Summer 2021 by San Joaquin Medical Society

Summer 2021

CMA Annual Report • Ripple Effects of ACE’s • COVID-19 Sick Leave SUMMER 2021

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VOLUME 69, NUMBER 2 • JUNE 2021

2 | CALIFORNIA PHYSICIAN | 2020 ANNUAL REPORT

PICTURED ABOVE: CMA PRESIDENT, DR. PETER BRETAN AND CMA CEO DUSTIN CORCORAN

9 PRESIDENT'S MESSAGE 12 IN THE NEWS 22 AKILA WEBER, M.D. 25 ACES 28 SJMS SCHOLARSHIP LOAN FUND

44 COVID PAID LEAVE 46 PRACTICE NEWS AND RESOURCES

50 PUBLIC HEALTH UPDATE 52 NEW MEMBERS 54 IN MEMORIAM

2020 ANNUAL REPORT | CALIFORNIA MEDICAL ASSOCIATION | 3

35 CMA ANNUAL REPORT

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

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

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

COMMITTEE CHAIRPERSONS

CONTRIBUTING WRITERS Keenia Tappin, MD, Delecia Velasquez-

CMA AFFAIRS COMMITTEE Larry Frank, MD

Stump, MPH, Hemal Parikh, MPH, Hyma Jasti, MD, Jo Ann Kirby,

DECISION MEDICINE Kwabena Adubofour, MD

Jamie M. Bossuat, Esq

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

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

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

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

PLEASE DIRECT ALL INQUIRIES AND SUBMISSIONS TO:

Kwabena Adubofour, MD, Philip Edington, MD

San Joaquin Physician Magazine

Harpreet Singh, MD

3031 W. March Lane, Suite 222W Stockton, CA 95219 Phone: (209) 952-5299 Fax: (209) 952-5298 E-mail Address: lisa@sjcms.org MEDICAL SOCIETY OFFICE HOURS: Monday through Friday 9:00am to 5:00pm Closed for Lunch between 12pm-1pm

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EXECUTIVE DIRECTOR’S REPORT

MOVING RIGHT ALONG While many things have been on hold the past year, SJMS has remained steadfast in its commitment to encouraging and assisting the bright, talented youth of our community to pursue a career in medicine. Although modified to a hybrid of virtual and in person activities, Decision Medicine will take place this summer! The committee scored 112 applications before virtually interviewing 45 students and ultimately selecting the final 24 class of 2021. A huge thank you to Drs. Hyma Jasti, Kwabena Adubofour, George Khoury, Phil Cheng, Nguyen Vo and Marina Castillo for their engagement in this process.

LISA RICHMOND

By now, we hope you have heard of our Bridge to Medicine (BTM) program. BTM was founded by Dr. Grant Mellor, a past president and current chair of medical education programs for SJMS. The program guides high achieving students (high school & college) along their academic journey so that they have the best chance of being accepted to medical school and ultimately return to practice in our community. The demand for the program has increased and we need more mentors! Please see page 12 for more information as to how you can get involved. The medical society has been supporting local nursing and medical students since 1964 through its Scholarship Loan Fund (SLF). Recognizing the tremendous need for physicians in our communities, the SLF Board has worked to restructure the loan terms and offer incentives to those who return to establish their primary practice in one of the SJMS member counties of San Joaquin, Alpine, Amador or Calaveras. We hope you enjoy reading more about SLF in this issue’s feature story. It is election season! There are four candidates running for two open board seats. Please make sure to follow the instructions included on your ballot and return to our office by Friday, June 11. If you need a replacement ballot, please call our office at 209-952-5299. We want to thank Dr. Jasti for her incredible leadership as president during a very challenging year. Additionally, we are grateful for the years of service of outgoing Past President, Dr. Richelle Marasigan and board members, Drs. Ben Morrison and Sanjay Marwaha.

Be well,

Lisa Richmond

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A message from our President > Hyma Jasti, MD

A Shift in Healthcare Priorities We as physicians have worked hard in the past fourteen months. We faced extreme obstacles and challenges and made multiple sacrifices for ourselves and our families. Throughout it all I have seen poise, grace, and extreme professionalism. We ran on adrenaline, then on fumes, and continued to deliver the best care in whatever way we could: phone calls, emails, video chats, and putting on layers of PPE to see patients face to face. While this amazing flexibility and incredible adaptability clearly lead to a new peak of resilience in our community, we are only human, and physician burnout is a problem we need to tackle even as the pandemic continues. Though Covid cases are coming down and more and more are getting vaccinated, we are still cautious about returning to a new normal. The fear may stem from questioning if there will be another surge, how can we continue? Where will we find the energy, the resources, and new answers. Now that we are seeing a stabilization of the number of COVID – 19 patients, the acuity of other illnesses appears to be even greater than usual. This phenomenon is noted throughout our county and with various healthcare organizations.

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

Our outpatient facilities and offices are bustling now with patients getting care for chronic ongoing conditions. It is great to hear the hum of people working in the offices, where patients were greeted, even if in fewer numbers than before. The physicians, teams, and patients were genuinely happy to see each other again, but the work remains demanding. There are still telephone and video visits along with in clinic appointments and so much more including messages coming in from patients asking for advice. These are in addition to the increasing requests for management of both acute and chronic conditions. Now it is our job to help determine the best balance of clinical needs to be seen in person while meeting the patients’ and our expectations of quality care and service. Though many are quick to call this a “return to normal,” it is clear that the pandemic has changed the priorities of patients. Our Emergency rooms are getting filled with

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more non-Covid patients with CHF or COPD exacerbations. to take that same advice yourselves. Doctors are notoriously We are seeing more malignancies at advanced stages. We can the worst patients, but this pandemic will continue to test us. understand the findings of more mental health issues with Taking care of ourselves is one important way by which we isolation, job loss can continue to take and increased work care of patients. As Now it is our job to help determine the best demand. Is our financial options and balance of clinical needs to be seen in person health system ready resource allocations to take this extra while meeting the patients’ and our expectations shift, communication burden and be able and collaboration will of quality care and service. to keep our patients be key. We have to safe and healthy? step up to fill the gap What can be done as a community? of preventative care that has been going on for fourteen months now, plus address all the new issues the pandemic has brought. Perhaps a holistic approach is the answer to saving two birds This is a large order, and one that I know that we will fill. Our with one intervention. As we educate patients about diet, job now is to try and make sure that the expense (financial or exercise, mental health, and preventative care, do not forget otherwise) is not too great.

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In The News

IN THE

NEWS Calling All Mentors! Do you worry about who will take care of your patients when you retire? Are you looking for a meaningful way to give back to your community? If so, look no further! SJMS is currently recruiting volunteer mentors to join our Bridge to Medicine (BTM) committee. BTM guides high achieving students (high school & college) along their academic journey so that they have the best chance of being accepted to medical school and ultimately return to practice in our community. The committee meets every other month (virtually via Zoom) and consists of physicians (working & retired), alliance members and even a local college professor. Most importantly, you don’t need to be an expert! We have committee members with a wide array of skill sets and resources, so you are never alone. For more information, please contact Lisa Richmond at 952-5299 or Lisa@sjcms.org. Cal-HOP HIE Funding Opportunity Expiring Soon In September 2020, the California Department of Health Care Services (DHCS) launched a new effort to boost the use of health information technology by providers. The California Health Information Exchange Onboarding Program (CalHOP) committed $50 million to help more practices participate in health information exchanges (HIEs) by reducing or eliminating of the obstacle of paying for the interface between their EHR and the HIE. This funding opportunity expires in September 2021, so it is important that practices get the process started ASAP to take advantage of this opportunity.

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Cal-HOP will enable HIEs to provide direct assistance to individual practices and hospitals that seek to leverage a health information exchange to improve care coordination, engage with public health resources, and enhance patient outcomes through the use of comprehensive clinical data. Under Cal-HOP, Qualified Health Information Organizations (QHIOs) will support providers and hospitals in connecting their electronic health records to QHIOs to enable the exchange of admission, discharge, and transfer messages; connect to the Controlled Substance Utilization Review and Evaluation System (CURES); and implement advanced data exchange interfaces. The funding provided by Cal-HOP will greatly reduce the cost of onboarding to QHIOs for individual practices and hospitals. Providers are encouraged to contact their local HIO for more information at https://www.manifestmedex.org/ for-providers/. For more information about program requirements or how to begin enrollment under a QHIO, visit https://www.dhcs.ca.gov/provgovpart/Pages/CalHOP.aspx or email HIEOnboard@dhcs.ca.gov. San Joaquin General Hospital’s Trauma Center Advances to Level II Designation San Joaquin General Hospital’s Trauma Center has been upgraded from a Level III Trauma Center to a level II designation. A Level II Trauma Center is one that can deliver and initiate definitive care for all injured patients. A Level II Trauma Center is one where a hospital demonstrates the ability to provide basic assessment, resuscitation, surgery, intensive care and stabilization of injured patients. The advancement to Level

