEAR CARDIOLOGY (CBNC) Schedule an appointment today!

(209) 464 -7681

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Supporting Health Care Workers Serving on the COVID-19 Front Lines The emotional stress of responding to patients during the COVID-19 pandemic puts the personal and emotional health of front line health care workers at exceptional risk. To provide relief and help alleviate burnout, the California Medical Association (CMA) Wellness Program (CMA Wellness) has launched the Care 4 Caregivers Now program, connecting front line caregivers with a trained peer coach offering remote and confidential sessions at no cost.

SIGN UP TO RECEIVE COACHING If you are a health care worker in constant worry of COVID-19 infection, currently separated from your family, or facing any other emotional difficulty at this time, we invite you to schedule a confidential peer coaching session at no cost. +

Eligible caregivers include, physicians, physician assistants, nurses, nurse practitioners and respiratory therapists

+

There is no cost, and you may receive coaching for up to 30 days

+

Coaching sessions are confidential and conducted remotely via videoconference; access to a computer or smart phone is necessary

While not a substitute for therapy or medical care, your peer coach understands the rigors of the profession and can offer guidance, mentorship and emotional support. Coaches hold space to listen to your concerns. Their goal is to help you feel heard, understood and become more aware of your options.

VOLUNTEER TO BECOME A COACH Care 4 Caregivers Now provides physicians (M.D. and D.O.) and nurses, including those who are recently retired, the opportunity to lend their unique expertise during these unprecedented times. Coaching services are conducted remotely and not considered practicing medicine. All interested volunteers should have: +

Four hours for training, which includes on-demand videos and 90-minute live/small group training session

+

Access to computer audio/video and sufficient broadband (CMA Wellness supplies a Zoom account)

+

At least 4 hours/week for remote coaching and mastermind sessions to share best practices and receive ongoing support

+

Passion for supporting fellow health care providers

+

Compassion, empathy, patience and strong listening skills.

Sign up to receive coaching, or to volunteer as a coach at: Care4CaregiversNow.org.

cmadocs.org/care4caregivers z

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CMAwellness@cmadocs.org (800) 241-2466 FALL 2020

ON THE OTHER SIDE KIMBERLEY YESCAS GARIBAY, MD RESIDENT, INTERNAL MEDICINE PROGRAM SAN JOAQUIN GENERAL HOSPITAL

On March 29, 2020, Mr. N,a 32-year-old man with a history of mild seasonal asthma, came to our emergency room with symptoms of cough and shortness of breath. He thought it was just another asthma exacerbation and expected a short ED visit. However, concerned doctors and nurses, fully protected with face masks, shields and gowns, rushed in to care for him. His short visit to the ED turned into an isolation stay at the hospital where his family would not be allowed to visit him.

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taking care of his dad, bringing food and medications to his sick father, who lived just a few blocks away, without knowing that the dad already had the virus.

In the emergency department, his vital signs were concerning. His imaging studies and laboratory finding confirmed our suspicion for COVID-19 infection. Twelve hours after his arrival, despite aggressive respiratory support, it was becoming harder for him to breathe. By the early morning hours of March 30, Mr. N's oxygenation was so precarious that intubation was unavoidable. He was moved to the ICU where I was the primary ICU resident physician.

As I was discussing the need for intubation, I could see the fear in his eyes, the worry of what was to come. He felt anxious, scared and lonely. Mr. N, with tears in his eyes, spoke over the phone with his wife, AS I WAS DISCUSSING THE NEED praying together and sharing goodbyes.

We knew that mortality would be high FOR INTUBATION, I COULD SEE once intubated with COVID infection.

THE FEAR IN HIS EYES, THE However, I had to let him know that I WORRY OF WHAT WAS TO COME. would do my best to help him come out of it. I know that my ICU patients have to HE FELT ANXIOUS, SCARED AND rely on us, doctors and nurses, to give our LONELY. best to save their lives. That trust might provide him with very little relief, but it was the only hope he had.

He did not know then how long he would have to stay, or if he would leave alive. He called his wife to let her know During his first 24 hours in the ICU, his condition was about it. Would he be able to see her again? Would his deteriorating. There is no known cure for COVID-19. family ever see him again?

