Spring 2010

SPRING 2010 SAN JOAQUIN PHYSICIAN 1SPRING 2010 SAN JOAQUIN PHYSICIAN 1

Spring Issue 2010Spring Issue 2010

St. Joseph's Patient PaVilion oPens

2 SAN JOAQUIN PHYSICIAN SPRING 20102 SAN JOAQUIN PHYSICIAN SUMMER 2009

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SPRING 2010 SAN JOAQUIN PHYSICIAN 3

Volume 58, Number 1 • March 2010

{FeATUreS}

cAMBODIAN ODYSSeY Dr. Salamon Reports54

MIcrA: Hanging By A Thread16

{DePArTMeNTS}22 cMA WeBINArS

24 IN THe NeWS New Faces and Announcements

32 UOP’S HeALTH FOrUM

35 HOSPIce AND PALLIATIVe cAre

47 MeMBerSHIP BeNeFITS: Your Offi ce Manager Advocate has the answers

68 HOLIDAY PArTY reDUX

38 ST. JOSePH’S Patient Pavilion Opens

BUYerS gUIDe 61

4 SAN JOAQUIN PHYSICIAN SPRING 2010

Lawrence R. Frank, MD President

James Halderman, MD President-Elect

Robin Wong, MD Past-President

George Khoury, MD Secretary-Treasurer

Board Members

Shiraz Buhari, MD Moses Elam, MD Trinh Vu, MD �omas McKenzie, MD John Olowoyeye, MD Anil K. Sain, MD Javad Jamshidi, MD Raissa Hill, MD Kristin M. Benne�, MD Jerry Soung, MD

Medical Society Sta�

Michael Steenburgh Executive Director

Debbie Pope O�ce Coordinator

Gena Stoddart Membership Coordinator

Commi�ee Chairpersons

M�C Decision Medicine Ethics & Patient Relations F. Karl Gregorius, MD Kwabena Adubofour, MD to be appointed

Communications Legislative Community Relations Morris Senegor, MD Patricia Ha�on, MD Joseph Serra, MD

Audit & Finance Member Bene�ts Nominating Marvin Primack, MD Jasbir Gill, MD Hosahalli Padmesh, MD

Membership Public Health Scholarship Loan Fund to be appointed Karen Furst, MD Eric Chapa, MD

NORCAP Council Sandon Sa�er, MD

CMA House of Delegates Representatives

Shiraz Buhari, MD Lawrence R. Frank, MD James R. Halderman, MD Patricia Ha�on, MD Francis Isidoro, MD Peter Oliver, MD James J. Scillian, MD Gabriel K. Tanson, MD Robin Wong, MD Peter Gierke, MD


I’m Dr. Steve Hays, Medical Director of the Center for Advanced Lung Therapies at California Pacific Medical Center, a unique pro-gram bringing together expertise in pulmonary medicine, thoracic surgery, lung pathology and radiology to provide complete management of your complex pulmonary patients.

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I’d like to make an appointment to see you in your office. Why? I would like to take just a few minutes to familiarize you with our state of the art facilities, equipment and staff in intensive care, respiratory care, bronchoscopy and radiol-ogy and discuss treatment options for your next complex pulmonary patient.

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Moris Senegor, MDEditor

Editorial Committ eeShiraz Buhari, Md

Kwabena adubofour, MdRobin Wong, Md

William WestManaging Editor

[email protected]

Michael SteenburghContributing Editor

Sherry RobertsCreative director/Graphic designer

[email protected]

Contributing SourcesCalifornia Medical association

Los angeles County Medical association

San diego County Medical Society

Th e San Joaquin Physician magazine is published quarterly by the San Joaquin Medical Society

Suggestions, story ideas or completed storieswritt en by current

San Joaquin Medical Society members

are welcome and will be reviewed by the Editorial Committ ee.

Please direct all inquiries and submissions to:

San Joaquin Physician Magazine3031 W. March Lane, Suite 222W

Stockton, Ca 95219Phone: 209-952-5299

Fax: 209-952-5298Email address: [email protected]

Medical Society offi ce Hours:Monday through Friday

8:00 aM to 5:00 PM

MeSSAge > executive Director

are you ready for It?It (as in Information technology), or, in our case, HIt (Health Information technology), is a complicated and fast-moving target. If you haven’t stayed current with the latest in this area, there are a lot of exciting technologies coming down the information highway, and your San Joaquin Medical Society aims to help keep you well informed as it relates to your practice. In the summer 2009 issue of “Physician”, we ran stories with diff ering perspectives on Electronic Health Records (EHR) and various federal stimulus funding programs that were on the horizon. We could devote an entire issue to the numerous developments since then and still not do justice to this topic. Th erefore, we have decided to partner with Health Plan of San Joaquin and the CMa to off er a

unique series of “EHR trunk Shows” produced by Maxwell It, a truly vendor-neutral consulting fi rm that produces very concise evening programs for physicians seeking the latest lowdown in this rapidly changing environment. Check

out our advertisement on page 31 to learn more about these upcoming seminars with actual hands-on vendor demonstrations. Secondly, we have long heard many pleas from our members to off er more in the way of training and certifi cation seminars. So, for our fi rst eff ort in this area we are off ering a Certifi ed Coders training Series over a 5 week period for the very low cost of $649 (many of these programs cost upwards of $2,000). Th is unique off ering allows your coder to be out of the offi ce only one day a week for the 5 week period instead of att ending a full week program, oft en with the cost of hotel and travel expenses on top of the registration. Check out our ad for this program on page 51 and if we fi ll this Seminar we will book a Certifi ed offi ce Managers Series in the fall. and lastly, for those of you with simply no time for scheduled seminars on all these wonderful topics, we are working with CMa, norcal Insurance, Palmett oGBa and others to off er several web-based seminars (Webinars) that you can watch at your leisure or att end as a group in our new training room here at the society. Check out our listings on page 22 and fi nd something of interest. If you watch them here…we even buy the popcorn!

All the Best!

Mike SteenburghExecutive Director

“For our first effort in this area we are offering a Certified Coders training Series over a 5 week period for the very low cost of $649”


miracles happen.

(209) 943-2000 StJosephsCares.org l 1800 N. California St., Stockton, CA 95204

Some investments offer miraculous returns. Take the

Patient Pavilion at St. Joseph’s, for example. Planned in

response to the needs of our growing community, this

vital addition will save more lives, safely deliver more

babies and provide private patient rooms. However,

more than providing critical rooms and equipment, the

new Patient Pavilion is an investment in the health and

safety of every family who calls our community home.

Not-for profit. Serving our community.

Investing in Health,Growing to Serve

St. Joseph’s $115 million Patient Pavilion – Open March 2010


MeSSAge > From The President

ABOUT THE AUTHOR- Lawrence Frank, MD is the 2009-2010 President of San Joaquin Medical Soceity.

The upcoming budget looks like it will face a $52M deficit. County services, already severely strained, face further cuts in funding: 13% for 24/7 operations such as SJGH, 26% for agencies that protect the public, i.e. Public Health Services, and up to 39% for road maintenance, parks, etc.

Barbarians at the Gate

Whether we like it or not a new 1600-bed prison hospital that includes a skilled nursing and mental health facility is coming to Stockton and San Joaquin County, according to Clark Kelso, federally appointed receiver.

In addItIon, the vacant deWitt Juvenile Facility will be converted to care for an additional 1300 adults. The former women’s facility will be turned into a Re-Entry Facility. Within three years, San Joaquin County will have 3500+ additional inmates. It took lawsuits filed by the City of Stockton, San Joaquin County and the San Joaquin Chamber of Commerce, unlikely to prevail, to get the federal receiver into serious discussions about mitigating the repercussions to our county. no matter how Kelso and his supporters try to sweeten the pot, medical services, both public and private, will take a major hit. In 2001, Rebekah Evenson, a prisoners’ lawyer, sued the state for poor prisoners’ health care; in 2002, the court ordered to state to make substantial improvements. In 2005, as a result of a finding that health care services for state prisoners were so poor that they caused one death per week, Federal Judge Thelton Henderson ruled that a federal receiver, J. Clark Kelso, was to take over the prison health care system as the state was unable to comply with the constitutional ban on cruel and unusual punishment. (1)

after unsuccessful negotiations, Kelso’s suit against the State of California to get $8 billion to build 10000 beds for state prisoners failed, hardening state opposition. He has reduced his goal to 1734 (or so) beds but this will still take $1.9 billion in State funds. Good timing;

the state is looking at upwards of $20B budgetary deficit that will require cutting many programs to the bone. Governor Schwarzenegger (rightly) maintains California cannot afford this.(1) County budgetary constraints in the 2009-2010 year resulted in reductions in funding a number of County services. our Public Health Service that protects us from communicable disease with out-reach and direct-observed therapy lost 28 workers. The upcoming budget looks like it will face a $52M deficit. County services, already severely strained, face further cuts in funding: 13% for 24/7 operations such as SJGH, 26% for agencies that protect the public, i.e. Public Health Services, and up to 39% for road maintenance, parks, etc. Regional unemployment has increased the burden of uninsured seeking medical care at the county hospital with a dramatic increase in its deficit. (2)

Regional state legislators have weighed in against the receiver’s plans. Cathleen Galgiani, d-Livingston, objects to building any of these prison hospitals in California, noting that at a time when very hard and difficult decisions are being made to the detriment of providing medical care to the aged, the poor, veterans and the disabled, we are told to build a medical taj Mahal for prisoner health care. alyson Huber, d-El dorado Hills, inveighed against the lack of communication and collaboration with San Joaquin County in this decision.(3)

Kelso is trying to sell this as an economic


boon to our county. (1) There will be $1 billion in construction jobs in an area with a depressed construction industry. But this will be paid for by the (already beleaguered) state. (2) 3000 new jobs with wages higher than our regional average could pump additional money into our county. Under a separate agreement, CdCR will also pay for converting the women’s facility into a re-entry facility. With the exception of Bakersfield and Kern County (4), why have other cities passed on this promised economic boom? Many in Stockton question the promised jobs and worry about reduced quality of life. Public sentiment is turning against more new prisons to deal with crime and crowded prisons. are elected officials stuck in the boom mentality of the 20th century?(5)

If many of the needed construction and health care workers choose to commute from surrounding areas rather than move to San Joaquin County, how likely is it they will spend a lot of their high wages into our county’s economy. {I wonder if I would move from an area with a more secure educational infrastructure and other amenities to Stockton rather than commute and spend my money in, say, the East Bay or Sacramento County.} The California department of Correction and Rehabilitation (CdCR) pays health care workers very well, not only in salary but in benefits. San Joaquin County staff calculated that the new prison hospital would end up costing the county $105M at first, including $63M for road improvements followed by $17M annually to ramp up health care worker training and for wage competition. The county “paid for” Jail expansion would cost us $11M for pathology lab expansion plus an additional $6M in staffing wages. Even with this, the Sheriff is concerned about keeping his current staff when they are tempted to work at CdCR for higher wages.(6)

The new prison hospital/SnF will need 1440 additional health care workers: 15 Md’s, 329 Rn’s 111 LVns, 165 Cnas and 394 psychiatric technicians. They’ll receive higher wages and better benefits (PERS Retirement and lifetime medical insurance). The federal

government already has designated the San Joaquin Valley as undersupplied with health care workers. Local health care facilities already face extreme challenges in attracting and retaining skilled and experienced staff. I’m sure we are all gratified that Katrina Hagen, deputy director for Workforce development for the federal receiver, recognizes our predicament. She said they would try “creative” recruiting from out of county and transferring from other state prisons. (There is no try. do or do not. - Yoda). She would also seek funding to help delta College to train more medical workers. The increase in training and turning out more health care personnel will not occur in time to meet the projected three year time line CdCR projects for opening the new prisons and health care facilities. Scot Seamans, Hospital Council of northern and Central California was glad to hear these discussions but implementing these solutions will be difficult at best but noted that so far, nothing has been offered in writing.(7) The law suit(s) mentioned above were filed (and temporarily suspended) to get Mr. Kelso’s attention and to maximize mitigation by the state of the aforementioned costs to San Joaquin county. on 31 January, the League of Women Voters conducted a forum to further discuss the ramifications of locating the prison hospital just outside of Stockton. City, County and State/Federal representatives, including Mr. Kelso attended. Mayor Johnston wanted assurances that at least 50% of the new jobs, both in construction and in health care, would go to locals. Unfortunately, this very likely will result in robbing existing facilities of health care workers. She allowed that if local nursing and medical technical training programs grew significantly, Stockton could become a health care training center. Well and good but it will take years for such programs to develop and/or expand and produce trained (but not experienced) nurses, technicians, etc. Meanwhile, public and private hospitals may well suffer significant losses of experienced personnel to the detriment of care provided to our non-prisoner population. County Supervisor Bestolarides asked

JOIN THE FIGHT TO PROTECT MEDICINE

Every cause needs a powerful champion. This spring, you have an opportunity to become a champion for medicine and your patients, when more than 400 physicians, medical students, and CMA Alliance members come to Sacramento for CMA’s Annual Legislative Leadership Conference.

At the conference, you will hear about the issues facing medicine in Sacramento from an impressive array of experts who live and breathe the politics and policy on these issues. Armed with this knowledge, you will then head to the Capitol to meet with legislators to make sure the voice of doctors is heard in Sacramento.

WILL YOU JOIN US?Call the San Joaquin Medical Society

at (209) 952-5299 to RSVP

We will provide free shuttle service from the society o�ce departing at 7:00am and make arrangements for us to meet with each of our state representatives following the luncheon and be back to Stockton by 5:00pm.

C A L I F O R N I A M E D I C A L A S S O C I A T I O N

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how Mr. Kelso’s promises were to be kept and what would happen if they were not.(8)

as yet, no final agreement on how to mitigate the possible ill effects to Stockton and San Joaquin County has been reached and nothing, included promises of benefits to Stockton is in writing. Further, nearly all current prisons and jails are operating well above their “capacity” when built! Where will funding come to operate these facilities after

they are built. Particularly in these financially difficult times, these promises may end up being a bait and switch to lull us into placidly accepting an unpleasant fate. Yet, there are some who think Stockton and San Joaquin County will benefit. It calls to mind the variety of interpretations of the partially filled glass: Optimist: glass is half fullPessimist: the glass is half empty

Engineer: the glass is twice as big as it needs to beAccountant: does the glass need all that water?Buddhist: the glass is full – it contains both water and space.The government would say that the glass is fuller than if the opposition party were in power.The opposition would say that it

is irrelevant because the present administration has changed the way such volume statistics are collected.The philosopher would say that, if the glass was in the forest and no one was there to see it, would it be half anything?The economist would say that, in real terms, the glass is 25% fuller than at the same time last year.The banker would say that the glass has just under 50% of its net worth in liquid assets.The psychiatrist would ask, “What did your mother say about the glass?”The physicist would say that the volume of this cylinder is divided into two equal parts; one a colorless, odorless liquid, the other a colorless, odorless gas. Thus the cylinder is neither full nor empty. Rather, each half of the cylinder is full, one with a gas, one with a liquid.The seasoned drinker would say that the glass doesn’t have enough ice in it.

(1) State disputes federal authority By Bob Egelko Chronicle Staff Writer: The San Francisco Chronicle : Thursday, September 17 2009(2) County of San Joaquin Proposed Budget 2010-2011.(3) State legislators weigh in on Prison, The Record, December 19,2009.(4) Prison Lemon could be Kern’s Lemonade, Bakersfield Californian, October 29,2009(5) Stockton: Prison Capital, CA, The Record, Wednesday, Nov 4, 2009(6) Stockton, S.J. join suit over prison hospital, The Record, November 04, 2009(7) Medical center has hospitals worried, They fear losing staff to large state prison facilityBy Scott Smith The Record, January 21, 2010(8) Sides meet, talk prisons in Stockton, The Record, by Christian Burkin, January 31, 2010

MeSSAge > From The President



13th ANNUAL CALIFORNIA HEALTH CARE

The Era of Health Reform: Harnessing the Currents of Change

New for 2010: Academy Curricular Tracks

• Health Information Technology• Practice Management• Leadership Development

April 9-11, 2010 San Diego Marriott Hotel & Marina

• Hospital-Physician Alignment and New Models of Practice• Health System Reform: Then and Now• Leadership in a New Health Care Era• and more...

Continuing medical education: The California Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The California Medical Association designates this educational activity for a maximum of 18.25 AMA PRA Category 1 Credits ™. Physicians should only claim credit commensurate with the extent of their participation in the activity. This credit may also be applied to the CMA Certification in Continuing Medical Education.

