Summer 2017 by San Joaquin Medical Society

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VOLUME 65, NUMBER 2 â&#x20AC;¢ JUNE 2017

{FEATURES}

14 20 28 34 42 SUMMER 2017

8TH ANNUAL GOLF TOURNAMENT THE JOURNEY, TOGETHER

{DEPARTMENTS} 46 IN THE NEWS

New faces and Announcements

58 PRACTICE MANAGEMENT: MEDI-CAL HURDLES

Committed to Improving Quality Health Care

60 PUBLIC HEALTH FROM HERE TO THERE

Public Practice

63 NEW MEMBERS

SUPPORTING AND STRENGTHENING

SAN JOAQUIN PHYSICIAN

PRESIDENT Kwabena Adubofour, MD PRESIDENT-ELECT Grant Mellor, MD PAST-PRESIDENT John Zeiter, MD SECRETARY-TREASURER George Savage, MD BOARD MEMBERS Raissa Hill, DO, Dan Vongtama, MD, Alvaro Garza, MD, MPH, Mohsen Saadat, DO, Clyde Wong, MD, Peter Garbeff, MD, Sanjay Marwaha, MD, Ramin Manshadi, MD, Benjamin Morrison, MD

MEDICAL SOCIETY STAFF EXECUTIVE DIRECTOR Lisa Richmond MEMBERSHIP COORDINATOR Jessica Peluso ADMINISTRATIVE ASSISTANT Nicole Bojorques

SAN JOAQUIN PHYSICIAN MAGAZINE EDITOR Lisa Richmond EDITORIAL COMMITTEE Kwabena Adubofour, MD, Lisa Richmond MANAGING EDITOR Lisa Richmond

COMMITTEE CHAIRPERSONS DECISION MEDICINE Kwabena Adubofour, MD LEGISLATIVE Jasbir Gill, MD COMMUNITY RELATIONS Joseph Serra, MD PUBLIC HEALTH Alvaro Garza, MD

CREATIVE DIRECTOR Sherry Lavone Design CONTRIBUTING WRITERS George Khoury, MD, James Noonan, Kwabena Adubofour, MD, Alvaro Garza, MD, MPH, David Jensen, MD

SCHOLARSHIP LOAN FUND Matthew Wetstein, PhD THE SAN JOAQUIN PHYSICIAN MAGAZINE

CMA HOUSE OF DELEGATES REPRESENTATIVES

is produced by the San Joaquin Medical Society

Robin Wong, MD, Lawrence R. Frank, MD, James R. Halderman, MD, Roland Hart, MD,

SUGGESTIONS, story ideas or completed stories written

Grant Mellor, MD, Kwabena Adubofour, MD,

by current San Joaquin Medical Society members

Raissa Hill, DO, Ramin Manshadi, MD

are welcome and will be reviewed by the Editorial Committee. PLEASE DIRECT ALL INQUIRIES AND SUBMISSIONS TO: San Joaquin Physician Magazine 3031 W. March Lane, Suite 222W Stockton, CA 95219 Phone: (209) 952-5299 Fax: (209) 952-5298 E-mail Address: lisa@sjcms.org MEDICAL SOCIETY OFFICE HOURS: Monday through Friday 9:00 AM to 5:00 PM Closed for Lunch between 12pm-1pm

SAN JOAQUIN PHYSICIAN

SUMMER 2017

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EXECUTIVE DIRECTOR’S REPORT

TIME FLIES WHEN YOU’RE HAVING FUN I find that I measure time in different ways. In my personal life, it is by my kid’s activities- water polo season, winter break, swim season, summer vacation. At work, it revolves around our events which, at times, seem to bleed one into the next. Spring and Summer are the busiest as we move from our golf tournament to our Lifetime Achievement Award dinner to Decision Medicine. It can be a bit chaotic at times, but thankfully it is fun and our staff thrives under pressure.

LISA RICHMOND

In April, our hard-working Decision Medicine interview committee consisting of co-facilitators Brandon Piasecki, Jordan Fetsch and volunteer physicians Drs. Zeiter, Jamshidi, Pang, Khoury and Adubofour spent an entire Saturday screening 45 interviewees to select the elite 2017 Decision Medicine class. Each year, we are more impressed with the caliber of students applying. The final 24 students represent 16 San Joaquin High Schools in 5 different cities with an average GPA of 4.24. We cannot wait for this summer! Later in April, we hosted our 8th Annual Golf Tournament benefitting The First Tee of San Joaquin and Decision Medicine. It was a beautiful day and great time was had by all. We appreciate everybody who took time out their busy weekend to golf, and the generous donations of our sponsors. As the demands on our physicians continue to rise, we realize the importance of an afternoon of relaxation and fellowship with friends and colleagues. Please see Dr. Khoury’s article and pictures from the event. My job is never boring as I transition to a new boss every year. It has been a pleasure working with my longtime friend and colleague, Dr. Kwabena Adubofour, who has had the board focused on increasing membership benefits, as well as physician workforce development and creating additional fellowship opportunities to combat physician burnout. To that end, we are introducing a new membership card which will offer discounts at various local merchants. Active members should have one in their mailbox in the next few weeks! Additionally, we have partnered with the San Joaquin Dental Society for a young physician/dentist mixer in June and with the Alliance to bring back the SJMS/Alliance Family Picnic in September. More details to follow. Last, but certainly not least, we are excited to announce our 2017 Lifetime Achievement Award Recipient, Dr. Jasbir Gill and Young Physician Award Recipient, Dr. Nguyen Vo. You will find a wonderful feature on each physician towards the middle of this issue. Please join us to honor them at our annual membership dinner on Sunday, June 11 at Stockton Golf & Country Club. More details in the enclosed advertisement.

Have a wonderful summer!

Lisa Richmond

SAN JOAQUIN PHYSICIAN

SUMMER 2017

Save the Date

SEPTEMBER

SUNDAY

12:30PM

FOOD, GAMES, FUN!

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LIFE

Get Back To It

A message from our President > Kwabena O.M. Adubofour, MD, FACP

Why Compassion Matters and Other Thoughts “If you want others to be happy, practice compassion. If you want to be happy, practice compassion” The Dalai Lama

An honor and privilege to serve:

I did not realize that a year could come and go so quickly. It has been an honor and privilege to serve as your president during the past year. Strangely enough, I feel as if the year is just starting, given the fact that some projects decided by your board during my tenure as president are starting to just take off. It has been a blessing to be able to serve alongside such a dynamic, truly engaged and caring individuals on the board and in the administrative staff of your medical society. I hand the gavel over to someone who cares deeply about the house of medicine and this community. I want members to know that Dr. R. Grant Mellor, a Kaiser Pediatrician and Chief of Professional Development of our local TPMG, is a scholar and a gentleman. Grant shares my belief that our society needs to be more engaged and more responsive to the needs of our patients, our community and the needs of the members of the medical society. I urge you to extend the same amount of support that I was privileged to enjoy. ABOUT THE AUTHOR Kwabena O.M. Adubofour, MD, FACP Medical Director, East Main Clinic and Stockton Diabetes Intervention Center and Current President of San Joaquin County Medical Society.

SUMMER 2017

Your medical society needs YOU!

I also urge non-member physicians living in all the counties we serve to seriously consider becoming members of the society. The benefits are palpable. The only way we get to speak with one voice, a voice that shouts out loud and clear about advocacy on our behalf and on behalf of our patients is through organized medicine. We cannot remain on the sidelines any longer expecting magical things to happen in terms of the way we seek to practice in a hassle-free environment. Those of you who are already members, please consider serving on one of the committees of the medical society. In order to make a difference in the lives of member-physicians and our patients we must be meaningfully engaged.

SAN JOAQUIN PHYSICIAN

A message from our President > Kwabena O.M. Adubofour, MD, FACP

Graduate Medical Education – volunteer to help train our own doctors:

The board of your society is soon going to be hearing from the Director of student programs from a new medical school in Elk Grove. That discussion will center around the recruitment of physician mentors and teachers for medical student rotations. We need to embrace the opportunity to play a meaningful role in the lives of these future doctors. We need to encourage them to practice in the central valley after residency. In terms of residency training, come 2018, Dignity Health-Saint Joseph’s Medical Center- will be opening residency slots in Obstetrics and Gynecology, Family practice and Emergency Medicine. All areas in which the central valley could do with additional clinicians. This is another opportunity for society members to play a role in physician workforce development. Again, be a mentor, be a teacher and once again embrace the opportunity to meet these new residents and share your passion and love for the science and the art of medicine. The nature of our interactions with these medical students and residents will help shape them and maybe allow them to make the decision to stay and practice and raise their families in the central valley an easy one for them. Volunteer to help train them.

The only way we get to speak with one voice, a voice that shouts out loud and clear about advocacy on our behalf and on behalf of our patients is through organized medicine.

Why Compassion Matters:

In his book, “A Fearless Heart- How the Courage to Be Compassionate Can Transform Our Lives”, Thupten Jinpa, declares that “Compassion offers the possibility of responding to suffering with understanding, patience, and kindness”. He goes on to describe a current world in which we see each other as rivals and only seek our own self interests. He explains that compassion is what connects the feeling of empathy to acts of kindness, generosity and other altruistic acts. For some 8 week’s some of us had the privilege of being immersed in one of the most meaningful training programs I have engaged in - a word of gratitude to Mr. Don Wiley and Dr. Scott Neeley for putting together the Compassion Cultivation Training at no cost to physicians. I came away from the training convinced that there was more to this than just being nice and compassionate – I came away knowing that being nice and compassionate were acts that had the potential to speed up the recovery process of my patients but more importantly I came away from the training knowing that I had rediscovered why I became a doctor in the first place. I came away knowing that my daily practice of compassion and kindness could save me from burnout. I came away more resilient and more determined to increase my cellular levels of telomerase – you read that correctly! Yes, practicing compassion and meditating can increase levels of telomerase – a vital rejuvenating enzyme that extends the life of cells and helps repair cell damage. The evidence is already in. Here is to more acts of compassion and kindness designed to save ourselves.

Current Discussions on Healthcare:

Without as much as a hint of delving into the political discussions surrounding healthcare in this great nation, let me say this - at the end of the day what is “hugely” important is healthcare for every citizen of this country. Healthcare that is affordable and quality driven. A Healthcare system that seeks to prevent disease and promote, well, good health as defined by the World Health Organization (WHO) - a “State of complete physical, mental, and social wellbeing, and not merely the absence of disease or infirmity”. A system that clearly says we care about each other. A system that is filled with compassion and not one designed to enrich a few at the expense of the many.

SAN JOAQUIN PHYSICIAN

SUMMER 2017

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SUMMER 2017

By David Jensen, MD

HOW ABOUT A

CYCLING GROUP? Dr. Kwabena Adubofour has asked Dr. Moris Senegor and me to consider organizing a cycling group within our Medical Society. As such, we are soliciting our members to determine if there is interest. I have always enjoyed riding a bicycle. About seven years ago I took it to a higher level. I was involved with an early morning running group in our Brookside neighborhood that included Drs. John Canzano and Mario Sattah. I sarcastically refer to this group as a Think Tank because our discussions are mostly humorous and entertaining. Nothing too intellectual like you might expect with the Hoover Institute or similar organization. Anyway, the running group is also into road cycling. So to continue to hang with these hilarious people, I went all in with a custom fit carbon fiber road bike, clip-in pedals, loud spandex bike wear and everything else. Our initial rides were around Woodbridge, Acampo and, Linden. My first long ride was around Lake Camanche and over Pardee Dam, about 40 miles in the beautiful Sierra Nevada foothills. That was a lesson in the importance of continuous nutrition and hydration to prevent cramping. My second long ride was in the same location but this time all the way to Mokelumne Hill and back with Drs.