Based on the best practices at the time, he was given an experimental treatment with antivirals and continued When Mr. N presented, the concern of COVID-19 on supportive care. During his stay in the ICU, his wife infection was imminent. He had contact with his sick was in frequent communication with me. I did my best to father who was later diagnosed with COVID-19. He was

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keep her updated, knowing that she took some comfort in keeping up with her husband’s condition, the ups and downs. She was not allowed to be by his side.

She was not even allowed to see him. As a wife myself, I can only imagine how harrowing the situation was for her.

THE DAY AFTER THE EXTUBATION LOOKED BRIGHTER THAN ANY OTHER DAYS IN HIS LIFE. THE NEWS OF BEING ALIVE AND THE OPPORTUNITY TO BE WITH HIS FAMILY AGAIN WERE

After being on the ventilator for 8 long days, his condition finally started to improve, and he was successfully extubated. When Mr. N was removed from the ventilator, it was a day of celebration in the ICU ward. One more battle won against the virus and a gift of life for him and his family. On that day, he became a COVID -19 survivor. He joined the club that all COVID patients wish to be part of.

Mr. N and his family went through the unimaginable.

They faced the uncertainty day by day and sometimes hour by hour, yet his body kept on fighting. Maybe it was his young age, his desire to live and his faith that kept him going.

Later, Mr. N shared his experience with me. With misty eyes and quivering voice, he told me that before his intubation, “I was a little scared. I thought about my kids, my wife. My wife only works part time and I work full time. My family still needs me. So, I surrendered to God and put myself in his hands.”

PRICELESS. remembered seeing his wife at his bedside giving him smiles and strength to keep fighting. That was never the case. His wife was at home throughout his hospital stay, on her own quarantine, and she could not have visited him. Maybe it was their love for each other that gave him comforting visions and strength to carry on.

The day after the extubation looked brighter than any other days in his life. The news of being alive and the opportunity to be with his family again were priceless.

It was a life changing experience for Mr N and also for me as a doctor in training. He had the feeling as if he was being born again. He had a new purpose “to be even closer to my wife, his children, his parents and to God”. *Disclaimer: All information used in this article was obtained with patient’s authorization.

Do you have a poem, essay or other creative writing to share? Please submit to Lisa@sjcms.org.

While intubated, he went in and out of consciousness.

In one of the days when he was not sedated, he

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The

REMEDY for all your

Financial

NEEDS

As a member of the San Joaquin Medical Association, you’re privy to an exclusive benefit—Financial Center Credit Union membership for you and your staff !

In a time when the safety and soundness of funds is at the forefront of everyone’s minds, Financial Center membership is the perfect prescription for peace-of-mind. Voted Best Of San Joaquin, Financial Center is the most trusted credit union in the Valley. Time and time again, we offer our members the lowest rates on their loans as well as the safest place to save their money.

Follow the doctor’s orders and call us today. And don’t forget to pass this message onto your staff – they (and their wallets!) will thank you.

209-948-6024

•

www.fccuburt.org Federally insured by the NCUA.

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Practice News and Resources Free to SJMS/CMA Members!

The Office Managers Forum empowers physicians and their medical staff with valuable tools via expert led educations sessions from industry professionals who are committed to delivering quality healthcare. This monthly forum is held on the second Wednesday of the month from 11am- 1pm at Papapavlo’s Bistro in Stockton and includes lunch. Attendance is always FREE to our members. Nonmembers are welcome may attend one session free to experience one of the quality benefits of SJMS membership ($35 thereafter). Registration is required.

For more information or to be added to the mailing list, please contact Jessica Peluso, Membership Coordinator at Jessica@sjcms.org or (209) 952-5299

The Office Managers Forum empowers physicians and their medical staff with valuable tools via expert led educations sessions from industry professionals who are committed to delivering quality healthcare. For the time being, we will be offering Zoom Meetings until we can get back to meeting in person. This monthly forum is held on the second Wednesday of the month. Registration is required!

If you don’t receive a monthly invitation via E-Mail, please email Jessica@sjcms.org for the Zoom call info!

September 9th, 2020: 12:00PM to 1:30PM

COVID-19 Leaves of Absence The Families First Coronavirus Relief Act (FFCRA) provides for paid leave for employees unable to work due to COVID-19. This webinar will address the details of the leave available under the FFCRA and how it interacts with other leave protections on California. The webinar will cover: - The FFCRA and its exceptions - Califor nia Paid Sick Leave - FMLA and CFRA Leave - Disability accommodations under the FEHA and ADA - Califor nia School Activities Leave - Hypothetical examples of how to apply the laws

Presented by Jamie Bossuat, employment lawyer and shareholder at Kroloff Law Firm.

