vital signs feb 2012

February 2012 • Vol. 34 No. 2Official Magazine of

FRESNO COUNTYFresno-Madera Medical Society

KERN COUNTYKern County Medical Society

KINGS COUNTYKings County Medical Society

MADERA COUNTYFresno-Madera Medical Society

TULARE COUNTYTulare County Medical Society

See Inside:Recap of NORCAP Annual Educational ForumYosemite Postgraduate InstituteAn Evening With Ray Kurzweil

o

Vital Signs

2 FEBRUARY 2012 / V ITAL S IGNS

VITAL S IGNS / FEBRUARY 2012 3

Official Publication of

Fresno-Madera Medical Society

Kings County Medical Society

Kern County Medical Society

Tulare County Medical Society

February 2012Vol. 34 – Number 2

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 RepresentativeGail Locke

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: VitalSigns, Fresno-Madera Medi calSociety, PO Box 28337, Fresno, CA93729-8337.

Advertising Contact:Display:

Annette Paxton,[email protected]

Classified:Carol Rau,

559-224-4224, ext. [email protected]

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.

EDITORIAL..................................................................................................................................5

CMA NEWS ................................................................................................................................7

NEWS

TREATMENT RECOMMENDATION:Antifungal Medication Usually Not Indicated in the Treatment of Coccidioidomycosis ...................9

NORCAP: Recap of Annual Education Forum ...........................................................................10

AIR QUALITY: In The AIr .........................................................................................................11

Yosemite Postgraduate Institute ............................................................................................12

An Evening With Ray Kurzweil ................................................................................................12

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

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

• President’s Message

• In Memoriam

• Medical Staff Office Classes

• FMMS Evening at the Fresno Philharmonic

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

• President’s Message

• Ravi Patel, MD Honored

• Membership News

TULARE COUNTY MEDICAL SOCIETY.........................................................................................17

• Certified Medical Coder Course and Forum

Cover photography: Venetian Sunset Over the Grand Canalby Virgil Airola, MD

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


EDITORIAL

My Astonishing 2012New Year’s Resolution!

Prahalad B Jajodia, MDEditor, Vital Signs

This year I plan to become younger. That’s right. Younger. Alongwith other important initiatives, I plan to recapture the very bestemotional qualities of my youth. The zest. The vigor. You see,young isn’t so much a physical state as it is a joyous emotionalevent. It’s that Friday night feeling, knowing the winds of changehave arrived and everything good is coming your way.

In truth, we’re all modern day Ponce de Leóns searching forthe joy of youth. Fortunately, unlike the famed but rather foolishexplorer, we don’t need to sail uncharted waters to find it. It’sright here. We can have it anytime we want, just by doing thethings proven to create true and lasting happiness.

Being physically active, and the vitality it provides, is ahallmark of youth. If you have it, keep it. If not, reclaim thisvitality with daily exercise. Note to curmudgeons: Do it even ifit requires having fun.

That vat of cookie-dough ice cream in the freezer and thechicken-fried steak at La Ptomaine don’t love you and don’t careif you die of a heart attack. Let them go. Like unfaithful friends,they will not be missed. Eat right to feel young and healthy. Tip:The red, green, and yellow things in the supermarket are calledfruits and vegetables. They’re edible. The greasy stuff is called fat.It clogs drains. Don’t eat it.

Sleep at least six to seven hours a night (snoozing throughcommercials on American Idol doesn’t count), then wake uprefreshed and ready for the challenges of the new day.

Make a serious effort to communicate better with your family,colleagues, and patients for less stress and better results.Screaming “Just do it or I’ll flip out!” does not qualify as goodcommunication. Lowering stress levels is an important part offeeling young.

Show respect for others by always being on time; put yourcompetence on display with good time management. You’reyoung but not undisciplined.

Like all young people, you should continue your education,not only professionally but also about life, your relationships, andfinancial security for yourself and your family.

Spend less and save more. Isn’t this the same advice you giveto your children? The benefits are obvious: security and peace ofmind. Work smart, earn more, and save more in your retirementplan. Enough said.

Spend more time with your family and let them share in thejoy of your youth. They matter more than anything else.Vacation with them at least twice a year. A real vacation, not justa few days at home. Travel to new places and experience newthings. You will all gain perspective and become closer as afamily.