Steve Eager, Roland Winter, Gary Murata and a couple of others. Immediately I knew I was in over my head. They were kind enough to wait for me periodically but I didn’t want to hold them up. At one point my chain came off which caused further delay. Roland came back to check on me. He told the others that I was attacked by a flock of wild turkeys! We eventually made it to Mokelumne Hill for a rest stop. I returned safely by myself while the others continued riding. Since then I have had countless memorable rides including one around Lake Tahoe, 3 century rides (100 miles) in Sonoma , Monterey, and the Berkeley hills to name a few, not to mention our beautiful country roads in San Joaquin County and the neighboring foothills. I also enjoy the American River Bike Trail in Sacramento. Today’s road bikes are incredibly efficient and very fun to ride! Mountain bikes and hybrid bikes are other options. Some even come with electric motors if you think you might need assistance! I have to thank the Think Tank for introducing me to this wonderful sport, as well as former St. Joseph’s COO Mike Ricks. I’m not an expert in the field but I might know enough to help any of you get started if you are interested. I can also repair your flat tire!

CONTACT

me or Dr. Senegor (943-0305) if you are interested. David Jensen, MD l Dr.David.Jensen@DignityHealth.org l (209) 461-5338

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SAN JOAQUIN PHYSICIAN

8TH ANNUAL BY GEORGE KHOURY, MD

TOURNAMENT 14

SAN JOAQUIN PHYSICIAN

SUMMER 2017

Sometimes You Just Need a Little Help.

The weather was perfect for the 8th annual SJMS Golf Tournament benefitting The First Tee of San Joaquin and Decision Medicine, held on Sunday, April 30 at the beautiful Stockton Golf and Country Club. This annual event is a great occasion for our medical society and its members, to work with our larger community in providing opportunities to build and expand our youthâ&#x20AC;&#x2122;s aspirations and futures. The day started with a pregame barbeque lunch and Putting Contest. The game was played smoothly without delays on the perfectly manicured greens using a simple scramble format and evening ended

with a delicious dinner and many, happy raffle prize winners! Thank you to Rich Howarth, Kelly Spooner and staff at Stockton & Country Club for making the tournament run seamlessly. Our energetic, fully engaged committee worked hard to bring in 80 golfers, 40+ raffle and silent raffle prizes, as well as a grand door prize of $1000 gift certificate donated by 209 Furniture! We would like to thank everyone who participated in and sponsored this event. We are excited to announce that, we raised $4000 to benefit the First Tee and $4500 for SJMSâ&#x20AC;&#x2122; Decision Medicine.

eighth annual

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SAN JOAQUIN PHYSICIAN

Eighth Annual Golf Tournament

SAN JOAQUIN PHYSICIAN

SUMMER 2017

Sometimes You Just Need a Little Help.

8TH ANNUAL

TOURNAMENT

THANK YOU TO OUR SPONSORS

FIRST PLACE GROSS:

209 Furniture

Jim Nesbitt

American Hearing Aids

Ryan Winther

Art Godi Realtors

Justin Holcomb

Cassel Ginns, A Professional Law Corporation

Alan Corey

Crown Enterprises Darren Primack, MD

FIRST PLACE NET:

Financial Center Credit Union

George Savage

Lawrence Frank, MD

Carl Toliver

Oak Valley Community Bank

Ross Villinskas

Zeiter Eye Medical Group

AJ Hohn

SECOND PLACE: Phillip Herrera

GOLF TOURNAMENT COMMITTEE:

Michael Herrera

George Khoury, MD

Evan Herrera

Kwabena Adubofour, MD

Anthony Herrera

George Herron, MD Cathy Ghan,

CLOSET TO THE PIN:

Oak Valley Community Bank

Karin Heath

Lisa Richmond,

Josh Charlson

San Joaquin Medical Society Nicole Bojorques,

LONGEST DRIVE:

The First Tee of San Joaquin & SJMS

Kathleen Gallup

Donald Miller,

Mark Williams

The First Tee of San Joaquin Karin Heath

PUTTING CONTEST WINNER:

Gary Malloy

Scott Ginns

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SAN JOAQUIN PHYSICIAN

SUMMER 2017

The

Journey,

r e h t e g To BY JAMES NOONAN

Dr. Nguyen Vo spends her days shaping San Joaquin County’s next generation of physicians, while her own path in life has been shaped by friends, family and colleagues along the way.

The road to success is one that’s rarely walked alone. Such is the case for Dr. Nguyen Vo, this year’s recipient of the San Joaquin County Medical Society’s Young Physician Award, who would be the first to tell you that the milestones in her life, both personal and professional, would not have been possible without the support of those around her. Vo, who graduated from San Joaquin General Hospitals internal medicine residency program in 2012, has gone on to serve as a member of the program’s teaching faculty, conducting the valuable work of training the physicians who will one day care for some of the region’s most vulnerable patients. Leading her to this point in her career has been a lifetime of experiences that demonstrate just how vital one’s community can be for success. >>

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SAN JOAQUIN PHYSICIAN

“It’s all about teamwork,” she said. “It’s having that very special group of people behind you no matter what you’re doing.” This sense of teamwork and community began early in life, when, in 1990, a nineyear-old Vo and her parents emigrated from post-war Vietnam, eventually settling in Stockton, where Vo’s uncle had set down roots only a few years earlier. During the war, Vo’s father had fought for the South Vietnamese, meaning that he and his family were subject to a bitter divide that remained in the county after “It’s all about teamwork, it’s having that Saigon fell to very special group of people behind you the Communist North in 1975. no matter what you’re doing.” “After the war, it was almost worse. It was just survival mode. Under the new communist regime,

SAN JOAQUIN PHYSICIAN

SUMMER 2017

my parents couldn’t get a job. They rented a small space in someone else’s house and sold their wedding rings, their possessions, just to afford food,” she said. “They were trying to get out, so that I could have a better life. They gave up everything that they had to help me achieve my goals.” Once in Stockton, Vo began to form connections with her community, one that was shaped largely by hardships similar to what her own family had endured. It was here, she said, that the idea of a career in medicine began to take hold in her mind. “I can’t tell you exactly when it happened, but it started young. The most important thing for me was seeing the difficulties that my parents went through,” she said. “I wanted to do something with my life that would allow me to help others during their time of hardship. Medicine was my way to do that.”

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SAN JOAQUIN PHYSICIAN

“I had been away from home, essentially since college, I knew nothing about San Joaquin General, except that, growing up, that’s where immigrants got their health care.”

While Vo’s connection to her community Vo admits that it still required a small leap in California’s Central Valley was strong, of faith. she would be the first to tell you that, as a “I had been away from home, essentially young adult, setting up a practice here was since college,” she said. “I knew nothing the furthest thing from her mind. about San Joaquin General, except that, “In my high school days, I was like every growing up, that’s where immigrants got other teenager that just wanted to get away their health care.” from Stockton,” she said, noting that despite Today, Vo and her team of attending an undergraduate education San Diego and physicians are an integral part of delivering attending medical school in Grenada, the that care, helping service a population of draw of her hometown would eventually prove too strong to “I think that San Joaquin General has resist. “I explored. I was in the Caribbean, I was in New York, I been instrumental in expanding the was in New Jersey, and all those physician community” places, it never felt like home. It never felt like I belonged. It never felt like a place that I would spend my patients that she describes as “the most career.” wonderful, but also the most difficult” that During her time in medical school, an a physician is likely to encounter. On top of opportunity to return home to Stockton their responsibilities to these patients, Vo came about by way of a clinical training and her team also play an immense role in agreement that St. Georges University, helping ease the Central Valley’s ongoing Vo’s medical school, had with San Joaquin physician shortage, by training physicians General Hospital. While her then-boyfriend that they hope will stay local and help ease and now husband, Richard Wong, being in the medical burden being placed on the Stockton at the time made the prospect of region. returning to the Central Valley appealing, “We know how hard it is to recruit

SAN JOAQUIN PHYSICIAN

SUMMER 2017

physicians to the Central Valley,” Vo said, noting that her days making San Joaquin County a better place for under the direction of Dr. Sheela Kapre, the hospital’s physicians and patients, alike. longtime director of graduate medical education, San “This really isn’t a journey that I took,” Vo said. “It’s Joaquin General Hospital has developed a reputation something that we all did together.” of retaining the physicians who come there to train as students and residents. “I think that San Joaquin General has been instrumental in expanding the physician community,” Vo said. “It’s really somewhere that people can come and make a huge difference.” Meanwhile, Vo and her husband, Richard, who is an ophthalmologist with the A Professional Law Corporation Zeiter Eye Medical Group in Stockton, are also busy MICHAEL R. MORDAUNT balancing the obligations that come with raising two PETER J. KELLY young children. RICHARD J. SORDELLO, JR. “We do get a lot of help,” CORINNE K. REYNOLDS she said, noting that both her and her husband’s STEPHANIE ROUNDY colleagues have been LORI A. REIHL extremely flexible when it MELISSA I. DOUGHERTY comes to dealing with the demands of parenthood. “They’re a very special Our firm devotes its practice to civil litigation with decades of experience group of people. We truly representing healthcare professionals in: treat each other like we’re a family.” • MEDICAL MALPRACTICE ACTIONS Perhaps, if there were • MEDICAL BOARD INVESTIGATIONS some secret to the success • HOSPITAL CREDENTIALING that Vo has enjoyed up to PROCEEDINGS this point in life, it would be • PERSONAL INJURY LITIGATION that –surrounding herself with special people who are 2509 West March Lane, Suite 200 there to support her years of Stockton, California 95207 hard work. As a result, these Phone (209) 473-8732 Fax (209) 957-9165 people – her friends, family and colleagues – have all played a part in developing an individual who spends

SUMMER 2017

SAN JOAQUIN PHYSICIAN

SUMMER 2017

Strong community partnerships lead to happier, healthier people

Celebrate Health Partnering today for a healthier tomorrow

With over 345,000 members and growing, Health Plan of San Joaquin continues to build relationships with health care providers, resource agencies and local businesses to deliver on our mission to improve wellness throughout the communities we serve.