October 14th, 2020: 12:00PM to 1:30PM

Dangers of the Dark Web: What you need to know to keep you company safe Are your company’s digital credentials for sale?

Large companies are not the only ones who are subject to data breaches; businesses of any size and even individuals can fall victim to hackers. Cyber-attacks continue to grow in cost, size, and impact – causing 60% of SMBs to go out of business within 6 months of a cyber incident. Over 80% of data breaches leverage stolen passwords as the principal attack vector – often acquired on the Dark Web.

Register for our can’t-miss webinar, “Dangers of the Dark Web,” to lear n about cybersecurity best practices to protect your business without breaking the bank.

During

this interactive webinar you will lear n: • What the Dark Web is and why it matters to your business • How digital credentials are compromised • What attackers can do with this information • Real-world examples (Yes, it can happen to anyone) • Steps you can take to protect your company.

Special Offer!

All attendees will receive a free Dark Web ID Scan to uncover exposed credentials!

Presented by Mark Williams, CEO Crown Enterprises

CMA Practice Resources UnitedHealthcare updates its medical policy documentation requirements UnitedHealthcare (UHC) recently updated its Medical and Drug Policies and Coverage Determination Guidelines for UnitedHealthcare Commercial Plans to include updated documentation requirements and clinical coverage criteria effective for dates of service on or after August 1, 2020. Per the FAQ, UHC will now require the submission of images as part of the prior authorization process for the following services.

Surgical Treatment for Spine Pain Knee Replacement Surgery (Arthroplasty), Total and Partial Total Artificial Disc Replacement for the Spine Hip Resurfacing and Replacement Surgery (Arthroplasty) Functional Endoscopic Sinus Surgery (FESS) Balloon Sinus Ostial Dilation Surgical and Ablative Procedures for Venous Insufficiency and Varicose Veins Shoulder Replacement Surgery (Arthroplasty) Skin and Soft Tissue Substitutes UHC has advised that the update to imaging requirements varies by policy and is not necessarily limited to the policies listed above. For specific directions on how to upload images to UHC see the FAQ. Physicians should refer to the applicable UHC medical policies or the Medical Record Requirements for Pre-Service Reviews to determine if an unlisted policy requires image submission.

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Providers who have questions or need further clarification should contact the Provider Services number on the back of the patient’s UnitedHealthcare ID card or UHC Network Management at (866) 574-6088.

UnitedHealthcare moving exclusively to electronic payments The Califor nia Medical Association (CMA) has lear ned that UnitedHealthcare (UHC) is in the process of discontinuing physician payments via paper checks and will instead require both contracted and non-contracted physicians to receive payment via automated clearinghouse (ACH)/ direct deposit or through virtual credit card payments.

The change, first communicated in UHC’s March 2020 Network Bulletin, was originally planned to be rolled out in phases beginning in mid-2020. Due to the COVID-19 pandemic, the rollout of the program was delayed.

UHC has since announced in its August 2020 Network Bulletin that the program will move forward with a phased rollout beginning with its commercial line of business starting in August 2020. UHC Medicare Advantage and Community and State (Medicaid) Plans will follow with rollouts slated for fall 2020 and early 2021.

UHC will be publicizing the change to both contracted and noncontracted physicians, who will be directed to sign up for ACH/direct deposit through Optum Pay or via the UHCprovider.com/ payment website. Physicians who do not elect to sign up for ACH/direct deposit will automatically be signed up to receive virtual credit card payments in place of paper checks.

Physicians with questions or concerns, or that need to request a hardship exemption from this policy, should contact their UHC Provider Service Advocate or UHC at (877) 842-3210 for more information.

What is a virtual credit card?

With the virtual credit card (VCC) payment method, payors send credit card payment information and instructions to physicians, who process the payments using standard credit card technology.

This method is beneficial to payors, but costly for physicians. Health plans often receive cashback incentives from credit card companies for VCC transactions. Meanwhile, VCC payments are subject to transaction and interchange fees, which are bor ne by the physician practice and can run as high as 5%per transaction for physician practices. Physicians can avoid these interchange fees by enrolling in ACH/direct deposit.

