Spring 2021

Spring 2021

GAINS AND

LOSSES

IN YEARLONG COVID-19 BATTLE MOUNT COVID-19 Vaccination Medi-Cal Rx PPP Deductions #ThisIsOurShot

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2021

VOLUME 69, NUMBER 1 • MARCH 2021

PICTURED ABOVE: YI-SHIAU LEU, MD SHOWING HER PRIDE AFTER RECEIVING HER COVID-19 VACCINE.

9 PRESIDENT'S MESSAGE 12 IN THE NEWS 20 VACCINE UPDATE FOR

38 TELEHEALTH POLICY 41 COVERED CA EXPANDS 42 PRACTICE NEWS AND

25 MEDI-CAL RX 26 GAINS AND LOSSES 32 COVID RELIEF

46 PUBLIC HEALTH UPDATE 48 PPE DISTRIBUTION 50 NEW MEMBERS 52 IN MEMORIAM

EMPLOYERS

DEDUCTIONS

36 #THISISOURSHOT

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RESOURCES

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

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

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

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

CONTRIBUTING WRITERS Hyma Jasti, MD, Jo Ann Kirby, Maggie Park, MD, Jamie M. Bossuat, Esq, Larissa Wilcox, MS, Barb Alberson, MPH

MEDICAL EDUCATION PROGRAMS R. Grant Mellor, MD PUBLIC HEALTH COMMITTEE Maggie Park, MD SCHOLARSHIP LOAN FUND Gregg Jongeward, PhD

CMA HOUSE OF DELEGATES REPRESENTATIVES Robin Wong, MD, Lawrence R. Frank, MD

THE SAN JOAQUIN PHYSICIAN MAGAZINE is produced by the San Joaquin Medical Society SUGGESTIONS, story ideas are welcome and will be reviewed by the Editorial Committee.

James R. Halderman, MD, Raissa Hill, DO Richelle Marasigan, DO, Ramin Manshadi, MD

PLEASE DIRECT ALL INQUIRIES AND SUBMISSIONS TO:

Kwabena Adubofour, MD, Philip Edington, MD

San Joaquin Physician Magazine

Harpreet Singh, MD

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

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EXECUTIVE DIRECTOR’S REPORT

LIGHT AT THE END OF THE TUNNEL I think I see it in the distance…. yes, I think that may be it, the light at the end of the tunnel! While it been off to a slow start, the vaccine distribution is improving and the demand for the shot from our community is even more encouraging. For the first time in almost a year, it feels like we could get back to some normalcy soon(ish). There is hope.

LISA RICHMOND

What has been accomplished throughout the pandemic by our scientists and physicians is nothing short of incredible. The scientists worked tirelessly to create an effective vaccine in record time. Our physicians have had to confront a novel disease and learn “on the job.” They’ve taken their experience with COVID-19 and adapted and improved their approach to patient treatment for better outcomes overall. However, it hasn’t been easy for patients, their families or our healthcare workers.

While I appreciate and respect all of our healthcare heroes, I am going to focus on the physicians because after all, it is my job to do so. Throughout the pandemic, I have heard so many sad stories from our members treating COVID patients; experiences that will undoubtedly stick with them for a lifetime.

Many have contracted the virus, giving them firsthand understanding of how a patient feels. This has allowed them to practice even more empathy as they care for their patients’ physical and mental wellbeing after diagnosis. In this issue, we wanted to capture a sample of experiences from a couple of frontline physician members.

Typically, around this time, I would include save the date information for our annual golf tournament and our Young Physician/Lifetime Achievement Award dinner. While we have made the decision to skip this year’s tournament, we will be excited to get back to it in 2022. As for the June dinner, we will make that decision a little later in the Spring. I can promise that we will honor the 2020 recipients, Drs. Philip Cheng and Peter Garbeff at some point this year. We will update you just as soon as we can!

The fuzzy details of the upcoming year are definitely a challenge for this Type A personality. I am trying to embrace the “it is what it is” mentality. We may not be working on the usual activities, but there is always plenty to be done. The growth is in the flexibility.

We know that the needs of our members vary in these unusual times. Please reach out for assistance and resources. We are here to serve you!

With gratitude,

Lisa Richmond

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A message from our President > Hyma Jasti, MD

Vision 2021 and beyond As it comes to a little over a year of living with COVID, I’m taking a little extra time to look back. The daily news cycle has become so daunting that I often do not even want to bring myself to look at headlines anymore. However, the recent rush of good news does bring me much optimism. With vaccines rolling in, infection rates slowing, and schools and business reopening, I can see a little further into the future than I have been.

While I know things will never be as they were pre-COVID, there is definitely proof that our new normal can still be beautiful and full of light.

As choices continue to expand, the infrastructure that we have been forced to rapidly perfect in telehealth will be a choice rather than a necessity. We will be able to provide services for people who may have seemed unreachable a year ago. I personally have also expanded my understanding of mental health, management, and what resources I have been recommending to those who need it. This journal has spoken at length about how COVID has disproportionately affected vulnerable populations, but I am seeing the children of today being another population that is being hit hard. School is online and children are so far removed from their friends. Parents are strained in being teachers, and teachers are strained in learning completely new methods to educate.

How many among us have been fortunate enough to receive both doses of our COVID vaccine? While new strains are popping up, so too are promises of new vaccines right behind them. The general public is just as happy that a solution has started to present itself, even if it will definitely take a while to get the entire population immunized enough for us to go out unmasked any time in the near future. We’re still in early stages, but I do think it is a good start.

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

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I hope my optimism can help bring up all your hopes as well. I am cautious and continuing to take every precaution, but I do feel that the tides are changing. While the thought of better times ahead brings me joy, the lessons we have learned around the world will definitely not leave us anytime soon.

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SERVICES

Ambulance Veteran Transport Long Distance Transport

24/7 LIVE DISPATCH (209) 981-0433

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We Help You Get Paid CMA’s reimbursement experts have recouped $33 million from payors on behalf of member physicians in the past 12 years.

COVID-19 We know that many physician practices are struggling financially in the wake of the COVID-19 pandemic. That’s why CMA continues to work closely with state and federal leaders to ensure that physicians are included in COVID-19 relief programs. CMA has also ensured that there is payment parity between in-person and telehealth services, including telephonic visits, and will continue to fight for physicians’ ability to use telehealth services while not being undercut by out-of-state teledoc companies. Telehealth services have proven to be a critical tool for physicians so they can safely provide care to those who need it during the COVID-19 public health emergency.

PRACTICE MANAGEMENT ASSISTANCE CMA’s practice management experts provide free assistance to members and their staff on reimbursement, contracting and practice management related issues.

DIRECT PAYOR INTERVENTION CMA has recouped $33 million from payors on behalf of CMA member physicians in the past 12 years. These monies represent actual physician reimbursements that would have likely gone unpaid without CMA intervention.

EDUCATION CMA offers timely, high-quality education programs for physicians and their staff. From interactive in-person seminars to live and on-demand webinars, CMA provides the information needed to help run a successful medical practice.

PRACTICE MANAGEMENT NEWSLETTER CMA Practice Resources—known as CPR—is a monthly email bulletin that includes tips and tools to help physicians and their office staff improve practice efficiency and viability.

PAYOR CONTRACT ANALYSIS CMA members have free access to objective written analyses of major health plan contracts designed to help physicians understand their rights and options when contracting with a third-party payor, as well as which contract provisions are prohibited by California law.

“The value that CMA brings to physician practices cannot be understated. Membership is not a cost to my practice – it is an investment. I couldn’t run my practice without it.”

