Spring 2019

N E T S I L K LOO & NTIFY EARNING TO IDE L S R E D I V O R P E HEALTH CAR KING VICTIMS HUMAN TRAFFIC

2018 Holiday Party Recap New Laws Physician Wellness SPRING 2019

Spring 2019 SAN JOAQUIN PHYSICIAN

1

The convenience of CMEs and webinars anytime, anywhere via app or desktop empowers you to…

practice

INSIGHT

Risk Management

Industry-Leading CME offerings and educational opportunities

Medical Professional Liability Insurance

Flexible coverage that’s right for you

Professional Wellness Self-care resources for healthcare practitioners

844.4NORCAL | NORCAL-GROUP.COM 2 SAN JOAQUIN PHYSICIAN

© 2019 NORCAL Mutual Insurance Company | ng5125 NORCAL Group includes NORCAL Mutual Insurance Company and its affiliated companies.

SPRING 2019

VOLUME 67, NUMBER 1 • MARCH 2019

{FEATURES}

14 18 36 42

SPRING 2019

2018 HOLIDAY PARTY RECAP NEW LAWS FOR 2019 LOOK AND LISTEN

{DEPARTMENTS} 50 IN THE NEWS

New faces and Announcements

56 PRACTICE MANAGEMENT:

Committed to Improving Quality Health Care

58 PUBLIC HEALTH

Integrating Medical and Dental

NEW STATEWIDE EFFORT TO PROMOTE PHYSICIAN WELLNESS

60 IN MEMORIAM 62 NEW MEMBERS

SAN JOAQUIN PHYSICIAN

3

PRESIDENT R. Grant Mellor, MD PRESIDENT-ELECT Richelle Marsigan, DO SECRETARY-TREASURER Hyma Jasti, MD BOARD MEMBERS Kismet Baldwin, MD, Mohsen Saadat, DO, Clyde Wong, MD, Peter Garbeff, MD, Sanjay Marwaha, MD, Benjamin Morrison, MD, Raghunath Reddy, MD, John Zeiter, MD, Cyrus Buhari, DO, Nguyen Vo, MD

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

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

COMMITTEE CHAIRPERSONS DECISION MEDICINE Kwabena Adubofour, MD CMA AFFAIRS COMMITTEE Larry Frank, MD

CONTRIBUTING WRITERS R. Grant Mellor, MD, Kismet Baldwin, MD, Katelynn Peirce, MPH, CHES, Jo Ann Kirby

PUBLIC HEALTH COMMITTEE Kismet Baldwin, MD SCHOLARSHIP LOAN FUND Gregg Jongeward, PhD

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

CMA HOUSE OF DELEGATES REPRESENTATIVES Robin Wong, MD, Lawrence R. Frank, MD, James R. Halderman, MD, Grant Mellor, MD,

SUGGESTIONS, story ideas are welcome and will be reviewed by the Editorial Committee.

Raissa Hill, DO, Ramin Manshadi, MD, Kwabena Adubofour, MD, Philip Edington, MD, Steven Kmucha, MD

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 E-mail Address: lisa@sjcms.org MEDICAL SOCIETY OFFICE HOURS: Monday through Friday 9:00am to 5:00pm Closed for Lunch between 12pm-1pm

4

SAN JOAQUIN PHYSICIAN

SPRING 2019

Complete Women’s Health Care VOTED BEST OB/GYN PRACTICE IN SAN JOAQUIN COUNTY!

Over 90,000 Healthy Babies Delivered • Gill OB/GYN is the Leading OB/GYN Practice in SJ County • Expertly Trained Physicians and Staff • 65 Years of Experience • Specializing in High Risk Pregnancy • Leading the Way with Minimally Invasive Robotic Assisted Surgery

HEALTHCARE JUST AS UNIQUE AS YOU! Complete Pregnancy Care • High Risk Pregnancy • Infertility • Gynecology • Endometriosis • Urinary Incontinence Ovarian Cystic Disorder • Laparoscopy • Hysteroscopy Diagnosis & Treatment Of Cervical, Uterine, Ovarian Cancers • Robotic Surgery

BioTE Bioidentical Hormone Replacement Therapy

Hydrafacial, Vampire Face Lift & Breast Lift SPRING 2019

SAN JOAQUIN PHYSICIAN

5

•• S JOAQ AN M BEST N BEST I BEST BEST 2018U 2018 •2018 2018 • SAN JOAQ AN JOA •• S QU

IN

AN JOA •• S QU

WINNER WINNER WINNER WINNER

Help Your Patient Help Your Patient Help Your Patient Help Your Patient See What...

Help Your Patients See See What...

See What...

See What...

They’re Missing.

What They’re Missing They’re Missing.

They’re They’re Missing.

Missing.

M •• •• •• •• INE INEINEINE AZ AZ AZ AZ AG AG AG AG

IN AN JOA •• S QU M IN AN JOA •• S QU M IN

M

MILLENIALS: MILLENIALS &LASIK LASIK MILLENIALS MILLENIALS & LASIK MILLENIALS & LASIK & LASIK

PRESBYOPIA:

GEN BOOMERS PRESBYOPIA: GEN XX&& BOOMERS: PRESBYOPIA: GEN X & BOOMERS PRESBYOPIA PRESBYOPIA: GEN X & BOOMERS GEN X & BOOMERS

MILLENIALS TO BOOMERS - DRYTOEYE MILLENIALS ALL GENERATIONS: MILLENIALS BOOMERS - DRYTOEYE MILLENIALS BOOMERS DRYTOEYE DRY -EYE BOOMERS - DRY EYE

SENIORS - CATARACTS & FADING VISION SENIORS - CATARACTS SENIORS - CATARACTS & FADING VISION SENIORS: SENIORS - CATARACTS & FADING VISION & CATARACTS FADING VISION

& FADING VISION

Commited to Continuously advancing vision care and providing compasionate patient care Commited to Continuously advancing vision care and providing compasionate patient care Commited to Continuously advancing vision care and providing compasionateSERVICES patient care CATARACT SURGERY • GLAUCOMA CARE • RETINAL Commited to Continuously advancing vision care and providing compasionateSERVICES patient care CATARACT SURGERY • GLAUCOMA CARE • RETINAL

CATARACT SURGERY • GLAUCOMA CARE RETINAL •SERVICES EYELID SURGERY • LASIK • VISION EXAMS •• GLASSES CONTACTS Committed to continuously advancing vision careEXAMS andCARE providing compassionate patient care CATARACT SURGERY • GLAUCOMA RETINAL •SERVICES EYELID SURGERY • LASIK • VISION • •GLASSES CONTACTS EYELID SURGERY • LASIK • VISION EXAMS GLASSES CONTACTS CATARACT SURGERY • GLAUCOMA CARE• RETINAL • EYELID SURGERY • LASIK • VISION EXAMS • •GLASSES •SERVICES CONTACTS EYELID SURGERY • LASIK • VISION EXAMS • GLASSES • CONTACTS Joseph T. Zeiter, M.D.

Joseph John H. T. Zeiter, M.D.

Richard John H.M.Zeiter, Wong, M.D. M.D.

Richard John C.M. Canzano, Wong, M.D.

John Harold C. Canzano, Hand, M.D. M.D.

Joseph Harold E. Zeiter, Hand, M.D. Jr., M.D. Joseph E. Zeiter, Jr., M.D.

Joseph T. Zeiter, M.D.

Joseph John H. T. Zeiter, M.D.

Richard John H.M.Zeiter, Wong, M.D. M.D.

Richard John C.M. Canzano, Wong, M.D.

John Harold C. Canzano, Hand, M.D. M.D.

Joseph Harold E. Zeiter, Hand, M.D. Jr., M.D. Joseph E. Zeiter, Jr., M.D.

Joseph T. Zeiter, M.D.

Joseph John H. T. Zeiter, M.D.

Richard John H.M.Zeiter, Wong, M.D. M.D.

Richard John C.M. Canzano, Wong, M.D.

John Harold C. Canzano, Hand, M.D. M.D.

Joseph Harold E. Zeiter, Hand, M.D. Jr., M.D. Joseph E. Zeiter, Jr., M.D.

Joseph T. Zeiter, M.D.

Joseph John H. T. Zeiter, M.D.

Richard John H.M.Zeiter, Wong, M.D. M.D.

Richard John C.M. Canzano, Wong, M.D.

John Harold C. Canzano, Hand, M.D. M.D.

Joseph Harold E. Zeiter, Hand, M.D. Jr., M.D. Joseph E. Zeiter, Jr., M.D.

eiter, M.D.

Joseph John H.T.Zeiter, Zeiter,M.D. M.D.

Richard John H. M.Zeiter, Wong,M.D. M.D.

Richard John C. M. Canzano, Wong,M.D. M.D.

John Harold C. Canzano, Hand, M.D. M.D.

Joseph Harold E. Zeiter, Hand, Jr., M.D. M.D.

Michael Mequio, Joseph Jr., M.D. PeterE.V.J.Zeiter, Hetzner, O.D.

Judith Prima, O.D. Peter V. A. Hetzner,

Judith Linda A. Hsu, Prima, O.D. O.D.

Steven LindaA.Hsu, Wood, O.D.O.D.

Robert O.D. Robert Devinder E. Pedersen, K. Grewal,O.D. O.D. Devinder Grewal,O.D. O.D. Robert K. Dupree, StevenE.A.Pedersen, Wood, O.D.

Robert Dupree,

eiter, M.D.

Joseph John H.T.Zeiter, Zeiter,M.D. M.D.

Richard John H. M.Zeiter, Wong,M.D. M.D.

Richard John C. M. Canzano, Wong,M.D. M.D.

John Harold C. Canzano, Hand, M.D. M.D.

Joseph Harold E. Zeiter, Hand, Jr., M.D. M.D.

Michael Mequio, Joseph Jr., M.D. PeterE.V.J.Zeiter, Hetzner, O.D.

Judith Prima, O.D. Peter V. A. Hetzner,

Judith Linda A. Hsu, Prima, O.D. O.D.

Steven LindaA.Hsu, Wood, O.D.O.D.

Robert O.D. Robert Devinder E. Pedersen, K. Grewal,O.D. O.D. Devinder Grewal,O.D. O.D. Robert K. Dupree, StevenE.A.Pedersen, Wood, O.D.

Robert Dupree,

eiter, M.D.

Joseph John H.T.Zeiter, Zeiter,M.D. M.D.

Richard John H. M.Zeiter, Wong,M.D. M.D.

Richard John C. M. Canzano, Wong,M.D. M.D.

John Harold C. Canzano, Hand, M.D. M.D.

Joseph Harold E. Zeiter, Hand, Jr., M.D. M.D.

Michael Mequio, Joseph Jr., M.D. PeterE.V.J.Zeiter, Hetzner, O.D.

Judith Prima, O.D. Peter V. A. Hetzner,

Judith Linda A. Hsu, Prima, O.D. O.D.

Steven LindaA.Hsu, Wood, O.D.O.D.

Robert O.D. Robert Devinder E. Pedersen, K. Grewal,O.D. O.D. Devinder Grewal,O.D. O.D. Robert K. Dupree, StevenE.A.Pedersen, Wood, O.D.

Robert Dupree,

eiter, M.D.

Joseph John H.T.Zeiter, Zeiter,M.D. M.D.

Richard John H. M.Zeiter, Wong,M.D. M.D.

Richard John C. M. Canzano, Wong,M.D. M.D.

John Harold C. Canzano, Hand, M.D. M.D.

Joseph Harold E. Zeiter, Hand, Jr., M.D. M.D.

Michael Mequio, Joseph Jr., M.D. PeterE.V.J.Zeiter, Hetzner, O.D.

Judith Prima, O.D. Peter V. A. Hetzner,

Judith Linda A. Hsu, Prima, O.D. O.D.

Joseph Zeiter, M.D.

John Zeiter, M.D.

Richard Wong, M.D.

John Canzano, M.D.

Joseph Zeiter, Jr. , M.D.

Michael Mequio, M.D.

Peter Hetzner, O.D.

Linda Hsu, O.D.

tzner, O.D.

Peter JudithV.A.Hetzner, Prima, O.D. O.D.

Judith LindaA.Hsu, Prima, O.D. O.D.

Steven LindaA.Hsu, Wood, O.D.O.D.

Robert Pedersen, O.D. StevenE. A. Wood, O.D.

Devinder Robert E. K. Pedersen, Grewal,O.D. O.D. Devinder K. Grewal, O.D. Robert Dupree, O.D.

Robert Dupree, O.D.

tzner, O.D.

Peter JudithV.A.Hetzner, Prima, O.D. O.D.

Judith LindaA.Hsu, Prima, O.D. O.D.

Steven LindaA.Hsu, Wood, O.D.O.D.

Robert Pedersen, O.D. StevenE. A. Wood, O.D.

Devinder Robert E. K. Pedersen, Grewal,O.D. O.D. Devinder K. Grewal, O.D. Robert Dupree, O.D.

Robert Dupree, O.D.

tzner, O.D.

Peter JudithV.A.Hetzner, Prima, O.D. O.D.

Judith LindaA.Hsu, Prima, O.D. O.D.

Steven LindaA.Hsu, Wood, O.D.O.D.

Robert Dupree, O.D.

tzner, O.D.

Peter JudithV.A.Hetzner, Prima, O.D. O.D.

Judith LindaA.Hsu, Prima, O.D. O.D.

Steven LindaA.Hsu, Wood, O.D.O.D.

Robert Dupree, O.D.

Over 50 years ofE. K.Pedersen, Vision Care Robert E. A. Pedersen, O.D. Devinder Robert Grewal,O.D. O.D. Devinder K. Grewal, O.D. Robert Dupree, O.D. Steven Wood, O.D. Robert E. A. Pedersen, O.D. Devinder Robert Grewal,O.D. O.D. Devinder K. Grewal, O.D. Robert Dupree, O.D. Steven Wood, O.D. Over 50 years ofE. K.Pedersen, Vision Care Over 50 years of Vision Care Over 50 years of Vision Care

Over 55 years of Vision Care

6

SAN JOAQUIN PHYSICIAN

Robert O.D. Robert Devinder E. Pedersen, K.call Grewal,O.D. O.D. Devinder Grewal,O.D. O.D. Robert K. Dupree, Steven LindaA.Hsu, Wood, O.D. StevenE.A.Pedersen, Wood, please O.D. To refer AO.D.patient, To refer A patient, please call Robert O.D. Devinder Grewal, O.D. Robertplease Dupree, O.D. Jennifer ToPedersen, refer A patient, callPham, O.D. Ralph Miranda, O.D. To refer A patient, please call

209-461-2170 209-461-2170 209-461-2170 www.zeitereye.com 209-461-2170 www.zeitereye.com www.zeitereye.com 209-466-5566 www.zeitereye.com

Steven Wood, O.D.