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Public Health

Update

A Day in the Life at PHS: Managing COVID-19

BY KIMBERLY SMITH, RD, BARB ALBERSON, MPH, DAWN CUSTER, MSW, AND MARISELA PINEDA, MPH

In March 2020, public health departments nationwide were thrust into emergency response efforts to mitigate the potential spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), responsible for causing the coronavirus disease, COVID-19. In San Joaquin County, Public Health Services (PHS) immediately activated its Department Operations Center (DOC) that, according to the County’s Emergency Operations Plan, “. . . enables PHS to manage its response to any local health emergency or disaster, while maintaining essential public health services to the community at-large. Overarching goals are to protect the health of the population, reduce or minimize illness, injury and death, and to ensure a timely recovery from all-health hazards and surge across the whole community.”

For PHS, managing COVID-19 began with public awareness. We provided information through press releases, social media, and the Department’s website (www.sjcphs.org ) with guidances on preventing the spread of COVID-19, including defining symptoms, listing testing sites, and sharing the Orders of the San Joaquin County Public Health Officer. PHS DOC staff also spent many hours answering an influx of calls from all sectors asking about safety measures and what to do if exposed or experiencing symptoms. Risk Communication has proven to be a critical component from the start, providing health alerts as well as responses to inquiries by the media, and the provision of videos and presentations in English/Spanish tailored to the audience (e.g., for migrant agricultural workers). PHS works closely with the Office of Emergency Services (OES) on the media inquiries, coordinating the dissemination of messages, and in identifying other ways to keep the public informed. Social media continues to be an important channel of communication: by the end of July, Facebook, Twitter and Instagram = 1,175 posts and 2,871,272 impressions.

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From the get-go, local physicians have played a critical role in supporting these response efforts, fielding many of their own calls, as well as testing and counseling patients on how to stay safe. Often, the missing link has been the ability to share the series of events that occur once someone is tested. What follows should help physicians in explaining the role of the public health department and what patients can expect when they test positive.

What happens after someone is tested?

The first step is having specimens analyzed. Most specimens go to commercial laboratories but many also come to the PHS Laboratory, which is a California State and Federally certified facility. The PHS lab operates seven days a week and has been processing COVID-19 specimens from our County as well as the eight additional counties we serve (Alpine, Amador, Calaveras, Mariposa, Merced, Mono, Stanislaus, and Tuolumne). The outside labs are required to notify PHS of test results.

Collecting Epidemiological data (EPI) Once test results are known—notwithstanding what laboratory did the analysis—PHS’ Epidemiology (EPI) staff oversee data entry into CalREDIE, which is a statewide reporting system that is used to track test results and

FALL 2020

subsequent follow up. The EPI team compiles, deciphers, and reports statistics daily, communicating to the public through the SJC COVID-19 Data Dashboard located on the PHS website.

Public Health Follows Up Positive Results When a test is positive for COVID-19, Case Investigation and Contact Tracing are the next steps in the process in supporting individuals with suspected or confirmed infection. The goal is to determine if additional community members are at risk, who they are, and notifying them of the exposure. Priority is given to nursing home outbreaks and clusters in workplaces.

By finding spread patterns quickly, it can slow infection and help avoid outbreaks, maintaining hospital capacity and opening the way to safely reopen businesses. (California Connected: https://COVID19.ca.gov/contact-tracing/ )

Case Investigation In Case Investigation, public health staff direct individuals if they need to be on isolation and for how long. They also work with them to recall everyone with whom they have had close contact during the timeframe when they are infectious. Once data gathering is completed, these individuals move on to Contact Tracing.

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Helpful Links CDC: https://www.cdc.gov/coronavirus/2019-ncov/index.html CDPH: https://www.cdph.ca.gov/ Homelessness: http://www.sanjoaquincoc.org/COVID-19/

Contact tracing is a long-standing disease control method used in public health practice to help stop the spread of infectious disease, by identifying, testing and isolating those who have become ill (e.g., to combat TB, HIV, and Syphilis). For COVID-19, the process begins with assigning individuals identified as a contact of the infected person to a contact tracer. The contact tracer follows up via a confidential phone call. During the phone call, the contact tracer gathers information about the individual’s demographics, occupation, symptoms and comorbidities. The contact tracer then provides instructions for quarantine to protect the individual and others. This includes recommendations about self- monitoring, what to do if symptoms of infection start to appear, and when to be tested. During the exposed contact’s 14 day self-quarantine, the contact tracer will check-in with the individual on days 5 and 10 to see how they are doing.

