Winter 2010

Electrophysiology: Dameron Hospital Opens New Lab Winter Issue 2010 WINTER 2010

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Open Wide...

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Volume 58, Number 4 • December 2010

{FeATUreS}

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{DePArTMeNTS} 16 NeW MeMBer BeNeFIT: Fitness 360

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DAMerON hOSPITAL:

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Helping doctors treat and patients heal.

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James Halderman, MD President

at Lodi Memorial Hospital offers Board certified radiologists, comprehensive diagnostic services, and a convenient location for patients.

George Khoury, MD President-Elect Lawrence R. Frank, MD Past-President Thomas McKenzie, MD Secretary-Treasurer Board Members

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Decision Medicine Kwabena Adubofour, MD

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Community Relations Joseph Serra, MD

Audit & Finance Marvin Primack, MD

Member Benefits Jasbir Gill, MD

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Public Health Karen Furst, MD

Scholarship Loan Fund Eric Chapa, MD

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

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Lawrence R. Frank, MD Francis Isidoro, MD Gabriel K. Tanson, MD Roland Hart, MD

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

WINTER 2010

Which One?

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WINTER 2010

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MeSSAge Message>>executive ManagingDirector Editor

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For the past several months I have vetted a number of member benefit offerings to our board, with the goal that in 2011 we introduce at least 6-8 new services to our membership. As we approach the holiday season with this winter issue, it seems very appropriate that we use this opportunity to debut two extremely unique and very personal member benefits which are now available to every San Th ose words were Society spoken physician.

by Dr. Susan Kaweski, San Diego County Medical Society’s new Joaquin Medical president during her recent ceremony.

Shepersonal further stated, united must be, at What better way to startinstallation the New Year than with fitness “and training fromweour friends especially in these tumultuous times” to which I couldn’t agree more.

Th ese are diffi cult times FITNESS 360! We all value proper fitness, health and nutrition in our life, but those goals can for physicians and the medical often collide with your busy community as a whole. Far-reaching changes are happening atlifestyle a break-neck pace in Washington, and demands of practicing D.C., and at our own state capital. As Dr. Kaweski so eloquently need solidarity amongst our ranks like never before. One voice may be medicine.states, Fitnesswe360 is offering ignored and no one notices, but when a chorus sings in harmony – it’s pretty hard to not take our membership the guaranteed notice. lowest group pricing available with no contracts or initiation fees – and Membership oftoffering en perceived additionally,isare every as a non-essential cost of doing business. Something you sign upphysician for out ofmember, habit or their peer family pressure. Some see it as a duty, having joined early in their medical career and never taken thepractice opportunity to become more involved or seek any of our services members and even their and so sadly, never truly see the value of membership because their own perception is skewed staffs, the opportunity to experience towards it being something of 30 days of complimentary little or no value. Nothing could be further from the truth.

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To appreciate membership, have experience it or attoleast extensiveand truly Many physicians may not be you aware thattoStockton is home oneappreciate of the mostthe influential lobbying taking place every drug day on your behalf in bothinSacramento Forperfect those sense to us to respected evidence-based therapy publications the country,and so D.C. it made members who have had to call us and request assistance with a collection, billing, coding, approach them and seek out a unique partnership. Prescriber’s Letter is read by tens of thousands contract or personnel membership valueand is easy toonline comprehend and seldom enters which of physicians aroundissue, the world every month, their publications and services, their thoughts aft er help has been rendered.

For those that have att ended our annual House include CME webinars, treatment guidelines, patient handouts in English and Spanish, useful ofcharts, Delegates or yearly visit to the capital for Legislative Day, value is again securely reinforced reference material and more, are now available to every SJMS member and included in their because they see first-hand the25 impact unifiedannually. voice hasThis in these arenas of thought. membership along with over hoursour of CME exciting partnership with Therapeutic Research Center and publisher Jeff Jellin, PharmD, will save you significant time in your busy My hope isTo you havemore had about the opportunity to seeInformed first-handPrescriber) the value ofmember your membership andpage 44 practice. learn this VIP (Very benefit, go to feel about contribution making in the future of medicine being a part ofyour andpositive hear first handthefrom Jeff about you’re our new partnership and follow the easyby steps to access something much bigger than yourself.

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Mike Steenburgh Executive Director Mike Steenburgh

Moris Senegor, MD Moris Senegor, MD Editor Editor Editorial Committee Editorial Committee Shiraz Buhari, MD Shiraz Buhari, MD Kwabena Adubofour, MD Kwabena Adubofour, MD Robin Wong, MD Robin Wong, MD Michael Steenburgh William West Managing Editor Managing Editor William@sjcms.org Sherry Roberts Creative Director/Graphic Designer Michael Steenburgh sherry@sjcms.org Contributing Editor Contributing Writers Sherry Roberts William West Creative Director/Graphic Designer Bobbie Wallinger sherry@sjcms.org Scott Ginns Contributing Sources Contributing Sources California Medical Association California Medical Association Los Angeles County Los Angeles County Medical Association Medical Association San Diego County Medical Society San Diego County Medical Society The San Joaquin Physician magazine The San Joaquin Physician magazine is published quarterly by the is published quarterly by the San Joaquin Medical Society San Joaquin Medical Society Suggestions, story ideas or Suggestions, story ideas or completed stories completed stories written by current written by current San Joaquin Medical Society San Joaquin Medical Society members members are welcome and will be reviewed by are welcome and will be reviewed by the Editorial Committee. the Editorial Committee.

Please direct all inquiries Please direct all inquiries and submissions to: and submissions to: San Joaquin Physician Magazine San Joaquin Physician Magazine 3031 W. March Lane, Suite 222W 3031 W. March Lane, Suite 222W Stockton, CA 95219 Stockton, CA 95219 Phone: 209-952-5299 Phone: 209-952-5299 Fax: 209-952-5298 Fax: 209-952-5298 Email Address: gena@sjcms.org Email Address: gena@sjcms.org Medical Society Office Hours: Medical Society Office Hours: Monday through Friday Monday through Friday 8:00 AM to 5:00 PM 8:00 AM to 5:00 PM

Executive Director

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The “Price” Versus “Cost” Dilemma:

Can we Really Afford Healthcare Reform?

In a recent issue of San Joaquin Physician, Dr. Morris Senegor discussed how we learned that financial calamity in the private sector can lead to a short fall in tax revenues at several levels of government a couple of years later.

This loss of government income limits the ability of the various public agencies to fund medical care in both the public and private sectors. There are many economic factors that are in play in the delivery of medical care.

Two of these are price and cost.

It’s cheaper to buy a pint of milk than a quart of milk and pay a lower price but no one would argue that the “cost” of the actual milk was reduced.

In the rush to rein in medical care “costs,” the difference between price and cost has gotten lost.

Price versus cost is a concept often lost on the non economist. These terms are not the same thing. And they both can mean slightly different things to different people. “Price” is a negotiation based simply on supply and demand. “Cost” on the other hand, is mostly fixed because of the many levels of materials production involved in medical care

WINTER 2010

delivery and the many sectors of the economy that are in play. Costs vary only slightly with the rate of inflation or minor movements in the various markets. Those costs involve rent, personnel, utilities, insurance, financial services and other matters as well. Those are costs that the patient and the politician do not see. The providers of those hidden services price their wares in a competitive marketplace just like any other business. Their customers include all other businesses besides medical practice that pay more or less equally for equivalent services in that competitive marketplace.

The price of medical care can be as high as a provider is demanding to charge. It can also be as low as a consumer is willing to pay. Whether the demander is a doctor, a hospital, a laboratory, or something else, there is only so low a price he is willing to

President Obama’s Health Care Reform act will increase access to patients who cannot pay a medical bill. But the amount of money spent MUST increase because average costs per patient are fixed.

ABOUT THE AUTHOR – Dr. James Halderman is President of the San Joaquin Medical Society and practices at Sutter Tracy Community Hospital as an Anesthesiologist.

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Message > From The President accept before his practice becomes unable to pay its own it, and his practice income will fall and possibly fall below bills. Likewise, there is only so high a price that a patient, or his ability to pay his own practice “costs.” Leave it, and the insurer, or Medicare and Medicaid will pay before a decision patient is left to suffer without medical care; a situation that is made that the price is just too high to “afford.” At this point no one wants to see. the choice is made. Does the patient bite the bullet and There are other ways that this economic scenario plays out tolerate the pain and suffering or does he cough up the cash rather than in dollars and cents. The recent wave of reform and go see the doctor? An individual can make that decision sweeping the nation has had its intended effect of greater at any time as the severity of his condition plagues him. numbers of people becoming guaranteed of receiving more But an insurer or government agency must devise a point and more medical care. But someone will have to pay the of severity for each bill. Just open the last and every diagnosis premium statement and determine first, you received from your whether it is willing to medical insurer and you “One of the strongest talking points among pay, and second, how will see what I mean. much it will pay. The Costs are fixed and the those who advocate a government run patient must abide price follows. What medical system is that the cost of medical by the decision of his about all of those new guarantor and has little patients who will arrive care is too high and that we cannot afford sway in the matter. And at your office with a to continue along this path of steadily rising there is the beginning fresh new state or federal of the political rub. insurance card? Check expenditures. But what we are willing to We can argue all day the latest fee schedules pay for our care has nothing to do with long over how much for Medicare and to charge or pay for Medi-cal. They have what it actually cost to produce that care.” this medicine or that not increased; but the Dr. James Halderman procedure but at some fixed costs have risen. point the soft concept Will we have enough of pricing is going to doctors and nurses to collide head-on with see the new previously the hard concept fixed underserved patients cost. who will emerge from obscurity and knock on our door?

As we all know, different insurers pay more or less than Look up the latest statistics on new graduates of medical and others for the same treatments. The private guarantors pay nursing school. They have barely increased. Education cost a bit more than the actual “cost” of the treatments much of big bucks. Costs are fixed. Who will pay for those students’ the time. Government agencies pay a bit less the actual cost training? More hospital supplies will be needed for these for the same treatments. However, with government payers new patients. Costs are fixed. Who will provide the funding? at the state and at the federal level, the price willing to be There are several old and successful strategies in place paid is what is fixed. It is fixed by law. The law is written by to control costs. The British National Health Service has politicians who are in fact motivated by supply and demand. succeeded in lowering the cost of medical care among its But the politics of the government medical business has other citizens. Britain pays much less for medical care per citizen pressures besides those which are purely economic. That is than the United States. How? One way is by offering fewer how funny things start to happen. When politicians seeking seats in British medical schools. Fewer doctors in practice votes promise more medical care than that which they are means less money paid in physician fees. As we might willing to force the taxpayers to subsidize, the usual legislative expect, this tactic has caused a severe shortage of doctors in tactic is to cut “costs.” But what they are actually doing is Britain and has forced Britain to import foreign doctors from cutting the price. Whether the doctor acquiesces to this oversees for free. Costs are fixed. Although some money heavy handed tactic is his decision. Take it or leave it. Take is saved, some of these foreign schooled doctors are not as

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WINTER 2010

INTRODUCING

DAMERON HOSPITAL’S

Dameron Hospital has been working with St. Jude Medical of Minnesota to perform state-of-the-art electrophysiology services at Dameron to assist our growing local community.

Directed by Dr. Walter Chien, Dameron’s EP Department features a St. Jude Medical Version Four Recording System with Clear Wave Signal Acquisition Technology. This new technology puts Dameron Hospital at the forefront of today’s atrial fibrillation and cardiac arrhythmia care. Dr. Chien has a specialty in Electrophysiology Medicine and is experienced in EP evaluation and electrophysiology treatment.

We welcome Dr. Chien’s Practice at Dameron Hospital.

E L E C T R O P H Y S I O L O G Y D E PA R T M E N T

Walter Chien, M.D., CARDIOLOGY Director of Electrophysiology Dameron Hospital with Christopher Arismendi, M.D. C.E.O. Dameron Hospital

WINTER 2010

More Than Healthcare – Your Care!