STOCKTON • LODI • MANTECA • TRACY • SONORA refer a patient, please call STOCKTON •To LODI • MANTECA • TRACY • SONORA STOCKTON • LODI • MANTECA • TRACY • SONORA STOCKTON • LODI • MANTECA • TRACY • SONORA

STOCKTON • LODI • MANTECA • TRACY • SONORA

www.zeitereye.com

SPRING 2019

Robert Dupree,

SPRING 2019

SAN JOAQUIN PHYSICIAN

7

EXECUTIVE DIRECTOR’S REPORT

NEW GRADUATE MEDICAL EDUCATION FUNDING HEADED TO SAN JOAQUIN COUNTY As you may remember, back in 2016, the California Medical Association (CMA) took on big tobacco and won passing the California Health Care, Research and Prevention Tobacco Tax Act of 2016 (Proposition 56). The $2 per pack tobacco tax funded existing health programs and research into cures for cancer and other illnesses caused by smoking and tobacco products, as well as created new revenues dedicated to the state’s Medi-Cal program.

When Governor Jerry Brown tried to reallocate the revenue to offset his general budget fund, CMA fought the move and once again prevailed, and in 2018, physicians began receiving supplemental payments in both fee-for-service and Medi-Cal managed care when providing MediCal services under specific CPT codes.

Additionally, under Prop 56, the University of California (UC) received $40 million to support a statewide graduate medical education (GME) program and contracted with Physicians for a Healthy California or PHC (formerly CMA Foundation) to administer the “CalMedForce” grants. On February 6, PHC announced that more than $38 million in new state tobacco tax revenues had been awarded to GME programs across the state to fund 156 slots for physician residencies.

This first round of funding included awards to 73 separate GME programs located in hospitals, medical centers and community clinics to offer residencies to 156 recent medical school graduates. This investment is greatly needed as a shortage of available residency slots has contributed to a bottleneck of medical student graduates and exacerbated the state’s physician shortage, and indeed, programs that focus on medically-underserved areas and populations were given priority.

We were so excited our community received a collective total of $2,475,000 for the local programs listed below because evidence has shown that robust training programs are the best way to attract and retain talented physicians to our area:

• San Joaquin General Hospital Family Medicine Residency- $225,000 • San Joaquin General Hospital Internal Medicine Residency- $675,000 • St. Joseph’s Medical Center Emergency Medicine Residency- $675,000 • St. Joseph’s Medical Center Internal Medicine Residency- $900,000

These funds and programs will help transform San Joaquin County into a hub for graduate medical education and serves as just one example of the power of advocacy that takes place on our members’ behalf every day in Sacramento and Washington DC. In this case, it translates into millions of dollars invested into our community to improve access to care, physician shortage and public health.

Furthermore, another $220 million of the revenue generated from Prop 56 has been appropriated to the Physicians and Dentists Loan Repayment Act Program for recently graduated physicians ($190 million) and dentists ($30 million), and the Department of Healthcare Services has contracted with PHC to administer the funds. More information on this exciting program coming soon!

Sincerely,

Lisa Richmond

8

SAN JOAQUIN PHYSICIAN

SPRING 2019

SPRING 2019

SAN JOAQUIN PHYSICIAN

9

10

SAN JOAQUIN PHYSICIAN

SPRING 2019

A message from our President > R. Grant Mellor, MD

A Reminder of Why We Support SJMS & CMA I was asked to share the short speech I delivered at December’s holiday dinner, which was written to serve as a reminder of why we belong to The San Joaquin Medical Society and the California Medical Association. Here it is. “…Although tonight is about having fun and relaxing with colleagues and family, we cannot forget that this night is really about keeping our professional group strong and protecting the medical profession against many recurrent challenges. #1: We must not forget MICRA. This is the law that shields us from the excessive and ridiculous malpractice suits we see in so many other states. There was a serious challenge to MICRA a few years ago. But the CMA was there, and it very effectively beat back this attack by the trial lawyers’ association. You can bet there will be future attacks on MICRA, and that we’ll need to defend it again, and again, and again. But you can also bet that the CMA will be there for those future battles, because we are here tonight to keep the CMA strong.

ABOUT THE AUTHOR ­ R. Grant Mellor, MD- Pediatrician and Chief of Professional Development, Central Valley Service Area, The Permanente Medical Group and current President of the San Joaquin Medical Society

#2: There is a constant assault on immunizations, especially childhood immunizations, which are the bedrock of our modern healthcare system. I sometimes imagine what life was like before modern vaccines two hundred years ago, when so many children used to die. Or even forty years ago, before the Hib and Pneumococcus vaccines, when your average pediatrician like me used to average a lumbar puncture a week. (Now, in my practice, our LP trays expire before we use them!)

Yet there are those who continually work to persuade parents not to vaccinate their children. Seven years ago, they had the upper hand. It was looking bad for California, as we were dipping well below thresholds for herd immunity. We had a measles outbreak in Disneyland!

Fortunately, the CMA was there. The CMA was a driving force behind passage of Richard Pan’s bill SB277, requiring that children who enter kindergarten get their

SPRING 2019

SAN JOAQUIN PHYSICIAN

11

immunizations, and disallowing the personal exemption. We won this battle -- and childhood immunization rates are now at a safe level, protecting your children and your grandchildren.

You can be sure we’ll have to fight this battle to protect vaccinations, over and over again. You can also be sure that the CMA will be there, because we are here to keep the CMA strong. #3: L ocally, in 2017, the SJMS engaged in the struggle to separate the Coroner’s Office from the Sheriff’s office in San Joaquin County. At stake was the independence of medical practice for our medical examiner colleagues. We took on the Sheriff’s office, we took on 100 years of precedent, and we won! There will be future local fights that need to be fought to defend our profession. And the SJMS will be there, because we are here to keep it strong.

Now it’s not just conflict we engage in. The vast majority of our work is that of quietly building and maintaining the health of our profession.

To highlight some ongoing local projects: 1. Decision Medicine. Every summer this program exposes

12

SAN JOAQUIN PHYSICIAN

24 local underprivileged high school students to the medical profession. Many have gone on to pursue medicine as careers.

Decision Medicine has been recognized and copied by other chapters within the CMA. 2. B ridge to Medicine: our newest initiative, to give individual guidance for those who are planning to attend medical school. (By the way, we need mentors!)

3. Our local medical community is Northern California’s fastest-growing teaching hub. Every year you’ll see more residents and medical students in our local hospitals and practices. It will not be surprising to see someone start a medical school (de novo or as a branch campus) in the Stockton area in the next decade. Local medical education is a permanent solution to the recruiting problems that we have all faced. SJMS will be there to promote the Central Valley, and to promote this necessary maturation of our medical community.”

So, there you have it – a list of reasons why we all need to continue to support our local and state medical societies. Keep your membership active, and volunteer to help when you can!

SPRING 2019

Sometimes You Just Need a Little Help.

EXCI

RAFFTING PRIZ LE E S

Tenth Annual Golf Tournament Join fellow San Joaquin Medical Society members and invited guests for a relaxing round of golf, BBQ lunch, dinner and after golf party. Exciting and generously donated raffle prizes you don’t want to miss. Plus an opportunity to benefit our local The First Tee of San Joaquin and SJMS’ Decision Medicine programs. Your hosts, Drs. Kwabena Adubofour, George Herron, Prasad Dighe and George Khoury are committed to making this an event to remember!

Sunday April 28, 2019 • Brookside Country Club • 4 Person Scramble $175 per golfer - Price includes green fees, golf cart, lunch, after golf dinner and party! See registration form for details. $50 of every entry fee goes to The First Tee of San Joaquin program Hole Sponsorships benefit SJMS’ Decision Medicine Program

Registration and Range Open 11:00am • Putting Contest Qualifying 11:00am - 12:30pm Buffet Lunch 12:00pm • Shotgun start 1:00pm

To sign up, please call the San Joaquin Medical Society office at 209-952-5299 SPRING 2019

SAN JOAQUIN PHYSICIAN

13

14

SAN JOAQUIN PHYSICIAN

SPRING 2019

2018 Holiday Party Thursday, December 13 at Stockton Golf and Country Club

SPRING 2019

SAN JOAQUIN PHYSICIAN

15

16

SAN JOAQUIN PHYSICIAN

SPRING 2019

SPRING 2019

SAN JOAQUIN PHYSICIAN

17

Significant New California Laws of Interest to Physicians for 2019

The California Legislature had an active year, passing many new laws affecting health care. In particular, There was a strong focus on health care coverage, drug prescribing, public health, and mental health issues. On the following pages you will find highlights of the most significant health laws of interest to The California Legislature had an active year, passing many new laws affecting health care. In particular, there was a strong focus on health care coverage, physicians. drug prescribing, public health, and mental health issues. On the following pages you will find highlights of the most significant health laws of interest to ALLIED HEALTH PROFESSIONALS physicians.

AB 2281 (Irwin) – Clinical laboratories: licensed medical laboratory technicians AB 2589 (Bigelow) – Controlled ALLIED HEALTH PROFESSIONALS CMA PosiIon: Support substances: human chorionic AB 2281 (Irwin) – Clinical laboratories: gonadotropin Exempts blood smear reviews other than manual leukocyte differenJals, microscopic urinalysis, and blood typing of moderate licensed medical laboratory technicians Current law lists human chorionic gonadotropin complexity such as automated ABO/Rh tesJng and anJbody screen tesJng from the prohibiJon of licensed medical laboratory

CMA Position: Support (hCG) as a Schedule III controlled substance technicians from performing microscopic analysis or immunohematology procedures.

Exempts blood smear reviews other than under the California Uniform Controlled manual leukocyte differentials, microscopic Substances Act. This bill exempts hCG from AB 2423 (Holden) – Physical therapists: direct access to services urinalysis, and blood typing of moderate being subject to the reagent regulations of the CMA PosiIon: Neutral complexity such as automated ABO/Rh Controlled Substances Act when possessed Provides physical therapists with an exempJon from the provision in the Physical Therapy PracJce Act that prohibits the physical testing and antibody screen testing from the by, sold to, purchased by, transferred to, or prohibition of licensed medical laboratory administered by a licensed veterinarian, or therapist from conJnuing treatment beyond 45 calendar days or 12 visits, whichever occurs first, without receiving specified technicians from performing microscopic a licensed veterinarian’s designated agent, doctor approval of the physical therapist’s plan of care to enable them to provide services within their scope of pracJce under the analysis or immunohematology procedures. exclusively for veterinary use. federal Individuals with DisabiliJes Act (IDEA) under a school-developed Individualized EducaJon Program (IEP) or an Individualized Family Service Plan (IFSP).

AB 2423 (Holden) – Physical therapists:

SB 762 (Hernandez) – Optometry: direct access to services administration of immunizations AB 2589 (Bigelow) – Controlled substances: human chorionic gonadotropin CMA Position: Neutral Requires training programs for certification of

Provides physical therapists with an exemption Current law lists human chorionic gonadotropin (hCG) as a Schedule III controlled substance under the California Uniform optometrists to administer immunizations to from the provision in the Physical Therapy be endorsed by the Accreditation Council for Controlled Substances Act. This bill exempts hCG from being subject to the reagent regulaJons of the Controlled Substances Act Practice Act that prohibits the physical Pharmacy Education in addition to the federal when possessed by, sold to, purchased by, transferred to, or administered by a licensed veterinarian, or a licensed veterinarian’s therapist from continuing treatment beyond Centers for Disease Control and Prevention. designated agent, exclusively for veterinary use.

45 calendar days or 12 visits, whichever occurs SB 1003 (Roth) – Respiratory therapy first, without receiving specified doctor SB 762 (Hernandez) – Optometry: administration of immunizations CMA Position: Neutral approval of the physical therapist’s plan of care Requires training programs for cerJficaJon of optometrists to administer immunizaJons to be endorsed by the AccreditaJon Prohibits any state agency, as defined, except to enable them to provide services within their Council for Pharmacy EducaJon in addiJon to the federal Centers for Disease Control and PrevenJon. for the Respiratory Care Board of California, scope of practice under the federal Individuals from defining or interpreting respiratory care with Disabilities Act (IDEA) under a schoolfor those licensed under the Respiratory Care SB 1003 (Roth) – Respiratory therapy developed Individualized Education Program Practice Act, or from developing standardized (IEP) or an Individualized Family Service Plan CMA PosiIon: Neutral procedures or protocols, unless authorized by (IFSP).

Prohibits any state agency, as defined, except for the Respiratory Care Board of California, from defining or interpreJng respiratory these provisions or specifically required by state care for those licensed under the Respiratory Care PracJce Act, or from developing standardized procedures or protocols, unless or federal statute. authorized by these provisions or specifically required by state or federal statute.

18

SAN JOAQUIN PHYSICIAN

SPRING 2019

CONSENT AB 3189 (Cooper) – Consent by minors to treatment for intimate partner violence Authorizes a minor who is 12 years of age or older and who states he or she is injured as a result of intimate partner violence, as defined, to consent to medical care related to the diagnosis or treatment of the injury and the collection of medical evidence with regard to the alleged intimate partner violence.

DEATH AND ORGAN DONATION AB 2096 (Frazier) – Personal income taxes: voluntary contributions: Organ and Tissue Donor Registry Voluntary Tax Contribution Fund Allows a taxpayer to designate an amount in excess of personal income tax liability to be transferred into the Organ and Tissue Donor Registry Voluntary Tax Contribution Fund, which the bill creates.

SB 1163 (Galgiani) – Postmortem examination or autopsy Makes various changes to provisions regarding postmortem examination or autopsies of unidentified bodies or remains, including to provisions regarding dental examinations, tomography scans, and retention of tissue and bone samples. Authorizes an agency tasked with the exhumation of a body or skeletal remains of a deceased person that has suffered significant deterioration or decomposition, where the circumstances surrounding the death afford a reasonable basis to suspect that the death was caused by or related to the criminal act of another, to perform the exhumation in consultation with a boardcertified forensic pathologist. Authorizes a board-certified forensic pathologist to suggest to the agency tasked with an exhumation to consider retaining the services of an anthropologist, as specified.

SPRING 2019

DRUG PRESCRIBING AND DISPENSING AB 315 (Wood) Pharmacy benefit management CMA Position: Sponsor Requires a pharmacy in inform a customer at the point of sale for a covered prescription drug whether the retail price is lower than the applicable cost-sharing amount for the prescription drug unless the pharmacy automatically charges the customer the lower price. If the customer pays the retail price, the bill requires the pharmacy to submit the claim to the plan or insurer in the same manner as if the customer had purchased the prescription drug by paying the cost-sharing amount when submitted by the network pharmacy.

AB 1751 (Low) – CURES database: Interstate data sharing CMA Position: Oppose Unless Amended Requires the Department of Justice, no later than July 1, 2020, to adopt regulations regarding the access and use of the information within CURES by consulting with stakeholders, and addressing certain processes, purposes, and conditions in the regulations. Authorizes the department, once final regulations have been issued, to enter into an agreement with any entity operating an interstate data sharing hub, or any agency operating a prescription drug monitoring program in another state, for purposes of interstate data sharing of prescription drug monitoring program information, as specified.

AB 1753 (Low) – Controlled substances: Security form CMA Position: Neutral Authorizes the Department of Justice to reduce or limit the number of approved security printers for controlled substance prescription forms to 3, as specified and requires

SAN JOAQUIN PHYSICIAN

19

20

SAN JOAQUIN PHYSICIAN

SPRING 2019

prescription forms for controlled substance prescriptions to have a uniquely serialized number, in a manner prescribed by the department, and requires a printer to submit specified information to the department for all prescription forms delivered.

