3SEPTEMBER 2013 Volume 40 Number 9

EDITORIAL & PUBLICATIONS COMMITTEE

Emily Dalton, M.D. George Ingraham, M.D.

Stephen Kamelgarn, M.D. “Guru”Leo Leer, M.D.

Scott Sattler, M.D.Erik Weibel, M.D. - Webmaster

EXECUTIVE DIRECTORPenny E. Figas

CONSORTIUM COORDINATORTerri Taylor

EXECUTIVE BOARDSandy Wilcox, M.D. President

John Mastroni, M.D. President-elect

John Nelson. secretary/treasurer

Mark Ellis, M.D. Past President

Timothy Dalsaso, M.D. director

Daniel Krauchuk, D.O. director

Courtney Ladika, M.D. director

David Ploss, M.D. director

Wesley Root, M.D., director

Donald Baird, M.D. Public HealtH officer

Warren Rehwaldt, M.D., Public HealtH officer

Norman Bensky, M.D. eastern district

Mark H. Davis, M.D. nortHern district

William Carlson, M.D. cMa delegate

Timothy Dalsaso, M.D. cMa delegate

Mark Ellis, M.D. cMa delegate

Corinne Frugoni, M.D. cMa alt. dele.Courtney Ladika, M.D. cMa alt. dele

George Jutila, M.D. solo & sMall grP foruM

Stephanie Dittmer, M.D. ssgPf Mark Davis, M.D. cMa dist. X trustee

Gregory Barkdull, M.D., Y.P.S.Courtney Ladika, M.D., Y.P.S.

North Coast Physician

North Coast Physician is published monthly by the Humboldt-Del Norte County Medical Society, 3100 Edgewood Road, P.O. Box 6457, Eureka, CA 95502. Telephone: (707) 442-2367; FAX: (707) 442-8134; E-Mail: hdncms@sbcglobal.net Web page: www.hdncms.org

North Coast Physician does not assume responsiblility for author’s statements or opinions; opinions expressed are not necessarily those of North Coast Physician or the Humboldt- Del Norte County Medical Society.

Cover Photo “Elk Tribe (2) 2013” Robert Soper, M.D.

In This Issue:

The Editorial and Publications Committee encourages ourmember’s comments for publication.

Please submit electronically prior to the 15th of the month preceding publication.

In My Opinion, Emily Dalton, M.D............................................................... 4

“Adoption”

Report from CMA Trustees, Drs. Bretan and Davis ................................ 5

OPEN FORUM

“What I Have Decided, What I Have Learned....”; Hal Grotke, M.D. 6

“Update Future of Sutter Coast Hospital”; Greg Duncan, M.D. .. 7

“Power of Belief, Part II”; Robert Moore, M.D. ................................... 8

MICRA: Protecting Community Clinics & Health Centers .................. 9

CMA Awarded Health Insurance Exchange Outreach Grant ............ 9

New President/CEO - St. Joseph/Redwood Memorial ........................ 10

PUBLIC HEALTH UPDATE; Donald I. Baird, M.D. ..................................... 12

“Report on Tuberculosis in CA Available”

“Protect Vulnerable Infants From Pertussis”

HDN Tattler / Coming, Going & Moving Around ................................... 14

NORCAL Risk Management Seminars ....................................................... 15

Welcome Medical Students .......................................................................... 16

Blood Bank News: AABB Audioconference Series ............................... 19

Blue Shield Automatically Opts Some Practices into Exchange ...... 20

CMA Webinar Calendar .................................................................................. 24

NORCAL CME Opportunities ........................................................................ 25

IMQ LAUNCHES ONE-STOP ONLINE CME PLATFORM ......................... 25

CME Educational Calendar ............................................................................ 26

Classified Ads ..................................................................................................... 27

4 North Coast Physician

In My OpInIOn

§

ADOPTIONEmily Dalton, m.D.