525 W. Acacia St. ■ Stockton, CA 95203 209.944-5550 ■ www.dameronhospital.org

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Message > From The President well educated as native schooled doctors. There are a limited number of highly qualified medical graduates outside the developed world from which to recruit. The United States also has to compete for these foreign candidates. Another successful British strategy has been to offer lower fees paid to doctors than they can earn from private payers. Costs are fixed. This one has led to the politically unsavory situation of a two-tiered level of care with stark differences in the

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quality of that care. In a nation that, unlike the United States, formally guarantees access to high quality medical care to all citizens, such a divide is leading to civil revolt.

There are a few new strategies put into practice recently in hopes of reducing costs. President Obama’s Health Care Reform act will increase access to patients who cannot pay a medical bill. But the amount of money spent MUST increase because average costs per patient are fixed. The State of Massachusetts has instituted a statelevel plan that was to guarantee access to all state residents. The payment to physicians is similar to the state Medicaid fee which is lower than private payers’ fee. Will physicians accept this lower fee? Maybe. Will money be saved? No, because the number of patient encounters will increase and the overall costs per patient are fixed. Have the patients who emerged from obscurity to claim their benefits received the medical care they have been promised? Not yet, because there is also a doctor shortage in Massachusetts too and the fixed cost of training a small army of new doctors to see these new patients is huge.

One of the strongest talking points among those who advocate a government run medical system is that the cost of medical care is too high and that we cannot afford to continue along this path of steadily rising expenditures. But what we are willing to pay for our care has nothing to do with what it actually cost to produce that care. There is no such thing as a free lunch. The idea that we can regulate or legislate a free lunch into the economics of medical care is a very dangerous delusion.

WINTER 2010

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Message > From The Editor

Reflections on Medical Staff Leadership What Rats and Pigeons have to teach Us

The following, the second in a series of essays reflecting on the Medical Staff , was presented on the occasion of my farewell Quarterly Staff Meeting as St. Joseph’s Chief of Staff, in 2008. It took many years to formulate my ideas, and nearly nine months to prepare the speech I delivered on that occasion, even tough that day I appeared to be talking off the top of my head. For those who recall the meeting, I apologize for the déjà-vu. For those not there, I hope it presents their experiences in a new light.

As humans, regardless of our age, education or social class, we are bound by the same psychological rules that govern our lives, and as it so happens sometimes, those of the common laboratory rat and pigeon.

ABOUT THE AUTHORMoris Senegor, MD serves as the Chairperson of the Publications Committee for the San Joaquin Medical Society and Editor of its flagship publication the San Joaquin Physician.

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As a young physician observing Medical Staff activities, I was initially a spectator and from the very beginning, sensed a political process that seemed akin to our society at large. We had elections, votes, some semblance of parliamentary procedure, and a seemingly democratic process. However as I became more involved, differences emerged from general government.

For instance Medical Staff elections seemed largely pre-determined; there were no campaigns, and no formal political parties. I eventually joined the Medical Executive Committee (MEC) and witnessed behind-thescenes governance. Now the process seemed yet more idiosyncratic, and more different from government at large.

The largest difference I noted was that the Medical Staff did not contain the three distinct branches of national government:

executive, legislative and judicial.

Instead, executive and legislative were fused into one body, the MEC and its subsidiaries, with hospital administration an uneasy partner in the process. The judicial body was conspicuously absent as an independent entity, with some fragments also mainly in the domain of the MEC. This was a prominent source of frustration among physicians who, when seeking recourse against MEC decisions, had to appeal to none other than the same MEC itself for reconsideration. In my many years of service, I witnessed several impassioned appeals and never once did the MEC reconsider or change its actions in question.

To be sure, there are clauses for due process in all hospital bylaws which can activate a judicial body, usually when action is taken against a physician’s privileges. These are seldom invoked; in my decade in

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the MEC I never witnessed such a hearing. For judicial like the Medici family of his time. The third is the people recourse physicians have to step out of hospital governance at large. If any of these three access uncontrolled power, and appeal to society at large and its legal system. This is also we end up with a deranged form of government. In the rarely used due to its cost in money and time. case of a king or a strong-man, such absolute power leads So exactly how did the Medical Staff reflect society at to tyranny. In the case of the aristocratic class, unchecked large, and why did it have to do so? I accidentally stumbled power results in oligarchy. Finally with the people at large, on an answer in the first few months of my term as Chief of their uncontrolled power leads to mob-rule, the worst form Staff, and it came from an unlikely source that I happened of government. In Machiavelli’s opinion a republic is a to be listening to at the time. It was a Teaching Company blend of these three elements, a cocktail if you will, where course on CD about Nicollo Machiavelli (1469-1527), the each is checking the other’s tendencies for absolute power.

Florentine philosopher and political scientist.

Different societies can devise different blends of these three In current times elements, thus resulting Machiavelli is in republics as diverse considered a villain as the U.S., China or for his advocacy of Korea.

When us modern Americans think of a inhumane ruthlessness As I studied “republic” we think of it as a reflection in consolidating and Machiavelli, it of ourselves, a democratic society with exercising power, dawned on me that duly elected members of government formulated in his this fundamental famous book “The concept of blended whose sole purpose is to serve the Prince”, a ubiquitous power is indeed society. But what about the People’s College staple. What the way in which Republic of China, the Republic of North most people don’t hospital Medical Staffs know is that this work reflect their parent Korea, or the United Soviet Socialist represents only one side society. To translate Republics (USSR). How do they fit of Machiavelli, the one to Machiavelli’s in?

How can they call themselves a exploring tyrannical definitions, for an “republic” and get away with it? rule. He was also a absolute leader we can student of republics, substitute a “Chief”, be - Moris Senegor, MD modeled especially after it Chief of Staff, Chief of the pre-Empire Roman a department, or CEO Republic, and wrote a of a hospital. Such much larger work on this subject, lesser known to college “Chief”’s are generally vested with enormous powers, and students because it is not as succinct as “The Prince”. In this thus have a threatening potential for tyranny. The analog work labeled “Discourses on Livy”, or “Discourses” in short, of aristocrats in the Medical Staff are those who serve in Machiavelli outlines the notion of a “republic” as he sees it. important Committees. Taking away traditional inheritance When us modern Americans think of a “republic” we as a source of aristocratic title, such physicians otherwise think of it as a reflection of ourselves, a democratic society are curiously similar to the traditional gentry. In any with duly elected members of government whose sole body-of-physicians there are a select few that indefinitely purpose is to serve the society. But what about the People’s rotate through Committees, the remainder being politically Republic of China, the Republic of North Korea, or the apathetic. They become a group of self-appointed elite United Soviet Socialist Republics (USSR). How do they fit by default, and their actions can be viewed as elitist and in? How can they call themselves a “republic” and get away potentially oligarchic by the rank and file. Finally the “people with it? at large” are those apathetic physicians who occasionally Machiavelli provides a unified definition which fits all the attend quarterly Staff meetings, have no inkling of how the above. According to him there are three elements in a society political process runs, and thus act as the “common person with potential for political power. The first is an absolute in the street”. They are the ones most apt to complain about monarch, like a king or dictator. Next is the aristocratic class, the inappropriate or unjustified power of the other two

WINTER 2010

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MeSSAge > From The editor groups when confronted with policies they dislike. Releasing bodies, is at the top of the enemies list. Then there is the the reins of power to them ( I literally used to call them “the much despised and feared Joint Commission, the hospital mob” when I was Chief of Staff), can be disastrous. As our accrediting body, with its seemingly arbitrary, faddish, and Founding Fathers knew well, there had to be a powerful elite cumbersome rules. Medicare, Medi Cal, private insurance body, in our case a Senate, to check the potential for mob companies, hospital parent companies such as CHW, rule. Someone had to issue unpopular or unpleasant rules for Kaiser, Tenet etc., all populate the list of external threats the ultimate benefit of the disgruntled recipients, the people with their unpopular demands upon the Medical Staff, at at large. times threatening to end certain physician practices. These If one now applies these analogies to the day-to-day threats, unsavory as they are, remain essential in keeping functioning of the Medical Staff, all of the fault lines in cohesiveness within the Medical Staff. There is no easier way hospital governance to resolve heated debate suddenly become on an issue of policy than clear. The sources by saying, “well, that’s what of tension in this the Joint Commission So what are we to make of my opinion world are those very demands we do!”. that us physicians who practice in same checks and All three elements of balances that keep the hospital Medical Staff hospitals reflect our parent society as a the political system intrinsically realize that mirror republic? Shall we stop bickering in equilibrium. “united we stand, divided with each other and engage in “love “Checks” are not we fall”, and thus in most pleasant to those healthy Medical Staffs the thy Chief” or “love thy CEO”? Shall we on the receiving inherent tensions of the quit complaining about policies issued end who would micro-“republic” remain by our MEC? Shall we ignore external rather take their restrained, and held back regulators and their pesky irritations? power further than from turning the system it should go. We see into a house of cards. I The answer is no, no and no. this phenomenon submit to you that if these - Moris Senegor, MD regularly in our external threats were to parent society with disappear, unrestrained countless debates tension would explode about the limits of like a volcano and there Presidential power for instance. In the Medical Staff, Chiefs would be no way to keep the Chief, aristocrats and mob issue edicts, manipulate meeting agendas, and engage in from engaging in the equivalent of civil war. This, I hear behind-the-scenes politicking in attempts to expand their occasionally does happen in certain hospitals, but I do not power. The potentially oligarchic elite as a collective body know of any local examples current or historic, within our issue policy decisions from say the MEC, which are received County, where such dysfunction has occurred. by howls from the rank-and-file on staff who scream that So what are we to make of my opinion that us physicians the MEC has no such power or authority over their hospital who practice in hospitals reflect our parent society as a practices. They then attempt to vote themselves out of mirror republic? Shall we stop bickering with each other and political predicaments or unpopular policies. Chiefs and engage in “love thy Chief” or “love thy CEO”? Shall we quit CEO’s are accused of tyranny (usually with alternative complaining about policies issued by our MEC? Shall we terms), the “aristocrats” forever rotating through the ignore external regulators and their pesky irritations? The committees of elitism; and these leaders in turn retort by answer is no, no and no. What we should do is continue the telling the physicians-in-the-street that they do not know same way as we always have, but instead of wondering what’s what’s for their own good. wrong with us, realize that existing tensions within the Staff Societies remain cohesive for various reasons, a major are healthy, and “that’s the way it is”. Not to mention, “that’s one being enemies or external threats. Medical Staffs are no the way it should be”. different. The U.S. Government and its various regulatory

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WINTER 2010

Independent But Not Alone.

Steven Wall, M.D. Hill Physicians provider since 2004.

Uses Hill inSite, Hill EHR, Ascender and RelayHealth for eClaims processing, electronic health records, practice management, preventive care reminders and secure online communications with patients.

Independence and strength are not mutually exclusive. Practices affiliated with Hill Physicians Medical Group retain independence while enjoying the strength that comes from being part of a large, well-integrated network of physicians. Hill’s advantages include: • Fast, accurate claims payments • Free electronic communication capabilities via RelayHealth • RN case management for complex, time-intensive cases • Deep discounts on EPM and EHR solutions for the federal mandate • Preventive care and disease management reminders for patients • High consumer awareness that attracts patients That’s why 3,500 independent primary care physicians, specialists and healthcare professionals have made Hill Physicians Medical Group one of the country’s leading Independent Physician Associations. Get more for your practice with Hill.

Your health. It’s our mission.

Get more information about Hill Physicians at www.HillPhysicians.com/Providers or contact: San Joaquin area: Paula Friend, regional director, (209) 762-5002, Paula.Friend@hpmg.com Sacramento area: Doug Robertson, regional director, (916) 286-7048, Doug.Robertson@hpmg.com Bay area: Jennifer Willson, regional director, (925) 327-6759, Jennifer.Willson@hpmg.com Hill Physicians’ 3,500 healthcare providers accept commercial HMOs from Aetna, Alliance CompleteCare (Alameda County), Anthem Blue Cross, Blue Shield, CIGNA, Health Administrators (San Joaquin), Health Net, PacifiCare and Western Health Advantage. Medicare Advantage plans in all regions. Medi-Cal in some regions for physicians who opt-in.