AB 2037 (Bonta) – Pharmacy: automated patient dispensing systems Provides an alternative program to authorize a pharmacy located in the state to provide pharmacy services to the patients of covered entities, as defined, that are eligible for discount drug programs under federal law, as specified, through the use of an automated patient dispensing system, as defined. Provides that the responsibility of the operation, maintenance, and security of the automated patient dispensing system would be the responsibility of the pharmacy and requires that the drugs dispensed from the system be labeled in accordance to existing law. Requires the pharmacy to compete an annual selfassessment.

AB 2086 (Gallagher) – Controlled substances: CURES database CMA Position: Support Allows prescribers to access the Controlled Substance Utilization Review and Evaluation System (CURES) database for a list of patients for whom that prescriber is listed as a prescriber in the CURES database.

AB 2256 (Santiago) – Law enforcement agencies: opioid antagonist CMA Position: Support Authorizes a pharmacy, wholesaler, or manufacturer to furnish naloxone hydrochloride or other opioid antagonists to a law enforcement agency, as provided.

SPRING 2019

AB 2487 (McCarty) – Physicians and surgeons: continuing education: opiatedependent patient treatment and management CMA Positing: Neutral Authorizes a physician and surgeon to complete a one-time continuing education course of 12 credit hours on opiate-dependent patient treatment and management, including eight hours of training in buprenorphine treatment as an alternative to the mandatory continuing education course on pain management and the treatment of terminally ill and dying patients.

AB 2760 (Wood) – Prescription drugs: prescribers: naloxone hydrochloride and other FDA-approved drugs CMA Position: Neutral Requires a prescriber, as defined, to offer a prescription for naloxone hydrochloride or another drug approved by the United States Food and Drug Administration for the complete or partial reversal of opioid depression to a patient when certain conditions are present and to provide education on overdose prevention and the use of naloxone hydrochloride or another drug to the patient and specified others, except as specified.

Subjects a prescriber to referral to the licensing board charged with regulating his or her license for the imposition of administrative sanctions, as that board deems appropriate, for violations of these provisions.

AB 2783 (O’Donnell) – Controlled substances: hydrocodone combination products Reclassifies specified hydrocodone combination products as Schedule II controlled substances under the California Uniform Controlled Substances Act.

SAN JOAQUIN PHYSICIAN

21

AB 2789 (Wood) – Prescriptions: electronic data transmission CMA Position: Oppose Requires, on and after January 1, 2022, health care practitioners authorized to issue prescriptions to have the capability to transmit electronic data transmission prescriptions and would require pharmacies to have the capability to receive those transmissions.

Mandates electronic prescribing, unless specified exceptions are met.

SB 212 (Jackson) – Solid waste: pharmaceutical and sharps waste stewardship CMA Position: Support Establishes a stewardship program, under which a manufacturer or distributor of covered drugs or sharps, or other entity defined to be covered by the bill, is required to establish and implement, either on its own or as part of a group of covered entities through membership in a stewardship organization, a stewardship program for covered drugs or for sharps, as applicable. Imposes various requirements on a covered entity or stewardship organization that operates a stewardship program, including submitting a proposed stewardship plan, an initial stewardship program budget, an annual budget, annual report, and other specified information to CalRecycle.

SB 1021 (Wiener) – Prescription drugs Extends existing provisions related to formularies for outpatient prescription drugs by health care service plans or health insurers and cost-sharing for covered outpatient prescription drugs until January 1, 2024. Prohibits, until January 1, 2024, a drug formulary maintained by a health care service plan or health insurer from containing more than 4 tiers, as specified.

Requires a prescription drug benefit to provide that an enrollee or an insured is not required to pay more than the retail price for a prescription drug if a pharmacy’s retail price is less than the

22

SAN JOAQUIN PHYSICIAN

applicable copayment or coinsurance amount, and the payment rendered by an enrollee or insured would constitute the applicable costsharing. Extends until January 1, 2023, coverage requirement to antiretroviral drug treatments that are medically necessary for the prevention of AIDS/HIV.

SB 1109 (Bates) – Controlled substances: Schedule II drugs: opioids CMA Position: Support Requires training and continuing education under the Medical Practice Act, Nursing Practice Act, Physician Assistant Practice Act, Dental Practice Act, Osteopathic Act, and the Optometry Practice Act to include risks of addiction associated with the use of Schedule II drugs. Requires pharmacy or practitioner dispensing an opioid to a patient for outpatient use to display a notice on the label or container that warns of the risk of overdose and addiction as specified. Requires a prescriber to discuss specified information with the minor, the minor’s parent or guardian or other adult authorized to consent to the minor’s medical treatment before directly dispensing or issuing for a minor the first prescription in a single course of treatment for a controlled substance containing an opioid.

Requires youth sports organizations to distribute specified Opioid Factsheet for Patients to each athlete and requires each athlete and their parent to sign a document acknowledging receipt.

SB 1254 (Stone) – Hospital pharmacies: medication profiles or lists for high-risk patients CMA Position: Neutral Requires a pharmacist at a hospital pharmacy to obtain an accurate medication profile or list for each high-risk patient upon admission of the patient under specified circumstances.

Authorizes an intern pharmacist or a pharmacy technician to perform the task of obtaining an accurate medication profile or list for a highrisk patient if certain conditions are satisfied.

SPRING 2019

Requires the hospital to establish criteria regarding who is a high-risk patient for purposes of the bill’s provisions and determine a timeframe for completion of the medication profile or list, based on the populations served by the hospital.

EMERGENCY SERVICES AB 2576 (Aguiar-Curry) – Emergencies: health care CMA Position: Support if Amended Authorizes a pharmacist or a community clinic to furnish a dangerous drug or device in reasonable quantities without a prescription during a declared emergency. Requires the Pharmacy Board to allow for the use of a mobile pharmacy or clinic during an emergency if certain conditions are met. Authorizes the Governor, during a state of emergency, to direct all state agencies to utilize, employ, and direct state personnel, equipment, and facilities for the performance of any and all activities that are designed to allow community clinics and health centers to provide and receive reimbursement for services provided during or immediately following the emergency, including directing DHCS to seek federal approvals to allow community clinics and health centers to provide and be reimbursed for Medi-Cal or other services that are provided either telephonically, or to patients at a shelter or other location within the geographical boundaries of the emergency as stated in the proclamation declaring the state of emergency

END-OF-LIFE AB 282 (Jones-Sawyer D) – Aiding, advising or encouraging suicide: exemption from prosecution Prohibits a person whose actions are compliant with the End of Life Option Act from being prosecuted for deliberately aiding, advising, or encouraging suicide.

SPRING 2019

AB 3211 (Kalra) – Advance health care directives Revises the language of the form for written advance health care directives created under the Health Care Decisions Law to allow a person to authorize an agent to consent to any temporary medical procedures necessary to maintain organs, tissues, and/or parts for the purpose of donation.

HEALTH CARE COVERAGE AB 595 (Wood) – Health care service plans: mergers and acquisitions CMA Position: Support if Amended Requires a health care service plan that intends to merge or consolidate with, or enter in an agreement resulting in its purchase, acquisition, or control by, any entity, as defined, including another health care service plan or a licensed health insurer, to give notice to, and secure prior approval from, the Director of the Department of Managed Health Care. Requires a health care service plan subject to these provisions to meet specified requirements and to provide information necessary for the director to make the determination to approve, conditionally approve, or disprove the transaction or agreement, as specified.

Requires health care services plans subject to these provisions to pay specified fees and to reimburse the director for specified costs related to making a decision on whether to approval, conditionally approve, or disapprove the transaction

AB 1860 (Limón) – Health care coverage: cancer treatment CMA Position: Support Existing law prohibits, until January 1, 2019, an individual or group health care service plan contract or health insurance policy issued, amended, or renewed on or after January 1, 2015, that provides coverage for prescribed, orally administered anticancer medications

SAN JOAQUIN PHYSICIAN

23

A COMMUNITY BUILT ON

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

To learn more about the program, call (209) 988-2283.

24

SAN JOAQUIN PHYSICIAN

SPRING 2019

used to kill or slow the growth of cancerous cells from requiring an enrollee or insured to pay, notwithstanding any deductible, a total amount of copayments and coinsurance that exceeds $200 for an individual prescription of up to a 30-day supply of a prescribed orally administered anticancer medication, as specified. Existing law authorizes health care service plans to adjust that $200 limit on January 1 of each year, to the extent that adjustment does not exceed the percentage increase in the Consumer Price Index for that year. Raises the limit on copayments and coinsurance to $250 for an individual prescription of up to a 30-day supply of a prescribed orally administered anticancer medication, eliminates provisions authorizing health plans and insurers to adjust this limit, and extends the period the limit remains in effect to January 1, 2024.

AB 2119 (Gloria) – Foster care: gender affirming health care and mental health care CMA Position: Support if Amended Makes specified findings and declarations regarding transgender and gender nonconforming children in foster care. Specifies that the rights of minors and nonminors in foster care to be involved in the development of case plan and plan for placement includes the development of case plan elements related to gender affirming health care, with consideration of their gender identity. Provides that the rights of minors and nonminors in foster care to receive medical, dental, vision, and mental health services includes covered gender affirming health care and gender affirming mental health care, as defined, subject to existing consent laws. Requires the Department of Social Services, in consultation with the Department of Health Care Services and other stakeholders, to develop, as specified, guidance and best practices to identify, coordinate, and support foster youth seeking

SPRING 2019

access to gender affirming health care services and gender affirming mental health services.

AB 2499 (Arambula) – Health care coverage: medical loss ratios CMA Position: Support Existing law requires a health care service plan or health insurer to provide an annual rebate to each enrollee or insured under that coverage, on a pro rata basis, if the medical loss ratio, calculated as specified, is less than a certain percentage. Existing law excludes all specialized health care service plan contracts and specialized health insurance policies from these requirements. Limits the exemption from annual rebate requirements to specialized health care service plan contracts and specialized health insurance policies that provide only dental or vision services.

AB 2674 (Aguiar-Curry) – Health care service plans: disciplinary actions CMA Position: Sponsor Under the Knox-Keene Health Care Service Plan Act of 1975, a health care service plan is prohibited from engaging in an unfair payment pattern, as defined, and allows providers to report instances in which a plan is engaging in an unfair payment pattern to the department. Requires the Department of Managed Health Care to review complaints of unfair payment patterns on or before July 1, 2019, and at least annually thereafter and permits the department to conduct an audit or enforcement action pursuant to existing authority if the review of the complaint data indicates a possible unfair payment pattern.

AB 2863 (Nazarian) – Health care coverage: prescriptions Requires a pharmacy to inform a customer at the point of sale for a covered prescription drug whether the retail price is lower than the cost-sharing amount for the drug unless the lower price is charged automatically.

SAN JOAQUIN PHYSICIAN

25

Limits the amount a health care service plan or health insurer may require an enrollee or insured to pay at the point of sale for a covered prescription to the lesser of the applicable costsharing amount or the retail price. Prohibits a health care service plan or health insurer from requiring a pharmacist or pharmacy to charge or collect a cost-sharing amount from an enrollee or insured that exceeds the total retail price for the prescription drug. Provides that the payment rendered by an enrollee or insured constitutes the applicable cost sharing and shall apply to any deductible as well as to the maximum out-of-pocket limit, as specified.

SB 1034 (Mitchell) – Health care: mammograms

AB 2941 (Berman) – Health care coverage: state of emergency

AB 1953 (Wood) – Skilled nursing facilities: disclosure of interests in business providing services

Requires a health care service plan or health insurer to provide its enrollees or insureds who have been displaced by a state of emergency, as defined, access to medically necessary health care services. Requires a health care service plan or health insurer, within 48 hours of a declaration of emergency by the Governor that displaces or has the immediate potential to displace enrollees or insureds, to file a notification with the regulator containing specified information regarding how the plan or insurer is communicating with and addressing the needs of its enrollees or insureds during the state of emergency.

SB 997 (Monning) – Health care service plans: physician to enrollee ratios Deletes the repeal date of existing law that would have sunset on January 1, 2019 and requires a health care service plan to ensure that there is at least one full-time equivalent primary care physician for every 2,000 enrollees and authorizes the assignment of up to an additional 1,000 enrollees, as specified, to a primary care physician for each full-time equivalent non-physician medical practitioner, as defined, supervised by that physician. These provisions will operate indefinitely.

26

SAN JOAQUIN PHYSICIAN

CMA Position: Neutral Extends, until January 1, 2025, the operation of existing law that requires a health facility at which a mammography examination is performed to include a prescribed notice on breast density in the summary of the written report that is sent to a patient, if specified circumstances apply. Makes technical and conforming changes.

HEALTH CARE FACILITIES AND FINANCING

Requires an organization that operates, conducts, owns, or maintains a skilled nursing facility to additionally report to the office whether the licensee, or a general partner, director, or officer of the licensee, has an ownership or control interest of 5% or more in a related party, as defined, that provides any service to the skilled nursing facility. If goods, fees, and services collectively worth ten thousand dollars ($10,000) or more per year are delivered to the skilled nursing facility, the disclosure shall include the related party’s profit and loss statement, and the Payroll-Based Journal public use data of the previous quarter for the skilled nursing facility’s direct caregivers.

AB 2428 (Gonzalez-Fletcher) – Federally qualified health centers: rural health clinics Exempts from Medi-Cal provider enrollment a primary care clinic with an additional physical plant added to its consolidated primary care clinic license from the requirement to separately enroll the additional physical plant as a separate provider and from the requirement to submit a complete application package, if the primary care clinic has notified the department

SPRING 2019

of its additional physical plant. Allows an FQHC or RHC adding a new licensed location to its primary care license to elect to have the reimbursement rate for the new location established in accordance with the standard PPS methodology, or to have one PPS rate for all its locations.

AB 2983 (Arambula) – Health care facilities: voluntary psychiatric care CMA Position: Support

SB 1397 (Hill) – Automated external defibrillators: requirement: modifications to existing buildings CMA Position: Support Applies the automated external defibrillator (AED) requirements to certain structures that are constructed prior to January 1, 2017, and subject to subsequent modifications, renovations, or tenant improvements, as specified.

Prohibits a general acute care hospital or an acute psychiatric hospital from requiring a person who voluntarily seeks care to be in custody as a danger to himself or herself or others or gravely disabled as a condition of accepting a transfer of that person after his or her written consent for treatment and transfer is documented or in the absence of evidence of probable cause for detention.

INSURANCE

SB 1152 (Hernandez) – Hospital patient discharge process: homeless patients

SB 1008 (Skinner) – Health insurance: dental services: reporting and disclosures

CMA Position: Oppose Unless Amended

CMA Position: Support

Requires each hospital to include a written homeless patient discharge planning policy and process within the hospital discharge policy.

Among other requirements, the policy shall require a hospital to inquire about a patient’s housing status; to connect the patient with available community resources and supportive services; and to identify a post discharge destination for the patient. Requires a hospital to document specified information before discharging a homeless patient, including that the patient has been offered a meal and weather-appropriate clothing. Requires, commencing on July 1, 2019, a hospital to develop a written plan for coordinating services and referrals for homeless patients with the county behavioral health agency, health care and social service agencies in the region, health care providers, and nonprofit social service providers, as available, to assist with ensuring appropriate homeless patient discharge.