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II designates a hospital’s exemplary trauma care and its proven ability to provide 24-hour immediate coverage by general surgeons, as well as coverage by the specialties of orthopedic surgery, neurosurgery, anesthesiology, emergency medicine, radiology and critical care. The designation of a Level II Trauma Center is awarded by both the San Joaquin County Emergency Medical Services Agency and the American College of Surgeons (ACS). The accreditation from the ACS will come later in the Summer. This achievement recognizes the trauma center's dedication to providing optimal care for critically injured patients within San Joaquin County. Trauma Centers not only provide emergency hospital resources necessary for trauma care, but also the entire spectrum of care to address the needs of all injured patients. This spectrum encompasses the Hospital’s pre-hospital phase through the rehabilitation process. The benefit of having a Level II Trauma Center in San Joaquin County means that local residents now have the security of having immediate and accredited emergency care for all life-threatening injuries. Trauma Centers provide a tremendous asset to local communities. San Joaquin General began a Level III Trauma Center in 2014, and through the years we have added the necessary staff & technologies to be recognized as a regional Level II Trauma Center. Family Honors San Joaquin General Hospital with a Gift of $350,000 San Joaquin General Hospital’s Foundation has received a gift of $350,000 in remembrance of the work of the late Dr. Samuel Hanson and his family. Dr. Hanson was a practicing OB/Gyn physician at San Joaquín General for many years. The gift was from the estate of Dr. Hanson’s daughter, Deborah Hanson Murphy in recognition of her father and the humanitarian efforts of San Joaquin General Hospital. Ms. Murphy had fond memories of visiting her father at the Hospital and witnessing the work of a caring medical staff. The Deborah Hanson Murphy gift represents the largest financial contribution to the Hospital’s Foundation in its history. Deborah Hanson Murphy was born at the Hospital in Stockton in 1931. She earned her Bachelor of Arts degree from Stanford University in 1953. She studied at the Art

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Students League in New York from 1957-1958 and after a brief career in journalism, lived in France and Italy from 1959-1967. After a brief return to live and work in Washington, D.C., where she was a docent at the National Gallery, she returned to France where she lived in the Montmartre neighborhood of Paris from 1986 until her death. Her work has been shown in various galleries and exhibitions in Paris and French provinces, New York and Los Angeles. Her works are found in the permanent collections of the Louvre and the Boston Museum of Fine Arts. Ms. Hanson Murphy has additionally donated six of her paintings to the Hospital and they will hang in both the maternity wing and the surgical wing. Her artistic work was deeply inspired by the renaissance painters and their use of light. She was also fascinated by the still life paintings of Georgio Morandi (1890-1964). Her husband, Richard W. Murphy, was a writer for Time Life who wrote a biography of the French artist Cezanne. Deborah was the oldest of three children of Irene and Samuel Hanson. “We are very honored that our Hospital has been recognized by the estate of Deborah Hanson Murphy. The gifts of Ms. Murphy are a wonderful example of saying ‘thank you’ to the efforts of our entire staff. These funds will go directly to support the health of all San Joaquin County residents.”, said David Culberson, C.E.O., San Joaquin General Hospital Hospice of San Joaquin Introduces New Team Physicians Hospice of San Joaquin introduces new Team Physicians, Medical Director, and Pacific Palliative Care Physician. A patient’s hospice care team consists of a highly-trained, multidisciplinary group of care professionals, with each member playing a role in the planning, provision, and management of the patient’s holistic end-of-life care. Playing a crucial role in the care team are the Hospice Team Physicians and Medical Director, an expert team of physicians that are responsible for ensuring that every patient’s care wishes are honored, that the hospice team is supported, and that the care goals set for each patient are being achieved. Hospice of San Joaquin has expanded its original strategic plan of having two team physicians and one Medical Director to introducing a total of four new team physicians and our new Medical Director, Dr.

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In The News

IN THE

NEWS Deepak Shrivastava, to enhance all home-base patient care. Transitioning from two teams, both covering the greater North and South county regions, to now having four, each team physician is responsible to oversee the patients on their particular team. The smaller teams result in less patients per team, which will help enhance Patient care, allows for greater oversite and teamwork between our Registered Nurse Case Managers and Hospice Clinical Staff to provide the highquality, compassionate end-of-life care we are committed to providing. Please welcome the following Team Physicians and Medical Director: • Dr. Herrera, Team Physician • Dr. Goswami, Team Physician • Dr. Vasavda, Team Physician • Dr. Shrivastava, Medical Director Also, please welcome: • Dr. Puthillath (AJ), Pacific Palliative Care Physician Health Plan of San Joaquin Marks 25th Anniversary Established by San Joaquin Valley residents in 1996 as a public health plan with the goal of improving community health through local engagement, Health Plan of San Joaquin (HPSJ) has been deeply rooted for more than a quarter of a century in the richly diverse communities they serve. For over two decades, HPSJ has been dedicated to broadening access to high-quality health care services by engaging members and local stakeholders to expand the provider network and effectively deliver programs to support the health care safety-net.

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Health Plan of San Joaquin continues helping get out the word: Authorized Vaccinators & California Vaccination (myCAvax) Program The California Department of Public Health (CDPH) list of professionals currently able to administer COVID-19 vaccines, including conditions for giving the shots, is at https://tinyurl.com/4th2nj3j. The myCAvax program updates for providers are at https://eziz.org/covid/. HPSJ adds it is encouraging its Provider Network to communicate with members to have them make an appointment for their COVID-19 vaccine appointment and at the same time check-in with them for medical and/or preventative care issues. For HPSJ members who have barriers with transportation, they can call HPSJ for assistance. HPSJ Myth Busters, COVID-19 Vaccines – Help for talking with patients As vaccine supplies ramp up, more and more of us will have opportunities to be vaccinated for COVID-19. To help you and your staff have conversations with patients, Health Plan of San Joaquin offers information, based on current science and public health guidance. Created to be accessible for lay people, and to answer many of the concerns HPSJ has been hearing from members and the community, find the fact sheets at https://www.hpsj.com/coronavirus/. HPSJ also offers a Spanish version at https://miembros.hpsj.com/coronavirus/

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Keeping HPSJ members and community safe during California fire season –Helping Providers prepare With California facing drought conditions and a more yearround fire season, Health Plan of San Joaquin now offers members detailed information and support at www.hpsj.com/stay-safe-during-fire-season/. To help health care providers be ready for fire, smoke and ash emergencies, as well as power outages, HPSJ points to the Centers for Disease Control and Prevention where CDC offers great tools to help serve your patients. Find the CDC tool kit at www.hpsj.com/providers/. HPSJ also asks members to

KNOW THEIR COLORS when it comes to air quality and California’s fire season. The EPA’s AirNow site has valuable information on how to stay healthy and safe, at www.airnow.gov/. Their free, colorful AirNow app, available at the Apple App Store or the Google Play Store, has hyper-local air quality updates so everyone can track the air quality in their area. Health Plan of San Joaquin Language Services – Essential for members’ access to best quality of health care Research has shown lack of language assistance is a major contributor to health disparities and poor treatment outcomes. In this richly multi-cultural community, HPSJ offers every member services to bridge language gaps and achieve health equity. Language services include providing medically qualified interpretation and written assistance to Limited English Proficiency (LEP) individuals in their primary language. This helps ensure patients understand their treatment process, are able to ask questions during the medical encounter, and facilitates timely access to care services. It also makes more likely each patient will adhere to their provider’s treatment plan and thus have the best possible health outcomes. HPSJ patients are encouraged to use these services, at no cost to them. For more about HPSJ’s services, including support for members who are deaf, hard of hearing, or blind, and how providers can help schedule services during office visits through HPSJ

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Customer Service, go to https://www.hpsj.com/language-assistance/. Improved Payment Experience – coming soon to Health Plan of San Joaquin Provider Network Look for information and updates, plus provider staff training opportunities, as HPSJ approaches the July 2021 switch-over date, at www.hpsj.com/pay. MORE Help for Adverse Childhood Experiences (ACEs) Health Plan of San Joaquin is helping its Provider Network stay on top of additional supports to keep children safe, especially during this pandemic. California’s ACEs Aware is hosting a series of activities to promote shared learning and quality improvement among Medi-Cal providers in adopting ACE screenings and providing trauma-informed care. View upcoming webinars and previous sessions at https://tinyurl. com/hbvczrn2. Hospital Surgeons See Benefits in Telemedicine Physicians at Shriners Hospitals for Children —Northern California have found that telemedicine has some serious benefits, not unlike a house call. Dr. Payam Saadai is the director of the hospital’s Pediatric Colorectal Center and leads a team that cares for patients with complicated gastrointestinal disorders, many of them surgical patients. Even in his area of medicine, he’s found telemedicine is beneficial. It is helpful to see where patients live, he said, and in a telemedicine visit, the physician can consult with home nurses, talk with family members and identify risks in the home. “Video visits are particularly useful in the early days of a diagnosis when new patient families have so many questions about their child’s care,” he said in a recent article. A study in the Lancet found telemedicine reduced outpatient visits and hospital admissions in patients with inf lammatory bowel disease, he notes.