For the peace that it brings, enhance the spiritual side of yourlife. Pray every day to the deity of your choice or, if none cometo mind, meditate on the priceless gift of life that fate has givenyou. This simple act is both clarifying and purifying. It will keepyou from doing wrong. You will make better decisions. You willbe happier. You will be younger. Guaranteed.

Help the poor and needy. Shareyour wealth and blessings withthose less fortunate. Donate aportion of your time and resourcesto improving the lot of those whowill never have anythingapproximating the plush life thatwe in the medical field sometimestake for granted. It will renew yourspirit.

Negative sentiments suck themarrow from your life and makeyou old before your time. Banishthem. Forgiveness is nottantamount to weakness oracquiescence; it simply means you don’t have to think about itanymore.

Focus on the key elements of agood and happy life, and do notdiffuse your energy.

It’s a blessing to live inAmerica. Enjoy the freedom andbounty of this great land.

My dear friends, I hope you’vecome to the same conclusion I

have: This year is a fine year to become younger. It can be thespringtime of your life. Again. Believe it. Make it so. And feel thewarm breezes buff your face as a new world filled with possibilitiesopens before you.

Peace and prosperity to you and yours.

Dr. Jajodia is a gastroenterologist in private practice in Fresno. Youcan reach him at [email protected].

IN TRUTH, WE’RE ALL MODERN DAYPONCE DELEÓNS SEARCHING FORTHE JOY OFYOUTH.FORTUNATELY,UNLIKE THEFAMED BUTRATHER FOOLISHEXPLORER, WEDON’T NEEDTO SAILUNCHARTEDWATERS TO FINDIT. IT’S RIGHTHERE.


CMA NEWS

SGR CUTS AVERTED UNTIL END OF FEBRUARYOn December 22, 2011, the House agreed to extend the budgetbill for two months (including a middle class tax cut andextension on unemployment benefits) and prevent the 27.4percent Medicare sustainable growth rate (SGR) cut to physicianreimbursement from going into effect on January 1, 2012. AHouse-Senate conference committee will begin work in lateJanuary on a longer term agreement, including a permanentsolution to SGR. California Congressman Henry Waxman (D-LA), the ranking Democrat on the House Energy Commerce (ie,health) Committee, is one of the conferees.

Several days before the House agreed to the Senate’s two-month patch, California Medical Association (CMA) PresidentJames T. Hay, M.D., sent a letter to Congress voicing theconcerns and frustrations of California physicians who have beenseeking a solution to the flawed SGR for 10 years. Stating thatCMA was “outraged” that there had been no resolution to thelong-standing problem before Congress went home for theholidays, the letter said, “The inability of Congress to adopt along-term plan to replace the formula will cause irreparable harmto physician practices and patients.

The letter also reminds Congressional leaders that physicians,in addition to being healers, are also employers. “Stable Medicarerates help physicians remain in practice, care for patients andprevent further unemployment and economic erosion.”

Contact: Elizabeth McNeil, 415-310-2877 or [email protected].

NEW 2012 MEDICARE FEE-FOR-SERVICE PAYMENTRATES TOOK EFFECT IN JANUARYHighlights:

• 2012 Physician Payment Rule takes effect with a 0.18percent increase in the conversion factor

• Palmetto posted new fee schedule on website by January 11,2012

• CMS/Palmetto won’t begin processing claims until January 18Despite the fact that the payroll tax extension legislation

passed by Congress in December (Public Law 112-078) delayedcuts to Medicare fee-for-service, the Centers for Medicare &Medicaid Services (CMS) has confirmed that all of the other

changes that were included in the Medicare physician paymentfinal rule for 2012 will still take effect.What to expect

Physicians should expect some changes in their payment rates.Numerous changes were made to the relative value units,geographic practice cost indexes, and multiple procedurepayment rules for 2012. Changes to electronic prescribingreporting and quality reporting programs will also beimplemented. All of these changes will take effect for dates ofservice beginning January 1, 2012. Please see the CaliforniaMedical Association (CMA) resource Medicare Part B 2012Important Changes: What They Mean to Your Practice.