Requires a health care service plan or a health insurer that issues, sells, renews, or offers a health care service plan contract or insurance policy that covers dental services in California to utilize a uniform, specified benefits and coverage disclosure matrix.

Requires the Department of Managed Health Care and the Department of Insurance to develop the uniform benefits and disclosure matrix in consultation with stakeholders and to implement the bill’s provisions relating to the benefits and coverage disclosure matrix through emergency regulations, as specified.

SPRING 2019

SB 910 (Hernandez) – Short-term limited duration health insurance Prohibits a health insurer from issuing, selling, renewing, or offering a short-term limited duration health insurance policy, as defined, for health care coverage in California. Makes conforming changes.

SB 1375 (Hernandez) – Health insurance: small employer groups Amends the definition of “eligible employee” for the purpose of determining whether a business is a “small employer” eligible to purchase group coverage by excluding sole proprietors, partners of a partnership, and the spouses of sole proprietors and partners.

SAN JOAQUIN PHYSICIAN

27

Prohibits employer group health care service plans and employer group health benefit plans from being issued, marketed, or sold to sole proprietorship or partnership without employees through any arrangement, and requires that only individual health care service plans and individual health benefit plans be sold to any entity without employees.

MEDI-CAL AB 1785 (Nazarian) – Medi-Cal eligibility: assets Excludes the principal and interest of a 529 savings plan, as defined, from consideration for purposes of any asset or resources test to determine eligibility for certain Medi-Cal benefits, as specified. Excludes qualified distributions from a 529 savings account from consideration for purposes of any income test to determine eligibility for certain Medi-Cal benefits.

AB 2861 (Salas) – Medi-Cal: telehealth: alcohol and drug use treatment CMA Position: Support Requires, to the extent federal financial participation is available and any necessary federal approvals have been obtained, that a Drug Medi-Cal certified provider receive reimbursement for individual counseling services provided through telehealth by a licensed practitioner of the healing arts or a registered or certified alcohol or other drug counselor, when medically necessary and in accordance with the Medicaid state plan.

SB 849 (Committee on Budget and Fiscal Review) – Medi-Cal Establishes, until January 1, 2026, the Proposition 56 Medi-Cal Physicians and Dentists Loan Repayment Act Program, to be developed by the State Department of Health Care Services to provide loan assistance payments to qualifying, recent graduate physicians and dentists that serve beneficiaries of Medi-Cal and other specified

28

SAN JOAQUIN PHYSICIAN

health care programs as specified. Allows the department to authorize a dental integration pilot program in San Mateo County as a component of the Medi-Cal 2020 demonstration project

SB 1287 (Hernandez) – Medi-Cal: medically necessary services Revises the Medi-Cal definition of “medically necessary” for purposes of an individual under 21 years of age to incorporate federal standards related to Early and Periodic Screening Diagnostic, and Treatment (EPSDT) services and requires the department and its contractors to update any specified materials to ensure the new medical necessity standard for coverage for individuals under 21 years of age is accurately reflected in all materials.

SB 1423 (Hernandez) – Medi-Cal: oral interpretation services Modifies the minimum qualifications that an interpreter is required to possess to provide oral interpretation services to limited Englishproficient (LEP) Medi-Cal beneficiaries enrolled in either a managed care plan or a mental health plan.

MEDICAL CANNABIS AB 710 (Wood) – Cannabidiol Provides that, if specified changes in federal law regarding the controlled substance cannabidiol occurs, a physician, pharmacist, or other authorized healing arts licensee who prescribes, furnishes, or dispenses a product composed of cannabidiol, in accordance with federal law, is deemed to be in compliance with state law governing those acts. Excludes from the Medicinal and Adult-Use Cannabis Regulation and Safety Act (MAUCRSA), any medicinal product composed of cannabidiol approved by the federal Food and Drugs Administration and either classified as a Schedule II-V controlled substance or exempted

by MAUCRSA.

SPRING 2019

AB 1996 (Lackey) – The California Cannabis Research Program

AB 2099 (Gloria) – Mental health: detention and evaluation

Conforms the name of the Cannabis Research Program as the California Marijuana Research Program hosted by the Center for Medicinal Cannabis Research, throughout the code.

Authorizes the program to cultivate cannabis for its use in research, as specified and expands the program to in include the study of naturally occurring constituents of cannabis and synthetic compounds that have effects similar to naturally occurring cannabinoids. Authorizes controlled clinical trials on testing methods for detecting harmful contaminants in cannabis, including mold and bacteria.

CMA Position: Support

MEDICAL RECORDS AB 2088 (Santiago) – Patient records: addenda Requires a health care provider to allow a patient, regardless of their age, who inspects their patient records to provide to the health care provider a written addendum with respect to any item or statement in their records that the patient believes to be incomplete or incorrect.

MENTAL HEALTH AB 1968 (Low) – Mental health: firearms CMA Position: Neutral Prohibits a person who has been taken into custody, assessed, and admitted to a designated facility because he or she is a danger to himself, herself, or others, as a result of a mental health disorder and who was previously taken into custody, assessed, and admitted one or more times within a period of one year preceding the most recent admittance from owning a firearm for the remainder of his or her life, subject to existing notice and hearing procedures.

SPRING 2019

Requires that a facility accepting a person taken into custody and placed in a designated facility for up to 72 hours for evaluation and treatment pursuant to existing law, treat a copy of the application stating the circumstances surrounding the event the same as the original.

AB 2193 (Maienschein) – Maternal mental health CMA Position: Neutral Requires, by July 1, 2019, health care service plans and health insurers to develop a maternal mental health program, as specified. Requires a licensed health care practitioner who provides prenatal or postpartum care for a patient to offer to screen or to appropriately screen a mother for maternal mental health conditions, subject to specified exceptions.

AB 2315 (Quirk-Silva) – Pupil health: mental and behavioral health services: telehealth technology: guidelines CMA Position: Support if Amended Requires the State Department of Education, in consultation with the State Department of Health Care Services and stakeholders, to, on or before July 1, 2020, develop and post guidelines, as specified, for the use of telehealth technology in public schools, to provide mental health and behavioral health services to pupils on school campuses.

AB 2325 (Irwin) – County mental health services: veterans CMA Position: Support Prevents a county from denying an eligible veteran county mental or behavioral health services while the veteran is waiting for a determination of eligibility for, and availability of, mental or behavioral health services provided by the United States Department of Veterans Affairs. Makes specific findings and

SAN JOAQUIN PHYSICIAN

29

declarations about the county’s duty to provide mental and behavioral health services to veterans.

AB 2639 (Berman) – Pupil suicide prevention policies: reviews: updates CMA Position: Support Requires the governing board or body of a local educational agency that serves pupils in grades 7 to 12 to review, at minimum every 5th year, its policy on pupil suicide prevention and, if necessary, update its policy.

AB 3032 (Frazier) – Maternal mental health conditions Requires a general acute care hospital or special hospital that has a perinatal unit to develop and implement, a program as specified, relating to maternal mental health conditions including, but not limited to, postpartum depression.

SB 1004 (Wiener) – Mental Health Services Act: prevention and early intervention CMA Position: Support Requires the Mental Health Services Oversight and Accountability Commission to establish priorities for the use of prevention and early intervention funds and to develop a statewide strategy for monitoring implementation of prevention and early intervention services, as specified. Requires the commission to establish a strategy for technical assistance, support, and evaluation to support the successful implementation of the objectives, metrics, data collection, and reporting strategy. Amends the Mental Health Services Act by requiring a portion of funds in the county plan relating to prevention and early intervention focus on the priorities established by the commission.

Permits a county to include other priorities, as determined through a stakeholder process

30

SAN JOAQUIN PHYSICIAN

SB 1113 (Monning) – Mental health in the workplace: voluntary standards CMA Position: Support Authorizes the Mental Health Services Oversight and Accountability Commission, in consultation with the Labor and Workforce Development Agency, to establish a framework and voluntary standard for mental health in the workplace that serves to reduce mental health stigma, increase public, employee, and employer awareness of the recovery goals of the Mental Health Services Act, and to provide guidance to California’s employer community to put in place strategies and programs, to support the mental health and wellness of employees.

PROFESSIONAL LICENSING AND DISCIPLINE AB 505 (Caballero) – Medical Board of California: adjudication: expert testimony CMA Position: Sponsor Authorizes the administrative law judge to extend the time for the exchange of specified expert witness testimony information with counsel for the other party to be completed, upon a motion based on a showing of good cause, for a period not to exceed 100 calendar days from the current requirement that the exchange of the information to be completed 30 calendar days prior to the commencement date of the hearing or as specified.

SB 1448 (Hill) – Healing arts licensees: probation status: disclosure CMA Position: Oppose Requires, on or after July 2, 2019, the licensing boards for podiatrists, naturopathic doctors, chiropractors, acupuncturists, physicians and surgeons, and osteopaths to provide, before the patient’s first visit, a specified disclosure to a patient or the patient’s representative if the licensee is on probation pursuant to a probationary order made on and after July 1,

SPRING 2019

2019. Also requires the licensing boards to post specified information related to licensees on probation on their website.

and parenting pupils including eight weeks of parental leave.

PUBLIC HEALTH

WORKFORCE & OFFICE SAFETY ISSUES

AB 2370 (Holden) – Lead exposure: child day care facilities: family day care homes

AB 1791 (Waldron) – Physicians and surgeons: continuing education

CMA Position: Support

Requires the Medical Board of California, in determining continuing education requirements, to consider including a course in integrating HIV/AIDS pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) medication maintenance and counseling in primary care settings, especially as it pertains to HIV testing, access to care, counseling, highrisk communities, patient concerns, exposure to HIV/AIDS, and the appropriate care and treatment referrals.

Makes various changes to the California Child Day Care Facilities Act including, but not limited to, requiring, as a condition of licensure, health and safety training in the prevention of lead exposure as a part of the preventive health practices course or courses component and requiring child day care facilities to provide the parent or guardian with written information on the risks and effects of lead exposure, blood lead testing recommendations and requirements, and options for obtaining blood lead testing, as specified. Requires specified child day care centers to have its drinking water tested for lead contamination levels.

AB 2507 (Jones-Sawyer) – County jails: infant and toddler breast milk feeding policy CMA Position: Support Requires, on or before January 1, 2020, a county sheriff or the administrator of a county jail to develop and implement an infant and toddler breast milk feeding policy for lactating inmates detained in or sentenced to a county jail that is based on currently accepted best practices.

REPRODUCTIVE HEALTH AB 2289 (Weber) – Pupil rights: pregnant and parenting pupils CMA Positi0n: Support Codifies federal and state regulations that prohibit an educational institution from applying any rule concerning a pupil’s actual or potential parental, family, or marital status that treats pupils differently on the basis of sex. Establishes accommodations for pregnant

SPRING 2019

AB 1976 (Limón) – Employment: lactation accommodation CMA Position: Sponsor Requires an employer to make reasonable efforts to provide an employee with use of a room or other location, other than a bathroom, for an employee to express breast milk in private. An employer shall be deemed in compliance if: (1) the employer is unable to provide a permanent lactation location because of operational, financial, or space limitations; (2) the temporary lactation location is private and free from intrusion while an employee expresses milk; (3) the temporary lactation location is used only for lactation purposes while an employee expresses milk.; and (4) the temporary lactation location otherwise meets the requirements of state law concerning lactation accommodation.

AB 2009 (Maienschein) – Interscholastic athletic programs: automated external defibrillator CMA Position: Support If a school district or charter school elects to

SAN JOAQUIN PHYSICIAN

31

offer any interscholastic athletic program, require the school district or charter school to: (1) ensure that there is a written emergency action plan in place, and posted as specified, that describes the location and procedures to be followed in the event of sudden cardiac arrest or other medical emergencies related to the athletic program’s activities or events; (2) acquire, commencing July 1, 2019 at least one AED for each school within the school district or the charter school to be available on campus; (3) encourage that the AED or AEDs are available for the purpose of rendering emergency care or treatment, as specified; (4) ensure that the AED or AEDs are available to athletic trainers and coaches and authorized persons at the athletic program’s on campus activities or events; and 5) ensure that the AED or AEDs are maintained and regularly tested, as specified.

AB 2202 (Gray) – U C School of Medicine: San Joaquin Valley Regional Medical Education Endowment Fund CMA Position: Support Creates the University of California San Francisco San Joaquin Valley Regional Medical Education Endowment Fund for the purpose of supporting the annual operating costs for the development, operation, and maintenance of a branch campus of the University of California, San Francisco, School of Medicine in the San Joaquin Valley.

AB 2311 (Arambula) – Medicine: trainees: international medical graduates CMA Position: Support Eliminates the reference to the specific courses in clinical instruction authorized to be offered to the international medical graduate participants in the pre-residency training program at the David Geffen School of Medicine of the University of California, Los Angeles.

32

SAN JOAQUIN PHYSICIAN

SB 1348 (Pan) – Postsecondary education: allied health professional clinical programs: reporting CMA Position: Support As part of the Strong Workforce Program, requires, beginning in 2019 and in each year thereafter, the Office of the California Community Colleges must report, for each community college program that offers a certificate or degree related to allied health professionals, specified information, including the number of students participating in the clinical training and the license number or employer identification number of each clinical training site, delineated by program and occupation, with multiyear implementation for the reporting.

These are just a sampling of the new laws impacting health care in 2018 and beyond.

For a comprehensive list, see “Significant New California Laws of Interest to Physicians for 2019,” at cmadocs.org/new-laws-2019.

Did you know CMA’s online health law library is free to members?

The California Medical Association (CMA) online health law library contains nearly 5,000 pages of up-to-date legal information on a variety of subjects of everyday importance to practicing physicians. One of CMA’s most valuable member benefits, the searchable online library contains all the information available in the California Physician’s Legal Handbook (CPLH), an annual publication from CMA’s Center for Legal Affairs.

CMA members can access the library documents free at cmadocs.org/health-lawlibrary. Nonmembers can purchase documents for $2 per page. CPLH, the complete health law library, is also available for purchase in a multivolume print set or annual online subscription service. To order a copy, visit cplh.org or call (800) 882-1262.

SPRING 2019

SAVE THE DATE

California Medical Association 45th Annual Legislative Advocacy Day Wednesday, April 24, 2019 Sacramento Convention Center | 3rd Floor Ballroom

Put your training into ACTION and visit your legislator!

CMA Legislative Advocacy Webinar Training Thursday, April 4 | 7–8PM Registration is FREE cmadocs.org/events

For more information, please contact Yna Shimabukuro at (916) 444-5532 or yshimabukuro@cmadocs.org.

SPRING 2019

SAN JOAQUIN PHYSICIAN

33

LIVE WITHOUT LIMITS

C

M

Y

CM

MY

CY

CMY

K

DAMERON HOSPITAL’S BARIATRIC WEIGHT LOSS PROGRAM

EXCELLENCE IN WEIGHT LOSS SURGERY

Sign up for a free monthly seminar: 209-944-5550 | Dameronhospital.org 34

SAN JOAQUIN PHYSICIAN

SPRING 2019

The

REMEDY for all your

Financial

NEEDS

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

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

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

209-948-6024

•

www.fccuburt.org Federally insured by the NCUA.