Mark Your Calendars:SEPTEMBER 6, 2013 6:00 - 8:00 P.M. Friday Beer Rounds - Madaket Cruise

SEPTEMBER 11, 2013 12:00 - 2:00 P.M. Spouse Coffee

SEPTEMBER 26, 2013 1 - 3 P.M. NORCAL RISK MANAGEMENT “OfficeManagerRoundtable”

6-8P.M. “BehaviorsThatUndermineACultureofSafety”(Physicians) SEPTEMBER28,2013 11-1P.M. WomenInMedicineSocial

NOVEMBER2,2013 6-8P.M. PhysicianSocial/TalentShow,Ingomar

Duringanofficevisitamothershowedmeaphotoofadarkskinnedgirlwithpearlywhiteteethuncoveredbyanimpishsmile.Thiswas the4yearold theywouldsoonbeadopting. TheroomwasfullofeageranticipationandIwasluckyenoughtobecaughtupinthejoyofthetheexpansionoftheirfamily. Iwasninewhenmyparentsadoptedfour-year-oldDavidintoourfamily,andIdoubt they thoughtmuch about how thatdecisionwould impactusnow, 44yearslater.Theyprobablyconsideredissueslikewhethertheycouldaffordhistuitionatthealternativeschoolweattended,orwhetherthethreeofuskidswouldallgetalong. In1968itwasaradicaldecisionforawhitefamilytoadoptablackchild.Myfather,whosefamilywerefromtheSouth,wasdisinheritedoverit.Courageously,hestoodfirmforthevaluesofunityandraceequality in this public andpersonalway,lovingDavidmuchmorethanwhateverhadbeenallocatedtohiminhisfather’swill. Wewere soft kids,mybrother andI, gentle and sheltered from the types ofstormsDavidmusthavegonethrough.He

arrivedwith his playful nature, boastingabouthowtoughhecouldbe.Weusedtolaughhisbravado--howhe,asmallchild,thoughthecouldphysicallyoverpoweranyintruder.Hewould,hesaid,kickthemandpunchthemandtiethemup!Wegiggled. When,inevitably,heandmybrotherfought, David used his uncut nails toscratch.Asmyfatherintervenedhisheartshrankfrombigtosmallandstandingoverthepale,bleedingboyheshoutedatDavid“HowdareyouhurtMYson!”Istoodback,knowinghowwrongthosewordswere,andhowhurtful.IknewinmybonesthatDavidwasjustasmuchmybrotherasthebrotherIgrewupwith,andthatonefightwouldneverchangethat.Hewasfamilynow,andthatwasthat. As a sibling triowe never lost theopportunitytoganguponeachother.SisandDavidagainstBobby,orSisandBobbyagainstDavid,andworstofall...bothbroth-ers against big sister. They tauntedmemercilessly,yetsomehowmanagedtostayjustoutofreachofmywildlyswingingfistsuntilallIcoulddowassqueezeouttearsofpureanger.Brothers! Whentheboyswere10and11they

spent an entire year doing nothing butswearingandspitting.Iwasthere,Isawit;Ilivedit.Iftheyweren’tcussing,theywerespitting.Iftheyweren’tspitting,theywerecussing.Occasionallyafirewouldbesetinbetweenthetwoactivities,butsoonitwasbacktohockingloogiesandfoullanguage.They seemed to havebecome alien crea-tures,andIworriedtheywouldneverrejointhehumanrace.Buteventuallythatphasepassed,andweallbecamebetterfriends.And as the years passed, our friendships blossomedevenmore. Todaymy brotherDavid and I areclose.Ifeelsoblessedtohavehiminmylife.Wevacationtogether,talkonthephoneandexchangeemailsregularly.Becauseofadoption, I have a great friend. Becauseofadoption,Ihave2beautifulniecesandanephew.Becauseofadoption,Ihaveanallywhenitcomestodealingwithageingparents. Becauseof adoption, I have thegreatestbrotheranyonecouldeveraskfor.Thankyou,adoption! Ifyouarethinkingaboutadopting,goforit!Thisisnotonlyagiftthatyougivetoapreciouschild,butalsogifttoallofyourfamily,past,presentandfuture.

5SEPTEMBER 2013

REpoRt fRom thE Cma boaRD of tRustEEs

DR. pEtER bREtan DR. maRk Davis

TheJuly26meetingoftheCMAboardoftrusteesfocusedonMICRA,governanceissuesandtheCMAstrategicplan.

MICRA.California’strialattorneysmadegoodontheirMaythreattoaskvoterstorepealCalifornia’s landmarkMedical In-juryCompensationReformAct(MICRA)by submitting language to theCaliforniaAttorneyGeneral,thefirststepinplacinganinitiativeontheballot.Theinitiative’smainprovisionwouldincreasethecaponspeculative, “non-economic” damagesfrom the current $250,000 tomore than$1.2million,withautomaticincreasesev-eryyear.Theinitiativewouldalsorequiredrugandalcoholtestingforallphysiciansonhospitalmedicalstaffs. Themeasure is nothingmore thanaself-servingattemptby trial lawyers togeneratemore in legal fees.CMAand acoalition of doctors, hospitals, insurancecompanies, nurses, community clinics,local governments, labor unions, police,emergency responders, employer groupsandotherswillwageasignificantcampaigntoexposethelawyers’self-servingagendaand defeat the measure. Iftheinitiativeissuccessful,itwillcausemalpracticeratestoskyrocket,forcetheclosureofsafetynetclinicsandrecre-ate the same conditions that threatenedto throwCalifornia’s healthcare systemintocrisisduringtheearly1970s.Imaginereceivingnoticethatyourmedicalmalprac-ticepremiumswillincrease250%oreven400%.That’swhatoccurredin1974and1975,leadingtoacrisisofunprecedentedproportionsthatforcedproviderstoclose