–Tom McKenzie, M.D., member since 1991

NEED HELP? Contact CMA’s Reimbursement Help Line at (888) 401-5911 or economicservices@cmadocs.org

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Rev. 12.1.2020

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In The News

IN THE

NEWS

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

integrity of the organization. Commissioners also appoint members to advisory committees; and are responsible for assuring that the goals of the Health Commission are met.

Save the date for CMA’s Virtual Legislative Advocacy Conference, April 5-9 The California Medical Association (CMA) will host its 47th Annual Legislative Advocacy Conference the week of April 5-9, 2021. Attendees will have the opportunity throughout the week to meet virtually with legislators on priority health care issues. Before these meetings, attendees will receive a virtual training on CMA’s current legislative priorities and policy issues affecting the practice of medicine.

Neelesh Bangalore, MD Neelesh Bangalore, MD appointed to Health Commission, Health Plan of San Joaquin Governing Board Neelesh Bangalore, MD is the newest delegate of the San Joaquin Medical Society to the Health Commission. His appointment was approved by the San Joaquin County Board of Supervisors at the end of January. Dr. Bangalore practices at Stockton Hematology Oncology Medical Group in Stockton and currently serves on the SJMS Board of Directors.

The Commission oversees the activities of the Health Plan of San Joaquin. Commissioners establish policies, hire, and oversee the chief executive officer and ensure the fiscal

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This is a unique event for California physician members, residents and medical students. Set aside April 5-9 and plan to join your colleagues as they prepare to lobby their legislative leaders and serve as champions for the house of medicine.

Contact: Lisa Richmond at Lisa@sjcms.org for more information The Ambulatory Surgery of Stockton now performing outpatient total joint replacement surgery!

The Ambulatory Surgery Center of Stockton, in partnership with Alpine Orthopaedic Medical Group, is now offering outpatient total joint replacement surgery for shoulder and knee replacement procedures. It is the first ambulatory surgery center in the Central Valley to offer same-day discharge following total joint replacement procedures.

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The program started in June 2020 with the first outpatient total shoulder replacement surgery performed by Dr. Jaicharan Iyengar, an orthopedic shoulder specialist at Alpine Orthopaedics/ Stockton Shoulder Institute.

"The COVID-19 pandemic has really forced us to rethink our hospital utilization paradigm in the context of the overall health care needs of our community," said Iyengar.

Since its launch, the ASC Stockton has performed more than 50 successful outpatient total joint replacement procedures and is planning to start a hip replacement program in 2021 under the leadership of Dr. Jaspreet Sidhu, a specialist in hip and knee replacement at Alpine Orthopaedics.

“There has been a growing trend towards outpatient total joint replacement nationwide and we are very pleased to now be able to offer this service at our outpatient surgery center. We expect this program to continue to grow as more and more outcomes data emerges that shows that outpatient total joint replacement is safe and effective,” said Uthman.

Patients who are interested in outpatient total joint replacement should schedule a consultation at Alpine Orthopaedic Medical Group, 2488 North California Street, Stockton, CA 95240. For more information, or to schedule an appointment, call 209-948-3333 FCPP Welcomes New OB/GYN to Manteca Group The First California Physician Partners (FCPP) OB/GYN Group is dedicated to providing high quality healthcare to women in the Central Valley. From preventative care to diagnosis and treatment of more complex gynecological problems, FCPP offers a full spectrum of care for patients.

We are proud to share that Gail Joseph, M.D., has joined the Manteca group alongside P. Andrew Waran, M.D., after spending the past four years practicing locally. She obtained her doctor of medicine degree from the University of Pittsburgh, School of Medicine and completed her residency at the University of Florida.

Together, Drs. Waran and Joseph provide complete OB/

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FCPP Welcomes Gail Joseph, MD GYN and urogynecology services for patients in Manteca and surrounding communities. They are both affiliated with Doctors Hospital of Manteca. For more information or to refer a patient, please call us at (209) 823-7646 or head to FCPPCentralValley.com.

Dameron Hospital first to offer state-of-theart spine surgery imaging system in San Joaquin Dameron Hospital has begun using a breakthrough technology for spine procedures that enable physicians to perform surgeries faster and with greater accuracy. The hospital's new TrackX system provides real-time imaging navigation showing the surgeon's precise placement of their instruments relative to the spine as they work.

Typically, spine surgeons require the use of a series of X-rays that generate a significant level of radiation exposure to the patient and the surgery team. It also consumes a substantial amount of time. Using computer-generated imaging, TrackX tracks the surgeon's instruments' placement in real-time and simulates the use of f luoroscopy (continuous X-ray imaging) without the use of X-rays.

Bayan Aghdasi, MD, performed the first spine surgery procedure at Dameron in December using the TrackX imaging system.

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In The News

IN THE

NEWS

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

increased efficiency and accuracy.

Overall, the TrackX imaging system reduces total radiation exposure by 91 percent, reduces localization time by more than 30 percent, and reduces the number of X-rays taken by 74.8 percent.

Dameron Hospital is among the first in the country to implement this new technology.

Among Top Ranked California Health Plans for Timely Access HPSJ Tells Providers: THANKS! We couldn’t have done it without you!

Drs. Haghdoost and Aghdasi perform spine procedure using TrackX "TrackX provides the most advanced, low-dose spinal navigation available, said Dr. Aghdasi." The system enables me to visualize the spine anatomy in real-time and allows for more accurate adjustments as the spine shifts into proper alignment during the procedure. It allows me to perform my surgeries faster and with greater precision while reducing radiation exposure for my patients, myself and my OR team."

TrackX's core technology focuses on disposable tracking attachments. Along with a motion-sensing bar, these tools snap onto the surgeon's instruments and X-ray C-arm's head.

Similar to how a Nintendo Wii works by using a controller and motion-sensing bar to accurately track the player's realtime movement, the TrackX Snap, software and C-arm Cap and Collar track the surgical instruments in real-time with

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According to the California Department of Managed Health Care (DMHC), HPSJ is among the top plans for giving enrollees timely access to urgent and non-urgent care. HPSJ is ranked second best out of 19 plans that offer Medi-Cal coverage, and ranked second best out of 38 health plans that offer commercial, individual/family (i.e., purchased privately or through Covered California), and Medi-Cal coverage. In the report, DMHC highlights that, “Providing timely access to health care services is a health plan’s fundamental duty to its enrollee.” These latest high rankings (Calendar Year 2019) represent an active partnership of HPSJ with their providers. This is a partnership that not only promoted urgent and non-urgent care access for HPSJ patients, it also illustrates how each provider partner went the extra mile to respond with accurate, complete reporting of timely compliance data.

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COVID-19 Vaccination Teamwork – Health Plan of San Joaquin Employees Volunteer for Clinic Support Roles Since the beginning of 2021, teams of HPSJ employee volunteers have been assisting at local mass-vaccination clinics. This means non-clinical HPSJ staff perform support tasks, ranging from assisting patients so they complete a checklist to ensure each is a qualified for vaccination, to handing out a vaccine information sheet to patients who complete the process. This frees up clinical personnel to focus more efficiently on vaccine administration.

HPSJ urges providers to consider monoclonal antibody infusion for mild-tomoderate COVID-19 patients The Food and Drug Administration (FDA) has approved for emergency use authorization (EUA) several monoclonal antibody treatments. Use of these treatments can mean a patient who gets the antibodies early in their COVID-19 diagnosed course may have a milder form of the disease and avoid hospitalizations; plus they may avoid poor outcomes.

HPSJ is reminding the medical members of its provider network to consider one of the monoclonal antibody

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infusions for their mild-to-moderate COVID-19 patients that are not hospitalized. For more details, go to HPSJ’s website, https://www.hpsj.com/top-topics-monthly-spotlightsjust-for-hpsj-providers-january-29-2021/.