Register by March 9th

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MeSSAge > From The editor

ABOUT THE AUTHOR-Moris Senegor, MD serves as the

Chairperson of the Publications Committ ee for the San Joaquin Medical Society and Editor of its fl agship

publication the San Joaquin Physician.

“With these additions the number of licensed beds in San Joaquin County rises from 982 to 1146.”

NEW BEDSSlow and expensive undertaking for area hospitals

In the current issue of San Joaquin Medicine we present a second cover story within a year, featuring the same theme, opening of a major addition to an area hospital.

our fi rst, published in the winter 2009 issue, was on Lodi Memorial; now we present St. Joseph’s. Lodi added 90 new licensed beds to its facility, St. Joseph’s 74, (78 new beds in the Pavilion, less 4 because of the creation of private rooms in the existing hospital).Th e creation of some 164 new beds in San Joaquin County is a historical event. Compared to the 1700 bed monster contemplated for arch Road by the California department of Corrections, 164 seems like a meager sum. But the prison hospital is intended to serve a large catchment area of California prisoners, while the seemingly more modest number of new beds in Lodi and Stockton are here to serve us, the local public at large. With these additions the number of licensed beds in San Joaquin County rises from 982 to 1146. Viewed from a diff erent perspective, the number of beds per 1000 population rises from 1.4 to 1.69, again a seemingly modest increase. Considering that the national Benchmark for hospital planning is 2.9, one gets a new sense of the scarcity of beds in our area. Incidentally the State-wide average of beds per1000 population is 2.3. to understand the magnitude of the accomplishment we fi rst need to go back to the early 1990’s around the time of Bill Clinton’s election as President. Th e managed care fervor that swept the country at that time

promised, among other things, to sharply reduce demand for medical services and by extension, hospital beds. Some downsizing did occur then, especially in 600-1000 bed large teaching hospitals in big cities. Here in San Joaquin County we held our own, and anxiously awaited the ax to fall. Well, it never did! In fact, not only did the “revolution” of those days fail to reduce bed capacity, it also ran afoul of a giant demographic locomotive that overran it with ease. Th e general aging of our population created greater demand for medical services along with hospital beds. Unfortunately administrators of that time,


MeSSAge > From The editor

preoccupied as they were with managed care, failed to foresee the bed crunch that was to befall their hospitals a decade later. The result was disastrous impaction that became endemic in area hospitals. It resulted in various unsightly practices such as overfilled ER’s full of patients on hallway gurneys. Critical patients who could not be moved from ER’s to already full ICU’s received their care from overworked ER staff untrained in ICU care, sometimes with adverse consequences. Cancellation of elective surgeries due to lack of beds became a periodic problem for patients and surgeons alike. Yet worse was the so-called “round-robin” shuffling of ambulances from hospital to hospital, depending on which ones declared themselves full. The result was chaos in emergency care and to a lesser degree elective admissions. The problem was not just local. We also had trouble transferring patients to tertiary care facilities in surrounding big cities like San Francisco, because they also experienced similar bed shortages. once recognized, rectifying this bed problem turned out to be impossibly slow. It so happens that hospital construction is unique and does not share much, structurally or financially with, for example, commercial office buildings. Regulations governing such construction are substantially more elaborate than residential or other sectors. This, in turn leads to higher costs in such projects. I recently spoke with the administrators who oversaw the Lodi and Stockton projects from conception to reality. don Wiley of St. Jo’s and Joe Harrington of Lodi Memorial both confirmed that their expansion plans got approved by their respective boards (the moment of conception) in 1998. It thus took approximately 12 years to bring them to conclusion. The cost of these expansion projects boggles the mind. The Lodi effort came out at approximately $ 1 million per bed. St. Joseph’s started with a similar budget in 2004. By 2010 the actual cost of the project had risen to around $ 1.3 million per bed. This rise in the final bill was primarily due to increased commodity prices such as steel and other construction materials during the purchase phase of the project. By contrast, in a volatile market, Lodi had better luck in timing. according to Harrington, their project came in $2.5 million under budget. He attributes this rare fortune to the same volatile market that raised the costs in Stockton. “We locked our contracts while the market was still high”, says don Wiley, who points out that at the time their

concern was yet continuing inflation of project cost. Until then he had faced a daunting rise in cost to the tune of $ 1 million per month. Lodi, on the other hand began theirs after the market decline, which, as we all know, turned out to be unimaginably deep. “Everyone was in a skid”, says Harrington, “so we got better discounts from our suppliers and contractors”. Regardless, the cost of either expansion project should elicit a collective gulp from us physicians. as external regulations governing all aspects of medicine have increased exponentially over the years, so have those related to construction. We can only expect that future projects will suffer more – not less - from such interference, and thus be costlier. I asked the two administrators about the cause of that 12 year delay from conception to completion. For St. Joseph’s it was a series of approval hurdles. after receiving Board approval, St. Jo’s

had to receive the blessings of its parent company CHW, and subsequently oSHPot, the State regulatory body that oversees hospital construction. The project got quagmired in red tape, primarily because of unacceptable plans submitted to oSHPot by architectural and engineering firms working with St. Joseph’s. By contrast Harrington in Lodi did not have much trouble with oSHPot; theirs got approved more rapidly. Their delay was due to financing. an independent hospital, lacking a “big brother” like CHW, Lodi had to obtain its own financing in the open

market, and it took a while to accomplish this before construction could begin. not considering the details, The Lodi and St. Jo’s experience is a lesson on how slow and costly new hospital construction has become in this day and age. This is why, in my opinion, these seemingly paltry 162 extra beds are of such historic significance for our community. We are unlikely to see more licensed beds any time soon. to my knowledge there are none on the drawing board from other hospitals. Lodi Memorial and St. Joseph’s deserve the gratitude of the entire County for allowing ease of access, and ultimately lower risk to the increasingly rising number of our sick. Joe Harrington and don Wiley should be congratulated for nurturing their projects from beginning to end through what I can only imagine to be numerous frustrating hairpin turns over what many would consider a significant portion of their professional careers. They leave behind a legacy that will serve our community well beyond the time they fade out of the scene.

The cost of these expansion

projects boggles the mind.

The Lodi effort came out at

approximately $1 million

per bed. St. Joseph’s started with

a similar budget in 2004. By 2010

the actual cost of the project had

risen to around

$1.3 million per bed.


For as long as MICRA has been around there have been threats to its existence. Here’s a look at the challenges it faces today.

By chris womack

24-29_4tm.indd 24 11/19/09 9:47:14 AM

MIcrA > hanging by a thread

By the end of the year, medical malpractice award caps will have run the gauntlet in four states—including California—as high state and federal courts consider challenges that seek to allow a return of sky-high damage awards.

In fact, the court challenge to California’s Medical Injury Com-pensation Reform act cap on “non-economic damages,” such as pain and suffering, has already run its course. In May, Van Buren v. Evans failed to remove the statewide cap of $250,000 on non-economic damages in a case before the state’s 5th district Court of appeals. With an assist from CMa and its allies, the court ruled that the cap doesn’t violate the plaintiff ’s constitutional rights, and that the legis-lature is allowed to limit such damage awards in the interest of pub-lic policy. the California Supreme Court declined to hear the case.

But the forces of the trial attorneys will be back to California. In fact, a campaign is afoot among attorneys in the state to find the best possible plaintiff for drawing MICR a into the line of fire. the effort is loosely connected to a nationwide push by trial attorneys against damage-award caps, and it includes this year’s other three challenges to these kinds of laws. In Maryland, the state Court of appeals started hearing arguments last month in Lockshin v. Semsker; Geor-gia’s cap is threatened by Atlanta Oculoplastic Surgery v. Nestlehutt; and the Illinois Supreme Court has yet to rule on last november’s LeBron v. Gottlieb Memorial Hospital.

the Big Prizeof course, MICRA’s damage-award cap is the big prize. The first of its kind, the cap was set at $250,000 in 1975. It is not indexed to inflation and it hasn’t moved a whit since it became law. MICRa was created by a special act of the legislature to address a doctor-supply crisis through the high liability premiums that caused it, and it is now supported by a deep foundation of case law. Many of these cases were eventually decided in the California Supreme Court in the 1980s and 1990s, effectively cementing the law as a fundamental element in any court’s consideration of medical malpractice throughout the state. Challenges to malpractice damage award caps in other states cannot affect California law, but the California Medical association and like-minded organizations monitor what’s going on as a possible harbinger of things to come. “there is an attorney with the personal injury attorneys’ group, who is going around the country looking for cases trying to overturn medical malpractice laws all over the country,” says Lisa Maas, the executive director of Californians a llied for Patient Protection. a one-issue organization devoted to protecting MICR a, CaPP is supported by a panoply of physicians’ organizations—including the CM a—as well as hospitals, dental societies, liability insurers, and even the Los angeles County department of Health Services. “We’re certainly keeping a watchful eye,” says CMa Legal Counsel alicia From. She is also aware that trial attorneys have their sights set on damage-award caps, including MICR a, but the state’s successful history of protecting the law doesn’t have her checking on their activities every day, she says.

that nationwide cap-busting effort is spearheaded by attorney Robert Peck, president of the Center for Constitutional Litigation in Washington, d.C. on its website, CCL describes itself as “a law firm dedicated to chal-lenging laws that impede access to justice,” and Peck himself argued the U.S. Supreme Court case Philip Morris v. Williams, which let an oregon jury’s verdict stand in his client’s favor, awarding $79.5 million in punitive

damages to the widow a man who died of lung cancer. In other words, he’s not small fish.

Concerning malpractice damage caps, Peck ’s firm CCL has been involved in Maryland’s Lockshin, Illinois’ LeBron, Califor-nia’s Van Buren case, and several previous high- and lower-court cases. the single uniting factor in these is an approach that considers the caps as violations of the U.S. Constitution’s 7th amendment right to a jury trial. that is, this new crop of chal-lenges contend that only a jury can have a say in damage awards, and any encroachment on that turf by the legislature is forbid-den. CCL and its local allies got to Van Buren too late in the pro-cess to shape it completely to the new strategy.

Back in the 1980s, when MICR a first became established into case law, the challenges focused mostly on other constitutional rights, such as the right to due process and the right to equal protec-tion under the law. In Fein v. Permanente Medical Group, the Califor-nia Supreme Court held up the law in the face of these challenges by a close vote of 4 to 3. “that really set the trend across the country,” says Christine Spagnoli, president of the Consumer attorneys of California, which is waging the new battle against caps at the regional level. “We looked at what was happening in these other states, with the challenges based on the 7th amendment right to a jury trial, and believed that it had not been raised” in disputes at the state level, she tells Southern California Physician.

Lately, members of the consumer attorneys group, abbreviated CaoC, have requested help from the members in raising a chal-lenge in this state, and for about a year, the group has been trying to drum up legal contests to the damage-award cap as part of its “MICR a Challenge Project.” Robert Peck is CaoC’s point-person for legal analysis. “We have absolutely gotten the word out [to mem-bers] that if they have a case that they think fits the issue, we’d be happy to support their efforts,” says Spagnoli. Van Buren was the first chance to do so. “the respondent’s brief in that case raised some arguments about the constitutionality of MICR a,” Spagnoli explains, so the lawyers were able to file a response brief that raised the issue squarely. But there wasn’t an opportunity to add much new information, and she says the group had only been cautiously opti-mistic about the case’s success.

that’s no reason for complacency among health care providers, however. “there are several other cases out there where it’s going to be raised or it has been raised,” Spagnoli adds, and these cases could come up in a higher court as soon as early next year. But she says she’s not comfortable sharing the names of the cases without the involved lawyers’ permission.

the Payoff Possibilitieswhy wouldn’t trial attorneys continue to fight for higher damage awards? after all, there is certainly the potential for a large payoff in the absence of award caps, judging from the national situation. and the ideal plaintiff to challenge MICRA is someone without much of an “economic” damage award to claim, such as a retiree who misses no work by being injured, and whose example would show California’s limited awards in sharp contrast. By the reckoning of Jury Verdict Research, a company based in Pennsylvania, about half of jury awards throughout the country exceeded $1 million between 1999 and 2002. (note that the

24-29_4tm.indd 24 11/19/09 9:47:14 AM


obstetricians in stockton and san Joaquin county can pay up to $39,000 in premiums a year, but in uncapped new york state, they will pay around $194,000.

amount had remained f lat for three previous years, that jury awards represent a small portion of malpractice award decisions, and that JVR’s methodology does not include award revisions or even consistent data gathering. But still, that’s a lot of money.) Similarly, a 2001 U.S. Bureau of Justice Statistics study of sampled medical malpractice awards pegs that year’s median at $425,000, with about 29 percent of awards exceeding $1 million. Median awards for malpractice trials involving a death came to around $837,000, while permanent injury awards were about $412,000. Punitive damages had a median of about $250,000. However, the BJS study does not clearly differentiate between economic damage awards and non-economic damage awards. trial lawyers might also be interested in the current small rise in the number medical liability claims against hospitals in 2009, which is outlined in an october report by the insurance company aon Corp. and the american Society for Healthcare Risk Management.

the authors expect the frequency of these claims to grow by about 1 percent this year, and to continue rising at that same annual rate. the frequency of claims had been declining for the previous seven years, says the report, whose conclusions are based on loss and exposure data from more than 1,500 facilities and health care systems of all sizes.

But to really get a grasp of the scale of possibilities in this state, consider the recent wrongful death lawsuit against Sacramento radio broadcaster Entercom, a case that doesn’t involve medical liability. Entercom station Kdnd held a contest in January 2007 to give a nintendo Wii video game system to whoever was able to drink the most water without vomiting or urinating. Soon after participating, contestant Jennifer Strange died of water intoxication.

Last month a jury awarded Strange’s husband and four children $16.6 million—$15.1 million of which consisted of non-economic damages, among the largest awards ever offered by a Sacramento jury. the final award will probably be whittled down by subsequent legal processes, but the case provides clear evidence that California juries will gladly distribute massive awards in cases of wrongful death or injury. attorneys are keenly aware of that fact.

Moreover, as Spagnoli explains, the value of California’s cap on non-economic damages has eroded since 1975. What was once a fair amount of money is now the equivalent of $60,000 in 1975 dollars, she says. “People who represent victims of medical negligence con-tinue to see the erosion of their ability to receive fair compensation,” Spagnoli adds.

how we Got herethis all testifies to organized medicine’s concern that when sympathetic and well-meaning juries have free rein to determine damage awards for pain and suff ering, they become quite generous. Medical liability insurance companies see this generosity as a threat to the bott om line, and

hike up doctors’ insurance premiums in response. For those doctors who already may not be running much of a profi t, that extra-large insurance bill can be the fi nal expense that drives them into the red or out of business.

on the large scale, CMa, CaPP, CHa and other allies say this phenomenon can have the effect of reducing patient access to medi-cal care across the state by making it harder for health care providers to stay in business. Back before MICR a became law in 1975, “there are doctors who got medical malpractice premium increases of 200 percent and 300 percent,” says Lisa Maas, CaPP’s executive director. “Some anesthesiologists in Los angeles could not get coverage at all, no matter how much they paid.” In the 1970s, adds Maas, the special-ists with the highest premiums—obstetricians and gynecologists—had suggested they would have to stop delivering babies, or that they would have to begin telling expectant mothers to cross the border to

give birth in nevada.as a result, doctors, clinics,

nurses, hospitals and others asked then-Governor Jerry Brown for an emergency ses-sion to address the crisis. “It was very bipartisan—you had some of your most liberal legislators supporting a bill to help control this crisis, and

that was MICR a,” as Maas tells it. the seven provisions of MICR a, including the cap on non-economic damages, were specifically crafted to allow California doctors to continue to practice (see sidebar, “the Seven Parts of MICR a”), and to attract more doctors to the state.

Paying for risk managementto Get a sense of MICRA ’s eff ect on physicians’ malpractice insurance premiums, consider the diff erences in the bills paid by high-risk specialists in states with and without legislative caps on damage awards. When MICRA was born in 1975, those were anesthesiology, neurosurgery, obstetrics and gynecology—anesthesiology has become less risky lately, but the others remain at the top of the list, says Maas. according to CaPP, obstetricians in Stockton and San Joaquin County pay $39,000 in premiums a year, but in uncapped new York State, those same specialists at the high end of the spectrum will pay around $194,000. In Florida, which also has no such cap, the high end is about $214,000. those figures don’t mean that malpractice premiums in California will remain static. Between 1975 and 2000, those premiums rose about 167 percent, according to a Physician Insurers association of america report widely cited by the american Medical association and other physician groups. But during that same span of time, malpractice premiums for doctors outside of California rose by 505 percent.

Let there be no doubt that the insurance companies love MICR a too. the loss ratios for malpractice insurance—the cost of claims divided by the premiums collected—are much more favorable in states with damage award caps. according to the national associa-tion of Insurance Commissioners, the average loss ratio in 2001 for the six states with a damage award cap was 68.98, compared to 100.86 in the 44 states without caps.



here’s a Brief rundown on the highest-profi le court challenges now facing other states’ legislative caps on non-economic damage awards:

• In Maryland, the Court of Appeals starts to consider the constitutionality of that state’s $725,000 cap on Nov. 5 in Lockshin v. Semsker. The main issue in this case is now whether the cap applies to all medical liability cases—a lower court judge previously ruled that it does not apply in cases where the plaintiff had waived arbitration. The cap sees yearly increases of $15,000, and wrongful death awards are limited to 150 percent of the cap.

• In Georgia, Atlanta Oculoplastic Surgery v. Nestlehut opened oral arguments before the State Supreme Court on Sept. 15. The case revolves around the issue of whether the state’s $350,000 non-economic damage cap represents a constitutional violation. The plaintiff’s argument has four parts: the law breaches the right to a trial by jury, since a lower court ruled that the legislatively imposed cap curtails a jury’s authority; it violates the right to equal protection under the law, since its fi nancial burden most affects those most harmed; the separation of powers is violated by the intrusion of the legislature onto the judiciary’s turf; that

that the cap creates a “special law” in an area governed by general laws.

• In Illinois, the State Supreme Court is considering arguments from last November’s LeBron v. Gottlieb Memorial Hospital. At issue is whether a lower court’s ruling should stand—in 2007, that court found that the state’s $500,000 cap for damages against doctors (and $1 million for damages against private hospitals) violated the state’s constitution, specifi cally that it threatens the separation of powers by allowing the legislature to curtail the powers of a jury to fairly compensate injured plaintiffs.

Caps in the Courts

the latest challengesince the law’s 1975 inception, MICRA has seen no shortage of court challenges, and clearly it’s going to see more. Th e CMa and its allies plan to remain active and engaged in the process, as they always have. Th rough the CMa-CHa-Cda amicus Curiae Committ ee, the provider groups have fi led friend-of-the-court briefs in at least 50 court cases disputing MICRA ’s legality since the beginning, says CMa Legal Counsel alicia From. “CMa’s been at the table from the get-go defending MICRA and educating the judiciary, as well as our members, about the law,” she adds.

Rather than getting embroiled in the specific facts in a particular case, says From, the CMa sees its role as providing a larger perspective, and going beyond the immediate facts to explain MICR a’s overall meaning to the court. this often involves explaining to the court the law’s original intent, comparing California’s current situation with other states which lack similar reforms, emphasizing cost savings, and showing how the law helps the state retain physicians, especially in high-risk specialties. the most recent fight, Van Buren, may prove to be a bellwether for future MICR a challenges. a lower-court jury had awarded plaintiff James Van Buren $2.5 million—$700,00 of that for pain and suffering—as part of a finding against Sian Evans, Md, and Yosemite Surgery associates. dr. Evans and Yosemite had been found medically negligent when dr. Evans, attempting to remove a peri-anal cyst, cut Van Buren’s sphincter muscle, leaving him permanently incontinent. In the face of the large damage award, dr. Evans and Yosemite had moved to have it reduced pursuant to MICR a, a motion that the lower court had granted. When plaintiff appealed the ruling in the California Court of appeals for the 5th district, the case became a direct attack on MICR a’s cap of $250,000 on non-economic damages, and it employed most of the usual complaints, with a new focus on the right to a trial by jury—specifically, the plaintiff argued his right to a jury trial had been violated because the legislature established a ceiling for the jury award. the other, more traditional lines of attack included a contention that the cap represented a violation of

the California Constitution’s separation of judicial and legislative powers, and that since the maximum award of $250,000 has lesser purchasing power than it did in 1975, MICR a violated his rights to equal protection under both the state and federal constitutions. Finally, Van Buren argued that he was not subject to MICR a because the intent behind it discourages settling out of court, which he had refused.

the CM a, CH a, and Cda promptly filed briefs in sup-port of MICR a through their joint amicus curiae committee, and the law firm Horvitz & Lev y represented them during oral arguments. Ca PP filed its own brief through attorney Fred J. Hiestand. In addition to arguing in favor of the cap, the organiza-tions aimed to give the court a broad view of the long series of cases that had already addressed the constitutional issues facing it, including the challenge based on the right to a jury trial.

Without much ado, the Court of appeals found all of the plain-tiff ’s contentions to be without merit, affirming the judgment of the lower court in an unpublished opinion. Essentially, the court agreed with organized medicine, finding that these issues had already been addressed by the California Supreme Court, and that it was bound to follow the higher court’s precedents. the court also dismissed Van Buren’s argument that he is not subject to MICR a.

In addressing the new attack from the Center for Constitutional Litigation and the Consumer attorneys of California based on the right to a jury trial, the appellate court simply relied on previous State Supreme Court rulings, and the Supreme Court later declined to consider the case. at the foundation of this victory for organized medicine is the 1985-vintage landmark decision in Fein v. Permanente Medical Group, which found no constitutional violation, stating in that “the legislature may expand or limit recoverable damages so long as its action is rationally related to a legitimate state interest.”

as for the other challenges in Van Buren, separation of pow-ers had already been addressed in several cases before the high court, and each one found the cap on damages to be an exercise of legislative power—not judicial power—by the legislature.



as the situation stands, organized medi-cine seems confident that trial attorneys are barking up the wrong constitutional tree with their new approach.

Previous Supreme Court rulings have also settled the equal protection argument, finding in Fein that the statute is rationally related to a legitimate state interest, and in Werner v. Southern California Newspapers, Inc. that the legislature is the correct forum in which to adjust the law to fit the plaintiff ’s wishes.

there have been legislative challenges to MICR a, too. Lisa Maas counts two or three legislative challenges to the law in the past two decades, with no successes. asked when the last was, she says it’s

been awhile. “there are probably times that we’ve prevented a bill from being introduced, just from the strength of our coalition and the intensity of our members, who talk to legislators to explain how important MICR a is.”

safe, But for how long?as the situation stands, organized medicine seems confi dent that trial att orneys are barking up the wrong constitutional tree with their new approach. “Th e primary constitutional challenges were the crux of the challenge in Van Buren,” says Maas. “Th ey’ve been addressed going all the way back to the Fein case and others.”

of course that’s not at all what you hear from the attorneys that are currently allied with CaoL and CCL. “I know the Van Buren court said this is an old issue, but that was very much in passing. they didn’t squarely take on whether the prior Cali-

fornia Supreme Court decisions addressed this constitutional challenge, and they didn’t,” says Spagnoli. From the beginning, she says, the case lacked the most substantive evidence, which would have undermined the key claim in Fein—that the MICR a cap is rationally related to a legitimate state interest. that body of evidence questions the efficacy of caps in keeping physicians’ liability premiums under control, and bringing it up in appel-late court would raise the question of whether the state has the

constitutional authority to regulate damage awards, if it is indeed possible that caps may not have a mean-ingful impact on insurance rates.

the plan is also to keep the challenges coming. “What we’re telling people is that you should try to

raise the constitutionality of MICR a, so that a trial judge has to make a ruling on it, to get it in front of the appellate court,” Spag-noli explains. “If you go back and look at Fein and other cases that upheld the cap, they never address the 7th amendment right to a jury trial, and there’s been precedent in the U.S. Supreme Court since then that raised has this squarely.”

of course, the willingness of appellate courts—and the Califor-nia Supreme Court—to look at the issue again depends on whether they agree with that the view that Spagnoli holds. If a court doesn’t see any reason to dissent with established state law, there will likely be no review in the high court. If the CMa and the rest of organized medicine maintain vigilant as they have for the past three decades, then the chances are good that the courts will stay true to precedent and the original intent of the law.

california’s Injury Compensation Reform Act is made up of seven components, including its most famous and most-litigated portion, the $250,000 cap on non-economic damages. Here are the other six:

• The law places limits on attorney contingency fees in professional negligence cases against physicians and other health care providers. Attorneys can collect only 40 percent of the fi rst $50,000 recovered, 33 percent of the next $50,000, one-quarter of the next $50,000, and 15 percent of a remainder up to $600,000.

• It sets the statute of limitations at one year from the discovery of an injury and an allegedly negligent cause, or at three years from an injury.

• It allows patients and physicians to agree to settle future disputes in binding arbitration through the use of specifi c contracts that are revocable within 30 days, and which employ specifi c language.

• It allows a physician to use periodic payments to satisfy a claimant’s future economic damages, if they are over

$50,000. • It requires a claimant to notify a

physician 90 days in advance, if he or she intends to sue for professional negligence. The statute of limitations is extended to accommodate nearly late notifi cations.

• The law allows a physician defendant to introduce evidence of collateral source payments during a medical liability lawsuit. This might include personal health insurance related to the damages sought, and the plaintiff is allowed to introduce evidence of the cost of insurance premiums.

The Seven Parts of MICRA


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mIcrA > hanging by a thread March 2 12:15pm-1:15pm CMA MEMBERS ONLY: Meaningful Use for your EHRIn order to receive incentive payments for electronic health records (EHR) implementation, physicians will have to demonstrate “meaningful use” of that system. The Federal Government recently released a draft rule that will define “meaningful use,” including which quality measures physicians will have to report. This CMA Webinar will walk physicians through the proposed rule, and offer practical tips for physicians who are gearing up for incentive payments in 2011.

March 3 12:15pm-1:15pm

CMA MEMBERS ONLY: Documentation – Medi-Cal Fraud and Abuse SeriesIn this webinar, Bruce Tarzy, MD, Medical Consultant with the Department of Health Care Services will describe the importance of documenting medical services provided to Medi-Cal recipients. And, impact of fraud and abuse to the Medi-Cal program.

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Medicare – New Year, Fresh StartThis webcast is designed as a Medicare refresher course, covering a variety of topics including the call inquiry process, filing an appeal and reading your remittance advice.

March 18 12:15pm-1:15pm

HIPAA Overview and Compliance – How to Be Compliant with Recent Changes The HITECH Act of 2009 mandated additional guidelines for HIPAA which impact HIPAA compliance, breach and penalties. In this webinar, David Ginsberg of PrivaPlan, will give a brief overview of HIPAA privacy and security rules, highlight the changes to HIPAA affecting security breach notification and business associate agreements, and provide resources to help physicians understand and comply with the new HIPAA regulations.

April 7 12:15 pm-1:15pm

Resubmit, Reopen or Appeal?This presentation will help you navigate the appeals process and answer all of your frequently asked questions regarding: Reopening vs. Redetermination. What form do I use and where do I send it? And, responding to the Additional Documentation Requests (ADR).

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IN THENEWS

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

Sutter Gould medical Foundation Opens Second medical Office Building; completes Stockton medical PlazaSutter Gould Medical Foundation (SGMF) has opened the second medical office building (SMP II) on the Stockton Medical Plaza campus at Hammer Lane and Don Avenue. The SMP II opened for patients December 14. “This project has enabled our Stockton-based Gould Medical Group specialists to move to the Plaza, and provides our patients a one-stop medical services experience,” said Paul DeChant, M.D., Chief Executive Office for Sutter Gould Medical Foundation. “We are extremely pleased with the way the project turned out.”The new medical office building provides office and exam rooms for specialists including dermatology, ENT, OB/Gyn, orthopedics, gynecology, pain management, urology, and general and

vascular surgery. Primary care physicians, endocrinology and neurology remain in the first building, or “SMP I”. The two buildings are connected by SGMF’s state-of-the-art imaging center and laboratory. “Patients are able to see their primary care physician, have lab work done, take an x-ray or CT scan, and see a specialist without leaving cover of our facilities,” said DeChant. “That was our goal, to provide expert care in a convenient manner. We believe the Stockton Medical Plaza fulfills that goal.” “An Urgent Care Center is another key feature of SMP II that we’ve added for our patients, and will open in the near future,” said Bruce Tigner, SGMF’s San Joaquin County Chief Operations Officer. “With the Urgent Care Center, our patients can see a Gould physician when they might not be able to see their regular Gould doctor – including extended weekday hours or on the weekends.”

Dr. Gellineau Joins Iris clinicLodi Memorial Community Clinic - Iris welcomes family-practice physician Victor Gellineau, MD. Dr. Gellineau joins Harvey Hashimoto, MD, and Terri Vaccarezza, FNP. The clinic is located at 801 S. Ham Ln., Ste. S, in Lodi. New patients and most insurances are accepted. Call 334-8540 to schedule an appointment. Surgeon rick rawson, mD, Joins St. Joseph’s medical GroupSt. Joseph’s Medical Group

of Stockton is pleased to welcome surgeon Rick Rawson, MD, to their team of Family Practitioners, Internal Medicine Specialists, Pediatricians, and General Medicine Practitioners. Dr. Rawson joined St. Joseph’s Medical Group effective August 10, 2009. He will remain in his current office located at 1617 N. California Street, Suite 1E, here in Stockton. After operating a private practice for almost 35 years, Dr. Rawson is looking forward to working for the CHW Medical Foundation team.“The quality of surgery is the most important determinant in patient outcomes,” says Dr. Rawson. “I became a surgeon to have a direct, positive impact on these outcomes. Now with the support of the larger organization taking on some of the details of running a practice (paperwork, billing, staffing, etc.), I can concentrate on what I enjoy most about being a surgeon – providing excellent patient care.”

Second Sutter Gould medical Office Opens


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Dr. Rick Rawson attended the University of Colorado, in Boulder, CO, and completed his residency at San Joaquin General Hospital. Board certified by the Diplomate American Board of General Surgery, Dr. Rawson has been a member of the medical staff at St. Joseph’s Medical Center since 1975. “Dr. Rawson has been a well-respected surgeon in this community for almost 35 years.” said Doug O’Ryan, Director of Physician Operations. “We are extremely pleased to welcome him to St. Joseph’s Medical Group and proud to offer such a comprehensive array of medical services to our patients.”3132 Dr. Nahl Joins Trinity clinic Lodi Memorial Community Clinic - Trinity welcomes internal-medicine physician Gary Nahl, MD. Dr. Nahl joins Drs. Joseph Nguyen and Vanessa Tsuda-Nguyen and family nurse practitioner Dawnette Person. The Lodi Memorial Community Clinic - Trinity is located at 10200 Trinity Pkwy., Ste. 102, in Stockton. New patients and most insurances are accepted. Call 948-0808 to schedule an appointment california medical Association Foundation to Launch california cervical cancer Free campaign Foundation partners with the California Department of Public Health in the campaign to prevent and impede the progression of cervical cancer The California Medical Association (CMA) Foundation is launching the California Cervical Cancer Free Campaign to raise awareness about cervical cancer and develop approaches to reduce the rate of this disease in California which kills more than 4,000 women nationwide. Each year, about 1,400 California women are diagnosed with cervical cancer and 400 die from this disease. Most cases of cervical cancer are caused by the Human Papillomavirus, or HPV. Millions of American women are infected with HPV, but due to its often symptomless nature, a woman can be unaware of her risk of developing cervical cancer. “Almost

all cervical cancers occur in women who have human papillomavirus (HPV),” said Dr. Dean Blumberg, Associate Professor of Pediatric Infectious Disease at UC Davis Children’s Hospital. “Prevention of HPV infection will prevent

cervical cancer.” The CMA Foundation will serve as the lead, coordinating agency for the California campaign and work with clinicians serving a large segment of patients from diverse communities, patient groups and community organizations. “With proven prevention methods, including the new HPV vaccine, regular screenings, and stronger public awareness, we have a tremendous opportunity to do even more to curb the devastating effects of cervical cancer,” said Carol Lee, Esq., president and CEO of the CMA Foundation. Key activities of the CMA Foundation’s California Cervical Cancer Free Campaign during 2010 include: • The dissemination of the updated CMA Foundation Cervical Cancer/HPV Provider Toolkit in early 2010. The toolkit will include a broader understanding of the health disparities associated with cervical cancer, new resources for patient/provider communications and consumer education resources. • The CMA Foundation’s Vaccine Summit to be held on June 1st in partnership with the California Department of Public Health. Strategies to strengthen both healthcare provider and consumer understanding of the issues related to cervical cancer, HPV and the HPV vaccine will be mapped out. • The Health Disparities Convening as part of the Foundation’s 2010 Network of Ethnic Physician Organizations (NEPO) Summit to be held in September. This pre-summit session will highlight best practices, key action steps and resources that are available to increase the use of vaccinations in diverse communities. • Survey of health care professionals on current vaccine practices to inform the campaign about the challenges for

health care professionals. • Convene health plans and payors to address vaccine coverage and access issues.

Victor Gellineau, mD

Surgeon rick rawson, mD

Gary Nahl, mD. Dr. Nahl


IN THENEWS

All women are susceptible to cervical cancer, which is the 10th most common cancer diagnosed among California women. It is also the 5th most common cancer in the Latino population, 6th most in the Vietnamese and 10th most common in the African American populations. Mortality from cervical cancer also varies by race/ethnicity with Hispanic and African American women having the highest rates. Mortality from cervical cancer is associated with later stage of diagnosis, and thus poorer access to preventive services, including infrequent or no Pap screening and/or lack of adherence to follow-up. Therefore, successful campaigns to reduce and eliminate cervical cancer must address the language and cultural needs of all women. The goal of the campaign is to increase screening and vaccination so that every woman has the chance to be protected from cervical cancer. “The message is so clear and so important – get yourself screened and vaccinated,” said Marlene von Friederichs-Fitzwater, cervical cancer survivor and director of the UC Davis Cancer Center’s Outreach Research and Education Program. “I know because I developed cervical cancer and was diagnosed at a late stage because I put off having a Pap test for several years when I was in my 30s. I put myself at risk, and, as a single mother, put my sons at risk of losing

their only parent.” Startup funding for the California Cervical Cancer Free Campaign is made possible by a grant from GlaxoSmithKline. For more information about the campaign, please contact Elissa

Maas, Vice President of Programs, CMA Foundation, at [email protected].

St. Joseph’s medical Staff Announces Inaugural Physician championsThe first Physician Champion awards were presented to Drs. Gurinder S. Grewal and Barbara Rankin during a recent recognition ceremony. St. Joseph’s initiated the Physician Champion award program to recognize and honor individual physicians who pursue and demonstrate excellence in the two categories, Quality and Community, with plans to continue the recognition of outstanding physicians as an annual event. Gurinder S. Grewal, MD, a cardiologist, was named Physician Champion of Quality. Dr. Grewal has demonstrated exceptional dedication to cardiac quality improvement initiatives since he became a member of St. Joseph’s Medical Staff, including acting as Medical Director for Cardiac Research, Chairman of the Cardiac Quality

Committee and Cardiac Care Committee and Medical Director of the Cath Lab since 2004. Dr. Grewal is also instrumental in leading Cardiac Cath Conferences, which serve as a forum to educate Cath Lab staff and encourage collaboration amongst physicians. “I am grateful to St. Joseph’s Medical Staff and administration for recognizing me and creating this award,” Grewal says. “I am deeply committed to my patients have always tried to promote high-quality patient care. I hope that in future years, the award will be presented to leaders who help make St. Joseph’s Medical Center the best facility,

and the leader in quality, in the Central Valley.” Named Physician Champion of Community, Barbara Rankin, MD, has worked to provide medical relief and care to uninsured and/or vulnerable people in the local community, including more than 20 years as a volunteer and Professional Clinic Advisor at St. Mary’s Interfaith Community Services. She has actively participated as a member of the Internal Medicine/Family Practice Quality Assurance Committee for the past three

years and has served on the Credentials Committee for 15 years. “We are pleased that the medical staff established the Physician Champion Program, so that the doctors have a forum for recognition of their peers, by their peers,” said Michael Ricks, Chief Operating Officer, St. Joseph’s Medical Center. “Both Physician Champions adhere to the highest personal standards and have the utmost respect for all the patients and fellow physicians with whom they interact.” The Physician Recognition program was well-received by the medical staff, and an overwhelming majority of the active medical staff participated in voting. Both were extremely close races, especially the Champion of Community, where the decision came down to a few winning votes. The other finalists were Susan McDonald, MD, for Champion of Quality, and Vincent Pennisi, MD, for Champion of Community.

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Inaugural Physician champions


Free medication EZMEDS USA was created for the primary purpose of making the millions facing financial challenges in this country aware of Patient Assistance Programs, and to assist eligible patients who cannot afford their prescription medications due to limited income or other financial hardships. When someone meets the eligibility criteria and is experiencing financial hardship with their prescription medications, EZMEDS USA helps them with worry-free, ongoing management of their prescription assistance needs So, how can EZ MEDS USA help? The problem: There are few who know about these programs or understand the complicated application and approval process required to participate in a P.A.P. The solution: EZMEDS USA. We are a patient advocacy company providing an easy, affordable solution to obtaining costly prescription medications. EZMEDS USA does all the legwork on the patient’s behalf, allowing them to enjoy a worry-free way to receive their medication and save substantial money • We monitor every step of the process for each program from start to medication delivery.• EZMEDS USA automatically handles refills or renewals to continue an ongoing supply of medication.EZMEDS USA interfaces with the physician(s) and program(s) as required on the patient’s behalf. To learn more about EZMEDS and how this resource can help you and your patients, please call Scott Galbraith at 209 406-1483 or email [email protected] or come to the April Office Managers Forum where Scott will be presenting this program.

St. Joseph’s Awards over $150,000 in Grants to community Benefit OrganizationsFurthering a Mission to Improve the Health of Our CommunitySt. Joseph’s Medical Center has awarded $154,187.00 in grant funding to seven local community benefit organizations that provide critical health and human services to residents in San Joaquin County. St. Joseph’s administration, mission, and community benefit representatives distributed the grants,

ranging from $4,000 to $25,000, during a luncheon held at the medical center. “We serve our mission beyond our walls and create healthier communities through our Community Grants program,” stated Sr. Abby Newton, Vice President-Mission Integration, St. Joseph’s Medical Center. “By collaborating with area agencies who support advocacy and social justice for the most vulnerable members of our communities, we further the health care ministry of our religious sponsors who have continuously worked to reach and serve those in need.” The Community Grants Program was established in 1990 to provide funding to community-based organizations that provide services to individuals in need. Since its inception, the program has distributed over $1,650,000 in grant funding to deserving nonprofit community benefit organizations with an interest in building healthier communities by improving health and living conditions. The program encourages organizations attempting to address the underlying causes of illness as well as specific health issues. This year, special consideration was given to programs promoting access to prenatal healthcare and healthcare for children, as well as those focusing on chronic disease such as diabetes and asthma. These health conditions were targeted as a result of community health needs assessments conducted by a partnership effort including local hospitals, county public health departments, and other community agencies. St. Joseph Medical Center annually sets aside revenues from operations to fund the community grant awards. The grants program is one way in which St. Joseph’s realizes its health care mission and enhances the advocacy and social justice efforts of its hospitals and its religious and community sponsors. Through this program, St. Joseph’s seeks to partner with other nonprofit organizations that are working to improve the health status and quality of life for the communities we serve. This year’s St. Joseph’s Community Grants were awarded to the following area organizations:

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Catholic Charities, Diocese of Stockton – To promote prenatal care in the first trimester and improve access to health care for the underserved by providing outreach and education to pregnant women about the importance of early prenatal care.Community Medical Centers – To provide a comprehensive Chronic Disease prevention program to clinic patients and community members of San Joaquin County. The program will include individual patient education, group classes and outreach at local health fairs. Emergency Food Bank of Stockton/San Joaquin – To deliver fresh fruits and vegetables coupled with informative nutrition education and health cooking demonstrations to resource-poor areas

throughout San Joaquin County. The goal of the program is to prevent the development of chronic diseases and to induce healthy lifestyles by enabling access to fresh produce and educational resources. Gospel Center Rescue Mission – To provide homeless/indigent patients with respite care at GCRM facilities that insures their continued recovery after surgery or other illness through the provision of basic post-operative care.St. Mary’s Interfaith Community Services – To ensure that the Virgil Gianelli M.D. Medical Clinic continues to meet and exceed safety and health standards, providing clients with appropriate care through the updating of aging equipment.San Joaquin County Office of Education – To develop and implement

a physical and nutrition education component in Venture Academy’s K-8 program in an effort to combat childhood obesity and other health-related issues. Women’s Center of San Joaquin County - To increase access to free and confidential crisis intervention and counseling services for children and teens who have been victims of, or who have been exposed to, domestic violence. The program will also serve the parents or guardians of child and teen victims. Victims and their parents will receive crisis intervention and counseling services, develop family safety plans, learn about domestic violence and its effects, develop healthy communication skills and receive information and referrals for additional services. About St. Joseph’s Medical CenterSt. Joseph’s Medical Center is a not-for-profit, fully accredited, regional hospital with 294 beds, a physician staff of over 400, and more than 2,400 employees. St. Joseph’s specializes in cardiovascular care, comprehensive cancer services, and women and children’s services including neonatal intensive care (NICU). St. Joseph’s Medical Center is the largest hospital, as well as the largest private employer in Stockton and San Joaquin County. In addition to being nationally recognized as a quality leader, St. Joseph’s is consistently chosen as the “most preferred hospital” by local consumers. Founded in 1899 by Fr. William O’Connor and administered by the Dominican Sisters of San Rafael, St. Joseph’s continues to lead the region in medical innovation as well as ongoing clinical research, developing tomorrow’s advancements, today. In 2009, St. Joseph’s provided over $47 million in charity care, community benefits, and unreimbursed patient care. St. Joseph’s Medical Center is a member of Catholic Healthcare West (CHW), a system of 42 hospitals and medical centers in California, Arizona and Nevada. For more information, please visit our website at StJosephsCares.org.

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San Joaquin Medical Alliance Invites You, Your Family & Friends to Attend Our Bunny Hop & International Potluck Sunday, March 28, 2010 1:00—4:00 pm at the home of Drs. Susan & Jerry McDonald, 11226 Mickie Grove Road, Lodi (8 Mile Rd off I-5 or Hwy 99 2then north on Micke Grove Rd.) This will be a casual, family, outdoor get together for old & new members and their children and grandchildren. Bring your favorite dish to share. Please RSVP by Friday, March 21 $10.00 Adults $5.00 Children. Betty Kellogg 7120 Alexandria Place Stockton, CA 95207 209-956-0696 (H) or 209-612-6308 (C)

Louise Talley has been chosen as our Alliance 2010 recipient of the Doreen Evert member of the Year Award.

Louise held several positions in our Alliance prior to assuming the role of President and subsequently became Nominating Committee Chair the following year. She was president of Junior Aid and after reaching sustainer status she was the recipient of their Mary Dunne Volunteer of the Year Award. She taught Sunday School at Central Methodist Church and taught a Cuban immigrant how to read English through a church sponsored program. Louise has served as president of the Junior Women’s Group of the Haggin Museum, president of The 19th Century Club, and president of PEO (a philanthropic educational organization). She was a founding member of ALS/SOS. Louise recently was named Stockton Symphony Alliance Member of the Year for 2009Please Join us to Present the Award to Louise! Thursday, April 8, 11:30 a.m. Dave Wong’s Restaurant 2828 W. March Lane Please RSVP by April 1 Send To: Nancy Schneider Mail check for $25 (SJMA) 1017 W. Lincoln Rd. 95207

ALLIANcE > news


San Joaquin Medical Society &Health Plan of San JoaquinPresent: ™Learn Best Practices for Selecting, Implementing, and Optimizing an Electronic Health Record (EHR) SystemWith the introduction of the HITECH Stimulus Act, 2010 is the year to fully adopt an EHR system. How do you plan for a successful EHR implementation? What level of “Meaningful Use” deployment is required to receive incentives? There are more than 250 EHR vendors in the market, how do you determine which EHR product meets Stimulus requirements and is the best fit for your practice and budget?

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UOP’S Beyond the Gates Health Care ForumNew University of the Pacific President Pamela Eibeck’s call for more university involvement in the community came to life during a mid-January gathering of health care professionals and academics at O’Connor Woods.

Story & Photos by William West

THE “ASSISTING WITH COMMUNITy SOLUTIONS for Health Care Issues Forum” was the first of a series of meetings to explore how the university’s resources can help meet the needs of Stockton and San Joaquin County. Hospital administrators, public health officials, and leaders in the medical, dental and pharmacy associations gave brief summaries of pressing needs. The high obesity and diabetes rates in the county as well as the large percentage of the population that uses emergency rooms as a primary health care provider were two identified issues. There was so much interest in the forum that the West Hall at O’Connor Woods was quickly filled and two other rooms handled the overflow by means of closed circuit video feeds. There was unanimity that a dearth of health care professionals hampers community well-being. The impending construction of a state prison hospital will further strain the current population of doctors, nurses, and technicians. Here is a summary of some of the panelist’s comments: Ken Cohen, CEO of San Joaquin General Hospital, spoke about infrastructure challenges that included clean air, clean water, and education. He maintained that those who get

their training here are more likely to remain in the community. In discussions later in the forum, suggestions were made that UOP consider implementing training programs in the health professions beyond their highly respected pharmacy school. Mention was made that Delta College is discussing increasing the size of nursing classes with the Department of Corrections. Financing for the increases might be sponsored by the state. Bill Mitchell, director of San Joaquin County Public Health Services, stated that he was going lose 20 percent of his staff due to state budget cuts. Health fairs to screen residents for communicable and chronic diseases sponsored by UOP might help. Mike Steenburgh, Executive Director of the S.J. Medical Society, spoke about the history of the society and related the successes of Decision Medicine in fostering medical careers for students. He spoke of the need for partnering between UOP and health organizations such as Public Health, but also between Health Plan of San Joaquin and other medical groups. He also addressed the idea of a health care career fair for students on the UOP campus. Don Wiley, President of St. Joseph’s Hospital, spoke about the importance of partnering with groups like Health Plan of

cOmmUNITY > Health care Forum

Pamela Eibeck, President of the University of the Pacific, thanks attendees at the health forum


San Joaquin. He reminded listeners that St. Joseph’s isn’t just the area biggest hospital; it is also the area’s biggest charitable organization. Diane Vigil, Executive Director of the Dameron Hospital Foundation, spoke about a partnership with Hamilton Elementary School that introduces young students to actual health care professionals. Hamilton students’ standardized test science scores have improved by 30 percent since the program began two years ago. She posed the challenge to the group to fi nd ways to replicate this program in other schools. Th e keynote speaker was Don Wegmiller, Chairman and CEO of C-Suite Resources, a fi rm specializing in market intelligence on the health care industry for fi rms serving hospitals and health systems,. He is a former chairman of the American Hospital Association. He spoke about the need for a complete change in the health care model in the United States. Th e mantra must be collaboration. Currently, most medical endeavors are insular and self-contained, with their own cost structures. Hospitals and HMOs and private practices all have their own imperatives. Th ey get in the way of each other’s data systems. No one organization

has all the answers and everyone must share best practices to come up with an aff ordable system. Th e insurance system, Wegmiller maintained, needs huge change. For it to work, everyone must have access to the system.

Collaboration must reach outside stric tly health care organizations to all community players. For example, the Salvation Army may know more about the health needs of a certain population than any other group—and could head off an epidemic if they had good communication with local health care providers. Mr. Wegmiller suggested a visit to “milagrohouse.org” to see an example of community collaboration in Lancaster,

Pennsylvania. Th e panelist’s presentations were followed by a discussion with a group of UOP professors and administrators on how to implement some of the ideas and how to address some of the nagging problems. A lunch followed for the participants who continued to discuss ways to improve the health care climate in the local community. Th is fall, UOP will present a report for the community based on the statements of the participants, university faculty, and public feedback.

“Addressing the health care needs of a community requires as many organizations as possible in one big collaboration,” Don Wegmiller, former President of the American Hospital Association. “You would be surprised how much your local churches and the Salvation Army know about the health care needs of their people….and how to organize to help them.”““Addressing the health care needs of a ““Addressing the health care needs of a

community requires as many organizations “community requires as many organizations

“and the Salvation Army know about the “and the Salvation Army know about the health care needs of their people….and “health care needs of their people….and

Don Wiley, President of St. Joseph’s Medical Center, addresses pressing community healt care needs during his presentation. His fellow panelists are (left-to-right) michael Steenburgh, S.J. Medical Society Executive Director; Amy Scriven, S.J. Dental Society; Dr. michael rehbein, Kaiser Permanente; marisella Guerrero, President S.J. Pharmacy Association; (in back) moderator Dave Frederickson, Jacoby center; Don Wiley; (in back) Donald Wegmiller, former head of the American Medical Association and keynoter speaker; Ken cohen, CEO S.J. General Hospital; William mitchell, S.J. County Public Health Director; Dale Bishop,Medical Director for Health Plan of San Joaquin; and Diane Vigil, Executive Director of the Dameron Hospital Foundation.



Hospice care < PrAcTIcE mANAGEmENT

“76 million baby boomers are confronting end-of-life issues for their parents as well as for themselves.”