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SAN JOAQUIN PHYSICIAN

28 SAN JOAQUIN PHYSICIAN

SUMMER 2017

CALIFORNIANS WITH

MEDI-CAL FACEHURDLES TO SEE SPECIALISTS THROUGHOUT THE STATE BY ELIZABETH ZIMA

California’s communities face a severe shortage of physicians, which is expected to get exponentially worse as the population continues to grow and our aging physician workforce moves toward retirement. Medi-Cal enrollment has surged since 2014, but the percentage of California physicians serving MediCal patients has dropped, a trend that is hampering access to care for enrollees. One in every three Californians (14.3 million) is dependent on Medi-Cal for health care, so this disparity also negatively impacts a patient’s ability to access needed treatment, according to a recent study by the California Health Care Foundation. There is a fundamental problem with Medi-Cal that is hindering patient access to care, and to specialists in particular – Medi-Cal physician reimbursement is so low that physicians cannot cover the cost of providing care. Currently, California has some of the lowest reimbursement rates for providers ($18 for an office visit), creating an unsustainable disparity between the number of Medi-Cal patients and the physicians who are able to accept them as patients. “Specialists are paid so poorly that they don’t want to take Medi-Cal patients,” said Mark Dressner, MD, a Long Beach clinic family physician and former president of the California Academy of Family Physicians. “We’re really disappointed and concerned with what it’s going to do for patient access.” >>

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SAN JOAQUIN PHYSICIAN

Medi-Cal Hurdles > Seeing Specialists

The volume of poor and uninsured patients that need to see specialists has overwhelmed the health care system in Los Angeles causing appointment delays. Dr. Dressner says he is extremely frustrated with the problem. “If I have patients that need a rheumatology consultation, it can take two years for them to get an appointment,” he explains. Some of his patients have to travel over 50 miles to see specialists who will take Medi-Cal because none of the specialists in the immediate area will. Not only are physicians frustrated with the lack of access to care, the patients themselves are frustrated with their treatment. Barbara Appling, a 56-year-old diabetic, was referred to an orthopedist in the Los Angeles area near her home. “I called the office repeatedly for an appointment. It took four months to get one. Then, when I went to the office, I

through the Shasta Community Health Center in Redding, says some of the most difficult issues she faces are getting her sickest patients referrals to specialty providers. The frustration of not being able to refer wears on her – like the time her patient suffered without an appointment. “She had complicated medical problems, and she was homeless,” Dr. Lupeika says. “She had a cancer on her face that had been partly removed, but it came back. We couldn’t get a biopsy. It is really hard to get our patients into specialists due to insurance issues.” Lack of access to specialists also plagues San Diego County. “The challenge that we face is that reimbursement to physicians is the third-lowest in the country. So that limits access to specialty care,” says Patrick Tellez, MD, MPH, a pediatric allergy and immunology specialist and Chief Medical Officer for North County Health Services, which provides health care to a I called the office repeatedly for an diverse community of low-income patients at 13 health centers in North San Diego and appointment. IT TOOK FOUR MONTHS to get Riverside counties. one. Then, when I went to the office, I was there “Our mission, as a primary medical, dental and behavioral health practice attending to for 40 minutes waiting to be seen – until the office over 65,000 patients annually, is to assure manager told me THEY COULD NOT SEE ME. that our patients are able to access and receive needed primary and specialty care was there for 40 minutes waiting to be seen – until the office that meets the high standards that every one of us expects manager told me they could not see me.” Appling has both when we are the patient,” says Dr. Tellez. “However, when Medi-Cal and Medicare insurance. The office staff member the reimbursement for specialty care is so low, specialists can told her the doctor didn’t take either. only afford to accept a small percentage of patients that truly “I’m very frustrated that I cannot see a doctor when I need need and deserve the care.” to. People have refused to take Medi-Cal since I got it,” she “So, while in an average month we as primary care said. Due to low Medi-Cal reimbursement rates, physicians providers may make about 2,500 or more referrals to who see Medi-Cal patients often do so at a financial loss specialty care, due to affordability, wait times and constrained to their practices. In order to maintain viable practices that access, less than half are able to be seen. As a result, this has can continue to serve their communities, physicians who the long-term adverse impact of increasing the cost of care for take Medi-Cal often need to limit the number of Medi-Cal everyone. Improving access to specialty care has been shown patients that can be treated in their practice. to help prevent preventable complications of chronic disease, Because they do not have ready access to physicians, Mediwhich lowers the long-term cost of care… it acts like a rising Cal patients are more likely to postpone needed care due to tide that floats all boats.” long appointment wait times. They are also twice as likely to Of California’s 58 counties, Merced County has the use emergency room visits to access specialty care (compared 43rd worst physician-to-patient-ratio, with just 45.4 to individuals with private insurance or Medicare). family physicians per 100,000 residents. That’s far less In areas where the numbers of specialists are low, than California’s statewide ratio of 77.3 doctors per physicians are more likely to report difficulty obtaining 100,000 residents. According to the Merced County 2016 referrals for Medi-Cal patients than for privately insured Community Health Assessment, the entire county is patients. considered a health-professional shortage area. Debra Lupeika, MD, a family physician providing care Eduardo T. Villarama, MD, family physician and regional

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SUMMER 2017

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SUMMER 2017

Medi-Cal Hurdles > Seeing Specialists

medical director of Golden Valley Health Centers in Merced, $1.2 billion in new health care revenue for its intended purpose, says he is aware of many instances when patients who needed instead of writing a blank check to the general fund.” to see a specialist were turned away. “We have more than 70 percent Medi-Cal patient We have more than 70 PERCENT MEDI-CAL PATIENT population, and specialty care POPULATION, and specialty care providers regularly turn providers regularly turn them away or are not able to accommodate them away or are not able to accommodate the demand the demand because the specialists because the specialists are not reimbursed appropriately. are not reimbursed appropriately.” He says a few of his patients, “one with seizure disorder and the other we suspect to have multiple sclerosis,” have had to wait for at CMA and the California Dental Association are calling on least six months to be seen by a specialist in neurology. “I know the legislature to uphold the will of Prop 56 voters and use for a fact that the patients being insured by Medi-Cal played a the tobacco tax revenues to increase Medi-Cal patient access role in our abilities to get them in sooner.” to doctors and dentists. Our plan strengthens Medi-Cal and Ample research demonstrates that the Medi-Cal system is Denti-Cal, which will lead to healthier patients and long-term struggling from chronic underfunding. Last year, the California financial savings to the state. Medical Association (CMA) co-sponsored the Proposition Serve Medi-Cal patients? Please send your experience and 56 tobacco tax to raise money to improve access to and quality perspective to communications@cmanet.org. CMA wants to of medical services for all Californians – especially our most highlight the access to care challenges facing you, your patients vulnerable communities who rely on Medi-Cal. and community. The language was clear – tobacco tax revenues must be used to increase access to health care by providing improved payments for treatment and services. However, Governor Jerry Brown’s $120 • • billion budget proposal for the 2017-18 fiscal year takes $1.2 billion of the Prop 56 tobacco tax money to cover existing state budget obligations in Medi-Cal. With 14.3 million Californians – and 50 percent of all the state’s children – relying on Medi-Cal programs to provide basic and specialty care for serious diseases, the stakes are high. The Governor’s proposed budget simply adds more patients to the back We Can Help. of the line and maintains the status quo, The environment of health care is changing—you have the which does nothing to help patients gain opportunity to not only become sustainable but to succeed. Our needed access to doctors and dentists. team will help you become ADEPTSM at the business of health care. “People voted overwhelmingly in support of improving payments for Irv Barnett, MBA, CMPE programs and providers to ensure that ibarnett@V2VMS.com patients can see a doctor when and where 916.747.9611 v2vms.com they need one,” says CMA President Ruth Haskins, MD, “We must honor the will of the voters and use the estimated SACRAMENTO | ATLANTA | BELLINGHAM | LEWISTON

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DR. JASBIR GILL’S LIFE HAS TAKEN HIM FROM ONE CORNER OF THE GLOBE TO ANOTHER, ALLOWING HIM TO TOUCH COUNTLESS LIVES ALONG THE WAY.

When one views history as the voyage from “what was” to “what will be,” it becomes clear that it prefers a less than direct path. Like a prize fighter, it bobs and weaves, jutting left and right, up and down, creating our ever evolving unique reality every step of the way. It is these seemingly random historical detours and sojourns that truly impact our collective historical journey. If this is true for history, then perhaps the same can be said for those who to aspire to make it. Dr. Jasbir Gill, the man who spent his career pioneering minimally invasive gynecological surgery techniques in San Joaquin County hospitals and ushered in a new era for organized medicine in the region through the purchase of the San Joaquin County Medical Society’s first permanent headquarters building in the late-1990s, is one such person, and while such contributions have, today, made him a pillar of the local medical community, his path toward such a life was anything but direct. >> “It has been a long road,” Gill said. “I think I’m a better person because of it.” Born in Northern India, his path through life took on its somewhat circuitous nature at an early age. When Gill was only 10 years old, his father took a position with a timber company that required he and his family to relocate to Jinja, Uganda, a town that sits on the shores of Lake Victoria, at the headwaters of the Nile River. The transition, he recalls, was a tumultuous one, but would present both challenges and opportunities that would help shape his eventual path toward a career in medicine. “When we first arrived, I didn’t speak a word of English,” Gill said. “It wasn’t until I was 11 years old that I even spoke the language.” While the move to a distant foreign country was sure to present certain difficulties, Gill notes that it was during these years that the spark that would eventually grow into a long and fruitful career in medicine was first ignited. The timber company that employed his father, he explained, had hired a physician to treat and care for workers at the job site. As a child, Gill took an immediate interest in this man’s work, and eventually found himself lending the occasional helping hand to get an up-close look at what the medical profession in those days entailed. “I used to carry around his black bag when he was making house calls,” Gill said. “He would allow me to do things like change the dressing on a wound. All of it intrigued me.” It was during these formative years in Gill’s life that he had his first experience in providing medical care to the communities that needed it most. Through his involvement with the national scouting organization, he played a critical role in establishing a network of first aid clinics in the communities around his home province. This experience, along with his continued academic work while finishing high school, saw Gill’s desire to enter the field of medicine grow stronger, and when it came time to select a program

“IT HAS BEEN A LONG ROAD, I THINK I’M A BETTER PERSON BECAUSE OF IT.”

through which he could begin his medical education, another chance encounter in Uganda would see him soon uprooting and taking yet another unpredictable turn on his path toward San Joaquin County. As Gill was finishing his studies in high school, an Irish priest who was known as Brother Lawrence would frequent the timber operation, making lumber purchases for building projects back home. Over the course of their interactions, Gill got to know Brother Lawrence, who would eventually convince him that Ireland should be his next stop on the path through life. “He was such a nice man,” Gill said. “And he always spoke so highly of Ireland.” While the decision to attend the Royal College of Surgeons in Ireland came about through rather serendipitous circumstances, relocating to a third country in less than the first two decades of his life presented Gill with an entirely new set of circumstances and challenges to face. “There was certainly some culture shock and it took me some time to adjust,” he said, adding that the stress of moving to a completely new country was only compounded by the rigorous expectation that come along with medical school. “I was coming from high school at that time, and remember feeling very insecure.” Such insecurities ultimately proved to be unfounded, as Gill excelled in his studies, gaining recognition from his instructors. At roughly the same time, he would be receiving some high praise due to the public health efforts he had made years earlier back in Uganda. While a student in medical school, Gill learned that he was being invited to

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“MY ONLY DREAM DURING MY FIRST YEARS THERE WAS TO LIVE IN A HOME WITH CENTRAL HEATING.”

London to receive the Duke of Edinburgh’s Gold Award in recognition of his work back in high school to establish first aid clinics throughout his home province. The award, which to this day serves as a great point of personal pride, was presented to him by Prince Philip at Buckingham Palace in July of 1968. Ultimately, Gill’s time in Ireland proved to be some of the more formative years of his life, and he still recalls the years he spent in Dublin fondly, remembering that it afforded him the opportunity to develop on both a professional and personal level. “After medical school, I brought my family back to see Ireland,” he said, noting that despite its friendly people and beautiful landscape, life in Ireland did pose certain challenges to a man who had spent his earlier years in either India or east Africa. “My only dream during my first years there was to live in a home with central heating,” Gill said. In the final year of medical school, Gill had made plans to begin his residency, and for a brief moment, it looked as though he would be returning to a familiar locale, rather than continuing the trend of bounding from one unknown country to the next. History, however, would take yet another unexpected turn. Gill had been accepted to the residency program at the University Hospital in Kampala, Uganda, when in August of 1972, then-President Idi Amin

