Spring 2010 by San Joaquin Medical Society

St. Joseph's

Patient PaVilion oPens Spring Issue 2010 SPRING 2010

SAN JOAQUIN PHYSICIAN

Protect Your Assets and Your Future With the recent downturn in the economy and the impact on personal assets, many members are reassessing their need for Long Term Care insurance. With so many options to choose from, where do you turn for assistance?

s a member of the San Joaquin Medical Society, you don’t have to worry. That’s because you have access to Long Term Care Insurance specialists from Marsh, the Society’s sponsored insurance program broker and administrator. You’ll get first-rate service you deserve from licensed consultants who will: • Tell you about the 5% member discount offered by two insurance carriers • Offer needs-based analysis customized for your personal situation and budget • Help guide you through the Long Term Care insurance buying process • Custom-tailor a plan for you What’s more, you’ll never be pressured to buy and you’re never under any obligation.

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Volume 58, Number 1 • March 2010

16 38 54 61 SPRING 2010

{FeATUreS} MIcrA:

Hanging By A Thread

ST. JOSePH’S

Patient Pavilion Opens

cAMBODIAN ODYSSeY Dr. Salamon Reports

BUYerS gUIDe

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cMA WeBINArS IN THe NeWS New Faces and Announcements

UOP’S HeALTH FOrUM

HOSPIce AND PALLIATIVe cAre

47 68

MeMBerSHIP BeNeFITS: Your Ofﬁce Manager Advocate has the answers HOLIDAY PArTY reDUX

SAN JOAQUIN PHYSICIAN

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Lawrence R. Frank, MD President James Halderman, MD President-Elect Robin Wong, MD Past-President

George Khoury, MD Secretary-Treasurer Board Members

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Shiraz Buhari, MD Thomas McKenzie, MD Javad Jamshidi, MD

Moses Elam, MD John Olowoyeye, MD Raissa Hill, MD Jerry Soung, MD

Trinh Vu, MD Anil K. Sain, MD Kristin M. Bennett, MD

Medical Society Staff Michael Steenburgh Executive Director Debbie Pope Office Coordinator Gena Stoddart Membership Coordinator

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Committee Chairpersons MRAC F. Karl Gregorius, MD

Decision Medicine Kwabena Adubofour, MD

Ethics & Patient Relations to be appointed

Communications Morris Senegor, MD

Legislative Patricia Hatton, MD

Community Relations Joseph Serra, MD

Audit & Finance Marvin Primack, MD

Member Benefits Jasbir Gill, MD

Nominating Hosahalli Padmesh, MD

Membership to be appointed

Public Health Karen Furst, MD

Scholarship Loan Fund Eric Chapa, MD

NORCAP Council Sandon Saffier, MD CMA House of Delegates Representatives Shiraz Buhari, MD Patricia Hatton, MD James J. Scillian, MD

SAN JOAQUIN PHYSICIAN

Lawrence R. Frank, MD Francis Isidoro, MD Gabriel K. Tanson, MD Peter Gierke, MD

James R. Halderman, MD Peter Oliver, MD Robin Wong, MD

SPRING 2010

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SAN JOAQUIN PHYSICIAN

MeSSAge > executive Director

are you ready for It?

It (as in Information technology), or, in our case, HIt (Health Information technology), is a complicated and fast-moving target. If you haven’t stayed current with the latest in this area, there are a lot of exciting technologies coming down the information highway, and your San Joaquin Medical Society aims to help keep you well informed as it relates to your practice. In the summer 2009 issue of “Physician”, we ran stories with differing perspectives on Electronic Health Records (EHR) and various federal stimulus funding programs that were on the horizon. We could devote an entire issue to the numerous developments since then and still not do justice to this topic. Therefore, we have decided to partner with Health Plan of San Joaquin and the CMa to offer a unique series of “EHR trunk Shows” produced by Maxwell “For our first effort in this area we It, a truly vendor-neutral are offering a Certified Coders consulting firm that produces training Series over a 5 week period very concise evening programs for physicians seeking the for the very low cost of $649” latest lowdown in this rapidly changing environment. Check out our advertisement on page 31 to learn more about these upcoming seminars with actual hands-on vendor demonstrations. Secondly, we have long heard many pleas from our members to offer more in the way of training and certification seminars. So, for our first effort in this area we are offering a Certified Coders training Series over a 5 week period for the very low cost of $649 (many of these programs cost upwards of $2,000). This unique offering allows your coder to be out of the office only one day a week for the 5 week period instead of attending a full week program, often with the cost of hotel and travel expenses on top of the registration. Check out our ad for this program on page 51 and if we fill this Seminar we will book a Certified office Managers Series in the fall. and lastly, for those of you with simply no time for scheduled seminars on all these wonderful topics, we are working with CMa, norcal Insurance, PalmettoGBa and others to offer several web-based seminars (Webinars) that you can watch at your leisure or attend as a group in our new training room here at the society. Check out our listings on page 22 and find something of interest. If you watch them here… we even buy the popcorn! All the Best!

Moris Senegor, MD Editor Editorial Committee Shiraz Buhari, Md Kwabena adubofour, Md Robin Wong, Md William West Managing Editor William@sjcms.org Michael Steenburgh Contributing Editor Sherry Roberts Creative director/Graphic designer sherry@sjcms.org Contributing Sources California Medical association Los angeles County Medical association San diego County Medical Society The San Joaquin Physician magazine is published quarterly by the San Joaquin Medical Society Suggestions, story ideas or completed stories written by current San Joaquin Medical Society members are welcome and will be reviewed by the Editorial Committee. Please direct all inquiries and submissions to: San Joaquin Physician Magazine 3031 W. March Lane, Suite 222W Stockton, Ca 95219 Phone: 209-952-5299 Fax: 209-952-5298 Email address: gena@sjcms.org Medical Society office Hours: Monday through Friday 8:00 aM to 5:00 PM

Mike Steenburgh Executive Director

SAN JOAQUIN PHYSICIAN

SPRING 2010

St. Joseph’s $115 million Patient Pavilion – Open March 2010

Investing in Health, Growing to Serve

Some investments offer miraculous returns. Take the Patient Pavilion at St. Joseph’s, for example. Planned in response to the needs of our growing community, this vital addition will save more lives, safely deliver more babies and provide private patient rooms. However, more than providing critical rooms and equipment, the new Patient Pavilion is an investment in the health and safety of every family who calls our community home. Not-for profit. Serving our community.

miracles happen.

(209) 943-2000 StJosephsCares.org SPRING 2010

1800 N. California St., Stockton, CA 95204 SAN JOAQUIN PHYSICIAN

Message > From The President

Barbarians at the Gate Whether we like it or not a new 1600-bed prison hospital that includes a skilled nursing and mental health facility is coming to Stockton and San Joaquin County, according to Clark Kelso, federally appointed receiver.

The upcoming budget looks like it will face a $52M deficit. County services, already severely strained, face further cuts in funding: 13% for 24/7 operations such as SJGH, 26% for agencies that protect the public, i.e. Public Health Services, and up to 39% for road maintenance, parks, etc.

ABOUT THE AUTHORLawrence Frank, MD is the 2009-2010 President of San Joaquin Medical Soceity.

SAN JOAQUIN PHYSICIAN

In addition, the vacant DeWitt Juvenile Facility will be converted to care for an additional 1300 adults. The former women’s facility will be turned into a Re-Entry Facility. Within three years, San Joaquin County will have 3500+ additional inmates. It took lawsuits filed by the City of Stockton, San Joaquin County and the San Joaquin Chamber of Commerce, unlikely to prevail, to get the federal receiver into serious discussions about mitigating the repercussions to our county. No matter how Kelso and his supporters try to sweeten the pot, medical services, both public and private, will take a major hit. In 2001, Rebekah Evenson, a prisoners’ lawyer, sued the state for poor prisoners’ health care; in 2002, the court ordered to state to make substantial improvements. In 2005, as a result of a finding that health care services for state prisoners were so poor that they caused one death per week, Federal Judge Thelton Henderson ruled that a federal receiver, J. Clark Kelso, was to take over the prison health care system as the state was unable to comply with the constitutional ban on cruel and unusual punishment. (1) After unsuccessful negotiations, Kelso’s suit against the State of California to get $8 billion to build 10000 beds for state prisoners failed, hardening state opposition. He has reduced his goal to 1734 (or so) beds but this will still take $1.9 billion in State funds. Good timing;

the state is looking at upwards of $20B budgetary deficit that will require cutting many programs to the bone. Governor Schwarzenegger (rightly) maintains California cannot afford this.(1) County budgetary constraints in the 2009-2010 year resulted in reductions in funding a number of County services. Our Public Health Service that protects us from communicable disease with outreach and direct-observed therapy lost 28 workers. The upcoming budget looks like it will face a $52M deficit. County services, already severely strained, face further cuts in funding: 13% for 24/7 operations such as SJGH, 26% for agencies that protect the public, i.e. Public Health Services, and up to 39% for road maintenance, parks, etc. Regional unemployment has increased the burden of uninsured seeking medical care at the county hospital with a dramatic increase in its deficit. (2) Regional state legislators have weighed in against the receiver’s plans. Cathleen Galgiani, D-Livingston, objects to building any of these prison hospitals in California, noting that at a time when very hard and difficult decisions are being made to the detriment of providing medical care to the aged, the poor, veterans and the disabled, we are told to build a medical Taj Mahal for prisoner health care. Alyson Huber, D-El Dorado Hills, inveighed against the lack of communication and collaboration with San Joaquin County in this decision.(3) Kelso is trying to sell this as an economic

SPRING 2010

boon to our county. (1) There will be $1 billion in construction jobs in an area with a depressed construction industry. But this will be paid for by the (already beleaguered) state. (2) 3000 new jobs with wages higher than our regional average could pump additional money into our county. Under a separate agreement, CDCR will also pay for converting the women’s facility into a re-entry facility. With the exception of Bakersfield and Kern County (4), why have other cities passed on this promised economic boom? Many in Stockton question the promised jobs and worry about reduced quality of life. Public sentiment is turning against more new prisons to deal with crime and crowded prisons. Are elected officials stuck in the boom mentality of the 20th century?(5) If many of the needed construction and health care workers choose to commute from surrounding areas rather than move to San Joaquin County, how likely is it they will spend a lot of their high wages into our county’s economy. {I wonder if I would move from an area with a more secure educational infrastructure and other amenities to Stockton rather than commute and spend my money in, say, the East Bay or Sacramento County.} The California Department of Correction and Rehabilitation (CDCR) pays health care workers very well, not only in salary but in benefits. San Joaquin County staff calculated that the new prison hospital would end up costing the county $105M at first, including $63M for road improvements followed by $17M annually to ramp up health care worker training and for wage competition. The county “paid for” Jail expansion would cost us $11M for pathology lab expansion plus an additional $6M in staffing wages. Even with this, the Sheriff is concerned about keeping his current staff when they are tempted to work at CDCR for higher wages.(6) The new prison hospital/SNF will need 1440 additional health care workers: 15 MD’s, 329 RN’s 111 LVNs, 165 CNAs and 394 psychiatric technicians. They’ll receive higher wages and better benefits (PERS Retirement and lifetime medical insurance). The federal

SPRING 2010

government already has designated the San Joaquin Valley as undersupplied with health care workers. Local health care facilities already face extreme challenges in attracting and retaining skilled and experienced staff. I’m sure we are all gratified that Katrina Hagen, Deputy Director for Workforce Development for the federal receiver, recognizes our predicament. She said they would try “creative” recruiting from out of county and transferring from other state prisons. (There is no try. Do or do not. - Yoda). She would also seek funding to help Delta College to train more medical workers. The increase in training and turning out more health care personnel will not occur in time to meet the projected three year time line CDCR projects for opening the new prisons and health care facilities. Scot Seamans, Hospital Council of Northern and Central California was glad to hear these discussions but implementing these solutions will be difficult at best but noted that so far, nothing has been offered in writing.(7) The law suit(s) mentioned above were filed (and temporarily suspended) to get Mr. Kelso’s attention and to maximize mitigation by the state of the aforementioned costs to San Joaquin county. On 31 January, the League of Women Voters conducted a forum to further discuss the ramifications of locating the prison hospital just outside of Stockton. City, County and State/ Federal representatives, including Mr. Kelso attended. Mayor Johnston wanted assurances that at least 50% of the new jobs, both in construction and in health care, would go to locals. Unfortunately, this very likely will result in robbing existing facilities of health care workers. She allowed that if local nursing and medical technical training programs grew significantly, Stockton could become a health care training center. Well and good but it will take years for such programs to develop and/or expand and produce trained (but not experienced) nurses, technicians, etc. Meanwhile, public and private hospitals may well suffer significant losses of experienced personnel to the detriment of care provided to our non-prisoner population. County Supervisor Bestolarides asked

JOIN THE FIGHT

TO PROTECT MEDICINE Every cause needs a powerful champion. This spring, you have an opportunity to become a champion for medicine and your patients, when more than 400 physicians, medical students, and CMA Alliance members come to Sacramento for CMA’s Annual Legislative Leadership Conference. At the conference, you will hear about the issues facing medicine in Sacramento from an impressive array of experts who live and breathe the politics and policy on these issues. Armed with this knowledge, you will then head to the Capitol to meet with legislators to make sure the voice of doctors is heard in Sacramento.

WILL YOU JOIN US? Call the San Joaquin Medical Society at (209) 952-5299 to RSVP We will provide free shuttle service from the society office departing at 7:00am and make arrangements for us to meet with each of our state representatives following the luncheon and be back to Stockton by 5:00pm.

C A L I F O R N I A M E D I C A L A S S O C I AT I O N

36th ANNUAL LEGISLATIVE LEADERSHIP CONFERENCE Tuesday, April 27th • Sacramento • Sheraton Grand Hotel

SAN JOAQUIN PHYSICIAN

Message > From The President how Mr. Kelso’s promises were to be kept and what would happen if they were not.(8) As yet, no final agreement on how to mitigate the possible ill effects to Stockton and San Joaquin County has been reached and nothing, included promises of benefits to Stockton is in writing. Further, nearly all current prisons and jails are operating well above their “capacity” when built! Where will funding come to operate these facilities after

they are built. Particularly in these financially difficult times, these promises may end up being a bait and switch to lull us into placidly accepting an unpleasant fate. Yet, there are some who think Stockton and San Joaquin County will benefit. It calls to mind the variety of interpretations of the partially filled glass: Optimist: glass is half full Pessimist: the glass is half empty

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(209) 957-3888 Caring Support Guidance Choices

Engineer: the glass is twice as big as it needs to be Accountant: does the glass need all that water? Buddhist: the glass is full – it contains both water and space. The government would say that the glass is fuller than if the opposition party were in power. The opposition would say that it is irrelevant because the present administration has changed the way such volume statistics are collected. The philosopher would say that, if the glass was in the forest and no one was there to see it, would it be half anything? The economist would say that, in real terms, the glass is 25% fuller than at the same time last year. The banker would say that the glass has just under 50% of its net worth in liquid assets. The psychiatrist would ask, “What did your mother say about the glass?” The physicist would say that the volume of this cylinder is divided into two equal parts; one a colorless, odorless liquid, the other a colorless, odorless gas. Thus the cylinder is neither full nor empty. Rather, each half of the cylinder is full, one with a gas, one with a liquid. The seasoned drinker would say that the glass doesn’t have enough ice in it. (1) State disputes federal authority By Bob Egelko Chronicle Staff Writer: The San Francisco Chronicle : Thursday, September 17 2009 (2) County of San Joaquin Proposed Budget 2010-2011. (3) State legislators weigh in on Prison, The Record, December 19,2009. (4) Prison Lemon could be Kern’s Lemonade, Bakersfield Californian, October 29,2009 (5) Stockton: Prison Capital, CA, The Record, Wednesday, Nov 4, 2009 (6) Stockton, S.J. join suit over prison hospital, The Record, November 04, 2009 (7) Medical center has hospitals worried, They fear losing staff to large state prison facility By Scott Smith The Record, January 21, 2010 (8) Sides meet, talk prisons in Stockton, The Record, by Christian Burkin, January 31, 2010

SPRING 2010

SAN JOAQUIN PHYSICIAN

13th ANNUAL CALIFORNIA HEALTH CARE The Era of Health Reform: Harnessing the Currents of Change April 9-11, 2010 • • • •

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Hospital-Physician Alignment and New Models of Practice Health System Reform: Then and Now Leadership in a New Health Care Era and more...

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TO REGISTER - call 800.795.2262 or visit our website at caleadershipacademy.com Continuing medical education: The California Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The California Medical Association designates this educational activity for a maximum of 18.25 AMA PRA Category 1 Credits ™. Physicians should only claim credit commensurate with the extent of their participation in the activity. This credit may also be applied to the CMA Certification in Continuing Medical Education.

SAN JOAQUIN PHYSICIAN

SPRING 2010

MeSSAge > From The editor

NEW BEDS

Slow and expensive undertaking for area hospitals

In the current issue of San Joaquin Medicine we present a second cover story within a year, featuring the same theme, opening of a major addition to an area hospital.

“With these additions the number of licensed beds in San Joaquin County rises from 982 to 1146.”