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In The News

IN THE

NEWS Kaiser Permanente Northern California Hospitals Receive Top Marks for Patient Safety The Leapfrog Group recognized 16 Kaiser Permanente Northern California hospitals with a top score of “A” in its biannual Hospital Safety Grades report, which examined and graded approximately 2,700 hospitals throughout the United States.

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patient experience. In addition to the Leapfrog Group ratings, Cal Hospital Compare, which features quality and performance information on California hospitals, also recently named eight Kaiser Permanente Northern California hospitals to its Patient Safety Honor Roll. The hospitals include Fresno, Manteca, Redwood City, Roseville, Santa Clara, Santa Rosa, South San Francisco, and Vallejo.

Kaiser Permanente hospitals in Northern California with “A” scores include Fremont, Fresno, Manteca, Modesto, Oakland, Redwood City, Richmond, Roseville, Sacramento, San Francisco, San Rafael, Santa Clara, Santa Rosa, South San Francisco, Vacaville, and Vallejo. Additionally, Kaiser Permanente hospitals in Antioch, San Jose, South Sacramento, and Walnut Creek received “B” scores.

The Patient Safety Honor Roll uses patient safety measures to evaluate hospitals across a variety of areas including hospital acquired infections, adverse patient safety events, sepsis management, patient experience, and Leapfrog Hospital Safety grade. The eight Kaiser Permanente Northern California hospitals were among a total of 73 California hospitals that made the honor roll.

The COVID-19 pandemic has created unprecedented challenges for the collective national health care system. Kaiser Permanente Northern California hospitals continue to be consistently recognized as among the country’s best for outstanding patient safety, positive outcomes, and

“Patient safety and positive outcomes are top priorities and goals shared at every level of Kaiser Permanente,” says Corwin Harper, Senior Vice President and Area Manager for Kaiser Permanente, Central Valley Service Area. “We are proud to see these efforts recognized, though this only

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

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Preeti Srivatsa, M.D.

George Kunhardt, M.D.

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In The News

IN THE

NEWS renews our ongoing commitment to ensure our patients, visitors and staff find safety and comfort throughout our facilities.” Doctors Hospital of Manteca Names Gregg Garrison Chief Financial Officer Doctors Hospital of Manteca has appointed Gregg Garrison as its new Chief Financial Officer (CFO), effective March 12, 2021. “Gregg brings a high level of expertise to support our financial and growth strategies as we expand to meet the needs of our growing community,” said Murali Naidu, M.D., CEO of Doctors Hospital of Manteca. “He has many years of experience in understanding the various services we provide from a financial perspective and we are thrilled to have him on our team.”

Gregg Garrison

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Garrison is currently the CFO at Emanuel Medical Center in Turlock, a sister hospital of Doctors Hospital of Manteca, and will now serve as CFO over both hospitals. Prior to joining Emanuel in 2020, Garrison served as CFO

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for HCA Houston Healthcare West for nearly 11 years, CFO for Summer Branch Medical Center in Houston, Texas, and CFO for Twelve Oaks Medical Center, also in Houston. He’s no stranger to Manteca. Garrison served as CFO of Doctors Hospital of Manteca for two years from 1995-1997. Garrison earned his Bachelor of Science degree in Business Administration from the University of Central Missouri in Warrensburg, Missouri, as well as his Master of Business Administration degree from the same university. He also completed graduate studies in Health Services Administration at the University of Kansas. Garrison is affiliated with the American Institute of Certified Public Accountants and the Healthcare Financial Management Association. Doctors Hospital of Manteca Employee Recognized as Tenet Hero Special honor is part of Tenet Healthcare’s annual recognition program Doctors Hospital of Manteca is proud to announce that Emily Hoogendoorn, Social Worker, has been honored by Tenet Healthcare as part of its annual recognition program. Emily has been named a “Tenet Hero” for her incredible contributions in 2020. The Tenet Heroes program celebrates individuals who make a meaningful impact within their respective communities that goes above and beyond their daily job responsibilities. Nominated by fellow colleagues, Tenet Heroes exemplify the company’s core values and key tenets of its Community Built on Care.

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“We welcome Eddie back to BAC, and we are excited to see him in this new role,” said BAC’s Chief Executive Officer Dana Bockstahler. “His business banking expertise and years of delivering exceptional service and solutions will be of great value to our customers.” Committed and invested in the local community, Eddie volunteers for local non-profit organizations and currently serves as a board member of the San Joaquin County Hispanic Chamber of Commerce. Eddie can be reached at (209) 4736827 or eddie.lira@bankbac.com.

Emily Hoogendoorn Emily was recognized as a Tenet Hero for her amazing dedication and commitment as the hospital social worker. She covers every unit within Doctors Hospital of Manteca with ease and compassion, from the Emergency Department to the ICU to Labor & Delivery and everything in between. “Emily has inspired us through her actions to make a positive and meaningful difference in our community,” said Murali Naidu, M.D., CEO of Doctors Hospital of Manteca. “We are grateful for Emily’s efforts, self less nature and commitment to compassionate care particularly throughout the COVID-19 pandemic, and we are proud to work alongside her.” Eddie Lira Joins BAC Community Bank Executive Team Eddie Lira has been appointed to the executive team of locallyowned BAC Community Bank as Executive Vice President, Chief Business Development Officer. Eddie is a commercial banking professional with over 15 years of experience in leadership, portfolio management, and business development. Most recently, Eddie worked for a large national bank, overseeing a team of business professionals across the Central Valley. This team was focused on providing business lending, cash management, and deposit solutions for customers under their care. Eddie’s past responsibilities include serving as Vice President, Commercial Banking Officer for 6 years at BAC Community Bank.

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St. Joseph's Nationally Recognized with an ‘A’ for the Summer 2021 Leapfrog Hospital Safety Grade Dignity Health-St. Joseph’s Medical Center was awarded an ‘A’ in the Summer 2021 Leapfrog Hospital Safety Grade, a national distinction recognizing St. Joseph’s Medical Center’s achievements providing safer health care. The Leapfrog Group is an independent national watchdog organization committed to health care quality and safety. The Safety Grade is a letter grade assigned to all general hospitals across the country and updated every six months, assessing how well the hospital prevents medical errors and other harms to patients. “Patient safety is everyone’s goal at St. Joseph’s Medical Center, and I am thankful for the dedication to safety and quality that I see demonstrated by our team every day,” said Don Wiley, president and CEO of St. Joseph’s. “The Leapfrog Hospital Safety ‘A’ Grade illustrates our commitment to providing the highest quality care to our community.” Developed under the guidance of a national Expert Panel, the Leapfrog Hospital Safety Grade uses 28 measures of publicly available hospital safety data to assign grades to more than 2,600 U.S. acute-care hospitals twice per year. The Hospital Safety Grade’s methodology is peer-reviewed and fully transparent, and the results are free to the public. St. Joseph’s Launches New Residencies in Psychiatry and Anesthesia This summer, St. Joseph’s Medical Center will be launching a new Psychiatry Residency program and an Anesthesia Residency program. The two newly accredited programs will welcome seven psychiatry residents and six anesthesia residents to St. Joseph’s this summer With established residencies in Family Medicine, Emergency Medicine, Internal Medicine and Transitional Year already

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underway, St. Joseph’s Graduate Medical Education Program plans to train more than 180 doctors yearly, once the program is fully implemented, making it one of the largest and most complex graduate medical education programs in Northern California. With both primary care physicians and specialists being in short supply in the Central Valley, St. Joseph’s Graduate Medical Education Program will help to meet both the current and future need for care in our community. Studies show that as many as half of all residents go on to practice within 50 miles of where they trained. That staying power is crucial for the Central Valley, where both primary care physicians and specialists are in chronically short supply.

Maternal Quality Care Collaborative’s Maternal Data Center. Cal Hospital Compare provides quality and performance information on California hospitals to help healthcare consumers make smarter and more informed choices when making medical decisions. Cal Hospital Compare firmly believes that by making this information publicly available — will improve the health care system.