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SAN JOAQUIN PHYSICIAN

In the span of only a few decades, Gill had made his way from Northern Indian to French “WE PROVIDE COMPLETE CARE, FROM Camp, by way of Michigan, Boston, Dublin and THE CRADLE TO THE GRAVE.” Uganda. While his path up to this point had been anything but conventional, it’s safe to say that the lives of those that he has touched - both patients and colleagues - would ordered the expulsion of all ethnic Asians from the countries not be the same had Gill’s path not taken him where it did. borders. Amin’s order suddenly turned tens of thousands From 1977 until 1992, Gill served as the Associate Director of ethnic Asians living in Uganda into refugees overnight. of the Residency Program in Obstetrics and Gynecology at San Meanwhile, the decision brought a swift end to Gill’s plans of Joaquin General Hospital, making him a trusted teacher and returning to Uganda. advisor to entire generation of surgeons in San Joaquin County. “Everything was canceled,” he recalls. “Suddenly, I was left in “That whole time I could bring residents in to watch my Ireland with nowhere to go.” surgeries” Gill said, reflecting on his decade and a half spent Gill was left scrambling, and was eventually able to secure a shaping the careers of young physicians. “I think the whole refugee-status student visa to the United States. Here, he would experience really keeps you on your toes.” go on to complete a year-long medical internship at Malden As great an impact as Gill has had on the physician Hospital in Boston under the supervision of Dr. Warren community in San Joaquin County, it could be argued that his Bennett, who Gill now credits as having a major role in shaping impact on the lives of his patients has been even greater. Today, his view of how a physician should interact with their patients. his Gill Obstetrics and Gynecology Medical Group, which “I learned so much from his kindness,” Gill said. “He taught he founded along with his wife Param Gill, M.D., employs me how to communicate, how to talk to patients.” more than 20 physicians and operates multiple clinic locations After his brief stint in Boston, Gill would complete his OB/ throughout San Joaquin County. GYN residency through the University of Michigan at Pontiac “We provide complete care, from the cradle to the grave,” Gill General Hospital. He would finish his training in 1977, and only said, noting that the medical group has been responsible for the then would he begin to set his sights on the communities within delivering tens of thousands of babies across the staff’s more California’s Central Valley that he would benefit so greatly over than 60 years of combined medical experience. the course of his career. While at the helm of both the Gill OB/GYN Medical Group “I wanted to find somewhere with land that could be farmed,” and the San Joaquin Medical Society, he worked tirelessly as Gill said, noting that he had long held agricultural aspirations an advocate for patients’ rights, particularly when it came to in addition to medical ones. “San Joaquin General Hospital squaring off with insurance companies over preauthorization of provided that.”

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Please join us for the

Annual Membership Dinner honoring our

2017 Lifetime Achievement Award Recipient

JASBIR S. GILL, MD Young Physician Award Recipient – Nguyen T. Vo, MD

S U N D AY, J U N E 1 1 , 2 0 1 7

Cocktail Reception 6:00pm | Dinner 7:00pm

S TO C K TO N G O L F & C O U N T RY C LU B

3800 Country Club Boulevard | Stockton, California Member Physicians and Spouse/Guest – $45 per person Non-Members and Invited Guests – $75 per person

Additionally, we will honor the passing of the gavel from Kwabena Adubofour, MD to R. Grant Mellor, MD

If you would like to attend this event, please call in your reservation to the Medical Society: (209) 952-5299 before June 2

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SUMMER 2017

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potentially lifesaving medically procedures, such as ultrasounds to San Joaquin County in the first place, that he would have used to detect various types of cancer. taken on such a diverse portfolio of interests after his visionary Gill also established and ran the region’s Pacific Women’s medical career. He, along with his wife Param and sons, Medical Clinic, a network of care facilities intended to provide Chaman, Vick and Ricky, have made an indelible mark on the prenatal care to financially disadvantaged women, and was community they now call home. instrumental in actively promoting the mission of Su Salud, a “I have been blessed in life, and have been fortunate enough medical organization dedicated to caring for the uninsured and to help many people along the way,” he said. “In the end, that’s working poor in San Joaquin County. what medicine is really all about.” While his achievements and efforts to increase both access and quality of care in the region have been immense, Gill’s contributions to the field of minimally invasive surgery is perhaps the foundation on which his legacy will be built. Beginning in the late 1980s, Gill began specializing in minimally invasive techniques such as laparoscopic Lawyers Who Solve the Legal Issues procedures to treat ailments such as Confronting Physicians urinary incontinence, and he would Malm Fagundes LLP offers the strength and resources of later go on to complete the first carbon attorneys and professional staff experienced in a range of services. Our attorneys provide advice and counsel in dioxide laser laparoscopy hysterectomy medical malpractice litigation, business, real estate, and in the region. personal needs of physician clients. “These procedures mean less blood Joe Fagundes provides experienced, successful loss and less pain for the patient,” Gill representation of physicians and other health care providers in defending malpractice suits, said. “Instead of three to four days in the protecting hospital privileges, and answering hospital and several weeks recovering, medical board inquiries. He also provides guidance and assistance in real estate and the patient can go home within 24 to financial matters. 48 hours, and is typically back at work Scott Malm advises physicians and their within the week.” offices regarding business formation, employment and labor matters, Today, with the techniques that and personal estate planning. he helped introduce having become standard practice in the field, Gill is able to enjoy the slightly less stressful, yet by no means less demanding, lifestyle that retirement has afforded him. These days, he oversees the family’s agricultural operation, which, among other things, is responsible for growing grapes for regional powerhouses such as Bogle Vineyards. He’s also playing a role in the family’s real estate development aspirations, including We welcome the opportunity to their mixed-use Gill Grove project in speak with you regarding your downtown Stockton, while helping legal needs during a confidential consultation. Visit our website at manage their RV resort in Flag City. malmfagundes.com and call us at It should be no surprise to those 209-870-7900. that know Gill well, and know the malmfagundes.com uncommon path that brought him

Representing and Advising Area Physicians for Over 30 Years

SUMMER 2017

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42 SAN JOAQUIN PHYSICIAN

SUMMER 2017

SUPPORTING STRENGTHENING BY GAIL JARA, EXECUTIVE DIRECTOR, CPPPH

CALIFORNIA PUBLIC PROTECTION & PHYSICIAN HEALTH (CPPPH) LOOKING OUT FOR PHYSICIAN HEALTH AND WELLBEING.

BACKGROUND CPPPH was incorporated in 2009 as a 501 (c) 3 with organizations convened by CMA and chaired by Jim Hay, MD, then the Speaker of the California Medical Association House of Delegates. He called together those with a long-standing involvement with physician health, namely the California Society of Addiction Medicine, the California Psychiatric Association, the California Medical Association, and the California Hospital Association. Why? Because the Medical Board of California had closed its “Diversion Program for Physicians” and left the medical societies and medical staffs with no central resource and not enough information for responding to physicians with potentially impairing conditions. In the years since, CPPPH has focused on supporting and strengthening the committees responsible for physician health and wellness in our medical staffs and medical societies - all with the understanding that supporting physician health contributes to public safety by providing services for physicians who face medical, substance use, psychological, behavioral and/or emotional issues that, if left unaddressed, could adversely impact their ability to deliver safe patient care. >>

SUMMER 2017

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SAN JOAQUIN PHYSICIAN

SUMMER 2017

HELPING MEDICAL STAFFS AND MEDICAL GROUPS Doctor Dean’s article in the Fall 2016 issue of Central Coast Physicians, “How Physicians Treat One Another Matters”, is a reminder of how frequently “behavior” arises as an issue, how it is connected to stress/burnout and physician health, and how easily it can become a problem that a medical staff or medical group has to address. That is the purpose of the CPPPH paper, “Behaviors that Undermine a Culture of Safety.” It addresses behavior defined as “a pattern of personal conduct, or even a single instance, deemed by peers to be outside of professional standards and detrimental to a patient, patient’s family member, the health care team or the efficient delivery of health care services.” We know that there are circumstances where the demands of a situation result in a person’s crossing over the lines of acceptable behavior. What do you do about that? Without an assessment of the specifics and surrounding details, it is not possible to determine what constitutes an appropriate personal response or a medical staff response in each situation. The paper is written to assist in making those decisions. It is the same for the CPPPH guideline titled “Assessing Late Career Practitioners: Age-based Screening: Policies and

CPPPH NEWSLETTER CPPPH eNews comes out three times a year with information and articles for those interested in physician health. All past copies are on the CPPPH website. To get on the mailing list to receive a copy emailed to you when it comes out, send your email address to CPPPHInc@gmail.com.

Procedures.” It is written as an in-depth review of the factors to consider and a description of the kind of personal approach that can be the difference between hostility and peer support.

BURNOUT All organizations and many authors are talking about burnout now, and the challenge is finding what can be done at the level at which most of us function. According to Karen Miotto, MD, the Chair of the CPPPH Board, we have to focus now on learning about the approaches that have been shown to be effective: systemic change that can lessen rates of burnout and prevent the problems we deal with before they start. That is the information CPPPH is finding and sharing. Last August, a day-long workshop featured presentations, tools,

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and how-to exercises from two programs that have been in place for more than three years. The presenters were Jo Shapiro, MD, Director of the Center for Professionalism and Peer Support at the Brigham and Women’s Hospital (BWH) in Boston, and James W. Pichert, PhD, Co-Founder, Vanderbilt Center for Patient and Professional Advocacy. This August, the same conference, called Keys to Physician Wellness -- From Burnout to Professional Satisfaction: Personal and Organizational Stories, will continue the same approach featuring Christine Maslach, PhD and her research on burnout in the workplace and Stephen Beeson, MD and his Physician Effectiveness Program. Both present practical information about what to do, how to do it, and why it is done that way.

PHYSICIAN HEALTH PROGRAM FOR CALIFORNIA The original mission of CPPPH was to advocate for physician health program for California so that physicians here would have the same services that physicians in every other state in the country (except 3) have. Here is the full story of where that stands now. In September of 2016, Governor Jerry Brown signed SB1177 authorizing the Medical Board of California (MBC) to establish the Physician and Surgeon Health and Wellness Program “for the early identification of, and appropriate interventions to support a physician and surgeon in his or her rehabilitation from, substance abuse.” The law requires that the program comply with the 1441 Uniform Standards Regarding Substance-Abusing Healing Arts Licensees. The law as passed has no provision for funding the new program from physician licensure fees or state funds. The law says the program will be paid for by participant fees. The next step is for the MBC to prepare regulations and then issue a Request for Proposal seeking an entity to administer the program in line with the regulations. On January 11, 2017, the Medical Board convened a meeting of interested parties to hear comments on what the Board plans to put in the regulations that will govern the new program. MBC staff distributed their notes showing what they plan to put into the regulations, which can be found on the CPPPH website. According to the schedule announced at that meeting, the Medical Board must complete three separate steps in order to open a program: 1) regulations adopted for operations of the program, 2) an RFP issued and an administering agency selected, 3) a second set of regulations adopted to set the fee that will be charged to each participant. No timeline has been published by the Medical Board. Meanwhile, CPPPH continues its workshops, consultation, and guidelines to strengthen wellbeing committees and physician health resources.

SAN JOAQUIN PHYSICIAN

In The News

IN THE

NEWS Alliance Community Giving The San Joaquin Medical Society Alliance has a history of giving back to the community. Historically a nursing scholarship was funded through the Medical Society Scholarship Loan Fund in the amount of $500-$1000 per year. In March 1989, the Alliance established the San Joaquin County Medical Society Auxiliary Scholarship at Delta College. In August of 2006, the Auxiliary transferred the monies and administration of the scholarship directly to Delta College. In September of the same year, the name of the scholarship was changed to the Helen Stein Nursing Scholarship in honor and memory of longtime member Helen Stein. The Alliance continues to fund the scholarship fund and two $500 scholarships are given each year. You are not reading incorrectly- for years it was the Auxiliary and in the mid-nineties it became the Alliance. To help perpetuate the scholarship, we are asking the medical community to assist the Alliance with donations to the fund. Checks can be made to the Helen Stein Scholarship Fund and either sent to Alliance treasurer, Florence Kamigaki, 3849 Pennisula Court, 95219 or directly to Delta College, 5151 Pacific Ave, 95207 Attn: Financial Aid Office. The Alliance also collects toiletries (those little bottles you find in hotels) and once a year the members make small bags of necessities and donated them to a local shelter. The society office has a shelf for them and can be dropped off when the office is open. The Alliance has also been a contributor to Decision Medicine, Hospice, Child Abuse, to name a few, and distributed SAVE (Stop Americas Violence Everywhere) placemats and coloring books to schools. This year, with a grant from the CMA Alliance we will distribute brochures Prescription Opioid Epidemic: Know the Facts.