In addition, although P.L. 112-078 provided for a 0 percentupdate to the Medicare conversion factor for January andFebruary 2012, the final CMS rule indicated that there would bea 0.18 percent increase in the conversion factor for budgetneutrality, and that this change will also be effective January 1,2012. The budget neutrality increase is due to CMS adoption ofthe relative value system (RVS) Update Committeerecommendations for misvalued codes. The 2011 conversionfactor was $33.9764. The 2012 conversion factor will be$34.0376.

Contractors are expected to have the new rates posted to theirweb sites by January 11.

On January 4, 2012, CMS published a correction notice in theFederal Register to the 2012 final rule that modifies the relativevalues for a number of services. The agency also posted a revisedrelative value file on its website reflecting both the correctionsand the legislation that stopped the 27.4 percent cut.

CMA will continue to provide updates as informationbecomes available.

Contact: CMA reimbursement helpline, 888-401-5911 [email protected].

RESIDENCY ‘SCRAMBLE’ SWAPPED FOR SOAPThe National Resident Matching Program (NRMP) is revisingits annual residency match to improve how vacant residency slotsare filled after ”Match Day.” Starting in 2012, the NRMP willadminister a new system to link unmatched students withunfilled residency positions.

Called the Supplemental Offer and Acceptance Program(SOAP), the system is designed to create a formal process forapplying for unfilled positions. SOAP replaces the previousresidency “Scramble,” a highly competitive and disorganizedprocess in which unlinked students contacted programs withunfilled positions in an effort to find a slot, often forcing studentsto accept the first offer they got on the spot. In 2011, most of the1,060 available positions were filled within the first 24 hours.

As a result of SOAP, Match Day will move from the thirdThursday to the third Friday of March. In 2012, Match Day willbe on March 16.

On March 14, residency programs with unfilled positions willfinalize their preference lists of applicants, and the NRMP willbegin making offers to applicants.

All NRMP applicants will be notified about their eligibilityfor SOAP the Friday before Match Week. Unlike the Scramble,

Í Í Í Í Í

CMA’s LEGISLATIVE DAYIN SACRAMENTOTuesday, April 17, 2012

The FMMS will be chartering a busfor the trip to the Capitol.

Information: 224-4224 x 118 or [email protected].

Í Í Í Í Í

SAVE THE DATE

Please see on next page


Feb. 15: HIPAA Risk Analysis forMeaningful UseDavid Ginsberg • 12:15 – 1:15 pmMarch 7: Managing Difficult Employeesand Reducing Conflict in the PracticeDebra Phairas • 12:15 – 1:15 pmMarch 21: HIPAA Update 2012David Ginsberg • 12:15 – 1:15 pmApril 4: A Guide to Managing Upsetand/or Difficult PatientsDebra Phairas • 12:15 – 1:15 pmApril 18: Best Practices for ManagingYour Accounts ReceivableMary Jean Sage • 12:15 – 1:15 pmMay 2: Medicare: Top 10 Claim andDocu mentation Errors That Cost YourPractice MoneyKevin Garrick • 12:15 – 1:15 pmMay 16: Telephone Etiquette forMedical PersonnelMary Jean Sage • 12:15 – 1:15 pmJune 6: A Manager’s Guide to LoweringPractice CostsDebra Phairas • 12:15 – 1:15 pm

June 20: Writing Effective AppealsMary Jean Sage • 12:15 – 1:15 pmJuly 18: Preparing for a Medicareand/or Medi-Cal AuditMary Jean Sage • 12:15 – 1:15 pmAug. 1: Coding for Medical NecessityArthur Lurvey, MD • 12:15 – 1:15 pmAug. 15: Program Integrity in Medicareand Medi-Cal – The Physician’s RoleBruce Tarzy, MD • 12:15 – 1:15 pmSept. 5: A Guide to Reviewing PayorContractsKris Marck • 12:15 – 1:15 pmSept. 19: Creating and ImplementingFinancial and Office PoliciesDebra Phairas • 12:15 – 1:15 pmOct. 3: Protect Your PracticeFrom Payor AbuseMark Lane • 12:15 – 1:15 pmOct. 17: Establishing Expectations forHigh Performance from Medical StaffDebra Phairas • 12:15 – 1:15 pmNov. 7: Understanding ARC and CARCRevenue CodesDavid Ginsberg • 12:15 – 1:15 pm

CMA Center for Economic ServicesWebinars At-A-GlancePlease note that this calendar does not includeCMA’s ICD-10 training courses to be offered in 2012.