WINTER 2010

SAN JOAQUIN PHYSICIAN

19

COMMUNITY > Internship

Orthopedist George Westin of Alpine Orthopedic is observed by Fitness 360 owner and community intern Todd Speer who is standing far right. Dr. Westin is performing a total hip replacement at Dameron Hospital and is being assisted by Dr. Earl Taylor who is not shown.

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WINTER 2010

Community

Internship Program The eleven local leaders who shadowed physicians in the Community Internship Program found the experience to be revelatory. Started by Dr. Joseph Serra a dozen years ago in conjunction with the S.J. Medical Society, one purpose of opening the doors of the treatment room is the hope that familiarity will fuel better decision-making and support by business groups and governmental agencies. “Because of what I saw, one of my takeaways was a better sensitivity to matching up resources to functionality when we make hard decisions about the County Hospital,” said Steve Bestolarides, S.J. County Supervisor. “It opened my eyes to the business of medicine that happens in institutions. It was quite impressive to see all the work that went on in the background that patients don’t see. The interaction between the doctors and nurses was great, and all the chart reading and interpretation, is very impressive.”

By William West

WINTER 2010

l

Photos by Mike Steenburgh

SAN JOAQUIN PHYSICIAN

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COMMUNITY > Internship

San Joaquin County Supervisor and community intern SteveBestolarides spent an afternoon shadowing Pediatrician Trinh Vu while she visited her patients at Dameron Hospital. With the parents consent, Supervisor Bestolardies joined Dr. Vu as she examined a newborn girl who had been born just hours earlier.

Mr. Bestolarides is married to a nurse and has knowledge of the medical world through her, but found the program enlightening beyond his expectations. All the community participants told similar stories of surprise and varying degrees of awe at the pace of the medical world and the myriad tasks involved.

“This was my third time,” said Bill Trezza, the CEO of the Bank of Agriculture and Commerce. “As a businessman I appreciate the business aspect, but also the interesting thing for me was learning how our bodies work.

It is overwhelming the amount of knowledge that doctors

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possess. This program is an eye-opener and a terrific idea.

My final thought is that we need you guys, you doctors, to be paid a lot more.”

The physician shadowees universally enjoyed the process of showing the community interns the nature of their practices. Doctors learn from the interaction as well.

They have the opportunity to see through the eyes of a rookie or a potential patient. Routines that are normal procedure for doctors take on a new meaning when an intern asks a question or expresses an emotion about what has transpired in the operating room or the doctor’s office.

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“This program is a two-way street, we learn from the community interns and we hope they learn from us”

“This program is a two-way street,” said Dr. Serra. “We learn from the community interns and we hope they learn from us. We want to know how we can do better. We have some physicians coming back to do this for all 12 years. It is appealing and valuable.”

“It was valuable because it showed us maybe where we can improve and the feedback we got was welcome,” said Radiologist, Dr. George Khoury.

“We are in a high stress spot and the feedback from community members was helpful,” said Dr. Dan Vongtama, Radiation Oncologist at St. Teresa’s Comprehensive Cancer Center.

“I enjoyed Mary Ann (Mary Ann Soria, the Director of Health Services at St. Mary’s Interfaith Community Services), and hope the input will help,” said Dr. Patricia Hatton, an OBGYN who was one of the participating doctors.

“Sharing experiences with these folks was very rewarding,” said Dr. Charles Stillman, a Radiologist with Valley MRI. ”They asked more intelligent questions than do some medical residents.”

“Dr. Hatton and Dr. Stillman showed me the advanced state of medicine in this country,” said Ms.Soria, “especially compared to the Philippines where I am from. We serve the homeless and the uninsured and it gave me better ideas how to serve my clients.”

Paradoxically, exposure to a physician’s world demystifies procedures but sparks awe at the skill and knowledge involved.

“Fitness and the human body are my business,” said Todd Speer, coowner of Fitness 360 in Lincoln Center. “So I was very interested in how the body works. I feel blessed and enlightened to be a part of this. It was extremely educational. The depth of interaction is great. Dr. Eager and Dr. Westin were doctors I observed. I saw shoulder and knee surgeries. I can’t really express how amazing those surgeries were to me. Now I have a better understanding of the body than I already had.”

“I think it is very important that we support this program,” said Mr. Speer.

Bill Jeffry, Adjunct Professor of Law at the McGeorge School of Law, indicated he was impressed with the range of tools in the medical toolbox.

The insights he gained went beyond the medical.

“The political issues behind medicine were illuminated for me during this program.”

Susan Drake, recent Rotary Governor and retired EDD manager, shared in the group’s respect for the way physicians handled a jam-packed schedule.

“The thing that I noticed was how the day never stopped,” Mrs. Drake said.

“Dr. Federal and his analyses of images, hundreds of them, were amazing. I was reassured to know there was someone that smart and thorough behind the scenes. This kind of program makes Stockton special.”

“Another thing I learned was that a general practitioner has to know everything about everything,” Mrs. Drake said. “A slight exaggeration, I know, but it really is amazing what they know.”

Dudley Drake, State Farm Insurance Agent and former naval officer chimed in in agreement with his wife, Susan, and added, “I was most impressed by how hard they worked. You just can’t see, as a patient in the little room, how much they are running around.”

“This whole experience was amazing. I saw knee surgery,” said Eddie Lira, Commercial Banking Officer with Bank of Agriculture and Commerce.

Dr. Joe Serra WINTER 2010

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23

OMMUNIT

PARTICIPATING PHYSICIANS Kwabena Adubofour, MD Steven Eager, MD

W. Aubrey Federal, MD Harvey Gilbert, MD

Patricia Hatton, MD

George Khoury, MD

Thomas McKenzie, MD Joseph Serra, MD

Charles Stillman, MD Dan Vongtama, MD Trinh Vu, MD

Walter Wager, Jr., MD Richard Waters, MD

George Westin, Jr., MD

PARTICIPATING ORGANIZATIONS Alpine Orthopedic Medical Group, Inc.

Ambulatory Surgery Center of Stockton Ben Schaffer Cancer Institute Dameron Hospital

Lodi Memorial Hospital

Lodi Orthopaedic Medical Group, Inc. St Joseph's Medical Center

St Teresa Comprehensive Cancer Center Stockton Cardiology Medical Group Stockton Diagnostic Imaging

Sutter Gould Medical Foundation

Valley MRI & Family Medical Imaging Center

PARTICIPATING COMMUNITY MEMBERS Ron Addington - Business Council, Inc.

Steve Bestolarides – County Board of Supervisors Carol Clemons – Angel’s Caring Helpers Dudley Drake – State Farm Insurance Susan Drake – Rotary

Bill Jeffery - University of the Pacific

Eddie Lira - Bank of Agriculture & Commerce

MaryAnn Soria - St. Mary's Interfaith Dining Room Todd Speer - Fitness 360

“From the business side there are many of the same challenges as other business people. I have a great deal of respect for the doctors that have to deal with both the medical and the business parts of a practice.”

“I was with Dr. Richard Water and saw angiograms being performed” said Bob Young, General Manager of Stockton Golf and Country Club. “I was just three feet away and at the doctor’s shoulder. I scrubbed. “I was also with Dr. Dan, the oncologist. He treated me like a brother. It was one of the most remarkable experiences of my life.”

Dr. Serra found the response from community to be tremendous right from the very start. From the very first year they had the maximum number of interns they could handle.

This year, despite some restrictions because of HIPPA, the program was able to provide a comprehensive look at local practices.

“I’ve always felt that this was an outstanding program to introduce people in the community to what goes on everyday,” said Dr. Serra. “The community needs the exposure. It’s good to have the leaders in the community understand what physicians are doing day-to-day and how many hours they spend in their practices.”

“And the physicians need the people in the community understand the issues we face in medical delivery these days,” said Dr. Serra. “We will be doing it twice a year starting in May of next year. Already have three or four people in the community saying they want to do it.”

DATES FOR OUR SPRING 2011 COMMUNITY INTERNSHIP PROGRAM: Our spring program is scheduled for the week of May 9 – 12, 2011 and applications will be accepted online beginning in January.

Interested business, political, educational and non-profit community leaders are welcome to apply. Our program is restricted to 10-14 participants each session in order to ensure a high level of involvement for everyone and personal one-to-one interaction between our physician mentors and community participants.

William Trezza - Bank of Agriculture & Commerce Bob Young - Stockton Golf & Country Club

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SAN JOAQUIN PHYSICIAN

WINTER 2010

DOC TOR S GROW YOUR PR ACTICE AT TR ACY’S PREMIER MEDICAL CAMPUS

TR AC Y NEEDS :: Family Practice :: OB/GYN :: Pediatrics :: Internal Medicine :: Oncology :: Psychiatry :: Cardiac/Thoracic :: Dermatology :: Orthopedics :: Ophthalmology :: Allergy :: ENT :: General Surgery :: Plastic Surgery :: Pulmonary Disease :: Urology

Grant Line Center is Tracy’s newest medical campus. It is centrally located just 2 blocks from the 205 freeway on Grant Line Road, at Corral Hollow Road. Tracy is currently underserved and needs more physicians now. This is a perfect opportunity for you to expand your practice into a market that needs your services. Please schedule a tour today and see what Grant Line Center can offer you, your practice, and your patients.

FOR TOURS OR FURTHER INFORMATION Michael Torres Brian Peterson Associate Senior Associate Lic. 01807409 Lic. 01718738 T 209.476.2932 209.473.7800 brian.peterson@cbre.com mike.torres@cbre.com CB Richard Ellis, Inc. Broker Lic. 00409987 WINTER 2010

Visit Our Website Today:

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SAN JOAQUIN PHYSICIAN

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PRACTICE MANAGEMENT > Record Keeping

Record Keeping:

How Detailed Should A Physician’s Office Chart Be? By: Scott A. Ginns, Esquire, Cassel Malm Fagundes In a physician’s busy practice, at times documentation suffers. The question is how does documentation impact a physician in a medical malpractice action or Medical Board inquiry.

As an attorney, I have regularly encouraged my physician clients to be very detailed in their documentation. In the context of a medical malpractice case, there are almost always some holes in the record. Invariably, something occurred which was not documented that becomes a key issue in the case creating a “he said, she said” credibility situation.

During litigation, I rely on the good character and credibility of the physician to fill in the gaps with their testimony at deposition and trial.

When the patient’s expert testifies that a breach in the standard of care occurred by failing to document a certain finding, or thought process, we defend the case by asserting that documentation is not a patient care issue, but a bookkeeping issue. We emphasize that the important thing is that the patient was provided with appropriate care, that a lack of documentation did not impact actual patient care and it did not cause any damage to the patient. So long as the jury believes the physician that the appropriate care did in fact occur, the jury will likely rule in favor of the physician in spite of missing documentation.

If the jury does not believe the physician, however, the lack of documentation can turn a defensible case on the medicine into a plaintiff’s verdict.

All of this can be avoided with thorough and complete documentation. In fact, this was the situation when I successfully defended an Internal Medicine specialist in a case in which the plaintiff had an immediate family history of heart disease. The patient presented to the physician’s office with chest pain after lifting a heavy object on the job. A thorough and complete work-up for chest pain, including ruling out a cardiac source, was documented. The plaintiff suffered a myocardial infarction two

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weeks later, however the doctor’s charting was so excellent that the case was defended despite the patient’s claims that the doctor failed to rule out a cardiac source of his chest pain.

A second issue arises when the California Medical Board investigates either a patient complaint or follows up on the reporting of a settlement. If the Medical Boards sends the case to an outside medical reviewer, the reviewer is asked to review the entire medical record, looking for breaches in the “standard of practice”. “Standard of practice” is a term interpreted to be more comprehensive than the usual “standard of care” by some Medical Board physician reviewers.

Business and Professions Code Section 2266 titled “Record Maintenance: Services to Patients,” states: “The failure of a physician and surgeon to maintain adequate and accurate records relating to the provision of services to their patients constitutes unprofessional conduct.”

Under the general category of Unprofessional Conduct, the Medical Board sets disciplinary guidelines which include probation on one’s license, limitations on the scope of a physician’s practice and requirements to participate in courses as set by the PACE program.

Every physician should review an article available on the Medical Board website titled “Preventive Medicine and the Seven Deadly Sins: Avoiding Discipline against your Medical License.”

Specific reference is made in that article to the California Medical Association’s published Document #1135 from January 2006 which sets forth guidelines for the content of medical records. The CMA publication stresses that the medical records serve as a basis for planning and maintaining quality of patient

WINTER 2010

care, but also that inadequate record keeping interferes with the ability of a physician’s peers to perform peer review.

Additionally, the publication reiterates that a good record is often the best defense of a physician in a medical malpractice action.

Pertinent excerpts from CMA Document #1135 are set forth below: a. The medical record should be complete and legible. (If the Medical Board cannot read the physician’s handwriting, they will take the position that Business and Professions Code section 2266 has been violated.) b. The documentation of each patient encounter should include: the date; the reason for the encounter; appropriate history and physical exam; review of lab, x-ray data, and other ancillary services, where appropriate; assessment; and plan for care (including discharge plan, if appropriate). c. Past and present diagnoses should be accessible to the treating and/or consulting physician. d. The reasons for and results of x-rays, lab tests, and other ancillary services should be documented or included in the medical record. e. Relevant health risk factors should be identified. f. The patient’s progress, including response to treatment, change in the treatment, change in diagnosis, and patient noncompliance, should be documented. g. The written plan for care should include, when appropriate: treatment and medications, specifying frequency and dosage, any referrals and consultations; patient/family education; and specific instructions for follow-up. h. The documentation should support the intensity of the patient evaluation and/or the treatment including thought processes and the complexity of medical decision-making. i. All entries to the medical record should be dated and authenticated. j. The CPT/ICD-9 codes reported on the health insurance claim form or billing statement should reflect the documentation in the medical record.

Of note, I recently represented a physician in an Administrative hearing following an Accusation filed on behalf of the Medical Board. Documentation issues became a major focus of the case. The claim was not that the doctor failed to provide proper treatment, but that the doctor failed to throughly and completely

WINTER 2010

In order to avoid pitfalls in both medical malpractice cases and Medical Board inquiries, remember the age old adage “the job ain’t done until the paperwork is finished.”

document the treatment that was provided. Although the record taken as a whole explained the physician’s thought process and the reasons for medications ordered, the physician failed to document in the progress note all of the specifics for each visit. The Medical Board expert testified that there was a failure in documentation amounting to a breach in the “standard of practice” and that there was a statutory violation constituting unprofessional conduct.

In order to avoid these pitfalls in both medical malpractice cases and Medical Board inquiries, remember the age old adage “the job ain’t done until the paperwork is finished.”

Good luck!

Scott can be contacted via e-mail at scottg@cmf-law.com.

SAN JOAQUIN PHYSICIAN

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COMMUNITY > news

IN THE

NEWS

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

DR. SERRA AND HIS TEAM OUTSIDE THE AIRPORT DR. SERRA COMPLETES 10TH MEDICAL MISSION TRIP TO MALAWAI Dr. Joe Serra, a long-time member of San Joaquin Medical Society and Stockton Rotarian, continues his quest to provide supplies and medical assistance throughout the world with even more vigor since his retirement as an orthopedic surgeon in the Stockton community.

This summer, “Dr. Joe”, as he is often referred by his patients, made his tenth trip to Africa on a medical mission this time arriving in Malawi the same day as a 40 ft. container of medical supplies arrived destined for distribution to two hospitals in the impoverished region.

“It was a dream come true”, he stated. It took two28

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years to raise the twenty-six thousand dollars needed to pay the shipping fees for the ton of supplies provided by MedShare.

“The supplies cost nothing”, Serra explained.

“MedShare, the Atlanta-based organization with a local branch in San Leandro, California collects unused hospital supplies from Valley and Bay Area hospitals and, in effect, re-cycles the various items to countries with limited funds for purchasing medical resources.”

This year, Dr. Serra was joined by fellow Rotarians, Dr. Cathy Peterson, chair of the Physical Therapy department at the University of the Pacific, Cathy’s dad, Ron Peterson, a Rotarian from Iowa, Gary Gillis, former Stockton Fire Chief along with his daughter Erin, an emergency room

WINTER 2010

news < COMMUNITY physician, as well at Escalon Rotarian, Dave Mantooth and wife, Sally and Stockton Rotarian, Frank Moore.

The cost of the shipping was covered by various Rotary chapters as well as donations from members and friends of San Joaquin Medical society and each member of the team paid for their own transportation and living expenses while on the trip.

Serra is planning another medical mission, serving as a teacher/ mentor at one of the hospitals in Malawi sometime next year.

are ranked by an analysis of performance measures in quality outcomes, quality improvement, and financial performance.

“The 2010 HomeCare Elite winners continue to demonstrate a commitment to providing their patients with the best possible care while performing at the highest level,” said Amanda Twiss, CEO of OCS HomeCare. “We congratulate St. Joseph’s Home Health Care on being one of the top home care agencies in the country. In addition, we salute all forward-thinking DR. FAHEY JOINS VINE providers who are already working CLINIC IN LODI on measuring and improving their The Lodi Memorial Community performance using OASIS-C Clinic - Vine welcomes general outcomes and process measures surgeon Gordon Thomas and HH-CAHPS results. This Fahey, MD. This specialtyimportant data will also be used in medicine practice is also home to identifying the HomeCare Elite in endocrinologist Frank Huang, MD, the future.” and neurologist Weiping Yao, MD. St. Joseph’s Home Health Care Dr. Fahey graduated from Director, Pat Collier, RN, MS, the Medical College of Georgia, credits her caring staff and their Atlanta, in 2000. He completed hands-on experience with the internship and residency programs company’s ability to rank as one at the University of California, of the HomeCare Elite. She said, San Francisco, Fresno Medical “St. Joseph’s is very pleased to be DR. FAHEY Education Program. He is certified honored with this distinction for by the American Board of Surgery. the fourth year in a row. Our goal The Lodi Memorial Community Clinic - Vine is is to provide high-quality patient care to our patients located at 1235 W. Vine St., Ste. 22, in Lodi. Current in the comfort of their own homes so they can live as patients can call for appointments, and new patients are independently as possible.” welcomed with a physician’s referral. Most insurances are St. Joseph’s Medical Center’s Home Health Care offers accepted. Call 334-8520 to schedule an appointment. patients skilled services at home including registered For more information on the Lodi Memorial Community nursing care, physical therapy, occupational therapy, Clinic – Vine, its providers and other services offered by speech therapy, home health aide services, and medical Lodi Memorial Hospital, visit the hospital’s website, social services. St. Joseph’s Home Health Care is www.lodihealth.org. a Medicare certified, licensed, Joint Commission accredited, Home Health Agency that serves patients of all ages – from infants to the elderly.

ST. JOSEPH’S HOME HEALTH CARE “On the fifth anniversary of HomeCare Elite, NAMED TO 2010 HOMECARE ELITE DecisionHealth would like to congratulate all of the St. Joseph’s Medical Center today announced that it has winners who have achieved excellent clinical and been named to the 2010 HomeCare Elite™, a compilation financial outcomes, especially during times of such of the top-performing home health agencies in the United drastic regulatory changes,” added Marci Heydt, States. Now in its fifth year, the HomeCare Elite identifies executive editor of DecisionHealth’s Home Health Line. the top 25 percent of agencies and further highlights The 2010 HomeCare Elite is the only performance the top 100 and top 500 agencies overall. Winners recognition of its kind in the home health industry. The

WINTER 2010

SAN JOAQUIN PHYSICIAN

29

COMMUNITY > news

IN THE

NEWS 2010 HomeCare Elite is brought to the industry by OCS HomeCare, the leading provider of homecare information, and DecisionHealth, publisher of homecare’s most respected independent newsletter Home Health Line. The data used for this analysis were compiled from publicly available information. The entire list of the 2010 HomeCare Elite agencies can be viewed by visiting the OCS HomeCare website at www.ocshomecare.com. $4,000 Check Presentation to First Tee The San Joaquin Medical Society has once again made a substantial contribution to The First Tee OF San Joaquin with the proceeds from the SJMS’ Second Annual Golf Tournament, held at Brookside County Club on November 6, 2010.

This organization provides training and scholarships to young golfers in our community ages twelve to eighteen years of age.

Under the direction of SJMS hosts, Drs. Kwabena Adubofour and George Khoury, the second annual tournament proved even more successful this year with an increase in participants. Thirty-eight Medical Society members and friends participated this year and enjoyed a

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great round of golf, a fantastic buffet lunch and beautiful weather.

Betty $4,000 Check Presentation to First Tee Lou Beyer, Executive Director of Ramnik Clair. Tournament Host the First Tee organization, praised Kwabena Adubofour won the overall the physicians for their dedication to actual Closest to the Hole of all promoting the program. According with a 14” shot on the 12th hole. Dr. to Beyer, “The First Tee of San Pederson managed to win the “Most Joaquin is most grateful to the Water Balls” award and Dr. Stuart Medical Society for presenting such Jacobs walked away with the “Most an outstanding golf tournament to Balls in the Rough” award with a benefit our chapter”. staggering count of 32!

Ms. Beyer continued, “The mission Congratulations to all the golfers of “First Tee” is to impact the lives of who played making this a truly “winyoung people by providing learning win” event. facilities and educational programs that promote character development and life-enhancing values through California Children’s the game of golf ”.

Services (CCS) Medical The overall champion for the Director Needed event was Dr. John Zeiter who San Joaquin County Public Health shot a 79 on the course, followed Services is recruiting for a dynamic

by Dr. Ronald Dong (81), Dr. Rick and motivated fulltime Pediatric or Rawson (85), Dr. Ramnik Clair (85), Family Practice physician to provide Dr. James Pucelik (86), Dr. Steve medical consultation for California Billigmeier (87), Dr. Tim Coats Children’s Services.

(88), Dr. Prasad Dighe (89), Dr. Lian Apply online now at www.jobaps.

Soung (91) and rounding out the top com/sj. For information, call or visit ten spots, Dr. Rodney DeGuzman us at: who shot a 93.

San Joaquin County Human Other notable achievements were Resources, 44 N San Joaquin Street the Longest Drive won by Dr. Suite 330, Stockton, CA 95202

WINTER 2010

news < COMMUNITY DR. SUJEETH PUNNAM JOINS DELTA HEART & MEDICAL CLINIC The Delta Heart & Medical Clinic and Dr. John Olowoyeye is pleased to announce the association of Dr. Sujeeth Punnam who joined the practice this past September.

Dr. Punnam is Board Certified in Internal Medicine and Cardiovascular Disease. He previously practiced in Texas and received his education at Kakatiya Medical College at the University of Medical Sciences, India and completed his residency at Crozer Chester Medical Center in Upland, Pennsylvania. In addition to his Internal Medicine Fellowship which was completed at Michigan State University, Dr. Punnam completed his Interventional Cardiology Fellowship at Borgess Medical Center in East Lansing, Michigan.

Dr. Punnam is accepting new patients and can be reached at Delta Heart & Medical Clinic, 1801 East March Lane, Suite A-170, Stockton. Telephone is (209) 951-9884 DR. REGINA WONG JOINS PEDIATRIC CLINIC IN LODI The Lodi Memorial Hospital Pediatric Clinic welcomes pediatrician Regina Wong, MD. Dr. Wong graduated from the University of Maryland School of Medicine, Baltimore, in 2005. She completed a residency program in pediatrics at the Loma Linda University Medical Center, in Loma Linda, CA. The Lodi Memorial Hospital

WINTER 2010

Dr. Sujeeth Punnam

Dr. Regina Wong Pediatric Clinic is located at 2415 W. Vine St., Ste. 100, in Lodi. This pediatric practice is also home to Akbar Umar, MD; Jay Ratilal, MD; and Christopher Doria, MD. New patients are welcomed. Most insurances are accepted. Call 3333135 to schedule an appointment.

For more information on the Lodi Memorial Hospital Pediatric Clinic, its providers and other services offered

by Lodi Memorial Hospital, visit the hospital’s website, www.lodihealth.org.