SPRING 2010

our first, published in the winter 2009 issue, was on Lodi Memorial; now we present St. Joseph’s. Lodi added 90 new licensed beds to its facility, St. Joseph’s 74, (78 new beds in the Pavilion, less 4 because of the creation of private rooms in the existing hospital).The creation of some 164 new beds in San Joaquin County is a historical event. Compared to the 1700 bed monster contemplated for arch Road by the California department of Corrections, 164 seems like a meager sum. But the prison hospital is intended to serve a large catchment area of California prisoners, while the seemingly more modest number of new beds in Lodi and Stockton are here to serve us, the local public at large. With these additions the number of licensed beds in San Joaquin County rises from 982 to 1146. Viewed from a different perspective, the number of beds per 1000 population rises from 1.4 to 1.69, again a seemingly modest increase. Considering that the national Benchmark for hospital planning is 2.9, one gets a new sense of the scarcity of beds in our area. Incidentally the State-wide average of beds per1000 population is 2.3. to understand the magnitude of the accomplishment we first need to go back to the early 1990’s around the time of Bill Clinton’s election as President. The managed care fervor that swept the country at that time

promised, among other things, to sharply reduce demand for medical services and by extension, hospital beds. Some downsizing did occur then, especially in 600-1000 bed large teaching hospitals in big cities. Here in San Joaquin County we held our own, and anxiously awaited the ax to fall. Well, it never did! In fact, not only did the “revolution” of those days fail to reduce bed capacity, it also ran afoul of a giant demographic locomotive that overran it with ease. The general aging of our population created greater demand for medical services along with hospital beds. Unfortunately administrators of that time, ABOUT THE AUTHORMoris Senegor, MD serves as the Chairperson of the Publications Committee for the San Joaquin Medical Society and Editor of its flagship publication the San Joaquin Physician.

SAN JOAQUIN PHYSICIAN

Message > From The Editor concern was yet continuing inflation of project cost. Until then preoccupied as they were with managed care, failed to foresee he had faced a daunting rise in cost to the tune of $ 1 million per the bed crunch that was to befall their hospitals a decade later. month. Lodi, on the other hand began theirs after the market The result was disastrous impaction that became endemic in decline, which, as we all know, turned out to be unimaginably area hospitals. It resulted in various unsightly practices such deep. “Everyone was in a skid”, says Harrington, “so we got better as overfilled ER’s full of patients on hallway gurneys. Critical discounts from our suppliers and contractors”. patients who could not be moved from ER’s to already full ICU’s Regardless, the cost of either expansion project should elicit received their care from overworked ER staff untrained in ICU a collective gulp from us physicians. As external regulations care, sometimes with adverse consequences. Cancellation of governing all aspects of medicine have increased exponentially elective surgeries due to lack of beds became a periodic problem over the years, so have those related to construction. We can only for patients and surgeons alike. Yet worse was the so-called expect that future projects will suffer more – not less - from such “round-robin” shuffling of ambulances from hospital to hospital, interference, and thus be costlier. depending on which ones declared themselves full. The result I asked the two administrators about the cause of that 12 year was chaos in emergency care and to a lesser degree elective delay from conception to completion. For St. Joseph’s it was a admissions. The problem was not just local. We also had trouble series of approval hurdles. After receiving Board approval, St. Jo’s transferring patients to tertiary care facilities in surrounding big had to receive the blessings of cities like San Francisco, its parent company CHW, because they also and subsequently OSHPOT, experienced similar bed The cost of these expansion the State regulatory body shortages. that oversees hospital Once recognized, projects boggles the mind. construction. The project rectifying this bed got quagmired in red problem turned out to The Lodi effort came out at tape, primarily because be impossibly slow. It so of unacceptable plans happens that hospital approximately submitted to OSHPOT construction is unique by architectural and and does not share per bed. St. Joseph’s started with engineering firms working much, structurally or with St. Joseph’s. By contrast financially with, for a similar budget in 2004. By 2010 Harrington in Lodi did example, commercial not have much trouble office buildings. the actual cost of the project had with OSHPOT; theirs got Regulations governing approved more rapidly. Their such construction are risen to around delay was due to financing. substantially more An independent hospital, elaborate than residential per bed. lacking a “big brother” like or other sectors. This, CHW, Lodi had to obtain in turn leads to higher its own financing in the open costs in such projects. I market, and it took a while to recently spoke with the accomplish this before construction could begin. administrators who oversaw the Lodi and Stockton projects from Not considering the details, The Lodi and St. Jo’s experience conception to reality. Don Wiley of St. Jo’s and Joe Harrington is a lesson on how slow and costly new hospital construction of Lodi Memorial both confirmed that their expansion plans got has become in this day and age. This is why, in my opinion, these approved by their respective boards (the moment of conception) seemingly paltry 162 extra beds are of such historic significance in 1998. It thus took approximately 12 years to bring them to for our community. We are unlikely to see more licensed beds conclusion. any time soon. To my knowledge there are none on the drawing The cost of these expansion projects boggles the mind. The board from other hospitals. Lodi effort came out at approximately $ 1 million per bed. St. Lodi Memorial and St. Joseph’s deserve the gratitude of the Joseph’s started with a similar budget in 2004. By 2010 the actual entire County for allowing ease of access, and ultimately lower cost of the project had risen to around $ 1.3 million per bed. This risk to the increasingly rising number of our sick. Joe Harrington rise in the final bill was primarily due to increased commodity and Don Wiley should be congratulated for nurturing their prices such as steel and other construction materials during the projects from beginning to end through what I can only imagine purchase phase of the project. By contrast, in a volatile market, to be numerous frustrating hairpin turns over what many would Lodi had better luck in timing. According to Harrington, their consider a significant portion of their professional careers. They project came in $2.5 million under budget. He attributes this leave behind a legacy that will serve our community well beyond rare fortune to the same volatile market that raised the costs in the time they fade out of the scene. Stockton. “We locked our contracts while the market was still high”, says Don Wiley, who points out that at the time their

$1 million

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SAN JOAQUIN PHYSICIAN

SPRING 2010

SAN JOAQUIN PHYSICIAN

micra > hanging by a thread

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of the year, medical malpractice award caps will have run the gauntlet in four states—including California—as high state and federal courts consider challenges that seek to allow a return of sky-high damage awards. In fact, the court challenge to California’s Medical Injury Compensation Reform Act cap on “non-economic damages,” such as pain and suffering, has already run its course. In May, Van Buren v. Evans failed to remove the statewide cap of $250,000 on non-economic damages in a case before the state’s 5th District Court of Appeals. With an assist from CMA and its allies, the court ruled that the cap doesn’t violate the plaintiff ’s constitutional rights, and that the legislature is allowed to limit such damage awards in the interest of public policy. The California Supreme Court declined to hear the case. But the forces of the trial attorneys will be back to California. In fact, a campaign is afoot among attorneys in the state to find the best possible plaintiff for drawing MICRA into the line of fire. The effort is loosely connected to a nationwide push by trial attorneys against damage-award caps, and it includes this year’s other three challenges to these kinds of laws. In Maryland, the state Court of Appeals started hearing arguments last month in Lockshin v. Semsker; Georgia’s cap is threatened by Atlanta Oculoplastic Surgery v. Nestlehutt; and the Illinois Supreme Court has yet to rule on last November’s LeBron v. Gottlieb Memorial Hospital.

The Big Prize Of course, MICRA’s damage-award cap is the big prize. The first of its kind, the cap was set at $250,000 in 1975. It is not indexed to inflation and it hasn’t moved a whit since it became law. MICRA was created by a special act of the legislature to address a doctorsupply crisis through the high liability premiums that caused it, and it is now supported by a deep foundation of case law. Many of these cases were eventually decided in the California Supreme Court in the 1980s and 1990s, effectively cementing the law as a fundamental element in any court’s consideration of medical malpractice throughout the state. Challenges to malpractice damage award caps in other states cannot affect California law, but the California Medical Association and like-minded organizations monitor what’s going on as a possible harbinger of things to come. “There is an attorney with the personal injury attorneys’ group, who is going around the country looking for cases trying to overturn medical malpractice laws all over the country,” says Lisa Maas, the executive director of Californians Allied for Patient Protection. A one-issue organization devoted to protecting MICR A, CAPP is supported by a panoply of physicians’ organizations—including the CMA—as well as hospitals, dental societies, liability insurers, and even the Los Angeles County Department of Health Services. “We’re certainly keeping a watchful eye,” says CMA Legal Counsel Alicia From. She is also aware that trial attorneys have their sights set on damage-award caps, including MICRA, but the state’s successful history of protecting the law doesn’t have her checking on their activities every day, she says. That nationwide cap-busting effort is spearheaded by attorney Robert Peck, president of the Center for Constitutional Litigation in Washington, D.C. On its website, CCL describes itself as “a law firm dedicated to challenging laws that impede access to justice,” and Peck himself argued the U.S. Supreme Court case Philip Morris v. Williams, which let an Oregon jury’s verdict stand in his client’s favor, awarding $79.5 million in punitive

damages to the widow a man who died of lung cancer. In other words, he’s not small fish. Concerning malpractice damage caps, Peck’s firm CCL has been involved in Maryland’s Lockshin, Illinois’ LeBron, California’s Van Buren case, and several previous high- and lower-court cases. The single uniting factor in these is an approach that considers the caps as violations of the U.S. Constitution’s 7th Amendment right to a jury trial. That is, this new crop of challenges contend that only a jury can have a say in damage awards, and any encroachment on that turf by the legislature is forbidden. CCL and its local allies got to Van Buren too late in the process to shape it completely to the new strategy. Back in the 1980s, when MICRA first became established into case law, the challenges focused mostly on other constitutional rights, such as the right to due process and the right to equal protection under the law. In Fein v. Permanente Medical Group, the California Supreme Court held up the law in the face of these challenges by a close vote of 4 to 3. “That really set the trend across the country,” says Christine Spagnoli, president of the Consumer Attorneys of California, which is waging the new battle against caps at the regional level. “We looked at what was happening in these other states, with the challenges based on the 7th Amendment right to a jury trial, and believed that it had not been raised” in disputes at the state level, she tells Southern California Physician. Lately, members of the consumer attorneys group, abbreviated CAOC, have requested help from the members in raising a challenge in this state, and for about a year, the group has been trying to drum up legal contests to the damage-award cap as part of its “MICRA Challenge Project.” Robert Peck is CAOC’s point-person for legal analysis. “We have absolutely gotten the word out [to members] that if they have a case that they think fits the issue, we’d be happy to support their efforts,” says Spagnoli. Van Buren was the first chance to do so. “The respondent’s brief in that case raised some arguments about the constitutionality of MICRA,” Spagnoli explains, so the lawyers were able to file a response brief that raised the issue squarely. But there wasn’t an opportunity to add much new information, and she says the group had only been cautiously optimistic about the case’s success. That’s no reason for complacency among health care providers, however. “There are several other cases out there where it’s going to be raised or it has been raised,” Spagnoli adds, and these cases could come up in a higher court as soon as early next year. But she says she’s not comfortable sharing the names of the cases without the involved lawyers’ permission.

The Payoff Possibilities Why wouldn’t trial attorneys continue to fight for higher damage awards? After all, there is certainly the potential for a large payoff in the absence of award caps, judging from the national situation. And the ideal plaintiff to challenge MICRA is someone without much of an “economic” damage award to claim, such as a retiree who misses no work by being injured, and whose example would show California’s limited awards in sharp contrast. By the reckoning of Jury Verdict Research, a company based in Pennsylvania, about half of jury awards throughout the country exceeded $1 million between 1999 and 2002. (Note that the

MIcrA > hanging by a thread amount had remained flat for three previous years, that jury awards represent a small portion of malpractice award decisions, and that JVR’s methodology does not include award revisions or even consistent data gathering. But still, that’s a lot of money.) Similarly, a 2001 U.S. Bureau of Justice Statistics study of sampled medical malpractice awards pegs that year’s median at $425,000, with about 29 percent of awards exceeding $1 million. Median awards for malpractice trials involving a death came to around $837,000, while permanent injury awards were about $412,000. Punitive damages had a median of about $250,000. However, the BJS study does not clearly differentiate between economic damage awards and non-economic damage awards. trial lawyers might also be interested in the current small rise in the number medical liability claims against hospitals in 2009, which is outlined in an october report by the insurance company aon Corp. and the american Society for Healthcare Risk Management.

hike up doctors’ insurance premiums in response. For those doctors who already may not be running much of a profit, that extra-large insurance bill can be the final expense that drives them into the red or out of business. on the large scale, CMa, CaPP, CHa and other allies say this phenomenon can have the effect of reducing patient access to medical care across the state by making it harder for health care providers to stay in business. Back before MICRa became law in 1975, “there are doctors who got medical malpractice premium increases of 200 percent and 300 percent,” says Lisa Maas, CaPP’s executive director. “Some anesthesiologists in Los angeles could not get coverage at all, no matter how much they paid.” In the 1970s, adds Maas, the specialists with the highest premiums—obstetricians and gynecologists— had suggested they would have to stop delivering babies, or that they would have to begin telling expectant mothers to cross the border to give birth in nevada. as a result, doctors, clinics, nurses, hospitals and others asked then-Governor Jerry Brown for an emergency session to address the crisis. “It was very bipartisan—you had some of your most liberal legislators supporting a bill to help control this crisis, and that was MICRa,” as Maas tells it. the seven provisions of MICRa, including the cap on non-economic damages, were specifically crafted to allow California doctors to continue to practice (see sidebar, “the Seven Parts of MICRa”), and to attract more doctors to the state.

obstetricians in stockton and san Joaquin county can pay up to $39,000 in premiums a year, but in uncapped new york state, they will pay around $194,000. the authors expect the frequency of these claims to grow by about 1 percent this year, and to continue rising at that same annual rate. the frequency of claims had been declining for the previous seven years, says the report, whose conclusions are based on loss and exposure data from more than 1,500 facilities and health care systems of all sizes. But to really get a grasp of the scale of possibilities in this state, consider the recent wrongful death lawsuit against Sacramento radio broadcaster Entercom, a case that doesn’t involve medical liability. Entercom station Kdnd held a contest in January 2007 to give a nintendo Wii video game system to whoever was able to drink the most water without vomiting or urinating. Soon after participating, contestant Jennifer Strange died of water intoxication. Last month a jury awarded Strange’s husband and four children $16.6 million—$15.1 million of which consisted of non-economic damages, among the largest awards ever offered by a Sacramento jury. the final award will probably be whittled down by subsequent legal processes, but the case provides clear evidence that California juries will gladly distribute massive awards in cases of wrongful death or injury. attorneys are keenly aware of that fact. Moreover, as Spagnoli explains, the value of California’s cap on non-economic damages has eroded since 1975. What was once a fair amount of money is now the equivalent of $60,000 in 1975 dollars, she says. “People who represent victims of medical negligence continue to see the erosion of their ability to receive fair compensation,” Spagnoli adds.

how we Got here this all testifies to organized medicine’s concern that when sympathetic and well-meaning juries have free rein to determine damage awards for pain and suffering, they become quite generous. Medical liability insurance companies see this generosity as a threat to the bottom line, and

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Paying for risk management to Get a sense of MICRA’s effect on physicians’ malpractice insurance premiums, consider the differences in the bills paid by highrisk specialists in states with and without legislative caps on damage awards. When MICRA was born in 1975, those were anesthesiology, neurosurgery, obstetrics and gynecology—anesthesiology has become less risky lately, but the others remain at the top of the list, says Maas. according to CaPP, obstetricians in Stockton and San Joaquin County pay $39,000 in premiums a year, but in uncapped new York State, those same specialists at the high end of the spectrum will pay around $194,000. In Florida, which also has no such cap, the high end is about $214,000. those figures don’t mean that malpractice premiums in California will remain static. Between 1975 and 2000, those premiums rose about 167 percent, according to a Physician Insurers association of america report widely cited by the american Medical association and other physician groups. But during that same span of time, malpractice premiums for doctors outside of California rose by 505 percent. Let there be no doubt that the insurance companies love MICRa too. the loss ratios for malpractice insurance—the cost of claims divided by the premiums collected—are much more favorable in states with damage award caps. according to the national association of Insurance Commissioners, the average loss ratio in 2001 for the six states with a damage award cap was 68.98, compared to 100.86 in the 44 states without caps.