St. Joseph’s Awarded Honor Roll Designation by Cal Hospital Compare St. Joseph’s is proud to have received the 2020 Honor Roll Award for Patient Safety, Opioid Care and Maternity Care by Cal Hospital Compare. To receive the Patient Safety Award, a hospital must have a high patient safety profile in comparison to other hospitals across a variety of care domains including hospital acquired infections, adverse events, sepsis management, and patient experience. To receive the Opioid Care Award, hospitals must have scored ≥ 21 points on the 2020 Opioid Management Hospital Self-Assessment and scored at least one point in each of the following 4 domains of care: safe and effective opioid use, identifying and treating patients with opioid use disorder, overdose prevention, and applying cross-cutting opioid management best practices. In order to receive the Maternity Care Award, St. Joseph’s had to achieve the statewide cesarean section rate of 23.9 percent or lower for low risk, first birth deliveries, and participate in California

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Akilah Weber, M.D.,

sworn into office as third physician legislator serving in Sacramento San Diego physician Akilah Weber, M.D., was sworn into office on April 19, 2021, as California’s newest Assemblymember in a ceremony held at the State Capitol. Dr. Weber won her election to the 79th Assembly District earlier this month with 52% of the vote, soundly defeating a crowded field of candidates. The seat became vacant when Dr. Weber’s mother Shirley Weber was appointed by Governor Gavin Newsom as California’s first Black Secretary of State. The elder Weber administered the oath of office to her daughter, another historic first. Afterward, Dr. Weber, surrounded by her husband and two sons, gave a brief thank you speech from her desk, then promptly began her duties of voting on legislation. Support for Dr. Weber materialized rapidly after she announced her intention to run. The California Medical Association (CMA) Political Action Committee (CALPAC) Board of Directors, along with the leadership of the San Diego County Medical Society (SDCMS), led a substantive peer-to-peer outreach effort engaging physician donors and stakeholder groups in and outside of San Diego. Nearly 100 CMA physician members made critical, personal contributions to Dr. Weber’s

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successful campaign. SDCMS was joined in its support of Dr. Weber by the political action committees of the Los Angeles, Orange, San Francisco and San Mateo county medical societies, along with numerous specialty societies and associations. Additionally, the CMA Independent Expenditure Committee lead a major coalition effort with indirect support of Dr. Weber totaling over $500,000, which cemented Dr. Weber’s early victory, and highlighted the House of Medicine’s support for physician candidates running for impactful offices. The successful election and swearing in of the newest physician to the California Legislature highlight the importance and necessity of CMA physicians donating to CALPAC. Having physicians in elected office exponentially amplifies the voice of the physician community on important legislation. Without physicians giving to CALPAC, it would have not had the resources or political capital necessary to help Dr. Weber achieve such a clear-cut victory. CALPAC asks that you visit calpac.org and donate to today, for the elections of tomorrow, and asks you to make direct contributions to future physician candidates for office, when those opportunities arise.

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THE

OF ACES By Keenia Tappin, MD

“Adverse childhood experiences are the single greatest, unaddressed public health threat facing our nation today.” – DR. ROBERT BLOCK, FORMER PRESIDENT OF THE AMERICAN COLLEGE OF PEDIATRICS.

From 1995-1997, Dr. Felitti from Southern California Kaiser and Dr. Anda from the CDC conducted the landmark Adverse Childhood Experiences (ACE) Study. The study included ~17,000 Southern California Kaiser members who were 54% female, 46% male, 75% Caucasian, and 39% college educated. The study was designed to look for a correlation between exposure to abuse or family dysfunction during childhood and development of common deadly medical and public health problems in adulthood. The 10 ACEs included in the study were psychological, physical, and sexual abuse, emotional neglect, physical neglect, household substance abuse (alcohol or illicit drug use), mother treated violently, mental illness, depression in the household, parental separation or divorce, and having an incarcerated household member. The negative adult health outcomes assessed included: severe obesity, being a smoker, being an alcoholic, lack of physical activity, 2 or more weeks of depressed mood in a year, lifetime attempt at suicide, illicit drug use, ≥50 sexual intercourse partners, and history of sexually transmitted disease. Adult chronic diseases assessed included: ischemic heart disease, cancer, stroke, chronic bronchitis/ emphysema, diabetes, hepatitis, fair or poor self-rated health.

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This landmark study revealed two unexpected and pivotal facts about trauma during childhood. Firstly, ACEs are common. 36% of the participants had no ACEs, 26% had 1 ACE, 16% had 2 ACEs, 9.5% had 3 ACEs, and 12% had 4 or more ACEs. The top 3 ACEs were physical abuse (28%), household substance use (27%), and parental separation or divorce (23%). Secondly, there is a graded dose-response relationship between number of ACEs and development of negative adult health outcomes. For instance, when participants with 0 ACEs were compared to those with 4 or more ACEs, the latter group was 2.2 times more likely to be a smoker, 7.4 times more likely to consider themselves an alcoholic, 10.3 times more likely to have illicit IV drug use, and 12.2 times more likely to have a prior suicide attempt. In terms of chronic disease, participants with 4 or more ACEs versus those with 0 ACEs were 2.2 times more likely to have ischemic heart disease, 2.4 times more likely to have a history of stroke, and 3.9 times more likely to have chronic bronchitis or emphysema. Once the results came in the next question became, how exactly are these ACEs linked to risky health behaviors and diseases in adulthood? Is it simply that people who experience trauma are more likely to

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Trust your patients to our cardiac experts. St. Joseph’s commitment to continually advance cardiac care has not wavered throughout the pandemic. From advances in new cardiac procedures such as the Convergent procedure for advanced atrial fibrillation, to performing over 300 TAVRs and achieving top-star rating for cardiac surgery, we remain dedicated cardiovascular excellence. Learn more about St. Joseph’s award-winning cardiac services at StJosephsCares.org/Heart.

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cope in unhealthy ways or is it linked to changes in the brain and other organs that occur during development? The answer is, it may be a little bit of both. In terms of unhealthy coping mechanisms, smoking is a prime example. Nicotine has been shown to have positive mood regulation effects. Also, when used alone or with other substances such as alcohol, it can stimulate the dopamine reward pathway via increased dopaminergic neuronal firing. Individuals exposed to repetitive trauma may find solace in the short term positive effects of smoking or alcohol. Unfortunately, chronic smoking predisposes to emphysema, heart disease, and malignancy. Chronic alcohol use is a factor in developing cancer, hepatitis, and cognitive impairment. Looking at neurodevelopment, trauma can have many long standing effects on the brain. First, it is well known that the brain is not structurally complete at birth. The infant’s brain is extremely adaptable and changes via pruning and strengthening of neuronal connection which occur based on interactions between the baby and their environment. According to the Harvard Center for the Developing Child, there are 3 types of stress responses which occur in the developing child. Positive stress is characterized by brief increases in heart rate and mild elevations in hormone levels. This is the type of stress that is essential for normal development. Examples include trying something new, first day of school, getting a vaccine. Tolerable stress is the next level up, where an individual may have time-limited activation of the fight or flight stress response that is tempered by supportive relationships with a caring adult. After a short period of time, the child comes back to their emotional baseline and suffers no long lasting effects. Examples include, death of a loved one, natural disaster, or experiencing a frightening event. Lastly, there is toxic stress, which is characterized by prolonged activation of the fight or flight stress response system without adequate supportive relationships to ameliorate its effects. Examples include any of the ACEs (abuse, neglect, household dysfunction) which occur repeatedly or an accumulation of multiple ACEs. This prolonged activation of the stress response leads to changes in the developing brain, hypothalamic pituitary axis, and other organs of the child. Changes can also be seen at the epigenetic level with modifications to the way one’s DNA is read and processed. While the groundbreaking ACEs study along with other key neurodevelopment research have helped us identify the problem and effects of ACEs, it does not offer us a solution. What do we do about children already exposed or the adults walking around with numerous ACEs suffering from the known long-term consequences? Is there hope for them or are they simply a lost cause? Have faith, all is not lost! The solution to the riddle of

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ACEs lies in the building of resiliency. Resiliency is defined as the ability to recover from or adjust easily to adversity or change. While this skill is easier to develop in a child when compared to an adult, both can achieve this goal. It is accessible to all people at all ages. So how do we build resiliency? Interpersonal relationships and connection to community are key factors for adults. We can be part of the solution by creating a space of love, safety, and connection for our children, for one another, and for ourselves. References: 1. Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American journal of preventive medicine, 14(4), 245-258. 2. American Academy of Pediatrics. (2019). Adverse childhood experiences and the lifelong consequences of trauma. 2014. For more information on ACEs, effects, and solutions: 1. CDC: https://www.cdc.gov/violenceprevention/aces/index.html 2. Harvard Center for the Developing Child- Toxic stress: https:// developingchild.harvard.edu/science/key-concepts/toxic-stress/ 3. Dr. Nadine Burke Harris ,California’s Attorney General, Ted Talk on ACEs: https://www.youtube.com/watch?v=95ovIJ3dsNk 4. ACEs connection network: https://www.acesconnection.com/

5. For information on Trauma informed care, ACEs screening, and primary care training for government reimbursement for ACEs screening see California ACEs Aware Initiative: https:/www. acesaware.org/

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Practicing local can potentially ease portion of medical school debt burden By Jo Ann Kirby A calling to serve others is often a driving motivator among many who embark on the path to don the white coat. But having a servant’s heart can come with a hefty price-tag. It’s a long and costly journey that can add up to years of debt-laden schooling, followed by a residency and oftentimes fellowships before a doctor’s full earning potential is reached. The San Joaquin Medical Society’s Scholarship Loan Fund has granted a total of $4 million in affordable loans to 324 students since its inception in 1962 and offers new incentives for doctors to practice locally. Dr. Julianne Angeles, a family medicine practitioner who works for San Joaquin County Hospital Employee & Occupational Health and also sees patients at San Joaquin County Community Clinics, said the SLF loan she received was helpful from the start because it meant she could focus on her medical school studies without having to take on part-time jobs to finance her education. After becoming eligible to apply for the fund’s new Principal Forgiveness Program, which converts a portion of the loan into a scholarship for each year they practice locally, up to five years, she has even more reason to be grateful. “Because I had to finance my own education, I have accrued a significant amount of student loan debt. This scholarship helps me alleviate the financial burden of student loans so I can continue my work to serving the urban underserved,” said Angeles, who is also juggling a mortgage payment in addition to the other bills one