Health Plan of San Joaquin helping get out the word: Licensees Authorized to Administer Vaccines in California The California Department of Public Health (CDPH) has updated the list of professionals currently able to administer COVID-19 vaccines, including conditions for giving the shots. Check the CDPH page at https://www.cdph.ca.gov/ Programs/CID/DCDC/Pages/Immunization/AuthorizedLicensees.aspx.

Community and Consumer Alerts from Health Plan of San Joaquin to HPSJ Members Protect Yourself from COVID-19 scams! – Crooks are now making fake dates for COVID-19 vaccines. These are not real. Keep checking with your county public health agency for the real vaccine facts – and the latest on vaccine offerings,

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In The News

IN THE

NEWS

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

including the site for San Joaquin County (https://www. sjready.org/) and the site for Stanislaus County (http://schsa.org/ coronavirus/vaccine/).

HPSJ Members, Do NOT Be Fooled! No-Cost COVID-19 tests are available There is no cost to HPSJ’s members for medically-needed COVID-19 screening and testing. HPSJ has 363,723 members in Stanislaus and San Joaquin Counties. Any who have questions are asked to contact their local public health department or HSPJ Customer Service at 888-9367526 (TTY/TTD 711) or visit hpsj.com/COVID-Members at https://www.hpsj.com/coronavirus/.

St. Joseph’s Launches Operation White Lights Dignity Health St. Joseph’s Medical Center launched a campaign called Operation White Lights to honor all those called to care during the pandemic. Operation White Lights encourages the public to display white lights and

white ribbons in support of health care workers and first responders everywhere.

“Everyone who works in health care has demonstrated unwavering courage in the face of this pandemic,” says Don Wiley, President and CEO of St. Joseph’s Medical Center.

“Their strength and humanity is a light of hope for so many

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

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In The News

IN THE

NEWS patients and families impacted by COVID-19. Operation White Lights is a way to lift up our healers and let them know the community cares about them.”

St. Joseph’s encourages community leaders, businesses, and residents to join Operation White Lights by displaying white lights and ribbons on homes, businesses, cars, or worn on lapels as a gesture of support for care teams and first responders throughout San Joaquin County and by sharing messages of gratitude on social media.

St. Joseph’s Medical Center began displaying white lights on its campus in January and along with luminaries with messages of gratitude and encouragement.

St. Joseph’s Awards $283K in Community Grants Dignity Health - St. Joseph's Medical Center has awarded $283,392 in grant funding to five local community-based organizations seeking to provide health and human services to residents most in need in San Joaquin County. Grants were awarded to organizations and projects working to address underlying causes of illness. Several of the projects are aimed at helping our community’s youth through innovative mentoring, counseling, physical activity and training programs, and support services. Additional projects seek to provide dental care to veterans in need and digital literacy support to vulnerable populations.

Five projects were awarded funding this year, with each grant recipient working in partnership with other community organizations. Grants were awarded to Boys & Girls Club

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

of Greater Sacramento for the Row & Rise Together, Delta Healthcare’s AIM Project, Dentists Organized for Veterans, Lutheran Social Services A Clean Start, Visionary Homebuilders of California’s Community LinkDigital Literacy Program.

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 $3.7 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 Foundation to Provide Pulse Oximeters to COVID-19 Patients Patients who have tested positive for COVID-19 can benefit from a simple tool that is becoming as common as a thermometer in a home medicine cabinet - the Pulse Oximeter. That’s why St. Joseph’s Foundation of San Joaquin is raising funds to purchase pulse oximeters to help safely discharge COVID-19 patients from the Emergency Department.

"Many patients arrive in the ER who are experiencing COVID-19 symptoms but are not ill enough to be hospitalized," said Benjamin D. Wiederhold, MD, Medical Director of St. Joseph’s Emergency Department. "With proper tools and instructions, these patients can be sent home to safely recover. A Pulse Oximeter is a key tool for home monitoring."

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Decision Medicine Alumni in Stockton for Clinical Rotations Oxygen Saturation is a key to recovering from COVID-19 at home. A Pulse Oximeter is an electronic device that clips to your finger measuring heart rate and oxygen saturation in blood red cells. Medical intervention is necessary if oxygen saturation levels begin to fall.

University of California, San Diego. She has been back in the community completing her clinical rotations at St. Joseph’s Medical Center and various community clinics, including the East Main Clinic with DM Co-Founder, Dr. Kwabena Adubofour.

Along with a pulse oximeter, each patient will receive an education card with instructions on use and what levels necessitate returning to the ED.

When asked about her experience, she said “Decision Medicine was an integral step in my journey to medicine.

I saw firsthand how medicine was practiced in my own community and the importance of access to quality healthcare. I am so grateful to return for clinical rotations because I want to give back to the community that gave me so much. I love that I can support my family and community members who have inspired me in so many ways. My goal for the future is to practice primary care in my community because I want to serve as a health advocate, practice preventive medicine, build genuine relationships, and see families long-term.”

A $25 donation to our Emergency Response Fund will help purchase one Pulse Oximeter for a St. Joseph's patient. If you would like to make a donation, please visit StJosephsCares. org/Donate or call (209) 467-6347.

Decision Medicine Alumni in Stockton for Clinical Rotations Farwa Feroze is a 3rd year medical student at Touro University- California. She is an alumnus of Decision Medicine (DM) 2013 and later graduated Summa Cum Laude with a Bachelor of Science in Public Health from

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COVID-19

Vaccination Update for Employers By: Jamie M. Bossuat, Esq.

Many employers are wondering whether they can require or incentivize their employees to receive the COVID-19 vaccine.

Below are a few answers to commonly asked questions.

Q: Can I require my employees to receive a COVID-19 vaccine?

A: Yes, with some limitations. First, you should evaluate

whether the vaccine is job-related and consistent with business necessity. Second, you should ensure that your policies provide for employee accommodations. On December 16, 2020, the EEOC issued guidance which permits employers to require vaccinations but requires employers to provide reasonable accommodations to employees who are unable to receive the vaccine due to medical or religious reasons.

Q: How do I determine if I must accommodate a medical or religious concern?

A: This depends on the reason you are relying on for requiring the vaccine. For some jobs, such as healthcare, it may be the case that getting vaccinated is a standard qualification for performing the service. The decision must be based on objective medical information. For example, a strong factor supporting requiring the vaccine is if a government

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Made for more community

We’re all made for more. More helping out. More showing up.

More working together to build healthy families and futures. It’s about all of us coming together to increase access to care and build a healthier San Joaquin County. Adventist Health’s vision goes beyond the physical walls of our facilities in transforming the health and well-being of our community today and for generations to come.

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agency requires the vaccine as a condition of employing an individual in your industry. Accommodations for an employee who will not receive a vaccine must be evaluated in the interactive process with the employee. Some possible accommodations may include wearing a face mask while on-site even when no longer required for others, teleworking, or a leave of absence. Denying an accommodation requires an “undue hardship” on the employer, which will vary based upon a business’s individual circumstances.

Q: Can I exclude someone from the workplace because their failure to receive a vaccination is a “direct threat” to the employee or others?

A: In some circumstances, yes. This is another exception

to the requirement that a vaccine-related concern be accommodated. However, the standard is very high and must be based on objective medical evidence and an individualized assessment. The fact that employees have been working with masks for several months may make this difficult to establish.

Q: Can I encourage vaccinations even if I do not require them?

A:

Yes. Much like annual f lu shots in some portions of the healthcare industry, an employer can encourage a vaccine and then put in place additional safety precautions for those who elect not to receive a vaccination.