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

Thank you in advance for your support and you are welcome to join the Alliance. Contact 2schneiders@comcast.net for more information. San Joaquin General Hospital Physician Residents Receive Competitive Fellowships Seven San Joaquin General Hospital resident physicians have received prestigious fellowships to advance their medical expertise. Three internal medicine residents, Pardis Irannejad, M.D., Reza Goshtaseb, M.D., and Prabhjot Bhinder, M.D, along with two surgery residents, Sumit Kumar, M.D. and Alexander Kurjatko, M.D., and family medicine residents, Josh Kunellis, M.D. and Sabhrup Biring, M.D., will be starting fellowship programs after they graduate from their respective residency programs this June. Dr. Pardis Irannejad, Internal Medicine chief resident, will be going to UC San Francisco for a nephrology fellowship. Dr. Reza Goshtaseb will be completing a nephrology fellowship at UC Irvine. Dr. Prabhjot Bhinder will be doing a medical oncology fellowship at University of Florida in Jacksonville. Surgery chief residents, Drs. Sumit Kumar and Alexander Kurjatko, will both be completing surgical critical care fellowships. Dr. Kumar will be going to Johns Hopkins University in Baltimore, MD and Dr. Alexander Kurjatko will be going to Mayo Clinic in Rochester, MN. Family medicine chief resident, Dr. Josh Kunellis, will be doing a sports medicine fellowship at Mercy Health System in Janesville, WI. Dr. Sabhrup Biring will be completing an obstetrics fellowship at San Joaquin General Hospital. â&#x20AC;&#x153;Fellowships of this nature are very competitive and these young physiciansâ&#x20AC;&#x2122; achievements are a wonderful example

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of the level of academic excellence our hospital and training programs are known for,” said Dr. Mohsen Saadat, Chief of Medicine and Program Director of the Internal Medicine residency training program. “In addition to primary care and hospitalists, our surgery, radiology, emergency medicine, anesthesiology, rheumatology, trauma, and pulmonary/critical care departments have benefited from our residents and fellows returning to San Joaquin County and practicing medicine in their specialty locally.” “We are proud of our residents. We have a good mix of residents entering primary care and fellowship training. Our hope is more of our residents return to practice in this community,” said Dr. Sheela Kapre, CMO and Chair of Graduate Medical Education. Both Dr. Kapre and Dr. Saadat trained in the Internal Medicine residency program at San Joaquin General Hospital. A teaching program for doctors was established at San Joaquin General Hospital in 1902 with the selection of a local graduate as the first intern. San Joaquin General Hospital currently has three residency training programs. The Internal Medicine program has 27 residents who are trained under the leadership of Dr. Mohsen Saadat. The Surgery program is overseen by Program Director Dr. Nathaniel Matolo and has 17 residents. The Family Medicine program has 23 residents being trained under the guidance of Program Director Dr. Asma Jafri. San Joaquin General Hospital’s Residency Training Programs are affiliated with the University of California, Davis School of Medicine. San Joaquin General Hospital Physician Residents Receive National Honors Three of San Joaquin General Hospital’s Internal Medicine residents have been honored by the American College of Physicians as “Young Achievers in Medicine” in 2017. The three resident physicians in Internal Medicine are Pardis Irannejad, M.D., Mohsen Damavand, M.D., and Sandhya Matha, M.D., who are now completing their residency program at San Joaquin General Hospital under the guidance of Internal Medicine Department Chair and Program Director Dr. Mohsen Saadat. The three young physicians recently traveled to San Diego and were honored at the American College of Physicians’ National Internal Medicine Meeting. The American College of Physicians is a national organization of medical internists

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and physician specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across a wide spectrum from daily health to complex illnesses. On behalf of the national competition for this recognition, Dr. Darilyn Moyer, Executive Vice President and CEO of the ACP, said: “The ACP is proud to have such high caliber resident/fellow members. This group of early career internists demonstrates academic excellence and represents the best of what the future of internal medicine holds.” San Joaquin General Hospital currently has 27 Internal Medicine residents. “I am proud of the national recognition of Drs. Irannejad, Damavand, and Matha from the ACP. It’s an example of the knowledge and dedication of our resident physicians to providing the highest level of medical care for local County residents,” said David Culberson, CEO of San Joaquin General Hospital. San Joaquin General Hospital’s Internal Medicine Residency Training Program is affiliated with the University of California, Davis School of Medicine. The educational experience graduating physicians receive at San Joaquin General is designed to be challenging, rewarding, and intellectually stimulating. “The three nationally honored physicians are an excellent example of the quality of our residency program physicians,” added Culberson.

Pardis Irannejad, MD Dr. Pardis Irannejad was born in Santa Cruz, CA and lived in different cities across California until age 14, when she moved to Iran and attended an international high school. She went to Semmelweis University in Budapest, Hungary for medical school. After Pardis Irannejad, MD graduating in December 2011, she moved back to CA and worked as a polysomnographic technician while studying for the USMLE board exams and applying for residency. Her hobbies are playing piano, singing, and hiking. Dr. Irannejad will be starting a nephrology fellowship at UC San Francisco in July. Her winning ACP Poster involved the advanced detection of rare heart conditions, specifically: “Septic Coronary Embolism Causing Acute Myocardial Infarction: A rare but fatal complication of prosthetic valve endocarditis.”

SAN JOAQUIN PHYSICIAN

In The News

IN THE

NEWS Mohsen Damavand, M.D. Dr. Mohsen Damavand was born and raised in Tehran, Iran until he was 12 years old. He then lived in Germany for two years before moving to California. Dr. Damavand went to UCLA for undergrad and then stayed and did a year of research in Mohsen Damavand, M.D. melanoma immunotherapy after graduating. He attended St. George’s University School of Medicine and graduated medical school in 2014. Dr. Damavand’s ACP Poster was: “Hyponatremia: An atypical presentation of cryptococcal meningitis.” Meningitis is an infection or fungus in the lining of the spinal cord and brain which can have fatal implications.

Sandhya Matha, MD

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Dr. Sandhya Matha grew up in Visakhapatnam, Andhra Pradesh, India and went to Andhra Medical College. She graduated medical school in December 2014. Sandhya is married and has one

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

child. She looks forward to serving the people of the Central Valley and Northern California. Her ACP Poster was “Protocol-Driven Medical Practice – Good or Bad?”

Podesta Ranch Elementary

Podesta Elementary Children Bring Gifts to the Children in San Joaquin General Hospital Children from Podesta Ranch Elementary School in Lodi brought gifts to the children who are admitted in San Joaquin General Hospital on May 25th. Under the direction of Mamta Jain, M.D. Chair, Department of Pediatrics at San Joaquin General, the Pediatric Clinic and Hospital is very thankful to teacher Erin Di Piero and the staff of Podesta Elementary for their charitable efforts. The Hospital is always grateful to schools and community organizations willing to help the Hospital’s efforts to provide the highest level of medical care to the residents of San Joaquin County. “We greatly appreciate gifts for the children here, specifically

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children’s books. Children’s books for all ages are greatly needed in our Pediatric Dept.” Dr. Jain said. “Children’s reading skills and comprehension are needed for accurate medical analysis. Even when it’s not a part of our medical evaluation, we like to give every child who visits our clinic a book just to help their mental development”, Dr. Jain added.

EOS Imaging System Installed at Shriners Hospital Kids with scoliosis and other spinal deformities are among the patients who will benefit from a new EOS Imaging System installed at Shriners Hospitals for Children – Northern California. EOS is an innovative imaging technology that uses significantly less radiation than traditional x-rays. EOS provides full-body images of patients in a natural standing or seated position in both 2D and 3D. These weight-bearing images reveal a patient’s natural posture and allow physicians to analyze the interactions between bones, joints and ligaments from different angles. “At Shriners Hospital we treat several hundred children a year with adolescent idiopathic scoliosis and scores with early onset congenital scoliosis. Our new EOS system will allow three-dimensional spinal imaging while only exposing patients to one twentieth (1/20th) of the radiation dose associated with regular diagnostic radiographs,” says spine surgeon Rolando F. Roberto, M.D. “This technology is also used in the treatment of upper and lower limb disorders, improving our treatment precision. As the ionizing radiation dose delivered is as low as reasonable achievable, this imaging modality is much safer than standard diagnostic imaging,” Dr. Roberto adds. The EOS project was funded by donations from individuals and foundations throughout the regions served by the Northern California Shriners Hospital. Trudy C. Severtson provided the lead gift for the project with her donation of $450,000. Also, donating directly to the EOS project were the Armrod Charitable Foundation ($250,000), Wayne and Gladys Valley Foundation ($145,000) and the AJL Charitable Foundation ($60,000).

Lodi Memorial ranks in Top Five Percent of national Inpatient Rehabilitation Facilities Lodi Health is pleased to announce that Lodi Memorial Hospital’s Acute Physical Rehabilitation program ranked in the top five percent of 781 inpatient rehabilitation facilities (IRF) that qualified to be ranked in the IRF database of Uniform Data System for Medical Rehabilitation (UDSMR) in 2016. Lodi Memorial has been in the top five percent for seven consecutive years. “We are honored to receive top recognition for the quality care our Acute Physical Rehabilitation doctors, therapists and nurses provide every day,” said Lodi Health CEO Daniel Wolcott. “Our team works with each patient individually to help them regain mobility and regain their independence once again.” The rankings were determined by using UDSmr’s program evaluation model, a case mix-adjusted and severity-adjusted tool that provides facilities with a composite performance score and percentile ranking drawn from nearly three-quarters of all IRFs in the country. UDSMR’s PEM Report Card uses the indicators of efficiency and effectiveness contained in the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI), the Centers for Medicare and Medicaid Services’ reporting tool for the Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS). The goal of the PEM Report Card is to recognize high-performing facilities for their delivery of quality patient care that is effective, efficient, timely, and patient-centered. “To recognize the efficient and effective care it provides to its patients, we are pleased to present this award to Lodi Memorial’s Acute Physical Rehabilitation,” said Troy Hillman, Manager of the Analytical Services Group at UDSMR. “Development of the PEM Report Card has served as a tool to identify and recognize high-performing facilities, to work with them to learn how they provide efficient and effective care, and to share what we learn with others to elevate the performance of all.

Lodi Health Receives Standout Score for Maternity Care The Maternal Child department at Lodi Memorial Hospital recently received a total score of 93 out of 100 for data submitted in 2015 for the Centers for Disease Control and

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SAN JOAQUIN PHYSICIAN

In The News

IN THE

NEWS Prevention (CDC)’s maternity Practices in Infant Nutrition and Care (mPINC) survey. The report highlights the hard work and commitment of Lodi Memorial as a birthing facility working to support best practices for breastfeeding. The mPINC survey is a national, voluntary survey of infant feeding practices in maternity care settings. Lodi Memorial Hospital was among 2,582 facilities nationwide to participate. Scores were recently released in a benchmark report stating that Lodi Memorial performed better than 88 percent of other hospitals of similar size in the nation in measures of infant feeding care practices, policies and staffing expectations. Lodi Memorial’s score of 93 exceeds the state score of 85, and the national average mPINC score of 79. “Lodi Memorial Hospital sees breastfeeding as a community priority because it provides the optimal nutrition for infants and gets babies the healthy start they need, in addition to providing health benefits to mothers,” said Maternal Child Services Director Valerie Stump. “It is important to our dedicated team of nurses and lactation consultants that Lodi Memorial continue to strengthen the breastfeeding culture to support mothers and babies. This survey proves that our efforts are successful for our patients.” Lodi Memorial earned perfect scores (100 percent) for labor-and-delivery care, breastfeeding assistance, mother-infant contact, staff training and structural and organizational aspects of care delivery. In 2014, Lodi Memorial Hospital earned its Baby-Friendly designation, which promotes these best practices in infant care, including breastfeeding education, a focus on skin-to-skin contact and rooming in – the practice of keeping mother and child together in the same room throughout their hospital stay. Lodi Memorial also has a weekly support group for breastfeeding moms to continue support once they are discharged.

SAN JOAQUIN PHYSICIAN

Available Space to Lease for Medical Office: For Medical office in Weber Ranch Professional park, 1801 East March Lane, Stockton, CA; call today at (209) 951-8830 or (209) 951-8395; 1367 sq. ft. fully finished ready to move in with 4 exam rooms, Doctor's Chamber with separate bath room. Manager's room, work station for MAs, Patient's bath room, storage room, and Reception (waiting room).

Warren Kirk Named CEO of Tenet Healthcare’s Central Valley Market Warren Kirk has been named CEO of Tenet Healthcare’s Central Valley market. Kirk, who will continue to serve as CEO of Doctors Medical Center of Modesto, will oversee the operations of the three-hospital network, which also includes Emanuel Medical Center in Turlock and Doctors Hospital of Manteca in Manteca. “Warren is a highly experienced and accomplished hospital executive who understands the specific healthcare needs of the Central Valley,” said Jeffrey Koury, CEO of Tenet’s Western Region. “This is an important market for us. As part of our long-term plans in the community, he will provide the strong leadership we need to successfully develop coordinated service lines, enhance access to high-quality healthcare and provide an even greater care experience to patients.” Kirk has served as CEO of Doctors Medical Center since 2011. During his tenure, he has led the hospital through a period of sustained growth and success, with measurable improvements in both quality and service. He has successfully met the challenge of overseeing this very busy hospital, which has experienced a significant increase in volumes – in everything from ED visits to inpatient surgeries – in recent years. At the same time, Kirk has worked hard to improve employee and physician satisfaction, implement new technologies, treatments and service lines, and attract new physicians to the hospital. “I am honored to be given this opportunity to lead our combined efforts to further improve the reach and effectiveness of our healthcare delivery system in this area,” Kirk said. “I look forward to joining with my colleagues at Emanuel Medical Center and Doctors Hospital of Manteca as we work collaboratively to fulfill our joint mission of consistently providing high quality,

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compassionate care to Central Valley residents.” Sue Micheletti, CEO of Emanuel Medical Center, and Ikenna “Ike” Mmeje, CEO of Doctors Hospital of Manteca will now report to Kirk.

Doctors Hospital of Manteca Receives an “A” for Patient Safety in Spring 2017 Leapfrog Hospital Safety Grade The Leapfrog Group, a nonprofit organization committed to driving quality, safety, and transparency in the U.S. health care system, today released new Leapfrog Hospital Safety Grades, which assign A, B, C, D and F letter grades to hospitals nationwide. Doctors Hospital of Manteca was one of 823 hospitals to receive an “A” for its commitment to reducing errors, infections, and accidents that can harm patients. “Doctors Hospital of Manteca is proud to be recognized once again as an ‘A’ hospital for patient safety by The Leapfrog Group,” said Ikenna Mmeje, CEO of Doctors Hospital of Manteca. “This is an outstanding affirmation of the commitment and dedication our physicians, nurses and other staff demonstrate every day in providing high-quality, compassionate care to our patients.” He added, “We are focused on continually improving care delivery and patient satisfaction. Our clinical leadership regularly reviews our hospital’s patient care processes and compares our data to nationally-recognized benchmarks and best practices. Nothing is more important to us than offering our patients trusted care in a safe environment.” “Hospitals that earn top marks nationally in the Leapfrog Hospital Safety Grade, ‘have achieved the highest safety standards in the country,” said Leah Binder, president and CEO of The Leapfrog Group. “That takes commitment from every member of the hospital staff, who all deserve thanks and congratulations when their hospitals achieve an ‘A’ Safety Grade.”

Rahul Gohil, MD, joins Dameron Hospital as ED General Surgeon Rahul Gohil, MD, has joined Dameron Hospital as a general surgeon for its Emergency Department. Dr. Gohil is boardcertified with the American Board of Surgery and the American College of Surgeons, and is a part of Dameron’s Surgicalist Program which provides dedicated onsite surgeons that

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provide emergent/urgent surgery case coverage for the hospital. This practice model allows Dr. Gohil to devote most of his time to Dameron’s ED and focus on providing the hospital’s patients with timely treatment, comprehensive decision-making, and consistent patient care planning. Rhaul Gohil, MD He is a graduate of Case Western Reserve University School of Medicine in Cleveland, Ohio, where he also served his residency. Dr. Gohil also has a Molecular Genetics degree from Ohio University. When he’s not performing surgeries at Dameron, Dr. Gohil enjoys hiking, tennis, golf, cooking, yoga, art and architecture.

Dameron Hospital Now Offering Accelerated Recovery Knee Replacement Procedure Dameron Hospital’s new Rapid Strides Accelerated Recovery© Knee Replacement Program is a minimally invasive knee replacement procedure that provides patients with an accelerated recovery and rehabilitation process following surgery. Total knee replacement surgery is typically performed to provide relief from severe knee arthritis pain that is inhibiting the patient’s ability to stand or walk. The Rapid Strides Knee Replacement Program uses stateof-the-art techniques to ensure a safe and accelerated recovery from knee replacement surgery. According to Dr. Kevin Mikaelian, Orthopedic Surgeon and Rapid Strides Medical Director, the unique combination of advanced surgical techniques, combined with highly effective pain management, achieves excellent results for patients in terms of pain relief, mobility and restoring their quality of life. “We use multiple anesthetic techniques before, during and after surgery to significantly decrease pain and swelling caused by joint replacement surgery,” said Dr. Mikaelian. “We also perform a much smaller incision to access and replace the knee joint, which provides the patient with immediate benefits in terms of speeding up the healing process and regaining use of their leg. Our patients are able to walk several feet within a few

SAN JOAQUIN PHYSICIAN

Introducing the San Joaquin Medical Society MemberCard! As part of your membership with San Joaquin Medical Society you will receive quality discounts on dining, attractions and more with the brand new SJMS Membercard! • Enjoy discounts on dining at more than a dozen local restaurants. • Save when visiting participating area attractions and wineries! DIRECTORY RSHIP OF MEMBE BENEFITS

• Earn reward points at over 11,000 online retailers nationwide.

Merchants honoring the SJMS MemberCard: • Midgley’s Public House • Papapavlo’s Bistro & Bar • Ben Mackie Fitness • Mettler Family Vineyards • ...and many more! Plus gain access to the MemberCard Mobile App available for both Android and iPhone devices. The App allows you to ﬁnd available discounts, map to participating businesses and redeem beneﬁts directly on your phone! 52

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SUMMER 2017

In The News

hours of surgery and are usually discharged the next day. Most patients will be able to walk without assistance in about half the time it takes following a traditional knee replacement.” “One of our priorities is to provide residents with the most advanced medical care available right here in our community, and the Rapid Strides Program is another way that we are meeting this objective,” added Lorraine Auerbach, President and CEO of Dameron Hospital. “Local residents no longer have to leave town to have access to this state-of-the-art medical procedure.”

Dr. Gail Joseph Dr. Joseph has joined the Manteca community practicing with the Gill Ob/Gyn Medical Group. She delivers at Doctors Hospital of Manteca. She completed her medical degree at The University of Pittsburgh School of medicine and did her Ob/Gyn Dr. Gail Joseph residency at Sacred Heart Hospital in Pensacola Florida. She has a passion for women’s health, particularly issues affecting underserved and socially disadvantaged populations. Her platform is empowering patients to make healthy decisions by taking the time to educate them. She is accepting new patients.

SJ Women Physicians Group

San Joaquin Women Physicians Group Spring Mixer 2017 On Saturday March 3, 2017, Golden Haven and its Executive and Medical Director, Rowena Ramirez, M.D. hosted the San Joaquin Women Physicians Group Spring Mixer. The guests toured Golden Haven and dined on a 7-course homemade gourmet meal and signature cocktails. Members of the group heard a casual interactive talk and participated in a discussion about long-term memory care and the considerations that must be made for appropriate long-term placement and medical care of patients with Alzheimer’s and other forms of dementia. Although long-term residential memory care and assisted living, in general, are typically paid for privately, the discussion included government-subsidized options, like the Assisted Living/Medi-Cal Waiver Program (ALWP), that are available at select facilities in select counties in California. Golden Haven is a 150-bed capacity residential care facility for elderly (RCFE) with cognitive &/or memory impairment and has been familybuilt, owned, and operated for the past 27 years.

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George Khoury, MD

Former SJMS President is one of Three New Commissioners appointed by San Joaquin Board of Supervisors for HPSJ Governing Board –Two Commissioners Reappointed

San Joaquin County Director of Health Care Services Greg Diederich – chair of the San Joaquin Health Commission – has announced that the San Miguel Villapudua Joaquin County Board of Supervisors has formally appointed three new members of the Health Commission, the governing board of Health Plan of San Joaquin (HPSJ). These new members are: • George M. Khoury, MD, 2011-2012 president of the San Joaquin Medical Society (SJMS), is a Medical Society delegate to the Commission

SAN JOAQUIN PHYSICIAN

In The News

IN THE

NEWS • San Joaquin County Board of Supervisors Member Miguel Villapudua, District 1 • San Joaquin County Board of Supervisors Member Tom Patti, District 3 “As HPSJ celebrates its Tom Patti 21st anniversary in 2017, part of our continuing strength is the combination of public servants, community representatives and local physicians who come together and serve on the Commission,” said Diederich. “As county supervisors who are very active in the community, having Miguel Villapudua and Tom Patti join the governing board provides even more capacity for us to listen to our communities and our members. Having Dr. George Khoury bring his long medical experience here in San Joaquin County, and his deep commitment to public-private-community partnerships that serve the well-being of our local social fabric, is an added blessing. This is how the Commission is able to provide robust oversight and continues strengthening the services and partnerships that are the foundation of HPSJ’s commitment to our community,” added Diederich. Chairman Diederich also said he is pleased to announce that two Commissioners have been reappointed. They are Community Representative Frank “Larry” Ruhstaller and Medical Society Delegate Michael Herrera, DO.

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

Palliative CareEnhancing quality of life throughout serious illness HPSJ currently is working under a planning grant from the California Healthcare Foundation (CHCF) to Patricia Sabella, RN implement a Palliative Care Program for our HPSJ patients with Congestive Heart Failure, Chronic Pulmonary Disease, Late Stage Cancer and Advanced Liver Disease. The program is “Care Options” and will allow patients the option of choosing palliative care in their home, with special services to include visits by a palliative care certified RN/Social Worker and outpatient clinic visits, or telephonic palliative calls in close coordination with the patient’s specialist physician. While many confuse them and sometimes even use the terms interchangeably, there are crucial differences between palliative care and hospice care. Palliative Care refers to patient- and family-centered care that optimizes quality of life by anticipating, preventing and treating suffering. Palliative care throughout the continuum of illness involves addressing physical, intellectual, emotional and social, as well as spiritual, needs. Such care can be provided concurrently with curative care. Hospice Care supports a delivery system geared to patients with limited life expectancy who are in the terminal state of an illness. While assisting patients, and family members, with a limited life expectancy, this care helps patients and family members cope as death nears. “The Care Options program will assist our patients who

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may have had palliative care started during a hospitalization, but who fall in a gap of continued care on the outpatient side after hospital discharge,” said Director of HPSJ Care Management Patricia Sabella, RN. “This is a gap our health plan wants to solve. The program is planned to begin in late summer 2017,” she added.