SPRING 2019

SAN JOAQUIN PHYSICIAN

35

K O LO & N E T LIS

By Jo Ann Kirby

IFY TO IDENT G N I N R A RS LE PROVIDE E R A C H CTIMS HEALT CKING VI I F F A R T HUMAN

Health care providers can often be the first responders in identifying a vulnerable victim of human trafficking and a growing awareness in the medical community has the potential to guide critical decision making so that patients receive the care and services they need.

Human trafficking is a public health concern that affects individuals, families and entire communities across generations, according to the U.S. Department of Health and Human Services and it is estimated that most victims will come in contact with health providers at some point.

“I was actually hemorrhaging from being trafficked,” Stockton-born Denise Estrada said of injuries that led her to an emergency room when she was just 13 years old.

An attentive doctor, suspecting that she was a victim of sexual violence, contacted law enforcement.

“If it weren’t for that doctor, I probably never would have received justice,” Estrada said. >>

SPRING 2019

SAN JOAQUIN PHYSICIAN

37

These days, Estrada bravely shares her story with law enforcement and medical professionals as a victim’s advocate.

Earlier this year, she spoke at the San Joaquin County Human Trafficking Task Force’s Second Annual Summit. She explained how an older male relative had been prostituting her at labor camps.

“I think it’s important for health care providers not to be quick to judge,” Estrada, who is an administrative medical professional. “Educating people so that victims can get the services they need is so vital.”

Human trafficking is a form of modern-day slavery. It’s a federal crime that occurs when a trafficker uses force, fraud or coercion to control another person for the purpose of engaging in commercial sex acts or soliciting labor or services against his or her will. Any person under age 18 who performs a commercial sex act is considered a victim of human trafficking,

38

SAN JOAQUIN PHYSICIAN

regardless of whether force, fraud or coercion was present.

California is one of the nation’s top four destination states for trafficking human beings, says state attorney general Xavier Becerra. In 2017 and 2018, the San Joaquin County District Attorney’s Office filled 39 cases involving human trafficking, pimping and pandering. And in 2017, an estimated 1 out of 7 endangered runaways reported to the National Center for Missing and Exploited Children were likely child sex trafficking victims.

Suzanne Schultz, program manager for the San Joaquin County Family Justice Center, said that when the human trafficking task force was first formed four years ago, she realized everyone had a lot to learn.

“We had to get educated ourselves and look at victims through the correct lens,” she said of how it’s important to look at a person arrested for prostitution as a victim rather than a

SPRING 2019

suspect. “It was really a mindset change.”

Recruitment tactics including being propositioned for a job offer or a groomed for a relationship that then traps them into prostitution. Some victims, including Estrada, were lured by family members. Schultz tells the story of one teen victim who first got caught up in human trafficking when she and a friend were approached at a popular mall. A man first scored the teen victim’s phone number and then took his time gaining the victim’s trust and cultivating a relationship before telling her he wanted her to have sex with his friends.

The county task force is doing its part to make as many people as possible aware, reaching out to schools, businesses, churches, and malls where first encounters often occur. Over 60 law enforcement organizations, health care providers, social service agencies and nonprofits have joined the task force.

And now, health providers are learning the red flags that would identify patients as victims of trafficking as well as medical conditions that signal the patient is a victim.

Some red flags include a fearful patient with a companion who does all the talking and refuses to leave the patient unattended.

Health conditions a victim might seek treatment for could include STDs, reproductive injuries, malnutrition, sleep deprivation, and symptoms associated with physical violence such as broken bones, hematomas, cigarette burns or stab wounds.

“Dignity Health as a system has implemented a human trafficking response protocol,” Anitra Williams, director of nursing operations at St. Joseph’s Medical Center in Stockton, said. “There are red flags that we teach and within the first week, we identified a 14-year-old and were able to get her help. This girl was very subordinate and fearful, our security guard was able to identify that as a red flag.”

Williams says she is reaching out to other medical providers to share the protocol. When a patient is identified as a potential trafficking victim at St. Joseph’s, there is a detailed plan of action.

The protocol includes a resource algorithm of numbers for staffers to call including Child Protective Services or Adult Protective Services, law enforcement, the National Human Trafficking Resource Center at 1 (888) 373-7888 and additional resources that include victim’s advocacy agencies.

At Community Medical Centers, a federally qualified health center serving as a safety net provider to support the underinsured, uninsured and Medi-Cal population, Victoria Felt said the next step is ensuring that those on the task force become true partners and collaborators to ensure patients get the long-term services they need.

To that end Schultz at the D.A.’s Office, opened the Family Justice Center in October. It’s billed as a “one-stop shop” where

SPRING 2019

“ W E H A D T O GET EDUCATED OURSELVES AND LOOK AT VICTIMS THROUGH THE CORRECT LENS.” - Suzanne Schultz

SAN JOAQUIN PHYSICIAN

39

victims of crimes such as trafficking or domestic violence can be guided through a dizzying array of services and resources. The renovated space is located on first floor of the old San Joaquin County Courthouse at 222 E. Weber Ave. in Stockton and partners include the Child Abuse Prevention Council, Stockton Police Department, Women’s Center-Youth & Family Services, and even the San Joaquin County Office of Education and Department of Child Support Services.

Identifying victims who could use the support of the Family Justice Center starts with the trusted first responders who might

treating such patients, said one doctor.

“It’s how you approach the patient,” Dr. Benjamin Morrison, chief medical officer of Community Medical Center in Stockton, said. "We don’t want them to feel judged. We want them to feel comfortable sharing information with us. We have to check our bias and our judgment at the door. The worst is when a patient doesn’t want to share information with us and they feel alone. We are really changing culture and awareness.”

Health care providers can open a dialogue with the patient by asking if the patient feels safe while realizing an adult may not be ready to accept help immediately.

This compassionate approach could “ T H E R E A R E R E D F L A G S T H A T W E prompt the victim to open up at a follow-up visit. To a victim, that sort TEACH AND WITHIN THE FIRST of manner can make all the difference.

“From a health care standpoint, it’s very WEEK, WE IDENTIFIED A 14-YEARvital that you turn around and look at the patient. If you are typing into the OLD AND WERE ABLE TO GET HER computer, maybe you don’t notice that the patient isn’t the one answering the HELP.” - Anitra Williams questions,” said Estrada, who was first identified as a victim by a doctor and come in contact with victims. By the time a doctor or other now advocates for victims. She says many people played a part health care provider comes in contact with the victim, they in making sure she received justice but is adamant that had could have severe injuries, signs of a drug addiction and display the doctor not done his due diligence by giving her his full and a certain level of desperation from being prostituted out, Schultz mindful regard, she might not have been saved that day. said.

“As a health care professional, engage and make eye “They don’t want to traffic someone who has STDs or a contact,” Estrada said. “Listen and look.” broken arm,” Schultz said, of the motivation to seek health care.

“Some of these abusers see these victims as subhuman and will For more information on human trafficking or to get involved beat or stab them when they don’t make their quota.” in the countywide task force, please contact Suzanne Shultz at Health care providers should set aside their bias when (209)468-2437 or Suzanne.Schultz@sjcda.org.

According to the Dignity Health protocol, red flags for human trafficking include: · Delayed presentation for medical care · Scripted, memorized or mechanically recited history · Stated age older than appearance · Discrepancy between stated history and clinical presentation · Subordinate, hyper-vigilant or fearful demeanor

40

SAN JOAQUIN PHYSICIAN

· Inability to produce ID · Documents in possession of an accompanying party · Reluctance to speak on one’s own behalf · Companion who insists on speaking for the patient and may refuse to leave

· Evidence of lack of care for previous medical conditions · Evidence of physical violence including torture · Tattoos or other marks that may indicate a claim of ownership by another

SPRING 2019

The National Human Trafficking Resource Center lists health indicators for human trafficking victims that include: · Bruising, burns, cuts or wounds · Blunt force trauma · Fractures · Broken teeth · Signs of torture · Neurological conditions such as

SPRING 2019

traumatic brain injury or migraines · Malnutrition · Dehydration · Sexually transmitted infections · Repeated unwanted pregnancies · Genital trauma

· Retained foreign body · Bruising, burns, cuts or wounds · Substance abuse disorders · Mental health issues

SAN JOAQUIN PHYSICIAN

41

CMA Announces New Statewide Effort to Promote Physician Wellness

BY KATHERINE BOROSKI As the delivery of health care undergoes fundamental shifts and the rate of burnout among physicians continues to rise, physician wellness and professional fulfillment have become hot topics throughout the health care community – and for good reason.

In a recent Medscape survey, nearly two-thirds of U.S. doctors said they felt burned out, depressed or both.

More troubling still, one-third of respondents said such feelings affected their relationships with patients.

Burnout can erode the quality of patient care and decrease patient satisfaction. It can also limit patient access to care, as physicians experiencing burnout often cope by reducing the number of patients they see, reducing their clinical time or leaving the profession entirely.

To help physicians succeed in their life’s work of caring for patients, the California Medical Association (CMA) has made physician wellness and the prevention of burnout a core priority. By advancing initiatives that enhance efficiency, professional satisfaction and the delivery of care, CMA is striving to help physicians navigate and succeed in a continually evolving health care environment.

42

SAN JOAQUIN PHYSICIAN

SPRING 2019

To that end, CMA is working with nationally from local physician commensality groups (to help recognized leaders on physician wellness who bring physicians reconnect with their peers and to find unparalleled academic expertise and hands-on meaning in their work) to tools that help physicians experience to build an organizational initiative to calibrate their well-being, while also linking improve physician fulfillment and well-being. those physicians who have markers of burnout The new initiative is a statewide collaborative to additional resources. Training will be made effort with physician wellness experts from the available to empower physician leaders to build Stanford Medicine WellMD Center: Tait Shanafelt, practice environments that support professional M.D., associate dean, chief wellness officer and fulfillment. The program will also include an annual professor of hematology; and Mickey Trockel, M.D., comprehensive, longitudinal assessment of the project co-leader and clinical associate professor of experiences of California physicians to identify new psychiatry and behavioral sciences. opportunities and measure progress.

Under the leadership of CEO Kathleen Creason, “This project aims to promote wellness for CMA’s Physician Wellness Services will be the most all physicians, deliver specific interventions to comprehensive effort in the country to increase those most at risk for burnout, and provide timely physician wellness as a vehicle to improve “The well-being of the nation’s physicians is a critical the quality of care they provide patients. factor in maintaining access to care and the quality “CMA is extremely proud to work with of our health care system,” - Kathleen Creason Dr. Shanafelt and his team to better combat physician burnout, which occurs from medical interventions to those already in distress,” said Dr. school through active practice,” said CMA President Trockel. “Along with broad focus on promoting wellDavid H. Aizuss, M.D. “This program’s scope, being, this tiered approach also sets the ambitious innovative approach and resources are unmatched goal of preventing physician suicide in California.” in the nation, and it will substantially improve National studies led by Dr. Shanafelt indicate that physician wellness while supporting patient access burnout is more common among physicians than to quality care.”

U.S. workers in other fields. Physician burnout has The program will utilize a population health also been associated with risk for suicide among framework to address systemic contributors to physicians. physician burnout, along with providing tailored “The well-being of the nation’s physicians is a support for physicians at increased risk or critical factor in maintaining access to care and the experiencing specific challenges. In addition to quality of our health care system,” said Creason. creating tools to support changes that the health “The program will help physicians conquer these care system can make to increase physician issues, so they can do what they do best – care for well-being, the program will assist those already patients.” expressing signs of burnout.

For more information on CMA’s Physician “This collaboration will implement a Wellness Services Program, contact Kathleen comprehensive approach to promote the wellness Creason at kcreason@cmadocs.org or of California’s physicians,” said Dr. Shanafelt. “Given (916) 551-2031. the strong links between physician distress and the care they provide patients, we believe improving Katherine Boroski is Senior Director of physician wellness benefits not only physicians, but Communications for the California Medical the patients and communities they serve.”

Association. She can be reached via email at The program will also include offerings that range kboroski@cmadocs.org.

SPRING 2019

SAN JOAQUIN PHYSICIAN

43

Let’s dia-BEAT-this!

Working together to BEAT PreDiabetes

Presented by San Joaquin County Obesity and Chronic Disease Taskforce

FREE CME/CEU!

Saturday, April 13, 2019 8:00 AM - 2:00 PM

Hear from: Flojaune Cofer, PhD, MPH Director of State Policy and Research Public Health Advocates Jay Shubrook, DO Professor in the Pharmacy Care Department Touro University, California.

Kwabena O.M. Adubofour, MD FACP Medical Director, East Main Clinic Primary Care Internal Medicine/ Diabetes Clinic Practice Lakshmi Dhanvanthari, MD Chief Medical Officer Health Plan of San Joaquin

Hilton Stockton 2323 Grand Canal Blvd, Stockton, California 95207

How to register?

Sponsored by:

Click HERE and register online or follow the steps below: 1. Visit www.eventbrite.com 2. Enter “Let’s dia-beat-this” into the “Looking for” field 3. Click “Register” and proceed to checkout

44

In lieu of a conference fee, we kindly ask that you donate two children’s books. These books will be HPSJ’s Little Free Library. By building on the unique relationship between parents and medical providers, this program help families and communities encourage early literacy skills so children enter school prepared for success!

SAN JOAQUIN PHYSICIAN

SPRING 2019

experience of over 125 years in medical practice operations. Our goal is to empower physician practices by providing resources and guidance to improve the success of your practice.

CALIFORNIA MEDICAL ASSOCIATION

Assistance ranges from coaching and education to direct intervention with payors or regulators.

Fresno Madera MedicalPAID? Society TROUBLE GETTING 66th Annual Institute You don’t have toYosemite fight unfairPostgraduate payment practices CMA CAN HELP! March 24 - 26, 2017 I’VE RECOVERED Practice Management: Tip of the Month

CMA members can call on CMA’s practice management experts for one-on-one help with payment, billing and contracting issues. If you answer “yes” to any of the following questions, it might be time to call for help.

alone. CMA can help.

70,000

$

In the past nine years, CMA’s Center for • Are your claims being denied after obtaining prior • Do you have questions about the new law on payment Economic Services has recovered over authorization? from my payors using and billing for out of network services (Assembly Bill 72)?

CMA’s Center for $15.5 million from payors on behalf of Economic Services •CMA Do you members. have questions about Covered California?

• Do you need help with Medicare-related issues?

Members can call on CMA’s practice management experts for free one-on-one help with contracting, billing CMA’s Centerproblems. for Economic Services is staffed and payment Assistance ranges fromby coaching and education to direct intervention with payors • Are your claims not being paid in a timely manner?

• Have you been presented with a managed care management experts with combined orpractice regulators.

CMA has recovered $29a million on behalf of its physician members over the past 10 years. contract and you’re not sure if the terms are experience of over 125 years in medical practice • Are you not being paid according to your contract? consistent with California law? operations.

Our goal isvisit to empower physician For more information, cmadocs.org/tips. practices by providing resources and guidance to •improve Are you receiving untimely requests for refunds or is a • Have you done everything you can to resolve an issue the success of your practice. payor recouping money from your check without

with a payor, but have hit a brick wall?

Assistance ranges coaching andrequest? education to first notifying you infrom writing of a refund Registration is now open direct intervention with payors or regulators.

Call (559) 224-4224 118 for Trouble Getting Paid?

CMA Can ext.

Help!

more information or visit www.FMMS.org Call (800) 786-4262 or email economicservices@cmadocs.org.

Access to CMA’s reimbursement experts is a FREE, members-only benefit. help?

Call 786-4262 or email economicservices@cmanet.org.

CMANeed members can call on (800) CMA’s practice management experts for one-on-one help with payment, billing and contracting issues. If you answer “yes” to any of the following questions, it might be time to call for help.

• Do you have questions about the new law on payment and billing for out of network services (Assembly Bill 72)?

• Are your claims being denied after obtaining prior authorization?

• Do you have questions about Covered California?

• Do you need help with Medicare-related issues?

• Are your claims not being paid in a timely manner?

• Have you been presented with a managed care contract and you’re not sure if the terms are

• Are you not being paid according to your contract?

• Are you receiving untimely requests for refunds or is a payor recouping money from your check without

consistent with California law?

• Have you done everything you can to resolve an issue with a payor, but have hit a brick wall?

first notifying you in writing of a refund request?

Access to CMA’s reimbursement experts is a FREE, members-only benefit.

Need help? Call (800) 786-4262 or email economicservices@cmanet.org.

62 SAN2019 JOAQUIN PHYSICIAN SPRING

SPRING 2018 SAN JOAQUIN PHYSICIAN 45

Healthcare industry takes on high physician suicide rates, mental health stigma

By Maria Castellucci - Reprinted from Modern Healthcare

Dr. Michael Weinstein, a trauma surgeon at Jefferson Health in Philadelphia, has suffered from depression for much of his life. Although he has received treatment throughout his two-decade career, Weinstein never discussed it with his colleagues, fearful they would perceive him as weak. “It was something I hid because of the associated stigma and also lack of awareness that many people in the profession would potentially be having similar types of issues,� he said.

Then, in 2016, it got worse. Seemingly out of nowhere, he fell into a deep depression. It was so bad, he began to contemplate suicide. His wife forced Weinstein to see his primary-care physician, who convinced him to take a leave from work and admit himself to a psychiatric facility, where he underwent electroconvulsive therapy. >>

46

SAN JOAQUIN PHYSICIAN

SPRING 2019

“I needed someone to tell me to stop working. It was the fear of telling people I couldn’t do this anymore, it felt like a sign of weakness or my own failing,” Weinstein said.

The fear he felt to discuss and seek help for his suicidal thoughts is believed to be common among physicians and the major reason why experts believe doctors experience higher rates of suicide than the general population. Questions on medical licensure applications about past and current mental health conditions discourage physicians from seeking help out of fear they’ll lose their jobs. Additionally, a pervasive culture ingrained since medical school—where physicians are told to be strong and put the health of their patients before themselves—only adds to the pressure.

“There is almost this macho culture that you might find in law enforcement and the military that physicians can relate to—that you have to tough it out,” said Dr. Christine Moutier, chief medical officer at the American Foundation for Suicide Prevention who has written extensively about physician suicide.

Physician suicide has been a problem in healthcare for decades. Studies dating back to the 1920s show that physicians suffer from suicide at high rates. Physicians with mental health conditions have long been discriminated against and suicides have often been kept hidden from colleagues and the public.

The difference in the past few years is that the industry is responding. Recent concerns around burnout have pushed organizations to rethink how they approach physician well-being, which has led to more action around how to deal with physician mental health concerns and suicide.

“I think burnout has opened the door to deal with the entire portfolio of psychological problems with clinicians,” said Dr. Thomas Nasca, CEO of the Accreditation Council for Graduate Medical Education. “It has made it acceptable to have these discussions. It’s a real opportunity for us to begin to fix these problems.”

Incomplete data

How many physicians actually die by suicide every year is not known.

The American Foundation for Suicide Prevention has stopped using the commonly cited statistic that 300 to 400 doctors commit suicide each year. “We have taken it off our website,” Moutier said. “It’s not a literal number and we don’t have a way to capture it with that level of granularity.”

The uncertainty about the suicide rate isn’t unique to physicians. The death investigation system in the U.S. doesn’t have a uniform reporting system. Coroners, who are elected county officials, aren’t required to have medical training or report the occupation of the deceased.

And how the suicide occurs makes a difference in how it’s reported, said Dr. Michael Myers, a professor of clinical psychiatry at SUNY-Downtown Medical Center in New York who has studied physician suicide.

If the suicide is public, such as when a doctor jumps to his death, it’s more likely to be reported as such. But if it occurs in a hospital setting or at home, administrators or family members can influence how the death is categorized.

Myers recalls when a classmate suddenly died during his medical school training in 1962.

“When we lost Bill, no one from the dean’s office spoke to us. The family shut down. No one talked about it.”

SPRING 2019

TEN FACTS ABOUT PHYSICIAN SUICIDE AND MENTAL HEALTH 1. Suicide is generally caused by the convergence of multiple risk factors, the most common being untreated or inadequately managed mental health conditions.

2. An estimated 300 physicians die by suicide in the U.S. per year.1 3. In cases where physicians died by suicide, depression is found to be a significant risk factor leading to their death at approximately the same rate as among nonphysician suicide deaths; but physicians who took their lives were less likely to be receiving mental health treatment compared with non-physicians who took their lives. 2 4. The suicide rate among male physicians is 1.41x higher than the general male population. And among female physicians the relative risk is even more pronounced — 2.27x greater than the general female population. 3 5. Suicide is the second leading cause of death in the 24-34 age range (accidents are the first).4

SAN JOAQUIN PHYSICIAN

47

Even with the dodgy data, studies that have been conducted overwhelmingly show physicians die by suicide at a higher rate than the general population. A recent review of studies published in the past decade found the rate of physician suicide was between 28 and 40 per 100,000 compared with the overall rate in the general population of 12.3 per 100,000. “In almost every one of the studies, physicians come out with a higher suicide rate than the general population, that we can say with a high degree of certainty,” Moutier said.

The issues with the data make it impossible to know if the suicide rate is getting better or worse.

But Nasca at the ACGME doesn’t think that matters. He’s asked rooms full of physicians to raise their hands if they haven’t had a colleague commit suicide. Rarely anyone does. “It’s overpowering when you do that,” Nasca said.

“Publicly shamed” A major deterrent to physicians seeking mental health services is fear they will lose their medical license.

In 2013, 43 states asked questions about mental health conditions on medical licensing applications for physicians seeking a license for the first time. States were also more likely to ask about past mental health conditions than questions about past physical disorders.

Disclosing a mental health issue can have humiliating consequences.

The Medical Licensing Board of Indiana put Dr. Adam Hill on probation for two years after he voluntarily reported a relapse during a recovery program for substance abuse. Hill said he felt “publicly shamed” by the experience. His medical liability insurance also skyrocketed.

A palliative-care physician at Riley Hospital for Children at IU Health in Indianapolis, Hill has recently been open about his issues with depression and alcoholism. And he admits he’s had suicidal thoughts.

“There are all these bureaucratic checkpoints that stigmatize the individual, they make you fearful to step forward,” he said. “We tie people’s paychecks and their livelihood to whether or not they have these red flags in their own medical chart, which is openly discriminatory.”

But there are movements to address the problem.

Earlier this year, the Federation of State Medical Boards issued recommendations that boards remove questions on applications that

48

SAN JOAQUIN PHYSICIAN

ask about past or current mental health conditions.

And for state boards insistent about asking mental health questions, the FSMB recommended boards phrase it more generally to “any condition” the physician currently isn’t treating that could impair their ability to practice. In following this recommendation, a physician wouldn’t have to disclose a mental health condition they are seeking help for.

But FSMB CEO Dr. Humayun Chaudhry readily points out these are just recommendations. They can’t force a state medical board to follow them. “Our preference would be that they don’t ask the question at all,” he said.

“We don’t want the licensing process, which is there to protect the public, to add to the stigma that doctors seem to have about seeking care. That is not the purpose of the state boards. It’s to protect the public but to do so in a manner that is sensible and reasonable and is ultimately going to help everyone,” he added.

Some state boards have opted not to ask any questions about mental health. North Carolina recently removed any questions about mental health conditions from its medical licensing renewal application.

Instead, a statement has been added advising physicians to seek treatment for conditions that might affect patient care. The board is in the process of adding it to first-time applications as well.

Also, like 45 other states, North Carolina has a health program that allows physicians to receive mental health treatment anonymously.

When the mental health question was still on the application, physicians who were seeking treatment through that program didn’t have to disclose it to the board.

“If people have a safe place to go where their license won’t be in potential jeopardy, they will take that step forward and ask for help and that’s evidenced by the fact that 45% of our participants are anonymous to the board,” said Joseph Jordan, CEO of the North Carolina Physicians Health Program.

Normalizing mental health disorders Medical license applications are just one piece of the puzzle to attack the stigma around mental health disorders in the profession.

Physicians still struggle to talk openly about depression and other behavioral health conditions with their colleagues because of fear they’ll be judged. But there are anecdotes that show such fears might be misplaced.

When Weinstein returned to Jefferson Health after a six-month leave of absence, he decided he’d be honest about where he’d been before rumors could swirl. After years of hiding his depression from colleagues, they embraced his story. Weinstein received emails from

SPRING 2019

co-workers talking about their own experiences or of those they knew who suffered from mental illness or committed suicide.

“The more we openly discuss these issues and write about them and tell people’s stories, I think more people will be able to get high-quality psychiatric mental healthcare,” he said.

“We need to support one another. I know firsthand what the depressed brain is like … but no matter what you have gone through, there is a light and there are so many reasons to appreciate being alive.”

Some institutions are trying to normalize the prevalence of mental health conditions among its physician workforce.

When residents arrive at Mayo Clinic they are immediately told about the issue of mental health in the profession and why physicians might be reluctant to seek care. Residents are then informed about confidential counseling services available.

Mayo has offered counseling services to its staff for over 20 years, but they weren’t actively promoted until about two years ago, said Dr. Sandra Rackley, medical director of trainee wellbeing at Mayo.

“Most physicians wait until they are in a crisis when they reach out for help,” she said.

Mayo’s efforts are in line with the ACGME’s update last year to its common program requirements that call for residency programs to provide residents with “immediate access at all times to a mental health professional.”

“We have ensured there is infrastructure within all institutions (accredited for residency programs) to provide support to begin to address this issue,” Nasca said.

The Association of American Medical Colleges, which represents all U.S. allopathic medical schools, is also encouraging schools to offer and promote mental health services for students and faculty. Some schools are even breaking their classes up into smaller groups so the students can forge closer bonds with faculty and each other.

“I think that sense of community support is very valuable,” AAMC CEO Dr. Darrell Kirch said.

Hill at Riley Hospital said the growth of physician wellness programs and increased access to mental health resources are all good signs, but he emphasizes they aren’t enough.

“We really have to work on these licensing and insurance issues if we are really going to effect change,” he said. “It has to involve all of that, not just normalizing the conversation.”

6. The prevalence of depression among residents is higher than in similarly aged individuals in the general U.S. population — 28 percent of residents experience a major depressive episode during training versus the general population rate of 7-8 percent. 5 7. Among physicians, risk for suicide increases when mental health conditions go unaddressed and when selfmedication occurs as a way to address anxiety, insomnia, or other distressing symptoms.

Although self-medicating may reduce some symptoms, the underlying health problem is not effectively treated and this can lead to a tragic outcome.

8. In one prospective study, 23 percent of interns had suicidal thoughts, but among those interns who completed four sessions of web-based Cognitive Behavior Therapy nearly 50 percent fewer had suicidal ideation.6 9. Drivers of burnout include work load, work inefficiency,

SOURCES

1.Center, C., Davis, M., Detre, T., Ford, D. E., Hansbrough, W., Hendin, H., Laszlo, J., Litts, D.A., Mann, J., Mansky, P.A., Michels, R., Miles, S.H., Proujansky, R., Reynolds, C.F. 3rd, Silverman, M. M. (2003). Confronting Depression and Suicide in Physicians. JAMA, 289(23), 3161. doi:10.1001/jama.289.23.3161

lack of autonomy and meaning in work, and workhome conflict.

2.Gold, K. J., Sen, A., & Schwenk, T. L. (2013). Details on suicide among US physicians: Data from the National Violent Death Reporting System.

General Hospital Psychiatry, 35(1), 45-49. doi:10.1016/j.genhosppsych.2012.08.005 3. Schernhammer, E. S., & Colditz, G. A. (2004). Suicide Rates Among Physicians: A Quantitative and Gender Assessment (Meta-Analysis).

American Journal of Psychiatry AJP, 161(12), 2295-2302. doi:10.1176/appi.ajp.161.12.2295 4. CDC National Center for Injury Prevention and Control. (2015). 10 Leading Causes of Death by Age Group, United States - 2014 Retrieved from http://www.cdc.gov/injury/images/lc-charts/leading _causes_of _death_age_ group_2014_1050w760h.gif 5. Mata, D. A., Ramos, M. A., Bansal, N., Khan, R., Guille, C., Angelantonio, E. D., & Sen, S. (2015). Prevalence of Depression and Depressive Symptoms among Resident Physicians. JAMA, 314(22), 2373. doi:10.1001/jama.2015.15845 6. Guille, C., Zhao, Z., Krystal, J., Nichols, B., Brady, K., & Sen, S. (2015). Web-Based Cognitive Behavioral Therapy Intervention for the Prevention of Suicidal Ideation in Medical Interns. JAMA Psychiatry, 72(12), 1192. doi:10.1001/jamapsychiatry.2015.1880

10. Unaddressed mental health conditions are, in the long run, more likely to negatively impact one’s professional reputation and practice than reaching out for help early.

afsp.org SPRING 2019

SAN JOAQUIN PHYSICIAN

49

In The News

IN THE

NEWS

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

“Champion of Quality,” a physician who continuously pursues quality improvement through innovation.

This year’s awardees are James Morrissey, M.D. for Physician Champion of Community and Philip Cheng, M.D. for Physician Champion of Quality.

Dr. James Morrissey is one of the most experienced and skilled cardiothoracic surgeons in the nation, who has dedicated his career to delivering high quality care to the people of Stockton and San Joaquin County. He founded and has sustained the cardiac surgery program at St. Joseph’s Medical Center and has led the program in delivering nationally Philip Cheng, M.D. and James Morrissey, M.D. recognized high-quality care to the community for over 40 years.

St. Joseph’s Recognizes James Morrissey, Dr. Philip Cheng is a M.D. and Philip Cheng, M.D. as Physician neonatologist who has been instrumental in bringing the Champions most up-to-date technology and treatment protocols to the Each year St. Joseph’s medical staff physicians are called upon Neonatal Intensive Care Unit at St. Joseph’s Medical Center. to nominate their deserving peers to be recognized as part Also, as the Chair of the Pediatrics Department at St. Joseph’s, of St. Joseph’s Medical Center’s annual Physician Champion Dr. Cheng routinely goes above and beyond to help those Awards. The awards recognize a “Champion of Community,” in need, always available for consultations and to perform described as a physician who has demonstrated a commitment procedures when called upon by colleagues. to improving the health status of the community, and a

50

SAN JOAQUIN PHYSICIAN

SPRING 2019

St. Joseph’s Awards $250K in Community Grants St. Joseph’s Medical Center has awarded over $250,000 in grant funding to five local community benefit organizations in partnership with other local agencies seeking to build healthier communities by improving health and living conditions.

The Asian Pacific Self-development & Residential Association (APSARA) in partnership with Catholic Charities and Community Partnership for Families was awarded $70,892 for the Community Health Connectors project.

The presence of Community Health Connectors (CHC’s) will provide access to resources, increase opportunities for health education and provide case management for those with multiple chronic health conditions.

The Emergency Food Bank in partnership with Family Resource & Referral Center, First 5 of San Joaquin & University of California, Cal Fresh Nutrition Education received $50,000 for Child Care Mobile Farmer’s Market project. This project will deliver fresh fruits and vegetables free of charge to 15 child care facilities within Stockton to be used for meals and snacks.

Read to Me, Stockton in partnership with Books for Babes, Stockton Unified School District & S. J. County Office of Education received a grant for $20,000 for the Early Infant Literacy Project. Working with partners they will enroll 800 newborns and toddlers to age three in Dolly Parton’s Imagination Library, providing approximately 10,000 books to children for one year with the goal of introducing them and their parents to early literacy activities.

Reinvent South Stockton California in partnership with Reinvent South Stockton Coalition, San Joaquin County Public Health, and Trustbuilder Organization received a grant for $90,000 for the Families Connect Project. Local residents will be hired to help connect with residents in South Stockton and Midtown Magnolia neighborhoods. They will plan events, engage in community outreach, and refer families to case management services in order to reduce stresses and trauma, allow for attendance and success at work and school and to feel connected to their community and have a support system of care.

San Joaquin County Child Abuse Prevention Council in partnership with San Joaquin Public Health & San Joaquin General Hospital received a grant for $22,424 for the ACEing Parenting Program. The ACEing Parenting Program is intended to gauge the efficacy of a strategy where physicians engage the parents of their minor patients in a discussion about Adverse Childhood Experiences, with the goal of mitigating the circle of abuse.

SPRING 2019

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 $3.4 million in grant funding to deserving nonprofit community benefit organizations with an interest in building healthier communities by improving health and living conditions. St. Joseph’s Medical Center annually sets aside revenues from operations to fund the community grant awards.

St. Joseph’s Expands Graduate Medical Education Program A new generation of doctors are being ushered into the Central Valley, thanks to the Graduate Medical Education Program at St. Joseph’s Medical Center. The first two residency programs, emergency medicine and family medicine, welcomed 15 residents last summer, with additional residents training in internal medicine and obstetrics-gynecology, slated to begin in July 2019.

Altogether, St. Joseph’s has plans to launch 12 residency programs over the next five to seven years, training physicians in the following fields: anesthesiology, emergency medicine, family medicine, general surgery, internal medicine, interventional radiology, obstetrics-gynecology, orthopedic surgery, psychiatry, thoracic surgery, transitional year (required to qualify for many specialties), and urology.

When the program is fully implemented, a total of 184 new doctors will train at St. Joseph’s yearly, making it one of the largest and most complex graduate medical education programs in Northern California.

In addition to training new physicians, residency programs greatly benefit local communities. Studies show that as many as half of all residents go on to practice within 50 miles of where they trained. That staying power is crucial for the Central Valley, where both primary care physicians and specialists are in chronically short supply.

Along with retaining doctors at the start of their careers, residency programs attract already established physicians, who are eager to train residents in the latest technologies and treatments. Research also shows that teaching hospitals have significantly better patient outcomes.

CB Merchant Services Awards Grants to Local Nonprofits C B Merchant Services (CBMS) is pleased to announce grants totaling $108,000 were made to 38 nonprofit organizations

SAN JOAQUIN PHYSICIAN

51

In The News

IN THE

NEWS located in San Joaquin, Stanislaus and Calaveras Counties in 2018. In addition, CBMS annually sponsors a $2000 competitive essay scholarship opportunity, administered by the CAC Educational Scholarship Foundation (cacesf.org), which is open to all graduating high school seniors in California. Funds awarded may be used to attend any accredited public or private college, university or trade school.

“Me and My Baby” Perinatal Program – Now available for HPSJ pregnant members Health Plan of San Joaquin (HPSJ) continues to identify opportunities to assist patients in meeting their health care needs by improving the health plan’s programs.

Each year in the United States, approximately 700 women die because of pregnancy-related complications. But, looking at the leading causes of pregnancy-related deaths, 59% are preventable!

Recently, Health Plan of San Joaquin worked with the Advisory Board to look at HPSJ’s prenatal program and high-risk pregnancies. They wanted to identify areas to improve within the program, to meet local community needs.

As a result of working with the Advisory Board, HPSJ has organized a Perinatal Program, “Me and My Baby,” which they now offer to their pregnant members.

HPSJ knows a healthy pregnancy is a vital component in promoting healthy birth outcomes (HBO) and overall maternal health. Poor-to-no access to prenatal care increases the likelihood of low birth weights (LBW), pre-term births, and the risk for maternal complications leading to a longer hospital length of stay (LOS). The average hospital LOS of pre-term births is eight times longer as compared to full-term newborns.

HPSJ’s “Me and My Baby” Program deploys a revamped

52

SAN JOAQUIN PHYSICIAN

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

care management identification program for HPSJ’s high-risk pregnant members. This combines timely, knowledgeable, warmly offered communication and support during prenatal and postpartum periods. In the “Me and My Baby” Tool Kit HPSJ offers: • Population identification • Risk stratification • Health education • Mental health screening • Community resources • Care coordination by dedicated, experienced staff.

To refer any pregnant HPSJ member to this program, please call 888.315.7526, or go online to HPSJ.com/prenatal.

You also can make a referral through the secure DRE Provider Portal under “search patients,” then click “Referral.”

DPP (Diabetes Prevention Program) has arrived Health Plan of San Joaquin working with local provider and community partners The Diabetes Prevention Program (DPP) is a year-long, evidence-based lifestyle change program. It is taught by peer coaches and designed to prevent or delay the onset of type 2 diabetes among individuals diagnosed with prediabetes.

This program was established by the Centers for Disease Control and Prevention (CDC). They have created national standards and guidelines, known as the Diabetes Prevention Recognition Program (DPRP), to ensure consistency, continuity, and efficacy of program delivery.

Beginning January 1, 2019, all Managed Care Plans (MCP) were mandated to cover the DPP benefit and make it available to eligible members. MCPs must comply with requirements for the DPP benefit as the California Department of Health

SPRING 2019

Care Services (DHCS) All Policy Letter (APL) describes – •D PP providers must comply with the most current CDC DPRP guidelines and obtain pending, preliminary, or full CDC recognition.

• S essions must be taught by peer coaches (these may be a physician, non-physician practitioner, or an unlicensed person who is trained to deliver the curriculum).

•M embers must meet current eligibility requirements to qualify for the DPP benefit.

•C lasses can be delivered: in-person, via distance (remote) learning, online, or in a combination of these methods.

Health Plan of San Joaquin (HPSJ) is working with local, qualified providers to deliver in-person classes in San Joaquin and Stanislaus counties. We also are vetting online offerings to make the DPP program available to as many of our members as possible. HPSJ is collaborating with community partners to build much more local capacity for a robust in-person list of offerings.

For additional information, please contact HPSJ’s Care Management team, at 209.942.6352.

For the Behavioral Health of your HPSJ patients Reminder from Health Plan of San Joaquin Beacon Health Options is the behavioral health (BH) partner of Health Plan of San Joaquin. Beacon Health Options is available to:

SPRING 2019

• S creen and help connect your patients to appropriate mental health services •A ccess Beacon’s PCP decision support service No PCP referral and no prior authorization are required.

Connection to Mental Health Services is as easy as: 1. HPSJ Provider calls Beacon for referral 2. Provider can refer directly to Mental Health Provider 3. HPSJ Member can call Beacon directly Beacon can screen members to determine the severity of their symptoms and refer those with severe impairments to their county Mental Health Plan and those with a mild-to-moderate behavioral health condition to HPSJ’s network of behavioral health professionals.

Simply call Beacon 888.581.7526 PCP Decision Support Services with a Beacon Psychiatrist Beacon offers telephonic doctor-to-doctor clinical decision support with a licensed psychiatrist. This curbside consult can help with concerns and/or questions about prescribing psychotropic medications to the member.

Call Beacon or fax a Beacon PCP Referral form. The referral form can be accessed through the PCP toolkit online at pcptoolkit.beaconhealthoptions.com.

Identify that you are a Health Plan of San Joaquin PCP requesting a telephonic consultation with a Beacon psychiatrist.

Identify the best date and time for the consultation and the best number where a psychiatrist can reach you.

SAN JOAQUIN PHYSICIAN

53

In The News

IN THE

NEWS Careers at Health Plan of San Joaquin – They are Hiring For two decades, Health Plan of San Joaquin (HPSJ) has been linked to the health of our community. HPSJ is a public, not-for-profit Medi-Cal plan serving both San Joaquin and Stanislaus counties – in the heart of the Delta Region and Central Valley Wine Country. HPSJ has competitive pay and benefits, including excellent health insurance and retirement plans. They also offer career development opportunities like HPSJ University and tuition reimbursement programs. A range of exciting new opportunities has been added to their website’s Careers section, where there also is a link to join their TALENT NETWORK.

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

Officer Jackie Verkuyl (hired in 2003), Chief Credit Officer Janet Jenkins (hired in 1983), and Chief Lending Officer Paul Haley (hired in 2011).

Over the years, Dana Bockstahler has filled many roles at BAC Community Bank, from chief financial officer to operations administrator. “She served as chief operating officer for the past 15 years, and as such managed the Bank’s daily affairs,” said Trezza. “This enabled me to work extensively in the field with customers and prospects.”

Bockstahler’s appointment as CEO is a natural progression in her responsibilities at BAC Community Bank.

“I look forward to building upon the strong community relationships and financial foundation Bill developed over the years,” said Bockstahler.

“Bill has been an integral part of BAC Community Bank for the past 37 years. It is difficult to put all of his accomplishments into words,” Ron Berberian, the Bank’s chairman and president stated. “And through most of those

Trezza Retires, Bockstahler Steps into New Role William R. (Bill) Trezza, Chief Executive Officer of BAC Community Bank, retires after 37 years of visionary leadership, cultivating We don’t get paid relationships, developing staff, and ongoing until get pai p paid... d... community support. Bill has led BAC Community Bank through growth and development while HIPAA-compliant creating an executive Low rates team to lead for years to come. This executive Fast recovery team consists of successor Chief Executive Officer Ethical collections Dana Bockstahler (hired in 1987), Chief Financial

YOU Y YO U

54

SAN JOAQUIN PHYSICIAN

CALL NOW TO GET STARTED!

800-399-2400 WWW.CBMERCHANTSERVICES.COM

SPRING 2019

years, Dana Bockstahler and the rest of our executive team have worked hand-in-hand with Bill making the Bank what it is today.” Berberian added, “So that there is no impact to customers, preparations for a seamless transition have been in the works for quite some time.” Bill remains an active member of the Bank’s board of directors and continues to work with several local community organizations into his retirement.

Save the Date for San Joaquin General Hospital’s Annual Research Day June 28th San Joaquin General Hospital will be conducting its second annual Research Day on June 28th. This medical symposium is an event organized through the Hospital’s Department of Surgical Residency and includes all medical educational departments throughout San Joaquin General’s Hospital and Clinics.

The Hospital is welcoming the entire medical community of San Joaquin County to San Joaquin General Hospital’s diversified medical campus. This annual event showcases the Hospital’s medical faculties, its on-staff medical residents and will feature nationally respected guest speakers presenting exciting research and advancements.

There will also be presentations by several SJGH medical residents regarding medical science, innovation and medical research.

The event is being hosted by Dinesh Vyas, MD, Director of the General Surgery Residency Program at San Joaquin General Hospital in conjunction with Sheela Kapre, MD, SJGH Chief Medical Officer.

The presentations begin at 8 AM and carry through Noon on

SPRING 2019

Friday June 28th. Four hours of accredited CME will be available to attendees and lunch will be served. For more information, as well as to RSVP, please contact Jessica Kolatch, SJGH Department of Surgery Graduate Medical Education (209) 468-6622.

ARE YOU READING CPR? CPR contains the latest practice management news, and tips on reimbursement and contracting related issues.

SUBSCRIBE NOW Sign up now for a free subscription at www.cmadocs.org/subscribe

SAN JOAQUIN PHYSICIAN

55

practice manager Free to SJMS/CMA Members!

resources

The Office Manager’s Forum empowers physicians and their medical staff with valuable tools via expert led educational sessions from industry professionals who are committed to delivering quality health care.

For more than 130 years, the San Joaquin Medical Society (SJMS) has been at the forefront of current medicine, providing its physician’s and their staff with assistance and valuable practice resources. SJMS is proud to offer the Office Manager’s Forum, a monthly educational seminar designed to enhance the healthcare environment with professional development opportunities while providing solutions to some of the challenges that come from managing a practice.

Attendees gain knowledge on a broad array of topics related to the field of medical staff services, office management, billing and coding, human resources, accounting and back office support.

The Office Manager’s Forum is held on the second Wednesday of each month from 11:00AM – 1:00PM at Papapavlo’s in Stockton and includes a complimentary lunch. Attendance is always FREE to our members. Non-members are welcome and may attend for one month at no cost to experience one of the quality benefits that comes with Society Membership ($35.00 thereafter). Registration required.

For more information or to be added to the mailing list email Jessica Peluso, SJMS Membership Coordinator, at Jessica@SJCMS.org or call (209) 952-5299.

MARCH 13TH, 2019:

APRIL 10TH, 2019:

“BEST PRACTICES FOR CONTRACTINGSTRATEGIES”

“PREVENTION OF BULLYING IN THE WORKPLACE”

11:00AM TO 1:00PM

11:00AM TO 1:00PM

This presentation provides best practice strategies and

• Definition of bullying in the law

valuable resources to consider when contemplating

• Prevalence of bullying & statistics about who bullies

a new contract, contract renegotiation or developing

and how frequently

a strategy for future payor negotiations. Developing

• Negative impacts of bullying in the workplace

a strong contracting strategy can optimize the

• California’s “abusive conduct” training requirement

outcomes when presenting your “Business Case” to

• Preventing bullying

the payor and help avoid the quick “not interested”

• Investigating bullying (or other types of complaints) –

payor response.

steps to take and best practices

Topics covered:

~Velma Lim has 31 years of

• CMA’s contracting resources: toolkits, legal

experience representing private

resources, health plan details, template letters and

and public employers in state

worksheets

and federal courts. She provides

• Strategies when creating the best “Business Case”

counseling and legal advice to

for your practice

employers concerning personnel

• Post negotiation organization of your contracts from

policies, disciplinary and

paper to scanned on-line references

termination issues, avoiding and addressing claims of wrongful

Bring your contracting questions and be prepared

termination, discrimination, harassment, retaliation,

to delve into developing the best strategy for your

and compliance with other employment laws. She

practice’s contracting future.

has written many articles and presented numerous seminars for employment attorneys, businesses, and

~Kristine Marck, Associate

HR professionals.

Director in CMA’s Center for Economic Services.

~Jamie Bossuat practices employment litigation

After over 25 years in the health/

which includes a wide range of matters including

managed care industry, she

sexual harassment, disability discrimination and

has a balance of working for

accommodation, age and sex discrimination,

and with physicians and a

pregnancy and medical leave, wage claims, and

drive to assist them in these

whistleblower retaliation.

difficult times. Her extensive experience offers her a unique perspective and a number of encounters to draw from. Her distilled skills focus her advocacy in the areas on managed care contracting, Medi-Cal stakeholder activities and liaison work with varied health plans, IPAs and Medical Groups.

MAY 8TH, 2019:

11:00AM TO 1:00PM

“TBD”

Public Health

Update

Integrating Medical and Dental:

Preventive Measures for Pregnant Women and Children

BY KATELYNN PEIRCE, MPH, CHES AND KISMET BALDWIN, MD

Across the nation, there has been a growing recognition that oral health is an integral part of overall health. The health effects of poor oral hygiene are far reaching; associations between poor oral health and strokes, cardiovascular disease, respiratory disease, and diabetes have been documented 1-3.

Preterm birth and low birth weight have also been associated with poor maternal oral health during pregnancy. For too long, oral health care, especially for children, has been viewed as outside of the purview of mainstream healthcare, and together with education and prevention services, have had few resources dedicated to this end. There is a lack of dental providers in San Joaquin County, especially those who accept Medi-Cal beneficiaries and those who will see children under five years of age. Medical providers are in a position to fill some of this gap. While the oral health of everyone who lives in San Joaquin County is a priority, a major focus has been placed on preventative care for children and pregnant women. Medical providers are uniquely poised to deliver reimbursable in-office oral health education and referral services for pregnant women and preventive services for children4.

Childhood caries is a preventable chronic condition that has become so common that it is perceived as a normal part of development. Childhood caries contributes to premature loss of the deciduous teeth and can damage the permanent

58

SAN JOAQUIN PHYSICIAN

teeth that have not yet erupted from the gums5. Children often see their doctor many times before they see a dentist for the first time. Doctors can initiate discussions with parents about oral health, good nutrition, and the use of preventive measures, like fluoride varnish and regular oral hygiene.

When considering the oral health of children, it is important to understand that maternal oral health is linked to that of their child; therefore, maternal oral health care should be an integral part of prenatal health care. Preventing early childhood caries starts in utero, when mothers begin adopting healthier habits. Gum and periodontal conditions are often exacerbated during pregnancy and those with untreated decay are at risk of spreading the bacteria to their newborn baby6. Unfortunately, few women in San Joaquin County receive dental care during pregnancy. From 20152016, only 29% of women who had a live birth reported having a dental visit during their pregnancy, a significantly lower percentage than the State average (43%)7. Patients should be advised that preventive dental services, like cleanings and exams are safe during all trimesters, but radiography and restorative treatment should be delayed until after the first trimester8. Dental services during the third trimester are also safe, but may be uncomfortable for the mother.

SPRING 2019

Protective Factors for Medical Provider Consideration

Integrating oral health practices into the medical setting is considered a best practice for improving the oral health of the community. Below are some key strategies to consider:

For pregnant women:

• Provide nutrition counseling for pregnant women and their teeth. Incorporating whole foods, like fresh fruit and vegetables are especially important during this time.

• A dvise expecting mothers to visit the dentist regularly during pregnancy and reassure the family that most dental services are safe during this time.

For children:

• Advise parents to schedule their child’s first dental visit after the first tooth has erupted and before their first birthday.

• A pply fluoride varnish at least twice a year or prescribe fluoride supplements for children up to age 6. Fluoride varnish can be applied in the medical office and is considered a best-practice for reducing the risk of caries among children under six years of age9.

• C onduct oral health screenings as part of well-child exams. Children with lesions or obvious dental decay should be referred to a dental professional for further treatment.

• E ncourage parents to find a dental home for their child.

Establishing a regular source of dental care is the most important way to create peace of mind for the parent and child.

SPRING 2019

In 2018, San Joaquin County Public Health Services joined together with First 5 San Joaquin and the SJ TEETH Collaborative to develop a 5-year strategic plan for oral health. It provides a comprehensive blueprint for the coordination and delivery of oral health prevention and treatment services to vulnerable and underserved residents throughout the County. The SJ TEETH Collaborative, a group of over 40 agencies organizations that have come together to improve oral health within the county, will provide leadership and guidance to assure that the strategic plan is implemented.

SJ TEETH’s First 5 San Joaquin is offering Continuing Education hours to medical providers to increase their knowledge and practice of oral health in the medical setting. Providers who complete the online courses are also eligible to receive a small stipend for their time. For more information on accessing the stipend program, go to http://www.sjckids.org/FundingOpportunities. For information on the SJ TEETH program, call First 5 at 209-953-5437 or visit our website at www.SJTEETH.org.

References Scannapieco, F.A., Papadonatos, G.D., & Dunford, R.G. (1996). Associations between oral conditions and respiratory disease in a national sample survey population. Annals of Periodontology, 3(1), 251-256.

Lamster, I.B., Lalla, E., Borgnakke, W.S., & Taylor, G.W. (2008). The relationship between oral health and diabetes mellitus. The Journal of the American Dental Association, 139, 19S-24S. DeStefano, F., Anda, R.F., Kahn, H.S., Williamson, D.F., & Russell, C.M. (1993). Dental disease and risk of coronary health disease and mortality. BMJ, 306, 688-691.

Atchison, K.A., Weintraub, J.A., & Rozier, R.G. (2018) Bridging the dental-medical divide: Case studies integration oral health care and primary health care. The Journal of the American Dental Association, 149(10), 850-858.

American Academy of Pediatric Dentistry. (2014). The state of little teeth report: An examination of the epidemic of tooth decay among our youngest children. Retrieved from http://www.aapd.org/assets/1/7/State_of _Little_Teeth_Final.pdf Bertness, J. & Holt, K. (2017). Oral health care during pregnancy: A resource guide.

Washington, DC: National Maternal and Child Oral Health Resource Center.

California Department of Public Health. (2017). Maternal and infant health assessment survey. Retrieved from https://www.cdph.ca.gov/Programs/CFH/DMCAH/MIHA/ Pages/Data-and-Reports.aspx.

Silk, H., Douglass, A.B., Douglass, J.M., & Silk, L. (2018). Oral health during pregnancy.

American Family Physician, 77(8), 1139-1144. Retrieved from http://www.ginecologoostetrica.it/wp-content/uploads/2017/05/1_IgieneOrala_oral_health_during _ pregnancy1.pdf Braun, P.A., Widmer-Racich, K., Sevick, C., Starzky, E.J., Mauritson, K., Hambidge, S.J. (2017). Effectiveness on Early Childhood Caries of an oral health promotion program for medical providers. American Journal of Public Health, 107, S97-S103. doi: 10.2105/ AJPH.2017.303817

SAN JOAQUIN PHYSICIAN

59

In Memoriam

In Memoriam WELDON D. SCHUMACHER, MD Jan. 4, 1936 - Dec. 13, 2018

Weldon D. Schumacher, M.D. was born in Tacoma, Washington on January 4, 1936 and passed away in Lodi on December 13, 2018. Weldon was a prominent physician, cherry grower and member of the Lodi community for many years. Weldon graduated from Loma Linda University and Loma Linda University School of Medicine. After doing graduate work he practiced in Glendale, California until 1966 at which time he was drafted into the United States Army. The Army deployed him to Vietnam where, as a Captain, he was responsible for the immediate acute care of casualties off of the battle fields for which he was awarded the Army Commendation Medal and Bronze Star. Honorably discharged in 1968, he and his wife, Joanne, moved to Lodi where he established his practice of family medicine.

While in private practice, Dr. Schumacher was active in the local medical organizations including memberships in San Joaquin Medical Society, California Medical Association, the American Medical Association and the American Association of Family Practice. He served as a member and Chairman of the board of directors and

60

SAN JOAQUIN PHYSICIAN

Chief of Staff of Lodi Community Hospital; he was an active leader in the expansion and modernization of the hospital.

Weldon and his wife were active members of the English Oaks Seventh-day Adventist church in Lodi where he served in a variety of capacities including the church board and chairman of the fundraising committee.

Weldon was a founder and supporter of the Lodi Education Endowment Foundation. Over the years Weldon was an active member of the Lodi community including memberships and services to the Community Concert Association, Lodi Executive Club and the Chamber of Commerce. He was a founding director and served as Vice Chairman for Bank of Lodi and First Financial Bancorp. Weldon was preceded in death by his loving wife Joanne and is survived by his daughter Cindy Lou Laughlin, granddaughter Kelsi Ward and grandson Brian Laughlin.

SPRING 2019

In Memoriam

In Memoriam JOSEPH A. BARKETT, MD May 1, 1928 - November 15, 2018

Surrounded by his loving wife, Marie, and his children and grandchildren, Dr. Joseph Barkett passed away in the early morning of November 15, 2018 at the age of 90 years.

Dr. Joe will be missed immensely and is lovingly remembered by his wife Marie and his children, William Barkett and his wife, Lisa, Lisa Barkett O’Leary and her husband Martin, and Anthony Barkett and his wife, Rima. Dr. Barkett, “Jidou”, will also be greatly missed and fondly remembered by his eight grandchildren, Joseph Barkett, Alexandra O’Leary, Jacqueline Barkett Chervak (James Chervak), Lauren O’Leary Warmerdam (Brett Warmerdam), Anthony Barkett, Katherine O’Leary, Marena O’Leary and Yasmin Barkett.

Dr. Joe was born in Serhel, Lebanon on May 1, 1928 to Sadia and Anthony Barkett. He arrived in Stockton at the age of 9. Unable to speak a word of English, he quickly assimilated into American life and culture, excelling academically and obtained his undergraduate degree from Santa Clara University and his medical degree from Creighton University School of Medicine in Omaha, Nebraska. Upon graduation he joined the Navy where he proudly served his country.

While in the Navy, Dr. Joe met his beloved wife of 61 years, Marie Joseph. Joe and Marie started their life together in Stockton, CA where they began their

SPRING 2019

family and built his career in private general practice in Stockton.

A lifelong Democrat, Dr. Joe was active in local, state and federal politics since the late 1950’s. A strong advocate for San Joaquin County and the City of Stockton, he was appointed at age 36 as Chairman of the World Trade Authority by CA Governor Pat Brown to promote California businesses internationally. Joe served on the Santa Clara Board of Regents, was a Founding Member and Trustee at the University of California, Merced and a member of the San Joaquin Medical Society for 50 years.

He was amazingly accomplished and lived a spectacular life.

Dr. Joe and Marie had a long, happy life together. Joe was a wonderful husband, beloved father and adored “Jidou” who enjoyed his family gatherings around the kitchen table sharing many stories of ethnic pride and the value of hard work and an education. He was particularly proud of his 8 grandchildren who share his commitment to education and community involvement. He loved traveling the world with his wife, family and friends. An avid reader, card player, a remarkable dancer and gifted story-teller, he captured the hearts of many. He was an extraordinarily caring, compassionate and giving person who was always available to lend his advice and help to anyone in need.

SAN JOAQUIN PHYSICIAN

61

12 NEW

SJMS MEMBERS THIS WINTER!

...and even more on the way.

Daniel Wee, M.D.

Catherine Mathis, M.D.

Khurram Durrani, M.D.

1899 W March Ln Stockton, CA (209) 623-4700 Washington University School of Medicine

1617 N. California St, Ste 2A Stockton, CA (209) 466-8546 Creighton University School of Medicine

19 E 6th St Tracy, CA (209) 833-3654 University of Peshawar, Khyber Medical College

Ophthalmology

Charles Kim, M.D. Ophthalmology

1899 W March Ln Stockton, CA (209) 623-4700 University of California School of Medical - Davis

Majid Roubach, M.D. Ophthalmology

1899 W March Lane Stockton, CA (209) 623-4700 Mashhad University of Medical Sciences

Tarandeep Kaur, M.D. Endocrinology

782 E Harding Way Stockton, CA (209) 546-5200 Baba Farid University of Health Sciences

62

SAN JOAQUIN PHYSICIAN

OB/GYN

Psychiatry

Joseph Kevin Johnson, M.D.

Sunny Philip, M.D.

999 S Fairmont Ave Stockton, CA (209) 366-2001 University of Colorado School of Medicine

2626 N California St, Ste B Stockton, CA (209) 466-2626 St Georges University School of Medicine

Internal Medicine

Oncology

Christopher Russo, M.D.

Chunhui Fang, M.D.

2505 Hammer Ln Stockton, CA (209) 833-2367 UCSF Fresno

2626 N California St, Ste B Stockton, CA (209) 474-1458 Beijing Medical University

Internal Medicine

Jasdeep Dhami, M.D. Family Practice

445 W Eaton Ave Tracy, CA (209) 832-0535 Baba Farid University of Health Sciences

Hematology Oncology

Akbar Gilani, M.D. Psychiatry

4001 Highway 104 Stockton, CA (209) 274-4911 University of Punjab Allama Iqbal Medical College

SPRING 2019

INNOVATIVE MEDICAL SOLUTIONS IN A MULTICULTURAL WORLD Experience the difference with JRivera Associates. Expect exceptional service of on-site, telephonic, and video remote interpretation as well as written translation at reasonable rates. Many health plans cover linguistic services in compliance with regulatory requirements of providing Limited English Proficient (LEP) patients with professional interpreters and written translated materials. JRivera Associates is a team dedicated to providing physicians and their practices with the tools and technology to inform, empower and embrace communication to those who need it most...your patients.

CALL US TODAY AT 209-405-0951 FOR A FREE INTRODUCTORY INTERPRETATION/TRANSLATION SERVICE!

Medical Interpretation and Translation | Over 47 languages to support your patients

JRIVERA ASSOCIATES 139 S. GUILD AVENUE SPRING 2019 CA 95240 LODI,

P: 209-405-0951 E: SERVICES@JRIVA.COM W: WWW.JRIVA.COM

SAN JOAQUIN PHYSICIAN

63

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

Inspired by your graceful moves.

We are on this earth for a reason. You move through life with a style your own, displaying elegance and grace. Nothing can knock you off rhythm. You look at life as a celebration, and your example makes us all feel the same. You, and everyone with your upbeat spirit, inspire us to do more than practice medicine. You inspire us to transform lives.

See inspiration in action at www.AdventistHealthLodiMemorial.org

PRSRT STD. U.S. POSTAGE

PAID

Permit No. 60 Stockton, CA