Q: Can I offer a monetary incentive for employees to receive a COVID-19 vaccine?

A:

Yes, but with limitations. Employers should consider rules applicable to wellness programs and IRS requirements relating to taxability of such payments. (A payment for receiving a vaccination is likely to be treated by the IRS as an employer-sponsored wellness program.) Additionally,

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employers must decide how they will address employees who are not otherwise eligible for the incentive due to a medical or religious reason.

Q: Must I pay employees for the cost of the vaccine or the time spent receiving the vaccine?

A: If you are requiring the vaccine based upon business necessity, then it is likely in California that the employer would be required to cover the costs incurred by the employee in receiving the vaccine, including time spent.

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Strong community partnerships lead to happier, healthier people.

HPSJ has partnered with safety-net and traditional providers for over 25 years to create access to quality healthcare for low-income children, families and individuals- some of the most vulnerable citizens of our community.

Whether your practice was there from the start, or has recently joined us, we want to extend a sincere thank you for sharing our mission of improved wellness through meaningful partnerships and collaboration.

Community • Partnership • Wellness

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www.hpsj.com | 888.936.PLAN (7526) SAN JOAQUIN PHYSICIAN

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DHCS announces delay to Medi-Cal Rx implementation The California Department of Health Care Services (DHCS) announced it would delay the April 1, 2021, implementation of the Medi-Cal Rx program. According to DHCS, the delay is needed to give the agency time to review new conflict avoidance protocols submitted by Magellan Health, Inc., the project’s contracted vendor.

In January 2021, Centene Corporation announced plans to acquire Magellan. Centene operates – through subsidiaries – managed care plans and pharmacies that participate in MediCal. This transaction was unexpected and requires additional time for exploration of acceptable conflict avoidance protocols to ensure that there will be acceptable firewalls between the corporate entities to protect the pharmacy claims data of all Medi-Cal beneficiaries.

DHCS anticipates it will be in a position to provide an update on the implementation timeline in May. The California Medical Association (CMA) had been advocating for a delay to the implementation to avoid a disruption in benefits and critical care for beneficiaries at a time when the state continues to wrestle with the enormity of the effects of the ongoing pandemic—which are having an undue burden on our state’s health care system.

While CMA continues to support the Governor’s efforts to lower the cost of drugs for all Californians and will continue to partner with the administration in broader health care cost-containment efforts, CMA has remained engaged in the proposed rollout, and vocal about its concerns for the potential lapse in care and benefits that would occur from

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implementing the program at this time while physicians are still dealing with the COVID-19 pandemic.

On February 1, 2021, CMA sent a letter to Governor Gavin Newsom expressing concerns regarding the planned implementation of his Executive Order on pharmaceuticals and its direction to carve the pharmacy benefit out of the Medi-Cal managed care benefit, potentially disrupting critical care between patients and physicians as well as benefits for millions of Medi-Cal beneficiaries.

“In a normal year, the implementation of this change would have been a significant workload,” said Dustin Corcoran, CMA CEO. “Given the constraints on our healthcare system due to the COVID-19 pandemic, we think it is prudent to delay the implementation of this important program.”

To date, only a minutia of the tens of thousands of state prescribing providers have registered for the program, and an even smaller portion of them have received the necessary information to begin to use the proposed portal – the main mechanism that will allow providers to submit authorization requests for their patients.

Citing a lack of enrollment and education on the process for providers, CMA has recommended aligning the Medi-Cal Rx implementation with the implementation of the CalAIM initiative, and postponing implementation until such time as the CalAIM transition occurs and a significant majority of Medi-Cal prescribers have registered and are trained to use the Medi-Cal Rx portal.

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GAINS AND

LOSSES

IN YEARLONG COVID-19 BATTLE MOUNT What the fight on the frontlines of a pandemic taught us

BY JO ANN KIRBY

Embattled health care workers on the frontline of the fight against Covid-19 have cared for critically ill patients through equipment shortages, scrambled to convert floor rooms into ICU beds, powered through several deadly surges, facilitated heartbreaking conversations between patients and their family members, and have even been sent home sick with the virus themselves.

Through it all, they have remained committed to care for the sick and say that the pandemic has resulted in unparalleled teamwork, sped up advances in telehealth, and ushered in vaccine and therapy breakthroughs to fight the disease.

“I told everyone, this is a war zone but this is why we chose medicine,” said Dr. Sanjeev Goswami, medical director of the critical care/intensivist program and chief of staff elect. at St. Joseph’s Medical Center as well as medical director and chief of staff at Dameron Hospital. “In human history, we’ve been so lucky that we haven’t had a pandemic in our lifetime until now.”

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It was March 10, 2020, when the San Joaquin County Public Health announced confirmation of the first positive test result for Covid-19 in a San Joaquin County resident who returned from a cruise on the Grand Princess where an outbreak occurred. A year later, close to 1,200 residents have died from the suffocating virus and more than 66,000 cases have been reported countywide.

As news of the deadly coronavirus spread, doctors here were able to brace themselves before the easily transmitted Covid-19 virus reached San Joaquin County. “In January 2020, when we were seeing news about Covid-19 outbreaks in other countries like China and then Italy, we thought that we would be okay as we have the most advanced health care system,” said Dr. Gurinder Singh, who practices pulmonary critical care and sleep medicine as the director of SJGH’s Medical ICU, Pulmonary and Sleep Lab and also serves as associate program director of its Internal Medicine residency program.

Covid-19’s deadly impact on New York was eye opening and gave doctors on the West Coast a head’s up. There was initial “ It is a very difficult time for all healthcare providers, patients and their families. Family members cannot come and visit their loved one when they’re critically ill with Covid. They can’t hold their hands when they are dying.” - SANJEEV GOSWAMI, MD

confusion about the correct personal protective equipment needed, the role of immune suppressants such as steroids, and when to intubate patients. With the experience of soldiering through several surges, doctors improved their understanding of the disease and say results from new trials related to different treatments have been helpful in decision making. “This disease was impacting lungs in a different way. Some people were getting sick and thought they were OK, then they were having trouble breathing and having to go on a ventilator,” Dr. Goswami said of the first surge of Covid-19 patients. “At that time we were seeing more older people. In this wave, we are seeing younger people.”

As the pandemic progressed, regular webcasts and guidelines related to the management of Covid-19 patients by national critical care societies such as the American College of Chest Physicians and Society of Critical Care Medicine became useful for those on the frontlines. “We are trying to rescue more of our patients with noninvasive modes of ventilation like high flow nasal cannula,” Dr. Singh said. “We are using prone ventilation early, which seems to be effective in lung protective ventilation and reduced barotrauma.”

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SANJEEV GOSWAMI, MD

GURINDER SINGH, MD

at Lodi Memorial and Dameron.

Thankfully, most health care workers therapists, training residents and attending physicians for their in San Joaquin County have now dedication and resilience to be strong and support each other during had the opportunity to receive the these tough times.” - GURINDER SINGH, MD Moderna or Pfizer vaccine.