Shortages Continue to Motivate HPSJ Scholarships to Encourage Central Valley’s Future Doctors, Nurses & Pharmacists Since 2015, Health Plan of San Joaquin’s scholarship program to encourage young students with an interest in pursuing a health or medical career that would lead them back to the Central Valley – the HPSJ Health Careers Scholarships Program (HCSP) – has partnered with seven local schools and programs to award two scholarships of $2,500 to each location. Nine of the scholarships had been identified as this San Joaquin Physician issue goes to press. From HPSJ’s seven program partners, here are the announced awardees and their area of health career concentration: San Joaquin Medical Society – Decision Medicine D’Angelo Martinez, future physician Maha Siddiqui, future OB-GYN San Joaquin Delta College – Nursing Program Mahedia Zadran, future OB-GYN Philysia Gipson, future pediatric nurse Health Careers Academy High School (Stockton) Jose Aguilar, future cardiologist Kranesh Kumar, future physician CSU Stanislaus, School of Nursing Debra Simon, future nurse Additional Health Careers Scholar to be announced Modesto Junior College – Nursing Program Ashley Lee, future pediatric nurse Ricardo Olvera, future intensive care unit nurse The remaining five 2017 HPSJ Health Careers Scholarships, through program partners University of the Pacific School of

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Pharmacy and Grace M. Davis High School Careers Academy, as well as the second for CSU Stanislaus Nursing School, will be announced during the summer along with awards ceremonies in each location. Beyond continuing to invest in scholarships for Central Valley future doctors, nurses and pharmacists, HPSJ has announced it will continue the mentorship program begun in 2016. Each Health Careers scholar is assigned a volunteer mentor from HPSJ staff who is available throughout their academic year to offer encouragement, perspective and the benefit of their own experiences navigating academia and the professional health care world.

HPSJ Providers Speak, HPSJ Listens – Customer Service Like any excellent health plan, providing world class customer service is one of the foundations of the not-for-profit Health Plan of San Joaquin (HPSJ) and its ability to provide access to quality care for each of their over 346,000 Mike McCarns members. It is also the lynchpin for the day-to-day calls that support local providers and practitioners in the HPSJ network. In March, HPSJ brought together front and back office staff from several of their provider offices in San Joaquin and Stanislaus counties for a focus group. Discussion focused on issues and concerns with the HPSJ Customer Service call center. “We wanted to learn, from providers, where we were falling short and where we were excelling,” said HSPJ Customer Service Director Mike McCarns. The group spent 90 minutes discussing why calls are coming into the Call Center and how effective HPSJ is in handling callers’ needs. “What we learned,” said McCarns, “is helping us to reshape our current call center structure, as well as Interactive Voice Response (IVR) and training for each Customer Service Representative. A couple of the changes HPSJ staff could implement immediately. These included the ability to provide Coordination of Benefits information to providers over the phone and the ability to make retroactive changes to a member’s PCP in the middle of a month.

SAN JOAQUIN PHYSICIAN

In The News

IN THE

NEWS As analysis of the provider feedback continues, HPSJ says it will be looking for ways to change their protocols and practices to ensure practice interactions with HPSJ are more timely, accurate, helpful and mutually pleasant. Local providers and practices staff are encouraged to continue the conversation by reaching out to their HPSJ provider services and customer call center representatives with comments and questions.

During his tenure at St. Joseph’s, Spring was instrumental in many projects, including the opening St. Joseph’s Patient Pavilion in 2010 and the implementation of the electronic health record. Stepping into the role of COO, Michael Williams, has over nine years of progressive experience in management positions at St. Joseph’s, most recently as the Director of Care Coordination and Interim COO. Williams’ educational background includes a Master’s of Science in Nursing, Health Care Accreditation Certified Professional (HACP), and completion of Dignity Health’s Emerging Leaders program and Lean Six Sigma Black Belt training. Additionally, Williams graduated with his Doctorate of Nursing Practice in the spring.

St. Joseph’s Offers the World’s Smallest Pacemaker Terry Spring and Michael Williams

St. Joseph’s Chief Operating Officer, Terry Spring, Retires and Michael Williams Appointed New COO St. Joseph’s Medical Center has announced that Terry Spring has retired from his position as Chief Operating Officer, with Michael Williams, RN, MSN being appointed as his successor. Terry Spring began his career at St. Joseph’s in 1987 as the Manager of Materials Management. In 1994 he assumed the role of Director of Support Services/Materials Management and in 2000 he transitioned to the role of Vice President. Since 2015, Spring has been the Chief Operating Officer for St. Joseph’s. “I am very proud and honored to have worked side by side with Terry for so many years and on many outstanding projects,” said Don Wiley, President and CEO of St. Joseph’s. “His ability to know so many details and how to get things accomplished have significantly enhanced our organization’s success for many years.”

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St. Joseph’s Medical Center is proud to be one of the first hospitals in California to offer the world’s smallest pacemaker for patients with bradycardia. The Micra® Transcatheter Pacing System (TPS) is a new type of heart device, approved for Medicare reimbursement, that provides patients with the most advanced pacing technology at one-tenth the size of a traditional pacemaker. “The availability of this new pacemaker technology represents yet another step forward toward the goal of being able to offer cutting edge cardiovascular care to patients who would otherwise be considered high-risk for traditional pacemaker implantation,” said Cyrus Buhari, MD, the interventional cardiologist to implant the first Micra® pacemaker at St. Joseph›s Heart & Vascular Institute. Pacemakers are the most common way to treat bradycardia to help restore the heart’s normal rhythm and relieve symptoms by sending electrical impulses to the heart to increase the heart rate. Comparable in size to a large vitamin, the Micra® TPS is unlike traditional pacemakers because the device does not require cardiac wires (leads) or a surgical «pocket» under the skin to deliver a pacing therapy. The device is cosmetically invisible

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and it is small enough to be delivered through a catheter and implanted directly into the heart. It delivers electrical impulses that pace the heart, automatically adjusting pacing therapy based on a person›s activity. The Micra TPS also incorporates a retrieval feature to enable retrieval of the device when possible; however, the device is designed to be left in the body. For patients who need more than one heart device, the miniaturized Micra TPS was designed with a unique feature that enables it to be permanently turned off so it can remain in the body and a new device can be implanted without risk of electrical interaction. The Micra TPS is the first and only transcatheter pacing system to be approved for both 1.5 and 3 Tesla (T) full-body magnetic resonance imaging (MRI) scans and is designed to allow patients to be followed by their physicians and send data remotely via the Medtronic CareLink® Network. The Micra TPS was approved by the U.S. Food and Drug Administration in April 2016, and has been granted Medicare reimbursement, allowing broad patient access to the novel pacing technology.

St. Joseph’s Expands Maternity & NICU St. Joseph’s recently added an additional 10 private rooms to its Women and Infants Center. The additional patient rooms were added to an existing space located in the Patient Pavilion. Additionally, St. Joseph’s Level III Neonatal Intensive Care Unit is also expanding by an additional eight beds, bringing the total to 30 beds. These two expansion projects, costing nearly $9 million total, will help facilitate a smooth arrival for the nearly 3,500 infants St. Joseph’s anticipates will be delivered at their facility this year.

Richard S. Isaacs, MD, to Assume Role of Executive Director and CEO of the Permanente Medical Group The Permanente Medical Group (TPMG) has announced that Richard S. Isaacs, MD, FACS, will officially assume the role of executive director and CEO on June 1, 2017. TPMG is the largest and one of the most distinguished medical groups in the nation, with nearly 9,000 physicians and over 35,000 nurses and staff delivering high-quality care to more than 4 million Kaiser Permanente members in Northern California. Dr. Isaacs will succeed current executive director and CEO Robert Pearl, MD, who has served in that leadership role for TPMG since 1999. Dr. Isaacs will also succeed Dr. Pearl as president and CEO of the Mid-Atlantic Permanente Medical

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Group — whose 1,600 physicians and employees provide care for more than 700,000 Kaiser Permanente members in Maryland, Virginia and Washington, D.C. — and co-CEO of the National Permanente Executive Committee of The Richard Isaacs, MD Permanente Federation. Dr. Isaacs has served as physician in chief for the Kaiser Permanente South Sacramento Medical Center since 2005. In this role, he has been responsible for all clinical operations throughout the inpatient and outpatient arenas. As physician in chief, Dr. Isaacs played a critical leadership role in helping his medical staff pioneer several innovative initiatives that were ultimately adopted by Kaiser Permanente nationwide, including the implementation of Kaiser Permanente’s electronic medical record. In 2008, Kaiser Permanente South Sacramento Medical Center became the first Level II trauma center within Kaiser Permanente. More recently, the area’s collaborative Greater Sacramento Sports Medicine program has expanded to provide expert care to regional and professional athletes. Prior to becoming physician in chief, Dr. Isaacs served as The Permanente Medical Group’s chair of the Regional Chiefs’ Group for Head and Neck Surgery and chief of the Department of Head and Neck Surgery for Kaiser Permanente South Sacramento. Born and raised in Detroit, Dr. Isaacs received his medical degree from Wayne State University School of Medicine in that city. He completed his Otolaryngology-Head and Neck Surgery training in New York at the Manhattan Eye, Ear, and Throat Hospital/New York Hospital-Cornell Medical College/ Memorial Sloan-Kettering Cancer Center. Subsequently, he received his Head and Neck Oncologic and Skull Base Surgical training from the University of California, Davis. He joined The Permanente Medical Group following the completion of his surgical training in 1995. He is board certified in Otolaryngology with advanced certification in Head and Neck Oncologic Surgery, is a fellow of the American Academy of Otolaryngology-Head and Neck Surgery, and is a fellow of the American College of Surgeons. Dr. Isaacs, who has published several articles in national publications, is actively involved in medical education and has served as a clinical professor of Otolaryngology at the University of California, Davis School of Medicine, Drexel University School of Medicine and California Northstate University School of Medicine.

SAN JOAQUIN PHYSICIAN

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.