Public Health Essential Services It is important to note that PHS also continues to keep up with ongoing program commitments, completing scopes of work and meeting State and Federal requirements and mandates.

For example, we continue to provide services for our WIC clients and young families served by our Maternal Child and Adolescent Health programs. Our Disease Control and Prevention (DCP) staff, in addition to working on COVID-19 cases, continue to investigate outbreaks of other diseases (TB, Influenza, Congenital Syphilis, rabies, etc.) EPI staff 52

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contribute here, since disease surveillance remains a critical every day function.

Final Note San Joaquin County residents need to continue in their efforts to prevent the spread of COVID-19. It can definitely be challenging but there are resources that can provide assistance.

The local 2-1-1 system provides residents access to critical information 24/7 in one centralized location. Community members have the option of listening to automated messages or receiving live support. They may receive information regarding testing sites as well as community referrals such as those for medical services, childcare, food assistance, and transportation. Members of the community with questions regarding business operations, including skilled nursing facilities, may be connected to a Public Health Nurse within our PHS call center. The goal here is to help callers comply with the most current guidance from the Centers for Disease Control and Prevention (CDC), California Department of Public Health (CDPH), or as an Order of the San Joaquin County Public Health Officer. Importantly, physicians are also encouraged to access 2-1-1 since it offers services designed specifically for medical professionals to assist them is supporting their patients’ needs.

FALL 2020

A COMMUNITY BUILT ON

COLLABORATION Doctors Hospital of Manteca is excited to introduce a first-of-its-kind resource for physicians and patients in Manteca: the da Vinci Xi robot. Local access to roboticassisted surgery techniques provides doctors the ability to offer helpful benefits for treating a range of conditions with less invasive surgery, shorter hospital stays, faster recovery times and less scarring.

To learn more about the program, call (209) 923-6370.

FALL 2020

SAN JOAQUIN PHYSICIAN

53

6 NEW

SJMS MEMBERS THIS FALL!

...and even more on the way.

Tanveer Bajwa, M.D.

Dherain Patel, M.D.

Vincent Brandeis, M.D.

Internal Medicine

Family Practice

Obstetrics and Gynecology

5345 N El Dorado St Ste 3

2505 W Hammer Ln

Howard University College of

Stockton, CA

Stockton, CA

Medicine

(209) 478-4041

(209) 957-7050

Baba Farid University of Health

St Georges University School of

Sciences, Faridkot, India

Medicine

Sital Singh, M.D. Gastroenterology 999 S Fairmont Ave Ste 125

Frederick Cason, M.D.

Sukhmine Nedopil, M.D.

General Surgery

General Surgery

(209) 334-8514

500 W Hospital Rd

999 South Fairmont Avenue,

Creighton University

French Camp, CA

Ste 100

(209) 468-6000

Lodi, CA

St Louis University School of Medicine

(209) 334-8512

Lodi, CA

University of California Davis Medical Center

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SAN JOAQUIN PHYSICIAN

FALL 2020

JOIN NOW AND RECEIVE

16 FOR 12

16 MONTHS OF MEMBERSHIP FOR THE PRICE OF 12* *Starting September 1, new members who join and pay in-full for the next year will receive the remaining months of this year for free.

JOIN TODAY TO START RECEIVING YOUR BENEFITS! When you join the California Medical Association and San Joaquin Medical Society, you join nearly 50,000 members statewide who are actively protecting the practice of medicine and defending public health.

SIGN UP AT: WEB: cmadocs.org/join • PHONE: (800) 786-4262

FALL 2020

SAN JOAQUIN PHYSICIAN

55

San Joaquin Medical Society 3031 W. March Lane, Suite 222W Stockton, California 95219-6568 RETURN SERVICE REQUESTED

PRSRT STD. U.S. POSTAGE

PAID

Permit No. 60 Stockton, CA

San Joaquin Medical Society Member Benefits • Complimentary Security and Risk Assessment of your IT Infrastructure (valued at $500) • Compromised Credential Report from the Dark Web • 10% Discount of Monthly Managed Services for 1 Year (valued at a maximum of $5,000) • 6 Months Free Hosting of VoIP Phone System / Free Licensing for 3 years / 20% Off Set-up and On-boarding (valued at a maximum of $2500) • Waived Set-up Fee (valued at $1,000 - $2,000 – user # dependent) Call Shari Peck @ 209-423-2760 or email shari@ce-technology.com