But a winter surge of cases after As the largest hospital in San Joaquin County, St. Joe’s has the holidays would stretch hospital consistently cared for the most Covid-19 patients at any one capacity at unprecedented levels when a record 355 Covid-19 time including a record high of 124 on December 18. “Some patients were hospitalized on December 28 countywide. of our patients, when they come to the hospital, they already That milestone was matched again on January 6, which also waited 10 to 14 days at home without any improvement,” Dr. happened to be the deadliest day of the pandemic, San Joaquin Goswami said, adding that they are then often critically ill by County Public Health Officer Dr. Maggie Park said. On that the time they do go to the hospital. day, 14 patients succumbed to the virus. As the death toll from Early in the pandemic, health care workers dealt with supply the pandemic accelerated, the difficult conversations medical shortages. Then, staffing became a challenge as health care staff must make with family members was taking an emotional workers were sidelined by the virus. Sadly, some local health toll, especially as nursing staff helped family members say care workers even lost their lives to Covid-19. “With this goodbye to loved ones via iPads. pandemic, initially we saw the shortage of PPE but it did not “It is a very difficult time for all healthcare providers, patients last too long. Now we have enough of a supply of PPE. In our and their families,” Dr. Goswami said. “Family members county we were dealing with different drug shortages at times cannot come and visit their loved one when they’re critically ill and staff shortages in the ICUs,” Dr. Goswami said. “I ended up with Covid. They can’t hold their hands when they are dying.” getting Covid in September. It gave me a good idea of how the Even more heartbreaking are situations where multiple family patient feels. The muscle aches, fatigue, shortness of breath." members are critically sick at the same time. “All of us working Traveling agencies had to fill staffing voids and the in ICU have lost patients,” Dr. Singh said. “I think we will Department of Defense twice sent medical teams to help out carry the feeling of helplessness for some time. Some of these “I feel thankful and honored to work with our amazing nurses, respiratory

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telephone calls towards the end can be very depressing for the family and healthcare providers.”

One very difficult conversation took place with a 24-yearold Covid-19 patient who was afraid to go on a ventilator. “Her last words to me were ‘I don’t want to die.’ ’’ said Dr. Goswami, recalling casualties of the pandemic he won’t soon forget. “We had a couple who were being treated at separate hospitals and the husband was so depressed that he couldn’t see his wife. I’ve had many tough conversations. It’s draining.”

Through it all, Dr. Singh said teamwork has become essential, especially when the task involves expanding ICU capacity. With the county’s seven hospitals at 155% capacity at one point in late December, hospital teams scrambled to add 54 additional ICU beds. “I feel thankful and honored to work with our amazing nurses, respiratory therapists, training residents and attending physicians for their dedication and resilience to be strong and support each other during these tough times,” he said. “While taking care of these patients, we also had full support from hospital administration. There is a daily Covid task force meeting and any issues which are brought up are quickly resolved.”

Dr. Singh said the pandemic has also prompted the county hospital to increase its telemedicine appointments. “We are learning to be more innovative,” he said, citing the ability to screen share test results and X-ray or CT images with patients.

While a slow vaccine rollout coupled with a decline in cases, hospitalizations and deaths began to offer a glimmer of hope in February, those on the front lines fighting the pandemic say now is not the time to become complacent in the fight against this opportunistic virus. “I’m concerned about the possibility of high transmission rates with variants, which could lead to a spring surge despite our vaccination efforts,” Dr. Park said, adding that county public health has been constrained by a lack of enough vaccine doses to meet the need.

Looking ahead, doctors said they hope renewed attention can be made to discovering more effective therapies to treat the virus. “Preventive measures like facemasks and social distancing are here to stay for some time, even after vaccination until we can have a significant breakthrough for oral antivrials, which could be used in the early state soon after the infection to prevent the profession of disease and need for hospitalization,” Dr. Singh said.

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Safety first.

Healing always.

While safety in health care is essential, during a pandemic, it becomes that much more critical. St. Joseph’s Medical Center received an ‘A’ rating from The Leapfrog Group, a national, independent watchdog that sets the highest standards for patient safety in the United States. This grade places St. Joseph’s among the safest hospitals in the nation – an accomplishment that has never meant more than it does today, because giving our patients safe care is our top priority.

Learn more about St. Joseph’s Medical Center’s efforts to keep patients safe during the pandemic and beyond at dignityhealth.org/Stockton/covid19.

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CALIFORNIA COVID-19 RELIEF PACKAGE ALLOWS

PPP deductions of up to $150k Governor Gavin Newsom and state legislative leaders have announced an agreement on a package of immediate actions intended to speed needed relief to individuals, families and businesses suffering significant economic hardship from the COVID-19 recession. A part of this package is bringing California tax law to partial conformity with federal tax policy regarding loans provided by the Paycheck Protection Plan (PPP) – a proposal that will benefit many small and solo medical practices across California.

The new California agreement will allow companies who received a PPP loan to deduct up to $150,000 in expenses paid for by those PPP funds. Under the agreement, all businesses that took out loans of $150,000 or less will be able to maximize their deduction for state purposes. Those that took out higher loans will be subject to a deduction ceiling of $150,000.

Based on publicly available information furnished by the Small Business Administration, 87.9% of awarded physician practices in California received a PPP loan of $150k or less and would be fully covered by this emergency legislation.

While the California Medical Association (CMA) supports the state’s swift action to provide financial relief to individuals, small businesses and physician practices impacted by the pandemic, more must be done to address the needs of practices who have been forced to cut or furlough staff or shut their

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doors during the worst of the COVID-19 pandemic. The fallout from the last year could have a lasting impact on our state’s health care infrastructure and make it harder for many patients to receive the medical care they need when they need it.

“This is an important first step that will help a number of small and solo medical practices,” said Peter N. Bretan, Jr., M.D., CMA president, “But the state needs to do more to help physician practices that continue to struggle through this pandemic.”

CMA has been out front on the issue with a coalition including business groups, health care providers, and Assemblymember Autumn Burke working to ensure that California tax code fully conforms with federal code providing necessary support to California practices, so that they can keep their doors open and their staff employed, and so that they can continue to provide critical care to their patients.

“If physician practices don’t receive the full extent of the support they need, we risk threatening patients’ access to care and the future viability of our health care delivery system,” said Dr. Bretan. “Aligning California tax code with federal tax code is a simple step that can be taken to provide support to physicians who need it, so that they can provide care to members of our communities when they need it most.

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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.

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Participate in California’s Largest Health Information Exchange

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Determine if patients are filling their prescriptions and completing referrals

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See which physicians they are seeing and how often

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Know if your patients are using the ER or Urgent Care Centers

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Identify preventive screenings that have been completed, so you can improve your quality performance

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Reduce duplicate testing and identify drug interactions

REDUCE READMISSIONS BY FOLLOWING UP QUICKLY AND EFFECTIVELY AFTER A HOSPITAL ENCOUNTER •

Receive real-time notifications when your patients have a hospital encounter so you can follow-up within 24 hours and schedule a visit within 7 days

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Initiate Transitional Care Management (TCM) on time so you can get Medicare reimbursement

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HOW CALIFORNIA PRACTICES USE MX TOOLS TO REDUCE COST, IMPROVE QUALITY OF CARE AND INCREASE PATIENT SATISFACTION

MX NOTIFY

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viewing data across clinical settings

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and payers •

Review recent labs and radiology results

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ID preventative screenings that have been completed outside your practice

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that builds off lessons learned during the pandemic, meets the demand for virtual remote care, and ensures access for all populations. “As we continue to wrestle with the pandemic and to work towards a more equitable health care landscape, providing and sustaining access to care through telehealth must remain a priority,” said California Medical Association (CMA) President Peter N. Bretan, Jr., M.D. “Telehealth has become an essential tool for physicians’ practices during this time because it allows them to provide safe and effective care to their patients. Additionally, telehealth bridges access barriers by utilizing technology to better harness physician time and expertise, and connecting patients to their care providers more quickly, efficiently and conveniently. Protecting the telehealth expansions, especially those that relate to telephonic visits which play a crucial role in bridging access barriers, is essential to both meeting our health care demands in this moment, and to ensuring that all Californians – regardless of

their geography, income, or background - can receive access to quality care in the future.” CMA and a broad coalition of health care providers and advocacy groups are urging the legislature to pass AB 32 (Aguiar-Curry), which offers California a telehealth solution that is inclusive, fair and ensures equal access to care for all Californians. Policy changes outlined in AB 32 include: creating payment parity between Medi-Cal managed care plans and commercial plans and allowing virtual enrollment for limited scope Medi-Cal programs. Additionally, the intent of the bill is to continue the provision of telehealth in MediCal programs, including video and audio-only technology, by making the telehealth flexibilities instituted during the public health emergency permanent. If passed, AB 32 will be a critical component of California’s telehealth policy infrastructure and would help pave the way for future health care innovation and advancement.