Hospice Care & Palliative Care:

Choosing the Right Level of CareThe concepts of hospice care and palliative care are parallel--

both philosophies provide quality of life when quantity is no longer possible.

Hospice care Vs palliatiVe carePalliative care is comfort care and follows the curative course that the patient has been on, frequently beginning in the hospital setting. Hospice care is also comfort care and follows the palliative course, is typically provided in the home, and is “time limited” to six months or less after all therapies have been completed. The dilemma for the physician is, “which is the appropriate level of care for my patient when cure is no longer an option?” What constitutes a quality Hospital-Based Palliative Care Team, and how does one choose an outstanding Hospice? Today, physicians and patients can access over 1,400 hospital-based palliative care programs and there are now well over 4,700 hospice programs in the United States.1 One reason for this expansion is to accommodate an aging population living with chronic illnesses; and, simply, a cure is not always possible. This fact will be especially important to the 76 million baby boomers as they confront end-of-life issues for their parents as well as for themselves.

The physician should expect the following from the hospital-based palliative care team:Evidence-based symptom palliation and psychological support; shared decision-making that supports both the patient and the family or caregiver; dignity and respect regarding the patient’s cultural values; practical, financial and legal assistance for patients and families, and coordination of care across the health care settings. The physician should expect the same from the hospice team, plus: accreditation or certification through a national organization; nurses and social workers certified in hospice and palliative medicine; use of standardized assessment tools; one designated case manager/social worker team assigned to each patient; and, an understanding of how the hospice monitors and improves its patient care. Whether a patient receives care from a hospital-based team or a hospice team, both must strive to provide patient and family-centered competent and compassionate care. This allows for a life closure with dignity and respect—hallmarks of all palliative care.

By Aubrey Wuerl, RN • Education CoordinatorHospice of San Joaquin

1Teno, JM, Connor, SF, Referring a patient and family to high-quality palliative care at the close of life. Journal of the American Medical Association, 2009, (301), No 6; 651–658.


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St. JoSeph’S patient pavilion openS

Women’S & Children’S Center, private roomS, healing gardenS

By William West

The design of the new Patient Pavilion at St. Joseph’s Medical Center, that beguiling curve of glass on the corner of Harding Way and California Street, makes the hospital more hospitable. Patient rooms are reminiscent of home in their muted colors and built-in wooden shelves; doctors have sleeping quarters near the labor and delivery rooms; private rooms give cancer patients and their families needed emotional space.

The staff has its own entrance doors that lessen foot-traffic in visitor areas, also reducing noise for patients. Multiple windows and other glass features allow natural light in more areas, especially into patient rooms. A subset of architects, including designers of the Patient Pavilion, studied for fifty years the way a hospital building affects patients and staff. Many of the lessons learned in that half century are elements of the new pavilion.

40 SAN JOAQUIN PHYSICIAN WINTER 2009

From the street the pavilion incorrectly appears to be one solid building, but once inside it reveals large areas of open space and views from every room. Two courtyards with healing gardens offer open-air respite. The courtyards are substantial: 1300- and 2000-square-feet. There are meditation rooms. The feel for patients and staff is less that of a big-box industrial space, but more human-scale and natural. The dominant eye-catching element is the pedestrian bridge from the existing hospital to the new pavilion. Clad in glass it sweeps across Maple Street in a serpentine leap. March 19, 2010, is the scheduled opening date; eight years after the schematic design process began. “I would like to say that Sister Gabriel is watching down over us with great affection for this project,” said Dr. Param Gill, Obstetrican-Gynecologist, and immediate past Chief of Staff at St. Joseph’s. The late Sister Mary Gabriel, O.P., member of the Dominican Sisters of San Rafael that sponsor St. Joseph’s, was a legendary leader of St. Joseph’s for more than four decades until her retirement in 1990. She tirelessly advocated for increased levels of community care and for hospital improvements. (O.P. stands for “ordo praedictorum” or “order of preachers”.) Dr. Gill and her medical group bring a lot of babies into the world via St.Joseph’s, thus she is doubly interested in the Pavilion’s new Women’s and Children’s Center. The first floor contains rooms dedicated to deliveries and newborns. The neonatal intensive

care unit (NICU) beds are located on the second floor. “St. Joseph’s delivers something like 150-to-200 babies per month,” said Dr. Gill. “Our medical group delivered 1100 babies last year at St. Joseph’s.” Of the 78 new beds in the pavilion, 58 are related to women’s and children’s medical needs. There are 20 postpartum beds and 6 high-risk private postpartum beds; 22 NICU beds; 8 delivery rooms; 2 maternity triage rooms, and 2 maternity operating rooms. “This is the first facility in the county to have private postpartum rooms, including bath and shower,” said Dr. Kevin Rine, Chair of the Obstetrics and Gynecology Department. Meeting with designers during the planning process, Dr. Rine advised them what doctors and patients need. Sometimes its small things, like a place for the baby warmer, which always seemed to be floating around the room and in the way. In the new rooms the baby warmer has a built-in storage garage in which to park. Other things are more important, like now having two operating rooms instead of just one so scheduling isn’t interrupted by emergencies. No more being forced to transport patients to the main OR. Better for patients and better for doctors. “We are bringing on line a brand new monitoring system,” said Dr. Rine. “It will allow us to monitor tracings, like fetal heart rate, from home. We can advise the nurses how to treat right away.” The third floor contains the private rooms for oncology patients and other med/surg patients depending on census needs. “The cancer unit is going into the Patient Pavilion and its a unique unit,” said Dr. Aminder Mehdi, Director of the Oncology Department. “It is specifically a cancer nursing unit. The new unit in the Pavilion will have 20 beds and all the rooms will be private. This is very important because cancer patients need privacy to deal with the emotional effects of cancer. They Continued on next page >>

WINTER 2009 SAN JOAQUIN PHYSICIAN 41FALL 2009 SAN JOAQUIN PHYSICIAN 41

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cOver StOry > St. Joseph’s Patient Pavilion Opens

need privacy to be with their families.” The additional beds for oncology patients, expectant mothers, and neonates frees up other beds in the older sections of the hospital, thus addressing a pressing need. Put simply, during the winter the hospital would sometimes run out of beds. Will there be enough new beds? “We did our business plan to determine the needs for beds,” said Terry Spring, Vice President of Administration. “A study and economic forecast was done internally by the Strategy and Planning Division for Catholic Healthcare West. We believe that this addition will carry us out about 20 years.” The economic slowdown has reduced population growth rates and thus extended the projection by a few years. The hospital will now have a total of 365 beds. The benefit of economic slowdown is that population will increase at a slower rate, but the challenge is that it reduces income. Sobering projections of low reimbursement rates from Medicare and Medi-Cal, as well as the growing number of patients without insurance, put a strain on hospital budgets. Meanwhile, operational costs are increasing. Throw in debt service on $90 million of loans for the new pavilion and you’ve got two lines on a chart that are going in opposite directions. St. Joseph’s decided in August, 2009, to limit Medi-Cal patients from certain procedures. This will have an affect on the new pavilion’s revenue. “Some elective gynecological procedures will no longer be performed if they will be paid for under certain Medi-Cal payment umbrellas,” said Don Wiley, President of St. Joseph’s Medical Center. Mr. Wiley said that St. Joseph’s has been working with obstetricians to help their patients find insurance to cover these elective procedures. He emphasized that a woman who comes to the hospital in labor is not turned away. Those certain Medi-Cal patients who decided on elective procedures are directed to the county hospital. “The original idea to limit Medi-Cal procedures was not aimed at OBGYN


surgeries but was meant for medical / surgical patients in general,” said Mr. Wiley. There has been some slow down in Medi-Cal deliveries in January, decreasing from 25 to 15, but there has been a slowdown in births throughout the nation, attributable to economic conditions according to many. Medi-Cal reimbursement has been about 24 percent of total gross revenue, and Mr. Wiley noted that the new policy on elective procedures has lowered that to about 20 percent. The recession has hit top-line revenue numbers for all hospitals in the nation. Yet there are dozens of $100 million projects at completion across the country. Locally, Lodi Memorial Hospital’s new South Wing opened recently. Kaiser Hospital in Modesto completed its new facility in the last two years. The seeming illogic of taking on new debt during a time of diminished revenues is explained by the lengthy planning and building timeline for new hospital facilities. St. Joseph’s began their design process in 2002. So did hospitals across the country. A few years later there were groundbreaking ceremonies. American hospitals began 53- million-square-feet of new construction in 2008, according to a report from industry-watcher McGraw-Hill Construction. The new pavilion costs $117 million, of which a previously mentioned $90 million is borrowed. St. Joseph’s Foundation has raised $12 million toward its goal of $20 million for the new pavilion. The remainder came from reserves. The Pavilion joins other construction milestones for the largest hospital and largest employer in San Joaquin County. In 1916 a two-story Mission Renaissance style building was erected and is still known as “the Main”. In 1926 a third floor was built on top of the Main and this gave St. Joseph’s 125 beds. In 1954 there was a major addition that gave the hospital 52 more beds. In 1962 a south wing was added that included 90 new beds, surgical suites with eight operating rooms and an intensive care unit. In 1967, completion of the west wing fourth floor on the 1962 building added 24 more beds. In 1970 a $4 million addition was finished, including a Coronary Care department and new Maternity and Emergency departments and an additional 90 beds. St. Joseph’s then had a total of 300 licensed beds. Derek Parker is a director of the architectural firm Anshen and Allen, designers of the Patient Pavilion and other projects at

St. Joseph’s. Anshen and Allen got their first hospital project at Good Samaritan in San Jose in 1962. The young Mr. Parker was assigned the project. “I didn’t know anything about designing hospitals-I thought pediatrics was care of the feet-but I became fascinated with the complexity,” Mr. Parker said in an interview for the Center for Health Design. “It wasn’t just design for the sake of design; you had to know what you were designing for. So, for six months, I worked as an orderly at a hospital to learn how a hospital functions.” “After that, I became very interested with the notion of whether design has a role in health,” Mr. Parker said. “I became convinced that the built environment made a difference in the quality of healthcare.” He wasn’t alone. Studies show natural light reduces depression and nature scenes reduce reported pain levels. Ergo,

healing gardens and lots of windows. Alphonsus Regional Medical Center in Boise, Idaho, lowered noise volume and patients’ self-reported sleep quality improved by half — up from 4.9 to 7.3 on a scale of 10. At Bronson Methodist Hospital in Michigan, they added new private rooms, improved air-flow, changed location of sinks and hospital-acquired infections declined 11 percent. Mr. Parker created the Center for Health

Design, located in Concord, California, that pushes for evidence-based design. He started the Pebble Project which is a research initiative that seeks opportunities for collecting hard evidence about the affects of buildings on health and healing. There are more than 50 research projects gathering data to show how environment affects outcomes. “Of course, we have a tendency in America to over-hype everything,” said Mr. Parker. “And I think to some degree we’ve done that with evidence-based design. I’ve been hyping it for a long time. The point has now been made, now how do we make it more credible? Hopefully, the data coming out of the Pebble Project will continue to do this.” Anshen and Allen’s clients include Boston University Medical Center, Duke University, Belfast Royal Hospital, Harvard University, Kaiser Permanente, Massachusetts General Hospital, Children’s Hospital of Oakland, Oregon Health and Science University, Royal Infirmary of Edinburgh, Melbourne’s Royal Victoria Children’s’ Hospital, Sinai Hospital and literally scores more.

“All hospitals have budgeting constraints. With that in mind, putting money into a Women’s Pavilion brings two important points to my mind. First, women make most of the healthcare decisions in a family. Second, if they have a positive birth experience it means they will more likely bring family back to that hospital.” – Dr. Param Gill


Speaking of clients, Mr. Parker believes that architects are only as good as their clients. He included former St. Joseph’s President Ed Schroeder in his list along with some very heady company. “We can only do good work when we have a vision-driven client. Th ey are very rare. Jonas Salk, Lucile Packard (Stanford Children’s Hospital), Blair Sadler (San Diego Children’s Hospital), Ed Schroeder (St. Joseph’s in Stockton, Ca.),” said Mr. Parker. “Alan Yordy (Sacred Heart Medical Center) and Tom Tonkin (Community Hospital of the Monterey

Peninsula) are a few that come to mind.”Mr. Schroeder is now the CEO of O’Connor Woods. Dr. Gill knows the improved ambience in the pavilion will help her patients. “Women are very aff ected by aesthetics and when in labor their surroundings have a major aff ect,” said Dr. Gill. “Studies show that soothing aesthetics mean less use of pain medications.” “Another great thing about the new pavilion is a private postpartum room where dad can stay the night with mother and baby,” Dr. Gill added. “Th e family as a whole starts the day

the baby is born, not with the father pacing around somewhere or staying at home. And there are sleeping rooms for the doctors right by the patient rooms so they can stay if need be.”Dr. Peter Chao, perinatalogist who last year opened a practice in Stockton, is “looking forward to the new pavilion because it will be more spacious and easier for patients and doctors. Th e neonatal rooms are very roomy and pleasant.”Th e native New Yorker, worked at Kaiser in Los Angeles where a staff gynecologist who was expert in perinatalogy became a kind of mentor. “I always admired her ability to use ultrasounds for diagnosis,” said Dr. Chao. “I was at the right place at the right time.” “It used to be that diffi cult pregnancies were treated only in major medical centers,” said Dr. Chao, “but now they are being treated in more outlying areas. I’m looking forward to working in the new pavilion.” “No woman should have to leave the area to handle their pregnancy unless the baby will need immediate surgery,” said Dr. Gill. “Dr. Chao and the new pavilion mean that 99 percent of women can stay here.”

cOver StOry > St. Joseph’s Patient Pavilion Opens

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Stockton 1617 N. California St., Ste. 2-A – Ph. (209) 466-8546Stockton 435 E. Harding Way – Ph. (209) 464-4796Stockton 2509 W. March Ln., Ste. 250 – Ph. (209) 957-1000

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

visit our website at www.gillobgyn.com

GILL OBSTETRICS & GYNECOLOGY

Gill Obstetrics has a rich history of serving generations of

expertise and compassionate care in a welcoming environment where

After all… each woman's needs are unique and you deserve special care!

GYNECOLOGY

Stockton 1617 N. California St., Ste. 2-A – Ph. (209) 466-8546Stockton 435 E. Harding Way – Ph. (209) 464-4796Stockton 2509 W. March Ln., Ste. 250 – Ph. (209) 957-1000

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

visit our website at www.gillobgyn.com


Q

Benefi ts < memberShIP

yOUr OFFIce mANAGer ADvOcAte hAS the ANSWerS

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

brIeFly NOteDUtIlIZING DrUG PrOGrAmS FOr Free meDS Discarding Expired DrugsHandling Workers Comp Patient RecordsFilling Out Patients FormsBeing Paid for Non-Emergency Call Coverage from an IPA

GeNA StODDArtmemberShIP cOOrDINAtOr

(209) [email protected]

Continued on page next page>>

QUESTION: Many of the drug manufacturers offer free or greatly reduced medications to deserving patients – is there a simple way to access these programs?

ANSWER: Yes. San Joaquin Medical Society has learned of a new program being offered by EZ –Meds of Scottsdale, Arizona that facilitates this process for the patient and the physician as well. They provide your practice with a simple one-page application in which your patient provides qualifying information and a list of medications they are prescribed for. Once they are approved via phone, EZ-Med provides the practice the correct forms and coordinates delivery of the approved meds via the mail. There is a very low application fee and monthly charge to utilize the service. Contact EZ-Meds local representative Scott Galbraith at (209) 406-1483 for more information.

QUESTION: What should I do with expired medication?ANSWER: According to the Drug Enforcement Agency (DEA), if the office cannot return the medication back to the pharmaceutical company for credit, then they can call the only distributor in California, EXP Pharmaceutical Services Corporation, at (800) 350-0397, to take these drugs and dispose

QQUESTION:QQUESTION:ANSWER: QANSWER: (DEA), if the office cannot return the medication back to the Q(DEA), if the office cannot return the medication back to the pharmaceutical company for credit, then they can call the Qpharmaceutical company for credit, then they can call the


Qof them properly. EXP will mail out a box for the medication with directions on how to ship it back. The quantity does not matter, so even small packages are accepted. For further information, visit EXP’s website.

QUESTION: A patient that I evaluated for a workers’ compensation case is now requesting a copy of his medical records. Do I have to comply with the patient access laws with respect to persons I have evaluated for judicial or administrative proceedings?

ANSWER: We are of the opinion that treating physicians must comply with these disclosure requirements regardless of how they are paid. Thus, the fact that a treating physician is paid by a workers’ compensation insurer does not affect the patient’s right to information. However, the opinions and/or conclusions of a physician retained as an expert in a workers’ compensation case are not subject to disclosure pursuant to the patient access law because the individual in that case is not a “patient” of the expert. Physicians acting as experts should consult with the attorney who retained them concerning requests for information by an individual they evaluate. Physicians should be aware that people they examine at the direction of attorneys pursuant to Code of Civil Procedure §§2032.010 et seq. are entitled to a copy of the physician’s report pursuant to Code of Civil Procedure §§2032.610 et seq. For further information, consult CMA’s ON-CALL document #1150, “Patient Access to Medical Records,” available free to SJMS-CMA members at www.cmanet.org. For assistance in logging onto CMA’s website, contact Gena at (209) 952-5299 or at [email protected]

QUESTION: Sometimes my office staff fills out forms on our patients’ behalf. Are there any steps I should take before I start charging my patients for the completion of forms?

ANSWER: Yes. You may wish to consider reviewing all managed care contracts to see whether there are any restrictions. Some contracts may only allow you to bill patients for co-pays and deductibles. This may be interpreted as a prohibition against charging for

QQUESTION:QQUESTION:forms on our patients’ behalf. Are there any steps I Qforms on our patients’ behalf. Are there any steps I should take before I start charging my patients for the Qshould take before I start charging my patients for the completion of forms?Qcompletion of forms?

OmFOmFOFFIce mANAGerS FOrUm ScheDUleJoin Gena each second Wednesday of the month at Valley Brew for our popular “Office Managers Forum” in which the medical society plays host to a wonderful lunch and a brief 45 minute seminar on various topics. It kicks off at 11:00am and ends promptly at 1:00pm – lunch is complimentary and our speakers always allow time for great Q & A sessions. Call Gena at (209) 952-5299 to RSVP up to the day before and feel free to invite a guest along!

mArch tOPIc – “Understanding Risk Management from the Office Managers Perspective” presented by Norcal Insurance

APrIl tOPIc - “Assisting your patients receive free medications” presented by EZ-Meds

mAy tOPIc – “What Every Office Manager Should Know to Run a Practice” presented by Frank Navarro from California Medical Association. Frank will also be offering an evening presentation for physicians.

JUNe – “EHR’s – A Simple Overview?” presented by CMA


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Q

forms. Contact your payers. You may want to let them know you plan to institute a charge for form completion and avoid problems down the road. Also, notify your patients ahead of time. This will avoid surprise and hard feelings. Office staff should be briefed on exactly how to respond when patients question the need for the fees or ask whether the fee can be waived.

QUESTION: My group and I take non-emergency call at a local hospital. We sometimes assist patients who are insured through IPAs, of which we are not contacted with. Can they pay us whatever they want to?

ANSWER: Yes and no. IPAs should be paying physicians at their usual and customary rate (UCR). By the way, the Department of Managed Health Care (DMHC) opined that Medicare rates should not be used as a benchmark. If you are not being paid your UCR, then CMA recommends that physicians file an appeal with the IPA. If after an appeal has been filed, and the IPA does not pay a sufficient amount, then you can file a complaint with the DMHC as this is an unfair payment practice. For more information on how to appeal and filing a complaint with the DMHC, members can obtain CMA On-Call Document #1051, “Physician Complaints about Managed Care Plans” from the San Joaquin Medical Society.


CERTIFIED MEDICAL CODER COURSEBECOME A CERTIFIED MEDICAL CODER IN 5 DAYS!

Certified coders have never been in greater demand.More physicians need Certified Medical Coders who are capable of understanding the complexities of the reimbursement process. Improve your practice’s financial health. Your skills will help guard against improper claim submission and contribute to a higher rate of paid claims for your physician’s practice.

CLASS SIZE LIMITED TO 24 – SIGN UP NOW!

COURSE CURRICULUMMedical Terminology for Diagnostic & Procedural Coding•Roots, prefixes and suffixes•Anatomy and physiology•Body structure and body systems

ICD-9-CM Diagnostic Coding•Coding conventions•Guidelines from CMs•Primary vs. secondary codes•Signs/symptoms and ill-defined conditions•Neoplasms and adverse effects•Injuries, burns, fractures and wounds•Supplementary classifications•OB/GYN codes

CPT Procedural Coding•CPT categories, format and guidelines•Diagnostic vs. therapeutic services•E&M services for all categories plus modifiers•Surgical Coding guidelines and procedures•Modifiers for surgical procedures•Coding from chart notes and operative reports

Ancillary Services & Advanced Coding•Maternity and delivery services•Radiology•Pathology & lab services in the physician’s office•Medicine & intervention•Coding problem set exercises•Medical and surgical specialties

COURSE DETAILSWhen: Five Tuesdays;April 13, 20, 27, May 4 and 11, 20108:00 a.m. – 4:00 p.m. each day(Sign-in 15 minutes prior to each session)

Where: San Joaquin Medical Society Training Room3031 W. March Lane, Suite 222W, Stockton

Cost: SJMS member physicians/staff: $649 Nonmember physicians/staff: $949 (if room) Registration fee includes certification exam

To sign up, simply call the San Joaquin Medical Society at (209) 952-5299 or sign up online at www.sjcms.orgRegistration Deadline March 31, 2010

Presented by Practice Management Institute and hosted by the San Joaquin Medical Society.

Cancellation Policy: A full refund less $20 processing fee if cancellation is received 7+ days prior to program start date. A 50% refund if cancellation is 6 days to 48 hours prior to start date. No refund if cancellation is less than 48 hours in advance. PMI strictly adheres to this policy.

Required Materials to bring to each class: CPT, ICD-9-CM Volume 1&2, HCPCS manual and medical dictionary

Need to re-certify? Exam only: $299 (May 11)


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membership < meDIcAl SOcIety

Neelesh Bangalore, MDHematology/OncologySt. Teresa Comprehensive Cancer Center4722 Quail Lakes Dr, Ste AStockton, CA 95207Offi ce: (209) 474-1458Gauhati University Medical College: 1985

Carlos Delgado, DOFamily MedicineSutter Gould Medical Foundation2505 W Hammer LaneStockton, CA 95209Offi ce: (209) 957-7050New York College of Osteopathic Medicine: 2004

Michael Herrera, DOEmergency MedicineSt. Joseph’s Medical Center1800 N California Street

Stockton, CA 95204Offi ce: (209) 467-6400College of Osteopathic Medicine of the Pacifi c: 1993

Mahveen Hussain, MDInternal MedicineSan Joaquin General Hospital500 W Hospital RoadFrench Camp, CA 95231Offi ce: (209) 468-6700New York Medical College: 1998

Charnpal Mangat, MDObstetrics & GynecologyP. Gill OB & GYN Medical Group, Inc1617 N California St, Ste 2AStockton, CA 95204Offi ce: (209) 466-8546Punjab University, Dayanand Medical College: 1997

Ranneet Mangat, MDObstetrics & GynecologyP. Gill OB & GYN Medical Group, Inc999 S Fairmont Ave, Ste 230Lodi, CA 95240Offi ce: (209) 334-4924Punjab University, Dayanand Medical College: 1997

James Norwood, MDInternal MedicineSutter Gould Medical Foundation600 Coffee RoadModesto, CA 95355Offi ce: (209) 524-1211University of Nebraska: 1989

Bennet Omalu, MDAnatomic/Clinical PathologySan Joaquin General Hospital500 W Hospital RoadFrench Camp, CA 95231Offi ce: (209) 468-6000University of Nigeria School of Medicine: 1990

Kinnari Parikh, MDInternal MedicineSan Joaquin General Hospital500 W Hospital RoadFrench Camp, CA 95231Offi ce: (209) 468-6000Gujarat University, BJ Medical College: 2004

Rahul Somani, MDRadiologySt. Joseph’s Medical Center

1800 N California StreetStockton, CA 95204Offi ce: (209) 467-6363Indiana University School of Medicine: 1989

Winlove Suasin, MDRadiation OncologySt. Joseph’s Medical Center1800 N California StreetStockton, CA 95204Offi ce: (209) 467-6560Creighton University School of Medicine: 1990

Stephen Tinio, MDFamily Medicine3132 W March Lane, Ste 5Stockton, CA 95219Offi ce: (209) 475-5500Institute of Medicine, Far Eastern University: 2003

Dan Vongtama, MDRadiation OncologySt. Teresa Comprehensive Cancer Center4722 Quail Lakes Dr, Ste BStockton, CA 95207Offi ce: (209) 472-1848Northwestern University: 2004

Edmund Yao, MDInternal Medicine1507 W March LaneStockton, CA 95210Offi ce: (209) 472-7100College of Medicine, University of the East: 1991

14 NEW MEMBERS IN THE PAST

60 DAYS!...and even more on the way.


cOmmUNIty ServIce > Off the charts


Cambodian odyssey

StOry & PhOtOS by Dr. Peter SAlAmON

angkor Hospital for Children,Siem Reap, Cambodia

Last year Health Volunteers Overseas/Orthopaedic Overseas inquired if I wished to volunteer for two weeks at the Angkor Children’s Hospital in Siem Reap, Cambodia. I was already scheduled to spend two weeks volunteering in Phnom Penh, Cambodia, and it seemed natural to add the Children’s Hospital in Siem Reap. I agreed. In the interim, long before the trip was to begin, the assignment in Phnom Penh was cancelled because of local holidays and a conference that conflicted with my scheduled time in Phnom Penh. Nonetheless, I wanted to volunteer at the Angkor Children’s Hospital, and I decided to proceed. >>



The trip was fairly long, flying from Sacramento to Los Angeles and then on to Bangkok, Thailand, where I flew to Siem Reap, Cambodia. The hospital arranged for a driver, who held a sign with my name on it at the airport and drove me to my guesthouse. I was immediately aware of the heat and humidity in Siem Reap. The average temperature at this time of year is above 90 degrees, and the humidity 100%. The first week in Cambodia I stayed at a small guesthouse near the hospital, which was convenient and inexpensive. The second week, when my wife arrived, we checked into the Angkor Palace Resort & Spa a Five-Star Cambodian-owned resort. Cambodia is extremely inexpensive. At the guesthouse an air-conditioned room with bath was $12 a night. The luxury resort hotel was $85 per night. The day after arrival I arranged a guide to take me to visit the temples of Angkor Wat. The Khmer civilization was extremely advanced. These spectacular temples and cities were built in the tenth and eleventh centuries and were abandoned approximately 200 years later. They were rediscovered by a French botanist in the early 1800’s. They are remarkably well-preserved, and anyone who makes a trip to Siem Reap should plan on spending a few days visiting these magnificent structures.

My first day at the hospital was Monday, October 19. After an introduction and tour with the volunteer coordinator and some very minimal paperwork, I was introduced to the surgical staff with which I spent the majority of my time. There are three surgeons at the Angkor Hospital for Children. They are all general pediatric surgeons who have had no formal residency training. They learn on the job, and my role was to help them to learn to do orthopaedic procedures. Their surgical skills are remarkably good, but they don’t have enough orthopaedic training to appreciate how to approach some of the various orthopaedic conditions with which they are faced. The orthopaedic surgical volunteer supply at Angkor Hospital for Children seems to be sufficient. The hospital consists of a number of one-story buildings which, for the most part, are not air-conditioned. There are four wards. The patients all stay in the same room. The parents stay with the children. There is one single operating room at the Angkor Children’s Hospital, and the operating room and recovery room are air-conditioned. The operating room is run quite well. The equipment is a potpourri of primitive and relatively modern, although outdated, equipment. Nonetheless, it gives an opportunity to improvise and work with less than we are accustomed to at home. They do have an x-ray machine and a portable x-ray machine, so single-shot x-rays can be taken in the operating room. Good quality x-rays are available on all the patients. They also have ultrasound, which seems to work reasonably well. There are no other advanced imaging systems, such as CT scan or MRI scan. Those are essentially not available to the average patient in Cambodia. Because there is only one operating room, only one volunteer can be present at any given time. The volunteers come from numerous specialties including pediatric general surgery, urology, cardiothoracic surgery, plastic surgery, and orthopaedic surgery. During the two weeks I was at the Angkor Children’s Hospital the operating



cOmmUNIty ServIce > Off the chartsroom schedule was fairly light with routine cases, so that I could do orthopaedic cases every day. Nonetheless, the local surgeons had occasional urgent cases that would take precedence over my schedule. The anesthesiologists are very highly skilled and do anesthesia well with few complications. They do general anesthesia on very tiny infants. Almost every orthopaedic surgical patient received some type of a nerve block along with the general anesthetic. They do caudal anesthetics, femoral blocks, ankle blocks, and sciatic blocks. The surgical turnover is extremely efficient, so fast you barely have time for a cup of tea before the next patient is asleep in the operating room. Nonetheless, the number of cases is not enough for a two-week volunteer stint. Most days I did two or three operations and was done by noon. The entire operating room shuts down from 12:00 to 2:00 for lunch. The first day there was a screening clinic. The local surgeons had assembled approximately 40 patients for me to examine and determine whether or not I could help them surgically. The diagnoses for which I did surgery were chronic dislocation of the patella secondary to quadriceps contracture, quadriceps contracture as an isolated problem, congenital muscular torticollis in an 11-year-old, cavovarus foot deformity in a 13-year-old, and a malunion of the femur in a 14-year-old with about 2-inches of shortening, on whom I did an epiphysiodesis on the contralateral side, and late-diagnosed congenital displacement of the hip. The cases were interesting and challenging. I tried to allow the Cambodian surgeons to do the operations, with me assisting. I felt they would learn a great deal more than by watching me operate. That seemed to work out very well because they are very highly skilled and pick things up quickly. The present rate is about one pediatric orthopaedic surgical volunteer about every three months, and that does not allow accumulation of enough surgical patients for a two-week stint. My advice to first-time visitors is to spend one week working at the hospital, and the second week traveling in Cambodia and seeing the spectacular Angkor Wat and associated temple ruins. The town of Siem Reap is a little bit touristy. A lot of young tourists come here, and a lot of Asian tours pass through this area. We ran into people from all over the Far East, including the Philippines, Japan, and Korea, as well as a few groups from Western Europe. Most of them passed through Siem Reap in a period of two or three days, and then moved on. We were easily the longest tenants at the resort hotel. Everyone on the staff got to know us. The hospital is run by a group called Friends without a Border, and there is an American pediatrician who is

the full-time education coordinator. He and the chief of surgery coordinate the volunteer visits. That way, a plastic surgeon, urologist, general surgeon, orthopaedist, and ENT don’t turn up at the same time and have to compete for operating room space. I would recommend that those wishing to volunteer contact Friends without a Border directly, as I think they are quite happy to have volunteers for a week at a time. Once they know you at the hospital, I believe they would be eager to have you return. They see a lot of chronic musculoskeletal infection (osteomyelitis) which often needs to be treated surgically. There are also many malunited displaced fractures (i.e., type III supracondylar fractures of the humerus) that had been treated by traditional bone healers. These have healed in malunited positions and are beyond the ability of the surgeons in Siem Reap, or for that matter, the volunteer surgeons, to correct with the type of equipment that is available. There is little choice but to accept the deformity, as the children seem to function reasonably well. I saw no acute fractures, although I am told they are seen from time to time. The femur fractures are treated in traction. The Ponseti method of treatment for club feet has caught on here. There is a group called Handicapped International which does all the casting of club feet (by physiotherapists). The percutaneous tenotomies are done by the surgeons at the hospital, and then the additional casting and construction of the Denis Browne bar and corrective shoes is done at Handicapped International. The splints are extremely innovative. They look like they are much more comfortable than what we use in the United States. Travel around Siem Reap is usually by Tut Tut, a small carriage pulled by a motor-scooter that can easily pull two adults. While I was staying at the guesthouse I could walk to the hospital in one minute. While staying out at the resort hotel I traveled by Tut Tut each morning, which took about ten minutes and usually cost $3. The restaurants in Cambodia are outstanding and extremely inexpensive. It was not unusual for my wife and I to dine out in a nice restaurant, have three Khmer dishes and beer, and walk away from the restaurant with a bill of about $12. Some of the restaurants even offered live Cambodian entertainment, which did not add to the price. The de facto currency of Cambodia is the U.S. dollar. There is a Cambodian currency called the Reil, but no one uses it. The prices in all the restaurants, shops, and hotels are in U.S. dollars. The transactions, even on the street, are in U.S. dollars. The ATM machines (which were plentiful) give out U.S. dollars and not the local currency.

SPRING 2010 SAN JOAQUIN PHYSICIAN 59FCCU Full page.indd 1 12/16/2008 10:01:30 AM



There is no reason to change money at all. My suggestion is to bring a number of dollar bills, which are very useful (perhaps 100 for a 1-2 week stay). Credit cards are useful only in a few places. There are numerous choices of accommodations in Siem Reap. These range from small guest houses, where I stayed the first week, to numerous, rather luxurious hotels. The area is gearing up for what I believe they anticipate is a huge influx of tourists in the next few years. The attraction, of course, is Angkor Wat. There are easily 100 new hotels that have been built in the area. They range from comfortable hotels to luxury resorts. The Angkor Palace Resort & Spa offered special rates to various groups, including people affiliated with the United Nations and to people like myself, volunteers at the Angkor Children’s Hospital. The information brochures provided by the Friends without a Border provide a list of available accommodations, but it is easy to go on-line and look at the many choices, which is what we did. We contacted the hotel directly, asking if they had arrangements with the Angkor Children’s Hospital. The volunteer coordinator at the hospital also is extremely helpful in

arranging accommodations. My take on the needs of the Angkor Children’s Hospital, as far as pediatric orthopaedic volunteer consultants, would be the need for one surgeon approximately every two to three months for one week at a time. That way, on the first day accumulated cases can be screened and an operating room schedule set up for the rest of the week. In that way, each surgical day would be a little bit longer, and I believe all of the cases could be completed. On the first visit to Siem Reap I think it is important to spend a little bit more time to get the lay of the land and enjoy some of the incredible history and architecture of the area. After seeing that on your first visit, one can accomplish almost everything one has to do in a week at the hospital. Procedures can even be staged if there is enough sequential pediatric orthopaedic coverage. This is an excellent opportunity to teach, as the local surgeons are extremely skilled and only need some direction as to handling many of the difficult problems my visit was extremely gratifying and I highly recommend this type of experience to all physicians and surgeons.


Accountant

Iacopi, Lenz & Company3031 W March Lane, Ste 300EStockton CA 95219(209) 957-3691

Adult Day Care Centers

Somerford Place3530 Deer Park DrStockton CA 95219(209) 951-6500

Alcohol & Drug Treatment St. Joseph’s Behavioral Health Center 2510 N. California St Stockton CA 95204 (209) 461-2000

Answering Services

Front O�ce Sta�, Inc701 S Ham Lane, Ste A Lodi CA 95242 (800) 836-7189

Assisted Living and Alzheimers/Dementia

Facilities Atria Bayside Landing 3318 Brookside Road Stockton CA 95219 (209) 473-1300

Camlu Assisted Living60137 N Pershing Ave Stockton CA 95207 (209) 951-2030

Golden Living Portside 2740 N California St Stockton CA 95204(209) 466-3522 Plymouth Square 1319 N Madison St Stockton CA 95202 (209) 466-4341

Sunny Place of Stockton Espie Vierra 807 W Swain Road Stockton CA 95207 (209) 956-8677 www.sunnyplaceofstockton.com

The Commons on Thornton 10711 Thornton Road Stockton CA 95209 (209) 476-1500

Villa Marche Steven Gianandrea 1119 Rose Marie Lane Stockton CA 95207 (209) 477-4858 Wagner Heights Nursing Vicki Sihoto 9289 Branstetter Place Stockton CA 95209 (209) 477-5252

Attorney / Law Firms

Cassel Malm Fagundes Scott Malm 6 El Dorado South, Ste 315 Stockton CA 95202 (209) 870-7900

Khouri Law Firm Mike Khouri 4040 Barranca Pkwy, Ste 200 Irvine CA 92604 (949) 336-2433

Riggio, Mordaunt & Kelly Don RiggioMichael MordauntPeter Kelly 2509 W March Lane, Ste 200 Stockton CA 95207 (209) 473-8732

Automobile Sales & Leasing

Berberian Motors Brian Martucci 3755 North West Lane Stockton CA 95204 (209) 944-5511 www.berberianmotors.com

Banking Services

Bank of Agriculture & Commerce Eddie Lira Stockton CA(209) 444-3356www.bankbac.com

Community Bank of San Joaquin22 W Yokuts Ave Stockton CA 95207 (209) 955-8710

Financial Center Credit Union 4603 N Pershing Ave Stockton CA 95207 (209) 948-6024 www.fccuburt.org

Oak Valley Community Bank Loretta Trevena 2935 W March Lane Stockton CA 95219 (209) 320-7856 www.ovcb.com

Paci�c State Bank Rita Stolp Stockton CA 95201 (209) 870-2210

Bonds

Sanguinetti & Co Insurnace Brokers Steven Sanguinetti 7337 Paci�c Ave Stockton CA 95207 (209) 954-1000 www.sanguinettico.com

Bottled Water

Brookfalls Premium Bottled Waters 435 N. Yosemite St. Stockton CA 95203 (209) 467-4426

Collection Agency

CB Merchant Services 217 N. San Joaquin Stockton CA 95202 (209) 944-9001 J & S Collections P.O. Box 691506 Stockton CA 95269 (209) 951-6334 T A Ross-Collections P.O. Box 4637 Stockton CA 95204 (209) 956-2509

Computer Networks Support

Verve Networks Chad Sublet 6820 Paci�c Ave, Ste 2A Stockton CA 95207 (209) 244-7120 www.vervenetworks.net

The Buyer’s Guide continues on the next page

Practice Management & Medical Services Buyer’s Guidea practical resource for Busy Physicians and Office Managers

This handy resource, which is also featured on our web site, is designed to provide our busy physician members and sta� a dependable resource for locating local vendors interested in serving the medical business community with the best quality products and service.

Although the San Joaquin Medical Society has the utmost con�dence in these businesses and vendors, we o�er no personal endorsement of their goods or services.

Visit the electronic version of our Buyer’s Guide at www.sjcms.org


Computer Sales & Repair

Minden Computer Hal Singer Stockton CA 95267 (209) 477-6214 www.mindencomputer.com

Consultant/Practice Management

Moss Adams, LLP Irv Barnett 3100 Zinfandel Dr, 5th Floor Rancho Cordova CA 95670 (916) 503-8100 www.mossadams.com

Copy Machines, Supplies & Service

Business O�ce Systems 819 performance Dr Stockton CA 95206 (209) 952-2677 C A Reding Company 4617 Quail Lakes Dr, Ste 1 Stockton CA 95207 (209) 957-6022

Lucas Business Systems 3555 Deer Park Dr, Ste 180 Stockton CA 95219 (209) 466-3786

Country Club Stockton Golf & Country Club 3800 W Country Club Stockton CA 95204 (209) 466-4313

Credit Card Processing Heartland Payment Systems Na� Bendetson (323) 850-8883 www.heartlandpaymentsystems.com

Disabled Persons Equipment & Supplies

Arc Of Amador & Calaveras 75 Academy Dr Sutter Creek CA 95685 (209) 267-5978 Family Resource Network 5250 Claremont Ave Stockton CA 95207 (209) 472-3674

Medi-Van33 Maxwell St Lodi CA 95240 (209) 333-7800

Mother Lode Independent Living 67 Linoberg St ,Ste A Sonora CA 95370 (209) 532-0963

Open Door Svc Inc 2453 Grand Canal Blvd Stockton CA 95207 (209) 475-1529

Rainbow Transportation 10203 River Park Cir Stockton CA 95209 (209) 477-6130

TMP Svc North 4696 E Waterloo Rd Stockton CA 95215 (209) 931-7979

Employee Bene�ts

Marsh A�nity Group Roy Lyons 777 South Figueroa Street Los Angeles CA 90017 (800) 842-3761 www.marsha�nity.com

Sanguinetti & Company Insurnace Brokers Steven Sanguinetti 7337 Paci�c Ave Stockton CA 95207 (209) 954-1000 www.sanguinettico.com

Employment Agency

Accountabilities, Inc 5250 Claremont Ave, Ste 150 Stockton CA 95207 (209) 472-3619

AppleOne/ACT-1 2233 Grand Canal Blvd, Ste 202 Stockton CA 95207 (209) 476-8591

Pridesta� 3421 Brookside Road, Ste B Stockton CA 95219 (209) 477-6446

File Storage & Management

Paci�c Storage Company Mike Long 734 Wilshire Avenue Stockton CA 95203 (209) 320-6618 www.paci�c-records.com

Financial Planning

Notman Financial Group 3133 W March Lane, Ste 2000 Stockton CA 95219 (209) 955-5955

Professional Management Consultants, Inc. Debra Hightower 1300 W Lodi Ave, Ste A - 20 Lodi CA 95242 (209) 473-8494


SB Planning, Inc Stephen Benjestorf 215 W Oak Street, Ste 5 Lodi CA 95240 (209) 625-8523 www.sbplanninginc.com

Stull Financial David Stull 5637 N Pershing Ave, Ste C11D Stockton CA 95207 (209) 957-1673 www.stull�nancial.com

Gastroenterology

Lakshma Tiyyagura, MD 420 W Acacia St, Ste 18 Stockton CA 95203 (209) 466-4685

Gifts, Food Items

Edible Arrangements 135 N Hunter Stockton CA 95202 (209) 943-1200

Graphic Design & Printing

Excellence In Printing Tom Spitaleri 7602 Murray Drive, Ste 102 Stockton CA 95210 (209) 473-4442

Health Clubs

In Shape Health Clubs 1016 E Bianchi Road, Ste A23 Stockton CA 95210 (209) 475-2231

Health Passport

Aman Gifts, LLC Mary Louise Applebaum P.O. Box 891 Manteca CA 95336 (209) 830-5935 www.amangiftsLLC.com

Hearing Aids

American Hearing Aids 880 W Benjamin Holt Dr Lincoln Center South Stockton CA 95207 (209) 952-9950

Better Hearing Center 1231 W Robinhood Dr, Ste A2 Stockton CA 95207 (209) 957-1744

Stockton Hearing & Speech Center 4623 Quail Lakes Dr Stockton CA 95207 (209) 951-6491

Home Health Care Services

Addus Healthcare 1125 N Hunter Stockton CA 95202 (209) 463-8091

Agape In Home Services 309 Cherry Lane Manteca CA 95337 (209) 239-8080

Angeleon Care Home LLC 1288 Parkview St Manteca CA 95337 (209) 825-1837

Angel’s Caring Helpers 6333 Paci�c Ave, Ste 360 Stockton CA 95209 (209) 298-6473

Arcadia Health Care 4561 Quail Lakes Dr, Ste B2 Stockton CA 95207 (209) 477-9480

Austin Road Home 2313 W Alpine Ave Stockton CA 95204 (209) 463-6360

Caring Hearts Open Arms 343 E Main St Stockton CA 95202 (209) 235-3097

Elekarim Residential Care 1785 Henry Long Blvd Stockton CA 95206 (209) 983-8093

Gentiva Health Services Kristi Halva 1776 W March Lane, Ste 150 Stockton CA 95207 (209) 474-7881 www.gentiva.com

Graceful Living for Seniors 1647 Willow Park Way Stockton CA 95206 (209) 474-7176

Home Instead Senior Care 1350 W Robinhood Dr Stockton CA 95207 (209) 933-9737

Housecalls Home Health Agency 1050 N Union Stockton CA 95205 (209) 463-8005

Icare Manor 1215 W Swain Rd Stockton CA 95207 (209) 957-8385


Home Health Care Services Continued

Interim Healthcare 5250 Claremont Ave, Ste 121 Stockton CA 95207 (209) 472-6040

Paci�c Homecare Services 2027 Grand Canal Blvd Stockton CA 95207 (209) 956-2532

Prestige Home Health Services 4212 N Pershing Ave Stockton CA 95207 (209) 478-0758

Remolona Family Guest Home 360 Button Ave Manteca CA 95336 (209) 823-9122

ResCare HomeCare 5250 Claremont Ave, Ste 146 Stockton CA 95207 (209) 473-1202

St Joseph’s Home Health Care 2333 W March Lane Stockton CA 95207 (209) 473-6700

The Senior’s Choice Phalin Klusman 1806 W Kettleman Lane, Ste L Lodi CA 95242 (209) 369-7712

Tri Valley Home Health Care 37 W Yokuts Ave Stockton CA 95207 (209) 957-0708

Visiting Angels 1545 St. Mark’s Plaza, Ste 1B Stockton CA 95207 (209) 952-3585

Hospice Care

Hospice of San Joaquin Gene Acevedo 8888 Paci�c Avenue Stockton CA 95204 (209) 957-3888

Insurance - Malpractice Cooperative of American Physicians (CAP) Gary Homer 915 L Street, Ste 390 Sacramento CA 95814 (916) 409-0405 www.cap-mpt.com

MIEC Van Anderson 6250 Claremont Ave Oakland CA 94618 (800)-227-4527 www.miec.com

NORCAL Mutual Insurance Ken Stacy 560 Davis Street, Ste 200 San Francisco CA 94111 (800) 652-1051 www.norcalmutual.com

Insurance Services

Financial Services & Employee Bene�ts Gary Giovanetti 4555 N Pershing Ave, Ste 33 Stockton CA 95207 (209) 603-5460

Marsh A�nity Group Roy Lyons 777 South Figueroa Street Los Angeles CA 90017 (800) 842-3761 www.marsha�nity.com


Stull Financial David Stull 5637 N Pershing Ave, Ste C11D Stockton CA 95207 (209) 957-1673 (209) 957-1676

Internet Marketing

Mayaco Marketing & Internet Steve Morales 6333 Paci�c Ave, Ste 521 Stockton CA 95207 (209) 957-8629 www.mayaco.com

Jewelers

Gary J. Long Jewelers 320 Lincoln Center Stockton CA 95207 (209) 477-6881

Loans - Business & Personal

Bank of Agriculture & Commerce Eddie Lira Stockton CA (209) 444-3356www.bankbac.com

Financial Center Credit Union 4603 N Pershing Ave Stockton CA 95207 (209) 948-6024 www.fccuburt.org

Lymphedema Clinic & Therapy

Stockton Physical Therapy Virtu Arora 221 Tuxedo Ct, Ste B Stockton CA 95204 (209) 464-0200

Medical Alarms Lifeline St Joseph’s 1800 N California St Stockton CA 95204 (209) 467-6468

Peace of Mind Products Phalin Klusman 2414 W Kettleman Lane, Ste 210 Lodi CA 95242 (888) 824-8848

Medical Billing

Tokay Medical Billing, Inc Larry Dold 222 W Lockeford St, Ste 11 Lodi CA 95240 (209) 339-9036

Valley Medical Management Amy Wolf P.O. Box 230 Lodi CA 95241 (209) 367-4501 www.valleymedmgmt.com

VMBS, Inc Connie Simmons 2155 W March Lane, Ste 3D Stockton CA 95207 (209) 475-0309


Hands On Healing,A Passion For Performance

Lodi Physical Therapy was established in 1963 as one of the first private practice

physical therapy facilities in Northern California. For over 45 years, we have provided the best and most up-to-date

treatment available in physical therapy. Our top priority is our patients’ optimal

function and their success in meeting their goals. All treatments are administered

by licensed physical therapists to direct healing of all kinds of physical dysfunction.

Lodi Physical Therapy209-368-7433

www.lodipt.com


Medical Diagnostic Imaging

Central Valley PET Imaging 4744 Quail Lakes Dr Stockton CA 95207 (209) 476-7300

Delta Radiology Medical Group Inc 999 S Fairmont Ave, Ste 110 Lodi CA 95240 (209) 371-0117 www.deltarad.com

Lodi Endoscopy Center 840 S Fairmont, Ste 1 Lodi CA 95240 (209) 371-8700 www.endoscopyo�odi.com

Lodi MRI 801 S Ham Lane Lodi CA 95242 (209) 366-1000

Open Advantage MRI 3115 W March Lane, Ste 110 Stockton CA 95219 (209) 957-5447

St. Joseph’s Imaging Centers 1617 N. California St, Ste 1A Stockton CA 95213 (209) 944-6063

St. Joseph’s Women’s Imaging Center 2320 N. California St, Ste 3 Stockton CA 95213 (209) 466-5028

Stockton Endoscopy Center 415 E Harding Way Stockton CA 95204 (209) 942-1179

Stockton MRI Lisa Herbst 2320 N California St, Ste 2 Stockton CA 95203 (209) 466-2000 www.stocktonmri.com

Tate Diagnostic Inc 628 Lincoln Center Stockton CA 95207 (209) 952-9300 Valley PET Institute 311 S Ham Lane Lodi CA 95242 (209) 365-1761

Medical Equipment & Supplies

American Med 2216 N California St, Ste B Stockton CA 95204 (209) 938-0833

American X-Ray & Medical Supply 10501 Highway 88 Jackson CA 95642 (209) 223-1758

Apria Healthcare 7514 Murray Drive Stockton CA 95210 (209) 475-6860

Beverly-Hi Medical Pharmacy Jamie Knox 4217 Coronado Ave, Ste E Stockton CA 95204 (209) 466-9744

Butte Therapy Systems -Stockton Curtis Saxton 1050 N Union Street Stockton CA 95205 (209) 465-0300 www.btsstockton.com

Central Valley Medical Support PO Box 2564 Manteca CA 95336 (209) 823-2337

Circadian Systems 8099 Savage Way Valley Springs CA 95252 (209) 786-6000

Community Catalysts of California 3541 Townshend Circle Stockton CA 95212 (209) 474-9700

Conquest Imaging 3728 Imperial Way, Ste B Stockton CA 95215 (209) 942-2654

Dave’s Custom Upholstery David Stephens 22080 E Third Avenue Linden CA 95236 (209) 887-3283 www.valleymedicalrepair.com

Ecologically Sound Medical Svc 1865 N Macarthur Dr Tracy CA 95376 (209) 835-6868

Ehlers Health Supply Lodi CA (209) 334-4407 Stockton CA (209) 836-9004

E-Medical Supplies Inc 18835 N Lower Sacramento Rd Woodbridge CA 95258 (209) 366-1918

Hyberbaric Mild Chamber Sales 702 Porter Ave Stockton CA 95207 (209) 957-0237

Johnson’s Medical Supply 109 N Sutter Stockton CA 95202 (209) 467-7744

Kerry’s Medical 7817 Thornton Rd Stockton CA 95207 (209) 951-3300

Lifeline-Emergency Response 935 S State Highway 49 Jackson CA 95642 (209) 223-1485

Lift Easy 1943 Belmont Pl Manteca CA 95337 (209) 923-4095

Lodi Sickroom Supply 4217 Coronado Ave Stockton CA 95204 (209) 943-2118

Manshadi Medical Supply & Equipment 2633 Paci�c Ave Stockton CA 95207 (209) 946-9152

Med-Mart 2666 West Lane, Ste A Stockton CA 95205 (209) 463-1123

Merry X-Ray Chemical Inc 711 San Juan Ave Stockton CA 95203 (209) 465-3828

Northern Medical Supply Jackson CA 95642 (209) 223-7306

Medical Exam & Treatment Tables

Physical Therapy TablesDental Chairs

Waiting Room SeatingX-Ray Chairs

Pickup & Delivery Available

Call the professionals for upholstery restorations

and repairs

Preferred Sutter Vender #20069

Superior quality at a fair price!

209-887-DAVE (3283)Serving the San Joaquin Valley for over 30 years


Medical Equipment & Supplies Continued

Owens & Minor Inc 17720 Shideler Pkwy, Ste B Lathrop CA 95330 (209) 858-7970

Peace of Mind Products Phalin Klusman 2414 W Kettleman Lane, Ste 210 Lodi CA 95242 (888) 824-8848

Priority One Medical 1112 W Fremont Stockton CA 95203 (209) 461-7228

Scrubs ‘n Such 14745 Mono Way Sonora CA 95370 (209) 588-8883

Silver Star United Inc 4532 Winding River Cir Stockton CA 95219 (209) 951-1910

SRI Surgical Express 6801 Longe St Stockton CA 95206 (209) 982-5800 Sterile Recoveries Inc 6801 S Lounge Stockton CA 95206 (209) 982-5800 WEBB Surgical Supply 1045 N California St Stockton CA 95204 (209) 464-8369

Medical Info Consulting

International Healthlink Professionals, Inc. Mary Louise Applebaum P.O. Box 549 Manteca CA 95336 (209) 825-5995 www.ihelpinc.com

Medical Management Digital Capture Medical Billing 4750 Quail Lakes Dr Stockton CA 95207 (209) 954-1449 International Healthlink Professionals, Inc. Mary Louise Applebaum P.O. Box 549 Manteca CA 95336 (209) 825-5995 www.ihelpinc.com

Interplan Corp 2575 Grand Canal Stockton CA 95207 (209) 954-7617

Moss Adams, LLP Irv Barnett 3100 Zinfandel Dr, 5th Floor Rancho Cordova CA 95670 (916) 503-8100 www.mossadams.com

Medical Transcription Services

Medical Transcription Kitty Trudeau 1977 Forest Lane Manteca CA 95336 (209) 823-5138

Medication Assistance EZ Meds USA Scott Galbraith P.O. Box 15640 Scottsdale AZ 85267 (209) 406-1483 www.ezmedsusa.com

Microscopes, Equipment & Supplies

Microscope Depot 392 W Larch Rd, Ste 28 Tracy CA 95304 (209) 839-2990

Occupational Medicine US Healthworks Medical Group Marie Chevalier 3663 E Arch Rd, Ste 400 Stockton CA 95215 (209) 943-2202 www.ushealthworks.com

O�ce Equipment Ikon O�ce Solutions 2291 W March Lane, Ste B205 Stockton CA 95219 (209) 475-5700

Quality O�ce Liquidations Phillip Sipat Rough & Ready Island, Bldg 713 Stockton CA 95201 (209) 464-4388 www.qualityo�celiquidations.com

O�ce Supplies T.H.E. O�ce City 2495 Station Drive Stockton CA 95215 (209) 444-5400

Optical Goods Pearle Vision 5308 Paci�c Ave, Ste 84 Stockton CA 95207 (209) 952-1701

Personal Trainer Fitness 360, LLC 840 W Benjamin Holt Dr Stockton CA 95207 (209) 808-1802 Pump Institute Nicole Grauman 220 S. Church Street Lodi CA 95240 (209) 365-7867 www.pumpinstitute.net

Pharmacies Paci�c Compounding Pharmacy 312 N Lincoln Center Stockton CA 95207 (209) 474-7271 RX Express Pharmacy Michelle Moreno 711 E Market Stockton CA 95202 (209) 465-1001

Physical Therapy Advanced Physical TherapyBrenda Stern707 Lincoln CenterStockton, CA 95207(209) 478-3900

Balance 2540 Paci�c Avenue Stockton CA 95204 (209) 946-0806 California Rehabilitation 1208 E North Street Manteca CA 95336 (209) 824-2290 Dameron Hospital Physical, Occupational & Speech Therapy 420 W Acacia, Ste 8 Stockton CA 95203 (209) 461-3142 Lodi Physical Therapy Lauri Merrill 631 S Ham Lane Lodi CA 95242 (209) 368-7433 www.lodipt.com

Manteca Care & Rehabilitation Center 410 Eastwood Ave Manteca CA 95336 (209) 239-1222 Manteca Physical Therapy 1041 N Main Manteca CA 95336 (209) 239-4325 McFall Medical Therapy 1810 Hoyt Lane Manteca CA 95336 (209) 825-9511

Northern California Physical Therapy 4629 Quail Lakes Dr. Stockton CA 95207 (209) 956-5699 NovaCare Physical Rehabilitation 1973 N Tracy Blvd Tracy CA 95376 (209) 833-9490 Paci�c Athletic Rehabilitation Center Mike Serra 5910 Paci�c Ave Stockton CA 95207 (209) 475-1000

Pine St Physical & Occupational Therapy 534 E Pine Street Stockton CA 95204 (209) 463-5800

Recovery Physical Therapy 3215 N California St, Ste 4 Stockton CA 95204 (209) 578-0443 Richard & Kerrie Harty Physical Therapy 7829 N Pershing Ave Stockton CA 95207 (209) 954-1324 St Joseph’s Physical Therapy 1800 N California Stockton CA 95204 (209) 467-6365 Star Clinic 2357 W March Lane Stockton CA 95207 (209) 951-6037 Stockton Physical Therapy Virtu Arora 221 Tuxedo Ct, Ste B Stockton CA 95204 (209) 464-0200 Tokheim Corbett Physical Therapy 1191 E Yosemite Ave Manteca CA 95336 (209) 824-9888 Vibrantcare Rehabilitation 965 E Yosemite Ave Manteca CA 95336 (209) 823-3736 Xcel Orthopaedic Physical Therapy 1429 W Fremont Stockton CA 95203 (209) 546-0944



Professional Massage A Better Body Therapy 7839 N Pershing Ave Stockton CA 95207 (209) 957-5211

Rehabilitation Services Davis Counseling Associate Inc 2291 W March Lane Stockton CA 95207 (209) 477-8288 Elan Senior Living 8105 Mariners Dr Stockton CA 95219 (209) 473-4620 Golden Livingcenter- Hy-Pana 4545 Shelley Court Stockton CA 95207 (209) 477-0271 Golden Livingcenter-Chateau 1221 Rose Marie Lane Stockton CA 95207 (209) 477-2664

Hampton Care Center 442 Hampton Stockton CA 95204 (209) 466-0456 Health Care Services 322 N California St Stockton CA 95202 (209) 933-9976 Masterplan Rehabilitation Services Inc 41 W Yokuts Ave Stockton CA 95207 (209) 952-6142 Service First of Northern California 102 W Bianchi Rd Stockton CA 95207 (209) 644-6300 South Paci�c Rehabilitation Services 1630 N Edison Stockton CA 95204 (209) 469-9955 The Gift of Speech 3031 W March Lane Stockton CA 95219 (209) 952-2588

Valley Garden Healthcare & Rehabilitation 1517 E Knickerbocker Dr Stockton CA 95210 (209) 957-4539

Residential Care Facilities Fulton Villa 517 E Fulton Avenue Stockton CA 95204 (209) 466-2116

Wagner Heights Residential Care 2435 Wagner Heights Road Stockton CA 95209 (209) 477-5353

Restaurants Centrale Kitchen & Bar 1825 Paci�c Avenue, Ste 2 Stockton CA 95204 (209) 939-1825

LeBistro 3121 W Benjamin Holt Dr Stockton CA 95219 (209) 951-0885

Papapavlo’s Bistro & Bar

501 N Lincoln Center Stockton CA 95207 (209) 477-6133

Paragary’s Bar & Grill 110 N. El Dorado Street Stockton CA 95202 (209) 943-1110

Rosewood Bar & Grill 28 S School Street Lodi CA 95240 (209) 369-0470

Valley Brew 157 W Adams Street Stockton CA 95204 (209) 464-2739

Retirement Plans SB Planning, Inc Stephen Benjestorf 215 W Oak Street, Ste 5 Lodi CA 95240 (209) 625-8523 www.sbplanninginc.com

Stull Financial David Stull 5637 N Pershing Ave, Ste C11D Stockton CA 95207 (209) 957-1673 www.stull�nancial.com

Shredding Services

Paci�c Storage Company Mike Long 734 Wilshire Avenue Stockton CA 95203 (209) 320-6618 www.paci�c-records.com

Sta�ng Services

Bright Star Sta�ng 5079 Lone Tree Way Antioch CA 94531 (925) 779-9000

Surgical Center Trinity Surgical Center 10200 Trinity Parkway, Ste 101 Stockton CA 95219 (209) 323-3484 Transportation Services

Vince’s Transportation LLC 1711 Pecos Cir Stockton CA 95209 (209) 473-0803

Travel Agency

Segale Travel Service 2321 W March Lane, Ste A Stockton CA 95207 (209) 952-6606

Stockton Travel Service 6507 Paci�c Avenue Stockton CA 95207 (209) 478-6836

Uniforms

Uni�rst Corporation 819 N Hunter Street Stockton CA 95202 (209) 941-8364

Weber Point Uniforms 330 E Main Street Stockton CA 95202 (209) 464-7911

Upholstery & Repair

Dave’s Custom Upholstery David Stephens 22080 E Third Avenue Linden CA 95236 (209) 887-3283 www.valleymedicalrepair.com

Urgent Care

US Healthworks Medical Group Marie Chevalier 3663 E Arch Rd, Ste 400 Stockton CA 95215 (209) 943-2202 www.ushealthworks.com

Web Design Services Mayaco Marketing & Internet Steve Morales 6333 Paci�c Ave, Ste 521 Stockton CA 95207 (209) 957-8629 www.mayaco.com

Wheel Chair Lifts & Ramps

Lift-U Escalon CA (209) 838-2400

Practice Management & Medical Services Buyer’s Guide

a practical resource for Busy Physicians and O�ce ManagersLaunched in conjunction with our new website this past January, the Buyer’s Guide is intended to provide our members and their sta�s a quick go to source for reliable vendors and professional service providers interested in serving the medical community.

For more information on getting your business or services listed please contact the San Joaquin Medical Society at (209) 952-5299 and be sure to check out our searchable online Buyer’s Guide at www.sjcms.org

SPRING 2010 SAN JOAQUIN PHYSICIAN 67Optional buffet meal available for $25 or box supper for $10

Tickets starting at $20 Call (209) 951-0196 (Mon-Fri, 9am - 5 pm)

www.stocktonsymphony.org or

at the Symphony office, 46 W. Fremont St., Stockton, CA 95202

Join us for a sensational evening featuring favorite blockbuster themes from Ghostbusters, Gone with the Wind, Raiders of the Lost Ark, James Bond, Star Wars, and so many more! Feel free to come dressed as your favorite movie star, action hero, or comic character—anything goes! Bring a canned or non-perishable food item for the Food Drive, enjoy the fantastic buffet

on location and prove yourself a devoted fan as you bid on fabulous auction treasures. Don’t miss this extraordinary event!

68 SAN JOAQUIN PHYSICIAN SPRING 201068 SAN JOAQUIN PHYSICIAN

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SAN JOAQUIN PHYSICIAN 69

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1. Patrick Langham led the 17 member San Joaquin Delta College Monday Night Swing Band to the delight of all in attendance.

2. Dr. Joseph & Dorothy Serra

3. Dr. Raissa & Eric Hill

4. St. Joe’s Chief Operations Offi cer Mike Ricks tears up the dance fl oor with his wife Heather

5. Mike Steenburgh, Dr. Elizabeth Kass, Lloyd Karger & Dr. Moses Elam

6. Dr. Edward & Nancy Schneider, Georgette Hunefeld

7. Dr. Elvira Milano & Dr. Karen Buchler

8. Everyone enjoyed dancing to the big band sounds of evening

9. Dr. Henry Zeiter, Dean & Kathy Janssen, Bill Trezza, & Don Wiley

10. Dr. Jerold & Judith Yecies, & Dr. Robert & Eleanor Lawrence

11. San Joaquin County Supervisor Steve Bestolarides and his wife Doreen

12. Dr. Earl Taylor, Dr. Gerald Bock, & Dr. George Westin


Rita StolpVice President

Pacific State Bank1889 W. March Lane

Stockton, CA

Phone (209) 870-2210Cell (209) 684-2675

email: [email protected]

Banking Medical

ProfessionalsSince 1986

ValleyBrew_SJ Physcn_Ad 11/26/08, 1:34 PM1

Loaded with Practical Features and Useful Resources:

• Physician Locator• Handy Buyer’s Guide• Daily CMA Updates • Member Benefits & Discounts• Hundreds of Useful Links• Office Resources• Dozens of Webinar Links• Monthly Event Calendar• Tons of Patient Resources• Physician Magazine Archive• and much more!

Finally. An online resource designed

with you in mind.

www.SJCMS.org


The Most Advanced and Comprehensive Medical Imaging Center in San Joaquin County Just Got Better with the Addition of the Central Valley’s only 128 Multislice CT Scanner with Lowest Radiation Dose

PHONE 209-466-2000w w w.stocktonmri .com

Imaging Services Include: The only true and Positional Standing Open MRI

Siemens Ultrasound Units

All Board Certi�ed Radiologists with fellowship:

The Fastest 128 Multislice

Siemens Somatom De�nition AS+ (128)

STOCKTON MRI& Molecular Imaging Medical Center, Inc.

San Joaquin Medical Society3031 W. March Lane, Suite 222WStockton, California 95219-6568

RETURN SERVICE REQUESTED

PRSRT STD.U.S. POSTAGEPAIDPermit No. 60Stockton, CA

Strength and flexibility. That’s what your practice needs to thrive during

challenging economic times. NORCAL Mutual Insurance Company has received

an “A” (Excellent) financial rating from A.M. Best, the leading provider of insurance

industry ratings, for the past quarter century. Our financial stability has allowed

us to declare more than $372 million in dividends to our policyholders.

Visit www.norcalmutual.com today, or call 800.652.1051.

Our passion protects your practice.

Does Your Insurance Company Have the Strength to Endure?

NORCAL is proud to be endorsed by the San Joaquin Medical Society as the preferred professional liability insurer for its members.

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Spring 2010

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