Vital Signs December 2012

2 DECEMBER 2012 / V ITAL S IGNS

S A N D I E G O

O R A N G E

L O S A N G E L E S

P A L O A L T O

S A C R A M E N T O

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VITAL S IGNS / DECEMBER 2012 3

Official Publication of

Fresno-Madera Medical Society

Kings County Medical Society

Kern County Medical Society

Tulare County Medical Society

December 2012Vol. 34 – Number 12

Editor, Prahalad Jajodia, MDManaging Editor, Carol Rau

Fresno-Madera Medical SocietyEditorial CommitteeVirgil M. Airola, MDJohn T. Bonner, MDHemant Dhingra, MDDavid N. Hadden, MDRoydon Steinke, MD

Kings RepresentativeTBD

Kern RepresentativeJohn L. Digges, MD

Tulare RepresentativeThelma Yeary

Vital Signs SubscriptionsSubscriptions to Vital Signs are$24 per year. Payment is due inadvance. Make checks payable tothe Fresno-Madera Medical Society.To subscribe, mail your check andsubscription request to: Vital Signs,Fresno-Madera Medi cal Society,PO Box 28337, Fresno, CA 93729-8337.

Advertising Contact:Display:

Annette Paxton,559-454-9331

apaxton@cvip.net

Classified:Carol Rau,

559-224-4224, ext. 118csrau@fmms.org

ContentsVitalSigns

Vital Signs is published monthly by Fresno-Madera Medical Society. Editorials and opinion piecesaccepted for publication do not necessarily reflect the opinion of the Medical Society. All medicalsocieties require authors to disclose any significant conflicts of interest in the text and/or footnotes ofsubmitted materials. Questions regarding content should be directed to 559-224-4224, ext. 118.

CMA NEWS ................................................................................................................................5

CMA: Docs Who Feel They’re Always Pushing Rocks Up The Hill .................................................7

EMERGENCY CARE: Emergency Rooms Crisis – Solutions..........................................................8

PRACTICE MANAGEMENT: What to Know Before You Store Patient Credit Card Numbers ...........12

2013 Yosemite Postgraduate Institute ...................................................................................14

CLASSIFIEDS ...........................................................................................................................18

FRESNO-MADERA MEDICAL SOCIETY .......................................................................................13

• President’s Message

• Walk With A Doctor Program

• Season of Light: FMMS Member Event Wednesday, December 5

KERN COUNTY MEDICAL SOCIETY ............................................................................................15

• Pediatric Consultant Position, Kern County CCS

• Introducing the Upright MRI

• Membership News

TULARE COUNTY MEDICAL SOCIETY.........................................................................................16

• President’s Message

• Kaweah Delta Health Care District Receives Accreditation for Residency Programs

• Information Regarding Palmetto to Noridian Transition

Cover photography: “Winter Holiday”by Cynthia Ginn, RN

Calling all photographers:Please consider submitting one of your photographs for publication in Vital Signs. – Editorial Committee

You said what to the Medical Board’s investigator?Physicians often come to us after they have been interviewed by a Medical Board investigator or after they have already provided a written description of their care.

Did you know that a Medical Board investigator is a sworn peace officer, with a gun, and a badge, and the power to arrest you?

When the Medical Board demands an explanation, seek help immediately. The attorneys at Baker, Manock & Jensen have helped many physicians through the maze that is a Medical Board investigation. We would be honored to help you.

George L. Strasser5260 North Palm Avenue

Fresno, CA 93704559 432-5400

gstrasser@bakermanock.comwww.bakermanock.com

CMA NEWSquestions about the amendment can contact Blue Cross’s NetworkRelations Department at 855-238-0095 or networkrelations@wellpoint.com.

Contact: CMA reimbursement helpline 888-401-5911 oreconomicservices@cmanet.org.

UNSURE WHETHER YOU SHOULD SIGN THE NEWBLUE SHIELD AGREEMENT? The California Medical Association (CMA) continues to receivea high volume of calls from physicians and their staff regarding thenew Blue Shield contracts. However, more recent reports fromphysicians indicate Blue Shield representatives have become moreaggressive in their attempts to get physicians to sign the newcontracts.

To assist physicians, CMA has published an updated analysis ofthe new Blue Shield contract, which is available to members inCMA’s online resource library at www.cmanet.org/resource-library.

CMA has also prepared answers to the most common questionsreceived:

Why is Blue Shield asking me to sign a new agreement?According to Blue Shield, the reason for the recontractinginitiative is twofold: 1) Blue Shield has not done a large scalerecontracting with physicians in over a decade, so the newcontracts will ensure consistency and compliance with new lawsand regulations; and 2) Blue Shield is offering various tierednetworks based on price point in anticipation of possibleparticipation in California’s Health Benefit Exchange and othernew delivery models.

The new contract includes three new product types(Networks A, B and C). What types of products are these?Exhibit B in the Blue Shield contract identifies these networks asCommercial PPO/EPO (Blue Shield Networks A, B and C),respectively reimbursing at staggered percentages of the rates setforth in the Blue Shield Provider Allowances. Blue Shield hasadvised CMA that these three tiered networks are being offered inanticipation of possible participation in the state’s health benefitexchange.

CMA has been actively working with exchange stakeholders toaddress significant concerns regarding the proposed grace periodregulations, monitoring of network adequacy and clinician-levelperformance measurement in qualified health plans offered in theexchange. More information on contracting with exchange planscan be found in the “Reform Essentials” section of the CMA’swebsite, www.cmanet.org/cma-reform-essentials.

Can I designate which products I am willing to participate in?Yes. Exhibit A of the new Blue Shield contract allows physicians todesignate which products they are willing to participate in byproduct type. Additionally, a section of Blue Shield’s frequentlyasked questions (FAQ) encourages physicians to read Exhibit Acarefully to ensure you clearly understand your participation choices.

What happens if I do not sign and return the agreement bythe date requested? Blue Shield has assured CMA that if aphysician chooses not to sign the new agreement, his or her currentparticipation status with Blue Shield will not be affected. BlueShield had advised CMA, however, that physicians who do notsign and return the new agreement will receive follow-up calls andletters from Blue Shield representa tives encouraging them to sign

ANTHEM BLUE CROSS AMENDINGSOME PHYSICIAN CONTRACTS TO INCLUDEINDIVIDUAL/EXCHANGE PRODUCTOn October 24, Anthem Blue Cross sent a notice to 8,345physicians who are part of the Blue Cross Select PPO networkannouncing its intent to participate in the California HealthBenefit Exchange, the state’s new insurance marketplace called forunder the Affordable Care Act. Beginning in 2014, individualsand small business will be able to purchase health insurance usingtax subsidies and credits from the exchange.

According to the notice, Blue Cross will be creating a newprovider network called the “Anthem Individual/ExchangeNetwork,” which will serve both individuals who purchasecoverage through the exchange and individuals who purchasecoverage from Anthem Blue Cross in the individual marketoutside of the exchange. In other words, the fee schedule wouldapply to all individual business, whether bought on or off of theexchange.

Blue Cross has clarified for the California Medical Association(CMA) that this fee schedule change will not apply to SmallBusiness Health Options Program (SHOP) business purchasedthrough the exchange.

It’s important to note that the letter also states that Blue Crossis amending the physician’s Blue Cross Prudent Buyer Agreementto automatically include the new individual/ exchange network,effective January 1, 2014. The new fee schedule associated withthis product was included with the notice.

CMA has been actively working with exchange stakeholders toaddress significant concerns regarding the exchange grace period,monitoring of network adequacy and clinician-level performancemeasurement in qualified health plans offered in the exchange(http://www.cmanet.org/news/detail/?article=physicians-may-already-be-contracted-with).

Though not mentioned in the Blue Cross cover letter, SectionsVI and VIII of the enclosed amendment provide instructions forphysicians who wish to opt out of the individual/exchangenetwork. Physicians who do not wish to participate in this networkmust notify Blue Cross of their intent to opt out by December 31,2012. Opt out notices should be in writing and sent via certifiedmail, return receipt to the address specified in Section VI of theamendment.

CMA is working with Blue Cross to obtain additionalclarification on the amendment and will provide updates as theyare received.

Please note that a small subset of Select PPO Networkphysicians did not receive the October 24 notice automaticallyopting them into the individual/exchange network. This subset ofphysicians received a notice from Blue Cross dated October 9regarding fee schedule reductions. Physicians who choose todiscontinue participation in the Select PPO network at thereduced rates have until December 14 to notify Blue Cross inwriting.

As always, physicians are encouraged to carefully review allproposed amendments to payor contracts. You do not have toaccept substandard contracts that are not beneficial to yourpractice.

Physicians who did not receive a letter and are unsure whetherthey are affected by this change or those who have general Please see CMA News on page 6

the agreement and return to Blue Shield. It’s important that physicians under -

stand if they do not wish to participate inthe new tiered networks offered inanticipation of the Exchange or any otherproduct types offered, they are not requiredto sign and return the new agreements.Their current participation status will notchange.

Physicians who want to participate inthe new tiered networks will need to decidewhether they wish to opt out of any producttypes and affirmatively do so by checkingthose product type boxes in Exhibit Anumber 2, then sign and return theagreement to Blue Shield. As indicated inExhibit A number 2, by checking the boxthe physicians is stating he/she does notagree to participate in that product. A boxleft blank indicates the physician agrees toparticipate in that product.

Questions: CMA’s reimbursement helpline888-401-5911 or economicservices@cmanet.org.

PALMETTO PROTESTSMEDICARE CONTRACT AWARD Palmetto GBA has officially protested theCenters for Medicare & Medicare Services(CMS) awarding of the Medicare Admini -strative Contractor (MAC) contract forJurisdiction E to Noridian AdministrativeServices.

CMS previously announced thatNoridian would assume the MAC duties forthe new Jurisdiction E, which includesCalifornia, Nevada, and Hawaii, as well asthe U.S. territories of American Samoa,Guam and the Northern Mariana Islands,following a competitive bidding process.Palmetto had previously held that con tractand is now protesting the decision.

Notice of the protest can be found onthe GAO Bid Protest Docket under FileNumber B-407668.2. The due date for adecision is January 23, 2013. This protestmeans that the earliest a handover fromPalmetto to Noridian could take placewould be mid-to-late 2013.

Palmetto has assured CMA that whilethe protest is being considered by theGAO, business will continue as usual.Once a final decision has been made, CMAwill notify members and work with CMSand the contractors to develop anynecessary transition plans.

CMA NEWSContinued from page 5

Please see CMA News on page 6

Docs Who Feel They’re AlwaysPushing Rocks Up The Hill

Virgil Airola, MD

Did you hear that you already saved morethan 50 percent on your medical malpracticeinsurance premium for next year? Twolegislators in Sacramento, Steinberg in theSenate and Dickenson in the Assembly, triedin the final week of the 2012 legislativesession to raise your cost of doing business byweakening MICRA, but the CaliforniaMedical Association fought for you andWON! Your premiums won’t change as a result!

This kind of last minute stuff happens every year inSacramento as the crush of bills peaks in the CaliforniaLegislature at the final bell. What would happen if nobody waswatching? It’s like Sisyphus pushing his rock up the hill. Checkit out: http://www.cmanet.org/resource-library/list?filter&keyword=148.

When I know CMA’s watching, I feel every doctor�member ofCMA is a brick in a wall around our patients and our medicalpractice – a wall that protects us all and is stronger with more“bricks” as members.

The Dickenson bill, AB 1062, was changed (“gutted andamended”) to lower the standard of evidence in elder abuse cases,so trial attorneys could more easily sue physicians and more easilywin cases under the Elder and Dependent Abuse Act. The “endrun” around MICRA in the bill made all attorney fees exemptfrom the limitations provided under MICRA, so patientplaintiffs would be paying successful attorneys higher fees.

The Steinberg bill, SB 1528, would provide that in asuccessful malpractice lawsuit a Medi-Cal beneficiary, treatedunder a managed care arrangement or contract, would recoverfrom a defendant physician the “reasonable value of benefits”which is defined in the bill as “the usual customary andreasonable charge made to the general public by the provider forsimilar services,” not what Medi-Cal pays for those services.

These are just two of the too-numerous-to-count examples ofhow CMA fights daily battles all year round in Sacramento andWashington to help keep your practice stable. So when I thinkof REAL VALUE for my DOLLAR, I think I get the combinedvalue of every CMA and local Medical Society members’ duesdollar from the cost of my membership in these organizations justfrom stuff like the examples I listed above.

And CMA and the Fresno�Madera Medical Society providelots of other benefits to my practice, my colleagues, and mypatients – help with fighting billing issues with insurancecompanies, medical school scholarships, educational loanrepayment program information and advocacy, practicemanagement materials and seminars, educational meetings,social events, web�based info on all kinds of issues affectingmedicine, and ADVOCACY, ADVOCACY, ADVOCACY inSacramento and Washington! Check it out on the web at:http://www.cmanet.org/ and http://www.fmms.org.

CMA NEWS

CMS ANNOUNCES EXTENSION OF 2013 ELECTRONICPRESCRIBING HARDSHIP EXEMPTION REQUEST The Centers for Medicare and Medicaid Services has reopened thehardship reporting period to request an exemption from the 2013e-prescribing payment adjustment. Requests can be submitteduntil January 31, 2013, and must be submitted via the CMSQuality Reporting Communication Support Page at www.qualitynet.org (https://www.qualitynet.org/portal/server.pt/community/communications_support_system/234).

If you have questions or needs assistance submitting a hardshipexemption request, please contact the QualityNet Help Desk at866-288-8912 or qnetsupport@sdps.org. They are availableMonday through Friday from 7:00 a.m. to 7:00 p.m. CST.

NEW MEDICARE PRIVATE CONTRACTING ADVOCACYMATERIALS AVAILABLEThe California Medical Association (CMA) and the AmericanMedical Association (AMA) continue to push Congress to passlegislation to allow a private contracting option for Medicarepatients. There are two bills, jointly known as the MedicarePatient Empowerment Act, currently making their way throughthe legislative process that would allow Medicare patients to enterinto private contracting arrangements with physicians withoutpenalties for either party.

CMA and AMA have launched a grassroots campaign to securecosponsors for the bills – HB 1700, introduced by Rep. Tom Price(R-GA), and SB 1042, introduced by Sen. Lisa Murkowski (R-AK). A range of resource materials has been developed to supportthe campaign, including a downloadable patient flyer for physicianoffices and a web-based petition for patients and physicians.Physicians who sign the petition may also order patient brochuresfor their offices at no cost. These materials and more are availableat www.ama-assn.org/go/ privatecontracting.

CMA has long sought a private contracting option forMedicare patients. Currently, seniors who wish to see a doctor whodoes not accept Medicare must pay for all services by thatphysician out of their own pocket. The physician may not seekreimbursement from Medicare for the care provided, nor willMedicare reimburse the beneficiary – despite the fact that seniorshave paid into the program in the form of payroll taxes throughouttheir working lives.

Medicare private contracting approach would expand access tocare without costing the federal government additional resources.It would allow seniors to continue to use their Medicare benefits,even if the physician they choose does not see them through theMedicare program. In such a scenario, the patient would only beresponsible for the difference between what Medicare typicallycovers and what the physician charges.

For additional information on Medicare contracting options,see CMA On-Call document #0151, “Medicare Participation (andNon-Participation)”. The document is free to members in theresource library at www.cmanet.org/resource-library.

Contact: Elizabeth McNeil, 415-882-3376 or emcneil@cmanet.org.

Continued from page 6

Virgil Airola, MD

difficult to relive the final hours before my mother’s devastatingstroke, to hear her final words as recorded in the nurse’s notes.After reviewing the 811 pages, it became clear that there was moreto the story of my mother’s death. The admission notesdocumented that she was to be started on heparin shortly afterbeing admitted with a HR of 160. However, the heparin was notstarted until 11 am the next day, almost 15 hours later. It is unclearwhether the medication was unavailable from the pharmacy, anorder was missed, or there was difficulty prescribing theanticoagulation. A transthoracic echocardiogram was normal theevening of admission, and the lethal thrombus likely propagatedduring the prolonged period without anticoagulation.

A NATIONAL CRISISTragedies like this are not uncommon in the U.S. An Institute

of Medicine report detailed a national crisis in emergency care in2006; six years later, many of the challenges of overcrowding, am -bulance diversion, and the boarding of admitted patients (like mymother) in the ED have only become more dire. In a landmarkstudy in JAMA, Dr. Renee Hsia plotted the survival of hospital EDson Kaplan-Meier curves, identifying the characteristics predi ctiveof the closure of an ED, including for-profit or safety-net status.

At UCSF, my career has focused on strengthening emergencysurgical care through the dedicated availability of a surgeon to seepatients needing surgery in the ED and hospital. This surgicalhospitalist model has been implemented at over 400 hospitalsacross the country since my colleagues and I introduced theprogram in 2005. However, I was still unable to change the lethaloutcome of delays in treatment as my mother received care at adifferent institution.

Unfortunately, the passage of the Affordable Care Act (ACA)may only make stories like my mother’s more common, if lack ofaccess to primary care results in increased numbers of Americansseeking access to an overwhelmed emergency system. TheAmerican College of Emergency Physicians (ACEP) has identifiedthe passage of a law in 1986 – Emergency Medical Treatment andActive Labor Act (EMTALA) as a key driver of this crisis as itmandates public access to emergency care regardless of one’s abilityto pay. ACEP has tirelessly worked to reform this well-intendedbut underfunded mandate that has forced some EDs to close, andnegatively impacted quality of care. Maybe there is some comfortthat similar challenges in emergency care are being reportedworldwide.

A JOURNEY TO AMERICAN EMERGENCY DEPARTMENTSThe untimely death of my mother inspired me to take almost a

year off to work on Capitol Hill with our elected officials, themedia, and leading medical organizations to better understand thechallenges in emergency care. I was inspired by Abraham Flexner,the champion of medical education reform, to visit over 50 EDs totake inventory and search for new solutions. I rode on planes andtrains and drove over 7000 miles in the summer of 2011 to meetwith and to hear the personal stories of the people who had written

Combining music with surgery is what many surgeons do routinely.In a concert lecture I attended years ago, San Francisco Symphonyconductor Michael Tilson Thomas shared his strategy to draw outthe best performance from the orchestra. He challenges eachmember with three questions as they prepare for a newcomposition. First, what was the political and social historiccontext that was the inspiration for the music’s creation? Second,what was the composer trying to communicate? But these questionsonly serve as the foundation for the third most important question:what does the music mean to you? Perhaps we should all carefullyreflect what strengthening the emergency care system means to usindividually before we collectively attempt to define its future.

A PATIENT’S STORYMy personal answer to Michael Tilson Thomas is revealed

through the story of a patient. This particular patient was 69-years-old, who awoke one day with an irregular heart beat and mildshortness of breath. Her heart rate accelerated to 130 on a homeblood pressure cuff, but her blood pressure was stable later that daywhen she was seen in the Emergency Department (ED). She wasdiagnosed with rapid atrial fibrillation and admitted around 8 pm.on a Thursday evening for anticoagulation therapy with heparin,and a plan for electrical cardioversion the next day after atransesophageal echocardiogram.

Because an inpatient bed was unavailable, she spent the entirenight in the ED. She was not admitted to a hospital bed until lateFriday morning, after other patients had been discharged. She hadslept poorly in the ED hallways, and was hungry after having fastedfor the procedures that day. The cardiologist spoke with the patientand her family that Friday afternoon, and explained that because ofthe delays in her admission, the planned procedures had beencancelled, and she would remain on blood thinners over theweekend until the echocardiogram and cardioversion could beperformed on Monday.

Unexpectedly, on Saturday afternoon, the patient suffered asudden and massive stroke with complete occlusion of the carotidartery from the arch of the aorta to the intracranial branches of themiddle cerebral artery. She was rushed to the OR where aneurosurgeon attempted to remove the blood clot, but the carotidartery tore, leading to massive intracranial bleeding and braindeath. She was kept alive in the ICU until funeral preparationscould be completed. She died at noon on the following Tuesday,112 hours after she first stepped into the hospital. The patient wasmy mother.

Some may recognize this story from an article in the NewEngland Journal of Medicine that was published on the 2½-yearanniversary of my mother’s passing “The Waits that Matter.” I wasamazed by the response from around the nation, and even theworld, to the coverage the story received in The New York Timesand The Wall Street Journal. Four months after the article waspublished, I received a surprise in the mail, an honoraria granted toPerspectives authors by the Massachusetts Medical Society. I usedthe money to obtain a copy of my mother’s medical record. It was

EMERGENC Y C A R E

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to me after the publication of my article inthe New England Journal of Medicine.What struck me was the recurring theme ofpersonal loss they too had suffered from anoverwhelmed emergency system. Yet weshould also not forget the successfuloutcome for Congresswoman GabrielleGiffords after the deadly rampage inArizona in 2011; the story of her amazingrecovery catalyzed a positive change inperception in Washington, DC, about theheroism and courage of emergencyphysicians and trauma surgeons. Indeed it isa privilege and an honor to take emergencycall, and the need for emergency carereflects the trust that society places in itsemergency workforce. Ultimately, identi -fying ways to support those courageousphysicians willing to place themselves onthe front lines of clinical care will be key tosolving the emergency care crisis.

As I traveled across our amazinglybeautiful country, I noted several recurringthemes. In some parts, one can drivethrough deserts for hundreds of miles andnot see an ED, whereas in some cities onecan walk out of one Level 1 Trauma centerright into another one a few blocks away. Iwas amazed by the billboards advertisinghow short waiting times to be seen were incertain EDs, suggesting the delivery of EDcare is becoming competitive. I noted awide variability and lack of standardizationnot only in care, but also in organization. Insome hospitals, the ED is part of theDepartment of Medicine, in others it is partof the Department of Surgery, and in yetothers, it is its own stand-alonedepartment, which I believe is superior. Asa mystery shopper, I often visited EDsunannounced through the front door, towitness care delivery through the eyes ofthe patient. In some EDs I was greeted by avalet for parking or by a nurse with a cup ofcoffee, and at others by ominous andforeboding security personnel seated be -hind bulletproof glass and metal de tectors.I marveled that the most glistening andmagnificent parts of hospitals were thecancer centers, and hope one day thattowers dedicated to emergency care willalso arise. I was pleased to see the emer -gence of dedicated children’s EDs, high -lighting that children are not simply smalladults. One of the most impressive EDs was

Please see Emergency Care on page 11

EMERGENC Y C A R E

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At Kaiser Permanente Southern California, we believe our achievements are best measured by the health and wellness of the community we serve. That’s why we provide a fully integrated system of care guided by values such as integrity, quality, service and, of course, results. The advantages of working with us reach far beyond our comprehensive network of support and state-of-the-art electronic medical records system. We also offer a multi-disciplinary team approach and manage your administrative concerns.

If you would like to work with an organization that gives you the tools, resources and freedom you need to get the best outcomes possible for your patients, come to Kaiser Permanente. Per Diem opportunities offer flexible schedules as well as the chance to earn supplemental income. As for full-time opportunities, physicians have access to a compensation and benefits package that’s designed to impress you.

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at UCSF Fresno, which I regard asa premier ED nationally. I wouldlike to thank Greg Hendey, MD,for his enlightening tour of this 70-bed, Level-1 Trauma ED, withstate-of-the-art trauma resus ci -tation bays, a burn unit, and preciseattention to efficiency andeconomy in patient flow as it servesan annual ED census of over110,000 patients.

THREE-PART SOLUTIONOn the basis of my experiences around the country, I’ve reached

the conclusion that the emergency care crisis is entirely solvable,through better distribution and prioritization of resources andincentives, and by standardizing and coordinating care nationally.I believe the solution involves three things:

1) we must inspire young people to work in emergency care;2) we need to rewrite the laws, the ACA, and EMTALA; and3) we must tell powerful stories to attract the attention of the

media and of Capitol Hill, as the pathway forward to changing thelaw.

Regarding inspiring more young physicians to work inemergency care, Thomas C Ricketts, MD, and George F Sheldon,MD, at University of North Carolina Chapel Hill have preparedexcellent maps highlighting areas with shortages of surgeons,documenting nearly 1,200 counties in America without a generalsurgeon available. A remarkable solution proposed in Washington,DC, is to create a General Surgery National Health Service Corpsto deploy board-certified surgeons for 3- to 6-month rotationsacross rural America. A visionary federal approach could besimilarly applied to all specialties, and would require the creation ofnew maps for Capitol Hill and U.S. Department of Health andHuman Services to determine where which specialties are neededmost. A starting point could be the current distribution of critical-access hospitals nationally, or alternatively, the distribution of postoffices. Equally important is to identify where to recruit physicianswilling to relocate temporarily.

I believe we have an opportunity to harness the altruism ofAmerican physicians who seek to address global disparities inhealth care, and to persuade them to travel to hospitals in our ownbeautiful country. More than 25 years ago, a young surgeon arrivedin Tucson, AZ, to solve the challenges of Arizona’s emergency caresystem. The surgeon dedicated his career to implementing a traumasystem in southern Arizona grounded in the concept ofregionalization. The successful outcome for CongresswomanGiffords is a testament to the efforts of that surgeon – RichardCarmona, MD – who would later become the 17th U.S. SurgeonGeneral. Our nation can and must do better to improve ouremergency care delivery system, by focusing time and energy tosolve the challenges facing emergency rooms nationwide. I dobelieve that within the field of medicine, we have the special

opportunity to redefine andtransform emergency carenationally, by thinking differently.Perhaps further answers will comefrom one of the medical studentsor residents in training today, whowill follow Dr. Carmona’sinspirational path and define theirown personal answer to MichaelTilson Thomas’s question.

Turning to the second proposedsolution of rewriting the law, this isat the heart of activity inWashington, DC. Capitol Hillwrites the laws, the Supreme Court

reviews these laws and determines their constitu tionality, and thePresident (often an attorney) prepares Executive Orders that carrythe force of the law. A Congressional staffer once shared with methe following: “On the game show Jeopardy, one must phrase theanswer in the form of a question. In Washington, one must phrasethe pro posed solution in the language of a law that can bepresented to Congress for a vote.”

We must recognize that market forces have led to the closure ofEDs all across America in the past decade; leaving this problem tothe business sector will not be the final answer. A single institutionwill be unable to solve this crisis on a larger scale, and hospitalswill need to work together rather than compete against oneanother. Accountable care organizations should be charged tosolve overcrowding and boarding. Dr. Ellen Weber from UCSFwrote about the positive long-term results of a new policy inEngland mandating either patient admission or discharge homewithin four hours of arrival at an ED. It may take rewriting theACA and EMTALA to use the “law” to instill “order” in the ED.If this is unsuccessful, reforming Medicare Part A reimbursementto hospitals for boarded patients may become necessary. Reformingpatient expectations is also essential. The ED has been describedby Kate Heilpern, MD, the Chair of Emergency Medicine atEmory, as a mirror for society’s problems – the overuse of guns,underuse of seatbelts, and drinking and driving. Perhaps the timehas arrived to consider a 28th Amendment to decide whetheraccess to basic medical care and emergency treatment is aconstitutionally guaranteed right? Only after reaching agreementhere can our nation then move to the equally important discussionof the responsibilities and expectations inherent in that right.

In Washington, DC, two of the profound lessons I learned fromattending Capitol Hill hearings are the power of the law, and thepower of storytelling as the gateway to the media and television toconvince Congress and State legislatures to enact new laws. Ivisited the R. Adams Cowley Shock Trauma Center in Marylandand learned of R. Adams Cowley, MD, who coined the term “thegolden hour,” and pioneered the concepts of advanced trauma lifesupport and regionalized care to dedicated trauma facilities. Thetipping point came in 1975, when attorney Dutch Ruppersbergerwas involved in a near fatal automobile accident and survived afterbeing transported directly to Shock Trauma, bypassing othernontrauma EDs en route. Mr. Ruppersberger later ran for public

EMERGENC Y C A R E

Please see Emergency on page 17

Emergency Care

Everyone uses credit cards. Patients love to rack up points fortravel and cash-back rewards. But before you store a credit cardnumber in your practice database, be aware of the consequences ifyour patient records ever become compromised. Credit cardcompanies can impose huge fines if your office system is notsecuring patient credit card information adequately and it becomescompromised – to the tune of up to $100,000 per incident. Afterreviewing this article and weighing the risks, ask yourself, “Doesmy practice really need to store credit card information on file?”

I have a small practice. How does this apply to me?All credit card companies belong to the Payment Card Industry

(PCI). PCI has established a Security Standards Council to set andmanage standards known as the Data Security Standard, or PCIDSS. If your practice accepts or processes payment cards, you mustcomply with the PCI DSS.

Patients prefer that I keep their credit card numbers on file.What if I want to store credit card numbers?

There are many rules to follow to be in compliance. You will berequired to build and maintain a strong network; protectcardholder data; maintain a vulnerability management program;implement strong access control measures; regularly monitor andtest networks; and maintain an information security policy.

Here are some tips from the Payment Card Industry website:• Encrypt all credit card numbers if stored in any system or

database, including but not limited to logs and backups. • Ensure the network has adequate firewall and up-to-date

antivirus software.• Use strong encryption for transmission of cardholder date

over the Internet.• Regularly apply all systems and software security patches.• Quarterly, run external vulnerability scans or penetration

tests on the network.• Limit access to cardholder information to staff with a

legitimate business need.• Enforce strong passwords.• Avoid printing any card data on paper. If any exists, it must

be carefully secured and destroyed when no longer needed.• Maintain data security policies that provide clear guidance to

staff about handling of sensitive data (e.g., never e-mailPrimary Account Numbers or PANs) and how to respond incase they discover data is compromised.

You must assess your business systems and processes annually toensure you are in compliance. The PCI website can help you toassess your environment. You may be able to use a Self-AssessmentQuestionnaire, which must be completed annually, depending onthe bank card. For example Master Card allows you to self-assess ifyou process less than 50,000 transactions annually, while JCBInternational allows you up to 1 million transactions. Check witheach credit card company or look on its website to determine yourmerchant level and the requirements for your business.

If you are allowed to self-assess, it is not necessary to submit areport to the credit card companies or PCI, but compliance is still

P R AC T I C E M AN AG EMEN T

required at all times. There are several different self-assessmentquestionnaires, and it may be confusing to decide which one touse. Use the chart on the website to choose the questionnaire thatmost closely fits with your credit card collection practices.

If you are not allowed to self-assess, you will need to use aQualified Security Assessor (QSA) to conduct annual assessments.

What happens if I store credit card numbers and a practicecomputer is lost, stolen, or some other breach occurs?

You must be able to demonstrate that you have been incompliance with PCI DSS. If your practice computers, networkand/or database are compromised in any way, you must notify thecredit card companies. If you cannot demonstrate that the data wascompletely protected and that you have been in compliance withPCI DSS, you will be subject to significant fines and lawsuits. If thecredit card company does not terminate the contract, you may betreated the same as a higher level merchant and be required toconduct annual on-site assessments and validation by a QualifiedSecurity Assessor. Expect the annual on-site assessments to cost inthe $10,00-20,000 range or more. You will be required to remediateany inadequacies discovered during the annual assessments at yourown expense.

Who enforces compliance of the PCI DSS?American Express, Discover Financial Services, JCB Inter na -

tional, MasterCard Worldwide, and Visa Inc. Each of these institu -tions posts compliance guidance which may be slightly differentfrom the others. Before going to each credit card company website,read, understand, and follow all guidelines provided by PCI.

Why aren’t card readers or software safe enough from hackers?According to the PCI, there are many reasons credit card

readers or applications may not be secure. Card readers mayinadvertently store magnetic stripe data which contains SensitiveAuthentication Data or card verification codes; they may not beinstalled properly or securely and might be easily compromised;default settings or passwords may not have been changed onreaders or in applications; security patches were not kept updated;the credit card data on the network is not properly segregated to besecure; data may not be properly encrypted; web applications maynot be hardened against vulnerabilities.

What if I complete a self-assessment and uncover deficiencies?If the self-assessment uncovers deficiencies, remediation is

necessary. A remediation plan, known as an Action Plan for Non-Compliant Status, should be completed. PCI allows 12 months toremediate, but progress must be demonstrable. All remediation isat the expense of the merchant. If your practice is very large andyou process many transactions, you will need to work with a datasecurity firm. PCI provides a list of qualified assessors on its website.

How do I avoid the need for assessments altogether?If you accept credit cards for payment, an annual assessment is

required. But if you successfully follow these guidelines, the self-assessment questionnaire is short and painless:

What to Know Before You Store Patient Credit Card NumbersFran Cain

Information Technology Department, NORCAL Mutual Insurance Company

Please see Credit Cards on page 18

Post Office Box 28337Fresno, CA 93729-8337

1040 E. Herndon Ave #101Fresno, CA 93720

559-224-4224Fax 559-224-0276

website: www.fmms.org

FMMS Officers

Sergio Ilic, MDPresident

Ranjit Rajpal, MDPresident Elect

Prahalad Jajodia, MDVice President

Stewart Mason, MDSecretary/Treasurer

Oscar Sablan, MDPast President

Board of GovernorsA.M. Aminian, MD

Hemant Dhingra, MDUjagger-Singh Dhillon, MD

William Ebbeling, MDBabak Eghbalieh, MDAhmad Emami, MDDavid Hadden, MDS. Nam Kim, MD

Constantine Michas, MDKhalid Rauf, MD

Rohit Sundrani, MDMohammad Sheikh, MD

CMA DelegatesFMMS President

A.M. Aminian, MDJohn Bonner, MDAdam Brant, MDMichael Gen, MDBrent Kane, MDKevin Luu, MD

Andre Minuth, MDRoydon Steinke, MDToussaint Streat, MD

CMA Alternate DelegatesFMMS President-elect

Don H. Gaede, MDPrahalad Jajodia, MDPeter T. Nassar, MDTrilok Puniani, MD

Dalpinder Sandu, MDSalma Simjee, MDSteven Stoltz, MDRajeev Verma, MD

CMA YPS DelegatePaul J. Grewall, MD

CMA YPS AlternateYuk-Yuen Leung, MD

CMA Trustee District VIVirgil Airola, MD

Staff:Sandi PalumboExecutive Director

President’s Message

SERGIO D. ILIC, MD

DIFFICULT TO BELIEVE A YEAR HAS GONE BY ALREADY

This was an eventful year for the FMMS. When I was installed as president last year, I had severalgoals in mind, and I feel we have been successful in several of them.

The first goal was to increase the membership, and we did this by enrolling the totality of the Kaisermembers, an addition of ninety six. But there is still recruitment to be done. We need to convince allCCFMG members and the radiology and anesthesiology groups to stay in the Society as well asrecruiting the hospitalists and ethnic societies’ members, such as the Indian, Pakistani and Latinogroups. That will probably be the number one task of my successor Dr. Rajpal.

My second goal was to bring financial information to the members in the form of seminars to begiven at the Society office – not only for the practicing physician but also to the residents at the UCSF

Fresno campus. Amy Nuttal Zwaan and Eric Van Valkenburg fromCentral Valley Physician Benefits and LPL Financial are doing a greatjob in providing these seminars. The classes have been very wellreceived and successful. I feel that as doctors we do not know enoughabout finances, and we make too many costly mistakes that can veryeasily be avoided with some knowledge and help from well qualifiedadvisors.

My third goal was to make the general membership meetings moresocial. In February, we had a comedian, in May Dr. Ray Kurzweil gavea very exciting talk to almost 700 people , in September we had a winetasting dinner at APCAL winery and in November we had theinstallation at Roger Rockas for the third year followed by thewonderful show “Singin In The Rain.”

My fourth goal was to make the FMMS more relevant. This has tobe an ongoing effort, and in order to do this we have upgraded ourcomputer system so we can be more responsive to the new generationof doctors. We have a new web page that should be fully functioning

by the first of the new year, and we are on Facebook. This also gives us the capability of being incontact with members and non members easier. We have gone to the UCSF campus to give talks tothe residents and interns, so they get to know us and can participate in the Society’s activities andknow what we have to offer. We have also started a number of programs and events including “Walkwith a Doc.”

The Society is of tremendous value to all of us, members and non members. To give an example,through our efforts and CMA’s we have defeated a proposed law change to MICRA that would haveincreased the non-economic damages in a malpractice case to $500,000 or more. That would havemeant, if successful, an immediate increase in the malpractice premiums of about 50 percent or more.This would have been in dollars terms, a lot more than the dues we pay for the FMMS and CMA!

It has been an interesting year for me, and I want to thank the staff – Sandi, Carol, Sheryl andRashad for their help and the Board members and delegates as well. These accomplishments could nothave been done without the support of all of you.

I thank the FMMS for having entrusted me to lead the organization as its 129th President for theyear 2012. I truly enjoyed the year, and I hope the same support that was given to me will be availableto Dr. Rajpal for the 2013 term.

Fresno-Madera

THE SOCIETY IS

OF TREMENDOUS

VALUE TO ALL

OF US,

MEMBERS AND

NON MEMBERS

Fresno-Madera

Holiday Traditions: Their Connections to the SkyDowning Planetarium • Wednesday, December 5, 2012

This family-oriented program focuses on winter holiday traditions from manycultures and how they have been used for millennia to light up this darkest andcoldest of seasons. It showcases customs, highlights some of the winterconstellations, demonstrates the cause of the four seasons and the meaning ofthe winter solstice. This exclusive FMMS showing is at the Downing Planetarium,a 74-seat Star Theater under a 30-foot hemispherical dome located on the CSUFresno campus. Celebrate the holidays by spending a relaxing and educational-filled evening learning the history and development of many of the world’sDecember holiday customs. This show is designed for audiences grade K to adult.

Doors Open: 6:30 pmShow time: 7:00 pm

Star Gazing: 8:15 pm (weather permitting)

Cost: No Charge FMMS member • $6 non-FMMS memberTickets & parking passes held at door • Confirmation & directions will be emailed

No food or drinks allowed in theater • Information: 224-4224 x 118/csrau@fmms.org***Limited Seating = must RSVP to attend

Walking for as little as 30minutes a day can reduceyour risk of coronary heartdisease, improve your bloodpressure and blood sugarlevels, elevate your mood,and reduce your risk ofosteoporosis, cancer anddiabetes. Attedn a free walkand take steps toward ahealthier you!

FREE HEALTHY LIFESTYLE TALKS & WALKS WITH A DOC

NEXT WALK: DECEMBER 15WOODWARD REGIONAL PARKSUNSET VIEW SHELTEREveryone is welcomeRegistration 8:45am • Event 9amInformation: Call FMMS 559-224-4224or email: receptionist@fmms.org

Walk With A Doc is a free walking program for anyone who isinterested in taking steps to improve their health. Each walk islead by friendly, local physicians. In addition to the numeroushealth benefits you’ll enjoy just by walking, you’ll also get:• Healthy snacks• Healthy lifestyle tips/resources• Chance to talk with the doc while you walk

SAVE THE DATE:April 12-14, 2013

2013 YosemitePostgraduate

InstituteYosemite National Park

Information: csrau@fmms.orgor 559-224-4224x 118

2229 Q StreetBakersfield, CA 93301-2900

661-325-9025Fax 661-328-9372

website: www.kms.org

KCMS Officers

Joel R. Cohen, MDPresident

Wilbur Suesberry, MD President-elect

Noel Del Mundo, MDSecretary

Ronald L. Morton, MDTreasurer

Portia S. Choi, MD Immediate Past President

Board of DirectorsAlpha Anders, MDBrad Anderson, MD

Eric Boren, MDLawrence Cosner, MD

John Digges, MDJ. Michael Hewitt, MD

Calvin Kubo, MDMelissa Larsen, MDMark Nystrom, MDEdward Taylor, MD

CMA Delegates:Jennifer Abraham, MD

Eric Boren, MDJohn Digges, MD

Ronald Morton, MD

CMA Alternate Delegates:Lawrence Cosner, Jr., MD

Patrick Leung, MDMichelle Quiogue, MD

Staff:Sandi Palumbo, Executive Director

Kathy L. HughesMembership Secretary

Pediatric Consultant Position,Kern County CCS

A part time or full time position for a Pediatric Consultant withKern CCS available in July 2013. This position will be open tonegotiation and consists of the Pediatrician serving as an advisor orconsultant on a case by case basis to the California Children’sServices program. All interested parties should contact T. Pallitto,Kern CCS Administrator at 1800 Mt. Vernon Avenue, Flr 2,Bakersfield, CA 93306, 661-321-3000.

Introducing the Upright MRIThere is a new option for MRI scanning in Bakersfield.Claustrophobic, obese and children do not need to suffer the anxietythat a traditional “coffin” MRI brings about. The Upright MRI iscovered by insurances covered similar for a traditional MRI and thecost is the same across the board. The scanning on this technology isfirst rate.

This is the fourth Upright MRI in California(www.bakuprightmri.com) – two in Los Angeles and one in San Jose,so to have one in Bakersfield/Central Valley is great! Please helpspread the word. Drs. Arturo Palencia and Brad Anderson, as well asa Neuro Spine Surgeon are owners of this new amazing technology.Our community, patients and doctors will benefit from knowing thatit is here in Bakersfield!

OCTOBER 2012Active.............................................................................................250Resident Active Members .................................................................2Active/65+/1-20hr .............................................................................5Active/Hship/1/2 Hship.....................................................................0Government Employed......................................................................7Multiple memberships........................................................................1Retired..............................................................................................58Total ..............................................................................................323New members, pending dues .............................................................0New members, pending application ..................................................0Total Members ..............................................................................323

Membership RecapMEMBERSHIP NEWS

PO Box 1029Hanford, CA 93230

559-582-0310Fax 559-582-3581

KCMS Officers

Theresa P. Poindexter, MDPresident

Jeffrey W. Csiszar, MDPresident-elect

Mario Deguchi, MDSecretary Treasurer

Mario Deguchi, MDPast President

Board of DirectorsBradley Beard, MDJames E. Dean, MDLaura Howard, MD

Ying-Chien Lee, MDBo Lundy, MD

Michael MacLein, MDKenny Mai, MD

CMA Delegates:Jeffrey W. Csiszar, MD

Thomas S. Enloe, Jr., MDTheresa P. Poindexter, MD

CMA Alternate Delegates:Laura L. Howard, MD

Staff:Marilyn Rush

Executive Secretary

Kern Kings

Tulare

3333 S. FairwayVisalia, CA 93277

559-627-2262Fax 559-734-0431

website: www.tcmsonline.org

TCMS OfficersGaurang Pandya, MD

President

Steve Cantrell, MDPresident-elect

Thomas Gray, MDSecretary/Treasurer

Steve Carstens, DOImmediate Past President

Board of DirectorsVirinder Bhardwaj, MDCarlos Dominguez, MD

Parul Gupta, MDMonica Manga, MD

Christopher Rodarte, MDH. Charles Wolf, MD

CMA Delegates:Thomas Daglish, MD

Roger Haley, MDJohn Hipskind, MD

CMA Alternate Delegates:Robert Allen, MD

Ralph Kingsford, MD Mark Tetz, MD

Sixth District CMA TrusteeJames Foxe, MD

Sixth District CMA AlternateThomas Daglish, MD

Staff:Steve M. BeargeonExecutive Director

Francine HipskindProvider Relations

Thelma YearyExecutive Assistant

Dana RamosAdministrative Assistant

IT IS MY HONOR TO SERVE AS PRESIDENT OF TULARE COUNTY MEDICAL SOCIETY

Thelma asked me to write a last communication as president then I realized that this year has gone byvery fast. I must say that in many ways, this past year has been a transformational year, both personallyand professionally.

Global economy is sputtering. Who knew that what the Greeks do would impact practice ofmedicine in Tulare County? In an effort to bring vigor in U.S. economy Government injectedborrowed money in our economy. That kept the economy alive, but is still on life support. We still facefiscal cliff in January.

Nationally the Supreme Court did not repeal ACA and PresidentObama won the reelection. Reportedly the Affordable Care Act willsoon be fully implemented. The White house will release a truckloadof regulations. However our country has no identified resources to payfor full implementation of ACA. The providers like us will be asked todo more for less. Some of us will pursue other goals in life and willretire. Others may find a way to continue practicing after taking paycuts. Please look to the county society and CMA for help about whatchoices we have. Also ask your colleagues to join Medical Society andCMA for their benefit.

In California the insurance Exchange will sell plans by October2013. Many employers will realign their employment practices andbenefits to qualify many employees for a federal subsidy to pay forexchange premiums. Health plans have to show an adequate Exchangenetwork of contracted providers. Blue Shield of California hasmaintained that you are contracted to exchange plan enrollees. TheBlue Cross of California sent a contract amendment that says you areon panel for exchange but could opt out. Again please look to see whatis best for you and your patients. When in doubt please look to medicalsociety and CMA for help consider options.

In Tulare County we have been proactive. We have partnered withTulare Medical Reserve Corps. We have done one training exercise in

Porterville Sikh Center for mass vaccination. The St. Anne’s Parish is interested in partnering withus for development of their disaster preparedness plan and will hold an event in Holy Cross Churchin Porterville on December 2. Apparently the parish is not currently articulated with Red Cross andthe California emergency management service. This relationship for the church was made possiblebecause of the leadership of our medical society. The church can become an official shelter for localdisasters such as hurricane Sandy. Please consider joining Tulare Medical Reserve Corps. It isvoluntary participation that allows you to bring disaster preparedness resources to your family, friends,patients, church and community. If any one has any question please contact me at my office.

I along with the dedicated staff of Tulare County Medical Society wish you very happy holidays andsuccessful and prosperous new year!

Thank you again and God bless all of you!

You may reach Gaurang Pandya, MD, by calling 559-782-8533, or email: gpandyamd@gmail.com.

President’s Message

GAURANG PANDYA, MD

LOOK TO THECOUNTY SOCIETYAND CMA FORHELP ABOUTWHAT CHOICESWE HAVE. ALSOASK YOUR COLLEAGUES TOJOIN MEDICALSOCIETY ANDCMA FOR THEIR BENEFIT

TulareKaweah Delta Health Care District Receives

Accreditation for Residency ProgramsKaweah Delta Health Care District has received accreditation to offerresidency-training programs in Family Medicine and Emergency Medicine.The first group of residents will begin their training on July 1, 2013. KaweahDelta plans to start additional residencies in General Surgery and Psychiatry,as well as sponsoring a Transitional Year Program.

The Emergency Medicine Residency Program, led by Dr. Michael Burg,will enroll six residents per year, for a three-year training program. TheKDHCD program is one of only 160 emergency medicine programs in theU.S. There is a great need for emergency medicine residency programs acrossthe country, and Kaweah Delta’s record emergency department volumeshould attract high-quality applicants, Dr. Burg said. In general, emergencymedicine residencies are very competitive. “There are more applicants thanavailable training positions across the country, so there’s definitely a need formore providers,” said Burg, noting that Kaweah Delta’s program was only the14th new emergency medicine program accredited by the ACGME in thelast 10 years.

The Family Medicine Residency Program, led by Dr. Robert Allen, willinclude six residents per year, for a three-year training program. “Thisprogram is really important to the community because our desire is that itwill grow physicians who will become the family physicians of the future forTulare County, Visalia and the Central Valley,” said Dr. Robert Allen,Program Director of Kaweah Delta’s family medicine program. “Because ofthe aging physician population, there is a need for primary care physicians inour community.”

It is estimated that between 40-50% of the physicians that train in TulareCounty through the GME programs will remain and practice in the Visaliaarea. “This program is going to change the face of medical care in Visalia andthe Central Valley,” Burg said. “These young doctors are going to come herewith very high standards and want to practice great medicine.”

For more information about Kaweah Delta’s Graduate Medical EducationProgram and its faculty, please visit www.kdgme.org.

Information Regarding Palmettoto Noridian Transition

When our Provider Relations department asked a Noridian representativefor information as to when Noridian Administrative Services (NAS) will betaking the Medicare Part A & B from Palmetto GBA, the following responsewas received:

As of October 16, 2012, two protests have been filed against theJurisdiction E A/B MAC contract that was awarded to NoridianAdministrative Services on September 20. CMS has issued a stop work orderfor the Jurisdiction E contract, while the Government Accountability Office(GAO) reviews the procurement record. During the GAO review period,which is expected to be completed by the end of January 2013, Medicareproviders in California, Hawaii, Nevada, and the Pacific territories willcontinue to file their Medicare claims with the incumbent A/B MAC(Palmetto GBA). Because of the JE stop work order NAS may not do anywork related to the JE award. Implementation activity may not take placeuntil the stop work order is revoked.

Tulare County Medical Society’s Provider Relations will continue tomonitor this transition and keep our members as up to date as possible.Should you have any questions or concerns please feel free to call or e-mailFran Hipskind at 559-734-0393 or fran@tkfmc.org.

office and championed both Shock Trauma andregionalized care by sharing his personal story. Manyof you are likely aware that Parkinson’s disease wasone of the highest-funded diseases by Congress for anumber of years, as a result of the passionatetestimony and eloquence of Michael J. Fox onCapitol Hill.

On hearing the words “Once upon a time …” achild instantly recognizes that a story will follow,perhaps the fairy tale of a courageous hero that willcapture their imagination and simultaneouslyenlighten, empower, and inspire hope in the youngmind. The art of storytelling to educate continuesthroughout our lifetimes, as we share stories thatreveal the valuable lessons we have learned fromour successes and failures to create a deeper bondwith others. Regardless of one’s profession, thebetter a storyteller you are, the greater your chancesof succeeding by fully engaging and inspiring yourlisteners. In a 2010 article in the Journal of PatientSafety, actor Dennis Quaid highlighted a secretweapon in the national patient safety efforts – of thepotential of “story power as an untapped vehicle toinform, equip, and challenge leaders to drive changethat can save lives, save money, and build value incommunities.” He defined “story power” as theability to change or reinforce the behavior of othersby telling a story, as a call to action that harnessesthe power of full engagement. Quaid highlightedthe story of Josie King, an 18-month-old infant whodied at one of America’s most famous hospitals as aresult of missed orders to start oral fluids, followedby a medication error. A 10-minute videotapedinterview with her mother, Sorrel King, recountingthe tragic story has now been used in over 2,000hospitals through the Josie King Patient SafetyInitiative to transform the delivery of health careworldwide.

The power of storytelling is repeated inrecounting the near death experience of Quaid’snewborn twins Zoe Grace and Thomas BooneQuaid, who received 1,000 times the intendeddosage of the blood thinner heparin, leading to atwo-day battle between life and death. The largertragedy for our nation is that the same medicationerror occurred 11 months earlier elsewhere, killingother children, and has also happened since,because of the look-alike packaging of two differentconcentrations of heparin. Quaid has shared hisstory publicly to become a champion for high-quality care.

Emergency

Please see Emergency on page 18

Classifieds

MEDICAL OFFICES

Gar McIndoe (661) 631-3808David Williams (661) 631-3816Jason Alexander (661) 631-3818

FOR LEASE2701 16th St. – 2,400

2005 17th St. – 2,955 sf.Crown Pointe Phase II – 2,000-9,277 rsf.

3115 Latte Lane – 5,637 rsf.3115 Latte Lane – 2,660-2,925 sf.

Meridian Professional Center – 1,740-9,260 rsf.2204 “Q” Street – 3,200 rsf.

4040 San Dimas St. – 2,035 rsf.9300 Stockdale Hwy. – 3,743 - 5,378 rsf.9330 Stockdale Hwy. – 1,500-7,700 rsf.

1919 Truxtun Ave. – 2,080 sf.2323 16th St. – 1,194 rsf.2323 16th St. – 1,712 rsf.

2323 16th St. – 2,050 rsf.2323 16th St. – 2,568 rsf.

SUB-LEASE4100 Truxtun Ave. – Can Be Split

Medical Records & OfficesSprinklered – 4,764 usf.

Adm. & Billing – 6,613 rsf.2323 16th St. – 2,884 rsf.

FOR SALE1911 17th Street – 2,376 sf.

Crown Pointe Phase II – 2,000-9,277 rsf.Meridian Professional Center – 1,740-9,260 rsf.

9900 Stockdale Hwy. – 4,000 rsf.

MEMBERS: 3 months/3 lines* free;thereafter $20 for 30 words.NON-MEMBERS: First month/3 lines* $50;Second month/3 lines* $40; Third month/3lines* $30. *Three lines are approximately 40to 45 characters per line. Additional words are$1 per word. Contact the Society’s PublicAffairs Department, 559-224-4224, Ext. 118.

3,400 sq.ft. spaceSuitable for a Physical Therapy or

Individual practice; may be divided & remodeled to suit

Excellent parking andclose to St. Agnes Medical Center

Carl Abercrombie559-227-4658

c: 559-970-9035Jim Abercrombie

530-626-0321

Professional/Medical Office for LeaseCambridge Court

6335 N. Fresno Street, Fresno

NEWLYREMODELED1,200sq.ft. officewith fiveexam rooms

FRESNO/MADERA

• Secure your credit card readers.• Use a virtual terminal solution pro -

vider validated by the PCI.• Do not store credit card numbers, or

any of the information from the creditcard on any computer or system.Never store sensitive authenticationdata, this includes: Primary AccountNumber (PAN) commonly known asthe credit card number; the PersonalIdentifi cation Number (PIN); thedata from the magnetic stripe or, ifpresent, the chip; the card securitycode, the 3-digit number on the backof most credit cards or the 4-digit codeon the front of American Expresscards

• If the PAN is displayed, it must bemasked. Only the first six and last fourdigits may be displayed.

Now that you know some of the risksand requirements of storing credit card in -for mation, do you really need them on file?

For information, visit Payment Card In -dustry at www.pcisecurity standards.org.

Credit Cards

“A slow cultural shift over the past 20years, led by television (from St. Elsewhereto ER) has been humanizing society’s viewof the practice of medicine.” This commentwas an accolade to Atul Gawande, MD,MacArthur Genius award recipient andnoted author. His writings in the NewYorker have influenced the political debateabout health reform. But whereas singularmedical voices like his are having animpact, overall the profession of medicine isfailing to have an effect in Washington,DC. The impact of the Supreme Courtdecision in 2012 upholding the AffordableCare Act has been felt worldwide. Asphysicians, we must now harness the powerof storytelling to enlighten Capitol Hill toenact new laws to strengthen EMTALAand the ACA to support emergency health

care personnel, who struggle courageouslyeach day to meet the needs of society.

As the debate moves forward again,perhaps patients and physicians acrossAmerica will succeed in infusing thediscussion with the hopes, failures, andtriumphs from their personal stories. HaroldGoddard once said: “The destiny of theworld is determined less by the battles thatare lost and won than by the stories it lovesand believes in.” Whether one chooses toapply the power of storytelling to become abetter patient, physician, health careadvocate, or health policy leader, the timehas clearly arrived to enlighten Capitol Hillto enact new laws grounded in theprinciples of fairness, equality, and justice tofulfill the overarching intent of quality,efficiency, and safety in health care inAmerica.

Reprinted from The Permanente Journal 2012Summer; 16(3): John Maa, MD “Solving theEmergency Care crisis in America; the power of the lawand storytelling” 71-4. ©2012 with permission from ThePermanente Press.

Emergency

University Psychiatry Clinic: A sliding feescale clinic operated by the UCSF Fresno Dept. ofPsychiatry at CRMC M-F 8am-5pm. Call 559-320-0580.

1,250sf medical office, 950 E. Almond Ave.Madera. $1,000 per month. Contact MartinelliProperties 559-673-2166 or martinelliproper-ties@gmail.com.Medical office spaces: 1,000sf up to 2,500sf atNE. corner First/Herndon and NW corner First &Bullard starting at $1 psf++ by owner. Call 559-449-7668 or 559-284-2625. FresnoTimeshare. Newly renovated furnishedoffice in medical complex. Includes internet. Nominimum. Reasonable rate. info@fresnomedical-specialists.com

2,466sf medical/dental office at 924 Emily Way,Madera. $400,000 or for lease at 50¢ sf. ContactBre t t V is in ta iner a t 559 -447 -6265 orbv is in ta iner@pearson realty.com.

FT or PT opening for physician in a busy practice inVisalia. Offering full benefit pkg and more. ContactNicole at 559-627-3222 or Nicole@valleyindustrialmed.com.

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can save you money.

Visit: www.CountyCMAMemberInsurance.com

“When I found out how much money I could save ($1,650) on the sponsored workers’ compensation program, I joined CMA. The savings paid for my membership and then some. Now I have access to everything CMA offers.”

Nicholas Thanos, M.D. CMA Member

Fresno-Madera Medical SocietyKern County Medical SocietyTulare County Medical Society

VITAL SIGNSPost Office Box 28337Fresno, California 93729-8337

HAVE YOU MOVED?Please notify your medical society ofyour new address and phone number.

PRSRT STDU.S. Postage PAIDFresno, CAPermit No. 30

To improve patient safety, you need to stay on top of best practices. That’s why, as shown by the 2011 numbers

above, we provide you the risk management advice you need, when and how you want it. It’s why we provide

industry-leading CME online and through Claims Rx, our monthly publication based on closed claims. And why

we tailor solutions to help with your specific risk issues. The results include 98% policyholder retention, the

highest-level CME accreditation and reduced risk for you.

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CALL 877-453-4486 OR VISIT NORCALMUTUAL.COM

Proud to be endorsed by the Fresno-Madera Medical Society and the Kern, Kings and Tulare County Medical Societies

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Vital Signs December 2012

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Vital Signs - abss.k12.nc.us · PDF fileVital Signs •Provide ... OF ANY VITAL SIGN IMMEDIATELY 13 Vital Signs . ... Vital Signs Respiration Process of taking in oxygen and expelling

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