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Covered CA expands special enrollment through May 15 Covered California has announced that it will establish a new special-enrollment period beginning February 1, 2021, to give Californians another opportunities to sign up for health care coverage as the state continues to grapple with widespread disruptions due to the COVID-19 pandemic.

The new special-enrollment period will allow uninsured individuals to sign up for coverage without needing to meet the normal qualifying life events, such as recent loss of coverage or moving. Anyone who meets Covered California’s eligibility requirements can sign up for coverage between February 1 and May 15, 2021, and have their coverage begin on the first of the month following enrollment.

According to the announcement, the California Department of Managed Health Care (DMHC) and the California Department of Insurance have also extended their special-enrollment periods through May 15, requiring all plans in the individual market, including off-exchange health plans to allow individuals to sign up for coverage through May 15.

Individuals who sign up through Covered California will

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have access to private health insurance plans with monthly premiums that may be lowered due to federal and new state financial assistance that became effective in January 2020.

After selecting a plan, coverage would begin on the first of the following month — meaning individuals losing job-based coverage will not face a gap in coverage.

Consumers who sign up through CoveredCA.com may also find out that they are eligible for no-cost or low-cost coverage through Medi-Cal, and if so they can enroll online. Once enrolled, coverage is immediately effective.

Consumers can easily find out if they are eligible MediCal or other forms of financial help and see which plans are available in their area by using the CoveredCA.Com Shop and Compare Tool and entering their ZIP code, household income and the ages of those who need coverage.

Those interested in learning more about their coverage options can also call Covered California at (800) 300-1506.

Free and confidential assistance is available in a variety of languages.

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Practice News and Resources Free to SJMS/CMA Members!

The Office Managers Forum empowers physicians and their medical staff with valuable tools via expert led educations sessions from industry professionals who are committed to delivering quality healthcare.

For the time being, we will be offering Zoom Meetings until we can get back to meeting in person.

This monthly forum is normally held on the second Wednesday of each month. Registration is required!

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

March 4th, 2021: 12:15PM to 1:15PM

Webinar: Telehealth Series for Small and Medium Sized Practices Implementing telehealth is not an end in itself. Telehealth is a tool that physicians can leverage to improve quality and efficiency, and increase patient satisfaction. In this interactive session, physicians will learn how to build a strategy to incorporate telehealth into their practice, both during and after the COVID-19 pandemic.

To Register Visit: https://www.cmadocs.org/ event-info/sessionaltcd/CMA21_0304_TELE/t If you need assistance with registration, please email Victoria Travis at events@cmadocs.org.* Presenters: David Ford, CMA Vice President of Health Information Technology Kristina Mody, Senior Manager, Care Redesign, Califor nia Quality Collaborative

April 14th, 2021: 11:30AM-1PM

Managing Up!

Managers, Administrators and CEOs in medical practice positions need to successfully lear n to supervise staff or manage down, but also to achieve results by influencing their physician bosses by managing up. It is difficult to communicate to your physician boss that certain behaviors are keeping the practice from achieving optimal success.

Learning Objectives.

•A ttendees will learn how to give constructive feedback to physicians • A ttendees will learn how to manage change successfully • A ttendees will learn how to reduce conflict by team building activities • A ttendees will learn how to present key financial benchmarks to physicians

Topics Include:

•Q ualities Physicians Want in a Manager • Q ualities Physicians Do Not Like in a Manager

• C oaching Physicians Toward Productivity

• I mportance of Strategic Planning

• Managing Change

• 5 Steps for Presenting Recommendations for Behavioral Change

• T he Toughest Issues for Managers to Mediate with Physicians:

• I ncome Distribution

• P roductivity Differences

• C onflict among partners

• R isk to the practice – Labor Law, Fraud, OSHA, HIPAA, Medicare Compliance

• B ehavioral issues: divorce, depression, anger, disruptive, harassment, slow charge slip and EMR submission, running staff into overtime

• H ow to instill team spirit between physicians and staff – Morale building ideas from many practices Group sharing of successes, team building and problems – Interactive session Presenter: Debra Phairas, President of Practice & Liability Consultants, LLC

CMA Practice Resources

Reminder: New prescribing rules for controlled substances took effect Jan 1 As of January 1, 2021, all security prescription forms are required to have a uniquely serialized number, a corresponding barcode and other security features. Except for limited emergency situations, pharmacists are unable to fill a controlled substances prescription that is not on a compliant form.

Physicians who do not already have these prescription pads should place an order as soon as possible from a Department of Justiceapproved security prescription printer. https:// oag.ca.gov/security-printers/approved-list.

Califor nia Medical Association security prescription partner, RxSecurity, has been issuing uniquely serialized prescription forms since 2019.

For additional information on new compliant security prescription forms, please see the Joint Statement and FAQs from the Califor nia Department of Justice, the Califor nia State Board of Pharmacy and the Medical Board of Califor nia.

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Consumers can easily find out if they are eligible Medi-Cal or other forms of financial help and see which plans are available in their area by using the CoveredCA.Com Shop and Compare Tool and entering their ZIP code, household income and the ages of those who need coverage.

Those interested in learning more about their coverage options can also call Covered Califor nia at (800) 300-1506. Free and confidential assistance is available in a variety of languages.

CMA publishes Telehealth Resource Center The Califor nia Medical Association (CMA) has published a Telehealth Resource Center, which compiles the best available resources to help physicians implement and utilize telehealth in their practices. These resources have been thoroughly vetted by CMA to present only the most relevant resources. The resources listed can be sorted by category, topic, type and source to help physicians find the tools that address the specific issues they are facing. New resources will be added to this center regularly,

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so please check back often for updates. Find the information at www.cmadocs.org/telehealth/ resources.

Development of this resource center was funded by the California Health Care Foundation.

denied, DHCS said claims will be reprocessed automatically through the Erroneous Payment Correction process once the system changes are implemented.

Practices should consider the pros and cons of submitting now vs. holding claims until the DHCS system updates are complete to determine what is right for their practice.

DHCS claims for COVID-19 vaccine administration can be submitted, but will not be paid until system updates are made On December 18, 2020, the Califor nia Department of Health Care Services (DHCS) announced its plan for reimbursement of the administration of the COVID-19 vaccine, but at that time advised physicians to hold their vaccine claims since its systems were not yet able to accept them.

While providers may now submit claims, DHCS says claims will not be processed until additional system changes are made, which isn’t expected until late January. Until then, the claims will appear in a “pending” status.

According to guidance released on December 29, 2020, while DHCS is taking steps to pend these claims, it’s possible that some claims may inadvertently be processed and denied. If

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SPRING 2021

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Public Health

Update

Confidential Morbidity Reports (CMR) Affect Lives!

BY LARISSA WILCOX, MS, AND BARB ALBERSON, MPH

A Confidential Morbidity Report (CMR) is the first indication that there may be a disease outbreak – in essence, it is the “canary in the coal mine”. By law, health care providers must submit CMRs to San Joaquin County Public Health Services (PHS) for more than 85 reportable conditions. The conditions and the timeframes that diseases must be reported within can be found in CA Code of Regulations, Title 17, which is kept up to date by the California Department of Public Health (CDPH).

The importance of filling out the CMR completely and correctly cannot be overstated. It is not only the first report of the disease incident that public health receives, it is often the only direct line of communication from the provider to the public health department. As shown in the image below, CMRs can convey much of the information that is needed to get a general idea about the person with the disease but also can assist in determining if there is a potential outbreak. Especially important in determining an outbreak are residential address, occupation (with location), and date of symptoms onset. With these few pieces of information, PHS may be able to identify an outbreak early on which is critical to prevent further disease transmission. While

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it is the responsibility of the manager/supervisor of a business to alert PHS when three or more employees test positive, the timeliness of that information is usually not as prompt as the completed CMR from the provider.

The COVID-19 pandemic has shown just how important it is to complete CMRs correctly. At the beginning of the pandemic, when fewer cases were coming in, PHS had the capacity to contact and interview every case. When this was still possible, CMRs were used to preemptively identify suspected outbreaks and cater interviews accordingly in order to reduce interview fatigue among cases.

For example, early on in the pandemic, PHS was able to identify a group of COVID positive administrative staff that worked for a local hospital based on information from the submitted CMRs. This outbreak led to 9 cases, 2 hospitalizations, and 1 ICU admit. Each case was contacted, interviewed, and given isolation orders. Their office was shut down to prevent further spread of the virus and employees had to be cleared by their doctors before returning to work.

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As the pandemic has progressed and the number of local cases has dramatically increased, CMRs have often been the only way PHS can obtain the information needed to determine if a case impacts an essential service (healthcare workers, grocery store clerks, agricultural workers).

As the pandemic has progressed and the number of local cases has dramatically increased, CMRs have often been the only way PHS can obtain the information needed to determine if a case impacts an essential service (healthcare workers, grocery store clerks, agricultural workers).

A particular outbreak this winter at a superstore illustrates how much more difficult it has been for PHS when information on cases is scarce. Though public health had been alerted to a few cases at this location (mostly through Facebook), they were unable to verify an outbreak with the limited CMR data that they had. And while some CMRs mentioned the superstore as the occupation setting, without the specific occupation location (especially in the case of chain businesses) they were unable to attribute the cases to any particular location. Eventually the store manager reached out to PHS to alert them to the number of

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cases that were employed there. To recap, if public health had known earlier, the spread of the disease may have been reduced. COVID-19 is very contagious and knowing that there is an outbreak at a workplace as soon as possible is extremely important in reducing transmission and reducing deaths.

In summary, CMRs comprise our first alert system. When health care providers report what they encounter, they play a crucial role in assisting public health to reduce or prevent the spread of diseases among our residents.

Note: Visit the PHS COVID-19 dashboard to see how some of your CMR data is incorporated into a visual display for the public. https://experience.arcgis.com/ experience/4ec4f8e1dfd142998d1732c7f5c79e45

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SAFETY GLASSES

DISPOSABLE GLOVE

S

ISOLATION OVERALL

FACE MAS K

FACE SHIEL D

SHOES COVE R

CMA and San Joaquin Medical Society

DISTRIBUTE 100+ MILLION Free Pieces of PPE to Physicians & Medical Groups Statewide The California Medical Association (CMA), which represents nearly 50,000 physicians across all modes of practice and specialty, announced that over 100 million pieces of personal protective equipment (PPE) were distributed to physicians, medical groups and staff from August 1 to December 31, 2020. The donations supported approximately 100,000 California physicians and their staff, which represented a total value of more than $200 million.

“Lack of PPE throughout the COVID-19 pandemic has compounded hardships for medical practices and

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hindered physicians’ ability to serve patients,” said CMA President Peter N. Bretan, Jr., M.D. “We knew we had to act – and fast – to help physicians keep their practices open. What resulted was an unprecedented effort in the organization’s 165-year history. CMA is grateful to our partners for their collaboration and support, which ultimately helped so many Californians continue to receive health care.”

CMA partnered with local county medical societies, including San Joaquin Medical Society, to develop an entirely new statewide distribution system for essential medical equipment,

SPRING 2021

which included PPE donations from the Office of Emergency Services (OES).

Within weeks, PPE was being moved from state warehouses, repackaged into individual kits and loaded on trucks to be handed out at drive-through events across the state. Physicians and medical practices also accessed PPE through their local county medical society or CMA’s online request portal.

“As the problem with COVID-19 infections was becoming more and more serious we had a situation with significantly dwindling reserves of PPE. It was very timely of SJMS and CMA to supply us with much needed PPE.

or close our practice completely. The PPE helped our patient care team stay healthy and enabled us to continue serving our patients – our community is healthier because of this program.”

CMA President Dr. Bretan also reiterated that the lessons learned during the PPE distribution effort would be applied to helping the state build its vaccination network.

“The administration of COVID-19 vaccines brings hope into focus, but the global pandemic remains challenging,” said Dr. Bretan. “Equity and speed remain vital components of any successful vaccination strategy, and we “As the problem with COVID-19 infections was becoming more and cannot compromise more serious we had a situation with significantly dwindling reserves one for the other. The of PPE. It was very timely of SJMS and CMA to supply us with much lessons learned distributing needed PPE. This gracious act allowed us to continue to operate the PPE will guide clinic without affecting patient care” - Neelesh Bangalore, M.D of CMA as we help the state build out Stockton Hematology and Oncology Medical Group. their robust vaccination network connected to This gracious act allowed us to continue to operate the community physicians that millions of Californians already clinic without affecting patient care” said Neelesh Bangalore, rely on for flu shots and routine vaccinations.”

M.D of Stockton Hematology and Oncology Medical Group.

In 2021, CMA is extending support to practices and As of December 31, 2020, the effort has distributed a physicians with direct shipment of PPE supplies. combination of 35 million masks, 35 million sets of gloves,

2.3 million isolation gowns, 2.5 million face shields, 400,000 The new online portal offers California physicians the ability hooded coveralls, 21 million N95 respirators, 3 million to register for specific types of PPE including coveralls (50/ sanitizing wipes and 700,000 sanitizer bottles. per case), face shields (200), goggles (120), hand sanitizer (20), sanitizing wipes (400), isolation gowns (15), N95 masks (960), “I’m really impressed with the distribution operations to smallsurgical masks (2,000) and vinyl gloves (1,000). The cases of and medium-sized practices,” said Richard Siedman, M.D., PPE are free, and the medical practice pays a nominal cost for Chief Medical Officer of the LA Care Health Plan. “These shipping and handling. medical practices are critical to the overall health care delivery system in our state and enables physicians and their staff to To learn more, interested physicians should visit more safely provide the care that their patients need.” cmadocs.org/ppe.

“These free PPE kits were a lifeline during a very challenging year,” said Elk Grove cardiologist Rajan Hundal, M.D. “Without the donations, we would have had to limit hours

SPRING 2021

SAN JOAQUIN PHYSICIAN

49

9 NEW

SJMS MEMBERS THIS WINTER!

...and even more on the way.

Maryam Zaman, M.D.

Mehul Raval, M.D.

Preeti Srivatsa, M.D.

Family Practice

Nephrology

OB/GYN

445 W Eaton

1801 E March Lane, Ste B265

1234 E North St., Suite 102

Tracy, CA 95376

Stockton, CA 95210

Manteca, CA 95336

St Georges University School of

Sri Siddhartha Med Coll, 1996

Stanley Medical Coll, Madras

Medicine, 2017

Subrahmanyam Nasika, M.D.

University, 1990

Vishwa Sheth, M.D.

Lauren Brown-Berchtold, M.D.

Nephrology

Family Practice

Nephrology

1801 E March Lane, Ste B265

500 W Hospital Rd

1801 E March Lane, Ste B265

Stockton, CA 95210

French Camp, CA 95231

Stockton, CA 95210

Saurashtra University, 2009

Keck School of Medicine at USC,

Guntur Medical College, Andhra University, 2002

Ajay Rachakonda, M.D.

2013

James Friedman, M.D.

Gurinder Singh, M.D.

Orthopaedic Surgery

Pulmonary Critical Care Medicine

2488 N California St

500 W Hospital Rd

Nephrology

Stockton, CA 95204

French Camp, CA 95231

1801 E March Lane, Ste B265

Duke University Sch of Med, 2013

N.S.C.B. Medical College, 2002

Stockton, CA 95210 Maharashtra University of Health Science, 2003

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SAN JOAQUIN PHYSICIAN

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51

In Memoriam

In Memoriam HENRY ZEITER, MD JULY 1934 – DECEMBER 2020

Dr. Henry Joseph Zeiter, beloved husband, father, grandfather, great grandfather, and uncle, passed peacefully into Eternal Life early Sunday, December 20, 2020. He died of congestive heart failure in his Lodi home, and having said goodbye to his children and grandchildren in the previous days, he took his last breath with his wife Carol and daughter Suzie beside him holding his hand. He was 86 years old. Henry, a pillar of every community to which he belonged, was born in Serhel, Lebanon, on July 31, 1934 to Yousef (Joseph) and Budwyeh (Antoinette) Zeiter and was baptized a Maronite (Eastern rite) Catholic in the village church. The youngest of 7, he attended the Christian Brothers primary school where he learned French (his second language after Arabic). At 14, he and his parents moved to Caracas, Venezuela, where his brothers Tony and Philip lived, and at the Christian Brothers school there he added Spanish to his repertoire. At 16, Henry with his parents joined brothers Dr. Mike and Edmund in Windsor, Ontario where he completed secondary school at Assumption High School and learned English. (Later as an adult he became fluent in his fifth language, Italian.) He attended Assumption College in Windsor where he studied philosophy and literature, as well as the sciences that led him into the field of medicine at the University of Western Ontario Medical School. He did his internship and residency in ophthalmology at Harper Hospital and the Kresge Eye Institute in Detroit, Michigan.

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At Harper Hospital Henry met the love of his life, Carol Joyce Schooff.

It can be argued that he had many true loves: his Catholic Faith, his family, nature, the fine arts, ophthalmology, and the list goes on. But in this list of great loves, not only in his life but in the course of history, his love with Carol ranks high indeed. They met, he took her to a concert which featured a mutual favorite, Verdi’s Requiem, and he told her on that first date, “Carol, you know something? I’m going to marry you!” She said, “You’re crazy! You don’t even know me!” and thus their feisty lifelong love began. They married eight months later on January 21, 1961 in St. Matthew’s Church in Detroit. Their oldest son, John Henry, was born the following December in Detroit, with son Philip Joseph and daughters Suzanne Antoinette and Camille Marie subsequently born in Stockton. After completing residency, they moved to Stockton, California in 1962 where Henry began a surgical practice in downtown Stockton. He was later joined by his

SPRING 2021

nephew Dr. Joe, then by his son, Dr. John, and later still by his great nephew Dr. Joseph. The Zeiter Eye Medical Group continues to thrive nearly 60 years later, currently employing 6 ophthalmologists, 8 optometrists, and 100 staff. As a “Jiddo” (Arabic for grandfather), Henry was happily anticipating his grandson Dr. John Henry, Jr., joining the family business in 2 years.

Dr. Henry himself practiced ophthalmology for 40 years, never tiring of the intricacy of the eye and helping people to see.

Throughout his life, another of Henry’s passions was classical music, which he knew and loved from childhood. Thanks to Carol, he also learned to love tennis and skiing, but an even bigger pleasure for him was travel. He and Carol enjoyed visiting with her family around the country, and his family around the world, and he took his children on trips that were to produce lifelong memories (and education) for all of them.

His love of the liberal arts and the Catholic Church led Henry, along with Carol, to embrace the mission of Thomas Aquinas College, where he was a member of the Board of Governors

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for 33 years. In his retirement, Henry reveled in spending time with his 13 grandchildren and, most recently, his first great grandchild. A parishioner at St. Anne’s in Lodi, he became a Discalced Carmelite Secular (a lay member of the Carmelite Order) and was honored to be a Knight of the Holy Sepulchre.

He was a longtime member of the American Academy of Ophthalmology, the American Society of Cataract and Refractive Surgery, the American College of Surgeons, and the San Joaquin Medical Society (past president). He belonged to the Stockton Symphony Association (past president), and finally the International Order of Odd Fellows, Lodi Chapter.

Henry was predeceased by his six siblings and his daughter-inlaw Alicia Zeiter. He is survived by his wife Carol; his children John Henry (Lynette), Philip, Suzie (Tony Andres), and Camille; his grandchildren John Henry, Jr. (Amy), Danielle, Paul, and Sierra Zeiter, Joseph and Dominic Andres, and Tyler, Zachary, Christia, Alisandra, Joseph, Michael, and Mariana Zeiter; and his great granddaughter Liliana Mae Zeiter.

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53

In Memoriam

In Memoriam WILLIAM HAMBLEY, MD 1928-2020

Dr. William "Bill" Hambley, ear surgeon and longtime resident of the Lodi area, died on December 11, 2020 at the age of 92.

Bill was born on Novmeber 26, 1928 in Merced, CA, a city he called home throughout his school years. After high school, Bill joined the Army and served in Korea then Japan, where he served with his identical twin, Harold "Hal" Hambley. When he returned, he graduated from Modesto Junior College and University of California, San Francisco with degrees as both a pharmacist and a medical doctor. He furthered his training with six years of ENT training, two years of head and neck surgery and a fellowship at the House Ear Institute in Los Angeles. Dr. Hambley was a member of the San Joaquin Medical Society for 48 years.

Bill had six children and gained another three daughters when he married Marilyn Peters-Hambley in 1982.Bill is survived by his children, Diane Hambley, Richard Hambley (Catherine), Lynn Hambley, Thomas Hambley, and Elizabeth Davis (Troy); as well as daughters, Nicolle Alessi (Steve) and Lori Peters. He is also survived by his daughter-in-law, Ruth Hambley; grandchildren, Nicholas Reddick (Rachel), Ryan Hambley (Brooke), Mitchell Hambley, Marin Hambley, Ruthie Wozniak (Erwin), William Hambley, Kirk Hambley (Kayla), Timothy Hambley (Alannah), Tara Spaans, Tyler Davis, Connor Davis, and Hailey Davis; and great grandchildren, Sawyer, Marlowe, Vincent, Theo, Zellie and Cooper. He is preceded in death by first wife, Jane McConnell; son, Leland;

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step-daughter, Leslie Mayer; and his wife of 36 years, Marilyn Hambley. Bill and his identical twin, Hal, passed away within 13 days of each other, both from natural causes.

In addition to being a devoted father and husband to Marilyn, Bill enjoyed backpacking throughout the Sierras.

He was frequently seen with a backpack full of heavy books walking around the neighborhood conditioning for his next big hike. He also enjoyed gardening and digging ditches by hand and rerouting sprinkler pipes throughout his yard. Bill had his medical practice over 40 years in Stockton, California and was sometimes known as the "gentle giant" with his 6'4" height and big hands skillfully performing microscopic surgery. His quick wit and dry sense of humor will be missed by all who knew him.

SPRING 2021

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

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