CMA NEWS

SOAP applicants could receive multipleoffers in each round and will be able toconsider their options before making adecision.

In 2013, the NRMP plans to implementa new All-In Policy, requiring residencyprograms to place all of their first- andsecond-year residency positions in theMain Residency Match. The NRMP isaccepting comments on the change.

According to NRMP, there were 5,627unmatched applicants and 2,288 unfilledpositions in 2001. By 2010, the gap hadgrown to 8,794 unmatched applicantscompeting for 1,060 unfilled positions.

For more information, visit www.nrmp.org.

CMA HOTLINES• Membership Help Line: 800-786-4262• Legal Information Line: 415-882-5144• Reimbursement Help Line:

888-401-5911• Contract Analysis: 415-882-3361• Legislative Hotline: 866-462-2819• Medical-Legal Documents: On-Call at

www.cmanet.org/member

Continued from CMA News page 7

The use of oral antifungal medication may provide no benefit inthe treatment of three common forms of coccidioidomycosis:uncomplicated primary disease, residual asymptomatic pulmonarycavity and asymptomatic residual pulmonary nodule. Treatmentmay be both unnecessary and potentially harmful. Althoughgenerally well tolerated, fluconazole has been associated with rarebut serious hepatotoxicity and exfolliative dermatitis.Fluconazole has many drug-drug interactions and is thought to bea teratogen. If treatment is undertaken, the recommendedduration of treatment is prolonged. There are publishedguidelines for the treatment of all forms of coccidioidomycosis.

1,2

Medical providers in area endemic for coccidioidomycosis (CM)should be familiar with these guidelines. This paper addressesthose situations where oral antifungal medications are not knownto be beneficial.

In the pre-azole era, the toxicity and intravenousadministrations of amphotericin argued against the use of thismedication in low risk, uncomplicated CM. We know from thepre-azole era that most patients will do well with no oralantifungal therapy. Likely because of the toxicity of amphotericintreatment, oral azole therapy was adopted without controlledtrials. The use of oral azole therapy in the treatment of CMcontinues to be complicated by the lack of adequate controlledtrials.

Primary coccidioidomycosis most commonly presents asinfluenza-like illness usually associated with pulmonary infiltrateand less frequently with intrathoracic adenopathy or pulmonaryeffusion. Erythema nodosum or erythema multiformeoccasionally precede or are concurrently present. There is noevidence that treatment improves the symptoms or shortens theduration of primary pulmonary CM.3 The noted rashes are likelyimmunologic and are not an indication for treatment. Rathermarked fatigue is common after other symptoms of primary CMhave resolved. This fatigue can last weeks to months. The use oforal antifungal to treat fatigue is not recommended. Per the ATStreatment guidelines, “Most cases of primary pulmonarycoccidioidomycosis in individuals without identified risk factorsare self limited and do not require treatment.”2

The treatment guidelines of both the Infectious DiseaseSociety of America and the American Thoracic Society are basedon a comprehensive assessment of the individual case. Thedecision to treat with oral antifungal medication is made afterassessing the severity of the illness and the risk of progression tocomplicated coccidioical disease. While a routine CTexamination of the chest probably isn’t indicated, at a minimuma two view plain film of the chest should be included in theassessment. CM patients co-infected with untreated HIV can beexpected to do poorly, Consistent with current CDC guidelinesall adults with CM should be screened for HIV.

Disease severity isn’t explicitly defined in either guideline.


Antifungal Medication Usually Not Indicatedin the Treatment of Coccidioidomycosis

by Michael Mac Lean, MD, MSHealth Officer, Kings County California

T R E ATMEN T R E COMMENDAT I O N

Presumably, the treating physician/provider would use clinicaljudgment to determine the disease severity. Suggested indices ofseverity include: acute symptom of > 6 weeks duration; intensenight sweats of >3 weeks duration; weight loss of >10%;pulmonary infiltrate involving >50% of one lung or involvingmultiple areas of both lungs; prominent or persistent hilaradenopathy; anticoccidioidal complement fixation antibodytiters in excess of 1:16.

Treatment with antifungal medications is also indicated in thepresence of risk factors for chronic progressive pulmonary diseaseor for dissemination. Risk factors include age>55; diabetes;chronic pulmonary disease; chronic renal disease; congestiveheart failure; immune compromised patients due to HIV, alphaTNF inhibitors, corticosteroids and solid organ recipients.Women in the second or third trimester, African-Americans andFilipino-Americans are also at increased risk for dissemination,and treatment should be considered. This list of risk factors maynot be exhaustive.

Those patients who don’t have sever disease or risk factors forcomplicated CM and who are not treated with oral antifungalmedications require follow up. “All patients with primarypulmonary coccidioidomycosis should be followed for at least oneyear to assure complete resolution and the absence ofcomplications.” 2

Asymptomatic pulmonary nodule and asymptomaticpulmonary cavity can be residual conditions associated withprevious CM. The recommended follow up of primary pulmonarydisease may obviate the need for diagnostic workup of thesefindings, e.g., a fine needle biopsy of a pulmonary nodule. Thereis no evidence that in immune competent individuals’ treatmentwith oral antifungal medications has any effect and treatment isnot recommended.

1,2

This paper addresses those situations where treatment maynot be beneficial or indicated. If treatment is deemed indicated,inexperienced physicians/providers should review the publishedtreatment guidelines or seek consultation with an experiencedspecialist. The choice of drug and the duration of treatment arevariable depending on the clinical circumstances. The minimumduration of any treatment recommended is three months. Azolesmay be teratogens, and the use in pregnant women isproblematic.4 In Kings County the unplanned pregnancy rate farexceeds the state average. The use of fluconazole in any fertilewoman may warrant a careful weighing of risk and benefit.

References:1 Galgiani JA, et.al: Treatment guidelines for coccidioidomycosis. CID 2005;

41:1217-232 Limper HA, et.al: Treatment of fungal infections in adult pulmonary and critical

care patients. Am J Respir Crit. Care Med Vol 183. pp 96-128, 20113 Ampel NM, et.al: Factors and outcomes associated with the decision to treat

primary pulmonary coccidioidomycosis. CID 2009;48:172-1784 Bercovitch RS, et.al: Coccidioidomycosis during pregnancy: A review and

recommendations for management. Clin Infect Dis 2011; 53(4):363-368.


Recap of AnnualEducational Forum

by Bonna Rogers-Neufeld, MD, FACR

On December 10, 2011, an all-dayeducational seminarwas organized andspon sored by theNorthern CaliforniaPhysicians Council(“NORCAP”) in SanFrancisco. In responseto the California mal -practice crisis of 1975,northern Cali for niaphysicians bannedtogether at the county medical societylevel to form NORCAP. It is through thiseffort that NORCAL Mutual InsuranceCompany – a new kind of policyholder-owned medical professional liabilityinsurance company was formed andincorporated on September 18, 1975. Inthe same spirit of physician advocacy thatled to the passage of MICRA andformation of NORCAL, NORCAP con -tinues physician advocacy efforts, con -ducting the peer reviews when insuredphysicians seek to appeal insurer decisionsrelated to imposition of a surcharge orcancellation of liability insurance.

Annually NORCAP provides an all dayprogram inviting attendance by endorsingMedical Society executives, presidents,president-elects, NORCAP representativesand MRAC chairs. This year, FMMS wasrepresented by µSergio Ilic, MD, president-elect; Cynthia Bergmann, MD, NORCAPrepresentative; Oscar Sablan, MD,president; Sheryl R. Tatarian, staff FMMS;and Bonna Rogers-Neufeld, MD, FACR,MRAC chair.

The topics for the weekend includedHealth Care Reform, Electronic MedicalRecords, New Physician Payment Models,and High Risk Issues Associated withMalpractice.

A highlight was a multimediapresentation created by the Kaiser FamilyFoundation, which is a nine-minutecartoon-like presentation that explainsthe 1000 page Health Care Reform Act insimple terms. This is something I

NORC A P

Bonna Rogers-Neufeld, MD,FACR

Please see NORCAP on page 17


The connection between air pollution andhealth has never been obvious, even if youreyes were burning and your chest felt tight insmoggy 1950s Los Angeles. When thecounties of California first took on airpollution several decades ago, each countywas its own jurisdiction. Obviously bad airdoesn’t respect political boundaries, andeventually regional air boards were formed.The San Joaquin Valley Air PollutionControl District governing board (formed in 1981) was initially amix of a supervisor from each of the eight counties plus rotatinglarge and small city council members. The driving mandate forAir Boards has always been public health, but it was only in thelast four years that a health professional position was designatedfor the SJVAPCD Board. FMMS’ own Dr. John Telles was thefirst governor’s appointee. After serving three years, Dr Tellesresigned last year to focus more fully on his cardiology practice.Last November, I was appointed by Governor Brown to theSJVAPCD Board and also to the California Air Resources Boardas SJVAPCD member. Thanks to FMMS and other componentsociety members who supported my application. I’ll be morecareful what I ask for in the future!

I attended my first local Board meeting last month, as well asa State Board meeting in Sacramento. As you might guess, it is anew skill set (several!), and a significant volume of material tobecome familiar with for each month’s meetings (and Dr. Tellesset a very high bar for mastery of the material), plus time meetingand talking with people and organizations regarding upcomingagenda items. And it is a no-pay volunteer position. Butobviously the work is important, and it certainly gets one out ofthe office routine! I have many items I could report as good newsalthough none were major breakthroughs on the past six weeks ofunrelenting unhealthy air quality we have been experiencing inthe Valley since Thanksgiving. Thirty-seven consecutive days atthis writing of air quality far below federal health standards. Manyfriends and patients, back to the Valley for the holidays,commented on the need to find and dust off their inhalers. Alas,cleaning the air is a Sisyphean task, but then none of us got intomedicine expecting to eradicate all diseases, did we? 2012 will bea special challenge for the Valley Air Board as a revised cleanupplan for small particulates (pm2.5) is due. Yes La Nina has givenus stagnant air, but it is our home grown pollution we arebreathing that is making us sicker. The PM2.5s don’t just damageour lungs, but are small enough to pass through the alveoli andenter the blood stream. The evidence grows that their triggeringof inflammation accounts for myriad-associated negativecardiovascular effects. The magnitude of the cleanup challenge is

A I R Q U A L I T Y

In The Airby Alexander Sherriffs, MD

Edited by Michelle Garcia, Air Quality Director

suggested by considering the sources of the smallest and nastiestparticulates. NOX are a key precursor to particulates. Of some470 tons of NOX we create each day, 40 percent comes from theheavy duty trucks on our roads. About 15 percent comes fromoff-road equipment. A smaller contribution comes from farmequipment. Our cars have gotten cleaner over the years, andsmall trucks and cars contribute perhaps 10 percent. Our ValleyAir District does not have jurisdiction for on-road mobilesources.

Why be optimistic? The staffs of both CARB and SJVAPCDhave impressed me with their energy and enthusiasm for theirwork. Most of the businesses and organizations that testified inSacramento embraced change and were full of innovation forlower carbon fuels. Technologies are available, being utilized,and ready to scale up. Veterans groups from Iraq spokepassionately about moving the US away from its dependence onoil for energy. One immediate step that was taken for our Valleyinvolved CARB swapping out higher polluting drayage trucksfrom California ports for newer cleaner trucks. And instead ofjust junking those trucks, many can be retrofitted and will beswapped out for older higher polluting Valley farm trucks thatotherwise would not be taken out of service for another decade.We have so much to do, and we are impatient for progress, buteven small steps toward improved health matter. I look forwardto more involvement from our component medical societies inthe future.

n Fuel Combustion from Stationary Sources 10%

n Petroleum, 4%

n Industrict Processes, 4%

n Solvents/Consumer Products, 6%

n Farming Operations (non-mobile) 7%

n Other, 6%

n Autos and Light Trusts, 13%

n Heavy-Duty Trucks, 27%

n Other mobile, 23%

SOURCES OF SMOG-FORMING EMISSIONSSAN JOAQUIN VALLEY, 2006(Data Source: o3sip 1.04 RF 976)

Alex Sherriffs,MD


Make plans to attendYosemite Postgraduate Institute

MARCH 23-25, 2012

For further information

(559) 224-4224 x118• e-mail: [email protected] • website: fmms.org

“The Yosemite Postgraduate Institute is at a perfect venue – Yosemite Valley. Physicians of every specialty will benefit from this diverse and high quality program, and they and their families will be in awe of this beautiful environment. This will be my fifth time to attend. I also look forward to the enjoyment this event brings with seeing other physicians of the Central Valley.”

– Roydon Steinke, MD

Make plans to attend

Topics include: Wilderness Medicine• DermatologyGastroenterology • Cancer • UrogynocologyPulmonary • Dementia

Yosemite Postgraduate Institute

RAY KURZWEIL has been described as “the restless genius” by the Wall Street Journal and “the ultimate thinking machine” by Forbes. The magazine Inc. ranked him #8 among entrepreneurs in the United States, calling him the “rightful heir to Thomas Edison.”

As one of the leading inventors of our time, Ray was the principal developer of the first CCD flat-bed scanner, the first omni-font optical character recognition, the first print-to-speech reading machine for the blind, the first text-to-speech synthesizer, the first music synthesizer capable of recreating the grand piano and other orchestral instruments, and the first commercially marketed large-vocabulary speech recognition.

Among Ray’s many honors, he is the recipient of the $500,000 MIT-Lemelson Prize, the world’s largest for innovation. In 1999, he received

the National Medal of Technology, the nation’s highest honor in technology, from President Clinton. And in 2002, he was inducted into the National Inventor’s Hall of Fame, established by the US Patent Office.

He has received nineteen honorary Doctorates and honors from three US presidents.

Well known for predicting the future of artificial intelligence and the human race, Ray has been described as the prophet of the “Singularity” movement.

“Ray Kurzweil is the best person I know at predicting the future of artificial intelligence.”

– Bill Gates

May 11, 2012Fresno ConventionCenter

THE FRESNO-MADERA MEDICAL SOCIETY presents

Inventor, Scientist and Futurist An Evening withRAY KURZWEIL“2045: The Year Man Becomes Immortal” TITLE SPONSOR

Central ValleyPhysician Benefits

GOLD SPONSORS Cooperative of American PhysiciansHadden PathologyNORCAL Mutual Insurance Co.Premier Valley BankSpencer Medical Group

Single tickets and tables available.

$60: FMMS member $550 table of 10

$75: FMMS non-member $650 table of 10

$45: Medical Resident

For further informationor to reserve a table: 559-224-4224 X 118or [email protected]

Sponsorships still available.

PROGRAM INVITATIONS TO FOLLOW


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

Fresno-Madera

We have been looking at Congress to solve the 27.4% cut that the SGR demands this coming year.They delayed the final decision for two months until March 1. What is going to happen then? Noone knows.

Opting out of Medicare or not taking new Medicare patients are not good ideas, and I personallywill not do either. We are smart, so surely we can find better solutions to our health care system.

In my opinion, nationalizing the health Insurances is also a bad idea. We already have examplessuch as Medicaid/Medi-Cal and the VA systems. We know they do not work well. They arebureaucratic, and very few of us accept Medi-Cal.. Why then, make this a nationwide problem? Ifwe look at the Canadian and UK systems, they work well for emergencies, but for elective cases theydelay care (ration?) to the point where many patients come to the US for it. Many doctors also cometo practice here because they are unhappy with their health care system.

Perhaps making the health insurance companies NOT-for-profit will help. When I came to thiscountry in 1972, the Blues were not- for-profit, and they worked very well. Then they separated andbecame for-profit I believe in the late 70s or early 80s. These for-profit health insurance companiesneed to be held accountable and show why they keep increasing their premiums. If they can’t justifythe increases, they should be denied.

Malpractice reform should also be tackled. Why haven’t we heard more about reform in this area?Basically because the trial lawyers’ lobby is very strong, and Congress is made up of 95 percent oflawyers. If they want to make a real difference in the nation’s economy, they should put the interestof the public ahead of their own.

We are being told that the medical care we deliver is bad. I disagree with that assertion. The greatmajority of us are good doctors, and we do the best we can to get our patients better. I feel there isa very good tracking system here to identify our mistakes. Most countries don’t have such a system.Mistakes are buried or ignored, and there is no accountability or malpractice. A doctor can’t be sued,so adverse outcomes are not known.

We are being told that we spend too much money for the care we give. The problem is that mostpeople do not want to spend any money out of pocket. They spend a lot of money on their pets -but on their selfs? For patients that do not have insurance, the delivery of care is excellent andavailable. They can go to any emergency room and are treated with the most advanced lab tests,MRI’s, surgeries etc. without regards to their insurance status. All these contribute to the increasein costs in medical care.

It is also very important that we reach agreements on end-of-life care. We know that a largeamount of resources are spent during the last two years of life. Many treatments do not help withthe quality of life of the patient, but nonetheless, we provide treatments that prolong life andsuffering.

Can we do better? Yes, and we will to do better because the expenditures in medical care aregrowing at an unsustainable rate, and they have to decrease. We can improve on preventive care bycurbing smoking, excessive drinking and drug abuse. Anything we do, though, needs to becomplemented with mandatory insurance regardless of our age. Whether this will be deemed legalwill be determined by the Supreme Court’s decision later this year.

Other ideas would be to offer age-appropriate insurance. For example, 20 to 40 year olds can becovered for trauma and certain basic diseases at a lower premium, but not for most cancers (womenshould be covered for breast cancer and of course for pregnancy etc.), or heart attacks. As you getolder, you get more comprehensive coverage. When you reach Medicare age, you are covered foreverything. There will always be patients that get sick and develop diseases that are not in his or herplan, but that is the risk you are taking. You can always buy a more comprehensive plan if you wish.

These are some of my thoughts. In the meanwhile we need to wait and see what happens. Thereare too many factors out there that will shape the future of medical practice in the US for better orfor worse.

President’s Message

SERGIO D. ILIC, MD


Fresno-Madera

presents...

an Evening with theFresno Philharmonic

WickedDivas

SaturdayFebruary 11, 2012

William Saroyan Theatre6:00 p.m. Reception8:00 p.m. Concert

Bewitching, Beguiling, Bedazzling. Wicked Divas is a concertof amazing voices, humor, energy and sass delivering divashowstoppers from Broadway, opera and popular music,highlighted by selections from the Tony-award winningBroadway musical, Wicked. Begin your evening enjoying horsd’oeuvers and beverages while socializing at an exclusivepre-concert reception for Fresno-Madera Medical Societymembers and guests.

For further information or tickets,call 224-4224, x118 or [email protected]

With appreciation to our reception sponsor:Premier Valley Bank

Wicked Divas February 11, 2012RECEPTION:

___ FMMS member at no charge___ FMMS guest(s) at $10 each

CONCERT:___ Orchestra Seats at $55 each

Total Payment Enclosed: $

* Check (payable to FMMS) * MasterCard * VISA

Card #_________ | _________ | _________ | _________Verification # Expiration DateCardholder’s NameBilling Zip CodeCardholder’s SignaturePhonePreferred mailing address for tickets

Mail payment and form to:FMMS, PO Box 28337, Fresno, CA 93729-8337or FAX to: 559-224-0276

LEONARD THOMPSON, MD45-year member

Leonard Thompson, MD, a retired pediatrician, passedaway December 24, 2011 at the age of 77 after a shortbattle of cancer.

Dr. Thompson was born in Ohio in 1934. He receivedhis medical degree from Ohio State Univ. in 1960 andcompleted his internship and residency at FitzsimonsGeneral Hospital in Denver. After practicing at theIreland Army Hospital in Kentucky for three years, Dr.Thompson opened his private pediatric practice in Fresnoin 1966. He retired in 2009.

Dr. Thompson is survived by his wife, six children and10 grandchildren.

Medical Office Staff ClassesTuesday, February 28, 2012

Coding and Medicare Update 2012: 9am-12pm• OIG Work Plan 2012 review• Preparing for Version 5010 testing standards• