November/December 2014

NOVEMBER/DECEMBER 2014 | VOLUME 20 | NUMBER 6

Also Inside: Achieving the Impossible (GPCI)

Highlights From AMA's 2014 Interim Meeting

NEW HEALTH

LAWS FOR 2015

2 | THE BULLETIN | NOVEMBER / DECEMBER 2014

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Project 65621, SCCMA/MCMS, (11/14)Full Size: 8.5” x 11” Bleed: 8.75” x 11.25Folds to: N/A Perf: N/AColors: 4c processStock: N/APostage: N/AMisc: N/A

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Apply by December 31, 2014! To be eligible for coverage, applications must bereceived during the special open enrollment period ending on December 31, 2014.

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NOVEMBER / DECEMBER 2014 | THE BULLETIN | 3

Feature Articles 10 New Health Laws for 2015

16 POLST in 2014: What Health Care Professionals Need

to Know

18 Achieving the Impossible

30 Highlights From AMA’s 2014 Interim Meeting

34 Vote No on 46 Victory

40 California’s Unwitting Health Care Guinea Pigs

Departments 5 From the Editor’s Desk

6 Message From the SCCMA President

8 Message From the MCMS President

26 Member Spotlight: Robert G. Aptekar, MD

28 Thank You to SCCMA SAC-PAC Contributors

32 SCCMA Award Nominations

36 Medical Times From the Past

39 TPO Seminar: 11th Annual Employment Law &

Leadership Conference

44 Classified Ads

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OFFICERSPresident

James Crotty, MDPresident-Elect

Eleanor Martinez, MDPast President

Sameer Awsare, MDVP-Community Health

Cindy Russell, MDVP-External Affairs

Kenneth Blumenfeld, MDVP-Member Services

Peter Cassini, MDVP-Professional Conduct

Seema Sidhu, MDSecretary

Seham El-Diwany, MDTreasurer

Scott Benninghoven, MD

CHIEF EXECUTIVE OFFICERWilliam C. Parrish, Jr.

AMA TRUSTEE - SCCMAJames G. Hinsdale, MD

CMA TRUSTEES - SCCMA Thomas M. Dailey, MD

(District VII)Martin L. Fishman, MD

(District VII)Randal Pham, MD

(Ethnic Member Organization Societies)Tanya Spirtos, MD

(District VII)

COUNCILORSEl Camino Hospital of Los Gatos:

Arthur Basham, MDEl Camino Hospital:

Laura Cook, MDGood Samaritan Hospital:

David Feldman, MDKaiser Foundation Hospital - San Jose:

Hemali Sudhalkar, MDKaiser Permanente Hospital:

Anh Nguyen, MDO’Connor Hospital:

Michael Charney, MDRegional Med. Center of San Jose:

Erica McEnery, MDSaint Louise Regional Hospital:

Diane Sanchez, MDStanford Hospital & Clinics:

Vanila Singh, MDSanta Clara Valley Medical Center:

Richard Kramer, MD

Printed in U.S.A.

EditorJoseph S. Andresen, MD

Managing EditorPam Jensen

Opinions expressed by authors are their own, and not necessarily those of The Bulletin, SCCMA, or MCMS. The Bulletin reserves the right to edit all contributions for clarity and length, as well as to reject any material submitted in whole or in part. Acceptance of advertising in The Bulletin in no way constitutes approval or endorsement by SCCMA/MCMS of products or services advertised. The Bulletin and SCCMA/MCMS reserve the right to reject any advertising.

Address all editorial communication, reprint requests, and advertising to:

Pam Jensen, Managing Editor 700 Empey Way San Jose, CA 95128 408/998-8850, ext. 3012 Fax: 408/289-1064 [email protected]

© Copyright 2014 by the Santa Clara County Medical Association.

THE SANTA CLARA COUNTY MEDICAL ASSOCIATION

THE MONTEREY COUNTY MEDICAL SOCIETYBULLETIN

THE


OFFICERSPresident

Jeffrey Keating, MDPresident-Elect

James Hlavacek, MDPast President

Kelly O'Keefe, MDSecretary

Patricia Ruckle, MDTreasurer

Steven Vetter, MD

CHIEF EXECUTIVE OFFICERWilliam C. Parrish, Jr.

DIRECTORSPaul Anderson, MD Valerie Barnes, MD

Ronald Fuerstner, MD Gary Gray, DO

Steven Harrison, MD David Holley, MD John Jameson, MD

William Khieu, MD Eliot Light, MD

Edward Moreno, MD Marc Tunzi, MD Craig Walls, MD

Cary Yeh, MD

AMA TRUSTEE - MCMSDavid Holley, MD


By Joseph Andresen, MDPhysician Editor, The Bulletin

November 4th, Election Day has come and gone! Certainly there was the posturing, speculation, and anticipation that accompany a national midterm election. And, in case you missed it, this was a record setting midterm with the largest amount of money ever donated. Despite the $3 billion dollars spent by candidates, only an estimated 36.6% of eligible voters showed up at the polls. On one hand, the economy appears to be heading in the right direction, unemployment has just fallen below 6% and the stock market is at an all time high. Yet the job approval rating for the President is well below 50%, Congress at 8%, and only 10% of voters believe that congressmen listen to their constituents. Ebola, ISIS, Ukraine, global warming, the growing income disparity and a shrinking middle class, new job creation, and rising college costs are just a few challenges that lie ahead for our nation. May we all promote a government that can meet these challenges.

Well, how did we fare here in California? California’s Proposition 46, known as the Medical Malpractice Lawsuit Cap and Drug Testing of Doctors Initiative went down to defeat. The majority of Californians saw this as an attempt to promote trial lawyers interests in procuring large jury awards rather than getting an equitable settlement for patients harmed by medical negligence. The California Medical Association, with your crucial involvement, deserves special recognition for this important ac-complishment.

This is our November/December SCCMA Bulletin and fall is certain-ly in the air as I write these words. An engaging palate of seasonal oranges, yellow, and browns adorns the landscape with noticeably shorter days and cool, crisp mornings. With this in mind, highlighted below are several note-worthy articles included in this issue.

You’ve probably heard the expression that passing legislation is kind of like making sausage. You really don’t want to see what’s in it until the final result is produced.

Geographic Practice Cost Index (GPCI) has quite a story to tell when it comes to rectifying reasonable reimbursement to physicians caring for Medicare patients. For those who dare to look behind the curtain, read the

story of Dr. Larry De Ghetaldi and many others, and their greater than a decade journey to achieve a solution to the perennial Medicare SGR patch dilemma.

Dr. Robert Aptekar, a practicing orthopedic surgeon travels to Phnom Penh, Cambodia each year to provide care to patients at Children’s Surgical Centre. I’m warning you that reading about his adventures may inspire you to do something equally rewarding outside your normal life’s routine.

Dr. Michael A. Shea shares a historical perspective on the origin of the Stanford Medical School. A must read for any and all of us who have spent some time on the “Farm.”

May this time of change in seasons be one of new challenges, inter-ests, and rewards in your personal and professional lives.

FROM THE EDITOR’S DESK

A Time for Change...

JOSEPH S. ANDRESEN, MDEditor, The Bulletin

Joseph S. Andresen, MD, is the editor of The Bulletin. He is board certified in anesthesiology and is currently practicing in the Santa Clara Valley area.

Legislators make critical decisions about the future of medicine. Help elect those legislators and candidates who understand the

challenges of practicing medicine in California.

Join with your colleagues to support the physicians' legislative

and political policy agenda.

Join CALPAC - the physicians' voice in California

1-800-CALPAC-9

Who has the power to change the way you practice medicine?

CALPAC


By James R. Crotty, MD, MBAPresident, Santa Clara County Medical Association

I cannot think of another single word that carries so much weight, fear, and concern. I write about Ebola with the mission of the SCCMA in mind: to help the profession, to help physicians engaged in the practice of medicine, and to help the public health, particularly in Santa Clara Coun-ty. The public health threat is real and tangible. Most of us have learned the basic facts: Ebola Virus Disease (EVD) is caused by one of five species of Ebolavirus, and Zaire Ebolavirus is the species responsible for the cur-rent outbreak. It was first discovered near the Ebola River in Zaire (now the Democratic Republic of Congo) in 1976. There is an animal reservoir in bats, primates, porcupines, and antelopes. The mean incubation is 11 days (2 to 21 days). There have been 8,399 confirmed cases in the West African countries of Guinea, Liberia, and Sierra Leone with 4,033 deaths. This outbreak started in December 2013 and has been different than out-breaks in the past because it is occurring in highly populated urban areas. On August 8, 2014 the World Health Organization (WHO) declared this outbreak to be a Public Health Emergency of International Concern.

On September 15, Thomas Duncan, age 42, who lived in Monrovia, Liberia, helped his landlord’s daughter, who was stricken by Ebola, get to the hospital, but they were turned away for lack of space. Mr. Duncan then helped carry the woman back to the family home, where she died hours later. Mr. Duncan had made plans to visit family in Dallas. He showed no signs of fever or other symptoms of Ebola when he was screened on September 19 before boarding a flight from Monrovia to Brussels. He flew from Brussels to Washington Dulles, and then on to Dallas-Forth Worth. Mr. Duncan started showing symptoms on September 24 and sought medical care at Texas Health Presbyterian Hospital on September 25. His medical record shows that he had a fever to 103 that went down to 101.5 after Tylenol, and he was sent home. His condition worsened, and he was taken back to the hospital by ambulance on September 28. Officials con-firmed on September 30 that his blood tested positive for Ebola.

There have been concerns raised about the United States being unprepared. There have been concerns raised about physician leader-ship. The possibility that someone infected with this virus could travel anywhere in the world and thereby spread the virus into other coun-tries seems not to have been translated into some action plan. Two nurses who cared for him have since been identified as being posi-tive for EVD. I think most people realize that what happened in Tex-as could have happened anywhere, in any city, in the United States.

What are the take home messages from this event? 1. Hospitals and other health care settings need to be prepared.

The Centers for Disease Control and Prevention (CDC) has now come out with instructions and recommendations about any patient who presents seeking care with fever, headache, and other symptoms with a recent travel from West Africa countries of Guinea, Sierra Leone, Liberia, Nigeria, or nearby countries.

2. The virus seems to be spread not by droplets as Influenza, but rather by direct contact with body fluids. Therefore, strict personal protection is required including face mask, non-pervious gowns, gloves, masks, and foot protection. The CDC has revised its initial recommendations. It seems that initially there was skin exposed, now the recommendation is that no skin be exposed, and that there should be oversight and a “buddy system.”

3. There is no specific therapy for treatment, and the care is supportive.

4. Efforts are focused on decreasing the spread of the disease.5. There have been increased efforts to produce a vaccine and other

anti-viral medications. 6. Medical science does not have an answer to every illness.7. What happens in other countries does affect the health of

Americans.

Politically, the spread of this disease to the United States created a lost opportunity to demonstrate leadership for the profession. A Congres-sional hearing was called by the Chair of the House Committee on Energy and Commerce, Representative Tim Murphy R-Pa, examining the U.S. public health response to the Ebola outbreak on October 16. Dr. Tom Frie-den, Director of the Centers for Disease Control and Prevention, Dr. An-thony Fauci, Director of The National Institute of Allergy and Infectious Diseases, and Dr. Robin Robinson, Director of the Biomedical Advanced Research and Development Authority at the U.S. Department of Health and Human Services gave sworn testimony. There was criticism that not enough had been done to prevent the spread of this disease. The aspect of people traveling who could be infected was constantly questioned. Screening for fever was discussed, with an estimate that 10%-15% of peo-ple infected would not have fever. Screening was implemented in five U.S. airports, and there is discussion that this should be expanded. The prob-lems with screening are that many people, like Thomas E. Dunkin, would

MESSAGE FROM THE SCCMA PRESIDENT

Ebola

JAMES R. CROTTY, MD, MBAPresident, Santa Clara County Medical Association

James R. Crotty, MD, MBA, is the 2014-2015 president of the Santa Clara County Medical Association. He is a urologist and is currently practicing with The Permanente Medical Group/Kaiser in San Jose.


not likely manifest disease signs or symptoms. Screening will also find many people with low grade fever who do not have the disease. Screening people who are leaving the West African countries is problematic for the same reasons.

On October 17, President Obama appointed Ron Klain, a lawyer and former Chief-of-Staff for Vice President Joe Biden and Al Gore, to the newly created post of “Ebola Response Coordinator.” He will report to both White House Homeland Security Adviser Lisa Monaco and National Securty Adviser Susan Rice. Respected physician leaders have not, as yet, been given any prominent leadership roles in this effort. In fact, there has been political posturing calling for the resignation of Dr. Thomas Frieden, head of CDC.

More locally, the California Department of Health and Human Ser-vices has a Department of Public Health, whose Director, Dr. Ron Chap-man, participated in a tele-conference on October 15. The department’s website has up-to-date information about Ebola. There is a link to local health officers, where Dr. Sara Cody is listed.

There has been much in the press about quarantine. There are clear reasons for quarantine and Due process steps that are required. Since world-wide travel is relatively easy, someone would not have to come from

West Africa directly. Living for 21 days in quarantine is not something people would likely do voluntarily, and so depending on self-reporting for travel is problematic.

Ebola is here to stay. The fact that a person can become infected with the Ebola virus globally, and the fact that this virus has a 50% or more fa-tality rate, that there is a high contagious rate, and that there are no thera-pies other than support, means that we must be prepared. I think we can thank Thomas Duncan for helping us to call the alarm. Being prepared does not mean causing undue worry or panic. Being prepared does take resources and commitment. The same can be said for Influenza and earth-quake disasters.

Kaiser Permanente has designated two hospitals, Oakland, and South Sacramento, as centers of excellence for treatment of patients who are sus-pected or who have been tested positive for Ebola Virus Disease (EVD). It may be wise for our county to discuss this strategy. It makes sense to des-ignate centers where specialized training, equipment, and other resources can be focused.

There is some good news: the nurses have not succumbed to the dis-ease, and no other contacts have tested positive. Plan for the worse, hope for the best!


MESSAGE FROM THE MCMS PRESIDENT

Proposition 46

JEFFREY KEATING, MDPresident, Monterey County Medical Society

By Jeffrey Keating, MDPresident, Monterey County Medical Society

By the time this article is published, the election will have passed and we will know the outcome of Proposition 46. I have been speak-ing with friends and neighbors, basically anyone who will listen, about the issues at hand. Based on the reactions I have seen, Proposition 46’s increasing costs causes the most consternation and concern. Speaking of costs, my small group practice received a quote for health insurance for next year and there was only a “modest” 17% increase. This increase far outstrips the official inflation rate. This also includes a sig-nificant increase in the maximum out-of-pocket amount and other changes. In summary, we are paying more for less. I think this has not gone unnoticed by the public, how could it? So, once people learn that a family of four might expect an increase in medical costs of up to $1,000 per year, it definitely gets their attention. Being compassionate and caring people, Californians would likely choose to bear such an increase were it going to help the less fortunate in the community rather than the trial lawyers.

Speaking of the authors and main poten-tial beneficiaries of Proposition 46, probably the worst news for the trial lawyers is ebola. But then who could have predicted that a deadly viral illness seen in equatorial Africa would be seen here? And who could have predicted the perceived missteps by the Centers for Disease Control and Prevention (CDC) the feeling that there are mixed messages and changing poli-cies? I have the utmost respect for the CDC and know that scientifically their reasoning is sound, but public relations are important in the face of such a terrible infectious disease. So when you can’t trust the politicians and bureaucrats then

all you are left with is your local medical team, your doctor. A ballot initiative that would seri-ously undermine access to care and potentially drive physicians from the state is the last thing any reasonable voter would want, not now with so much uncertainty.

We live in a world where everything in-creasingly appears to be run by MBAs and law-

yers, where people with real skills have been turned into commodities. Perhaps one positive outcome of the 46 campaign is that it provided an opportunity to rebuild community ties and remind the public about what we do and what we stand for, and what we all have to lose, be-cause what is bad for the medical community is bad for the public.

Jeffrey Keating, MD, is the 2014-2015 president of the Monterey County Medical Society.

He is a pathologist and is currently practicing with Community Hospital of Monterey

Peninsula in Monterey.

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The California Legislature had an active year, passing many new laws affecting health care. Below are highlights of the new laws likely to impact physicians next year and beyond. For more details, see “Significant New California Laws of Interest to Physicians for 2015,” in the California Medical Association’s online resource library at www.cmanet.org/resource-library.

ALLIED HEALTH PROFESSIONALSAB 1841 (MULLIN) - MEDICAL ASSISTANTS

Clarifies that medical assistants (MAs) may hand out properly labeled and prepackaged prescription drugs to patients as part of their existing authorization to provide “technical supportive services.” Permits MAs to hand out prescription drugs in non-state operated facilities licensed by the Board of Pharmacy. Requires that a licensed physician and surgeon, a li-censed podiatrist, a physician assistant, a nurse practitioner, or a certified nurse-midwife provide the appropriate patient consultation regarding use of the drug.

CONFIDENTIAL INFORMATIONAB 1755 (GOMEZ) - MEDICAL INFORMATION

Revises provisions of law requiring licensed health facilities to pre-vent disclosure of patients’ medical information by extending the dead-line for health facilities to report unauthorized disclosures from five to 15 business days after unlawful or unauthorized access, use, or disclosure has been detected. This bill also authorizes the report made to the patient or the patient’s representative to be made by alternative means, including email, as specified by the patient. This bill also extends the deadline when reporting is delayed for law enforcement purposes, as specified, from five to 15 business days after the end of the delay. This bill gives the Depart-ment of Public Health full discretion to consider all factors when deter-mining whether to conduct investigations under these provisions.

DRUG PRESCRIBING AND DISPENSINGAB 467 (STONE) - PRESCRIPTION DRUGS: COLLECTION AND DISTRIBUTION PROGRAM

Establishes a license and regulatory framework for a “surplus medi-cation collection and distribution intermediary” to facilitate the donation of surplus medications in California. Requires the Board of Pharmacy to license a surplus medication collection and distribution intermediary, es-tablished for the purpose of facilitating the donation or transfer of medi-cations between entities under a specified unused medication repository and distribution program. Authorizes the intermediary to charge speci-fied fees. Relates to license renewal. Requires the keeping and maintaining of complete records. Provides that fees collected would be deposited in the Pharmacy Board Contingent Fund.

AB 1535 (BLOOM) - PHARMACISTS: NALOXONE HYDROCHLORIDE

Authorizes a pharmacist to furnish naloxone hydrochloride in ac-cordance with standardized procedures or protocols developed and ap-proved by both the Board of Pharmacy and the Medical Board. Requires

the development of protocols on the education of the person to whom the drug is furnished and notification of the patient’s primary care provider. Requires the pharmacists to complete related training. Prohibits furnish-ing the medication to the patient without consultation. Authorizes related regulations.

AB 1735 (HALL) - NITROUS OXIDE: DISPENSING AND DISTRIBUTING

Makes it a misdemeanor for any person to dispense or distribute ni-trous oxide to a person if it is known or should have been known that the nitrous oxide will be ingested or inhaled by the person for the purposes of causing intoxication, and that person proximately causes great bodily injury or death to himself, herself, or any other person. Requires each transaction to be recorded in a written or electronic document. Requires a signature and proper identification. Makes it a crime to misuse customer information.

AB 1743 (TING) - HYPODERMIC NEEDLES AND SYRINGES

Deletes the limit on the number of syringes a phar-macist has the discretion to sell to an adult without a pre-scription and extends, until January 1, 2021, the statewide authorization for pharmacists to sell syringes without a pre-scription, as specified. Exempts the possession of a speci-fied amount of hypodermic needles and syringes that are acquired from an authorized source.

HEALTH BENEFIT EXCHANGEAB 617 (NAZARIAN) - HEALTH BENEFIT EXCHANGE: APPEALS

Establishes an appeals process for eligibility determinations for insurance affordability pro-grams (including Medi-Cal and tax credits available through the California Health Benefit Exchange (Covered California) and requires Covered California to contract with the Department of Social Services to serve as the designated entity to hear appeals.

HEALTH CARE COVERAGESB 959 (HERNANDEZ, E.) - HEALTH CARE COVERAGE

Prohibits a change in premium rate or


coverage for an individual plan contract or policy unless the plan or insur-er delivers a written notice of the change at least 15 days prior to the start of the annual enrollment period applicable to the contract or 60 days prior to the effective date of renewal, whichever occurs earlier in the calendar year. Makes several corrections and clarifications to provisions of law govern-ing individual and small group health insurance, including clarifying that health plans and insurers have a single risk pool for enrollees and insureds.

SB 964 (HERNANDEZ, E.) - HEALTH CARE COVERAGE

Increases oversight of health care service plans with respect to com-pliance with timely access and provider network adequacy standards. Authorizes a health plan to include in its contracts with providers, pro-visions requiring compliance with timely access and network adequacy data reporting requirements.

Requires DMHC to annually review health plan compliance with timely access standards and to post its final findings from the review, and any waivers or alternative standards approved by DMHC, on its Web site. Au-thorizes DMHC to develop, and requires health plans to use, standard-ized methodologies for timely access reporting, and exempts the develop-ment and adoption of the standardized reporting methodologies from the Adm inistrative Procedures Act, the body of law governing state regula-tions, until January 1, 2020.

SB 1052 (TORRES) - HEALTH CARE COVERAGERequires a health care service plan or insurer that provides prescrip-

tion drug benefits or maintains drug formularies to post those formularies on its website and to update that posting with changes at specified times. Requires the development of a standard formulary template. Requires plans and insurers to use that template to display formularies. Requires the Covered California website provide a link to the formularies for each health plan through the Exchange.

SB 1053 (MITCHELL) - HEALTH CARE COVERAGE: CONTRACEPTIVES

Requires, effective January 1, 2016, most health plans and insurers to cover a variety of Food and Drug Administration-approved contraceptive drugs, devices, and products for women, as well as related counseling and follow-up services and voluntary sterilization procedures. Prohibits cost-sharing, restrictions, or delays in the provision of covered services, but al-lows cost-sharing and utilization management procedures if a therapeutic equivalent drug or device is offered by the plan with no cost-sharing.

HEALTH CARE FACILITIES AND FINANCING AB 1570 (CHESBRO) - RESIDENTIAL CARE FACILITIES FOR THE ELDERLY

Increases training requirements for licensees and staff of Residential Care Facilities for the Elderly (RCFE). Deletes the existing requirement of 40 hours of classroom instruction for RCFE licensee certification train-ing programs and replaces it with 80 hours of required coursework, which shall include at least 60 hours of coursework that shall be attended in person. Adds personal rights, management of antipsychotic medication, managing Alzheimer’s disease and related dementias, and managing the physical environment, including maintenance and housekeeping to the list of items covered in the RCFE licensee certification training program.

AB 2044 (RODRIGUEZ) - RESIDENTIAL CARE FACILITIES FOR THE ELDERLY

Relates to residential care facilities for the elderly. Requires that at least one administrator, facility manager, or designated substitute who has adequate qualifications be on the premises of a facility 24 hours per day. Requires a facility to employ, and an administrator to schedule, a sufficient


14 | THE BULLETIN | NOVEMBER / DECEMBER 201414 | THE BULLETIN | NOVEMBER / DECEMBER 2014

number of staff members. Requires certain training to include building and fire safety and the appropriate response to emergencies.

SB 1004 (HERNANDEZ, E.) - HEALTH CARE: PALLIATIVE CARE

Requires the Department of Health Care Services (DHCS) to assist Medi-Cal managed care plans in delivering palliative care services, and requires DHCS to consult with stakeholders and directs DHCS to ensure the delivery of palliative care services in a manner that is cost-neutral to the General Fund, to the extent practicable. Authorizes implementation through all plan letters and similar instructions.

SB 1299 (PADILLA) - WORKPLACE VIOLENCE PREVENTION PLANS: HOSPITALS

Requires the Occupational Safety and Health Administration Standards Board, no later than July 1, 2016, to adopt standards that re-quire specified hospitals to adopt a workplace violence prevention plan as part of their injury and illness prevention plan to protect health care workers and other facility per-sonnel from aggressive and violent behavior. Requires the Division of Occupational Safety and Health to post a report on violent incidents at hospitals on its website. Exempts certain hospitals.

MEDI-CALSB 396 (DE LEÓN) - PUBLIC SERVICES

Repeals the unenforceable provisions of Proposition 187 relating to public social services, public health care services, public education and other activities of state and local agencies.

SB 1341 (MITCHELL) - MEDI-CAL: STATEWIDE AUTOMATED WELFARE SYSTEM

Requires the Statewide Automated Welfare System to be the system of record for Medi-Cal and to contain all Medi-Cal eligibility rules and case management functionality. Authorizes the Healthcare Eligibility, En-rollment, and Retention System (CalHEERS) to house the business rules necessary for an eligibility determination. Requires CalHEERS to make

the business rules available to the System consortia to determine Medi-Cal eligibility. Requires notices for the Medi-Cal and premium tax credit programs.

SB 1457 (EVANS) - MEDICAL CARE: ELECTRONIC TREATMENT AUTHORIZATION

Requires requests for authorization for treatment or services in the Medi-Cal program, California Children’s Services (CCS) Program, and the Genetically Handicapped Persons Program (GHPP), excluding those submitted by dental providers enrolled in the Medi-Cal Dental Program, to be submitted in an electronic format determined by the Department of Health Care Services (DHCS) via DHCS’ website or other electronic

means designated by DHCS. Re-quires DHCS to implement an al-ternate format for submission when DHCS’ website is unavailable due to a system disruption. Implements this requirement by July 1, 2015, or a subsequent date determined by DHCS. Authorizes all-county let-ters, plan letters, or provider bul-letins.

MEDICAL EDUCATIONAB 496 (GORDON) - MEDICAL EVALUATION: SEXUAL ORIENTATION: GENDER IDENTITY

Amends existing law that re-quires continuing medical education accrediting associations to develop standards for compliance with the cultural competency requirement. Au-thorizes such associations to update these compliance standards in con-junction with an advisory group with expertise in such issues. Expands a recommendation regarding such care to include appropriate treatment and care of the lesbian, gay, bisexual, transgender, and intersex communi-ties.

AB 2214 (FOX) - EMERGENCY ROOM PHYSICIANS AND SURGEONS

Enacts the Dolores H. Fox Act to require the Medical Board of Cali-fornia to consider including a course in geriatric care for emergency room physicians and surgeons as part of its continuing education requirements.

New Health Laws for 2015, from page 13

These are just a sampling of the new laws impacting health care in 2015 and beyond. For a complete list, see “Significant New California Laws of Interest to Physicians for 2015,” in the California Medical Association’s online resource library at www.cmanet.org/resource-library.

NOVEMBER / DECEMBER 2014 | THE BULLETIN | 15NOVEMBER / DECEMBER 2014 | THE BULLETIN | 15

MEDICAL PRACTICE AND ETHICSAB 1577 (ATKINS) - CERTIFICATES OF DEATH: GENDER IDENTITY

Requires a person completing a certificate of death to record the de-cedent’s sex to reflect the decedent’s gender identity. Requires identity to be reported by the informant, unless the person completing the certificate is presented with a specified document, in which case the person would be required to record the decedent’s sex as that which corresponds with the gender identity as indicated in document. Provides the procedure in the absence of such document.

AB 2365 (PEREZ, J.) - CONTRACTS: UNLAWFUL CONTRACTS

Seeks to make clear in California law that non-disparagement clauses in specified consumer contracts are void and unenforceable. Provides that a contract or proposed contract for the sale or lease of consumer goods or services may not include a provision waving the consumer’s right to make any statement regarding the seller or lessor or its employees or agents con-cerning the goods or services. Makes it unlawful to threaten or to seek to enforce a provision made unlawful under this bill, or to otherwise penalize a consumer for making any statement protected under the bill. Provides that a provision in violation of this bill is deemed unconscionable and against public policy. Relates to online reviews or comments.

PROFESSIONAL LICENSING AND DISCIPLINESB 1159 (LARA) - LICENSE APPLICANTS: INDIVIDUAL TAX IDENTIFICATION

Prohibits licensing boards under the Department of Consumer Af-fairs from denying licensure to an applicant based on his or her citizenship or immigration status, and requires a licensing board and the State Bar to require, by January 1, 2016, that an applicant for licensure provide his or her individual taxpayer identification number or a social security number for an initial or renewal license.

PUBLIC HEALTHAB 1559 (PAN) - NEWBORN SCREENING PROGRAM

Requires the Department of Public Health to expand statewide screening of newborns to include screening for adrenoleukodystrophy as soon as the disease is adopted by the federal Recommended Uniform Screening Panel.

AB 1819 (HALL) - FAMILY DAY CARE HOME: SMOKING PROHIBITION

Prohibits the smoking of tobacco in a private residence that is licensed as a family day care home without regard to whether the act occurs during the hours of operation of the home. Makes a conforming change.

AB 1898 (BROWN) - PUBLIC HEALTH RECORDS: REPORTING: HIV/AIDS

Adds hepatitis B, hepatitis C, and meningococcal infection to the list of diseases that local health officer reports to the Department of Public Health (for the purpose of the investigation, control, or surveillance of hu-man immunodeficiency virus/acquired immune deficiency syndrome and co-infection).

AB 2069 (MAIENSCHEIN) - IMMUNIZATIONS: INFLUENZA

Requires the Department of Public Health to post specified educa-tional information regarding influenza disease and the availability of in-fluenza vaccinations on the department’s website. Authorizes the depart-ment to use additional available resources to educate the public regarding influenza, including, among other things, public service announcements.

AB 2217 (MELENDEZ) – PUPIL AND PERSONNEL HEALTH: AEDS

Authorizes a public school to solicit and receive non-state funds to acquire and maintain an automated external defibrillator (AED). Provides that the employees of the school district are not liable for civil damages re-sulting from certain uses, attempted uses or non-uses of an AED. Exempts a public school or district, that is in compliance with AED requirements, from civil damage liability.

REPRODUCTIVE ISSUES SB 1135 (JACKSON) - INMATES: STERILIZATION

Prohibits sterilization for the purpose of birth control of an individu-al under the control of the Department of Corrections and Rehabilitation or a county correctional facility. Prohibits any means of sterilization of an inmate, except when required for the immediate preservation of life in an emergency medical situation and when medically necessary to treat a diagnosed condition and certain requirements are satisfied. Requires re-ports of procedures. Relates to notification regarding sterilization.


By Judy Thomas, JD and Mark J Apfel, MD

The new California POLST went into effect on October 1, 2014, and healthcare professionals must take note of key changes to the form.

POLST (Physician Orders for Life-Sustain-ing Treatment) is a physician order signed by both a doctor and patient that specifies the types of medical treatment a patient wishes to receive toward the end of life. POLST is a tool that en-courages conversation between providers and patients about their end-of-life treatment op-tions, and helps patients make more informed decisions and communicate their wishes clearly. As a result, POLST can prevent unwanted or medically ineffective treatment, reduce patient and family suffering, and help ensure that pa-tient wishes are followed.

Most changes to POLST in 2014 are in

Sections B and C, where the order of treatment choices are reversed for consistency now start-ing with most aggressive treatment to least ag-gressive treatment. The POLST Documentation Committee and Task Force also developed goal statements for these sections in order to clarify and help patients better understand treatment options.

All information relevant to the new POLST can be found at http://caPOLST.org/2014polst. There you will find downloadable versions of the new form in English, Armenian, Chinese, Farsi, Hmong, Japanese, Korean, Pashto, Rus-sian, Spanish, Tagalog, and Vietnamese. POLST in braille can be ordered.

A list of upcoming POLST education op-portunities can be found at http://coalitionccc.org/training-events/polst-education.

Previous versions of POLST will still be honored after the 2014 form goes into effect,

however, it is ideal to complete a 2014 version of POLST—and void older versions of the form—when a patient’s POLST is updated.

Healthcare professionals with questions about POLST are encouraged to connect with their local POLST Coalition, see coalitionccc.org, or contact the Coalition for Compassion-ate Care of California at [email protected].

Judy Thomas, JD, is executive director of the Coalition for Compassionate Care of California (CCCC), an attorney who has worked in healthcare for more than 20 years, and is Chair of the National POLST Paradigm Task Force.

Mark J Apfel, MD, is medical director of Anderson Valley Health Center in Boonville, CA, and serves on the California POLST Physician Leadership Council.

POLST in 2014: What Health Care Professionals Need to Know

PRACTICE MANAGEMENT


Announcing a new Silicon Valley spine center option for those wanting freedom from back and neck pain

CAMPBELL LOCATION3425 S. Bascom AvenueSuite ICampbell, CA 95008

ATHERTON LOCATION3351 El Camino RealSuite 200Atherton, CA 94027

appointments & referrals: 408-377-3331SanJoseNeurospine.comonline spine encyclopedia at:

We provide a free 36-page Home Remedy Book that includes symptom charts that show when to see a doctor; home remedies; stretches that can relieve pain symptoms; and exercises that make the back stronger, more flexible and resistant to future strain. Call us, or email us at [email protected], and we’ll send 10 copies to your office for your patients. Our educational Internet presence at SanJoseNeurospine.com also has educational videos, medical illustrations, information on minimally invasive spine surgery options and a referral form.

Physician Profile

Home Remedy Book

View our video library to learn more about our practice online at:SanJoseNeurospine.com/videos

We’re pleased to announce a new option for back and neck pain patients: San Jose Neurospine, which began seeing patients in early September through its offices in Campbell and Atherton. The spine center includes the expertise of Adebukola Onibokun, MD, a board-certified neurological surgeon who specializes in minimally invasive spine surgery. Over his career, he has done more than 2,000 successful surgeries. Dr. Adebukola Onibokun emphasizes a conservative approach to the care of his patients and encourages non-surgical treatment first. Some of these non-surgical treatment options for back and neck pain can include pain relieving spinal injections that reduce inflammation around a nerve root and spine-specialized therapy which increases the flexibility of the back, strengthens muscles and ligaments and reduces likelihood of future strain. In this regard, he works very closely and collaboratively with outside pain management specialists and therapists to coordinate non-surgical treatment options. If non-surgical options fail, or when symptoms progress to weakness/numbness in an arm or leg, the center uses minimally invasive spine surgery techniques that enable most patients to be home later the same day.

San Jose Neurospine includes the expertise of Adebukola Onibokun, MD, a board-certified neurological surgeon who specializes in minimally invasive spine surgery. Dr. Onibokun (pronounced “Oh-knee-bow-kun”) is Board Certified by the American Board of Neurological Surgery and is a fellow of the American Association of Neurological Surgeons. Dr. Onibokun received his medical degree from the prestigious Northwestern University Medical School, graduating with honors. He then completed 7 years of Neurosurgery Residency training at UCLA Medical Center, a program that consistently ranks as one of the top five neurosurgery programs in the country. Dr. Onibokun has previously served as Chief of Neurosurgery at Elmhurst Memorial Hospital in the Chicago area, where he established their Minimally Invasive Spine Surgery program. Prior to relocating to California, he was a Health System Clinician at the Northwestern Medicine Regional practice.

Adebukola Onibokun, MDBoard-certified Neurological Surgeon

MIS Lumbar Discectomy& Posterior Cervical DiscectomyThis procedure is done by making a small 1-inch incision over the herniated disc and inserting a tubular retractor. Then the surgeon removes a small amount of the lamina bone that allows the surgeon to view the spinal nerve and disc. Once the surgeon can view the spinal nerve and disc, the surgeon will retract the nerve, remove the damaged disc, and replaces it with bone graft material.

MIS Lumbar FusionA minimally invasive lumbar fusion can be performed the same way as traditional open lumbar fusion, either from the back, through the abdomen, or from the side.

Lateral interbody fusion (LIF)A lateral interbody fusion, often used to treat spondylolysis, degenerative disc disease and herniated discs, is performed by removing a disc and replacing it with a spacer that will fuse with the surrounding vertebra. The procedure is completed on the side of the body in order to reduce the effect on the nerves and muscles.

Posterior cervical microforaminotomy (PCMF)A PCMF is performed to help relieve pressure and discomfort in the spine by making a small incision in the back of the neck and removing excess scar tissue and bone graft material.

Anterior cervical discectomyAn anterior cervical discectomy is used to reduce pressure or discomfort in the neck by removing a herniated disc through a small incision in the front of the neck. The space is then filled with bone graft material and plates or screws may be used to increase stability.

Artificial Disc ReplacementArtificial disc replacement is intended to be an alternative to spinal fusion surgery. Unlike a fusion that locks the two vertebrae in place, an artificial disc retains movement in the spine by simulating the natural rotational function of the disc.

Minimally invasive spine surgeries performed


How one “prick of conscience” launched a 12-year fight for fair

geographic payments for Medicare physicians

By Elizabeth Zima, CMA Staff WriterIn 2002, Larry De Ghetaldi, MD, met with his

Congresswoman, Anna G. Eshoo (CA-18), to see if he could enlist her help in changing the way that Medi-care reimbursed physicians in Santa Cruz County.

Something was wrong with the Medicare geo-graphic payment regions tied to the reimbursement formula known as the Geographic Practice Cost In-dex (GPCI). In his own Santa Cruz County, physi-cians were paid by Medicare approximately 20% less than in the next county north, Santa Clara, while the cost of providing care in both counties was essential-ly the same. The reason? Santa Cruz County was des-ignated as “rural,” while Santa Clara County was not.

In fact, the sixth largest city in the United States, San Diego, was also designated by Medicare as rural. Consequently, physicians seeing Medicare patients in San Diego were paid about 10% less than physi-cians in neighboring Orange County.

Since the 1990s, hospitals have been paid ac-cording to the local costs in their Metropolitan Statistical Areas (MSAs). The MSAs are defined by the federal Office of Management and Budget and annually updated by the Centers for Medicare and Medicaid Services (CMS), so that reimbursement accurately reflects local costs to deliver care. But for physicians, CMS used county-based localities, and these localities have not been updated in 17 years. As a result, 14 recently urbanized California counties, such as San Diego, Santa Cruz, and Sacramento, were still designated as rural. This caused many California physicians to be paid up to 13% per year below what Medicare says they should be paid if they were cor-rectly classified.

Because physicians were paid less in Santa Cruz County, Dr. De Ghetaldi noted that many Medicare patients were having problems finding physicians to care for them. In fact, no physician group in Santa Cruz was accepting new Medicare patients.

For this reason, he asked Congresswoman Es-hoo to help him convince CMS to reconsider the pay-ment regions it used to reimburse doctors.

“This was a week after Congress voted to go to war in Iraq,” Dr. De Ghetaldi said. “We had already spent several hours with CMS trying to get them to change the formula, but they had little incentive to do so.”

After explaining the issue to Eshoo, she told him: “Larry, it is easier to go to war, than to change this. We will leave Iraq before this fix is in place.” She said it with such certainty that Dr. De Ghetaldi was stunned – he didn’t want to believe that she was cor-rect.

THE LONG HAULWhat followed was a 12-year odyssey that in-

cluded divisive debates within the California Medi-cal Association (CMA) House of Delegates (HOD); changes in administration from the Bush White

House to the Obama White House; several changes in leadership of key congressional committees and their staff; innumerable frustrating meetings be-tween CMA and CMS; and countless rounds of re-lentless Congressional lobbying by CMA leadership.

What began for Dr. De Ghetaldi as a “prick of conscience” about the lack of care for seniors in his county became an obsession. He, in turn, found a small cadre of activists who formed a team that could not look away from what turned out to be a problem for the whole country – the fact that many areas that CMS had judged as rural in 1997 had become more urbanized with changing costs and demographics, but had not been updated to accurately reimburse physicians. This, in turn, was stymieing seniors from getting the care they needed. It was a huge national problem, and unconscionable that CMS had not kept pace with physician payments.

The team for the long haul was composed of physicians, lobbyists, and Members of Congress and their staff. The key players that took the issue from the CMA HOD floor to the national stage included Dr. De Ghetaldi; Edward Bentley, MD; Theodore Mazer, MD; Representative Sam Farr (D-Monterey, Santa Cruz) and his chief of staff, Rochelle Dornatt; and Elizabeth McNeil, CMA Vice President of Fed-eral Government Relations.

Dr. Bentley, an internist with a specialty in gas-troenterology, was president-elect of the Santa Bar-bara Medical Society in 2002 when he became aware of the GPCI locality issue. “I had been in practice in Ventura County, so I knew that reimbursements were lower (in Santa Barbara County).” But, he didn’t know why.

“I approached Dr. George Wolf [a CMA del-egate] from Santa Cruz County and asked him to put forward a resolution asking CMA to do something about the problem,” said Dr. Bentley. This caused a ruckus the first time the motion was introduced at HOD. “It was a divisive resolution,” he said. Part of the problem was that CMS required that the fix be ac-complished in a budget-neutral way. Unfortunately, this meant that in order to raise reimbursement lev-els for the underpaid counties, other counties would have to foot the bill.

To get to some agreement on the issue, a CMA task force was formed. It was headed by current CMA President, Richard Thorp, MD. “He lived in a county that benefitted from the locality arrangement that had been established by CMS, so he was in a difficult position,” said Dr. Bentley. Trying to put together a compromise that would gain consensus from all counties turned out to be so contentious it took three years to pass through the HOD.

When the task force looked at the issue, there were “clear winners and losers.” The other require-ment CMS had for action on this issue was that there had to be 100% approval from the state medical as-sociation to make changes.


For McNeil, who says a substantial part of her job at CMA for the past 12 years has been focused on a solution to the locality problem, the CMS requirement for consensus was a tactic to discourage change. But, instead, she says, it served to galvanize the group to come up with a solution for the state that would promote una-nimity and justice in payments.

What CMS had wrought when it created the California localities in 1966, and further distorted them in 1997, was a mishmash of counties grouped together. In 1997, Locality 99 was comprised of 47 rural counties, but over the last decade at least 13 had become more urban. Payments for all counties within Locality 99 are averaged, which produces inaccurate payments not based on local costs to provide care. CMS had failed to keep pace with the changing de-mographics.

“Our objective (in the task force) was to im-prove the accuracy of the payments,” said Dr. Bentley. It turned out to be very hard to do because Medicare is a budget-neutral program, where any payment change produces winners and losers.

While the task force worked on a solution to the problem, the group had restarted talks with CMS to see if it would take into consideration some creative plans to refine the payment regions.

CMA, Rep. Farr, and Dornatt started working with the powerful then-Chairman of the House Ways and Means Committee, Representa-tive Bill Thomas (R-Bakersfield). He fully agreed with CMA about the problem and said he would help to fix it. Yet year after year, he stalled any action on a fix.

In 2003, during markup of the Medicare Part D bill in the Ways and Means Committee, Rep. Farr tried to introduce language to fix the locality problem, but Rep. Thomas blocked the move. It was then that the “famous $100 bet” was struck on the House floor. Frustrated and ready to take a swing at Thomas, Farr instead bet Thomas that he would never permit a solution to the locality problem in California to pass. Thomas took the bet, telling him he would get it through. When Thomas retired in 2007, he made good on the bet, paying Farr $100.

Meanwhile, the CMA task force had achieved near consensus across the state that all California physicians would take a one-time, 1% cut to pay for the update without harming the rural physicians. “We presented the idea to CMS and their lawyers were afraid they would get sued. So we proposed a pilot project that had to go through public hearings, but CMS wouldn’t budge,” said McNeil.

In 2005, CMS proposed to update the payment regions and thus, the payments for the most harmed counties in California — Santa Cruz and Sonoma counties. The announcement disappointed doctors in other im-pacted counties and created angst throughout CMA membership because some physicians would see a small payment cut. The proposed regulation died because there wasn’t 100% consensus within CMA. “I thought CMA’s failure to reach consensus on this proposal was a real set-back, because we could have updated a few counties every two years until all were updated,” McNeil lamented. “We might have actually gotten it done before 2014!”

DEAD ENDThe group had reached a dead end. “We had tried the regulatory path

and then realized the only way to solve it was through an act of Congress,” said Dr. Bentley. CMS can only change payments in a budget-neutral man-

ner with winners and losers, so any change that holds rural physicians harmless from cuts requires additional funding and Congressional action.

Up to this point, CMS had been keeping private its cost inputs for the locality payments. In 2004, a staffer leaked the information to Dr. Bent-ley. He quickly went through the data and discovered that this problem was not confined to California. “The payment disparities were a national problem,” he said.

Working with CMA, Rep. Farr introduced several bills over the com-ing years, some with his Republican counterpart Representative Brian Bil-bray (R-San Diego), but nothing moved. CMA tried to educate the other negatively impacted state medical associations and get them on board. “It was like herding cats,” McNeil recalls. “It was an extremely difficult pro-cess. In the end, we were afraid it would take more time to bring on 10 medical associations than it would take to get the bill through Congress for California only.” In the 2014 legislation that ultimately passed, CMA attempted to insert a national study to help the other states. But in the end, Congress only chose to help California.

Rep. Thomas did, however, do the group one favor. Before he retired, he asked the U.S. General Accounting Office (GAO) to study the prob-lem. In 2006, Drs. Bentley and De Ghetaldi prepared a white paper for the Medicare Payment Advisory Commission (MedPAC), an independent body established to advise Congress on Medicare payment issues. “They acknowledged the problem,” said Dr. Bentley. The same paper was pre-sented to the GAO who took up the problem and studied it. “The GAO issued a report that validated our white paper,” he added.

In 2008, when California Representative Pete Stark (D-Fremont) be-came Chair of the House Ways and Means Subcommittee on Health, he (at the urging of Rep Farr, CMA, and other representatives) included a Cali-fornia GPCI solution in the Children’s Health and Medicare Protection (CHAMP) Act, which passed the House in 2008. He used the GAO report to justify its inclusion. Unfortunately, it did not pass the Senate.

Another turning point came in 2009, when CMA hosted a Congres-sional “GPCI Summit” between the House, Senate, CMS, and MedPAC. All of the House and Senate committee leaders were in a neutral meeting place in the basement of the Capitol. This summit is where CMA started to gain general buy-in that the problem needed to be fixed, particularly from the Senate. In 2010, both Drs. Bentley and DeGhetaldi were invited to tes-tify on behalf of CMA before the Institute of Medicine (IOM). “We pre-sented the white paper,” said Dr. Bentley. “I presented the data that dem-onstrated the payment inaccuracies. The IOM took our presentation and

the white paper and refined it.” The IOM report con-firmed the locality problem and recommended the CMA proposed solution to move localities to Metro-politan Statistical Areas consistent with the hospital payment regions. It was at this point that Congress began to really listen to the group. “When you have the backing of the IOM, the GAO, and MedPAC, they will listen,” Dr. Bentley said.

In 2009-10, Chairman Stark inserted the Cali-fornia locality update into the House’s version of the Affordable Care Act (ACA). The House passed it, but the Senate version did not include the fix. Although the GPCI fix was adopted during the House-Senate Conference Committee on health care reform, when the Senate Democrats lost the majority, Congress was eventually forced to accept the Senate version of the bill without the California GPCI provision. “I felt like a beaten dog, at this point,” said Dornatt. But the problem was still there. “Doctors were still coming in the door [complaining]; and beneficiaries com-plained they could not find doctors to care for them.”

STARTING OVERThe group started over again looking for a solu-

tion that would pass both Houses of Congress. The Senate had been extremely critical of a California-only solution. Some called it the “California gold rush.” CMA and Rep. Farr enlisted the help of Repre-sentative Darrell Issa (R-San Diego). Issa, the power-ful Chairman of the House Oversight and Govern-ment Reform Committee, agreed to work with Farr to push their respective leaders to include the GPCI fix in any budget or Medicare legislative packages moving through Congress.

At the same time, California Senator Dianne Feinstein found a California-only funding source for the locality legislation that would diminish the California “pork barrel” criticisms. Unfortunately, after the passage of the ACA, Congress became even more dysfunctional; the only Medicare bills mov-ing through Congress were the last-minute Medi-

care sustainable growth rate (SGR) short-term patch bills. Congressional leadership told the CMA team that no new policy issues would be included in those patch bills, which once again nixed CMA’s chances to achieve California locality reform in 2011 and 2012. However, that didn’t stop Farr and CMA from try-ing.

In early February of 2013, both the House and Senate began working on bills to solve the Medicare SGR issue. In 2012, the Republicans took control of the House with new leadership. Representative Kevin McCarthy (R-Bakersfield), who had replaced his mentor, Bill Thomas, became the House Majority Whip. Under his leadership, the House Republican Committee leaders renewed the call to fix the SGR. Their Democratic predecessors in the House had re-pealed the SGR twice, only to fail in the Senate. “We knew that both the House and the Senate wanted to fix the SGR because the cost of the fix had dropped dramatically,” Dornatt said. “The Medicare bill was intended to be a comprehensive payment reform bill, so we knew we had a shot at getting the California locality reform in,” said McNeil. Dornatt and Mc-Neil began to push for the insertion of a GPCI fix for California. The proposal updated the California Medicare physician payment regions. It increased payments in the new urban areas and prevented pay-ment reductions to California rural physicians, by using a hold harmless provision that was financed with administrative savings from the formation of a Medicaid County Organized Health System in Al-ameda County.

But, said Dr. Bentley, “no one likes to do a one-state deal; it is considered pork. This was a sensitive issue, and we were trying to run under the radar.”

Several committees in both the House and Sen-ate were working on an unprecedented bipartisan, bicameral solution to the Medicare payment reform issue. With the help of Rep. Henry Waxman (D-Los Angeles), who was the Ranking Democrat on the House Energy Commerce Committee, and Com-

mittee Chair Fred Upton (R- Michigan), Dornatt and McNeil managed to insert language to update the California localities into the bipartisan Energy and Commerce Medicare SGR payment reform legislation (H.R. 2810), which unanimously passed the Committee on July 31, 2013.

“We were frantically still negotiating language the morning of the mark-up,” recalled McNeil. “And we were literally one of the last amend-ments accepted into the bill. It was incredibly stressful. I knew we had to get GPCI into the first policy committee bill. Otherwise, we would be fighting an uphill battle the rest of the way, particularly going into the Senate.”

This version of the locality update was a compromise between Reps. Upton and Waxman. It was based on legislation proposed by Reps. Farr and Issa. House Majority Whip Rep. McCarthy was key to the agreement, with CMS also stepping in to assist. California Energy Commerce Com-mittee members Reps. Anna Eshoo, Lois Capps, and Doris Matsui, who all have impacted districts, also helped to push the solution.

DOING THE UNTHINKABLEIn the fall of 2013, it looked like Congress would do the unthinkable

— solve the flawed Medicare SGR. Two other powerful committees were expected to introduce versions of the SGR bill: the House Ways and Means Committee and the Senate Finance Committee. “There was unprecedent-ed unanimity in Congress that the time was now to fix the Medicare reim-bursement problem,” said McNeil.

While the SGR reform policy bill passed out of these committees be-fore the winter holidays, there was no consensus on how to pay for it. The House Republicans and the Senate Democrats couldn’t agree on the fund-ing sources, so they passed a policy-only bill.

On February 7, 2014, the three congressional committees announced a final joint bipartisan, bicameral agreement on the Medicare SGR repeal and payment reform legislation, H.R. 4015/S. 2000. Now Congress just needed to marry the policy to the funding sources to the tune of $150 bil-lion.

The California GPCI fix had made it into the final compromise bill, and the group worked feverishly to get the bill passed. But as the SGR deadline grew closer, the group realized there would be no compromise on the funding sources, and that Congress would yet again — for the 17th time in a decade — pass a short-term patch to stop the double-digit SGR reimbursements cuts. McNeil and Dornatt swung into action to see if they could at least insert the California GPCI fix into the patch legislation.

“When we knew there was the potential for a patch, we went to the top players in the House and Senate to get the California GPCI into it,” McNeil said. “Because of our lobbying efforts over the years, our relationships with the Congressional leadership and the committee staffers, they legitimately listened and were interested in helping.”

“However, a special California provision would never make it into such a small bill, so we had to find a larger, more national argument,” said McNeil “When the Committee staff revealed to us that the SGR patch bill would include an extension of the national Medicare work GPCI payment floor, I knew we had an angle.”

Nearly every other state in the country, except California, benefits from the work GPCI payment floor, so if physicians in other states were receiving an extension, McNeil and Dornatt argued that Congress should do something to help California phy-sicians and patients.

“California doesn’t benefit from the work GPCI floor because our localities are so out of whack,” said McNeil. “We urged GPCI payment parity for California and, incredibly, the

leaders agreed. It was incredible!” One day before the patch bill was up for a vote, McNeil was given a

heads up that the California GPCI fix was in the legislation. “CMA didn’t want the SGR patch; we wanted comprehensive reform,

but we wanted the GPCI fix to come through. CMA was incredibly con-flicted,” she said.

Dr. DeGhetaldi said he felt once again like the San Francisco Giants had won the World Series. “I felt chills when I watched the Senate vote,” he said. Then he went numb. He decided he couldn’t celebrate what had been a long, hard-fought battle, until President Obama signed the measure into law.

Dr. Bentley felt the same way. “Every time we thought it was a done deal, something happened at the last minute to prevent its passage. After so many years, you somehow don’t believe it is actually happening. I was preparing myself for more work.”

In the end, Dr. De Ghetaldi said, Eshoo was right. “It took us much longer than the Iraqi war to pass the fix.”

The GPCI fix was ultimately signed by the president and requires the reimbursement formula to be calculated based on same Metropolitan Sta-tistical Areas used to pay hospitals, which more accurately reflect the cost of practicing medicine. The higher payments will be phased in over a six year period starting in 2017.

McNeil says, she has to take the long view on some of the issues she works on. “It takes at least five to 10 years to pass a bill through Congress. Especially if it is a new idea and only affects a subset of people, so I suppose we are on track. This is a particularly sweet victory because it was so dif-ficult and achieved during one of the most contentious times in Congress. This was a hard-won geographic formula fight between physicians, involv-ing an agency that never takes risk, a dysfunctional Congress, and a state unpopular in Congress that was singled out for assistance. The odds were definitely against us. But CMA was fortunate to have a team of wise and relentless physician leaders who never gave up.”

“It is safe to say that everyone on Capitol Hill is grateful and relieved that they will never hear CMA utter the word ‘GPCI’ ever again,” laughs McNeil.



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Freestanding medical/retail building in shell condition. High traffic location with easy access to Hwys 280 & 17. Fantastic visibility.

14,000 SF FOR SALE 980-1,305 SF FOR LEASE/SALE 14,040 SF FOR LEASE/SALE 10,720 FOR SALE

560 S. Bascom Ave, San Jose 4155 Moorpark Ave, San Jose 3431-3439 De La Cruz Blvd, Santa Clara 1110-1118 Elko Dr, Sunnyvale

Theatre/auditorium + 4,200 SF of retail space. High visibility & traffic location. Close to Valley Medical Center, San Jose City College.

Building size: 20,462 SF. Great medical/dental location at Saratoga Ave & Moorpark Ave. Convenient access to Hwy 280.

Owner-user opportunity in a rare multi-tenant Flex/R&D building. Multiple entrances, grade level doors, flexible zoning.

Lot: 20,000 SF. Hard to find multi-tenant industrial flex/warehouse. Owner-user opportunity. Qualifies for SBA financing.

690 Saratoga Ave | Suite 200 | San Jose, CA 95129 408-217-6000 T | 408- 457-8803 F

www.HealthMedRealty.comLic. 01902032

scan me to see

our latest availabilities

HealthMed Realty is a Full-Service Commercial Real Estate Firm specializing in Medical & Dental Real Estate. Put our experience on your side and we will save you time and money. Call us today! (408) 217-6000

Do you have an office EMERGENCY?Call us at (408) 217-6000


1,020 SF AVAILABLE 811-9,588 SF AVAILABLE 250-1,320 SF AVAILABLE 3,318 SF AVAILABLE

3425 S. Bascom Ave, Campbell 1700 S. Winchester Blvd, Campbell 881 Fremont Ave, Los Altos 825 Pollard Rd, Los Gatos

Excellent corridor for medical/dental or professional office. Elevator served. Easy access to Hwys 17 & 85. Abundant parking.

Building signage & TI available. Elevator served. Abundant parking. Easy access to San Tomas Expressway and Hwys 17 & 85.

Ground floor space in shell condition. Small offices available. (min. divisible ±250 RSF). Close to Loyola Corners District of Los Altos.

Great medical building, steps away from El Camino Hospital Los Gatos. Ground floor unit, TI dollars available.

1,175-4,235 SF AVAILABLE 1,440 SF AVAILABLE 2,600-8,452 SF AVAILABLE 645-2,511 SF AVAILABLE

14830 Los Gatos Blvd, Los Gatos 15000 Los Gatos Blvd, Los Gatos 2930 Aborn Square Rd, San Jose 393 Blossom Hill Rd, San Jose

Brand new office suites in shell condition. Built with the highest quality materials and finishes. TI’s available. Easy access to Hwy 85.

2-story medical/dental office building. Great location with easy access to Hwys 17 & 85. Very close to Good Samaritan Hospital.

Neighborhood shopping center with wide array of retail tenants with Ross Dress For Less anchor.

Modern Class A medical building. Easy access to 85 and 101, and great promotional rate!

1,030-2,680 SF AVAILABLE 5,000 SF AVAILABLE 850 SF AVAILABLE 1,806-1,927 SF AVAILABLE

2242 Camden Ave, San Jose 123 Di Salvo Ave, San Jose 2011 Forest Ave, San Jose 2081 Forest Ave, San Jose

BRAND NEW exteriors, lobby & full ADA upgrades! Located close to Willow Glen, Cambrian & Los Gatos. Easy access to Hwys 880 & 17.

California Mission style building. Space is divisible. Waking distance from O’Connor Hospital. Great access to Hwys 280 & 880.

Medical dental suite available. Close to O’Connor Hospital. Great freeway access. Available NOW. TI’s available.

Medical office building with established tenants located directly adjacent to O’Connor Hospital. Flexible terms.

710-1,557 SF AVAILABLE 2,100 SF AVAILABLE 1.800 SF AVAILABLE 1,200-1,300 SF AVAILABLE

5150 Graves Ave, San Jose 2005 Naglee Ave, San Jose 521 Parrott St San Jose 20445 Prospect Rd, San Jose

Medical suite and fully plumbed dental suite available. Park-like setting. TI improvements available to qualified tenants.

Beautiful turn-key medical suite in the corner of Naglee Ave & Bascom Ave. Brand new interiors. Convenient access to Hwys 17 & 85.

Excellent for medical/dental or professional offices. Great street frontage. Ample power. Turn-key TI’s available.

Medical dental office building in a park-like setting. Fully plumbed suite available. Abundant parking. Easy access to Hwy 85.

1,050 SF AVAILABLE 743-4,332 SF AVAILABLE 2,136 SF FOR SALE 1,590 SF FOR SALE/LEASE

743 S. Winchester, San Jose 877 W. Fremont Ave, Sunnyvale 15055 Los Gatos Blvd, Los Gatos 15195 National Ave, Los Gatos

Medical office available in newer medical/retail center near Santana Row & freeways. New building, must see! TI’s available.

Foothill Medical-Dental Center is a 6 plus acre medical project in the heart of Sunnyvale. Medical & plumbed (dental) suites available.

Medical, dental, or retail uses allowed. Great Los Gatos Blvd location. Easy freeway access to Hwys 85 & 17.

Medical condo with 5 exam rooms, 2 bathrooms, break room, lab area, and 1 stall private garage. Close to Good Samaritan Hospital.

DEVELOPMENT OPPORTUNITY 7,191 SF FOR SALE 2,233 SF FOR SALE 5,872 SF FOR SALE

Saratoga Annex, Saratoga 20640 Third St, Saratoga 105 N. Bascom Ave, San Jose 200 N. Bascom Ave, San Jose

Rare parcel located in downtown Saratoga. Flexible CH-1 zoning allows a variety of residential and commercial uses. Lot size: 2,123 SF.

Rare opportunity to procure the historic Saratoga Barn, a 100% leased, multi-tenant office property. Rebuilt in 2008.

Second floor end unit class-A medical condo. Close to O’Connor Hospital. Great access from Hwys 880 & 280.

Freestanding medical/retail building in shell condition. High traffic location with easy access to Hwys 280 & 17. Fantastic visibility.

14,000 SF FOR SALE 980-1,305 SF FOR LEASE/SALE 14,040 SF FOR LEASE/SALE 10,720 FOR SALE

560 S. Bascom Ave, San Jose 4155 Moorpark Ave, San Jose 3431-3439 De La Cruz Blvd, Santa Clara 1110-1118 Elko Dr, Sunnyvale

Theatre/auditorium + 4,200 SF of retail space. High visibility & traffic location. Close to Valley Medical Center, San Jose City College.

Building size: 20,462 SF. Great medical/dental location at Saratoga Ave & Moorpark Ave. Convenient access to Hwy 280.

Owner-user opportunity in a rare multi-tenant Flex/R&D building. Multiple entrances, grade level doors, flexible zoning.

Lot: 20,000 SF. Hard to find multi-tenant industrial flex/warehouse. Owner-user opportunity. Qualifies for SBA financing.

690 Saratoga Ave | Suite 200 | San Jose, CA 95129 408-217-6000 T | 408- 457-8803 F

www.HealthMedRealty.comLic. 01902032

scan me to see

our latest availabilities

HealthMed Realty is a Full-Service Commercial Real Estate Firm specializing in Medical & Dental Real Estate. Put our experience on your side and we will save you time and money. Call us today! (408) 217-6000

Do you have an office EMERGENCY?Call us at (408) 217-6000


MEMBER SPOTLIGHT

Robert G. Aptekar, MD in Phnom Penh, CambodiaBy Susan Weiss

Robert G. Aptekar, MD, a practicing or-thopedic surgeon for more than 38 years in Los Gatos, CA, travels annually to Phnom Penh, Cambodia, to work at Children’s Surgical Cen-tre, a charity hospital. I had the privilege of ac-companying him in January 2013, the fourth trip, to document his work and the community in which he works.

Currently, there is no health insurance sys-tem in Cambodia, one of the poorest countries in the world. The country suffered greatly for 30 years under the brutal regime of Pol Pot. By executing most health care workers, including physicians, he left a legacy of a greatly reduced medical system. The country is working to im-prove its standards and depends on the gener-osity and efforts of outside health care profes-sionals.

Children’s Surgical Centre (CSC), a non-profit, non-governmental, and non-religious hospital was founded, in 1998, by Dr. Jim Gol-logly, a British orthopedic surgeon. Dr. Gollogly originally came to Cambodia, in 1995, to work

with the American Red Cross to help land mine victims and returned three years later to estab-lish the hospital to improve the quality of life for children and adults by providing free health care to the entire population.

Dr. Aptekar met Dr. Gollogly on a trip with Health Volunteers Overseas at another hospital and was invited to work at CSC in the future. He saw it as an opportunity to treat conditions not usually seen in this country, provide service to the local population, and train the local sur-geons to carry on the work in the future. CSC now offers medical services in orthopedics, op-thalmology, plastic surgery, fistula repair, and other areas including affiliation with Cambodi-an Acid Survivors Charity. If CSC did not exist, most of the population would not get advanced medical and surgical treatment.

Dr. Aptekar primarily performs total hip replacement surgery when at CSC. This work dramatically improves the lives of people who have severe hip conditions and limited mobility, whether from arthritis or trauma. He is there for one week and performs up to four surgeries

a day. This is the only opportunity for surgery of this type for patients who come from all over the country for the procedure. During the surgery, he is also training the medical staff who will be able to operate independently in the future, de-livering these services to the previously under-served population. His surgical patients are pre-screened throughout the year and those chosen wait for his arrival in January. Dr. Aptekar car-ries implants, donated through the organization Americares, with him for the surgeries, as those made in other Asian countries are inferior and the hospital cannot afford to purchase implants manufactured in western countries.

The day begins at 8:00 a.m. at the open clinic, with the entire professional staff of about 50 in attendance, when patients arrive for a medical diagnosis and surgeries for the day are reviewed. The hospital treats a range of surgi-cal problems. They have come from all parts of Cambodia with their families, who care for them during their hospital stay, living on the hospital grounds. The hospital provides free meals and clean drinking water for both the pa-

Humanity in the

Modern World


tients and their caregivers.Once a diagnosis has been made, the patients are sent to the appropri-

ate departments for their treatment. Dr. Aptekar’s pre-screened patients are prepped for surgery. The rest of his day is spent in surgery and post-operative care.

Being a charity hospital, CSC looks for financial support from many sources in order to provide free services to the population. Patient surgi-

cal profiles are posted on the website www.watsi.org to look for crowd-sourced funding. Private donors also make contributions to the hospital foundation. The difficulty of obtaining funding impacts the availability of new equipment and replacement supplies. Shortly after our visit, the physical therapy building had a major fire and was completely destroyed.

At the time, they did not know if they would be able to rebuild the facility. The photographs in this article highlight moments during the week,

including Dr. Aptekar in clinic, surgery, and rounds, plus other depart-ments and patients with their families. The complete work will be on dis-play at the Commonwealth Club in San Francisco in January, 2015. Dr. Aptekar and I will present the work in a lecture on January 14, 2015 at 6:00 p.m. Check with the Commonwealth Club for location. Dr. Aptekar is

now planning a volunteer trip to La Paz, Bolivia in 2015. I will be traveling with faculty from UNC dental school to Moldova, where they work with orphans and elderly patients.

Dr. Robert Aptekar has been a practicing orthopedic surgeon for over 38 years. He attended John Hopkins for pre-medical training, University of Michigan for medical school, and Stanford for his internship and residency. He is a member of many medical societies and has won many awards throughout his career.

Susan Weiss received a BA degree from the University of Michigan, has an MA degree from

Mills College and a MFA degree from San Francisco Art Institute. She began her artistic career after retiring as a Vice President from First Interstate Bank. This will be her second show at the Commonwealth Club. “Service Unquestioned,” the first show, documented military families during a deployment to Iraq and Afghanistan. You can see more of her work at www.susanweissart.com.

A newborn in the pediatric ward

Dr. Aptekar in surgery

Examining patients in the medical ward

Dr. Aptekar during a post operative examination

Evaluating a patient in the clinic

Thank You to SCCMA SAC-PAC Contributors

The SCCMA PAC is dedicated to advocating for policies and candidates who support the goals and ideals of the SCCMA and its physician community. SCCMA extends a huge thank you to the many members listed below who have made contributions to SAC-PAC (Santa Clara County Medical Association’s Political Action Committee) for the 2013-2014 fiscal year (as of September 29, 2014). SCCMA genuinely appreciates your commitment to defending and protecting MICRA.

$10,000Randal Pham

$150Peter AbaciCameron Oba

$75J Augusto BastidasScott BenninghovenElwyn CabebeJuan CarrilloMichael CharneyRichard CherlinJeffrey CoeJames DavillaKaren DevichLeonard DoberneChristine DoyleMartin FishmanBrandt ForemanDavid FranciscoPeter FungMichael Gold

John HeringerKristina HobsonDaryl HoffmanMark KenterFrancis KochStuart KrigelAndrew LanAmi LawsPeter LevinWilliam LewisEdward LittlejohnJohn LongwellEleanor MartinezRobert MarxJoseph MasonJohn MasseyJennifer Maw

William McCallumAndrew MenkesPrasanna MenonMichael MurrayMichael NagelSuresh NayakVinh Quy NguyenF Richard NoodlemanLewis OsofskySamuel PearlDennis PennerMark PennerJames PetrosBernard RechtMarshal RosarioBassam SaffouriHussein Samji

Randall SeagoVincent SeidJulia ShuleshkoNeal SlatkinMark SnyderTanya SpirtosR Lawrence SullivanErnest ThomasHugh WalshWilliam WaterfieldWaldemar WennerByron WilsonSusan WilturnerChi-Kwan YenTakashi YoshidaChristo Zouves



Breathe Again !!

Bacterial Infections / SinusitisCulture directed treatmentFunctional Endoscopic Sinus

SurgeryOrbital Decompression / Graves’

DiseaseImage Guided Surgical NavigationRevision - complex casesFrontal SinusitisAdvanced Endoscopic TechniquesSinuplastySinus Surgery WITHOUT packingNasal Obstruction / SeptoplastyAllergic Fungal SinusitisSinonasal Tumors / PolypsSmell / Taste problemsCSF leak repairsMucoceles / AbscessesIn-Office CT ScannerUrgent appointmentsJoint care: ENT - Allergy -

Pulmonary

CALIFORNIA SINUS CENTERS

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& InstituteWe CARE for:

Karen Fong, MD

Winston Vaughan, MD

Atherton (Stanford area)

Walnut Creek (East Bay)

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CA-Sinus.indd 1 11/15/13 2:54 PM


Highlights From AMA’s 2014 Interim Meeting

The nation’s physicians gathered at the 2014 American Medical As-sociation (AMA) interim meeting in Dallas, Texas, this past month. The delegates debated a large number of resolutions, establishing new policies related to the worldwide Ebola epidemic, expanded network access for the Affordable Care Act, and electronic health records. A number of these resolutions were put forward by the California delegation. Below are high-lights of some of the resolutions adopted as policy.

Ebola: Resolution 925 put forth by the California delegation was in-corporated into AMA policy that calls on AMA to strongly support U.S. and global efforts to fight the Ebola epidemic and support health care workers and volunteers that are fighting Ebola worldwide. The policy also supports the use of quarantine and isolation when it is based on science and asks AMA to make emergency recommendations on Ebola for the medical community and the general public.

Adequate Networks for Patient Access, Choice: AMA adopted poli-cy that calls for health insurers to make updates to their provider networks prior to the open enrollment period begins each year to avoid patient con-fusion. The policy also reiterates the need for health insurers to provide patients with an accurate, complete directory of participating physicians through multiple media outlets. These lists also should identify physicians who are not accepting new patients.

Medicaid Enhanced Rates: The AMA delegates adopted policy (Re-port 7) that requires AMA to advocate for the Affordable Care Act’s Med-icaid primary care payment increases to continue past 2014 in a manner that does not negatively impact payment for any other physicians.

AMA Promotion of Improved Electronic Records: The delegates passed a resolution (210) that asks AMA to continue advocating with the Centers for Medical & Medicaid Services (CMS) for a halt to meaningful use penalties.

Hospital Sponsored Electronic Health Records: The delegates re-ferred for study a California resolution (825) that asked AMA continue to urge Congress and the CMS to mandate that all EHR systems be interop-erable, and to require hospitals to protect physician rights to control and have access to their patients’ medical records. The resolution was referred so that current regulations, practices, and legal implications could be re-viewed.

Preventing Drug Manufacturers from Restricting their Distri-bution Networks: AMA reaffirmed policies D-110.993, H-110.992, and H-110.998 in lieu of California resolution 229 that asked the AMA to op-pose attempts by drug manufacturers and distributors to increase profits by restricting the distribution of their medications. The resolution also

asked AMA partner with the American Hospital Association, the federal government, and other interested parties, to oppose Genentech’s plan to restrict the distribution of its products as a restraint of trade.

Facilitating Multiple State Licensure: AMA delegates voted to sup-port the Federation of State Medical Boards compact designed to facilitate a speedier medical licensure process with fewer administrative burdens for physicians seeking licensure in multiple states (Report 3). The com-pact includes model legislation to make it easier for physicians to obtain licenses in multiple states while providing access to safe, quality care. The California Medical Association will be working with the Medical Board of California to review the compact and determine the best course of action in our state.

Cannabis: The delegates adopted a resolution (213) asking AMA to encourage model legislation to put a warning on all cannabis products not approved by the U.S. Food and Drug Administration that says: “Marijua-na has a high potential for abuse. It has no scientifically proven, currently accepted medical use for preventing or treating any disease process in the United States.” The resolution also urges legislatures to delay full legaliza-tion of any cannabis product until further research is completed on the public health, medical, economic, and social consequences of chronic use of cannabis.

More news from the AMA Interim Meeting is available on the AMA website at www.ama-assn.org.

AMA INTERIM MEETING


Samaritan Internal Medicine is

partnered with University HealthCare

Alliance, Stanford Hospital & Clinic’s

medical foundation. The structure allows

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Santa Clara County Medical Association700 Empey Way • San Jose, CA 95128 • 408/998-8850 • FAX 408/289-1064

November 2014

TO: All Members, Santa Clara County Medical Association (SCCMA)

FROM: Eleanor Martinez, MD, Chair, 2014-2015 Awards Committee

At the 2015 Medical Association’s annual banquet, the association will honor several individuals with its perpetual awards. These awards are significant honors which reflect the respect, recognition, and appreciation of our membership. The recipients are selected from among our outstanding members who have distinguished themselves with extraordinary service to medicine in general, to the association, to the community, or to medical education. Selections are made by the Awards Committee, with the aid of input from the membership at-large. Your suggestions for recipients for each of the awards, outlined on the next page of this memo, will be appreciated.

Please complete the form below to submit suggestions, keeping in mind the requirements for each award as listed on the opposite page. If you would like to nominate more than one person, or for more than one award, please photocopy this form or send a letter.

Suggestions must be received by February 16, 2015. Thank you for your recommendations.

If you previously suggested a candidate who was not given an award, please feel free to resubmit that name.

I THINK _____________________________________________________ WOULD BE A GOOD CANDIDATE FOR THE

_____________________________________________________________________________________ . (Name of Award)

PLEASE ATTACH ALL SUPPORTING INFORMATION, INCLUDING ACCOMPLISHMENTS AND CONTRIBUTIONS

THAT WILL HELP THE AWARDS COMMITTEE EVALUATE THE CANDIDATE FOR THE AWARD SELECTED. YOU

MAY MAIL, FAX, OR EMAIL THE INFORMATION TO PAM JENSEN AT SCCMA.

SUBMITTED BY: _________________________________________________________________________________ MD

(Please print)

MAIL FORM TO: SCCMA Attn: Pam Jensen 700 Empey Way San Jose, CA 95128EMAIL: [email protected]: 408/289-1064DEADLINE: February 16, 2015


ROBERT D. BURNETT, MD LEGACY AWARDFor a physician member of the Medical Association who has demonstrated extraordinary visionary leadership, tireless effort, selfless long-term commitment, and success in challenging and advancing the health care community, the well-being of patients, and the most exalted goals of the medical profession. The only four recipients of this award are Robert D. Burnett, MD, Philipp Lippe, MD, Robert Pearl, MD, and Sharon Levine, MD.

BENJAMIN J. CORY, MD AWARDFor a physician member of the Medical Association who has displayed forward-looking, pioneering ideas, enterprise, enthusiasm, and prolonged professional stature and ability.

AWARD FOR OUTSTANDING ACHIEVEMENT IN MEDICINEFor a physician member of the Medical Association who, during his/her medical career, has made unique contributions to the betterment of pa-tient care, for which he/she has achieved widespread recognition. Consideration shall be given to research and/or the development of procedures, methods of treatment, pharmaceutical agents, or technological advances in the field of medicine.

AWARD FOR OUTSTANDING CONTRIBUTION TO THE MEDICAL ASSOCIATIONFor a physician member of the Medical Association who has exhibited sustained interest and participation in one or more activities of the Associa-tion over and above that expected of the membership at-large.

AWARD FOR OUTSTANDING CONTRIBUTION IN MEDICAL EDUCATIONFor a physician member of the Medical Association who has exhibited sustained interest and participation in one or more medical education activi-ties over and above that expected of the membership at-large.

AWARD FOR OUTSTANDING CONTRIBUTION IN COMMUNITY SERVICEFor a physician member of the Medical Association who has exhibited sustained interest and participation in one or more activities of the com-munity over and above that expected of the membership at-large.

CITIZEN’S AWARDFor an individual who is not a member of the Medical Association, who has achieved public recognition for a significant contribution in the health field. (This usually will be a non-physician, although physicians are not categorically excluded.)

ANNUAL AWARDSSanta Clara CountyMedical Association

Benjamin J. Cory, MD Award

Outstanding Contribution To The Medical Association

Outstanding Contribution In

Medical Education

Outstanding Achievement In

Medicine

Outstanding Contribution In

Community Service Citizen’s Award

1994 Robert W. Jamplis Richard M. O’Neill John B. Shinn Thomas J. Fogarty Arthur A. Basham / Arthur L. Messinger

Gary W. Steinke, MD / Mrs. Pamela Steinke

1995 --- Robert W. Andonian Ronald L. Kaye Norman E. Shumway --- Mr. Howard W. Pearce

1996 Christopher C. Chow David M. Rosenthal William C. Fowkes Thomas A. Stamey Cindy Lee Russell / Minoru Yamate

Florene Poyadue, RN

1997 --- Bernice S. Comfort Robert J. Frascino Michael R. Fischetti Suzanne Jackson, RN

1998 Mansfield F. W. Smith Stanley D. Harmon Howard R. Porter Burton D. Brent William A. Johnson Judge Leonard Edwards

1999 Donald J. Prolo Steven S. Fountain C. Michael Knauer Jack S. Remington M. Ellen Mahoney Rigo Chacon

2000 Sharon A. Bogerty Stephen H. Jackson Theodore Fainstat Richard P. Jobe Barbara C. Erny Janet Childs

2001 --- Roger P. Kennedy Bert Johnson Nelson B. Powell / Robert W. Riley

Robert Michael Gould Tony & Brandon Silveria

2002 Robert M. Pearl Elliot C. Lepler Allen H. Johnson Bruce A. Reitz David Morgan Tom Campbell / Ted Lempert

2003 --- Joseph E. Mason, Jr. Anthony S. Felsovanyi

David A. Stevens Martin D. Fenstersheib Michael E. & Mary Ellen Fox

2004 Robert Wuerflein Eugene W. Kansky Barry Miller D. Craig Miller Elizabeth Menkin Jayne Haberman Cohen, DNSc

2005 Harvey J. Cohen Richard L. Miller Gus M. Garmel Rodney Perkins Elouise Joseph Doris Hawks, Esq.

2006 --- Arthur A. Basham Robert W. R. Archibald

G. David Adamson Harmeet S. Sachdev Edward A. Hinshaw, Esq.

2007 Stephen H. Jackson Cindy L. Russell Catherine L. Albin John R. Adler, Jr. Madhur Bhatnagar Debbi Ricks

2009 Bernadette Loftus Martin L. Fishman George P. Kent Thomas Krummel Seham El-Diwany Peggy Fleming-Jenkins

2010 Melvin Britton James G. Hinsdale David Levin Gary Steinberg Leo Strutner Judge Lawrence Terry

2011 --- Tanya Spirtos Dennis Siegler Robert Armstrong Gary Silver Kathleen King

2012 Steven S. Fountain Robert Gould William Jensen Eleanor Levin David Quincy Assemblymember Jim Beall

2013 James G. Hinsdale Stephen C. Henry Rosaline Vasquez Diane E. Craig Jeffrey D. Urman Congresswoman Anna Eshoo

2014 Martin L. Fishman David H. Campen Jonathan H. Blum Gary E. Hartman Keith A. Fabisiak Gay Crawford


VICTORYOn November 4,the voters of California

spoke loudly AND DEFINITIVELY, SENDING THE TRIAL LAWYERS’ PROPOSITION 46 TO DEFEAT BY A VOTE OF

67 TO 33. THE MESSAGE IS CLEAR – CALIFORNIANS SIMPLY DON’T WANT TO INCREASE HEALTH CARE COSTS AND REDUCE HEALTH ACCESS SO TRIAL ATTORNEYS CAN FILE MORE LAWSUITS.

An increase in the Medical Injury Compensation Reform Act (MICRA) cap on non-economic damages has been rejected in

California again and again: 10 times in court, 5 times in the Legislature and now overwhelmingly by voters. This idea now has its own dedicated spot in California’s political trash heap.

VICTORY

NOVEMBER / DECEMBER 2014 | THE BULLETIN | 35WINTER 2014 SAN JOAQUIN PHYSICIAN 45

SEPTEMBER 13, 2014

“…this measure

overreached in a decidedly

cynical way.”

AUGUST 11, 2014

“…the initiative…has

three distinct provisions

packaged together as a

take-it-or-leave-it deal.”

SEPTEMBER 23, 2014

“Prop 46: Trial lawyers’

pathetic scam”

SEPTEMBER 25, 2014

“Proponents…are trying

to trick voters into raising

malpractice awards.”

SEPTEMBER 25, 2014

“The statewide database

is nowhere near complete,

and data in it is unreliable.

It’s not ready for prime

time…”

AUGUST 7, 2014

“Unfortunately, they

added the random

drug testing because

it reportedly tested

well in focus groups

to boost support for

the measure.”

AUGUST 31, 2014

“…would disrupt health

care in California...”

VICTORYBut this time, we energized the membership of CMA as a whole to fight the fight together, as one unified voice of medicine, representing the patients we so deeply care about and the care that we have committed to provide them.

Despite the trial attorney proponents’ attempt to sweeten the deal by adding provisions that polled well– physician drug testing and mandatory checking of a prescription database – voters said NO on Election Night. As people throughout the state heard from physicians and No on 46 coalition members about the real intentions of the measure’s proponents, there was resounding opposition. One of the secret weapons of this effort was the size and diversity of our coalition. We helped amass one of the largest and most diverse campaigns in California history. The breadth of the coalition — which

includes labor, business, local government, health providers, community clinics, Planned Parenthood, ACLU, NAACP, taxpayers, teachers, firefighters and more – underscores just how important affordable, accessible health care is to every Californian.

In addition to the groups on the ground talking to voters about the deception and trickery behind Prop. 46, every major editorial board in California opposed the initiative.

The Los Angeles Times said, “As worthwhile as [Proposition 46’s] goals may be, the methods the measure would use to achieve them are too flawed to be enacted into law.”

The San Francisco Chronicle decried Prop. 46 saying that the measure, “overreached in a decidedly cynical

way.”

The Orange County Register, UT San Diego, San Jose Mercury News, Monterey County Herald, Sacramento

Bee and dozens of other newspapers echoed these sentiments.

The efforts of the California Medical Association and the county medical associations across the state is a tremendous showing of what we can do for the future of health care, the quality of medicine and the dedication to patients everywhere. Working together to spread the truth about Prop. 46, building

coalitions across communities and standing strong as one united voice is what

helped carry us to victory.

This was one of the most contentious and high-stakes ballot fights in California history and we rose to the occasion. We must use this unity moving forward and showcase to our colleagues the value the California Medical Association brings to

our great profession and stay united for whatever comes our way next.


By Michael A. Shea, MDLeon P. Fox Medical History Committee

To discover the roots of Stanford Medical School, we must begin with Dr. Elias Samuel Cooper (1820-l862). Dr. Cooper was a controversial, yet able, surgeon in Peoria, Illinois, when in 1854 he elected to pursue post-graduate studies in Edinburgh, Scotland. It was here that he expressed his desire to open a medical college in San Francisco (discovered in a letter from Dr. Cooper to his traveling companion Hugh Keenan). His reasons for choosing an area of the country that he had not even been to seem to be found in his writings. He mentions climate and the predicted future growth of the area as some of his reasons. “Great empire to build! Brilliant destiny in future!”

So it was, that in 1858, the Medical Department of the University of the Pacific was founded in San Francisco by Dr. Cooper, with 18 trustees –

ten of whom were clergymen and three were doctors (J. S. McClean, B. F. Hadden, and Henry Gibbons). The population of California, at that time, was under 380,000, and San Francisco about 56,000.

Entrance requirements were one year’s apprenticeship with a respect-able physician or graduation from high school. For medical graduation, two courses of 18 weeks were necessary, only one of which had to be taken in San Francisco. Tuition was set at $150.

Providentially, there was soon the addition to the faculty of a new member who was ultimately, by his own efforts, to ensure the survival of the school. (The precursor to Stanford Medical School) This was Cooper’s nephew, Dr. Levi Cooper Lane (1828-1902), who was appointed Professor of Physiology in 1861.

Elias Cooper died in 1862, succumbing at age 41 to an obscure neu-rological disorder. Without his leadership, the school’s momentum slack-

The Origin ofStanford Medical School


Cooper Medical College, 1882

ened. It was about this time that Dr. Hugh Toland, a mem-ber of the current Cooper school faculty announced his plans to open a new medical school. The Toland Medical School (the future UCSF) opened in San Francisco in 1864. Outclassed and outflanked, the Medical School of the Uni-versity of the Pacific suspended operation while Dr. Lane and several key faculty colleagues accepted the invitation of Dr. Toland to join the faculty of his new school. How-ever, they later regretted their decision and, in 1870, with-drew from the Toland School.

Under the leadership of Dr. Lane, they reactivated the Medical Department of the University of the Pacific, which had been suspended from 1865 through 1869.

When their rejuvenated School reopened in 1870, it was located on Stockton Street, south of Geary in San Francisco, next to the laboratories of University (city) Col-lege, a Presbyterian School founded in 1860. In 1872, the school became known as The Medical College of the Pa-cific.

After 1870, the faculty increased in size and competed successfully for students against the Medical Department of the University of California (formerly Toland Medical School). In 1876, each school awarded 20 diplomas.

When the school was reorganized in 1870, Levi Coo-per Lane was designated Professor of Surgery and Surgi-cal Anatomy, a dual appointment formerly held by Elias Samuel Cooper. Lane also assumed the leadership role that Cooper had previously filled in the affairs of the school.

Lane’s plan was divulged in 1882, when he donated to the school an impressive new building, constructed with his own private funds. It was located at the corner of Sacra-mento and Webster streets in San Francisco (see picture). That building, said to have no superior in the world for medical education at the time, was in continuous use as a medical school for the next 77 years (1882-1959).

On moving to the new facility, the school was incorporated as an in-dependent institution and the name changed from Medical College of the Pacific to Cooper Medical College in honor of Lane’s Uncle Elias.

Two additional structures were added to the medical school in the early 1890’s. The first was to enlarge the teaching facilities and the second was a 200-bed hospital, located at Clay and Webster Streets, adjacent to the medical school. From this, Dr. Lane established the Lane Hospital Train-ing School for Nurses, later to become The Stanford School of Nursing.

The final detail in Lane’s grand design was in 1898 when the Doctor and Mrs. Lane announced a provision in their wills for the founding of the Lane Medical Library, which is open to the present day.

Levi Cooper Lane died in 1902. Just before his death he made it pos-sible for the Cooper Board of Directors to exercise their own judgment for the future of Cooper Medical College. This, they did by arranging, in 1908, for the transfer of Cooper Medical College and all its property in San Francisco as a gift to Stanford University for the purpose of establishing a medical department in the University.

The first class of students entered The Stanford Medical Department

in September 1909. The last class of Cooper students graduated in May 1912 and Cooper Medical College ceased to exist.

In 1959, the Stanford Hospital, the School of Medicine, and Stanford Clinics moved to the Stanford Campus in Palo Alto.

In 1968, Stanford University purchased the city of Palo Alto’s entire interest in the hospital’s properties and facilities. The hospital was re-named the Stanford University Hospital.

Since its move to the campus, the School has grown steadily in na-tional status and now holds a respected place in the front ranks of medical education, scientific achievement, and clinical medicine.


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• Roth IRA Conversions – we assist our clients with analyzing the suitability of converting some or all of their IRA assets to a Roth IRA. Retiring physicians should particularly consider the benefits of a Roth IRA conversion which could be done in connection with the rollover of other retirement strategies.

• IRA Beneficiary Designations – it is a good idea to periodically review your beneficiary designations to ensure they are still current and consistent with your wishes.

• Estate Planning – if your estate planning documents have not been updated in the last five years, it may make sense to have your estate planning attorney review them for any potential revisions.

These are just a sample of the wealth management services that we provide to SCCMA and MCMS physician members and their families. Please contact us if you would like further information.

Planning Topics to Consider As We Approach Year-End:


`

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HOT TOPICS IN LABOR & EMPLOYMENT LAW The SAQUI LAW GROUP AM GENERAL SESSIONAn Enlivened Look at What’s Coming At You in 2015! If you haven’t seen Mike Saqui in action, get ready for a dynamic powerhouse ofknowledge, energy and edge of your seat learning! With the Governor signing more new legislation since 2008, Mike will take you through the latest labor and employment law twists and turns and give you jargon-free advice about what you need to do to get your HR practices in line for compliance in 2015. Can listening to an authoritative lawyer about new laws be exciting? One word…YES!

AFTERNOON BREAK-OUT SESSIONS 12:45pm – 4:00pm UP TO & INCLUDING TERMINATION: The Cornerstones of Disciplinary Action and Termination of Employment

Robert Russell, SPHR, TPO Principal & Kimberley Worley Esq., The Saqui Law Group Attend this “get to the point” program to learn how to plan and implement termination policies and practices that respect the dignity of your employees, whileavoiding regulatory traps you may not be aware of. Not just what to do or not, but how to do it with best HR practices. You’ll be glad you did!

HR Q&A – Balancing both Legal and Leadership Perspectives! Michael Saqui, Esq., The Saqui Law Group & Melissa Irwin, SPHR-CA,TPO Senior Consultant/Training Specialist Talk about brain power – a whole session with Mike Saqui & Melissa sharing both legal and HR answers and advice about the most critical questions on the

minds of our conference participants – questions from General Session? Get your answers here. This fun and fast-paced session is back by popular demand!

JUST TELL IT LIKE IT IS – Taking “How to Give and Receive Feedback” to the Next Level! Kathrine Parsons, SPHR-CA, TPO Senior Consultant with Briget Gomez, TPO Consultant Lack of communication contributes to 80 percent of workplace issues. These statistics show that constant (two way!) communication and ongoing feedback are critical to well-functioning and high-performing individuals, teams, and organizations. Get some “ready to use tips” from the TPO experts!

ESSENTIAL WAGE & HOUR – A 25-Year Surge in Litigation!Jennifer Schermerhorn, Esq. & Jorge Aguilar, Esq., The Saqui Law GroupAttend this fast paced, information-packed session to tune-in to what you need to know about wage and hour compliance in 2015. Jennifer and Jorge will help you stay ahead of significant wage and hour risks and prevent expensive (avoidable!) litigation. If you issue paychecks, you need to sit in on this one!

AFFILIATE SHOWCASE An impressive assemblage of professionals providing high quality services and support to business!

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By Craig H. KligerThis article is reprinted with the permission of Real Clear Policy (www.realclearpolicy.com)

Imagine waking up to find, as Dorothy famously did in The Wiz-ard of Oz, that you’re not in Kansas anymore, having been transported somewhere else without your volition or consent. The people you trust are nowhere to be found, and the ones you encounter range from “good” to not-so-“wonderful” to even “wicked.”

This has become reality for thousands of Californians who are eli-gible for both Medicare (available to the elderly and disabled) and Med-icaid (available to the poor), called “dual eligibles,” many of whom have complex medical problems. Unless they actively opt out of pilot programs authorized in 2010 by the Golden State – now called “Cal MediConnect” (www.calduals.org) – they are automatically (magically?) enrolled in managed-care plans. Unlike traditional Medicare, which allows enrollees to see any provider willing to accept it, these plans typically limit the doc-tors patients can see, potentially disrupting long-established care relation-ships with providers should they not participate.

Of course, California isn’t in this alone. The Medicare-Medicaid Co-ordination Office (MMCO) within the Centers for Medicare and Medic-aid Services (CMS) approved the state proposal that permitted the opt-out in early 2013, ostensibly consistent with the MMCO’s statutory goal of “making sure [dual eligibles] have full access to seamless, high quality health care and to make the system as cost-effective as possible.”

Yet because many of these patients don’t have English as a first lan-guage and/or have limited educational backgrounds, navigating the com-plexity of the opt-out process may be challenging despite the state’s prom-ise to send “multiple notices” prior to automatically enrolling patients. As a result, untold numbers have been or will be enrolled in these plans with-

out their knowledge and likely against their wills. About two-thirds of those eligible require a 30-day notice after receiving 60- and 90-day

ones, suggesting they haven’t responded. So it seems reasonable to presume the ultimate number will be very high. More disturbing,

it seems the process is relying on these questionable-at-best cir-cumstances to maximize participation and potential savings.

The state of California and CMS will almost certainly counter that these demonstration projects are an attempt

to improve care (by coordinating the services offered through the two programs) while reducing its cost

to the state and the federal government. Certainly both are noble goals. And I am confident those in-

volved are well-intentioned. But a careful read of the authorizing state statutes and federal documents strongly suggests that improving

quality is not the priority.While there are nebulous provisions that might al-

low CMS to request modifications to address quality issues, the agency’s only hard requirements for modification or termination

have to do with cost overruns. California has similar provisions: The pro-gram will become “inoperative,” for example, if the director of finance determines there are no “cost savings.”

In fact, because CMS’s directive from Congress (see §1115A(b)(3)(B)) envisions only three acceptable outcomes – improving the quality of care

without increasing spending, reducing spending without reducing the quality of care, or improving the quality of care and reducing spending – the demonstration would be deemed a failure and shut down if it substan-tially improved quality while only slightly increasing costs.

Further, a program truly dedicated to quality improvements would not use auto-enrollment, because changing someone’s health insurance – and, as suggested earlier, the set of providers he or she has access to – can have serious consequences. The unwitting enrollment of a California man in a regular Medicare Advantage (managed care) program in 2012 dis-rupted his planned treatment for age-related “wet” macular degeneration and resulted in legal blindness in the affected eye while things were sorted out. His case and others may have inspired CMS to give those that might be passively enrolled the opportunity to disenroll from or reenroll in the program monthly. Aside from the chaos this might cause, this provision does little to help those like this man, who need urgent or emergency care and have no idea where they can seek it.

The irony is that California saves very little on the provider services that are most disrupted by this process. The details are complicated, but essentially this happens because California’s Medicaid fees are low and services already must be administered through managed care wherever possible regardless. Where the state might save money is in the coordina-tion of long-term-care services. But these almost certainly could have been addressed separately.

MMCO has as a statutory goal of “increasing dual eligible individu-als’ understanding of and satisfaction with coverage under the Medicare and Medicaid programs.” So, how can it possibly defend what amounts to legitimized duping of huge numbers of the very people it is charged with protecting?

It’s not as if efforts haven’t been made to stop this. Aside from the hundreds of comments filed with CMS that did result in some revisions, the Los Angeles County Medical Association and others recently sought an injunction – denied to date – largely based on technicalities.

And it shouldn’t take a lawsuit for CMS to realize it is creating two classes of Medicare recipients by discriminating solely on the basis of eco-nomic disadvantage. Those with Medicare alone – an entitlement earned by working and paying payroll taxes over many years – retain their ability to choose managed care, not be forced into it, while those who happen to have Medicaid in addition become subject to this grand experiment.

Don’t get me wrong. This is not an indictment of all managed care, and I am clearly in favor of saving money if we can. But how we do that is important, and as well-intentioned as this might have been, it’s time for the man (or woman) behind the curtain at CMS – who, having govern-ment insurance, almost certainly doesn’t face the threat of waking up one morning locked into a health plan he or she had no say in picking – to demonstrate respect and concern for these vulnerable patients.

There’s still time: CMS’s Memorandum of Understanding with Cali-fornia allows the agency to terminate the program “without cause” with 90 days’ notice. For the sake of the welfare of the patients CMS is charged with protecting, this option should be exercised.Craig H. Kliger is an ophthalmologist and executive vice president of the California Academy of Eye Physicians and Surgeons.



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MEDICAL OFFICE SPACE FOR LEASE • SANTA CLARAMedical space available in medical building. Most rooms have water and waste. Reception, exam rooms, office, and lab. X-ray available in building. Billing available. 2,500–4,000 sq. ft. Call Rick at 408/228-0454.

MEDICAL SUITES • GILROYFirst class medical suites available next to Saint Louise Hospital in Gilroy, CA. Sizes available from 1,000 to 2,500+ sq. ft. Time-share also avail-able. Call Betty at 408/848-2525.

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OFFICE FOR RENT • SAN JOSE2395 Montpelier Dr #5, San Jose 95116. Rent $2,000 per month. Lease required. Owner pays triple net and monthly H/O dues. Two doctors set up. Three examination rooms. Approximately 1,100 sq. ft., furnished or unfurnished, adequate parking, walk to Regional Med Ctr. Close to X-Ray and lab. Previous tenant doctor retired. Call Marie at 408/268-2040.

MEDICAL OFFICE SPACE TO SHARE • SUNNYVALEConvenient location. One large private office plus one exam room, shared waiting room and front office. Newly built, total 1,280 sq. ft. Available now. Please call 408/438-1593.

MEDICAL OFFICE SPACE TO SUBLET • MTN VIEWMountain View medical office space to sublet. 1,100 sq. ft. Available three days a week. In large medical complex, behind El Camino Hospital. Base-ment storage, untilities included. Large treatment rooms, small lab space, BR, private office, etc. Call Dr. Klein at cell 650/269-1030.

MEDICAL OFFICE SUITE FOR LEASE • SAN JOSE 900 sq. ft. suite near Regional Medical Center of San Jose. Four treat-ment rooms, doctor’s office, and Reception area inside McKee Medical Center. Call 408/466-9178.

MEDICAL/DENTAL/PROFESSIONAL OFFICE SUITE • SALINASSecond story of professional building across from Salinas Valley Memo-rial Hospital. Private balcony. Freshly painted and carpeted, ready for occupancy. 1,235 sq. ft. at $0.963/sq. ft. Rent is $1,190/month. Contact Steven Gordon at 831/757-5246.

PRIME MEDICAL OFFICE FOR LEASE • SANTA CLARAIdeal for medical, dental, physical therapy, optometry, office use. Approxi-mately 1,700 sq. ft., near Santana Row. Excellent parking. Call owner at 408/858-9687.

EMPLOYMENT OPPORTUNITY

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Opportunity - Position DetailsWe are seeking a full time Internal Medicine physician to begin work fall of 2014. Our office is located in San Jose, CA and we currently utilize Epic EHR. We are a 5 person medical group with 4 MDs and 1 NP/PA providing internal medicine services to our community.

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INTERNAL MEDICINE PHYSICIAN NEEDEDWe are looking for an internal medicine physi-cian for our multi-specialty group. Please email your CV to [email protected].

URGENT CARE PHYSICIANPalo Alto Medical Foundation is growing and is looking for a BC/BE Emergency Medicine or Family Medicine Physician to join our Medical Group in the Urgent Care Department in Santa Cruz. For more information or to submit your CV directly, please contact: Rinky Dhamija, Physi-cian Recruiter, [email protected].

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Dr. Tanya Spirtos and Dr. Toby Frescholtz of Women’s Care Medical Group are delighted

to inform you that they are joining a medical mission team in January 2015!We would like to ask for your support of the team organized through the Phil-

ippine Medical Society of Northern California. This medical and surgical mission team will be traveling to Bohol, Philippines, from January 16-25, 2015. As you may recall, in 2013, the Bohol province was deeply impacted with the deadliest earth-quake to hit the Philippines in 23 years followed three weeks later by a devastating typhoon.

The PMSNC mission team includes a mix of physicians, dentists, optometrists, nurses, prosthetists, students and other allied health professionals. Medical ser-vices are composed of primary care, various surgical specialties, ophthalmology and dentistry. Health education for patients and continuing medical education for practitioners are also provided during these missions. Many of the patients we will serve in Bohol have never seen a doctor in their lives and often will travel 3-4 days to receive care from this mission team.

There are over 120 volunteers participating with this medical mission and for many, it is our first mission trip! Due to the volunteer efforts and your donations, we are able to serve thousands of patients each year and make a difference in their lives.

We are trying to raise $50,000 to cover the supply and equipment costs to transport all the necessary medical items to Bohol which will allow us to appropri-ately care for these patients. Your contribution of $100, or whatever you can give, will greatly help!

Peter Bretan MD, the organizer of this mission, was recently presented with the 2014 Benjamin Rush Award for Citizenship & Community Service by the American Medical Association. Dr. Bretan was presented the award “for his exceptional work as an innovator in renal transplant surgery and urology as well as for his unwavering disaster relief efforts around the globe”.

You can make a contribution online through PMSNC at: http://www.pmsnc.com/pages/donate.php.

If you wish to make a contribution, please click on the “Donate” button under Medical Missions and you will be securely directed to PMSNC’s PayPal account. All contributions are 100% tax-deductible, and will be acknowledged by PMSNC.

Thank you so much!

With thankfulness and anticipation, Dr. Tanya W. Spirtos Dr. Toby Frescholtz

PS - I welcome you to watch the highlights of the medical mission in 2014 to Tarlac, Philippines at: http://www.pmsnc.com/pages/volunteer.php

2015: A Healthcare/Medical Mission to

the Philippines


31 Chapters covering 110 pages of the local medical history from the Ohlone Period to the American Period • Origin of major Bay Area hospitals (SCVMC, O’Connor Hospital,

San Jose Hospital, Agnews State Hospital, and more)• History of UCSF and Stanford medical schools and founders • Biographies of pioneer physicians (e.g., Benjamin Cory, John

Townsend, John Marsh, Euthanasia Meade, Henry Warburton, and more)

• Topics of interest (e.g., Trephination, Bloodletting, Gold Rush Med-icine, Orifi cial Surgery, Cholera Epidemic of 1850, Famous Grizzly Bear Attack of 1854)

NOWAVAILABLE From Medicine Man to Medical Doctor Th e Medical History of Early Santa Clara Valley

$19.95 incl. S&H FOR INQUIRIES/ORDERS – SEND CHECK TO:Michael A. Shea, MD 6807 Leyland Park Drive San Jose, California 95120 Email: [email protected] Phone: 408/268-5820

All profi ts will be donated to the con-struction of the new medical museum at Santa Clara Valley Medical Center.

Authors:Michael A. Shea, MD;

Gerald E. Trobough, MD;Elizabeth Ahrens-Kley

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Since 1977, the Cooperative of American Physicians (CAP) has provided superior medical professional liability coverage and valuable risk and practice management programs to California’s finest physicians through its Mutual Protection Trust (MPT).

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Success.

Are You ICD-10 Ready? Get Your “ICD-10 Action Guide” FREE!

Since 1977, the Cooperative of American Physicians (CAP) has provided superior medical professional liability coverage and valuable risk and practice management programs to California’s finest physicians through its Mutual Protection Trust (MPT).

As a physician-directed organization, we understand the realities of running a medical practice these days, and are committed to supporting you with a range of programs and services that no other professional liability company offers. These include a 24-hour early intervention program, HR support, EHR consultation, a HIPAA hotline, and a robust group purchasing program, to name a few.

It’s what California’s finest physicians strive for. . .and what CAP can help you achieve.

On October 15, 2015, all medical practices must comply with new, expanded ICD-10 codes. CAP’s ICD-10 Action

Guide for Medical Practices has the answers you need to successfully make the transition.

Request your free electronic or hard copy today!

800-356-5672 CAPphysicians.com/icd10now

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Documents

November/December 2014