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accumulates as an adult. The SLF also sponsored Dr. Angeles’ first year of membership with the San Joaquin Medical Society with the goal of further engaging young physicians in the community. Membership gives her the chance to network with established doctors, become involved in leadership opportunities and more. In addition to earning an undergraduate degree, would-be doctors spend four years in medical school, followed by about three to seven years as a resident, where they train under the supervision of attending physicians, and possibly additional years if they specialize in an area that necessitates a fellowship. Even though they are officially a medical doctor when they start their residency, they earn relatively slim pay considering their debt load. According to Medscape, the average medical resident in family practice could expect to make about $60,000 in 2020. A 2020 Association of American Medical Colleges report titled “Physician Education Debt and the Cost to Attend Medical School,” reported that nearly three-quarters of all medical school students graduate with significant debt. And while that percentage has decreased in the past few years, those who do borrow for medical school face big loans: the average medical school debt for students who graduated in 2019 was $201,490. The median four-year cost for public university students can be $250,222. For private school students, the cost is around $330,180. >>

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HOW YOU CAN HELP Originally launched in the 1960s with funds from a polio vaccine fundraiser and donations from a national travel agency, the fund is now primarily supported by returns from its investments, repayment from loan recipients and donations from generous supporters. The board welcomes donations so that it can ultimately offer more awards each year. To meet the demand and continue to offer the principal forgiveness incentives for those who return to serve our community, SLF will gladly accept taxdeductible donations. Checks may be made payable to Scholarship Loan Fund, 3031 W. March Lane, Ste 222 West, Stockton, CA 95219. A receipt will be provided.

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For some doctors, including Angeles who attended Michigan State for her Master of Public Health and Doctor of Medicine degrees, student loan debt can be even more burdensome when the price includes out-of-state graduate school tuition. It can be a shock to medical school graduates when they learn that repayments need to be made on $200,000-plus of student loan debt while they are just starting their residency, said cardiologist Dr. Richard Waters who is a Stockton native, practices at Stockton Cardiology Medical Group and currently serves as vice chair of the Scholarship Loan Fund Board of Directors. As a past recipient of the loan in the late 90’s, Dr. Waters was instrumental in shaping some of the restructuring of the loan repayment and new incentives aimed at convincing local students to return to practice in community. Waters was just one year out of medical school when he had to start chipping away at his medical school debt. After a one-year internal medicine internship, two years of internal medicine residency, he had three years of cardiology fellowship followed by a one-year interventional cardiology fellowship. “I had to start repaying it in full while I was in my residency. I knew that. But it’s hard to realize what that means when you are in college. It’s hard to understand what going into full repayment five years later means. It was challenging to meet my repayments while I was in residency,” he said. For that reason and the fact that the area continues to suffer from a critical shortage of doctors and nurses, Waters is pleased that a portion of loan can truly become a scholarship if a recipient commits to practicing locally and meets forgiveness program’s requirements. “When I came back to the community and was asked to be part of the board, I wanted to do it. I thought it was a great opportunity to help make it even a better loan and possibly even make it a true scholarship,” Dr. Waters said. “We made changes to extend the amount of time between completing medical school and when you enter full repayment to make it more financially feasible and realistic.” Dr. David Araiza attended Tokay High School and then supported himself for several years before he started working his way through San Joaquin Delta College and UC Merced. He then attended medical school at UC Davis and is in his residency at San Joaquin General Hospital. Married with two small children, he said the prospect of so much student loan debt can deter medical school students from going into certain specialties if it means that delaying their earning potential would be further delayed by lengthy fellowships. Araiza, who has always planned to practice family

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SCHOLARSHIP LOAN FUND BOARD OF DIRECTORS Gregg Jongeward, PhD Chair Senior Associate Dean & Associate Professor, Biological Sciences University of the Pacific Richard Waters MD, Vice Chair Stockton Cardiology Medical Group Georgette Hunefeld, Chief Financial Officer Senior Director of Strategic Philanthropic Initiatives University of the Pacific Dr. David Araiza and Family medicine, will likely be an ideal candidate for the new incentives. “My focus was to always return to Stockton and provide high quality care to Medi-Cal, uninsured and underinsured patients,” said Araiza, who was inspired to become a doctor after seeing the need for quality medical care for Medi-Cal recipients based on the experiences of his extended family. While he is closer than ever to reaching his goal, his path to become a doctor has been a longer journey because he had

“ M y focus was always to return to Stockton to provide high quality care to Medi-Cal, uninsured and underinsured patients” - DAVID ARAIZA, MD

to work to support himself while simultaneously working towards his undergraduate degree. “This Scholarship Loan Fund helps,” he said. Now in his first year of residency, Araiza said that due to the COVID-19 pandemic, the federal government temporarily set interest at zero percent and suspended loan

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Elizabeth Grady, Secretary San Joaquin Medical Society Alliance Janwyn Funamura, MD Pediatrician Valley Mountain Regional Center Eric Chapa, MD Family Practice Royce Northcott San Joaquin Medical Society Alliance Julie D. Kay, RN, MSN Dean of Health and Fitness San Joaquin Delta College Nguyen Vo, MD Internal Medicine San Joaquin General Hospital

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payments. He and his family are living with relatives to cut expenses and using the break from his other student loan payments to beef up their savings. He said the Scholarship Loan Fund’s Loan is a great benefit for homegrown doctors and the potential to apply for the Principal Forgiveness Program lines up nicely with his goals to practice locally. “I really like what the San

“ W e know this is a wonderful community and we have talented people here who want careers in medicine, and we want to help them overcome the financial barriers to meet that goal but also we want to make it more attractive for them to come back home to practice ultimately.” - DR. WATERS

Joaquin Medical Society does with the assistance they provide,” Dr. Araiza said, adding that their programs really help first-generation college and medical school students who can benefit from, not only financial assistance but mentorship. “They have Decision Medicine and Bridge to Medicine to mentor students. I also wish there were more of these repayment plans for people who want to serve in the Valley and help the neediest.” `Waters hopes the Scholarship Loan Fund can continue to help encourage medical residents to ultimately practice locally while helping to ease their financial burden. The program typically funds a maximum of two recipients each year offering M.D./D.O. recipients $10,000 a year to a maximum of $40,000 and offering nursing students studying for their R.N./N.P. or P.A., $4,000 a year to a maximum of $8,000. It could award more loans if the fund can continue to expand. “We know this is a wonderful community and we have talented people here who want careers in medicine, and we want to help them overcome the financial barriers to meet that goal but also we want to make it more attractive for them to come back home to practice ultimately,” Dr. Waters said.

Richard Waters, MD

Julienne Angeles, MD, MPH

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Scholarship Loan Fund Fast Facts Residential Requirement

Applicants must have resided for a meaningful period of their lives in one or more of San Joaquin Medical Society’s member counties—San Joaquin, Alpine, Amador or Calaveras.

Application Timeline

Review of Fall Application Begins: May 1 Fall Interviews: May and June Review of Spring Application Begins: November 1 Spring Interviews: November and December

Loan Amounts

•M D/DO- $10,000 per year to a maximum of $40,000 • R N/NP/PA- $4,000 per year to a maximum of $8,000

Loan Terms

Doctor of Medicine and Doctor of Osteopathic Medicine Terms: 1. M edical Student Year 1 (MS-1) through Postgraduate Year 1 (PGY-1): The loan is interest-free; no payment is required. 2. P GY-2 through PGY-3: Interest-only payment is required. The interest rate is prime plus 1% (determined annually on June 30th by the Federal Reserve). Enrollment in medical school and residency must be uninterrupted and evidenced by proper documentation. Exceptions will be considered on a case-by-case basis. 3. Upon completion of PG-3: Repay the principal over a maximum of 60 months. The interest rate is prime plus 3% (determined annually on June 30th by the Federal Reserve). 4. T he student may make payments to the loan or pay it off at any time, regardless of the repayment period.