theirdoors,leaveCaliforniaorchoosetogowithoutcoverage.FailuretodefendMICRAwilldestroymedicalpractices,resultinginirreparabledamageandimpedingaccesstocareinCalifornia. CMAestimatesthatitwillneed$40-60million todefendMICRA.During themeeting,trusteeswereaskedtocontribute$2,000each;bytheend,morethan$60,000hadbeencontributed.[Editor’snote:CMAhasraisedmorethan$28milliontodate.]The board also authorizedCMA to loantheMICRAEducationFund$5milliontodefend the measure. Governance.YourdistrictXtrusteesexpressed our concern that the relevanceoftheCMAHouseofDelegatesnotbeun-dermined,andthattheHODshouldremainthepolicymakingbodyofCMA.WealsonotedthatitwouldbeareasonableideatoreplacereferencecommitteeswithincreasedactivityinCMAcouncilsandcommittees;that the business of theHOD should notbepredeterminedbya few; thatpreviousdebate of resolutions is paramount.Aftermuchdiscussion,theboardpassedaseriesofgovernancerecommendations.Themainpointsaresummarizedbelow.

•Beginningin2016,theHODwouldannually establish broad policy on threetofiveissuesdeterminedbythespeakers,subject to the advice and consent of theboardoftrusteestobethemostimportantissuesaffectingmembers, theAssociationandthepracticeofmedicine.TheboardoftrusteeswoulddetailandimplementHouse-adoptedpolicyontheseissuesandwouldassume responsibility for policy-makingonall othermatters.Theboardwouldbe

delegatedauthoritycurrentlyvestedintheHousefor internaladministrativematters,suchascomponentsocietychartersandcon-firmationofelectionsandappointments.

•To enablemore extensive and fo-cusedexpertisetobebroughttobearinlessrusheddeliberationsandtopromoteconti-nuityandcoherenceinCMApolicymaking,the issues determined as most important and designated forHouseofDelegates actionwouldbereferredtostandingCMAcouncilsandcommittees,whichwouldreplaceandserveasreferencecommitteesoftheHouseforpurposesofstudyingtheassignedissues,receivingtestimony,andpreparingreportswithrecommendationsforHouseaction.

•Standing councils and committeeswouldbeexpandedand/orrestructuredasappropriate and as needed to equip them for their greater role as drivers ofCMApolicy-making.Inadditiontoconsiderationof individualqualifications, effortswouldcontinuetoachievereasonablebalanceinthe geographic, specialty andmode-of-practicerepresentationofCMAmembershipincouncilandcommitteeappointments.

•Reportsandrecommendationsofthecouncil and committees serving as refer-encecommitteeswouldbemadeavailableatadateearlyenoughtoallowdelegationcaucusmeetingstooccurpriortotheannualsession, enabling floor action on recom-mendationstocommenceimmediatelyupontheconveningoftheHODandsavingCMA

“Trustees”, Continued on Pg. 23

23SEPTEMBER 2013

“Trustees”, Cont. from Pg. 5

andcomponentmedicalsocietiessubstantialcoststheywouldotherwiseincur.

•Theannual sessionwouldbecomeatwo-daymeetingconsistingof:(1)actiononcouncilandcommitteereportsaddress-ingthethreetofiveissuesspecifiedbythespeakers;(2)actiononanymatterstheboardoftrusteesmayrefertotheHouse;(3)elec-tions of officers; (4) educational sessionsonkeyissues;and(5)ceremonialfunctionsthatwouldbescheduledduringaneveningdinneropentoallCMAmembers.

•TheabilityofindividualmemberstointroducebusinessoftheAssociationwouldbepreservedbyenhancingtheexistingyear-roundresolutionprocess,wherebyresolu-tionsreceivedwouldbereferredtostandingcouncils and committees for purposes ofstudy,receiptoftestimonyandpreparationofreportswithrecommendationsforactionbytheboardoftrustees.

•Astransitionalstepstowardatwo-day annual session,HOD reference com-mitteeswouldbeginfunctioningasentirely“virtual”referencecommittees,beginningwithonecommitteein2013,twoormoreatthe2014annualsession,andallcommit-teesby2015.Testimonywouldbereceivedonline,andreportswithrecommendedac-tionswouldbedistributednolaterthantheopeningsessionoftheHOD.

•Thattheboardoftrusteesdirectthatastudybeundertakeninconsultationwithcomponentmedical societies toexploreapossibleredrawingoftheCMAgeographicdistrict boundaries, in order to reflect thegrowth and redistribution ofCalifornia’sphysician population and provide greaterrepresentationalequityamongcomponentsocietiesanddistricts.

Theimplicationsoftheserecommen-

dationsaresignificantforDistrictX.Pleaseletyourtrusteesknowyourviewssotheycanshare themwith theboardof trusteespriortothenextHOD,scheduledforOct.11-13.

StrategicPlan.TheCMAExecutiveCommitteehasidentifiedfivedistinctgoalsonwhichCMAshouldconcentrate itsef-forts: (1) growmembership by 5%; (2)commitmenttopublichealth;(3)prosperityforallphysicians;(4)defendMICRA;(5)leadchangeinhealthreform. §

“Sutter”, Cont. from Pg. 7

problemwithCriticalAccess--itwill in-creasecoststopatients,andnotjustcostsoftransportstodistanthospitals.Inordertoreducethenumberofemergencypatienttransfers imposed by theCriticalAccessbedlimit,Sutter'sconsultantwrotethefol-lowing: "theHospital [SutterCoast] canaggressivelyuseobservationbedservices;however, thismaynotbesufficient toal-low theHospital to eliminate the transferofpatientsoutsidethecommunity." Observation patients are short termpatients,whoarenotcountedaspartofthepatient limit imposed byCriticalAccess.Observationpatientsmaynotbecommin-gledwithpatientsontheinpatientnursingunitsinCriticalAccessHospitals,andaresubjecttohigherchargesthanstandardpa-tientsadmittedtothehospital.Hereisquotetakenfromthe2012SutterCoastHospitalCriticalAccess study: "The beneficiarymaynotbeawarethatobservationstaysfallunder[Medicare]PartBandrequirecoin-suranceandpossiblyotherCAHcharges."According toMedicare regulations, "thebeneficiary in an observation statuswillbeliableforacoinsurancechargeequalto20%of theCAH'scustomarycharges fortheservices."(Regulation485.620(a),6/7/13)

Oneshouldalsoknowunlessthehospitalelects to place their observation patientsinsomeofthe25availablehospitalbeds,theywillneedtooccupyastretcher.Only25hospitaltypebedsareallowedinCriticalAccessHospitals.Ofcourse,onbusydayslikeJune28,whentherewere36inpatientsplustwoobservationpatientsinSutterCoastHospital, it will be necessary formanypatients to be transferred elsewhere, dueto the25bed limit. Ourpatientnumbersare typically lowest during the summermonths.Whatwillhappenduringthebusierwintermonths,when respiratory illnessesarecommon? The hospital Board also held adiscussion onCriticalAccess during our8/1/13meeting,whichSutterHealth ex-ecutiveMikeCohill concludedbystatinghe believed theCriticalAccess programwould inevitablybe implementedhere inCrescentCity,whileacknowledginghehadnotspokentoAsanteoranyotherpotentialmanagementfirms. If youhave ideas or comments youwouldliketoshare,pleasesendthemtomeattheemailaddressbelow,orstopbymyofficeon1200MarshallSt. tolearnmoreor add your name to the more than 3,000 localresidentswhohavesignedapetitionopposingRegionalizationandCriticalAc-cessdesignationforSutterCoastHospital.Tojoinouremailnewsletter,justsendmeanemailtodrgjduncan@yahoo.com.

Next issue: The story behind the resignation of Sutter Coast's excellent former Chief Financial Officer, and the ensuing reports of financial losses for the first time in the hospital's history. §

6 North Coast Physician

Open FOruM

MedicineDepartmentmeetingattendedbyDr.O'BrienaswellasthePhysicianRecruit-ment and Retention Committee for the St. Joe’s system. Judgingbybody languageandfacialexpressionDr.O'Brienappearedinterested and asked some useful ques-tions.The thePhysicianRecruitment andRetentionCommitteemeetingJoeCarrollexpressedstronginterestbutthatwasjustafewdaysbeforehebecameill.Idon'tknowanyadministratorsatMadRiverhospital.WhenIhaveopportunitytodiscussitwithsomeonethereIwillneedhelpwithhowtosell themontheidea.Iwouldgreatlyap-preciateanyhelpwithapproachingthem. Iwill keepyou all informedof anyprogress.Iamgratefulforalltheofferstohelpintheprocessandtheoverwhelmingpositivefeedbackontheidea.I'mnotgoodataskingfororevenacceptinghelpbutatsomepointIwillnotbeabletodoitmyself.Istillhavepatientstoseeandabusinesstorun.RightnowinthepurelyinformationalphaseIwillhandleitfornow.

What I have decided, what I have learned and what I have left to learn

Lastmonth Iwrote about a few crazyideasIhavetoincreasephysicianrecruit-menttoourarea.IamveryseriousaboutushavingamedicalschoollocallybutIhavedecided that a familymedicine residencywillbefasterandeasier(inapurelyrela-tive sense) andget us afinishedproduct,ie. doctors ready to practice,muchmorequickly.ThemedicalschoolideawillhavetowaitatleastifI’mgoingtobeinvolvedinitsdevelopment. Thereareafewdifferentkindsoffam-ilymedicineresidenciesinafewdifferentsenses.First,thereisthe“sponsoringorga-nization.”Second,therearefullandruraltrackprograms.Third,thereareallopathicandosteopathicprograms.Thereareprob-ablyotherbroaddistinctionsofwhichIwilllearnasIcontinuetheprocess. Sponsoringorganizationscanbeeitherhospitals, ie. hospital basedprograms, orcommunityorganizations.Amongsponsor-ingcommunityorganizationsthosecanbeFQHCs,RuralHealthClinicsorconsortia.AsIhavereadthroughtheacademicrequire-mentssetforthbyACGMEIthinknoneofourlocalhospitalsorevenanytwoofourlocal hospitals have the patient volumeadequatetohaveahospitalbasedprogram.IthinkwewillneedtotrainourresidentsatSt.Joe’s,RedwoodMemorialANDMadRiverhospitals.Ithinkthatifwearegoingto get true cooperation from all of themtheprogramcannotbeoperatedbyanyofthem.IknowthatthereisnotaRuralHealthClinicinourareathatisbigenoughtobeasponsoringorganization.IplantotalkwithHermannSpetzleraboutwhethertheOpenDoorsystemmightwanttobethesponsor-ingorganization.Ipersonallyprefertheideaoftheconsortiumbasedprogramsoastobe

inclusiveinthecommunity.AnotherreasonthatIthinkthatacommunitybasedprogramispreferabletoahospitalbasedprogramisthattherearefederalgrantsforcommunitybasedandnothospitalbasedprimarycareresidencies.That is part of PPACA.Un-fortunatelythelatestgrantcycle,thethirdannually,closedtwodaysafterIlearnedofitandIamnowherenearreadytoapplyforagrant.IhavelearnedthatBlueShieldofCaliforniaFoundationhasgivengrantsforstartingcommunitybasedprograms.AAFP-foundationdoesnotprovidesuchgrantsanddidnothaveanyconcretesuggestionsforothergrantopportunities. Afewyearsagoourcommunityhosted14medicalstudentsforawholeacademicyear and that supersaturated the potentiallearningenvironment. Ifwewere to startafull,threeyear,allopathicprogramtherewouldbeaminimumof12residents,fourforeachyear.Iamconcernedthatmaybetoomuch to take on all at once.A ruraltrack program inwhich residents spendtheir intern year at an academic centerwould requireminimumof two residentsineachthesecondandthirdyearclasses.TheywouldmatchtoourprogramandthenmovehereafterfinishinginternshipsuchasatUCDavisMedicalCenterinSacramento.Anotheroptionmightbetohaveafull,threeyear,osteopathicprogramwithaminimumoftworesidentsforeachofthethreeyears.Iamveryconfidentthatourcommunitycouldsupport four tosixphysicians in training.I think thatplanning tobuildup toa fullprogramwith12residentsmaybearealisticgoalasweattractmorefacultytotheareaand asmore people have access to carethroughcoverageasaresultofPPACA. I have introduced the idea to the

hal GRotkE, m.D.

§

Did You Know..... Legal Help AvailableCMA’sonlinehealthlawlibrary

containsover4,500pagesofOn-Calldocumentsandvaluableinformationforphysiciansandtheirstaff.Accesstothelibraryisfreetomembers.

7SEPTEMBER 2013

Open FOruM

SUPERVISORS REQUEST INFORMATION, SUTTER HEALTH SAYS NO

GREGoRy DunCan, m.D. Chief-of-Staff Sutter Coast Hospital

First,IwritetothanktheBoardofSuper-visors forsendinganotherexcellent letterto SutterHealth, reiterating theSupervi-sors'ongoingoppositiontoSutterHealth'splanstodissolveour localhospitalBoardofDirectors, and transfer ownership andgovernance ofSutterCoastHospital to aSanFrancisco basedBoard appointed bySutterHealth.Thelatestletter,addressedtoSutterHealthCEOPatrickFryandSut-terCoastCEOLindaHorn, repeated theSupervisors'concernswithCriticalAccess,includingthefactsthat"theprogramwouldeliminate50%ofourhospitalbeds,neces-sitating hundreds of emergency patienttransferseveryyeartodistanthospitals,atthepatients'riskandexpense,andwithouttheirfamilyorlocaldoctoratthereceivinghospital."TheSupervisorsalsonotedthatCriticalAccesswouldprecipitatesignificantlayoffsatSutterCoast. SutterHealth'sresponsetotheSuper-visors'latestrequestforrecordswasblunt.Duringlastweek'shospitalBoardmeeting,Sutter Health Regional PresidentMikeCohillstated,"wewillnotbereleasingourmeetingminutestotheBoardofSupervisorsoranybodyelse." I understand Sutter Health is notlegally obligated to release our hospitalmeetingminutes,butIcertainlyagreewithseveralSupervisorswho requestedSutterHealthreleasethedataandmeetingminutes.IfullyagreewithSupervisorFinigan,whoadvisedinopensession,"Ifyoureallywantanopendiscussion,thenreleasethedata." Togetherwith theBoard of Super-visors and theHealthcareDistrict, Iwillcontinuetoworktopreserveafullservice,

locallyownedhospital,andpreventdown-sizingtoaCriticalAccessfacility. Second,we have identified anotherproblemwithCriticalAccess--itwill in-creasecoststopatients,andnotjustcostsoftransportstodistanthospitals.Inordertoreducethenumberofemergencypatienttransfers imposed by theCriticalAccessbedlimit,Sutter'sconsultantwrotethefol-lowing: "theHospital [SutterCoast] canaggressivelyuseobservationbedservices;however, thismaynotbesufficient toal-low theHospital to eliminate the transferofpatientsoutsidethecommunity." Observation patients are short termpatients,whoarenotcountedaspartofthepatient limit imposed byCriticalAccess.Observationpatientsmaynotbecommin-gledwithpatientsontheinpatientnursingunitsinCriticalAccessHospitals,andaresubjecttohigherchargesthanstandardpa-tientsadmittedtothehospital.Hereisquotetakenfromthe2012SutterCoastHospitalCriticalAccess study: "The beneficiarymaynotbeawarethatobservationstaysfallunder[Medicare]PartBandrequirecoin-suranceandpossiblyotherCAHcharges."According toMedicare regulations, "thebeneficiary in an observation statuswillbeliableforacoinsurancechargeequalto20%of theCAH'scustomarycharges fortheservices."(Regulation485.620(a),6/7/13) First, Iwrite to thank theBoard ofSupervisors for sending another excel-lent letter toSutterHealth, reiterating theSupervisors' ongoingopposition toSutterHealth'splanstodissolveourlocalhospitalBoardofDirectors,andtransferownership

andgovernanceofSutterCoastHospitaltoaSanFranciscobasedBoardappointedbySutterHealth.Thelatestletter,addressedtoSutterHealthCEOPatrickFryandSut-terCoastCEOLindaHorn, repeated theSupervisors'concernswithCriticalAccess,includingthefactsthat"theprogramwouldeliminate50%ofourhospitalbeds,neces-sitating hundreds of emergency patienttransferseveryyeartodistanthospitals,atthepatients'riskandexpense,andwithouttheirfamilyorlocaldoctoratthereceivinghospital."TheSupervisorsalsonotedthatCriticalAccesswouldprecipitatesignificantlayoffsatSutterCoast. SutterHealth'sresponsetotheSuper-visors'latestrequestforrecordswasblunt.Duringlastweek'shospitalBoardmeeting,Sutter Health Regional PresidentMikeCohillstated,"wewillnotbereleasingourmeetingminutestotheBoardofSupervisorsoranybodyelse." I understand Sutter Health is notlegally obligated to release our hospitalmeetingminutes,butIcertainlyagreewithseveralSupervisorswho requestedSutterHealthreleasethedataandmeetingminutes.IfullyagreewithSupervisorFinigan,whoadvisedinopensession,"Ifyoureallywantanopendiscussion,thenreleasethedata." Togetherwith theBoard of Super-visors and theHealthcareDistrict, Iwillcontinuetoworktopreserveafullservice,locallyownedhospital,andpreventdown-sizingtoaCriticalAccessfacility. Second,we have identified another

“Sutter”, continued on Pg. 23

23SEPTEMBER 2013

“Trustees”, Cont. from Pg. 5

andcomponentmedicalsocietiessubstantialcoststheywouldotherwiseincur.

•Theannual sessionwouldbecomeatwo-daymeetingconsistingof:(1)actiononcouncilandcommitteereportsaddress-ingthethreetofiveissuesspecifiedbythespeakers;(2)actiononanymatterstheboardoftrusteesmayrefertotheHouse;(3)elec-tions of officers; (4) educational sessionsonkeyissues;and(5)ceremonialfunctionsthatwouldbescheduledduringaneveningdinneropentoallCMAmembers.

•TheabilityofindividualmemberstointroducebusinessoftheAssociationwouldbepreservedbyenhancingtheexistingyear-roundresolutionprocess,wherebyresolu-tionsreceivedwouldbereferredtostandingcouncils and committees for purposes ofstudy,receiptoftestimonyandpreparationofreportswithrecommendationsforactionbytheboardoftrustees.

•Astransitionalstepstowardatwo-day annual session,HOD reference com-mitteeswouldbeginfunctioningasentirely“virtual”referencecommittees,beginningwithonecommitteein2013,twoormoreatthe2014annualsession,andallcommit-teesby2015.Testimonywouldbereceivedonline,andreportswithrecommendedac-tionswouldbedistributednolaterthantheopeningsessionoftheHOD.

•Thattheboardoftrusteesdirectthatastudybeundertakeninconsultationwithcomponentmedical societies toexploreapossibleredrawingoftheCMAgeographicdistrict boundaries, in order to reflect thegrowth and redistribution ofCalifornia’sphysician population and provide greaterrepresentationalequityamongcomponentsocietiesanddistricts.

Theimplicationsoftheserecommen-

dationsaresignificantforDistrictX.Pleaseletyourtrusteesknowyourviewssotheycanshare themwith theboardof trusteespriortothenextHOD,scheduledforOct.11-13.

StrategicPlan.TheCMAExecutiveCommitteehasidentifiedfivedistinctgoalsonwhichCMAshouldconcentrate itsef-forts: (1) growmembership by 5%; (2)commitmenttopublichealth;(3)prosperityforallphysicians;(4)defendMICRA;(5)leadchangeinhealthreform. §

“Sutter”, Cont. from Pg. 7

problemwithCriticalAccess--itwill in-creasecoststopatients,andnotjustcostsoftransportstodistanthospitals.Inordertoreducethenumberofemergencypatienttransfers imposed by theCriticalAccessbedlimit,Sutter'sconsultantwrotethefol-lowing: "theHospital [SutterCoast] canaggressivelyuseobservationbedservices;however, thismaynotbesufficient toal-low theHospital to eliminate the transferofpatientsoutsidethecommunity." Observation patients are short termpatients,whoarenotcountedaspartofthepatient limit imposed byCriticalAccess.Observationpatientsmaynotbecommin-gledwithpatientsontheinpatientnursingunitsinCriticalAccessHospitals,andaresubjecttohigherchargesthanstandardpa-tientsadmittedtothehospital.Hereisquotetakenfromthe2012SutterCoastHospitalCriticalAccess study: "The beneficiarymaynotbeawarethatobservationstaysfallunder[Medicare]PartBandrequirecoin-suranceandpossiblyotherCAHcharges."According toMedicare regulations, "thebeneficiary in an observation statuswillbeliableforacoinsurancechargeequalto20%of theCAH'scustomarycharges fortheservices."(Regulation485.620(a),6/7/13)

Oneshouldalsoknowunlessthehospitalelects to place their observation patientsinsomeofthe25availablehospitalbeds,theywillneedtooccupyastretcher.Only25hospitaltypebedsareallowedinCriticalAccessHospitals.Ofcourse,onbusydayslikeJune28,whentherewere36inpatientsplustwoobservationpatientsinSutterCoastHospital, it will be necessary formanypatients to be transferred elsewhere, dueto the25bed limit. Ourpatientnumbersare typically lowest during the summermonths.Whatwillhappenduringthebusierwintermonths,when respiratory illnessesarecommon? The hospital Board also held adiscussion onCriticalAccess during our8/1/13meeting,whichSutterHealth ex-ecutiveMikeCohill concludedbystatinghe believed theCriticalAccess programwould inevitablybe implementedhere inCrescentCity,whileacknowledginghehadnotspokentoAsanteoranyotherpotentialmanagementfirms. If youhave ideas or comments youwouldliketoshare,pleasesendthemtomeattheemailaddressbelow,orstopbymyofficeon1200MarshallSt. tolearnmoreor add your name to the more than 3,000 localresidentswhohavesignedapetitionopposingRegionalizationandCriticalAc-cessdesignationforSutterCoastHospital.Tojoinouremailnewsletter,justsendmeanemailtodrgjduncan@yahoo.com.

Next issue: The story behind the resignation of Sutter Coast's excellent former Chief Financial Officer, and the ensuing reports of financial losses for the first time in the hospital's history. §

27SEPTEMBER 2013

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FOR LEASE: JoinournewprofessionalmedicalfacilitiesnearMadRiverHospital.BuildtosuitinnewPlannedUnitDevelop-ment.1200-4000sq.ft.spaces.ContactMark,707-616-4416ore-mail:Jones202@suddenlink.net.

FIREWOOD FOR SALE. Call(707)499-2805

WANTED - FAMILY PRACTICE PHYSICIAN Fullorparttime.AviationMedicalExaminerpreferred.ContactGeorgeJutila,M.D.,725-3334orhome.md@suddenlink.net(GJ)

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E-Mail addrEss UpdatEs? alliEd HEaltH practitionEr UpdatEs? Find inForMation

pUblisHEd in tHE dirEctory tHat nEEds to bE UpdatEd? plEasE lEt tHE MEdical sociEty

know so wE can kEEp rEcords as Up-to-datE as possiblE.

BUSY MEDICAL PRACTICE LOOKINg FOR PA OR FNP. Parttimeortimenegotiable.PleasecallDee@707444-3885

FNP NEEDED. FullTime.BusyFamilyPractice.Contact:Lorraine(707)443-8335

FNP WANTED. 3daysperweek(Tuesday,Wednesday,Friday)8to5:30is27hourspatienttime,and8hourspaidpaperworktimeinaddition,thatisfulltime35hours.Withvaction,paidholidays,CMEtime,CMEpaid,malpracticeandliscencespaid.Hourlyratebasedonexperience.WorkinsmallsolofamilypracticeinEurekawithDrTeresaMarshallandCarolynBarnhartFNPwithwonderfulofficestaff,fullEMRwebbasedsystemthatiseasytolearnandtrainingtimepaid.Pleasecall445-5900oremailtodrmarshallsof-fice@att.netandaskanymorequestionsyouhave.

PRIMARY CARE NP/PA NEEDED. OutstandingPrimaryCareNP/PAsoughtbyprivatemultispecialtyclinic.ThisfulltimepositionlocatedinEurekawillbeanintegralpartofourprimarycaredeliveryteamandwillworkcloselywithanInternalMedicinePhysician.AnadultfocusedPhysicianAssistantorNursePractitionerwouldbetheidealcomplementtoourexistingstaff.Experiencewithelectronichealthrecordsisaplus. Weofferafriendlyandprofessionalenvironmentwithafocusonpatientcareandanexcellentreputationforqualityservicedatingbacktotheearly1970's.Acompetitivesalary,healthinsuranceandpensionbenefitsalongwithagenerousproductivitybonusstructurewillberewardedtothesuccessfulapplicant. Pleaserespondwithacoverletterandresumetoandyj@eimdoc.com

HOUSE FOR RENT. 4bedroom,2.5bathhouse for rent inEureka,CA.Withofficeandden,gasfireplaceinsertandnewupgradedkitchen.Wallofwindowsgivesviewofsecludedback-yard,sideyardhasraisedbedsforgardening.Goodneighborhood;walkingdistancetoEurekaHigh,4minutesdrivetoSt.Jo.Nosmokinginsideorout.Rent$1950./month.Call:707499-2405or707849-5178.

FAMILY PRACTICE MD/DO NEEDED. OpenDoorisseekingFamilyPracticeMD/DO’sforourMcKinleyville,CrescentCityandEurekaclinicsites.RequirementsincludeCAlicense,DEA,BoardCertification andEMRexperience. Visitwww.opendoorhealth.comtogettoknowus.EmailCVandcoverletterto:cwebb@opendoorhealth.com.

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