MAY 10TH, 2017:

BENCHMARKING YOUR PRACTICE – CURRENT TOOLS TO ANALYZE PRODUCTIVITY 11:00AM to 1:00PM Today’s physicians and office managers need a high level of business management skills particularly in the financial area. This workshop will teach critical skills in analyzing the practice profit/loss statement, accounts receivable ratios and cost accounting and how to access specialty comparison norms for benchmarking. At least one source of comparison benchmarking will be given to each participant. This workshop is presented by an experienced consultant and former practice administrator, Debra Phairas, MBA, President of Practice & Liability Consultants. For more information on firm credentials access: www.practiceconsultants.net •A ccounts Receivable Management and Cash Flow • Importance of Profit/Loss Statements as Management Tools • Benchmarking Overhead Categories by Medical Specialty •P ayroll to Collections and Full Time Equivalents Ratios for staffing levels •E ssential Ratios to Calculate on Monthly Status Reports

practice staff to develop programs and services to ensure quality health care for almost 350,000 members. Here in one place, over lunch, a team of HPSJ experts will offer a clear program and answer your questions about the following ways they stand ready to help your practice. •C ustomer Service – including interpretive services, hearing impaired assistance and bus passes •M eet our new Provider Services Representatives – plus an overview of new uses for the DRE/provider portal, latest help for Prior Authorized (PA) services and more •C laims: HPSJ continually strives to enhance provider satisfaction, including improving the timeliness of claims payments – Update on how we’re doing this •H ealth Navigators, Social Workers: What types of cases/patients to refer, and how •C are Management Options •H ealth Education Opportunities •C ultural Competency and Linguistic Services •H EDIS: GAP Reports, Coding Tip Sheet and more

•O ffice Visits, Hospital and Surgery/Procedures Productivity to achieve desired Net Income

• Your Questions

•C ost Accounting Techniques

JULY 12TH 2017:

JUNE 14TH 2017:

ALL THE WAYS HPSJ CAN SUPPORT YOUR PRACTICE & HPSJ PATIENTS 11:00AM to 1:00PM As the trend continues for growing numbers of patients to care for, it has never been more important for busy practices to find practical support. Health Plan of San Joaquin (HPSJ), a not-for-profit health plan, has been serving members and our multicultural community since 1996. As the leading Medi-Cal Managed Care provider in San Joaquin and Stanislaus counties, HPSJ offers a broad network of providers and works closely with physicians and

CANCELLED DUE TO FACILITATING OUR DECISION MEDICINE PROGRAM 11:00AM to 1:00PM

Public Health

Update

A Year of Public Health Practice, San Joaquin County Alvaro Garza, MD, MPH

What is public health practice? Many people might still think that it is health care for the poor. My answer is that it is about tending to the health of the public. Here, I review key aspects of public health in the county in the past year. Would the public even want to be healthy? Healthy people do make for happier, more productive, and thriving communities; and, our health is very much inter-dependent and highly influenced by our social, physical, and other public environments. Public health work is about preventing disease and injury, promoting health and well-being, and protecting from hazards to health. In general terms, the mission of public health in San Joaquin County is to promote a healthy future for all residents. Paraphrased from the accepted national definition, by the Institute of Medicine, public health is what we, as a county, do to ensure conditions in which everyone can be healthy. Clearly, a public health department (little public health)

SAN JOAQUIN PHYSICIAN

cannot, on its own, ensure such conditions. That relies on the big public health system, i.e., the collaboration between and among many community partners. These include health care providers and facilities, education agencies, employers and businesses, county and city departments like fire, sheriff, planning, transportation, and parks, community-based organizations, and elected officials. This last group is highly health-impactful since most policy decisions at all government levels (city, county, state, federal) can and do impact health and well-being, often offering opportunities for some segments while unintentionally creating barriers for others for healthier lives. The ‘how’ of public health practice is analogous to medical practice. While a healthcare provider deals with many individuals, we deal with many ‘publics’, e.g., county, cities, zip codes; age-groups, gender groups, race/ethnic groups, etc. While a provider assesses the health or disease condition of a patient, we assess and monitor the health of communities. While a

SUMMER 2017

provider determines and agrees with a patient on treatment regimens, we work with communities to determine and agree on policies, programs or other interventions to address the collective health issues. While a provider assures a treatment regimen is carried out, we assure that public health laws are enforced and that policies or programs are implemented and are effective. (Figure 1) In 2012, the Institute of Medicine recommended a minimum package of public health services that should be available in all jurisdictions. This package includes foundational areas of expertise (or programs), and foundational capabilities that support the programs (Figure 2). The following paragraphs review a few highlights in these foundational services in our county in 2016. Clinical labs and healthcare providers reported around 9,200 cases of communicable diseases that required some level of analysis. This represents a 7% decrease from that reported in 2015. Chlamydia and gonorrhea continue to account for about 50% of the reports. The county experienced a 52% increase in reports of coccidioidomycosis, 172 cases, over the prior year. The syphilis epidemic continues to increase, with 261 infectious cases, two-fold higher than the prior year, plus 16 infants born with syphilis, nearly three-fold higher than prior year. Tuberculosis continues to be a major health issue but reduced 28% last year from prior, with 42 cases of TB disease reported and managed. We continue to make progress in reducing tobacco smoking and increasing access to healthy food: the Refresh San Joaquin program worked with many neighborhood stores that serve under-resourced communities to stock fresh fruits and vegetables and reduce promotion of tobacco and alcohol products. Collaboration with many schools led to events for hundreds of students to walk or bike to school. Similarly, collaboration with organizations serving older adults encouraged their regular walking or other physical activity. We assisted the San Joaquin General Hospital maternity services in their adoption and implementation of breastfeeding model hospital policies to successfully achieve “Baby-Friendly” designation as defined by the international WHO/UNICEF criteria. Through the Black Infant Health program, staff

SUMMER 2017

provided support services to 54 African-American high-risk pregnant and parenting women, helping improve health outcomes for mothers and infants. The Public Health STD clinic provided services to about 1,400 patient visits, higher than projected. The California Children’s Services provided services to 1778 new cases in coordination and collaboration with medical care providers, pharmacies, and medical equipment companies. Physical and occupational therapy services were provided to 450 children with disabilities. The public health lab provided services countywide and for eight other counties. Being the basic science of public health, epidemiology staff developed many reports and responded to many data requests. We developed and disseminated information to the healthcare provider and larger communities on a variety of public health issues of importance for awareness and/or response, e.g., zika and flu. Just like hospitals require accreditation, public health departments are now voluntarily getting accredited nationally. We’re in that several year process now, developing a performance management and quality improvement system, a community health assessment, a community health improvement plan, and a strategic plan, with critical assistance from our many partners. In 2017, we continue to work towards ensuring conditions in which all our residents can be healthy, where opportunities are such that the healthy choice is the easy choice for everyone, every day, everywhere. That calls for continuing and enhancing collaborations with our many partners, with healthcare providers being key.

SAN JOAQUIN PHYSICIAN

SUMMER 2017

New Members

25 NEW

SJMS MEMBERS THIS SUMMER!

...and even more on the way. Mikla Derlet, M.D.

Ashwini Anumandala, M.D

Norman Schmidt, M.D.

(209) 588-4650 State University of NY Health Science Center at Brooklyn

2545 W Hammer Ln Stockton, CA 95209 NTR University of Health Sciences, Gandhi Medical College

1901 W. Kettleman Lane #200 Lodi, CA 95242 (209) 334-8540 Washington University School of Medicine

Pediatrics

Amandeep Gill, M.D. Hematology Oncology

500 W Hospital Rd, French Camp, CA 95231 (209) 468-6123

Susan Parson, M.D. Pathology

7000 Michael Canlis Blvd French Camp, CA 95231 (209) 468-4718 Saba University School of Medicine

Mandeep Singh, M.D. Internal Medicine

500 W Hospital Rd, French Camp, CA 95231 (209) 468-6000

Chirag Sheth, M.D. Internal Medicine

500 W Hospital Rd, French Camp, CA 95231 (209) 468-6624 C.U. Shah Medical College

SUMMER 2017

Internal Medicine

Ashok Daftary, M.D.

Family Practice

Internal Medicine

Daniel Choi, M.D.

2505 W Hammer Ln Stockton, CA 95209 (209) 475-5500 University of Bombay, Grant Medical College

Opthalmology

36 W. Yokuts Avenue, Suite 1 Stockton, CA 95207 (209) 952-3700

Juan Vergara Saavedra, M.D.

Opthalmology

Internal Medicine

2151 West Grant Line Road Tracy, CA 95377 (209) 827-4866 Universityersidad Autonoma de Nuevo Leon

Ramesh Dharawat, M.D. Cardiology

500 W Hospital Road French Camp, CA 95231 (209) 468-6624 Dr Vaishampayan Memorial Medical College, Shivaji University

Ethan Tittler, M.D. 36 W. Yokuts Avenue, Suite 1 Stockton, CA 95207 (209) 952-3700 University of Southern California School of Medicine

Dennis Alfaro, M.D. Emergency Medicine

500 West Hospital Road French Camp, CA 95231 University of Oklahoma College of Medicine

Continued >>

SAN JOAQUIN PHYSICIAN

SUMMER 2017

New Members

25 NEW

SJMS MEMBERS THIS SUMMER!

...and even more on the way. James Cooney, M.D.

Alice Kim, M.D.

Thomas Monachino, M.D.

975 South Fairmont Avenue Lodi, CA 95240 Georgetown University School of Medicine

27200 Calaroga Ave Hayward, CA 94545 (510) 264-4026 Touro University College of Osteopathic Medicine

975 South Fairmont Avenue Lodi, CA 95240 University of Iowa College of Medicine

Ruben Koshy, M.D.

768 Mountain Ranch Rd San Andreas, CA 95249 (209) 754-3521 University of Osteopathic Medicine & Health Science

Critical Care Medicine

Noel Ferrer, M.D. Anesthesiology

975 South Fairmont Avenue Lodi, CA 95240 Virgen Milagrosa Educcational Institute Medical Foundation

Xing Gao, M.D.

Critical Care Medicine 975 South Fairmont Avenue Lodi, CA 95240 Case Western Reserve University School of Medicine

Wyatt Jaffe, M.D. Emergency Medicine

2100 Powell Street, Suite 920 Emeryville, CA, 94608 Rosalind Franklin University, The Chicago Medical School

SUMMER 2017

Emergency Medicine

Pain Medicine

975 South Fairmont Avenue Lodi, CA 95240 (209) 469-8399 University of Illinois College of Medicine

Trung Le, M.D.

Emergency Medicine 500 West Hospital Road French Camp, CA 95231 University of Texas Medical School Houston

Vikrant Moharir, M.D. Emergency Medicine

768 Mountain Ranch Rd San Andreas, CA 95249 (209) 754-3521 Kansas City University of Phys & Surgeons

Anesthesiology

Robert Petty, M.D. Family Practice

Karen Philippi, M.D. Emergency Medicine

500 West Hospital Road French Camp, CA 95231 (209) 473-4158Oregon Health Science University Medical School

Todd Primack, M.D. Anesthesiology

975 South Fairmont Avenue Lodi, CA 95240 College of Osteopathic Medicine of the Pacific

SAN JOAQUIN PHYSICIAN

Gill Obstetrics & Gynecology Thank you for voting us BEST OB/GYN Practice!

90,000 HEALTHY BABIES DELIVERED

The physicians and staff at Gill OB/GYN congratulate Dr. Jasbir Gill on receiving the lifetime achievement award from the San Joaquin Medical Society. This is a testament to Dr. Gill's commitment to clinical medicine, academic teaching and public

Experience matters

leadership. We thank him for being a pillar of our practice and a champion for this community. With 60 years of experience and roots dating back to 1953, Gill Obstetrics has a rich history of serving generations of women throughout San Joaquin County. We offer clinical expertise and compassionate care in a welcoming environment where women can feel comfortable and secure, knowing that we put our patients needs first. After all...each woman needs are unique and you deserve special care!

Gill OB/GYN thanks you for entrusting us with your healthcare needs. It is our great privilege to bring new life in the world and share in your happiness. We have cared for the women of this community for over sixty years and look forward to becoming the first to welcome the next generation in your family and in our area. Ofelia Ortiz, M.D.

Gail Joseph, M.D.

COMPLETE PREGNANCY CARE Healthcare Just as Unique as You!

STOCKTON MRI & Molecular Imaging Medical Center, Inc. 2320 N. California Street • Stockton, CA 95204 PHONE 209-466-2000 • Fax 209-466-2600 w w w. s to c k to n m r i . co m

The Most Advanced and Comprehensive Medical Imaging Center in San Joaquin County Just Got Better with the Addition of the Central Valley’s only 128 Multislice CT Scanner with Lowest Radiation Dose Imaging Services Include: • The first PET-CT since 2003 • Full service of Nuclear Medicine • Most advanced G. E. High Field MRI (1.5 Tesla) • Full service of Digital Radiography and Fluoroscopy • New GE Logic 9e 3D & 4D Ultrasound Unit • 128 Slice Siemens CT Scanner

By Board Certified Radiologists: Javad Jamshidi, MD Francis Isidoro, MD

The Fastest 128 Multislice High Resolution CT in community practice:

Siemens Somatom Definition AS+ (128) SUMMER 2017

SAN JOAQUIN PHYSICIAN

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

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