Registered Nurse, Nurse Practitioner and Physician Assistant

1. T he loan is interest-free during the course of study, which must be uninterrupted. 2. T he month after completion of the program, the student is required to begin payments towards the principal, with an interest rate of prime plus 3% (determined annually on June 30th by the

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Federal Reserve) for a maximum of 60 months. The student may make payments to the loan or pay it off at any time, regardless of the repayment period

. Physician Incentives

Recognizing the tremendous need for physicians in our communities, any recipient who returns to establish their primary practice in one of the San Joaquin Medical Society (SJMS) member counties of San Joaquin, Alpine, Amador or Calaveras, may apply for the Scholarship Loan Fund (SLF) incentives as outlined below:

Principal Forgiveness Program

•U pon employment verification, the recipient will make interest-only payments. •A fter completion of one year of practice in an SJMS county, the SLF Board of Directors has the option (based on analysis of its finances) to offer forgiveness of up to 20% of the loan amount identified at the time of graduation from medical school. •T he recipient may apply for the SLF Principal Forgiveness Program annually while practicing in an SJMS county for a total of five years The Scholarship Loan Fund will ensure first year membership dues to the San Joaquin Medical Society and the California Medical Association, organizations dedicated to promoting the care and well-being of patients and the betterment of the medical profession, as well as offering a variety of resources and benefits to its members. For more details about the loan or to read the Winter 2013 article, including the history of SLF, please visit www.sjcms.org/programs/scholarshiploan-fund.aspx

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Advanced Interventional Radiology Procedures in Central Valley The interventional radiology (IR) team at Doctors Hospital of Manteca diagnoses and treats medical conditions using X-rays, ultrasound and computerized tomography (CT) in largely an outpatient setting. If your patient needs a minimally invasive image-guided alternative to open surgery, we offer the following core interventional procedures: Arterial study for angioplasty, stent, grafts and thrombolysis

Placing and removing inferior vena cava (IVC) filters

Biopsies

Thoracentesis

DVT/PE thrombectomy, thrombolysis

Urinary tract obstruction or stone management

Dialysis vascular access and maintenance of fistula, AV declot Embolization (uterine fibroid embolization, varicocele, for pelvic congestion and for aneurysms) Epidurals, pain block and myelogram Gastrostomy tube placement

Varicose vein treatment Vascular access (ports and lines) Venous thrombolysis, thrombectomy and recanalization Vertebral augmentation for compression fractures (kyphoplasty and vertebroplasty)

Paracentesis

To refer a patient, please call 855-476-4445 or visit DoctorsManteca.com 34

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ANNUAL REPORT 2020

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LETTER FROM OUR PRESIDENT The California Medical Association’s (CMA) nearly 50,000 members come from a diverse set of backgrounds with unique life experiences. But in 2020, we were bound together by the common goal to protect the health and lives of all Californians during the COVID-19 pandemic. Last year was unlike any other year in CMA’s distinguished 164-year history. As an association largely founded during a cholera outbreak, we quickly rose to the challenge and shifted gears to help our physician members and policymakers navigate the COVID-19 crisis. From expanding telehealth capabilities to securing personal protective gear to providing guidance and resources as the landscape shifted daily, there was no shortage of opportunities to fight for physicians and the practice of medicine. The approval of two COVID-19 vaccines in December 2020 has brought some much-needed positive news in the fight against the coronavirus. But too many physicians are still struggling to obtain clear and actionable information to share with their communities about how and when they can expect the vaccine. Many others are wrestling with financial hardships in the wake of the COVID crisis and need more support to keep their doors open so they can continue to serve patients. CMA will continue to advocate for physicians – whether it is a statewide strategy to simplify widespread vaccine distribution for physicians and the public, or to ensure that our physicians have the financial and policy support they need to guide their practices through the rest of this pandemic, and the months that follow. CMA was able to rise to the challenges and opportunities largely because of the passionate engagement from our physician members. In 2020, we proved once again that when physicians work together, we can move mountains for our patients and communities. Thank you for your service to California during the most extreme of circumstances. Together, we will continue to stand together “to promote the science and art of medicine, protection of public health and the betterment of the medical profession.”

Peter N. Bretan Jr., M.D. President

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2020 ANNUAL REPORT | CALIFORNIA MEDICAL ASSOCIATION | 1 SAN JOAQUIN PHYSICIAN 37

LETTER FROM OUR CEO The staff at the California Medical Association (CMA) are always honored to support physicians and the practice of medicine – and our work took on even more special meaning in 2020. The global pandemic nearly brought the health care system to its knees and created new challenges for physicians in all modes of practice and specialty. From forced office closures, debunking conspiracy theories, stayat-home orders, lack of personal protective equipment (PPE), death threats and declining patient visits, physicians faced an onslaught of obstacles that threatened the very health of their communities. Physicians rose to the challenge to swiftly take action to protect public health. CMA provided daily guidance to the state’s response and distributed more than 100 million pieces of PPE to physicians and medical practices across California. CMA created a new COVID-19 resource center with daily updates, toolkits, webinars and other resources, and we continued to fight for the practice of medicine through a comprehensive program of legislative, legal, regulatory, economic and social advocacy. Through it all, CMA’s goal remains the same: provide our members with the support necessary to empower them to focus on providing quality patient care. I want to thank each of you for your support and dedication to CMA because it’s what drives this organization to excellence. And when we work together to fight for the health of our patients and the vitality of the profession – we win.

Dustin Corcoran Chief Executive Officer

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2020 ANNUAL REPORT | CALIFORNIA MEDICAL ASSOCIATION | 3 SAN JOAQUIN PHYSICIAN 39

2020 YEAR IN REVIEW 2020 was unlike any other year in CMA’s 164-year history. As an association largely founded during a cholera outbreak, we quickly rose to the challenge and shifted all gears to help physician members, elected officials and policymakers navigate the COVID-19 crisis. This year’s achievements include:

Advised the state’s development of executive orders and laws to ensure physicians could respond to the pandemic, including on telehealth policy, regulatory waivers and public health officer safety.

Distributed more than 100 million pieces of personal protective equipment (PPE) to physician practices and medical groups statewide.

Secured more than $100 billion in financial assistance to physician practices in Coronavirus Aid, Relief, and Economic Security (CARES) Act and an additional $75 billion to the HHS Provider Relief Fund in the COVID-19 “Interim Economic Relief” bill.

Convened virtual grand rounds on COVID-19 topics, including transmission, schools re-opening, testing and vaccines.

Protected Proposition 56 funding (tobacco tax revenues) in the state budget, including $57 million for physician loan repayment and $38 million for graduate medical education programs.

Sponsored a new ban on flavored tobacco products that will save lives, as well as limit Big Tobacco’s ability to target children and communities of color.

Continued our court fight to protect the Affordable Care Act.

Created a new COVID-19 website with daily updates, toolkits, webinars and other resources for physicians.

Amended CMA’s mission statement to include health equity.

Helped shape a federal surprise billing ban that includes baseball-style arbitration to resolve disputes between physicians and payors.

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2020 ACCOMPLISHMENTS As a physician-led association, the California Medical Association (CMA) proudly advocates for nearly 50,000 members across all modes of practice and specialty. CMA’s advocacy mix includes legislation, voter ballot propositions, regulatory affairs, policymaking, legal affairs, practice management, reimbursement assistance and wellness programs. Last year, CMA rose to the challenge of a deadly pandemic, which the association had not faced since its founding in the 1850s during a cholera outbreak. CMA advised and engaged daily with the state’s development of executive orders and laws to ensure physicians could respond to the pandemic, including on telehealth policy, regulatory waivers and public health officer safety. Thanks to our member support and engagement, CMA also: +

Secured more than $190 billion in financial assistance from Congress through the Provider Relief Fund and $900 billion in forgiveable Paycheck Protection Program loans to help sustain physician practices through the pandemic ■

Secured a 2% Medicare physician payment increase while stopping a 10% payment cut to physician specialists

■

Secured a 6% increase in Medicaid overall funding while stopping a 50% funding cut

Distributed more than 100 million pieces of PPE to physician practices across California, in partnership with our component medical societies

Engaged community-based physicians, so Californians could be vaccinated in a place they are familiar with, under the care of a provider they trust

Convened virtual grand rounds on COVID-19 topics, including transmission, schools re-opening, testing and vaccines

Provided clear and actionable guidance to physicians and policy makers about how to reopen medical practices safely after many were shut down due to the pandemic

Created a new COVID-19 website with daily updates, toolkits, webinars and other resources for physicians

2020 ANNUAL REPORT | CALIFORNIA MEDICAL ASSOCIATION | 5 SUMMER 2021

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CASE STUDY: PPE DISTRIBUTION Lack of personal protective equipment (PPE) throughout 2020 compounded hardships for medical practices and hindered their ability to provide care during the COVID-19 pandemic. To alleviate the strain on practices and improve patient access to care, the California Medical Association (CMA) partnered with local county medical societies and the state of California to distribute more than 100 million pieces of PPE—including medical-grade masks, gloves and gowns—to over 100,000 physicians and their staff, free of charge. Setting up a statewide distribution system for essential equipment was uncharted waters for CMA, but the staff rose to the challenge and put together a plan that mobilized the county medical societies to develop an entirely new statewide distribution system for essential medical equipment, which included PPE donations from the Office of Emergency Services (OES). Within weeks, PPE was being moved from state warehouses, repackaged into individual kits and loaded on trucks to be handed out at drive-through events across the state. Physicians and medical practices also accessed PPE through their local county medical society or CMA’s online request portal. As of December 31, 2020, the effort had distributed a combination of 35 million masks, 35 million sets of gloves, 2.3 million isolation gowns, 2.5 million face shields, 400,000 hooded coveralls, 21 million N95 respirators, 3 million sanitizing wipes and 700,000 sanitizer bottles.

21 Million

2.5 Million

400,000

35 Million

N95 Respirators

Face Shields

Hooded Coveralls

Examination Gloves

2.3 Million

35 Million

3 Million

700,000

Isolation Gowns

Surgical Masks

Sanitizing Wipes

Sanitizer Bottles

To download CMA's full 2020 Annual Report, please visit cmadocs.org/2020. 6 | CALIFORNIA PHYSICIAN | 2020 ANNUAL REPORT 42 SAN JOAQUIN PHYSICIAN

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COVID-19

Paid Sick Leave Expansion BY: JAMIE M. BOSSUAT, ESQ. KROLOFF, BELCHER, SMART, PERRY & CHRISTOPHERSON

Many employers have questions about when to provide paid COVID-19 sick leave to employees. There are four laws that potentially provide coverage paid COVID-19 related leave for many California employers: California’s paid sick leave law, the Health Workplaces Healthy Families Act, the American Rescue Plan of 2021 which expanded the Families First Coronavirus Relief Act, and Cal/OSHA’s Emergency Temporary Standards pertaining to COVID-19. The Healthy Workplaces Healthy Families Act provides three days or 24 hours of paid sick leave for nearly all employees who work in California for 30 days or more for the same employer. The law provides for paid sick leave for prevention

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or treatment of the employee’s own health condition or that of a family member. This includes a COVID-19 illness, quarantine order, or isolation period. The California Labor Commissioner has taken the position that using paid sick leave for COVID-19 related reasons is at the employee’s election. On March 29, 2021, California’s COVID-19 supplemental paid sick leave law became effective. The law provides up to 80 hours of supplemental paid sick leave for employees working for businesses with more than 25 employees. The new law is retroactive, providing this leave from January 1, 2021 through September 30, 2021. A new poster is required and can be downloaded from the Labor Commissioner’s website.

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Additionally, the American Rescue Plan of 2021 expanded the scope of the Emergency Paid Sick Leave (EPSL) and Emergency Family and Medical leave (EFMLA) which were initially provided for in the Families First Coronavirus Relief Act (FFCRA). For employers with less than 500 employees, this expansion may provide a source of tax reimbursement for some employees utilizing California’s required leave. Although the EPSL and EFMLA and tax credits were extended through September 30, 2021, employers may choose whether to participate. For those who elect to extend the coverage for their employees, EPSL balances were reset to 80 hours on April 1, 2021. Additionally, the EFLMA was extended to provide 12 paid weeks of leave (rather than the original 10 paid weeks). However, the law did not provide an additional allotment of EFMLA hours, so employees who have exhausted their 12 weeks will not be entitled to additional leave or tax reimbursement.

SUMMER 2021

The reasons that employees can use both state and federal leave have also been expanded under both COVID-19 laws. Employees may receive paid time off to receive a vaccine, if they are experiencing vaccine-related side effects, and if they are in quarantine and waiting for COVID-19 test results. Additionally, employers should keep in mind that the Cal/ OSHA Emergency Temporary Standards require employers to maintain earnings, rights, and benefits of employees who are excluded from the workplace due to work-related exposures to COVID-19. Employers can consider benefit payments from workers compensation and public sources in determining how to maintain employee earnings, rights, and benefits. Lawsuits based upon a failure to provide leave or accommodations due to COVID-19 are on the rise and employers who have questions about how to properly implement laws relating to COVID-19 are advised to reach out to their labor and employment attorneys.

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Practice News and Resources Free to SJMS/CMA Members!

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

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

July 2021:

No Meeting due to facilitating our Decision Medicine Program August 11th , 2021: 11:30AM-1PM

The Modern Workforce Revisited – 5 Ways to Attract and Retain the Next Generation of Workers Presented by: Jeff Gilbert and Chad Sublet – Verve IT In our previous presentation, Jeff and Chad advocated for a new way of thinking about the Workplace in order to attract and retain the growing Millennial demographic. Now, here in 2021, more than 50% of the workforce is comprised of Millennials - and not only will this number continue to increase, but Generation Z is hot their heels. With the impact of COVID, and businesses globally rethinking their work-from-home policies, the Modern Workplace is now no longer a luxury - it is an essential business strategy to compete for the best talent in this new, moder n era. Join us as we revisit our original presentation and update you on the latest trends that will help you continue to attract and retain the next generation of workers.

Jeff Gilbert, CEO – Jeff has been in the Information Technology industry for 20 years, and has served in virtually all aspects of the IT world, getting his start in basic IT work, progressing through software development and architecture, and finally to IT Management. Jeff ’s career has led him to provide services for some of the world’s largest firms, including

global project management firms, and top 5 national defense firms. Jeff lives in Stockton with his wife Christina and their 4 sons.

Chad Sublet, Partner – Chad’s background includes 20+ years of customer service and sales. Starting his technical career with electronics repair in the USAF Minute Man program and transitioning those skills to satellite and weapons repair in the civilian world. Eventually growing his skillset to sales, and becoming a partner at Verve in 2008. Chad now has responsibility for the Verve Sales & Account Management team. Chad lives in Stockton with his wife Madeline and their 2 children.

CMA PRACTICE RESOURCES Dignity Health seeks to renew Anthem contract by July 15 deadline; reaches agreement with Aetna

The Califor nia Medical Association (CMA) has learned that the contract between Dignity Health California and Anthem Blue Cross is set to terminate for its commercial PPO, Prudent Buyer, HMO, Medicare Advantage, and MediCal HMO lines of business effective July 15, 2021, if both parties are unable to reach a new agreement. According to the Anthem Notice of Termination of Prudent Buyer Plan Participating Physician Agreement sent out to approximately 2,000 Prudent Buyer physicians, as a condition of their contracts they must maintain admitting privileges at an in-network hospital. If Dignity Health and Anthem cannot renegotiate their agreement by July 15, 2021, avoiding termination, and physicians’ admitting privileges are limited to Dignity Health hospitals, they must obtain admitting privileges at another in-network hospital. Failure to do so could result in termination of their Anthem contracts. CMA has inquired with the Califor nia

Department of Managed Health Care (DMHC) to obtain more information regarding the number of Anthem enrollees that would be impacted by the termination and will provide updates as details are available. This issue comes on the heels of a similar contract renegotiation involving Dignity Health and Aetna. However, CMA was advised that the two parties did reach a three-year agreement that is retroactive to April 1 (with no lapse in the agreements); there is no impact to physician contracts. In the event of an Anthem-Dignity Health contract termination on July 15, affected patients may be able to continue to see their physicians under Califor nia’s continuity of care law. Health plans, at the enrollee’s request, must provide for the completion of covered services as follows:

• • • • •

For an acute condition For a serious chronic condition For the duration of a pregnancy For the duration of a terminal illness For the care of children between birth and 36 months For the performance of a surgery or other procedure that has been authorized, may qualify to request continuity of care. To request continuity of care, patients should call the health plan number on the back of their ID cards. For more information on continuity of care requirements, see CMA Health Law Library document #7051, “Contract Termination By Physicians and Continuity of Care Provisions.” Physicians who have additional questions can contact Dignity Health by emailing Debbie Esparza at Debbie.Esparza@DignityHealth. org or Jennifer Kurkjian at Jennifer.Kurkjian@DignityHealth.org. Physicians can also contact Anthem Blue Cross

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at CAcontractsupport@anthem.com and Aetna at (888) 632-3862.

Optum Pay Basic increases access to UHC remittances

UnitedHealthcare recently announced that the Optum Pay basic service would restore access to claim payment and reconciliation activities for an unlimited number of users beginning May 22, 2021. As previously reported, the Califor nia Medical Association (CMA) had received numerous complaints from physicians regarding the loss of payment remittance advice (PRA) access through the UnitedHealthcare electronic payment platform, Optum Pay. CMA quickly jumped into action and coordinated with the American Medical Association along with many other state and specialty organizations, to escalate these concer ns with UnitedHealthcare. In response to our advocacy, UnitedHealthcare announced that the Optum Pay basic service would restore free access to payment remittances including:

•P roviding detailed remittance information (downloadable PDFs), as well as access to 835 files for each payment processed through Optum Pay

• Up to 13 months of payment data

The remaining concern voiced by physicians was the limit of two users per Optum Pay basic account, which proved difficult to manage in large practice groups or where multiple users required access to payment remittances. Effective May 22, 2021, basic accounts will allow an unlimited number of users.

UnitedHealthcare updates telehealth place-ofservice billing requirement UnitedHealthcare (UHC) is now requiring physicians to bill eligible telehealth services with place of service (POS) 02 for commercial products. Telehealth claims with any other POS will not be considered eligible for reimbursement.

SUMMER 2021

While the policy – announced in United’s October 2020 Reimbursement Policy Update Bulletin – became effective January 1, 2021, UHC advises that an unofficial transition period for payment of claims not billed with POS 02 was in place through midMarch. Effective March 13, 2021, telehealth claims not billed with POS 02 will not be paid and providers will be required to resubmit a corrected claim. The change implemented by UHC aligns with the Califor nia Department of Managed Health Care (DMHC) all plan letter (APL) issued on September 4, 2020, which reminded DMHC-regulated health plans of the continued requirement to reimburse providers at the same rate for telehealth services, including telephonic visits, as they would for services provided in person. This APL clarified that the prior APLs (20009 and 20-013) remain in effect for the duration of Califor nia’s declared state of emergency or until further notice from DMHC, whichever is earlier. The APL also clarified that these requirements apply to delegated entities to the extent the health plan delegated the services impacted by these APLs.

issued guidance requiring CDI-regulated insurance companies to reimburse providers at the same rate for telehealth services as they would for services provided in person. Insurers were also required to reimburse a service provided telephonically at the same rate as services provided via video. These requirements are in effect throughout the declared COVID-19 state of emergency.

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Public Health

Update

COVID-19 Surveillance Reveals Benefits of Opt-Out HIV Screening in Emergency Departments BY: DELECIA VELASQUEZ-STUMP, MPH & HEMAL PARIKH, MPH

Throughout the course of the COVID-19 pandemic we have seen decreases in the cases of disease across the board. In fact, in 2020, San Joaquin County (SJC) saw a decrease in almost every reportable disease except for one: Human Immunodeficiency Virus (HIV). SJC has seen a steady increase in new HIV cases since 2017. As of April 2021, there has been 41 new HIV cases compared to 26 last year and 19 in 2019. One way that the SJC emergency departments Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HIV 71. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Syphilis, primary and secondary. . . . . . Chlamydia . . . . . . . . . . . . . . . . . . . . . . . . . . Gonorrhea. . . . . . . . . . . . . . . . . . . . . . . . . . Syphilis, congenital. . . . . . . . . . . . . . . . . .

2017 . . . . 72. . . . . . . 376 . . . . . 3977 . . . . 1360 . . . . 15. . . . . . .

2018 . . . . 2019. . . . 82. . . . . . . 89. . . . . . 275. . . . . . 201. . . . . 4313 . . . . 4803. . . . 1398 . . . . 1708. . . . 27. . . . . . . 44. . . . . .

HIV may present similar symptoms to many other viral infections, such as COVID-19, but rather than being transmitted via airborne droplets, it is transmitted by direct contact from infected bodily

SAN JOAQUIN PHYSICIAN

(ED’s) can help end the HIV epidemic is to start implementing routine “opt-out” screening. Opt-out screening is the stigma-reducing method of notifying a patient that an HIV screening will be conducted during the other standard preemptive tests and they have the right to decline the test.4 The U.S. Centers for Disease Control and Prevention (CDC) recommends testing all health care patients for HIV using an “opt-out” approach.1 2020. . . % Change 8.5%. . . . . . . . . . . . . 173. . . . . . . -13.9% 3928. . . . . . -18.2% 1055. . . . . . -38.2% 26 . . . . . . . . -40.9%

fluids. These two viruses are very different but one of their first similarities is the psychological toll it has caused in the community. Although we are still learning about COVID-19, it is known to

SUMMER 2021

have symptoms such as fever, cough, shortness of breath, fatigue, body aches, diarrhea, and rashes.2 HIV’s symptoms include, but are not limited to, fever, chills, night sweats, muscle aches, fatigue, swollen lymph nodes, mouth ulcers and rashes.3 Most commonly, a patient infected with HIV experiences symptoms within 6 weeks after their exposure. Early HIV diagnosis is ideal so medication can be started to keep the immune system healthy and decrease further communicable spread. Patients presenting to health care providers in SJC for possible COVID-19 have instead been found to have HIV. The phenomenon was first noticed by an HIV communicable disease investigator (CDI) who brought to attention a recent uptick in cases being discussed by the State HIV team. The CDI was able to determine that many of the newly diagnosed HIV patients had COVID-19 like symptoms and went to their doctor or emergency room to be tested. However, when they received a negative COVID-19 test, other communal screening tests (including an HIV) were performed and came back positive. A local ED began routine opt out screening for HIV in 2019. Generally, the number of HIV tests performed is expected to increase when routine opt-out screening is initiated. During the COVID-19 pandemic, routine opt-out screening for this local ED yielded approximately 2.5 more HIV tests than previously counted in 2019. They were able to identify 37.5% of the county’s new HIV cases. Routine screenings are vital for preventative care which

SUMMER 2021

contribute to better health outcomes for patients. Primary care providers are the ideal providers to conduct preventative screenings but have been affected greatly due to the pandemic and its new precautions. Patients experienced longer wait times for in-person appointments while telehealth became the new norm. This resulted in a flood of emergency room visits that diagnosed many health conditions, such as HIV, that may have not been identified if routine opt-out testing was not offered. Routine opt-out HIV screening in the ED is a key strategy to achieve a 90% reduction of HIV infections in the US by 2030.1 About Ending the HIV Epidemic Initiative. CDC.gov. https:// www.cdc.gov/endhiv/about.html. Last reviewed April 21, 2021. Accessed May 12, 2021. Symptoms of COVID-19. CDC.gov. https://www.cdc.gov/ coronavirus/2019-ncov/symptoms-testing/symptoms.html. Last reviewed February 22, 2021. Accessed May 13, 2021 About HIV. CDC.gov. https://www.cdc.gov/hiv/basics/ whatishiv.html. Last reviewed April 7, 2021. Accessed May 11, 2021. Opt-Out Screening. CDC.gov. https://www.cdc.gov/hiv/ clinicians/screening/opt-out.html. Last reviewed March 4, 2020. Accessed May 14, 2021.

SAN JOAQUIN PHYSICIAN

6 NEW

SJMS MEMBERS THIS SPRING!

...and even more on the way. Mauree Beard, M.D.

Leslie Stuart, M.D.

Hank Sun, M.D.

Anesthesiology

525 West Acacia St

1205 East North Street

1756 Ironwood Alley

Stockton, CA

Manteca, CA

Oakland, CA

Meharry Medical College

University of California School of

Washington University School of

Medical - L.A.

Medicine

Anesthesiology

Alan Sabino, M.D.

Loc Nguyen, M.D.

975 South Fairmont Ave

Anesthesiology

Internal Medicine

Lodi, CA

525 West Acacia Street

4545 Georgetown Pl Ste C16

Uniformed Services University of

Stockton, CA

Health Sciences

Loma Linda University School of

Dartmouth Medical School

Richard Chou, M.D.

Medicine

SAN JOAQUIN PHYSICIAN

SUMMER 2021

The

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As a member of the San Joaquin Medical Association, you’re privy to an exclusive benefit—Financial Center Credit Union membership for you and your staff ! In a time when the safety and soundness of funds is at the forefront of everyone’s minds, Financial Center membership is the perfect prescription for peace-of-mind. Voted Best Of San Joaquin, Financial Center is the most trusted credit union in the Valley. Time and time again, we offer our members the lowest rates on their loans as well as the safest place to save their money. Follow the doctor’s orders and call us today. And don’t forget to pass this message onto your staff – they (and their wallets!) will thank you.

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SUMMER 2021

SAN JOAQUIN PHYSICIAN

In Memoriam

In Memoriam MARVIN H. PRIMACK, M.D. 1931-2021

Marv passed away on May 5, 2021 at 90 years young. He will be missed by Bune, his beloved bride of 65 years, his 4 children Todd (Jeanne), Teri Marias, Daren (Dina) and Heidi (Tim) Talbot. He is survived by grandchildren: Rachel Marias Dezendorf (Eric), Allison Primack, Robyn Primack, Sarah Primack, David Marias, Emily Timm (Spencer), Spencer Talbot, Sam Primack and Elianna Starr. Also survived by sisters-in-law Naomi Primack, Andrea Rothbart and brotherinlaw Brian Rothbart (Linda) and numerous nieces and nephews. Predeceased by his son-in-law Rick Marias, grandson Stephen Primack, sister and brother-in-law Gere and Sid Baskin, and brother Verne Primack. He practiced with Stockton Anesthesia at St. Joseph’s Medical Center for 26 years before moving to and later retiring from Lodi Outpatient Surgical Center. He was actively involved in group, hospital, and medical society leadership roles. He was a member of the San Joaquin Medical Society for 55 years and received the Lifetime Achievement award in 2013. Marv would be the first to say that he had a wonderful life. He loved his family, he loved to travel, and he loved the practice of medicine. A life well lived; a man well loved. May his memory be a blessing. The family is having a private family graveside service. If you desire, please make contribution to Cystic Fibrosis Research Institute (cfri.org), Temple Israel of Stockton, (templeisraelstockton. com) or Stockton Symphony (boxoffice@stocktonsymphony. org).

SAN JOAQUIN PHYSICIAN

SUMMER 2021

Strong community partnerships lead to happier, healthier people. HPSJ has partnered with safety-net and traditional providers for over 25 years to create access to quality healthcare for low-income children, families and individuals- some of the most vulnerable residents of our community. Whether your practice was there from the start, or has recently joined us, we want to extend a sincere thank you for sharing our mission of improved wellness through meaningful partnerships and collaboration.

Community • Partnership • Wellness

www.hpsj.com | 888.936.PLAN (7526)55

SUMMER 2021

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

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Summer 2021

Articles inside

IN MEMORIAM

NEW MEMBERS

AKILA WEBER, M.D

CMA ANNUAL REPORT

PUBLIC HEALTH UPDATE

ACES

PRACTICE NEWS AND RESOURCES

SJMS SCHOLARSHIP LOAN FUND

COVID PAID LEAVE

IN THE NEWS