NEW IMAGING CENTER OPENS AT TRINITY PARKWAY CENTER IN SPANOS PARK Trinity Mammography and Imaging Center has opened for patient care this past October and offers the latest in screening mammography technology. The center features the Hologic Selenia™ digital mammography system which incorporates revolutionary imaging technology, providing incredibly sharp breast images appearing on the technologist’s monitor in a matter of seconds. This speed means less time in the breast imaging suite for the patients. Delta Radiology Medical Group, Inc.’s highly skilled and board certified radiologists, Frank M. Hartwick, M.D., Majid Majidian, M.D., R. Brandon Rankin III, M.D., Grant W. Rogero, M.D. and Roger P. Vincent, M.D. will interpret the digital images and provide expedient reliable results to referring physicians.

Delta Radiology has been serving the community for over 40 years and is pleased to expand to this new site which will provide their patients another convenient location to serve them.

Trinity Mammography and Imaging Center is located at 10200 Trinity Parkway, Suite 204, in the Trinity Plaza with easy access off Eight Mile Road and I-5 near Lowes in the Spanos Retail Park.

They provide extended hours from 10 a.m. to 7 p.m. and allow walk-in appointments.

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LODI MEMORIAL HOSPITAL ACUTE REHABILITATION CENTER 20

YEARS OF SPECIALIZED, INPATIENT

REHABILITATION SERVICES FOR:

Stroke patients Brain-injury patients Spinal-cord-injury patients Multiple-trauma patients Other neurological conditions

THE

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news < COMMUNITY ST. JOSePh’S reCOgNIZeD FOr CONTINUeD eNVIrONMeNTAL eFFOrTS St. Joseph’s Medical Center’s environmental efforts have earned special recognition from the California Integrated Waste Management Board, awarding the hospital with its 2010 Waste Reduction Awards Program (WRA P) honor. The WRA P Awards are based on businesses’ efforts to reduce waste in their daily operations, including recycling programs, reducing packaging and using recycled or post-consumer materials.

The 2010 WRA P Award and continued recognition from Practice Greenhealth for Environmental Leadership honor the hospital’s environmental efforts, which include the recycling of cardboard, paper, cans, plastics, fluorescent light bulbs, batteries, ink jet cartridges and sterile wraps, and using reusable “sharps” containers that can be washed and reused up to 500 times. In addition, the hospital has switched to using reusable isolation gowns; uses 100% post-consumer waste Recycled Paper for all office supplies; installed energy efficient washers in their Laundry Department; and has a vermicomposting unit, or worm composting, which turns kitchen waste into highquality soil which is used by the hospital’s gardener as fertilizer.

“It can be easy to let

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environmental concerns take a back seat, but we realized that not taking action today means putt ing our health and future in jeopardy,” said John Kendle, St. Joseph’s Director of Operations, Support and Services.

“Environmental endeavors are really ingrained in the culture of our hospital, and we are happy to be pioneers in the health care industry’s green efforts in the hopes that other facilities will follow our lead.”

Th is is the fourth WRA P Award St. Joseph’s Medical Center has earned. The hospital has been a member of Practice Greenhealth’s Environmental Leadership Circle since 2005.

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PRACTICE MANAGEMENT > EHR Liability Litigation

Managing Professional Risk

EHR in Medical Liability Litigation NORCAL Mutual Insurance Company and NORCAL Group

By Mary-Lynn Ryan, Risk Management

Electronic health records (EHRs) hold great promise for improving patient safety and decreasing medical liability exposure, but as EHR systems have been adopted, a variety of new medical liability litigation issues have arisen. For example, some systems cannot create a printed patient record that will be understandable to a jury; and some offices are not staffed with a person who knows how to remove privileged or irrelevant information from an EHR before it is released to the plaintiff’s attorney.

EHR metadata (data about data) is a related concern. EHR system metadata shows how, when, and by whom EHR data was received, created, accessed and modified. State courts are indicating that EHR metadata can be relevant in medical liability lawsuits, and plaintiffs have begun seeking and obtaining metadata related to their cases. Consider how valuable metadata could be to an attorney attempting to establish a failure-to-monitor or delayed-diagnosis claim.

To address these emerging issues, providers are encouraged 1) to analyze their own EHR

systems and determine whether they can generate understandable patient record copies and metadata reports that are appropriate for medical liability litigation, and 2) to create policies and procedures that ensure only the release of appropriate patient information as a result of a discovery request, while protecting sensitive medical information subject to special confidentiality requirements.

Producing appropriate records for litigation is rarely a top marketing priority for EHR vendors, but a system’s ability to print an appropriate patient record should be an important consideration for any provider purchasing or updating an EHR system.

Medical records are a primary means of showing compliance with the standard of care, and it is difficult to defend even exemplary care if records are inadequate, confusing or incomplete. To get a sense of whether your practice is prepared for a request to release electronic health records, consider the following questions:1 What information will be disclosed upon a request for medical records?

Being prepared for the release of a patient’s medical information can mean the difference between success and failure in medical liability litigation. Because of the complexity of the EHR options available, planning and research are critical to the successful utilization of EHR.

1Teno, JM, Connor, SF, Referring a patient and family to high-quality palliative care at the close of life.

Journal of the American Medical Association, 2009, (301), No 6; 651–658.

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WINTER 2010

Do you have a standard report format that can be used in all record release situations (e.g., can patient requests, billing compliance requests, research requests and litigant requests all be satisfied with one type of medical record)?

Define the patient record of care in the system. The system needs to be programmed to generate an accurate account of a patient encounter or episode of care. The resulting document must be able to “tell the story” of a patient encounter in a way that satisfies the requirements of the party requesting the record.

Keep the patient record fluid and adaptable. The perfect “litigation” patient record may not satisfy laws, regulations and standards related to payers, patient safety organizations and/ or other entities that request patient information.

Does your system allow you to block confidential, sensitive medical information and privileged or irrelevant information when producing copies from the electronic record (e.g., drug and alcohol abuse, HIV, mental health, quality assurance, email from liability insurers or attorneys, etc.)?

Double check records before they are released and confirm that they do not include privileged or irrelevant information.

Does someone in your organization know how to produce an appropriate record?

Procedures performed at our center currently include:

Ensure that staff members are appropriately trained in releasing EHR and metadata.

Being prepared for the release of a patient’s medical information can mean the difference between success and failure in medical liability litigation. Because of the complexity of the EHR options available, planning and research are critical to the successful utilization of EHR. While it may take extra time and money to personalize and adequately understand an EHR system and put EHR policies in place, the added investment can yield rich benefits for patients and physicians alike.

1. Dougherty M, Washington L. Still Seeking the Legal EHR. Available on the American Health Information Management Web site at: http:// library.ahima.org/xpedio/groups/public/documents/ahima/bok1_046428. hcsp?dDocName=bok1_046428 (accessed 8/3/2010).

Managing Professional Risk is a quarterly feature of NORCAL Mutual Insurance Company and NORCAL Group. More information on this topic, with continuing medical education (CME) credit, is available to NORCAL Mutual insureds. To learn more, visit www.norcalmutual.com/cme.

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Wilson A. Heefner < COMMUNITY

WILSON A HEEFNER M.D. A HISTORIAN IN OUR MIDST

In the diverse milieu that comprises our medical community numerous personalities with unique interests abound. But a physician who has completely reinvented himself as a credentialed historian is certainly uncommon.

H

aving recently published his latest book, Dr. Wilson A Heefner, pathologist and military historian, basks in the success of what turns out to be the crowning achievement of his second career, a definitive biography of General Lucian Truscott, one of the most underappreciated U.S. Army commanders of the 20th century. Published by the Missouri University Press, this work has already sold 1500 copies since May 2010 when it first hit the shelves, a respectable amount for a relatively specialized subject.

Dr. Heefner, a soft spoken, self effacing man who looks younger than his age, was a pathologist at Dameron Hospital between 1968 and 1988 when he retired. He was also a U.S. Army veteran of 41 years, who retired from the Army Reserve with the rank of Colonel. He traces his interest in military history to before his years in the army, which he joined at the age of 17 straight out of High School. He points out that he grew up near Gettysburg, Pennsylvania, and therefore his curiosity was ingrained from childhood.

Heefner served in Japan during the Korean War as a hospital lab technician, and this in turn spawned a career in pathology.

After returning stateside, he completed college at the University of Gettysburg and medical school in Maryland. He began his career as an academic pathologist in Maryland but soon discovered that while he enjoyed teaching, medical research was not of any interest to him. Little did he know then that his research talents lay in a totally different discipline. Looking for positions in the West, he found one at Dameron Hospital and moved to Stockton where he has lived since.

In his decades as a pathologist in Stockton, Heefner avidly read about his favorite subject, mostly Civil War and the great

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World Wars of the 20th century, but did not take any additional steps beyond. He then got a chance to retire early at the age of 56, and reinvent himself. He recounts that in 1986, two years prior to his retirement, he enrolled in a University of the Pacific course in Japanese History, and discovered that he was the only pupil in that class. His professor, Leonard Humphreys would have ordinarily cancelled such a poorly enrolled course, but for the enthusiastic interest his student displayed. Heefner spent his precious one-on-one time with the professor discussing not only subjects of the course but also his desire to write historical works.

Humphreys responded by strongly recommending that Heefner enroll back in school and earn a degree in history, mainly to learn the research and writing techniques of historians which he indicated, are quite different than those of physicians.

This Dr. Heefner did without much ado at the University of Hawaii, in the island state to which he temporarily moved in the early years of his retirement, eventually earning a Masters Degree in U.S. History. In the process he discovered that there indeed was a fundamental difference between medical and historical researchers in the way they approach their work. He points out that in medicine a passive voice predominates. “This was done, that was done” is the usual refrain. The same goes for the military. The problem with the passive voice is that it fails to define responsibility. An even more obvious example of hazy responsibility is doctors referring to themselves as “we” instead of “I”, as in, “we removed the appendix uneventfully”, when a surgeon is addressing a family after an operation. Historians on the other hand use an active voice at all times. “Dr. so-and-so removed the appendix!”. This is more assertive and lands the responsibility for the information squarely on the shoulders of

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COMMUNITY > Wilson A. Heefner

whoever is making the statement. Therefore proclamations by historians have to be based on sound facts sifted out of historical evidence, the research method of this discipline.

Dr. Heefner’s Masters thesis became his first book, a biography of General Edwin D. Patrick. His interest in this otherwise obscure general had been aroused decades earlier when, as a young soldier he sailed in a troop transport ship named after this commander.

Referring to his first book he admits, “it suffered from a lack of editing”. Next came a biography of General Walton H. Walker, veteran of both World Wars, who lost his life in a jeep accident while commanding in the Korean theater. This was also poorly edited, according to Dr. Heefner. He has recently rectified this problem with crackerjack editors for his latest book on General Truscott.

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When I inquired what it was about people rather than events that attracted his attention, Heefner replied he has always been interested in personalities and attracted to biographies. As a bona fide historian, Heefner painstakingly researched primary source material such as national and military archives, surviving relatives and military colleagues of his subjects, and tried to read as much of their original writings such as letters and memoirs as were available. As it turns out, doing this from California is not so easy, since a vast majority of this information is located in the East Coast. Dr. Heefner who admits, “the research is the fun part”, incorporated his projects into various vacations and family gatherings in the East. Once a critical mass of research material was amassed, then came the writing.

This, according to Dr. Heefner, “is just hard work”.

His latest book on General Truscott took a total of eight years to research, write and publish.

He was inspired to engage this project in 1992 by his friend Martin Blumenson, during a tour of World War II battlefields of the Italian Campaign. While sipping wine with Blumenson in Salerno, site of the first Allied amphibious assault on the Italian mainland, Heefner recalls Blumenson recommending that he consider taking on Lucian Truscott, who showed exceptional capability and leadership in this land, in particular with his breakthrough from the boondoggled beachhead at Anzio further north.

Until then no serious biography of this exceptional individual had been written. Furthermore there was already a good place to start the project, a superb auto-biography by the General himself, which Heefner calls the best military memoir since that of Ulysses S. Grant. At the time Heefner was engaged with his earlier projects and did not take heed until

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2001 when he encountered Blumenson again in Paris, and this time was firmly persuaded to take on the “Dogface Soldier”, as General Truscott was known.

Despite being one of the best combat commanders of World War II, Lucian Truscott is not as well known as the likes of Bradley and Patton, partly because he commanded primarily in secondary theaters of the war, mainly in Italy and Southern France, which have received less historic attention than such operations as Normandy or the Battle of the Bulge. Furthermore Truscott was a rather self effacing man who did not seek the limelight like his more flashy colleagues Clark or Patton.

After his successful career in the War, he was plucked out of retirement to serve for the CIA in Europe during the Cold War. Heefner’s book sheds light into this aspect of the General’s career which is even lesser known.

Heefner’s research on Truscott led him to, among other things, his descendants. Truscott’s son, at one point told him “you know more about my father than I do!”. He was extremely cooperative and handed Heefner his father’s personal letters, including those from the front to his wife. These were intensely personal and uninhibited writings which the General never imagined would be seen by anyone but her. Heefner was impressed by the depth of Truscott’s love for his wife, and paternal sense of care for his troops that emerged from these letters. Heefner points out that one of the greatest difficulties facing a wartime General is how to balance appropriate care for the troops with rational, professional decisions to deploy them into deadly situations. In this regard Truscott was effective on both ends, to the degree that his name and reputation as a caring commander is still warmly recalled by contemporary soldiers who have inherited his army.

A famous episode related to Truscott’s Italian command which underscores his attitude towards his troops occurred in the war cemetery at

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Nettuno, outside Anzio, in Memorial Day 5/31/1945, when Truscott, addressing an audience for a speech, turned his back to them, and facing the crosses, quietly apologized to his troops. He then walked away. Heefner, who visited that very same cemetery indicates that every time he recounts this episode he gets teary eyed, and indeed his eyes welled as we discussed this incident.

When I asked him what project he was engaged in at present, Heefner told me that he was done with his research and writing. “Truscott exhausted me”, he remarked. But despite his age, he remains dynamic in pursuing other interests related to the subject.

Currently he is in the process of organizing a “Seventh Army Spearhead Tour” in September 2011, from the beaches of the French Riviera where Allied troops landed under Truscott’s command in Operations Anvil and Dragoon (what has come to be called “The Forgotten D-Day”), through the Rhone Valley, to Epinal where his Seventh Army achieved a momentous link-up with Patton’s Third Army fighting its way from Normandy. As a tour leader, he is soon headed to France for the purpose of reconnoitering the territory in advance of the trip, a proper military move.

Wilson Heefner seems at ease with his remarkable second career, about which he exhibits a deep fund of knowledge. He is also content with the two lives he has lived back-to-back, in pathology and history. He fully realizes that his accomplishment is extraordinary, and feels fortunate to have had the opportunity to bring a youthful dream into reality, something precious few physicians get to experience. He displays the same perfectionist, capable professionalism with a self-effacing attitude which was also the trademark of General Truscott. Indeed, this may be the source of his affinity and respect for the General on whom he has shined the spotlight of history.

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PHYSICIAN 43

Dear SJMS member, ving a national reas can boast of ha n a

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Re tic eu ap er ot Th the street from your the 20,000‐square‐fo l Office – and across ica ed M n h’s to ck ep to os t J r S in ou the S rs of our staff work the parking lot from ). About 60 membe ne La and Canada. ch .S. ar U M he on t t ce ou SJMS offi ead through pr e s ar st re he d t ing an headquarters build e in that it is 26 years. It is uniqu or n f to

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of these San Joaquin ns tio bu tri on e c th rk, and er’s Letter Thanks to Mike’s wo he unbiased Prescrib t t ge to le in SJMS. ab be w ill no part of membership as r, ea h y ac Joaquin physicians w s e dit lus over 25 CME cre recommendations, p

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n, CA 95219 March Ln, Stockto Center, 3120 W ch ar 49 se 22 Re 2. tic 47 Therapeu 40, FAX: 209.

TEL: 209.472.22 arch.com TherapeuticRese

SJMS Is Proud to Announce an Exclusive Benefit for Its Membership – Prescriber’s Letter Online, Mobile Access, and 25+ hours of CME...

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And now I am so pleased it is a reality. Not only that, but we were able to get our members the highest level of service Prescriber’s Letter offers – its VIP Member level. VIP stands for “Very Informed Prescriber” and that speaks volumes about the special nature of this member benefit. Other physicians throughout the nation pay $250 for this service, and it is now included in your SJMS membership, at no additional fee to you.

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You can access all of this on your computer, or mobile device of your choosing, including iPhones and Android phones.

We were also able to reserve every SJMS member a space on the monthly webinars where the Prescriber’s Letter Editorial Board deliberates and decides upon the Recommendations to be published. Plus, if your schedule does not allow you to listen to these sessions when they are offered live, you will have access to listen to the archived recorded sessions whenever you want.

Through this new arrangement with Prescriber’s Letter, your SJMS membership now includes more than 25 CME credits per year at no fee to you. You can get these CME credits from reading the Recommendations – from getting your clinical questions answered online at the Prescriber’s Letter website – and by participating in the live webinars or listening to the recorded webinars.

To begin taking advantage of this members-only benefit, visit our website at www.SJCMS.org and click on the Prescriber’s Letter logo located on our homepage, or you can just call our office (209-952-5299) and we’ll handle the entire subscription process for you.

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Mike Steenburgh Executive Director

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Thomas Vincent P.Streeter, Pennisi,M.D. M.D.

Harjit Sud, M

KeviDr. nRiE.neRine, M.D.

Denise Mor

Vijaya Sud, Bansal, M.D. Harjit M.D.

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Meena Shankar, M.D. Jennifer Phung, M.D.

Lynette Bird

Kevin E. Rine, M.D. Dr. Rine

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Stockton: 1617 N. California St., Ste. 2-A (209) 466-8546 • 435 E. Harding Way (209) 464-4796

Catherine Mathis, M.D.

2509 W. March Ln., Ste. 250 (209) 957-1000 • 10200 Trinity Parkway, Ste. 206 (209) 474-7800 Jasbir S. Gill, M.D.

Lodi: 999 S. Fairmont Ave., Ste. 225 &230 – Ph. (209) 334-4924 After all… each woman's needs are unique and you deserve special care!1234 E. North St., Ste. 102 – Ph. (209) 824-2202 Manteca:

INFERTILITY, INVITRO FERTILIZATION GYNECOLOGY Patricia A. Hatton, M.D ENDOMETRIOSIS URINARY INCONTINENCE PRENATAL & POSTPARTUM CARE HIGH RISK PREGNANCYOVARIAN CYSTIC DISORDER INFERTILITY, INVITRO FERTILIZATIONLAPAROSCOPY HYSTEROSCOPY Jennifer Phung, M.D. GYNECOLOGY DIAGNOSIS & TREATMENT OF CERVICAL, Vincent P. Pennisi, M.D. ENDOMETRIOSIS UTERINE & OVARIAN CANCERS URINARY INCONTINENCE

ourewebsi l obgyn.com We are proud to announce the opening of The Osteoporosis Detevictsioint Cent r using tsteatate ofwww. the argt iDEXA imaging. DEXA scanning is now recognized to be the most accurate predictor of fracture risk in women.

Darrell R. Burns, M.D.

Tonja Harris-Stansil, M.D

Stockton: 1617 N. California St., Ste. 2-A (209) 466-8546 • 435 E. Harding Way (209) 464-4796

Madhavi Ravipati, M.D. OVARIAN CYSTIC DISORDER LAPAROSCOPY HYSTEROSCOPY OSTEOPOROSIS DETECTION CENTER We are proud to announce the opening of The Osteoporosis Detection Center using state of the art DEXA DIAGNOSISimaging. & TREATMENT CERVICAL, DEXA scanningOF is now recognized to be the most accurate predictor ofM.Dfracture risk VickiinPattewomen. rson-Lambert, R.N.P.C. Mala Ashok, UTERINE & OVARIAN CANCERS

2509 W. March Ln., Ste. 250 (209) 957-1000 • 10200 Trinity Parkway, Ste. 206 (209) 474-7800

Lodi: 999 S. Fairmont Ave., Ste. 225 &230 – Ph. (209) 334-4924 Manteca: 1234 E. North St., Ste. 102 – Ph. (209) 824-2202

Stockton: 1617 N. California St., Ste. 2-A (209) 466-8546 • 435 E. Harding Way (209) 464-4796

2509 W. March Ln., Ste. 250 (209) 957-1000 • 10200 Trinity Parkway, Ste. 206 (209) 474-7800 Linda Bouchard, M.D.

Lodi: 999 S. Fairmont Ave., Ste. 225 &230 – Ph. (209) 334-4924 Manteca: 1234 E. North St., Ste. 102 – Ph. (209) 824-2202

visit Center our website atofwww.gillobgyn.com We are proud to announce the opening of The Osteoporosis Detection using state the art DEXA Jennifer Phung, M.D. imaging. DEXA scanning is now recognized to be the most accurate predictor of fracture risk in women.

Stockton: 1617 N. California St., Ste. 2-A (209) 466-8546 • 435 E. Harding Way (209) 464-4796

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2509 W. March Ln., Ste. 250 (209) 957-1000 • 10200 Trinity Parkway, Ste. 206 (209) 474-7800

Vicki Patterson-Lambert, R.N.P.C.

Lodi: 999 S. Fairmont Ave., Ste. 225 &230 – Ph. (209) 334-4924 Manteca: 1234 E. North St., Ste. 102 – Ph. (209) 824-2202 visit our website at www.gillobgyn.com

Lynette Bird, R.N., B.S.N. Lynette Bird, R.N., B.S.N.

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Denise Morgan, M.S.N. - N.P. Denise Morgan, M.S.N. - N.P.

WINTER 2010

Benefits < Membership

Unfair Payment Practice:

Timely filing denials Health plans usually impose claim filing deadlines, which require physicians to submit a claim within a certain time period after the date of service. If the physician fails to meet the deadline, the health plan will not pay for the service provided.

California law prohibits health plans and insurers from imposing claim filing deadlines that are less than 90 days for contracted physicians or 180 days for noncontracted physicians after the date of service. If the payor is not the primary payor under coordination of benefits (COB), the payor can­not impose a deadline for submitting a COB claim that is less than 90 days from the date of payment or date of denial from the primary payor.

Moreover, even if the physician fails to submit the claim on time, California law provides a “good cause” exception that requires payors to accept and adjudicate a claim if the physician demonstrates, upon appeal, “good cause” for the delay.

Below are steps you can take to prevent timely filing denials: • Submit claims as quickly as possible after services are rendered.

• Where possible, file claims electronically.

• Retain payor acknowledgement of receipt of claim. As discussed in the August 2010 issue of CPR, California law requires health plans to acknowledge receipt of an electronic claim within 2 days and a paper claim within 15 days of receipt.

• Appeal all claims that have been incorrectly denied for timely filing in writing.

Include a copy of the payor’s acknowledgment of receipt of the claim with your appeal.

• •Review health plan contracts to ensure that deadlines for filing claims are no less than 90 days.

• Report health plan violations of the timely filing laws to the appropriate regulator and to the California Medical Association.

• For a summary of California’s unfair payment practices, see Know Your Rights: Identify and Report Unfair Payment Practices.

Gena Welch Membership Coordinator (209) 952-5299 gena@sjcms.org

Briefly Noted Unfair Payment Practice: Timely filing denials Has your contracted health plan or IPA stopped paying claims?

Timeframes for timely claims submission

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

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Membership > Benefits TIP: As previously reported in the August 2010 issue of CMA’s CPR, an acknowledgement of receipt of a claim from a clearinghouse is not an acknowledgement that the claim has been transmitted to and received by the payor. Check with your clearinghouse to determine its process for tracking health plan receipt of claims.

CMA RESOURCES: CMA On-Call documents #0146, “Payment Denials

by Managed Care Plans and IPAs;” #1070, “Managed Care Contractual Protections;” and #1051, “Physician Complaints About Managed Care Plans;” Know Your Rights: Quick Guide for Appeals; Know Your Rights: Identify and Report Unfair Payment Practices.

Has your contracted health plan or IPA stopped paying claims?

The California Medical Association’s Center for Economic Services has recently received an increase in calls regarding physician concerns that a medical group/IPA with whom they contract is experiencing financial difficulties. One of the symptoms of an insolvent health plan, IPA, or other payor is the failure to pay claims in a timely manner. Another indication of financial distress is a payor that cuts checks within the statutory timeframes but does not release the checks in a timely manner.

If you are experiencing repeated payment delays you should investigate the financial health of the payor. To help physicians monitor the financial health of their contracted payors, CMA

Michael P. Hahn, MD

IntroducIng SpecI alIzIng I n or thopaedIc Surgery

dr. hahn has recently joined Alpine Orthopaedic Medical Group, Inc. his areas of special interest are: SpOrtS MedIcIne ShOulder & Knee SurGery dr. hahn is accepting new patients and is a provider of most health plans. to schedule an appointment, call (209) 946-7200.

Alpine Orthopaedic Medical Group, Inc.

has put together a Payor Solvency Checklist. This resource includes instructions on how to research and monitor the financial solvency of your contracted medical groups/IPAs and discusses options available to physicians in the event a payor stops paying claims.

CMA RESOURCES: CMA’s Payor Solvency Checklist; CMA On-Call documents #0223, “Risk-Bearing Medical Groups, Including IPAs: Regulation of Solvency,” #0131, “Insolvency of Health Plan, IPA or Other Entities that Contract with Health Plans(Pre-Bankruptcy or Closure),” #0106, “Bankruptcy of IPAs or Health Plans.”

Ask the Expert: Timeframes for timely claims submission QUESTION: My current contract with a health plan requires that I submit claims within 30 days of provid­ing the service and that failure to do so will result in my claim being denied. Can they do this?

ANSWER: No. California law prohibits health plans and their contracting medical groups/ IPAs from imposing a deadline for submission of a claim that is less than 90 days for contracting physicians. Contract provisions that require a shorter timeline to submit claims are prohibited.

You should contact the plan and request that your contract be modified to be compliant with California law. If the plan refuses, notify the California Medical Association and file a formal complaint with the appropriate regulator.

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WINTER 2010

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Community > Dameron Hospital

Dameron Hospital Introduces

By Bobbie Wallinger

New Electrophysiology Department

State-Of-The-Art Technology Will provide greater services to our community

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WINTER 2010

Dameron Hospital has introduced the latest in high tech equipment with the addition to the new Electrophysiology Department, under the management of Dr. Walter Chien, a Cardiologist who serves as the Director of the new Electrophysiology Department at the hospital.

The new equipment provides high-definition electrograms, the purpose of which is to provide more accurate arrhythmia diagnosis for patients whose lifestyle is dramatically hampered by the condition.

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Dr. Chris Arismendi, Medical Director of Dameron Hospital, is thrilled with the many new innovations the hospital is embracing and takes great satisfaction in having the latest technology available at Dameron Hospital.

Dr. Arismendi stated, “Dameron hospital is looking forward to working with Dr. Chien and St. Jude Medical to fulfill its mission of supporting physicians in providing quality patient care.”

At an introductory preview held at Dameron Hospital

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Community > Dameron Hospital in October, 2010, Dr. Chien, who referred to himself as, “An electrician of the heart”. A power point presentation before more than forty physicians and medical staff explained the benefits and features of the St. Jude Medical version Four Recording System with Clear Wave Signal Acquisition.

The process, created in 1992, is the most accurate diagnostic tool available and puts Dameron Hospital at the forefront of today’s atrial fibrillation and cardiac

arrhythmia care.

Dr. Chien, who trained in this new and innovative procedure at Stanford Medical Center in Palo Alto, California, is in the process of training physicians and medical support staff in the use and advantages of the EP-WorkMate TM Recording System.

Working closely with staff members from St. Jude Medical personnel, Dr. Chien, supervised a demonstration provided by Howard Shellaberger, David Vazquez and Jeremy Kosel of St. Judes, at which Medical staff from Dameron and guests from St. Joseph’s hospital were able to participate in a hands-on experience using a lamb’s heart. This additional training session held in November, 2010, enabled staff to see exactly how the ablation process works as a catheter enters the heart and burns rather than cuts around the affected area.

Dr. Chien stated, “One of the most important outcomes of this method is the improvement in the quality of life for our patients caring support using a safe, method of guidance correction by creating a well choices defined lesion which is easily controlled with no adverse result.”

Dr. Otashe Golden, Chief Hospitalist at Dameron, describing her impression of the power-point presentation

by Dr. Chien stated, “I thought it was fantastic. This is something patients in our community definitely need”.

She continued, “Patients would have had to be sent out of the area and now this treatment is available in our community”.

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(209) 957-3888

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WINTER 2010

SAN JOAQUIN MEDICAL SOCIETY

SPONSORS PREMIER

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$20 per person for Physician members (2 drink tickets included) $35 per person for non-members and invited guests (2 drink tickets included) Enjoy an evening of Served Hors d’oeuvres, Carved Baron of Beef, Various Gourmet Stations, and a wide array of Decadent Desserts to complete the evening

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WINTER 2010

Special Entertainment:

Dance to the Big Band sound of The Monday Night Band featuring Patrick Langham (20 member swing band) playing and singing the greatest sounds of the 30’s and 40’s and your favorite Holiday classics For more information please call the medical society office at (209) 952-5299 SAN JOAQUIN PHYSICIAN 55

MeDICAL SOCIeTY > Membership

4 NEW

MEMBERS IN THE PAST 60 DAYS!

...and even more on the way.

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Alpine Orthopaedic Medical Group, Inc. 2488 N California Street Stockton, CA 95204 Office: (209) 948-3333 University of California School of Medical - S.F.: 2003 Saira Khan, MD Family Medicine Sutter Gould Medical Foundation 2151 W Grant Line Road

Tracy, CA 95377 Office: (209) 832-0535 Khyber Medical College: 2002 Marie Schafle, MD Emergency Medicine 1270 Suzanne Dr. Suite A Angels Camp, CA 95222 Office: (209) 736-0100 University of California Irvine: 1974

Stockton Golf & Country Club tradition • private setting • heritage 3800 W. country club blvd • stockton, ca

Call for special membership pricing (209) 466-4313

State of the art fitness center

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Swimming Pool and Clubhouse

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WINTER 2010

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MeDICAL SOCIeTY > Membership

Six-Day Medical Mission Changes the Lives of Twenty Children In Honduras Drs. Peter Salamon and Gary Murata credit one another with putting together a recent medical mission to Honduras and clearly the two worked hand-in-glove in putting together a team. >>

By Bobbie Wallinger

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WINTER 2010

“Who could say no?” was the collective statement of the three medical professionals who joined Salamon and Murata on a life-changing medical mission to San Pedro Sula, Honduras this past Labor Day weekend.

While millions of American’s spent Labor Day weekend enjoying an end-of-summer day at the beach or just relaxing at home with family, Drs. Peter Salamon, Gary Murata, and Phillip Ruhl along with Rhul’s wife Marjo, (an RN) and Roberta (Bert) Gonzales, an OR tech, chose to begin a twenty-nine hour sojourn to Honduras.

And while not a vacation, in the common definition of the word, it was an opportunity for the team of five to travel over six thousand miles to spend one week on a medical mission to CURE’s hospital in San Pedro Sula where they were able to provide much needed surgery to twenty orthopedically challenged youngsters from age one-year to seventeenyears.

QUESTION:

Who came up with the idea for the trip?

According to Doctors Salamon and Murata, it was a natural follow-up to previous medical missions each had engaged in over the last few years and together gathered a group of dedicated medical professionals who could provide surgical care for children at CURE’s hospital in the Honduras.

QUESTION:

Just what is CURE? CURE is a non-profit organization created by Dr. Scott Harrison, a retired orthopedic surgeon, in conjunction with the Pediatric Orthopedic Society of North America.

A Christian based organization, CURE International established its first hospital in Kenya in 1998 and with the support of individual donors and corporate sponsors was able to provide ten CURE hospitals on two continents by 2008.

QUESTION:

Who was responsible for the building of San Pedro Sula Hospital ?

Dr. Murata, who has made five medical mission trips to the Honduras since 2003, enthusiastically shared the story of Dr. “Ned” Schewenkier, a pediatric orthopedist from Hershey, Pennsylvania who with his wife, moved to the Honduras to put together the project that resulted in the viability of building and maintaining the well-equipped facility.

The twenty-bed hospital, under the supervision of the

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medical society > Membership

Honduran Medical Director, Dr. Gustavo Vasquez, has two fully equipped operating rooms, and runs a five-day week clinic for purpose of evaluation and follow-up care, as well as providing

medical training for students.

QUESTION:

So, how does the American Team fit in?

We work with the Honduran staff, sharing U.S. technique and learning from them as well. The hospital’s administrator, Ruth Castro is, “the mechanic that keeps everything running”, according to Salamon and Murata. “She is a brilliant woman and if you need anything done, she’s the one that can make it happen.”

Question: How did the Honduran staff

react to the missionary team?

Gary Murata: “In the beginning, when the hospital was in its fledgling stage, there was some concern on the part of Honduran doctors that the facility would, in some way, be competition to the “Medical College” which is a kind of physicians union in Honduras. But as negotiations progressed the understanding between the CURE organization and established Honduran physicians mellowed and now there is a positive working relationship with all concerned.”

Question:

How did you maneuver the language barrier or do you all speak Spanish?

(This question was met with laughter by all team members)

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The answer is none of our team speaks Spanish but it was never a problem. In the operating room you work hand-in-hand with our Honduran scrub nurses and techs all speak excellent English.

As surgeons, the “tools of the trade” are easily identified and quite honestly we had no problems in making our needs known.

Question:

Where did you stay during your mission?

The hospital which is a fully running facility has an apartment located on the second floor of the building. We were housed in a male dorm and a female dorm and since the Ruhl’s are married they were given one of the two available mini-suites. The apartment was very comfortable with all the comforts of home including computer access and cable TV. The best part of the facility was the meals provided by the hospital chef, Gina.

QUESTION:

You stated the hospital was fully equipped but who pays for all this?

The hospital costs are completely covered by CURE. We, of course, paid our own transportation costs and also paid a fee to cover the expense of our housing and meals.

CURE pays all the staff at the hospital and believe us, it is fully staffed.

A medical director, hospital administrator, nurses, techs, housekeepers, a cook and helpers, physicians, anesthesiologist, social workers, clerks and, of course, the guards.

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QUESTION:

The guards?

Yes, the hospital is built in one of the poorest and perhaps, most dangerous locations in San Pedro Sula. Therefore, like many, many places in the Honduras the grounds are surrounded by barbed wire and the hospital engages the services of two fully armed guards, twenty-four seven to insure the safety of both patients and staff.

QUESTION: Were you ever concerned for your safety?

Not at all. We were cautioned however, not to walk the streets in the area at night…so we didn’t. And the reality is Honduras, like many third-world countries, is extremely poor and stolen merchandise, regardless of what it is, can be easily sold on the black market so safety and protection are simply a part of the culture.

QUESTION: Isn’t it very expensive to provide all the services you have described?

Again, we need to examine the economy of the Honduras and appreciate the fact the average operation costs only $1,000 dollars, U.S. compared to at least ten times that amount here at home. Patients are encouraged to engage in ownership in their care so nominal amounts are charged if the patient is able to afford some contribution to the hospital.

However, CURE covers all costs necessary for medical care.

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fifth trip on a medical mission to the Honduras why do you keep going back?

“I feel the need… no, the responsibility, to “give back”. CURE, as we have stated is a Christian based organization and I feel blessed to be able to offer my services in this way.”

Peter Salamon, Jewish by faith, has no problem with the morning devotional which is held every day at 7:00 A.M. at the hospital. Led by either the spiritual advisor, Senor Castro, or one of the medical personnel, songs are sung, a prayer is given, and all families, staff, and patients are invited to participate in the fifteen minute informal service.

QUESTION:

What was the most gratifying aspect of the trip?

Dr. Salamon responded by sharing his personal insight.

“The bonding that takes place among our colleagues and the Hondurans left us all feeling like family. And the opportunity to teach as well as learn from one another is unbelievable. We evaluated more than forty children at the clinic and operated on twenty youngsters with problems ranging from birth abnormalities, neglected trauma to residuals of infection. Referred to as the,

WINTER 2010

“Brigade” by our Honduran friends, we were able to correct some very serious problems while having the opportunity to learn and engage with another culture. Healing and education are my passions and here we have both.”

QUESTION:

Dr. Ruhl, what was the most gratifying part of the project?

“Definitely my strongest feelings came regarding the trust. It was an honor to have the trust of the parents that we were there to help and care for their children. It was a tremendous leap of faith for these families to allow strangers to perform such intricate procedures on their children.”

QUESTION:

What was the most challenging issue you faced?

“The hardest part for me was the stifling heat. While the buildings were air conditioned, outside was really hot, roughly 90 degrees with 90% humidity.

But aside from that I want to promise anyone in the medical field that if they embark on such a trip, there will never be a day in their life that they will regret doing it.”

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Nurses Marjo Ruhl and Roberta Gonzales who rounded out the team each provided and interesting perspective to the project when asked what was the most surprising as well as rewarding aspect of the trip?

Roberta came back with a new perspective about home. “If every American was to visit a third world country I am sure they would realize three things: They would be more frugal with their money. It is amazing how little one really “needs” versus “wants” in order to be content.

They would realize just how fortunate we are to live in the United States of America.

3. Love and family is more important than the materials things we have learned to feel are so important.”

QUESTION:

Would you want to return in the future?

Marjo Ruhl “IN A HEARTBEAT!” She continued, “A medical mission has been on my “bucket list” for years, but children and other family members needs required it be put on hold.

It was my dream especially since I was able to share the experience with my husband.”

All the team shared their wonder at the patience of the families who would wait all day, without complaint in order to have their children seen at the clinic. Also, according to Dr. Ruhl, the difference in the expectation of the parents. “They knew the children would experience post surgical pain, but that it was going to provide their child with a better life. In most cases the easement of the physical disability would open opportunities for the child to live a normal life.”

QUESTION:

Are there any plans for future trips?

“We are already in the planning process”, said Murata and Salamon who responded with enthusiasm when they spoke of the fact the entire team, Dr. Ruhl, Marjo Ruhl, R.N., and Roberta Gonzales all have indicated their desire to continue serving as a medical missionary team and all encouraged support for CURE. For further information regarding the medical mission go on line at CURE.org

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IN MEMORIAM > Dr. Dale Stoops

In Memoriam

Dr. Dale Stoops

January 26, 1928-October 7, 2010

Dale Stoops, physician, medical missionary, administrator, husband, father, and grandfather, passed away October 7, 2010 in Manteca, California at the age of 82 years.

Born, January 26, 1928, in Indiana, Dr. Stoop was a resident of San Joaquin County where he operated his medical practice in Manteca, California for more than 44 years.

Dr. Stoops was only 22-years old when he entered the United States Air Force, serving from 1950-1954. After completing his military obligation, his dream of becoming a physician began.

First attending University of California Irvine College of Medicine, he graduated in 1962. The next phase of his career was completing his residency at San Joaquin General Hospital with a specialty in General Surgery.

It was then he and his wife, Marjorie settled in Manteca where they raised children, Robert M. Stoops of Manteca, Linda K. Lutes of Angwin and Sharon A. Thigpen of Pope Valley. Dale was preceded in death by his son Robert A.

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Stoops as well as his parents, Earl and Dora Stoops.

Joining the San Joaquin Medical Society in June, 1968, he served on Foundation for Medical Care Board of Trustees including participating on various committees including Insurance Mediation, Medical Practices, Medical Legal, Medical Problems, Public Service and Member Services.

A General Surgeon, his passion for helping others extended far beyond his practice in Manteca, as he traveled the world providing medical mission care in Africa, Hong Kong, and Malaysia. Energized by his faith and his commitment to healing no distance was too long for this dedicated physician to assist, inspire, and heal those who were in need until his retirement in 1996.

He was also recognized for his commitment to his community, serving as Chief of Staff at Doctor’s Hospital of Manteca and serving on the Board of Directors at St. Joseph’s Medical Center.

In addition to his providing support to the medical community, Dr. Stoops was an energetic and thoughtful presence on the School Board for Manteca Unified School District.

A member of Seventh Day Adventist Church in Ceres and Manteca, he extended his energy to serving on the board of Directors at his home church as

well as being an active participant in the Manteca Kiwanis’s.

Dr. Stoops was acknowledged by his patients and colleagues alike as a, “great listener”, always taking time to hear the concerns of those around him. His desire to “heal” extended far beyond his surgical expertise by listening to the concerns of his patients and his patient’s families, appreciating the need to offer support to all involved. Perhaps that was a carry over to his devotion to his own family who brought him so much satisfaction.

One of his greatest joys was traveling the world with his wife, Marjorie, as well as his children and grandchildren.

A humble man, he will always be remembered as one who would give assistance to anyone in need with no expectation of anything in return.

In addition to his loving wife of sixty years, Marjorie and children, Robert, Linda, and Sharon, he is survived by his seven grandchildren: Gina Bermejo, Jennifer Hollingsworth, Sara Thigpen, Stephen Lutes, Scot Thigpen, Cedric Lutes, Gilbert Lutes and eight greatgrandchildren.

Donations in his memory may be sent to Doctor’s Hospital of Manteca Memorial

Fund.

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This no fee seminar for licensed professionals includes:

san JoaQUin CoUnTY DiaBeTes soCieTY soUTH sToCKTon DiaBeTes soCieTY san JoaQUin CoUnTY meDiCaL soCieTY

present

The 10th Annual Stockton Diabetes Seminar

• Free continental breakfast and lunch • Networking opportunities with healthcare providers engaged in innovative diabetes care • Updates on recent and important advances in diabetes care

In lieu of a conference fee, all attendees must bring a new book for a child up to 5 years of age.

The books will be donated to the children book section of the city of Stockton Library System.

“Reach Out and Read” is a program that builds on the special relationship between doctors and parents of young children to support children’s language and literacy development.

Your gift will be very much appreciated.

FosterIng excellence In the PrImary care oF

Diabetes saturday,

December 11, 2010

9:00am to 3:00pm

DEROSA UNIVERSITY CENTER, UNIVERSITY OF THE PACIFIC, STOCKTON To Register please call the San Joaquin Medical Society at 209.952.5299 or register online at www.SJCMS.org

toPIcs to be discussed at the seminar include:

• HEALTH LITERACY AND DIABETES CARE • MATCHING PATHOPHYSIOLOGY TO

PHARMACOTHERAPY • HISTORY OF DIABETES CARE – A JOURNEY THROUGH THE AGES • BILLING AND CODING FOR DIABETES SERVICES IN PRIMARY CARE • OPTIMIZING CONTROL – INSULIN USE IN TYPE 2 DIABETES • OPTIMIZING CONTROL – INCRETIN MIMETICS IN TYPE 2 DIABETES • OPTIMIZING CONTROL – MOTIVATIONAL INTERVIEWING IN THE PRIMARY CARE OF DIABETES • GASTRIC BYPASS SURGERY – IMPACT ON TYPE 2 DIABETES • WHAT DO PATIENTS WITH DIABETES WANT FROM PRIMARY CARE PHYSICIANS? – INTERACTIVE SESSION

sPeaKers

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• DEAN SCHILLINGER, MD • JEFF UNGER, MD • PATRICK COATS, MD • REINHARD BEEL,CEC, CDT • GEORGE CHAO, MD • WILLIAM POLONSKY, PhD, CDE • KWABENA ADUBOFOUR, SANMD JOAQUIN PHYSICIAN 65

IN MEMORIAM > Dr. Dale Stoops

IN MEMORIAM

Dr. William Brock May, 1913 –November 2010

By Bobbie Wallinger

It is with deep sadness physicians and former patients alike learned of the death of William Brock, MD, longtime Stockton resident, at his daughter Susan’s home in Caledonia, Illinois.

Born in Berkeley, California on May 18, 1913, Dr. Brock attended the University of California, San Francisco from 1931-1939 earning his undergraduate degree and his M.D. He graduated first in his medical school class and served in the Army Medical Corps in the Philippines during World War II. In addition to being a life-long member of the San Joaquin Medical Society and serving as its President in 1961, Dr. Brock was a member of the Pacific Coast Surgical Society, the Mount

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Reid Surgical Society, served as a founding board member of the Foundation for Medical Care and served on the Board of Governors for the American College of Surgeons.

In 1984 Dr. Brock was honored at an ACS meeting held in San Francisco in which 25 of his former 37 chief residents presented him a plaque with his likeness that now hangs in the medical library at San Joaquin General Hospital where he served for 44 years as the director of surgery.

According to local physician and former partner, Dr. Rick Rawson, “…After a short Fellowship in Cincinnati, Bill started his surgery practice in Stockton and was a great technical surgeon, but I think his

greatest gift was his ability to sift through information. He could assemble information about a patient and discard what was unimportant and keep that which was. He always seemed to arrive at the correct diagnosis. It was more difficult in his era because of the lack of sophisticated imaging….he had great judgment, knowing how far he could push a sick patient. He knew when to temporize with surgery. He also knew when to NOT operate. In most meetings, Bill would sit back and not say much until the end. When he spoke, that was usually the last word.”

The respect he received from fellow physicians is defined in the words of Dr. Peter Tuxen, MD, who considered

WINTER 2010

Brock as his mentor, greatest teacher and friend. On reflection, Tuxen stated, “There are, in surgery, many decisions to be made; what is best for the patient and what may be the best procedure.

When I am faced with a difficult choice I ask myself, ‘what would Dr. Brock do?” and after careful deliberation, I know what he most probably would do and I follow his example of choosing the safe and smart thing that will result in the best possible outcome”.

Dr. Tuxen and Dr. Rawson share the highest level of admiration for Dr. Brock and the tremendous work he accomplished here in the central valley and the enormous impact he had on so many surgeons who studied under him. Rawson states, “In addition to the usual surgical procedures, Bill did many complex procedures.

He operated on tracheoesophageal fistulas, Hirschsprung’s disease and gastroischesis. He did the first pancreaticoduodenectomy at St. Joseph’s Hospital.”

Both Tuxen and Rawson praised the immeasurable impact Brock had on the community and spoke of the fact Brock was “loved and respected by all his chief residents”. Rawson summed it up by stating, “His shadow loomed large over this community. He was an uncommon man. He was a doctor’s doctor. He was Mentor and a friend. He will be missed. Most of all, we were blessed to have him.”

SPRING 2010

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H E A LT H C A R E H A P P E N I N G S

Second Annual

Golf Tournament

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WINTER 2010

H E A LT H C A R E H A P P E N I N G S

Top left and right photos: The weather was perfect and the community responded to Sutter Gouldâ&#x20AC;&#x2122;s 4th Annual Community Health & Safety Fair which was held on September 18th. Activities included multiple seminars and health screenings, a blood drive with Delta Blood Bank, lots of fun activities for children and a Organic Cooking Demonstration featuring top chefs of San Joaquin County.

Center left and right photos: The annual Community Health Forum was once again well attended and featured UCSF Director of the Center for the Health Professions, Dr. Edward Oâ&#x20AC;&#x2122;Neil who gave spoke on the Changing Health Care Environment and its Implications in the Central Valley.

Bottom left photo: Drs. Ramin Manshadi, Jim Scillian (seated), Jim Halderman, Patricia Hatton, Lawrence Frank, Roland Hart, Peter Oliver and Randy Smart represented SJMS as our delegation at the 2010 House of Delegates in Sacramento on October 1-4, 2010.

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HEALTHCARE HAPPENINGS is now a regular feature in San Joaquin Physician Magazine and requests your photo submissions for publication consideration. All photos must be submitted as JPG files electronically and contain appropriate captions.

Email your submissions to submissions@sjcms.org

SAN JOAQUIN PHYSICIAN

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WINTER 2010

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

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