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the latest challenge since the law’s 1975 inception, MICRA has seen no shortage of court challenges, and clearly it’s going to see more. The CMa and its allies plan to remain active and engaged in the process, as they always have. Through the CMa-CHa-Cda amicus Curiae Committee, the provider groups have filed friend-of-the-court briefs in at least 50 court cases disputing MICRA’s legality since the beginning, says CMa Legal Counsel alicia From. “CMa’s been at the table from the get-go defending MICRA and educating the judiciary, as well as our members, about the law,” she adds. Rather than getting embroiled in the specific facts in a particular case, says From, the CMa sees its role as providing a larger perspective, and going beyond the immediate facts to explain MICR a’s overall meaning to the court. this often involves explaining to the court the law’s original intent, comparing California’s current situation with other states which lack similar reforms, emphasizing cost savings, and showing how the law helps the state retain physicians, especially in high-risk specialties. the most recent fight, Van Buren, may prove to be a bellwether for future MICRa challenges. a lower-court jury had awarded plaintiff James Van Buren $2.5 million—$700,00 of that for pain and suffering—as part of a finding against Sian Evans, Md, and Yosemite Surgery associates. dr. Evans and Yosemite had been found medically negligent when dr. Evans, attempting to remove a peri-anal cyst, cut Van Buren’s sphincter muscle, leaving him permanently incontinent. In the face of the large damage award, dr. Evans and Yosemite had moved to have it reduced pursuant to MICRa, a motion that the lower court had granted. When plaintiff appealed the ruling in the California Court of appeals for the 5th district, the case became a direct attack on MICR a’s cap of $250,000 on non-economic damages, and it employed most of the usual complaints, with a new focus on the right to a trial by jury—specifically, the plaintiff argued his right to a jury trial had been violated because the legislature established a ceiling for the jury award. the other, more traditional lines of attack included a contention that the cap represented a violation of

the California Constitution’s separation of judicial and legislative powers, and that since the maximum award of $250,000 has lesser purchasing power than it did in 1975, MICR a violated his rights to equal protection under both the state and federal constitutions. Finally, Van Buren argued that he was not subject to MICR a because the intent behind it discourages settling out of court, which he had refused. the CMa, CHa, and Cda promptly filed briefs in support of MICR a through their joint amicus curiae committee, and the law firm Horvitz & Levy represented them during oral arguments. CaPP filed its own brief through attorney Fred J. Hiestand. In addition to arguing in favor of the cap, the organizations aimed to give the court a broad view of the long series of cases that had already addressed the constitutional issues facing it, including the challenge based on the right to a jury trial. Without much ado, the Court of appeals found all of the plaintiff ’s contentions to be without merit, affirming the judgment of the lower court in an unpublished opinion. Essentially, the court agreed with organized medicine, finding that these issues had already been addressed by the California Supreme Court, and that it was bound to follow the higher court’s precedents. the court also dismissed Van Buren’s argument that he is not subject to MICRa. In addressing the new attack from the Center for Constitutional Litigation and the Consumer attorneys of California based on the right to a jury trial, the appellate court simply relied on previous State Supreme Court rulings, and the Supreme Court later declined to consider the case. at the foundation of this victory for organized medicine is the 1985-vintage landmark decision in Fein v. Permanente Medical Group, which found no constitutional violation, stating in that “the legislature may expand or limit recoverable damages so long as its action is rationally related to a legitimate state interest.” as for the other challenges in Van Buren, separation of powers had already been addressed in several cases before the high court, and each one found the cap on damages to be an exercise of legislative power—not judicial power—by the legislature.

Caps in the Courts here’s a Brief rundown on the highestprofile court challenges now facing other states’ legislative caps on non-economic damage awards: •

In Maryland, the Court of Appeals starts to consider the constitutionality of that state’s $725,000 cap on Nov. 5 in Lockshin v. Semsker. The main issue in this case is now whether the cap applies to all medical liability cases—a lower court judge previously ruled that it does not apply in cases where the plaintiff had waived arbitration. The cap sees yearly increases of $15,000, and wrongful death awards are limited to 150 percent of the cap.

SPRING 2010

•

In Georgia, Atlanta Oculoplastic Surgery v. Nestlehut opened oral arguments before the State Supreme Court on Sept. 15. The case revolves around the issue of whether the state’s $350,000 non-economic damage cap represents a constitutional violation. The plaintiff’s argument has four parts: the law breaches the right to a trial by jury, since a lower court ruled that the legislatively imposed cap curtails a jury’s authority; it violates the right to equal protection under the law, since its financial burden most affects those most harmed; the separation of powers is violated by the intrusion of the legislature onto the judiciary’s turf; that

that the cap creates a “special law” in an area governed by general laws. •

In Illinois, the State Supreme Court is considering arguments from last November’s LeBron v. Gottlieb Memorial Hospital. At issue is whether a lower court’s ruling should stand—in 2007, that court found that the state’s $500,000 cap for damages against doctors (and $1 million for damages against private hospitals) violated the state’s constitution, specifically that it threatens the separation of powers by allowing the legislature to curtail the powers of a jury to fairly compensate injured plaintiffs.

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MIcrA > hanging by a thread Previous Supreme Court rulings have also settled the equal protection argument, finding in Fein that the statute is rationally related to a legitimate state interest, and in Werner v. Southern California Newspapers, Inc. that the legislature is the correct forum in which to adjust the law to fit the plaintiff ’s wishes. there have been legislative challenges to MICRa, too. Lisa Maas counts two or three legislative challenges to the law in the past two decades, with no successes. asked when the last was, she says it’s

fornia Supreme Court decisions addressed this constitutional challenge, and they didn’t,” says Spagnoli. From the beginning, she says, the case lacked the most substantive evidence, which would have undermined the key claim in Fein—that the MICR a cap is rationally related to a legitimate state interest. that body of evidence questions the efficacy of caps in keeping physicians’ liability premiums under control, and bringing it up in appellate court would raise the question of whether the state has the constitutional authority to regulate damage awards, if it is indeed possible that caps may not have a meaningful impact on insurance rates. the plan is also to keep the challenges coming. “What we’re telling people is that you should try to raise the constitutionality of MICR a, so that a trial judge has to make a ruling on it, to get it in front of the appellate court,” Spagnoli explains. “If you go back and look at Fein and other cases that upheld the cap, they never address the 7th amendment right to a jury trial, and there’s been precedent in the U.S. Supreme Court since then that raised has this squarely.” of course, the willingness of appellate courts—and the California Supreme Court—to look at the issue again depends on whether they agree with that the view that Spagnoli holds. If a court doesn’t see any reason to dissent with established state law, there will likely be no review in the high court. If the CMa and the rest of organized medicine maintain vigilant as they have for the past three decades, then the chances are good that the courts will stay true to precedent and the original intent of the law.

as the situation stands, organized medicine seems confident that trial attorneys are barking up the wrong constitutional tree with their new approach. been awhile. “there are probably times that we’ve prevented a bill from being introduced, just from the strength of our coalition and the intensity of our members, who talk to legislators to explain how important MICRa is.”

safe, But for how long? as the situation stands, organized medicine seems confident that trial attorneys are barking up the wrong constitutional tree with their new approach. “The primary constitutional challenges were the crux of the challenge in Van Buren,” says Maas. “They’ve been addressed going all the way back to the Fein case and others.” of course that’s not at all what you hear from the attorneys that are currently allied with CaoL and CCL. “I know the Van Buren court said this is an old issue, but that was very much in passing. they didn’t squarely take on whether the prior Cali-

The Seven Parts of MICRA california’s Injury Compensation Reform Act is made up of seven components, including its most famous and most-litigated portion, the $250,000 cap on non-economic damages. Here are the other six: •

The law places limits on attorney contingency fees in professional negligence cases against physicians and other health care providers. Attorneys can collect only 40 percent of the first $50,000 recovered, 33 percent of the next $50,000, one-quarter of the next $50,000, and 15 percent of a remainder up to $600,000.

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•

It sets the statute of limitations at one year from the discovery of an injury and an allegedly negligent cause, or at three years from an injury.

•

It allows patients and physicians to agree to settle future disputes in binding arbitration through the use of specific contracts that are revocable within 30 days, and which employ specific language.

•

It allows a physician to use periodic payments to satisfy a claimant’s future economic damages, if they are over

•

$50,000. It requires a claimant to notify a physician 90 days in advance, if he or she intends to sue for professional negligence. The statute of limitations is extended to accommodate nearly late notifications. The law allows a physician defendant to introduce evidence of collateral source payments during a medical liability lawsuit. This might include personal health insurance related to the damages sought, and the plaintiff is allowed to introduce evidence of the cost of insurance premiums.

SPRING 2010

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micra > hanging by a thread

CMA

Webinars Available Online! CMA is excited to announce that we will be hosting a series of live monthly webinars to educate physicians on a

March 2 12:15pm-1:15pm

CMA MEMBERS ONLY: Meaningful Use for your EHR

In order to receive incentive payments for electronic health records (EHR) implementation, physicians will have to demonstrate “meaningful use” of that system. The Federal Government recently released a draft rule that will define “meaningful use,” including which quality measures physicians will have to report. This CMA Webinar will walk physicians through the proposed rule, and offer practical tips for physicians who are gearing up for incentive payments in 2011.

March 3 12:15pm-1:15pm

CMA MEMBERS ONLY: Documentation – Medi-Cal Fraud and Abuse Series

In this webinar, Bruce Tarzy, MD, Medical Consultant with the Department of Health Care Services will describe the importance of documenting medical services provided to Medi-Cal recipients. And, impact of fraud and abuse to the Medi-Cal program.

*March 10 12:15pm-1:15pm

Medicare – New Year, Fresh Start

technologies to reimbursement issues.

This webcast is designed as a Medicare refresher course, covering a variety of topics including the call inquiry process, filing an appeal and reading your remittance advice.

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March 18 12:15pm-1:15pm

range of topics from health information

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HIPAA Overview and Compliance – How to Be Compliant with Recent Changes

member help line, (888) 233-2937 or

The HITECH Act of 2009 mandated additional guidelines for HIPAA which impact HIPAA compliance, breach and penalties. In this webinar, David Ginsberg of PrivaPlan, will give a brief overview of HIPAA privacy and security rules, highlight the changes to HIPAA affecting security breach notification and business associate agreements, and provide resources to help physicians understand and comply with the new HIPAA regulations.

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April 7 12:15 pm-1:15pm

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*April 21 12:15 pm-1:15pm

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Presented by Catalina Ramirez, Ombudsman, Palmetto GBA. This presentation is designed to increase provider awareness and understanding of the most common claim denials. It will also provide you with the appropriate information on how to avoid or resolve these common denials.

*May 12 12:15 pm-1:15pm

Medicare Preventive Services

Are you and your patient’s getting the most out Medicare Part B benefits? Did you know that Medicare Part B covers sixteen (16) Preventive Services? Learn what they are and how to bill correctly for them in this informative webinar.

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CMA MEMBERS ONLY: Evaluation & Management Coding and Documentation

In this member’s only webinar, Dr. Arthur Lurvey, Medical Director for PalmettoGBA, offers and in-depth training for documenting and coding out-patient and in-patient E&M services.

June 9 12:15pm-1:15pm

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In this member’s only webinar, Practice Management Inc. presents how to evaluate and retain qualified personnel for your medical practice.

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SPRING 2010

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COMMUNITY > news

IN THE

NEWS

Providing staff, physicians and patients with relevant & up to date information Dr. Gellineau Joins Iris Clinic Lodi Memorial Community Clinic - Iris welcomes familypractice physician Victor Gellineau, MD. Dr. Gellineau joins Harvey Hashimoto, MD, and Terri Vaccarezza, FNP. The clinic is located at 801 S. Ham Ln., Ste. S, in Lodi. New patients and most insurances are accepted. Call 334-8540 to schedule an appointment.

Second Sutter Gould Medical Office Opens Sutter Gould Medical Foundation Opens Second Medical Office Building; Completes Stockton Medical Plaza Sutter Gould Medical Foundation (SGMF) has opened the second medical office building (SMP II) on the Stockton Medical Plaza campus at Hammer Lane and Don Avenue. The SMP II opened for patients December 14. “This project has enabled our Stockton-based Gould Medical Group specialists to move to the Plaza, and provides our patients a one-stop medical services experience,” said Paul DeChant, M.D., Chief Executive Office for Sutter Gould Medical Foundation. “We are extremely pleased with the way the project turned out.” The new medical office building provides office and exam rooms for specialists including dermatology, ENT, OB/ Gyn, orthopedics, gynecology, pain management, urology, and general and

SAN JOAQUIN PHYSICIAN

vascular surgery. Primary care physicians, endocrinology and neurology remain in the first building, or “SMP I”. The two buildings are connected by SGMF’s state-of-the-art imaging center and laboratory. “Patients are able to see their primary care physician, have lab work done, take an x-ray or CT scan, and see a specialist without leaving cover of our facilities,” said DeChant. “That was our goal, to provide expert care in a convenient manner. We believe the Stockton Medical Plaza fulfills that goal.” “An Urgent Care Center is another key feature of SMP II that we’ve added for our patients, and will open in the near future,” said Bruce Tigner, SGMF’s San Joaquin County Chief Operations Officer. “With the Urgent Care Center, our patients can see a Gould physician when they might not be able to see their regular Gould doctor – including extended weekday hours or on the weekends.”

Surgeon Rick Rawson, MD, Joins St. Joseph’s Medical Group St. Joseph’s Medical Group of Stockton is pleased to welcome surgeon Rick Rawson, MD, to their team of Family Practitioners, Internal Medicine Specialists, Pediatricians, and General Medicine Practitioners. Dr. Rawson joined St. Joseph’s Medical Group effective August 10, 2009. He will remain in his current office located at 1617 N. California Street, Suite 1E, here in Stockton. After operating a private practice for almost 35 years, Dr. Rawson is looking forward to working for the CHW Medical Foundation team. “The quality of surgery is the most important determinant in patient outcomes,” says Dr. Rawson. “I became a surgeon to have a direct, positive impact on these outcomes. Now with the support of the larger organization taking on some of the details of running a practice (paperwork, billing, staffing, etc.), I can concentrate on what I enjoy most about being a surgeon – providing excellent patient care.”

SPRING 2010

news < COMMUNITY Dr. Rick Rawson attended the University of Colorado, in Boulder, CO, and completed his residency at San Joaquin General Hospital. Board certified by the Diplomate American Board of General Surgery, Dr. Rawson has been a member of the medical staff at St. Joseph’s Medical Center since 1975. “Dr. Rawson has been a wellrespected surgeon in this community for almost 35 years.” said Doug O’Ryan, Director of Physician Operations. “We are extremely pleased to welcome him to St. Joseph’s Medical Group and proud to offer such a comprehensive array of medical services to our patients.” 3132

all cervical cancers occur in women who have human papillomavirus (HPV),” said Dr. Dean Blumberg, Associate Professor of Pediatric Infectious Disease at UC Davis Children’s Hospital. “Prevention of HPV infection will prevent cervical cancer.” The CMA Foundation will serve as the lead, coordinating agency for the California campaign and work with clinicians serving a large segment of patients from diverse communities, patient groups and community organizations. “With proven prevention methods, including the new HPV vaccine, regular screenings, and stronger public awareness, we have a tremendous opportunity to do even more to curb the devastating Dr. Nahl Joins Trinity Clinic effects of cervical cancer,” said Carol Victor Gellineau, MD Lodi Memorial Community Clinic Lee, Esq., president and CEO of the Trinity welcomes internal-medicine CMA Foundation. Key activities of physician Gary Nahl, MD. Dr. Nahl the CMA Foundation’s California joins Drs. Joseph Nguyen and Vanessa Cervical Cancer Free Campaign Tsuda-Nguyen and family nurse during 2010 include: practitioner Dawnette Person. • The dissemination of the updated The Lodi Memorial Community CMA Foundation Cervical Cancer/ Clinic - Trinity is located at 10200 HPV Provider Toolkit in early 2010. Trinity Pkwy., Ste. 102, in Stockton. The toolkit will include a broader New patients and most insurances are understanding of the health disparities accepted. Call 948-0808 to schedule associated with cervical cancer, an appointment new resources for patient/provider communications and consumer California Medical education resources. Association Foundation to • The CMA Foundation’s Vaccine Launch California Cervical Summit to be held on June 1st in Cancer Free Campaign partnership with the California Foundation partners with the Department of Public Health. Surgeon Rick Rawson, MD California Department of Public Strategies to strengthen both Health in the campaign to prevent and healthcare provider and consumer impede the progression of cervical understanding of the issues related to cancer cervical cancer, HPV and the HPV The California Medical Association vaccine will be mapped out. (CMA) Foundation is launching • The Health Disparities Convening as the California Cervical Cancer part of the Foundation’s 2010 Network Free Campaign to raise awareness of Ethnic Physician Organizations about cervical cancer and develop (NEPO) Summit to be held in approaches to reduce the rate of this September. This pre-summit session disease in California which kills more will highlight best practices, key action than 4,000 women nationwide. Each steps and resources that are available year, about 1,400 California women to increase the use of vaccinations in are diagnosed with cervical cancer and diverse communities. 400 die from this disease. • Survey of health care professionals Gary Nahl, MD. Dr. Nahl Most cases of cervical cancer are on current vaccine practices to inform caused by the Human Papillomavirus, the campaign about the challenges for or HPV. Millions of American women are infected with health care professionals. HPV, but due to its often symptomless nature, a woman can • Convene health plans and payors to address vaccine coverage be unaware of her risk of developing cervical cancer. “Almost and access issues.

SPRING 2010

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COMMUNITY > news

IN THE

their only parent.” Startup funding for the California Cervical Cancer Free Campaign is made possible by a grant from GlaxoSmithKline. For more information about the campaign, please contact Elissa Maas, Vice President of Programs, CMA Foundation, at emaas@thecmafoundation.org.

NEWS

All women are susceptible to cervical cancer, which is the 10th most common cancer diagnosed among California women. It is also the 5th most common cancer in the Latino population, 6th most in the Vietnamese and 10th most common in the African American populations. Mortality from cervical cancer also varies by race/ ethnicity with Hispanic and African American women having the highest rates. Mortality from cervical cancer is associated with later stage of diagnosis, and Inaugural Physician Champions thus poorer access to preventive services, St. Joseph’s Medical Staff including infrequent or no Pap screening Announces Inaugural and/or lack of adherence to follow-up. Physician Champions Therefore, successful campaigns to reduce The first Physician Champion awards were and eliminate cervical cancer must address presented to Drs. Gurinder S. Grewal and the language and cultural needs of all Barbara Rankin during a recent recognition women. ceremony. St. Joseph’s initiated the Physician The goal of the campaign is to increase Champion award program to recognize and screening and vaccination so that every honor individual physicians who pursue and woman has the chance to be protected demonstrate excellence in the two categories, from cervical cancer. “The message is Quality and Community, with plans to so clear and so important – get yourself continue the recognition of outstanding screened and vaccinated,” said Marlene physicians as an annual event. von Friederichs-Fitzwater, cervical cancer Gurinder S. Grewal, MD, a cardiologist, survivor and director of the UC Davis was named Physician Champion of Quality. Cancer Center’s Outreach Research and Dr. Grewal has demonstrated exceptional Education Program. “I know because dedication to cardiac quality improvement I developed cervical cancer and was initiatives since he became a member diagnosed at a late stage because I put off of St. Joseph’s Medical Staff, including having a Pap test for several years when I acting as Medical Director for Cardiac was in my 30s. I put myself at risk, and, as a Research, Chairman of the Cardiac Quality single mother, put my sons at risk of losing

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Committee and Cardiac Care Committee and Medical Director of the Cath Lab since 2004. Dr. Grewal is also instrumental in leading Cardiac Cath Conferences, which serve as a forum to educate Cath Lab staff and encourage collaboration amongst physicians. “I am grateful to St. Joseph’s Medical Staff and administration for recognizing me and creating this award,” Grewal says. “I am deeply committed to my patients have always tried to promote high-quality patient care. I hope that in future years, the award will be presented to leaders who help make St. Joseph’s Medical Center the best facility, and the leader in quality, in the Central Valley.” Named Physician Champion of Community, Barbara Rankin, MD, has worked to provide medical relief and care to uninsured and/or vulnerable people in the local community, including more than 20 years as a volunteer and Professional Clinic Advisor at St. Mary’s Interfaith Community Services. She has actively participated as a member of the Internal Medicine/Family Practice Quality Assurance Committee for the past three years and has served on the Credentials Committee for 15 years. “We are pleased that the medical staff established the Physician Champion Program, so that the doctors have a forum for recognition of their peers, by their peers,” said Michael Ricks, Chief Operating Officer, St. Joseph’s Medical Center. “Both Physician Champions adhere to the highest personal standards and have the utmost respect for all the patients and fellow physicians with whom they interact.” The Physician Recognition program was well-received by the medical staff, and an overwhelming majority of the active medical staff participated in voting. Both were extremely close races, especially the Champion of Community, where the decision came down to a few winning votes. The other finalists were Susan McDonald, MD, for Champion of Quality, and Vincent Pennisi, MD, for Champion of Community.

SPRING 2010

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EZMEDS USA was created for the primary purpose of making the millions facing financial challenges in this country aware of Patient Assistance Programs, and to assist eligible patients who cannot afford their prescription medications due to limited income or other financial hardships. When someone meets the eligibility criteria and is experiencing financial hardship with their prescription medications, EZMEDS USA helps them with worry-free, ongoing management of their prescription assistance needs So, how can EZ MEDS USA help? The problem: There are few who know about these programs or understand the complicated application and approval process required to participate in a P.A.P. The solution: EZMEDS USA. We are a patient advocacy company providing an easy, affordable solution to obtaining costly prescription medications. EZMEDS USA does all the legwork on the patient’s behalf, allowing them to enjoy a worry-free way to receive their medication and save substantial money • We monitor every step of the process for each program from start to medication delivery. • EZMEDS USA automatically handles refills or renewals to continue an ongoing supply of medication. EZMEDS USA interfaces with the physician(s) and program(s) as required on the patient’s behalf. To learn more about EZMEDS and how this resource can help you and your patients, please call Scott Galbraith at 209 406-1483 or email scottg@ezmedsusa.com or come to the April Office Managers Forum where Scott will be presenting this program. St. Joseph’s Awards over $150,000 in Grants to Community Benefit Organizations Furthering a Mission to Improve the Health of Our Community St. Joseph’s Medical Center has awarded $154,187.00 in grant funding to seven local community benefit organizations that provide critical health and human services to residents in San Joaquin County. St. Joseph’s administration, mission, and community benefit representatives distributed the grants,

SPRING 2010

ranging from $4,000 to $25,000, during a luncheon held at the medical center. “We serve our mission beyond our walls and create healthier communities through our Community Grants program,” stated Sr. Abby Newton, Vice President-Mission Integration, St. Joseph’s Medical Center. “By collaborating with area agencies who support advocacy and social justice for the most vulnerable members of our communities, we further the health care ministry of our religious sponsors who have continuously worked to reach and serve those in need.” The Community Grants Program was established in 1990 to provide funding to community-based organizations that provide services to individuals in need. Since its inception, the program has distributed over $1,650,000 in grant funding to deserving nonprofit community benefit organizations with an interest in building healthier communities by improving health and living conditions. The program encourages organizations attempting to address the underlying causes of illness as well as specific health issues. This year, special consideration was given to programs promoting access to prenatal healthcare and healthcare for children, as well as those focusing on chronic disease such as diabetes and asthma. These health conditions were targeted as a result of community health needs assessments conducted by a partnership effort including local hospitals, county public health departments, and other community agencies. St. Joseph Medical Center annually sets aside revenues from operations to fund the community grant awards. The grants program is one way in which St. Joseph’s realizes its health care mission and enhances the advocacy and social justice efforts of its hospitals and its religious and community sponsors. Through this program, St. Joseph’s seeks to partner with other nonprofit organizations that are working to improve the health status and quality of life for the communities we serve. This year’s St. Joseph’s Community Grants were awarded to the following area organizations:

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COMMUNITY > news throughout San Joaquin County. The goal of the program is to prevent the development of chronic diseases and to induce healthy lifestyles by enabling access to fresh produce and educational resources. Gospel Center Rescue Mission – To provide homeless/indigent patients with respite care at GCRM facilities that insures their continued recovery after surgery or other illness through the provision of basic post-operative care. St. Mary’s Interfaith Community Services – To ensure that the Virgil Gianelli M.D. Medical Clinic continues to meet and exceed safety and health standards, providing clients with appropriate care through the updating of aging equipment. San Joaquin County Office of Education – To develop and implement a physical and nutrition education component in Venture Academy’s K-8 program in an effort to combat childhood obesity and other health-related issues. Women’s Center of San Joaquin County - To increase access to free and confidential crisis intervention and counseling services for children and teens who have been victims of, or who have been exposed to, domestic violence. The program will also serve the parents or guardians of child and teen victims. Victims and their parents will receive crisis intervention and counseling services, develop family safety plans, learn about domestic violence and its effects, develop healthy communication skills and receive information and referrals for additional services. FOR ALL OF YOUR AMBULATORY SURGERY NEEDS About St. Joseph’s Medical Center St. Joseph’s Medical Center is a not-for-profit, fully accredited, regional hospital with 294 beds, a physician staff of over 400, and more than 2,400 employees. St. Joseph’s specializes in cardiovascular care, comprehensive cancer services, and women and children’s services A state-of-the-art 12,000 square foot facility featuring three operating rooms including neonatal intensive care (NICU). St. and a procedure room and the ability to recover patients up to 23 hours Joseph’s Medical Center is the largest hospital, as well as the largest private employer in Stockton and San Joaquin County. In addition Conveniently located in North Stockton off I-5 and Eight Mile Road to being nationally recognized as a quality (209) 323-3480 leader, St. Joseph’s is consistently chosen as the “most preferred hospital” by local consumers. Founded in 1899 by Fr. William O’Connor and administered by the Dominican Sisters of San Rafael, St. Joseph’s continues to lead the region in medical innovation as well as ongoing clinical research, developing tomorrow’s advancements, today. In 2009, St. Joseph’s provided over $47 million in charity care, community benefits, and unreimbursed patient care. St. Joseph’s Medical Center is a member of Catholic Healthcare West (CHW), a system of 42 hospitals and medical centers in California, Arizona and Nevada. For more information, please visit our website at StJosephsCares.org.

Catholic Charities, Diocese of Stockton – To promote prenatal care in the first trimester and improve access to health care for the underserved by providing outreach and education to pregnant women about the importance of early prenatal care. Community Medical Centers – To provide a comprehensive Chronic Disease prevention program to clinic patients and community members of San Joaquin County. The program will include individual patient education, group classes and outreach at local health fairs. Emergency Food Bank of Stockton/San Joaquin – To deliver fresh fruits and vegetables coupled with informative nutrition education and health cooking demonstrations to resource-poor areas

SAN JOAQUIN PHYSICIAN

SPRING 2010

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Alliance > news

San Joaquin Medical Alliance Invites You, Your Family & Friends to Attend Our

Bunny Hop & International Potluck Sunday, March 28, 2010 1:00—4:00 pm at the home of Drs. Susan & Jerry McDonald, 11226 Mickie Grove Road, Lodi (8 Mile Rd off I-5 or Hwy 99 2then north on Micke Grove Rd.) This will be a casual, family, outdoor get together for old & new members and their children and grandchildren. Bring your favorite dish to share. Please RSVP by Friday, March 21 $10.00 Adults $5.00 Children. Betty Kellogg 7120 Alexandria Place Stockton, CA 95207 209-956-0696 (H) or 209-612-6308 (C)

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Louise Talley

has been chosen as our Alliance 2010 recipient of the Doreen Evert Member of the Year Award. Louise held several positions in our Alliance prior to assuming the role of President and subsequently became Nominating Committee Chair the following year. She was president of Junior Aid and after reaching sustainer status she was the recipient of their Mary Dunne Volunteer of the Year Award. She taught Sunday School at Central Methodist Church and taught a Cuban immigrant how to read English through a church sponsored program. Louise has served as president of the Junior Women’s Group of the Haggin Museum, president of The 19th Century Club, and president of PEO (a philanthropic educational organization). She was a founding member of ALS/SOS. Louise recently was named Stockton Symphony Alliance Member of the Year for 2009Please Join us to Present the Award to Louise! Thursday, April 8, 11:30 a.m. Dave Wong’s Restaurant 2828 W. March Lane Please RSVP by April 1 Send To: Nancy Schneider Mail check for $25 (SJMA) 1017 W. Lincoln Rd. 95207

SPRING 2010

San Joaquin Medical Society & Health Plan of San Joaquin

Present: dŚĞ ,Z ĞƐƚ WƌĂĐƟĐĞ ^ĞƌŝĞƐ™

Learn Best Practices for Selecting, Implementing, and Optimizing an Electronic Health Record (EHR) System With the introduction of the HITECH Stimulus Act, 2010 is the year to fully adopt an EHR system. How do you plan for a successful EHR implementation? What level of “Meaningful Use” deployment is required to receive incentives? There are more than 250 EHR vendors in the market, how do you determine which EHR product meets Stimulus requirements and is the best fit for your practice and budget? DĂǆǁĞůů /d͕ ƚŚĞ ƉƌŽĚƵĐĞƌ ŽĨ ƚŚĞ ,Z ĞƐƚ WƌĂĐƟĐĞ ^ĞƌŝĞƐΡ ŝƐ Ă ŶĂƟŽŶĂůůǇ ƌĞĐŽŐŶŝǌĞĚ ,Z ĐŽŶƐƵůƟŶŐ ĐŽŵƉĂŶǇ ƚŚĂƚ ƉƌŽǀŝĚĞƐ ĞĚƵĐĂƟŽŶ͕ ƐĞůĨͲŚĞůƉ ƌĞƐŽƵƌĐĞƐ ĂŶĚ ǀĞŶĚŽƌ ĂŶĂůǇƐŝƐ ƚŚƌŽƵŐŚ ƐƚĂƚĞ ŵĞĚŝĐĂů ĂƐƐŽĐŝĂƟŽŶƐ͘ dŚĞ ƐĞŵŝŶĂƌƐ ĂƌĞ ĚĞƐŝŐŶĞĚ ƚŽ ďĞ ǀĞŶĚŽƌͲ ŶĞƵƚƌĂů ŝŶ ĐŽŶƚĞŶƚ ĂŶĚ ĂƌĞ ĨƌĞĞ Žƌ ĚŝƐĐŽƵŶƚĞĚ ĨŽƌ ŵĞŵďĞƌƐ ĂŶĚ ƐƚĂī͘

Basic Course Schedule

March 30, 2010 | 6:00pm – 8:30pm September 21, 2010 | 6:00pm – 8:30pm ŽƐƚ͗ &ƌĞĞ ĨŽƌ Ăůů ƉŚǇƐŝĐŝĂŶƐ ĂŶĚ ŽĨĨŝĐĞ ƐƚĂĨĨ͘ >ŝŐŚƚ ƐŶĂĐŬƐ Θ ďĞǀĞƌĂŐĞƐ ǁŝůů ďĞ ĂǀĂŝůĂďůĞ ĚƵƌŝŶŐ ƐĞŵŝŶĂƌ͘

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ͻ WƌĞƐĞŶƚ ĂŶ ŽǀĞƌǀŝĞǁ ŽĨ ƌĞĐŽŵŵĞŶĚĞĚ ƐĞůĞĐƟŽŶ ĐƌŝƚĞƌŝĂ ĂŶĚ ŵĞƚŚŽĚŽůŽŐǇ ƚŽ ŝĚĞŶƟĨǇ ƉŽƚĞŶƟĂů ǀĞŶĚŽƌƐ ͻ >ĞĂƌŶ ƚŽ ďƵŝůĚ Ă ĮǀĞ ǇĞĂƌ ďƵĚŐĞƚ ŵŽĚĞů ƚŚĂƚ ĐĂůĐƵůĂƚĞƐ Ăůů ĚŝƌĞĐƚ ĂŶĚ ŝŶĚŝƌĞĐƚ ĐŽƐƚƐ ĂƐƐŽĐŝĂƚĞĚ ǁŝƚŚ ƉƵƌĐŚĂƐĞ͕ ĂƐ ǁĞůů ĂƐ ĐŽƐƚ ƐĂǀŝŶŐƐ ͻ >ĞĂƌŶ ŚŽǁ ƚŽ ĞīĞĐƟǀĞůǇ ĐŽŵƉĂƌĞ ǀĞŶĚŽƌƐ

tŽƌŬƐŚŽƉ ͬ ^ĞůĞĐƟŽŶ ,ĂŶĚďŽŽŬ

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Sponsors: DISCLAIMER: DĂǆǁĞůů /d ŽŵƉĂŶǇ ʹ ƚŚĞ ůĞĂĚ ŚŽƐƚ ŽĨ ƚŚĞ ,Z ĞƐƚ WƌĂĐƟĐĞ ^ĞƌŝĞƐΡ Ͳ ǁŽƵůĚ ůŝŬĞ ƚŽ ƚŚĂŶŬ ƚŚĞ ƐƉŽŶƐŽƌƐ͕ ŵĞĚŝĐĂů ĂƐƐŽĐŝĂƟŽŶƐ ĂŶĚ ƌĞŐŝŽŶĂů ŚŽƐƉŝƚĂůƐ ƉĂƌƟĐŝƉĂƟŶŐ ƚŽ ŵĂŬĞ ƚŚĞ ĞǀĞŶƚƐ ƉŽƐƐŝďůĞ͘ dŚŝƐ ŝƐ Ă ǀĞŶĚŽƌͲŶĞƵƚƌĂů ĞĚƵĐĂƟŽŶ ƉƌŽŐƌĂŵ͘ ůů ƐƵƉƉŽƌƟŶŐ ŵĞĚŝĐĂů ĂƐƐŽĐŝĂƟŽŶƐ͕ ƉĂƌƟĐŝƉĂƟŶŐ ŚŽƐƉŝƚĂůƐ͕ ĂŶĚ DĂǆǁĞůů /d ŽŵƉĂŶǇ ĂƌĞ ŶŽƚ ĂĸůŝĂƚĞĚ ǁŝƚŚ ƚŚĞ ƉĂƌƟĐŝƉĂƟŶŐ ƐƉŽŶƐŽƌƐ͕ ŶŽƌ ĚŽ ƚŚĞǇ ĞŶĚŽƌƐĞ ĂŶǇ ƐƉĞĐŝĮĐ ŵĞĚŝĐĂů ƌĞĐŽƌĚ ƐǇƐƚĞŵ Žƌ ƌĞůĂƚĞĚ ƉƌŽĚƵĐƚ Žƌ ƐĞƌǀŝĐĞ ŝŶ ĐŽŶũƵŶĐƟŽŶ ǁŝƚŚ ƚŚĞƐĞ ƉƌŽŐƌĂŵƐ͘ Ξ ϮϬϭϬ DĂǆǁĞůů /d ŽŵƉĂŶǇ͘ ůů ƌŝŐŚƚƐ ƌĞƐĞƌǀĞĚ͘ ,Z ĞƐƚ WƌĂĐƟĐĞ ^ĞƌŝĞƐ ŝƐ Ă ƚƌĂĚĞŵĂƌŬ ŽĨ DĂǆǁĞůů /d ŽŵƉĂŶǇ͘ SPRING 2010

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COMMUNITY > Health Care Forum

UOP’S

Beyond the Gates Health Care Forum

New University of the Pacific President Pamela Eibeck’s call for more university involvement in the community came to life during a mid-January gathering of health care professionals and academics at O’Connor Woods. Story & Photos by William West

Pamela Eibeck, President of the University of the Pacific, thanks attendees at the health forum

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The “Assisting with Community Solutions for Health Care Issues Forum” was the first of a series of meetings to explore how the university’s resources can help meet the needs of Stockton and San Joaquin County. Hospital administrators, public health officials, and leaders in the medical, dental and pharmacy associations gave brief summaries of pressing needs. The high obesity and diabetes rates in the county as well as the large percentage of the population that uses emergency rooms as a primary health care provider were two identified issues. There was so much interest in the forum that the West Hall at O’Connor Woods was quickly filled and two other rooms handled the overflow by means of closed circuit video feeds. There was unanimity that a dearth of health care professionals hampers community wellbeing. The impending construction of a state prison hospital will further strain the current population of doctors, nurses, and technicians. Here is a summary of some of the panelist’s comments: Ken Cohen, CEO of San Joaquin General Hospital, spoke about infrastructure challenges that included clean air, clean water, and education. He maintained that those who get

their training here are more likely to remain in the community. In discussions later in the forum, suggestions were made that UOP consider implementing training programs in the health professions beyond their highly respected pharmacy school. Mention was made that Delta College is discussing increasing the size of nursing classes with the Department of Corrections. Financing for the increases might be sponsored by the state. Bill Mitchell, director of San Joaquin County Public Health Services, stated that he was going lose 20 percent of his staff due to state budget cuts. Health fairs to screen residents for communicable and chronic diseases sponsored by UOP might help. Mike Steenburgh, Executive Director of the S.J. Medical Society, spoke about the history of the society and related the successes of Decision Medicine in fostering medical careers for students. He spoke of the need for partnering between UOP and health organizations such as Public Health, but also between Health Plan of San Joaquin and other medical groups. He also addressed the idea of a health care career fair for students on the UOP campus. Don Wiley, President of St. Joseph’s Hospital, spoke about the importance of partnering with groups like Health Plan of

SPRING 2010

Don Wiley, President of St. Joseph’s Medical Center, addresses pressing community healt care needs during his presentation. His fellow panelists are (leftto-right) michael Steenburgh, S.J. Medical Society Executive Director; Amy Scriven, S.J. Dental Society; Dr. michael rehbein, Kaiser Permanente; marisella Guerrero, President S.J. Pharmacy Association; (in back) moderator Dave Frederickson, Jacoby center; Don Wiley; (in back) Donald Wegmiller, former head of the American Medical Association and keynoter speaker; Ken cohen, CEO S.J. General Hospital; William mitchell, S.J. County Public Health Director; Dale Bishop,Medical Director for Health Plan of San Joaquin; and Diane Vigil, Executive Director of the Dameron Hospital Foundation.

has all the answers and everyone must share best practices to San Joaquin. He reminded listeners that St. Joseph’s isn’t just come up with an affordable system. the area biggest hospital; it is also the area’s biggest charitable The insurance system, Wegmiller maintained, needs huge organization. change. For it to work, everyone must have access to the system. Diane Vigil, Executive Director of the Dameron Hospital Collaboration must reach outside Foundation, spoke about a stric tly health care organizations to partnership with Hamilton “Addressing the health care needs of a all community players. For example, Elementary School that community requires as many organizations the Salvation Army may know more introduces young students to as possible in one big collaboration,” about the health needs of a certain actual health care professionals. Don Wegmiller, former President of the population than any other group— Hamilton students’ standardized American Hospital Association. “You would and could head off an epidemic if test science scores have improved be surprised how much your local churches they had good communication with by 30 percent since the program local health care providers. and the Salvation Army know about the began two years ago. She posed Mr. Wegmiller suggested a the challenge to the group to find health care needs of their people….and visit to “milagrohouse.org” to ways to replicate this program in how to organize to help them.” see an example of community other schools. collaboration in Lancaster, The keynote speaker was Don Pennsylvania. Wegmiller, Chairman and CEO of C-Suite Resources, a firm The panelist’s presentations were followed by a discussion specializing in market intelligence on the health care industry with a group of UOP professors and administrators on how to for firms serving hospitals and health systems,. He is a former implement some of the ideas and how to address some of the chairman of the American Hospital Association. nagging problems. A lunch followed for the participants who He spoke about the need for a complete change in the continued to discuss ways to improve the health care climate in health care model in the United States. The mantra must be the local community. collaboration. Currently, most medical endeavors are insular This fall, UOP will present a report for the community based and self-contained, with their own cost structures. Hospitals and on the statements of the participants, university faculty, and HMOs and private practices all have their own imperatives. They public feedback. get in the way of each other’s data systems. No one organization

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SPRING 2010

Hospice Care < PRACTICE MANAGEMENT

Hospice Care & Palliative Care:

Choosing the Right Level of Care

The concepts of hospice care and palliative care are parallel-both philosophies provide quality of life when quantity is no longer possible. By Aubrey Wuerl, RN • Education Coordinator Hospice of San Joaquin

“76 million baby boomers are confronting end-oflife issues for their parents as well as for themselves.”

Hospice Care Vs Palliative Care

Palliative care is comfort care and follows the curative course that the patient has been on, frequently beginning in the hospital setting. Hospice care is also comfort care and follows the palliative course, is typically provided in the home, and is “time limited” to six months or less after all therapies have been completed. The dilemma for the physician is, “which is the appropriate level of care for my patient when cure is no longer an option?” What constitutes a quality Hospital-Based Palliative Care Team, and how does one choose an outstanding Hospice? Today, physicians and patients can access over 1,400 hospital-based palliative care programs and there are now well over 4,700 hospice programs in the United States.1 One reason for this expansion is to accommodate an aging population living with chronic illnesses; and, simply, a cure is not always possible. This fact will be especially important to the 76 million baby boomers as they confront end-of-life issues for their parents as well as for themselves.

The physician should expect the following from the hospital-based palliative care team: Evidence-based symptom palliation and psychological support; shared decision-making that supports both the patient and the family or caregiver; dignity and respect regarding the patient’s cultural values; practical, financial and legal assistance for patients and families, and coordination of care across the health care settings. The physician should expect the same from the hospice team, plus: accreditation or certification through a national organization; nurses and social workers certified in hospice and palliative medicine; use of standardized assessment tools; one designated case manager/social worker team assigned to each patient; and, an understanding of how the hospice monitors and improves its patient care. Whether a patient receives care from a hospital-based team or a hospice team, both must strive to provide patient and familycentered competent and compassionate care. This allows for a life closure with dignity and respect—hallmarks of all palliative care.

1Teno, JM, Connor, SF, Referring a patient and family to high-quality palliative care at the close of life. Journal of the American Medical Association, 2009, (301), No 6; 651–658.

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SPRING 2010

St. Joseph’s Patient Pavilion Opens

Women’s & Children’s Center, Private Rooms, Healing Gardens The design of the new Patient Pavilion at St. Joseph’s Medical Center, that beguiling curve of glass on the corner of Harding Way and California Street, makes the hospital more hospitable. Patient rooms are reminiscent of home in their muted colors and built-in wooden shelves; doctors have sleeping quarters near the labor and delivery rooms; private rooms give cancer patients and their families needed emotional space.

The staff has its own entrance doors that lessen foot-traffic in visitor areas, also reducing noise for patients. Multiple windows and other glass features allow natural light in more areas, especially into patient rooms. A subset of architects, including designers of the Patient Pavilion, studied for fifty years the way a hospital building affects patients and staff. Many of the lessons learned in that half century are elements of the new pavilion. By William West

SPRING 2010

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From the street the pavilion incorrectly appears to be one solid building, but once inside it reveals large areas of open space and views from every room. Two courtyards with healing gardens offer open-air respite. The courtyards are substantial: 1300- and 2000-square-feet. There are meditation rooms. The feel for patients and staff is less that of a big-box industrial space, but more human-scale and natural. The dominant eye-catching element is the pedestrian bridge from the existing hospital to the new pavilion. Clad in glass it sweeps across Maple Street in a serpentine leap. March 19, 2010, is the scheduled opening date; eight years after the schematic design process began. “I would like to say that Sister Gabriel is watching down over us with great affection for this project,” said Dr. Param Gill, Obstetrican-Gynecologist, and immediate past Chief of Staff at St. Joseph’s. The late Sister Mary Gabriel, O.P., member of the Dominican Sisters of San Rafael that sponsor St. Joseph’s, was a legendary leader of St. Joseph’s for more than four decades until her retirement in 1990. She tirelessly advocated for increased levels of community care and for hospital improvements. (O.P. stands for “ordo praedictorum” or “order of preachers”.) Dr. Gill and her medical group bring a lot of babies into the world via St.Joseph’s, thus she is doubly interested in the Pavilion’s new Women’s and Children’s Center. The first floor contains rooms dedicated to deliveries and newborns. The neonatal intensive

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care unit (NICU) beds are located on the second floor. “St. Joseph’s delivers something like 150-to-200 babies per month,” said Dr. Gill. “Our medical group delivered 1100 babies last year at St. Joseph’s.” Of the 78 new beds in the pavilion, 58 are related to women’s and children’s medical needs. There are 20 postpartum beds and 6 high-risk private postpartum beds; 22 NICU beds; 8 delivery rooms; 2 maternity triage rooms, and 2 maternity operating rooms. “This is the first facility in the county to have private postpartum rooms, including bath and shower,” said Dr. Kevin Rine, Chair of the Obstetrics and Gynecology Department. Meeting with designers during the planning process, Dr. Rine advised them what doctors and patients need. Sometimes its small things, like a place for the baby warmer, which always seemed to be floating around the room and in the way. In the new rooms the baby warmer has a built-in storage garage in which to park. Other things are more important, like now having two operating rooms instead of just one so scheduling isn’t interrupted by emergencies. No more being forced to transport patients to the main OR. Better for patients and better for doctors. “We are bringing on line a brand new monitoring system,” said Dr. Rine. “It will allow us to monitor tracings, like fetal heart rate, from home. We can advise the nurses how to treat right away.” The third floor contains the private rooms for oncology patients and other med/surg patients depending on census needs. “The cancer unit is going into the Patient Pavilion and its a unique unit,” said Dr. Aminder Mehdi, Director of the Oncology Department. “It is specifically a cancer nursing unit. The new unit in the Pavilion will have 20 beds and all the rooms will be private. This is very important because cancer patients need privacy to deal with the emotional effects of cancer. They Continued on next page >>

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cover story > St. Joseph’s Patient Pavilion Opens need privacy to be with their families.” The additional beds for oncology patients, expectant mothers, and neonates frees up other beds in the older sections of the hospital, thus addressing a pressing need. Put simply, during the winter the hospital would sometimes run out of beds. Will there be enough new beds? “We did our business plan to determine the needs for beds,” said Terry Spring, Vice President of Administration. “A study and economic forecast was done internally by the Strategy and Planning Division for Catholic Healthcare West. We believe that this addition will carry us out about 20 years.” The economic slowdown has reduced population growth rates and thus extended the projection by a few years. The hospital will now have a total of 365 beds. The benefit of economic slowdown is that population will increase at a slower rate, but the challenge is that it reduces income. Sobering projections of low reimbursement rates from Medicare and Medi-Cal, as well as the growing number of patients without insurance, put a strain on hospital budgets. Meanwhile, operational costs are increasing. Throw in debt service on $90 million of loans for the new pavilion and you’ve got two lines on a chart that are going in opposite directions. St. Joseph’s decided in August, 2009, to limit Medi-Cal patients from certain procedures. This will have an affect on the new pavilion’s revenue. “Some elective gynecological procedures will no longer be performed if they will be paid for under certain MediCal payment umbrellas,” said Don Wiley, President of St. Joseph’s Medical Center. Mr. Wiley said that St. Joseph’s has been working with obstetricians to help their patients find insurance to cover these elective procedures. He emphasized that a woman who comes to the hospital in labor is not turned away. Those certain Medi-Cal patients who decided on elective procedures are directed to the county hospital. “The original idea to limit Medi-Cal procedures was not aimed at OBGYN

SAN JOAQUIN PHYSICIAN

SPRING 2010

St. Joseph’s. Anshen and Allen got their first hospital project at surgeries but was meant for medical / surgical patients in Good Samaritan in San Jose in 1962. The young Mr. Parker was general,” said Mr. Wiley. assigned the project. There has been some slow down in Medi-Cal deliveries “I didn’t know anything about designing hospitals-I thought in January, decreasing from 25 to 15, but there has been a pediatrics was care of the feet-but I became fascinated with the slowdown in births throughout the nation, attributable to complexity,” Mr. Parker said in an interview for the Center for economic conditions according to many. Health Design. “It wasn’t just design for the sake of design; you Medi-Cal reimbursement has been about 24 percent of had to know what you were designing for. So, for six months, total gross revenue, and Mr. Wiley noted that the new policy on I worked as an orderly at a hospital to learn how a hospital elective procedures has lowered that to about 20 percent. functions.” The recession has hit top-line revenue numbers for all “After that, I became very interested with the notion of hospitals in the nation. Yet there are dozens of $100 million whether design has a role in health,” Mr. Parker said. “I became projects at completion across the country. Locally, Lodi convinced that the built environment made a difference in the Memorial Hospital’s new South Wing opened recently. Kaiser quality of healthcare.” Hospital in Modesto completed its new facility in the last two He wasn’t alone. Studies show natural light reduces years. The seeming illogic of taking on new debt during a time depression and nature scenes reduce reported pain levels. Ergo, of diminished revenues is explained by the lengthy planning healing gardens and lots and building timeline for of windows. Alphonsus new hospital facilities. Regional Medical Center St. Joseph’s began in Boise, Idaho, lowered their design process in “All hospitals have budgeting constraints. noise volume and 2002. So did hospitals With that in mind, putting money into a patients’ self-reported across the country. A sleep quality improved few years later there Women’s Pavilion brings two important by half — up from 4.9 were groundbreaking points to my mind. First, women make most of to 7.3 on a scale of 10. ceremonies. American At Bronson Methodist hospitals began 53the healthcare decisions in a family. Second, Hospital in Michigan, million-square-feet of they added new private new construction in if they have a positive birth experience it rooms, improved air2008, according to a means they will more likely bring family back flow, changed location report from industryof sinks and hospitalwatcher McGraw-Hill to that hospital.” – Dr. Param Gill acquired infections Construction. declined 11 percent. The new pavilion costs Mr. Parker created $117 million, of which the Center for Health a previously mentioned Design, located in Concord, California, that pushes for $90 million is borrowed. St. Joseph’s Foundation has raised $12 evidence-based design. He started the Pebble Project which is million toward its goal of $20 million for the new pavilion. The a research initiative that seeks opportunities for collecting hard remainder came from reserves. evidence about the affects of buildings on health and healing. The Pavilion joins other construction milestones for the There are more than 50 research projects gathering data to largest hospital and largest employer in San Joaquin County. show how environment affects outcomes. In 1916 a two-story Mission Renaissance style building was “Of course, we have a tendency in America to over-hype erected and is still known as “the Main”. In 1926 a third floor everything,” said Mr. Parker. “And I think to some degree we’ve was built on top of the Main and this gave St. Joseph’s 125 done that with evidence-based design. I’ve been hyping it for a beds. In 1954 there was a major addition that gave the hospital long time. The point has now been made, now how do we make 52 more beds. In 1962 a south wing was added that included it more credible? Hopefully, the data coming out of the Pebble 90 new beds, surgical suites with eight operating rooms and Project will continue to do this.” an intensive care unit. In 1967, completion of the west wing Anshen and Allen’s clients include Boston University fourth floor on the 1962 building added 24 more beds. In 1970 Medical Center, Duke University, Belfast Royal Hospital, a $4 million addition was finished, including a Coronary Care Harvard University, Kaiser Permanente, Massachusetts General department and new Maternity and Emergency departments Hospital, Children’s Hospital of Oakland, Oregon Health and and an additional 90 beds. St. Joseph’s then had a total of 300 Science University, Royal Infirmary of Edinburgh, Melbourne’s licensed beds. Royal Victoria Children’s’ Hospital, Sinai Hospital and literally Derek Parker is a director of the architectural firm Anshen and scores more. Allen, designers of the Patient Pavilion and other projects at

SPRING 2010

SAN JOAQUIN PHYSICIAN

cOver StOry > St. Joseph’s Patient Pavilion Opens

Peninsula) are a few that come to mind.” Mr. Schroeder is now the CEO of O’Connor Woods. Dr. Gill knows the improved ambience in the pavilion will help her patients. “Women are very affected by aesthetics and when in labor their surroundings have a major affect,” said Dr. Gill. “Studies show that soothing aesthetics mean less use of pain medications.” “Another great thing about the new pavilion is a private postpartum room where dad can stay the night with mother and baby,” Dr. Gill added. “The family as a whole starts the day the baby is born, not with the father pacing around somewhere or staying at home. And there are sleeping rooms for the doctors right by the patient rooms so they can stay if need be.” Dr. Peter Chao, perinatalogist who last year opened a practice in Stockton, is “looking forward to the new pavilion because it will be more spacious and easier for patients and doctors. The neonatal rooms are very roomy and pleasant.” The native New Yorker, worked at Kaiser in Los Angeles where a staff gynecologist who was expert in perinatalogy became a kind of mentor. “I always admired her ability to use ultrasounds for diagnosis,” said Dr. Chao. “I was at the right place at the right time.” “It used to be that difficult pregnancies were treated only in major medical centers,” said Verve brings corporate-level IT services to small Dr. Chao, “but now they are being treated in more outlying and medium businesses in the Central Valley. areas. I’m looking forward to working in the new pavilion.” We’re ready to help. “No woman should have to Call 209 244.7111 leave the area to handle their pregnancy unless the baby or visit us on the web. will need immediate surgery,” said Dr. Gill. “Dr. Chao and the new pavilion mean that www.vervenetworks.net 99 percent of women can stay here.”

Speaking of clients, Mr. Parker believes that architects are only as good as their clients. He included former St. Joseph’s President Ed Schroeder in his list along with some very heady company. “We can only do good work when we have a vision-driven client. They are very rare. Jonas Salk, Lucile Packard (Stanford Children’s Hospital), Blair Sadler (San Diego Children’s Hospital), Ed Schroeder (St. Joseph’s in Stockton, Ca.),” said Mr. Parker. “Alan Yordy (Sacred Heart Medical Center) and Tom Tonkin (Community Hospital of the Monterey

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Beneﬁts < memberShIP

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hAS the ANSWerS

QUESTION: Many of the drug manufacturers offer free or greatly reduced medications to deserving patients – is there a simple way to access these programs? ANSWER: Yes. San Joaquin Medical Society has learned of a new program being offered by EZ –Meds of Scottsdale, Arizona that facilitates this process for the patient and the physician as well. They provide your practice with a simple one-page application in which your patient provides qualifying information and a list of medications they are prescribed for. Once they are approved via phone, EZ-Med provides the practice the correct forms and coordinates delivery of the approved meds via the mail. There is a very low application fee and monthly charge to utilize the service. Contact EZ-Meds local representative Scott Galbraith at (209) 406-1483 for more information.

QUESTION: What should I do with expired medication? ANSWER: According to the Drug Enforcement Agency (DEA), if the office cannot return the medication back to the pharmaceutical company for credit, then they can call the only distributor in California, EXP Pharmaceutical Services Corporation, at (800) 350-0397, to take these drugs and dispose

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(209) 952-5299 gena@sjcms.org

brIeFly NOteD UtIlIZING DrUG PrOGrAmS FOr Free meDS Discarding Expired Drugs Handling Workers Comp Patient Records Filling Out Patients Forms Being Paid for Non-Emergency Call Coverage from an IPA

Continued on page next page>> OFFICE MANAGERS FORUM: Join Gena Stoddart each month at Valley Brew for a lively seminar attended by dozens of other ofﬁce managers who enjoy a complimentary lunch and some great networking as well. For more info or next month’s topic, call Gena at 952-5299 to be added to our guest list. Every second Wednesday from 11:00 - 1:00

SPRING 2010

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OmF Q OFFIce mANAGerS FOrUm ScheDUle

Join Gena each second Wednesday of the month at Valley Brew for our popular “Office Managers Forum” in which the medical society plays host to a wonderful lunch and a brief 45 minute seminar on various topics. It kicks off at 11:00am and ends promptly at 1:00pm – lunch is complimentary and our speakers always allow time for great Q & A sessions. Call Gena at (209) 952-5299 to RSVP up to the day before and feel free to invite a guest along!

mArch tOPIc – “Understanding Risk Management from the Office Managers Perspective” presented by Norcal Insurance

APrIl tOPIc “Assisting your patients receive free medications” presented by EZ-Meds

mAy tOPIc – “What Every Office Manager Should Know to Run a Practice” presented by Frank Navarro from California Medical Association. Frank will also be offering an evening presentation for physicians.

JUNe – “EHR’s – A Simple Overview?” presented by CMA

SAN JOAQUIN PHYSICIAN

of them properly. EXP will mail out a box for the medication with directions on how to ship it back. The quantity does not matter, so even small packages are accepted. For further information, visit EXP’s website. QUESTION: A patient that I evaluated for a workers’ compensation case is now requesting a copy of his medical records. Do I have to comply with the patient access laws with respect to persons I have evaluated for judicial or administrative proceedings? ANSWER: We are of the opinion that treating physicians must comply with these disclosure requirements regardless of how they are paid. Thus, the fact that a treating physician is paid by a workers’ compensation insurer does not affect the patient’s right to information. However, the opinions and/ or conclusions of a physician retained as an expert in a workers’ compensation case are not subject to disclosure pursuant to the patient access law because the individual in that case is not a “patient” of the expert. Physicians acting as experts should consult with the attorney who retained them concerning requests for information by an individual they evaluate. Physicians should be aware that people they examine at the direction of attorneys pursuant to Code of Civil Procedure §§2032.010 et seq. are entitled to a copy of the physician’s report pursuant to Code of Civil Procedure §§2032.610 et seq. For further information, consult CMA’s ON-CALL document #1150, “Patient Access to Medical Records,” available free to SJMSCMA members at www.cmanet.org. For assistance in logging onto CMA’s website, contact Gena at (209) 952-5299 or at gena@sjcms.org

QUESTION: Sometimes my office staff fills out forms on our patients’ behalf. Are there any steps I should take before I start charging my patients for the completion of forms? ANSWER: Yes. You may wish to consider reviewing all managed care contracts to see whether there are any restrictions. Some contracts may only allow you to bill patients for co-pays and deductibles. This may be interpreted as a prohibition against charging for

SPRING 2010

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Michael J. KHOURI Michael J. Khouri

CRIMINAL DEFENSE

ATTORNEY AT LAW FORMER DEPUTY DISTRICT ATTORNEY OVER 29 YEARS EXPERIENCE ADMITTED IN ALL CALIFORNIA STATE AND FEDERAL COURTS

PROFESSIONAL BOARD DISCIPLINE DEFENSE MEDI-CARE AND MEDI-CAL AUDIT AND FRAUD DEFENSE

OFFICE: (949) 336-2433 CELL: (949) 680-6332 4040 BARRANCA PARKWAY SUITE 270 IRVINE, CALIFORNIA 92604 www.khourilaw.com SPRING 2010

SAN JOAQUIN PHYSICIAN

forms. Contact your payers. You may want to let them know you plan to institute a charge for form completion and avoid problems down the road. Also, notify your patients ahead of time. This will avoid surprise and hard feelings. Office staff should be briefed on exactly how to respond when patients question the need for the fees or ask whether the fee can be waived.

QUESTION: My group and I take non-emergency call at a local hospital. We sometimes assist patients who are insured through IPAs, of which we are not contacted with. Can they pay us whatever they want to? ANSWER: Yes and no. IPAs should be paying physicians at their usual and customary rate (UCR). By the way, the Department of Managed Health Care (DMHC) opined that Medicare rates should not be used as a benchmark. If you are not being paid your UCR, then CMA recommends that physicians file an appeal with the IPA. If after an appeal has been filed, and the IPA does not pay a sufficient amount, then you can file a complaint with the DMHC as this is an unfair payment practice. For more information on how to appeal and filing a complaint with the DMHC, members can obtain CMA On-Call Document #1051, â&#x20AC;&#x153;Physician Complaints about Managed Care Plansâ&#x20AC;? from the San Joaquin Medical Society.

SAN JOAQUIN PHYSICIAN

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SPRING 2010

Certified coders have never been in greater demand.

More physicians need Certified Medical Coders who are capable of understanding the complexities of the reimbursement process. Improve your practice’s financial health. Your skills will help guard against improper claim submission and contribute to a higher rate of paid claims for your physician’s practice.

COURSE CURRICULUM

Medical Terminology for Diagnostic & Procedural Coding •Roots, prefixes and suffixes •Anatomy and physiology •Body structure and body systems

ICD-9-CM Diagnostic Coding •Coding conventions •Guidelines from CMs •Primary vs. secondary codes •Signs/symptoms and ill-defined conditions •Neoplasms and adverse effects •Injuries, burns, fractures and wounds •Supplementary classifications •OB/GYN codes

CERTIFIED

MEDICAL CODER

CPT Procedural Coding •CPT categories, format and guidelines •Diagnostic vs. therapeutic services •E&M services for all categories plus modifiers •Surgical Coding guidelines and procedures •Modifiers for surgical procedures •Coding from chart notes and operative reports

Ancillary Services & Advanced Coding •Maternity and delivery services •Radiology •Pathology & lab services in the physician’s office •Medicine & intervention •Coding problem set exercises •Medical and surgical specialties

CLASS SIZE LIMITED TO 24 – SIGN UP NOW! To sign up, simply call the San Joaquin Medical Society at (209) 952-5299 or sign up online at www.sjcms.org Registration Deadline March 31, 2010 SPRING 2010

COURSE

BECOME A CERTIFIED MEDICAL CODER IN 5 DAYS! COURSE DETAILS

When: Five Tuesdays; April 13, 20, 27, May 4 and 11, 2010 8:00 a.m. – 4:00 p.m. each day (Sign-in 15 minutes prior to each session) Where: San Joaquin Medical Society Training Room 3031 W. March Lane, Suite 222W, Stockton Cost: SJMS member physicians/staff: $649 Nonmember physicians/staff: $949 (if room) Registration fee includes certification exam Required Materials to bring to each class: CPT, ICD-9-CM Volume 1&2, HCPCS manual and medical dictionary

Need to re-certify? Exam only: $299 (May 11)

Presented by Practice Management Institute and hosted by the San Joaquin Medical Society. Cancellation Policy: A full refund less $20 processing fee if cancellation is received 7+ days prior to program start date. A 50% refund if cancellation is 6 days to 48 hours prior to start date. No refund if cancellation is less than 48 hours in advance. PMI strictly adheres to this policy. SAN JOAQUIN PHYSICIAN

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SAN JOAQUIN PHYSICIAN

SPRING 2010

membership < meDIcAl SOcIety

14 NEW

MEMBERS IN THE PAST 60 DAYS! ...and even more on the way. Neelesh Bangalore, MD Hematology/Oncology St. Teresa Comprehensive Cancer Center 4722 Quail Lakes Dr, Ste A Stockton, CA 95207 Ofﬁce: (209) 474-1458 Gauhati University Medical College: 1985 Carlos Delgado, DO Family Medicine Sutter Gould Medical Foundation 2505 W Hammer Lane Stockton, CA 95209 Ofﬁce: (209) 957-7050 New York College of Osteopathic Medicine: 2004 Michael Herrera, DO Emergency Medicine St. Joseph’s Medical Center 1800 N California Street

SPRING 2010

Stockton, CA 95204 Office: (209) 467-6400 College of Osteopathic Medicine of the Pacific: 1993 Mahveen Hussain, MD Internal Medicine San Joaquin General Hospital 500 W Hospital Road French Camp, CA 95231 Office: (209) 468-6700 New York Medical College: 1998 Charnpal Mangat, MD Obstetrics & Gynecology P. Gill OB & GYN Medical Group, Inc 1617 N California St, Ste 2A Stockton, CA 95204 Office: (209) 466-8546 Punjab University, Dayanand Medical College: 1997

Ranneet Mangat, MD Obstetrics & Gynecology P. Gill OB & GYN Medical Group, Inc 999 S Fairmont Ave, Ste 230 Lodi, CA 95240 Office: (209) 334-4924 Punjab University, Dayanand Medical College: 1997 James Norwood, MD Internal Medicine Sutter Gould Medical Foundation 600 Coffee Road Modesto, CA 95355 Office: (209) 524-1211 University of Nebraska: 1989 Bennet Omalu, MD Anatomic/Clinical Pathology San Joaquin General Hospital 500 W Hospital Road French Camp, CA 95231 Office: (209) 468-6000 University of Nigeria School of Medicine: 1990 Kinnari Parikh, MD Internal Medicine San Joaquin General Hospital 500 W Hospital Road French Camp, CA 95231 Office: (209) 468-6000 Gujarat University, BJ Medical College: 2004 Rahul Somani, MD Radiology St. Joseph’s Medical Center

1800 N California Street Stockton, CA 95204 Office: (209) 467-6363 Indiana University School of Medicine: 1989 Winlove Suasin, MD Radiation Oncology St. Joseph’s Medical Center 1800 N California Street Stockton, CA 95204 Office: (209) 467-6560 Creighton University School of Medicine: 1990 Stephen Tinio, MD Family Medicine 3132 W March Lane, Ste 5 Stockton, CA 95219 Office: (209) 475-5500 Institute of Medicine, Far Eastern University: 2003 Dan Vongtama, MD Radiation Oncology St. Teresa Comprehensive Cancer Center 4722 Quail Lakes Dr, Ste B Stockton, CA 95207 Office: (209) 472-1848 Northwestern University: 2004 Edmund Yao, MD Internal Medicine 1507 W March Lane Stockton, CA 95210 Office: (209) 472-7100 College of Medicine, University of the East: 1991

SAN JOAQUIN PHYSICIAN

Community Service > Off the Charts

SAN JOAQUIN PHYSICIAN

SPRING 2010

Cambodian

Odyssey Angkor Hospital for Children, Siem Reap, Cambodia Last year Health Volunteers Overseas/Orthopaedic Overseas inquired if I wished to volunteer for two weeks at the Angkor Children’s Hospital in Siem Reap, Cambodia. I was already scheduled to spend two weeks volunteering in Phnom Penh, Cambodia, and it seemed natural to add the Children’s Hospital in Siem Reap. I agreed. In the interim, long before the trip was to begin, the assignment in Phnom Penh was cancelled because of local holidays and a conference that conflicted with my scheduled time in Phnom Penh. Nonetheless, I wanted to volunteer at the Angkor Children’s Hospital, and I decided to proceed. >>

story & photos by Dr. Peter Salamon

SPRING 2010

SAN JOAQUIN PHYSICIAN

Community Service > Off the Charts

The trip was fairly long, flying from Sacramento to Los Angeles and then on to Bangkok, Thailand, where I flew to Siem Reap, Cambodia. The hospital arranged for a driver, who held a sign with my name on it at the airport and drove me to my guesthouse. I was immediately aware of the heat and humidity in Siem Reap. The average temperature at this time of year is above 90 degrees, and the humidity 100%. The first week in Cambodia I stayed at a small guesthouse near the hospital, which was convenient and inexpensive. The second week, when my wife arrived, we checked into the Angkor Palace Resort & Spa a Five-Star Cambodian-owned resort. Cambodia is extremely inexpensive. At the guesthouse an air-conditioned room with bath was $12 a night. The luxury resort hotel was $85 per night. The day after arrival I arranged a guide to take me to visit the temples of Angkor Wat. The Khmer civilization was extremely advanced. These spectacular temples and cities were built in the tenth and eleventh centuries and were abandoned approximately 200 years later. They were rediscovered by a French botanist in the early 1800’s. They are remarkably well-preserved, and anyone who makes a trip to Siem Reap should plan on spending a few days visiting these magnificent structures.

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My first day at the hospital was Monday, October 19. After an introduction and tour with the volunteer coordinator and some very minimal paperwork, I was introduced to the surgical staff with which I spent the majority of my time. There are three surgeons at the Angkor Hospital for Children. They are all general pediatric surgeons who have had no formal residency training. They learn on the job, and my role was to help them to learn to do orthopaedic procedures. Their surgical skills are remarkably good, but they don’t have enough orthopaedic training to appreciate how to approach some of the various orthopaedic conditions with which they are faced. The orthopaedic surgical volunteer supply at Angkor Hospital for Children seems to be sufficient. The hospital consists of a number of one-story buildings which, for the most part, are not air-conditioned. There are four wards. The patients all stay in the same room. The parents stay with the children. There is one single operating room at the Angkor Children’s Hospital, and the operating room and recovery room are airconditioned. The operating room is run quite well. The equipment is a potpourri of primitive and relatively modern, although outdated, equipment. Nonetheless, it gives an opportunity to improvise and work with less than we are accustomed to at home. They do have an x-ray machine and a portable x-ray machine, so single-shot x-rays can be taken in the operating room. Good quality x-rays are available on all the patients. They also have ultrasound, which seems to work reasonably well. There are no other advanced imaging systems, such as CT scan or MRI scan. Those are essentially not available to the average patient in Cambodia. Because there is only one operating room, only one volunteer can be present at any given time. The volunteers come from numerous specialties including pediatric general surgery, urology, cardiothoracic surgery, plastic surgery, and orthopaedic surgery. During the two weeks I was at the Angkor Children’s Hospital the operating

SPRING 2010

SAN JOAQUIN PHYSICIAN

Community Service > Off the Charts room schedule was fairly light with routine cases, so that I could do orthopaedic cases every day. Nonetheless, the local surgeons had occasional urgent cases that would take precedence over my schedule. The anesthesiologists are very highly skilled and do anesthesia well with few complications. They do general anesthesia on very tiny infants. Almost every orthopaedic surgical patient received some type of a nerve block along with the general anesthetic. They do caudal anesthetics, femoral blocks, ankle blocks, and sciatic blocks. The surgical turnover is extremely efficient, so fast you barely have time for a cup of tea before the next patient is asleep in the operating room. Nonetheless, the number of cases is not enough for a two-week volunteer stint. Most days I did two or three operations and was done by noon. The entire operating room shuts down from 12:00 to 2:00 for lunch. The first day there was a screening clinic. The local surgeons had assembled approximately 40 patients for me to examine and determine whether or not I could help them surgically. The diagnoses for which I did surgery were chronic dislocation of the patella secondary to quadriceps contracture, quadriceps contracture as an isolated problem, congenital muscular torticollis in an 11-year-old, cavovarus foot deformity in a 13-year-old, and a malunion of the femur in a 14-year-old with about 2-inches of shortening, on whom I did an epiphysiodesis on the contralateral side, and late-diagnosed congenital displacement of the hip. The cases were interesting and challenging. I tried to allow the Cambodian surgeons to do the operations, with me assisting. I felt they would learn a great deal more than by watching me operate. That seemed to work out very well because they are very highly skilled and pick things up quickly. The present rate is about one pediatric orthopaedic surgical volunteer about every three months, and that does not allow accumulation of enough surgical patients for a two-week stint. My advice to first-time visitors is to spend one week working at the hospital, and the second week traveling in Cambodia and seeing the spectacular Angkor Wat and associated temple ruins. The town of Siem Reap is a little bit touristy. A lot of young tourists come here, and a lot of Asian tours pass through this area. We ran into people from all over the Far East, including the Philippines, Japan, and Korea, as well as a few groups from Western Europe. Most of them passed through Siem Reap in a period of two or three days, and then moved on. We were easily the longest tenants at the resort hotel. Everyone on the staff got to know us. The hospital is run by a group called Friends without a Border, and there is an American pediatrician who is

SAN JOAQUIN PHYSICIAN

the full-time education coordinator. He and the chief of surgery coordinate the volunteer visits. That way, a plastic surgeon, urologist, general surgeon, orthopaedist, and ENT don’t turn up at the same time and have to compete for operating room space. I would recommend that those wishing to volunteer contact Friends without a Border directly, as I think they are quite happy to have volunteers for a week at a time. Once they know you at the hospital, I believe they would be eager to have you return. They see a lot of chronic musculoskeletal infection (osteomyelitis) which often needs to be treated surgically. There are also many malunited displaced fractures (i.e., type III supracondylar fractures of the humerus) that had been treated by traditional bone healers. These have healed in malunited positions and are beyond the ability of the surgeons in Siem Reap, or for that matter, the volunteer surgeons, to correct with the type of equipment that is available. There is little choice but to accept the deformity, as the children seem to function reasonably well. I saw no acute fractures, although I am told they are seen from time to time. The femur fractures are treated in traction. The Ponseti method of treatment for club feet has caught on here. There is a group called Handicapped International which does all the casting of club feet (by physiotherapists). The percutaneous tenotomies are done by the surgeons at the hospital, and then the additional casting and construction of the Denis Browne bar and corrective shoes is done at Handicapped International. The splints are extremely innovative. They look like they are much more comfortable than what we use in the United States. Travel around Siem Reap is usually by Tut Tut, a small carriage pulled by a motor-scooter that can easily pull two adults. While I was staying at the guesthouse I could walk to the hospital in one minute. While staying out at the resort hotel I traveled by Tut Tut each morning, which took about ten minutes and usually cost $3. The restaurants in Cambodia are outstanding and extremely inexpensive. It was not unusual for my wife and I to dine out in a nice restaurant, have three Khmer dishes and beer, and walk away from the restaurant with a bill of about $12. Some of the restaurants even offered live Cambodian entertainment, which did not add to the price. The de facto currency of Cambodia is the U.S. dollar. There is a Cambodian currency called the Reil, but no one uses it. The prices in all the restaurants, shops, and hotels are in U.S. dollars. The transactions, even on the street, are in U.S. dollars. The ATM machines (which were plentiful) give out U.S. dollars and not the local currency.

SPRING 2010

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SPRING 2010

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Community Service > Off the Charts There is no reason to change money at all. My suggestion is to bring a number of dollar bills, which are very useful (perhaps 100 for a 1-2 week stay). Credit cards are useful only in a few places. â&#x20AC;&#x192; There are numerous choices of accommodations in Siem Reap. These range from small guest houses, where I stayed the first week, to numerous, rather luxurious hotels. The area is gearing up for what I believe they anticipate is a huge influx of tourists in the next few years. The attraction, of course, is Angkor Wat. There are easily 100 new hotels that have been built in the area. They range from comfortable hotels to luxury resorts. The Angkor Palace Resort & Spa offered special rates to various groups, including people affiliated with the United Nations and to people like myself, volunteers at the Angkor Childrenâ&#x20AC;&#x2122;s Hospital. â&#x20AC;&#x192; The information brochures provided by the Friends without a Border provide a list of available accommodations, but it is easy to go on-line and look at the many choices, which is what we did. We contacted the hotel directly, asking if they had arrangements with the Angkor Childrenâ&#x20AC;&#x2122;s Hospital. The volunteer coordinator at the hospital also is extremely helpful in

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arranging accommodations. â&#x20AC;&#x192; My take on the needs of the Angkor Childrenâ&#x20AC;&#x2122;s Hospital, as far as pediatric orthopaedic volunteer consultants, would be the need for one surgeon approximately every two to three months for one week at a time. That way, on the first day accumulated cases can be screened and an operating room schedule set up for the rest of the week. In that way, each surgical day would be a little bit longer, and I believe all of the cases could be completed. â&#x20AC;&#x192; On the first visit to Siem Reap I think it is important to spend a little bit more time to get the lay of the land and enjoy some of the incredible history and architecture of the area. After seeing that on your first visit, one can accomplish almost everything one has to do in a week at the hospital. Procedures can even be staged if there is enough sequential pediatric orthopaedic coverage. â&#x20AC;&#x192; This is an excellent opportunity to teach, as the local surgeons are extremely skilled and only need some direction as to handling many of the difficult problems my visit was extremely gratifying and I highly recommend this type of experience to all physicians and surgeons.

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SPRING 2010

Practice Management & Medical Services Buyer’s Guide a practical resource for Busy Physicians and Office Managers This handy resource, which is also featured on our web site, is designed to provide our busy physician members and staff a dependable resource for locating local vendors interested in serving the medical business community with the best quality products and service. Although the San Joaquin Medical Society has the utmost confidence in these businesses and vendors, we offer no personal endorsement of their goods or services.

Visit the electronic version of our Buyer’s Guide at www.sjcms.org

Accountant Iacopi, Lenz & Company 3031 W March Lane, Ste 300E Stockton CA 95219 (209) 957-3691

Adult Day Care Centers Somerford Place 3530 Deer Park Dr Stockton CA 95219 (209) 951-6500

Alcohol & Drug Treatment St. Joseph’s Behavioral Health Center 2510 N. California St Stockton CA 95204 (209) 461-2000

Answering Services Front Office Staff, Inc 701 S Ham Lane, Ste A Lodi CA 95242 (800) 836-7189

Assisted Living and Alzheimers/Dementia Facilities Atria Bayside Landing 3318 Brookside Road Stockton CA 95219 (209) 473-1300 Camlu Assisted Living 60137 N Pershing Ave Stockton CA 95207 (209) 951-2030

SPRING 2010

Golden Living Portside 2740 N California St Stockton CA 95204 (209) 466-3522 Plymouth Square 1319 N Madison St Stockton CA 95202 (209) 466-4341 Sunny Place of Stockton Espie Vierra 807 W Swain Road Stockton CA 95207 (209) 956-8677 www.sunnyplaceofstockton.com The Commons on Thornton 10711 Thornton Road Stockton CA 95209 (209) 476-1500 Villa Marche Steven Gianandrea 1119 Rose Marie Lane Stockton CA 95207 (209) 477-4858 Wagner Heights Nursing Vicki Sihoto 9289 Branstetter Place Stockton CA 95209 (209) 477-5252

Attorney / Law Firms

Riggio, Mordaunt & Kelly Don Riggio Michael Mordaunt Peter Kelly 2509 W March Lane, Ste 200 Stockton CA 95207 (209) 473-8732

Automobile Sales & Leasing Berberian Motors Brian Martucci 3755 North West Lane Stockton CA 95204 (209) 944-5511 www.berberianmotors.com

Banking Services Bank of Agriculture & Commerce Eddie Lira Stockton CA (209) 444-3356 www.bankbac.com Community Bank of San Joaquin 22 W Yokuts Ave Stockton CA 95207 (209) 955-8710 Financial Center Credit Union 4603 N Pershing Ave Stockton CA 95207 (209) 948-6024 www.fccuburt.org

Cassel Malm Fagundes Scott Malm 6 El Dorado South, Ste 315 Stockton CA 95202 (209) 870-7900

Oak Valley Community Bank Loretta Trevena 2935 W March Lane Stockton CA 95219 (209) 320-7856 www.ovcb.com

Khouri Law Firm Mike Khouri 4040 Barranca Pkwy, Ste 200 Irvine CA 92604 (949) 336-2433

Pacific State Bank Rita Stolp Stockton CA 95201 (209) 870-2210

Bonds Sanguinetti & Co Insurnace Brokers Steven Sanguinetti 7337 Pacific Ave Stockton CA 95207 (209) 954-1000 www.sanguinettico.com

Bottled Water Brookfalls Premium Bottled Waters 435 N. Yosemite St. Stockton CA 95203 (209) 467-4426

Collection Agency CB Merchant Services 217 N. San Joaquin Stockton CA 95202 (209) 944-9001 J & S Collections P.O. Box 691506 Stockton CA 95269 (209) 951-6334 T A Ross-Collections P.O. Box 4637 Stockton CA 95204 (209) 956-2509

Computer Networks Support Verve Networks Chad Sublet 6820 Pacific Ave, Ste 2A Stockton CA 95207 (209) 244-7120 www.vervenetworks.net The Buyer’s Guide continues on the next page

SAN JOAQUIN PHYSICIAN

Computer Sales & Repair Minden Computer Hal Singer Stockton CA 95267 (209) 477-6214 www.mindencomputer.com

Consultant/Practice Management Moss Adams, LLP Irv Barnett 3100 Zinfandel Dr, 5th Floor Rancho Cordova CA 95670 (916) 503-8100 www.mossadams.com

Copy Machines, Supplies & Service Business Office Systems 819 performance Dr Stockton CA 95206 (209) 952-2677 C A Reding Company 4617 Quail Lakes Dr, Ste 1 Stockton CA 95207 (209) 957-6022 Lucas Business Systems 3555 Deer Park Dr, Ste 180 Stockton CA 95219 (209) 466-3786

Country Club Stockton Golf & Country Club 3800 W Country Club Stockton CA 95204 (209) 466-4313

Credit Card Processing Heartland Payment Systems Nafi Bendetson (323) 850-8883

www.heartlandpaymentsystems.com

Disabled Persons Equipment & Supplies Arc Of Amador & Calaveras 75 Academy Dr Sutter Creek CA 95685 (209) 267-5978 Family Resource Network 5250 Claremont Ave Stockton CA 95207 (209) 472-3674 Medi-Van 33 Maxwell St Lodi CA 95240 (209) 333-7800 Mother Lode Independent Living 67 Linoberg St ,Ste A Sonora CA 95370 (209) 532-0963

SAN JOAQUIN PHYSICIAN

Open Door Svc Inc 2453 Grand Canal Blvd Stockton CA 95207 (209) 475-1529 Rainbow Transportation 10203 River Park Cir Stockton CA 95209 (209) 477-6130 TMP Svc North 4696 E Waterloo Rd Stockton CA 95215 (209) 931-7979

Employee Benefits Marsh Affinity Group Roy Lyons 777 South Figueroa Street Los Angeles CA 90017 (800) 842-3761 www.marshaffinity.com Sanguinetti & Company Insurnace Brokers Steven Sanguinetti 7337 Pacific Ave Stockton CA 95207 (209) 954-1000 www.sanguinettico.com

Employment Agency Accountabilities, Inc 5250 Claremont Ave, Ste 150 Stockton CA 95207 (209) 472-3619 AppleOne/ACT-1 2233 Grand Canal Blvd, Ste 202 Stockton CA 95207 (209) 476-8591 Pridestaff 3421 Brookside Road, Ste B Stockton CA 95219 (209) 477-6446

File Storage & Management Pacific Storage Company Mike Long 734 Wilshire Avenue Stockton CA 95203 (209) 320-6618 www.pacific-records.com

Financial Planning Notman Financial Group 3133 W March Lane, Ste 2000 Stockton CA 95219 (209) 955-5955 Professional Management Consultants, Inc. Debra Hightower 1300 W Lodi Ave, Ste A - 20 Lodi CA 95242 (209) 473-8494

Sanguinetti & Company Insurnace Brokers Steven Sanguinetti 7337 Pacific Ave Stockton CA 95207 (209) 954-1000 www.sanguinettico.com

Stockton Hearing & Speech Center 4623 Quail Lakes Dr Stockton CA 95207 (209) 951-6491

SB Planning, Inc Stephen Benjestorf 215 W Oak Street, Ste 5 Lodi CA 95240 (209) 625-8523 www.sbplanninginc.com

Addus Healthcare 1125 N Hunter Stockton CA 95202 (209) 463-8091

Stull Financial David Stull 5637 N Pershing Ave, Ste C11D Stockton CA 95207 (209) 957-1673 www.stullfinancial.com

Gastroenterology Lakshma Tiyyagura, MD 420 W Acacia St, Ste 18 Stockton CA 95203 (209) 466-4685

Gifts, Food Items Edible Arrangements 135 N Hunter Stockton CA 95202 (209) 943-1200

Graphic Design & Printing Excellence In Printing Tom Spitaleri 7602 Murray Drive, Ste 102 Stockton CA 95210 (209) 473-4442

Health Clubs In Shape Health Clubs 1016 E Bianchi Road, Ste A23 Stockton CA 95210 (209) 475-2231

Health Passport Aman Gifts, LLC Mary Louise Applebaum P.O. Box 891 Manteca CA 95336 (209) 830-5935 www.amangiftsLLC.com

Hearing Aids American Hearing Aids 880 W Benjamin Holt Dr Lincoln Center South Stockton CA 95207 (209) 952-9950 Better Hearing Center 1231 W Robinhood Dr, Ste A2 Stockton CA 95207 (209) 957-1744

Home Health Care Services

Agape In Home Services 309 Cherry Lane Manteca CA 95337 (209) 239-8080 Angeleon Care Home LLC 1288 Parkview St Manteca CA 95337 (209) 825-1837 Angelâ&#x20AC;&#x2122;s Caring Helpers 6333 Pacific Ave, Ste 360 Stockton CA 95209 (209) 298-6473 Arcadia Health Care 4561 Quail Lakes Dr, Ste B2 Stockton CA 95207 (209) 477-9480 Austin Road Home 2313 W Alpine Ave Stockton CA 95204 (209) 463-6360 Caring Hearts Open Arms 343 E Main St Stockton CA 95202 (209) 235-3097 Elekarim Residential Care 1785 Henry Long Blvd Stockton CA 95206 (209) 983-8093 Gentiva Health Services Kristi Halva 1776 W March Lane, Ste 150 Stockton CA 95207 (209) 474-7881 www.gentiva.com Graceful Living for Seniors 1647 Willow Park Way Stockton CA 95206 (209) 474-7176 Home Instead Senior Care 1350 W Robinhood Dr Stockton CA 95207 (209) 933-9737 Housecalls Home Health Agency 1050 N Union Stockton CA 95205 (209) 463-8005 Icare Manor 1215 W Swain Rd Stockton CA 95207 (209) 957-8385 SPRING 2010

Home Health Care Services Continued Interim Healthcare 5250 Claremont Ave, Ste 121 Stockton CA 95207 (209) 472-6040 Pacific Homecare Services 2027 Grand Canal Blvd Stockton CA 95207 (209) 956-2532 Prestige Home Health Services 4212 N Pershing Ave Stockton CA 95207 (209) 478-0758 Remolona Family Guest Home 360 Button Ave Manteca CA 95336 (209) 823-9122 ResCare HomeCare 5250 Claremont Ave, Ste 146 Stockton CA 95207 (209) 473-1202 St Joseph’s Home Health Care 2333 W March Lane Stockton CA 95207 (209) 473-6700 The Senior’s Choice Phalin Klusman 1806 W Kettleman Lane, Ste L Lodi CA 95242 (209) 369-7712 Tri Valley Home Health Care 37 W Yokuts Ave Stockton CA 95207 (209) 957-0708 Visiting Angels 1545 St. Mark’s Plaza, Ste 1B Stockton CA 95207 (209) 952-3585

Hospice Care Hospice of San Joaquin Gene Acevedo 8888 Pacific Avenue Stockton CA 95204 (209) 957-3888

Insurance - Malpractice Cooperative of American Physicians (CAP) Gary Homer 915 L Street, Ste 390 Sacramento CA 95814 (916) 409-0405 www.cap-mpt.com

NORCAL Mutual Insurance Ken Stacy 560 Davis Street, Ste 200 San Francisco CA 94111 (800) 652-1051 www.norcalmutual.com

Insurance Services Financial Services & Employee Benefits Gary Giovanetti 4555 N Pershing Ave, Ste 33 Stockton CA 95207 (209) 603-5460 Marsh Affinity Group Roy Lyons 777 South Figueroa Street Los Angeles CA 90017 (800) 842-3761 www.marshaffinity.com Sanguinetti & Company Insurnace Brokers Steven Sanguinetti 7337 Pacific Ave Stockton CA 95207 (209) 954-1000 www.sanguinettico.com Stull Financial David Stull 5637 N Pershing Ave, Ste C11D Stockton CA 95207 (209) 957-1673 (209) 957-1676

Internet Marketing

Medical Alarms

Mayaco Marketing & Internet Steve Morales 6333 Pacific Ave, Ste 521 Stockton CA 95207 (209) 957-8629 www.mayaco.com

Lifeline St Joseph’s 1800 N California St Stockton CA 95204 (209) 467-6468 Peace of Mind Products Phalin Klusman 2414 W Kettleman Lane, Ste 210 Lodi CA 95242 (888) 824-8848

Jewelers Gary J. Long Jewelers 320 Lincoln Center Stockton CA 95207 (209) 477-6881

Medical Billing

Loans - Business & Personal Bank of Agriculture & Commerce Eddie Lira Stockton CA (209) 444-3356 www.bankbac.com Financial Center Credit Union 4603 N Pershing Ave Stockton CA 95207 (209) 948-6024 www.fccuburt.org

Lymphedema Clinic & Therapy Stockton Physical Therapy Virtu Arora 221 Tuxedo Ct, Ste B Stockton CA 95204 (209) 464-0200

Tokay Medical Billing, Inc Larry Dold 222 W Lockeford St, Ste 11 Lodi CA 95240 (209) 339-9036 Valley Medical Management Amy Wolf P.O. Box 230 Lodi CA 95241 (209) 367-4501 www.valleymedmgmt.com VMBS, Inc Connie Simmons 2155 W March Lane, Ste 3D Stockton CA 95207 (209) 475-0309 The Buyer’s Guide continues on the next page

Hands On Healing, A Passion For Performance Lodi Physical Therapy was established in 1963 as one of the first private practice physical therapy facilities in Northern California. For over 45 years, we have provided the best and most up-to-date treatment available in physical therapy. Our top priority is our patients’ optimal function and their success in meeting their goals. All treatments are administered by licensed physical therapists to direct healing of all kinds of physical dysfunction.

Lodi Physical Therapy 209-368-7433

www.lodipt.com

MIEC Van Anderson 6250 Claremont Ave Oakland CA 94618 (800)-227-4527 www.miec.com

SPRING 2010

SAN JOAQUIN PHYSICIAN

Medical Diagnostic Imaging Central Valley PET Imaging 4744 Quail Lakes Dr Stockton CA 95207 (209) 476-7300 Delta Radiology Medical Group Inc 999 S Fairmont Ave, Ste 110 Lodi CA 95240 (209) 371-0117 www.deltarad.com Lodi Endoscopy Center 840 S Fairmont, Ste 1 Lodi CA 95240 (209) 371-8700 www.endoscopyoflodi.com Lodi MRI 801 S Ham Lane Lodi CA 95242 (209) 366-1000 Open Advantage MRI 3115 W March Lane, Ste 110 Stockton CA 95219 (209) 957-5447 St. Joseph’s Imaging Centers 1617 N. California St, Ste 1A Stockton CA 95213 (209) 944-6063 St. Joseph’s Women’s Imaging Center 2320 N. California St, Ste 3 Stockton CA 95213 (209) 466-5028

American X-Ray & Medical Supply 10501 Highway 88 Jackson CA 95642 (209) 223-1758

Conquest Imaging 3728 Imperial Way, Ste B Stockton CA 95215 (209) 942-2654

Kerry’s Medical 7817 Thornton Rd Stockton CA 95207 (209) 951-3300

Apria Healthcare 7514 Murray Drive Stockton CA 95210 (209) 475-6860

Dave’s Custom Upholstery David Stephens 22080 E Third Avenue Linden CA 95236 (209) 887-3283 www.valleymedicalrepair.com

Lifeline-Emergency Response 935 S State Highway 49 Jackson CA 95642 (209) 223-1485

Beverly-Hi Medical Pharmacy Jamie Knox 4217 Coronado Ave, Ste E Stockton CA 95204 (209) 466-9744 Butte Therapy Systems -Stockton Curtis Saxton 1050 N Union Street Stockton CA 95205 (209) 465-0300 www.btsstockton.com

Ehlers Health Supply Lodi CA (209) 334-4407 Stockton CA (209) 836-9004

Central Valley Medical Support PO Box 2564 Manteca CA 95336 (209) 823-2337 Circadian Systems 8099 Savage Way Valley Springs CA 95252 (209) 786-6000 Community Catalysts of California 3541 Townshend Circle Stockton CA 95212 (209) 474-9700

Ecologically Sound Medical Svc 1865 N Macarthur Dr Tracy CA 95376 (209) 835-6868

E-Medical Supplies Inc 18835 N Lower Sacramento Rd Woodbridge CA 95258 (209) 366-1918 Hyberbaric Mild Chamber Sales 702 Porter Ave Stockton CA 95207 (209) 957-0237 Johnson’s Medical Supply 109 N Sutter Stockton CA 95202 (209) 467-7744

Stockton Endoscopy Center 415 E Harding Way Stockton CA 95204 (209) 942-1179

Lodi Sickroom Supply 4217 Coronado Ave Stockton CA 95204 (209) 943-2118 Manshadi Medical Supply & Equipment 2633 Pacific Ave Stockton CA 95207 (209) 946-9152 Med-Mart 2666 West Lane, Ste A Stockton CA 95205 (209) 463-1123 Merry X-Ray Chemical Inc 711 San Juan Ave Stockton CA 95203 (209) 465-3828 Northern Medical Supply Jackson CA 95642 (209) 223-7306

Medical Exam & Treatment Tables Physical Therapy Tables Dental Chairs Waiting Room Seating X-Ray Chairs

Stockton MRI Lisa Herbst 2320 N California St, Ste 2 Stockton CA 95203 (209) 466-2000 www.stocktonmri.com Tate Diagnostic Inc 628 Lincoln Center Stockton CA 95207 (209) 952-9300

Lift Easy 1943 Belmont Pl Manteca CA 95337 (209) 923-4095

Pickup & Delivery Available Preferred Sutter Vender #20069

Valley PET Institute 311 S Ham Lane Lodi CA 95242 (209) 365-1761

Call the professionals for upholstery restorations and repairs

Medical Equipment & Supplies American Med 2216 N California St, Ste B Stockton CA 95204 (209) 938-0833

Superior quality at a fair price!

209-887-DAVE (3283)

Serving the San Joaquin Valley for over 30 years

SAN JOAQUIN PHYSICIAN

SPRING 2010

Medical Equipment & Supplies Continued Owens & Minor Inc 17720 Shideler Pkwy, Ste B Lathrop CA 95330 (209) 858-7970 Peace of Mind Products Phalin Klusman 2414 W Kettleman Lane, Ste 210 Lodi CA 95242 (888) 824-8848 Priority One Medical 1112 W Fremont Stockton CA 95203 (209) 461-7228 Scrubs ‘n Such 14745 Mono Way Sonora CA 95370 (209) 588-8883 Silver Star United Inc 4532 Winding River Cir Stockton CA 95219 (209) 951-1910 SRI Surgical Express 6801 Longe St Stockton CA 95206 (209) 982-5800 Sterile Recoveries Inc 6801 S Lounge Stockton CA 95206 (209) 982-5800 WEBB Surgical Supply 1045 N California St Stockton CA 95204 (209) 464-8369

Medical Info Consulting International Healthlink Professionals, Inc. Mary Louise Applebaum P.O. Box 549 Manteca CA 95336 (209) 825-5995 www.ihelpinc.com

Medical Management Digital Capture Medical Billing 4750 Quail Lakes Dr Stockton CA 95207 (209) 954-1449 International Healthlink Professionals, Inc. Mary Louise Applebaum P.O. Box 549 Manteca CA 95336 (209) 825-5995 www.ihelpinc.com Interplan Corp 2575 Grand Canal Stockton CA 95207 (209) 954-7617

SPRING 2010

Moss Adams, LLP Irv Barnett 3100 Zinfandel Dr, 5th Floor Rancho Cordova CA 95670 (916) 503-8100 www.mossadams.com

Medical Transcription Services Medical Transcription Kitty Trudeau 1977 Forest Lane Manteca CA 95336 (209) 823-5138

Medication Assistance EZ Meds USA Scott Galbraith P.O. Box 15640 Scottsdale AZ 85267 (209) 406-1483 www.ezmedsusa.com

Microscopes, Equipment & Supplies Microscope Depot 392 W Larch Rd, Ste 28 Tracy CA 95304 (209) 839-2990

Occupational Medicine US Healthworks Medical Group Marie Chevalier 3663 E Arch Rd, Ste 400 Stockton CA 95215 (209) 943-2202 www.ushealthworks.com

Office Equipment Ikon Office Solutions 2291 W March Lane, Ste B205 Stockton CA 95219 (209) 475-5700 Quality Office Liquidations Phillip Sipat Rough & Ready Island, Bldg 713 Stockton CA 95201 (209) 464-4388 www.qualityofficeliquidations.com

Office Supplies T.H.E. Office City 2495 Station Drive Stockton CA 95215 (209) 444-5400

Optical Goods Pearle Vision 5308 Pacific Ave, Ste 84 Stockton CA 95207 (209) 952-1701

Personal Trainer Fitness 360, LLC 840 W Benjamin Holt Dr Stockton CA 95207 (209) 808-1802 Pump Institute Nicole Grauman 220 S. Church Street Lodi CA 95240 (209) 365-7867 www.pumpinstitute.net

Pharmacies Pacific Compounding Pharmacy 312 N Lincoln Center Stockton CA 95207 (209) 474-7271 RX Express Pharmacy Michelle Moreno 711 E Market Stockton CA 95202 (209) 465-1001

Physical Therapy Advanced Physical Therapy Brenda Stern 707 Lincoln Center Stockton, CA 95207 (209) 478-3900 Balance 2540 Pacific Avenue Stockton CA 95204 (209) 946-0806 California Rehabilitation 1208 E North Street Manteca CA 95336 (209) 824-2290 Dameron Hospital Physical, Occupational & Speech Therapy 420 W Acacia, Ste 8 Stockton CA 95203 (209) 461-3142 Lodi Physical Therapy Lauri Merrill 631 S Ham Lane Lodi CA 95242 (209) 368-7433 www.lodipt.com Manteca Care & Rehabilitation Center 410 Eastwood Ave Manteca CA 95336 (209) 239-1222 Manteca Physical Therapy 1041 N Main Manteca CA 95336 (209) 239-4325 McFall Medical Therapy 1810 Hoyt Lane Manteca CA 95336 (209) 825-9511

Northern California Physical Therapy 4629 Quail Lakes Dr. Stockton CA 95207 (209) 956-5699 NovaCare Physical Rehabilitation 1973 N Tracy Blvd Tracy CA 95376 (209) 833-9490 Pacific Athletic Rehabilitation Center Mike Serra 5910 Pacific Ave Stockton CA 95207 (209) 475-1000 Pine St Physical & Occupational Therapy 534 E Pine Street Stockton CA 95204 (209) 463-5800 Recovery Physical Therapy 3215 N California St, Ste 4 Stockton CA 95204 (209) 578-0443 Richard & Kerrie Harty Physical Therapy 7829 N Pershing Ave Stockton CA 95207 (209) 954-1324 St Joseph’s Physical Therapy 1800 N California Stockton CA 95204 (209) 467-6365 Star Clinic 2357 W March Lane Stockton CA 95207 (209) 951-6037 Stockton Physical Therapy Virtu Arora 221 Tuxedo Ct, Ste B Stockton CA 95204 (209) 464-0200 Tokheim Corbett Physical Therapy 1191 E Yosemite Ave Manteca CA 95336 (209) 824-9888 Vibrantcare Rehabilitation 965 E Yosemite Ave Manteca CA 95336 (209) 823-3736 Xcel Orthopaedic Physical Therapy 1429 W Fremont Stockton CA 95203 (209) 546-0944

The Buyer’s Guide continues on the next page

SAN JOAQUIN PHYSICIAN

Professional Massage A Better Body Therapy 7839 N Pershing Ave Stockton CA 95207 (209) 957-5211

Rehabilitation Services Davis Counseling Associate Inc 2291 W March Lane Stockton CA 95207 (209) 477-8288 Elan Senior Living 8105 Mariners Dr Stockton CA 95219 (209) 473-4620

Wagner Heights Residential Care 2435 Wagner Heights Road Stockton CA 95209 (209) 477-5353

Restaurants Centrale Kitchen & Bar 1825 Pacific Avenue, Ste 2 Stockton CA 95204 (209) 939-1825 LeBistro 3121 W Benjamin Holt Dr Stockton CA 95219 (209) 951-0885 Papapavlo’s Bistro & Bar

Golden Livingcenter- Hy-Pana 4545 Shelley Court Stockton CA 95207 (209) 477-0271

501 N Lincoln Center Stockton CA 95207 (209) 477-6133

Golden Livingcenter-Chateau 1221 Rose Marie Lane Stockton CA 95207 (209) 477-2664

Paragary’s Bar & Grill 110 N. El Dorado Street Stockton CA 95202 (209) 943-1110

Hampton Care Center 442 Hampton Stockton CA 95204 (209) 466-0456

Rosewood Bar & Grill 28 S School Street Lodi CA 95240 (209) 369-0470

Health Care Services 322 N California St Stockton CA 95202 (209) 933-9976

Valley Brew 157 W Adams Street Stockton CA 95204 (209) 464-2739

Masterplan Rehabilitation Services Inc 41 W Yokuts Ave Stockton CA 95207 (209) 952-6142 Service First of Northern California 102 W Bianchi Rd Stockton CA 95207 (209) 644-6300 South Pacific Rehabilitation Services 1630 N Edison Stockton CA 95204 (209) 469-9955 The Gift of Speech 3031 W March Lane Stockton CA 95219 (209) 952-2588 Valley Garden Healthcare & Rehabilitation 1517 E Knickerbocker Dr Stockton CA 95210 (209) 957-4539

Residential Care Facilities Fulton Villa 517 E Fulton Avenue Stockton CA 95204 (209) 466-2116

SAN JOAQUIN PHYSICIAN

Retirement Plans SB Planning, Inc Stephen Benjestorf 215 W Oak Street, Ste 5 Lodi CA 95240 (209) 625-8523 www.sbplanninginc.com Stull Financial David Stull 5637 N Pershing Ave, Ste C11D Stockton CA 95207 (209) 957-1673 www.stullfinancial.com

Shredding Services Pacific Storage Company Mike Long 734 Wilshire Avenue Stockton CA 95203 (209) 320-6618 www.pacific-records.com

Surgical Center Trinity Surgical Center 10200 Trinity Parkway, Ste 101 Stockton CA 95219 (209) 323-3484

Transportation Services Vince’s Transportation LLC 1711 Pecos Cir Stockton CA 95209 (209) 473-0803

Travel Agency Segale Travel Service 2321 W March Lane, Ste A Stockton CA 95207 (209) 952-6606 Stockton Travel Service 6507 Pacific Avenue Stockton CA 95207 (209) 478-6836

Uniforms Unifirst Corporation 819 N Hunter Street Stockton CA 95202 (209) 941-8364

Upholstery & Repair Dave’s Custom Upholstery David Stephens 22080 E Third Avenue Linden CA 95236 (209) 887-3283 www.valleymedicalrepair.com

Urgent Care US Healthworks Medical Group Marie Chevalier 3663 E Arch Rd, Ste 400 Stockton CA 95215 (209) 943-2202 www.ushealthworks.com

Web Design Services Mayaco Marketing & Internet Steve Morales 6333 Pacific Ave, Ste 521 Stockton CA 95207 (209) 957-8629 www.mayaco.com

Wheel Chair Lifts & Ramps Lift-U Escalon CA (209) 838-2400

Weber Point Uniforms 330 E Main Street Stockton CA 95202 (209) 464-7911

Practice Management & Medical Services Buyer’s Guide a practical resource for Busy Physicians and Office Managers Launched in conjunction with our new website this past January, the Buyer’s Guide is intended to provide our members and their staffs a quick go to source for reliable vendors and professional service providers interested in serving the medical community. For more information on getting your business or services listed please contact the San Joaquin Medical Society at (209) 952-5299 and be sure to check out our searchable online Buyer’s Guide at www.sjcms.org

Staffing Services Bright Star Staffing 5079 Lone Tree Way Antioch CA 94531 (925) 779-9000

SPRING 2010

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Join us for a sensational evening featuring favorite blockbuster themes from Ghostbusters, Gone with the Wind, Raiders of the Lost Ark, James Bond, Star Wars, and so many more! Feel free to come dressed as your favorite movie star, action hero, or comic characterâ&#x20AC;&#x201D;anything goes! Bring a canned or non-perishable food item for the Food Drive, enjoy the fantastic buffet on location and prove yourself a devoted fan as you bid on fabulous auction treasures. Donâ&#x20AC;&#x2122;t miss this extraordinary event!

Tickets starting at $20

Call

(209) 951-0196 (Mon-Fri, 9am - 5 pm) www.stocktonsymphony.org or

at the Symphony office, 46 W. Fremont St., Stockton, CA 95202 SPRING 2010

Optional buffet meal available for $25 or box supper for $10

SAN JOAQUIN PHYSICIAN

SPRING 2010

1. Patrick Langham led the 17 member San Joaquin Delta College Monday Night Swing Band to the delight of all in attendance. 2. Dr. Joseph & Dorothy Serra 3. Dr. Raissa & Eric Hill

4. St. Joe’s Chief Operations Ofﬁcer Mike Ricks tears up the dance ﬂoor with his wife Heather 5. Mike Steenburgh, Dr. Elizabeth Kass, Lloyd Karger & Dr. Moses Elam 6. Dr. Edward & Nancy Schneider, Georgette Hunefeld 7. Dr. Elvira Milano & Dr. Karen Buchler

8. Everyone enjoyed dancing to the big band sounds of evening 9. Dr. Henry Zeiter, Dean & Kathy Janssen, Bill Trezza, & Don Wiley 10. Dr. Jerold & Judith Yecies, & Dr. Robert & Eleanor Lawrence 11. San Joaquin County Supervisor Steve Bestolarides and his wife Doreen

SPRING 2010

12. Dr. Earl Taylor, Dr. Gerald Bock, & Dr. George Westin

SAN JOAQUIN PHYSICIAN

Rita Stolp Vice President Paciﬁc State Bank 1889 W. March Lane Stockton, CA

Finally. An online resource designed with you in mind. Loaded with Practical Features and Useful Resources:

Phone (209) 870-2210 Cell (209) 684-2675 email: rstolp@paciﬁcstatebank.com

Banking Medical Professionals Since 1986

• • • •

Physician Locator Handy Buyer’s Guide Daily CMA Updates Member Beneﬁts & Discounts

• • • • •

Hundreds of Useful Links Ofﬁce Resources Dozens of Webinar Links Monthly Event Calendar Tons of Patient Resources

• Physician Magazine Archive • and much more!

www.SJCMS.org

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SAN JOAQUIN PHYSICIAN

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SPRING 2010

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SAN JOAQUIN PHYSICIAN

PRSRT STD. U.S. POSTAGE

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

PAID

Permit No. 60 Stockton, CA

RETURN SERVICE REQUESTED

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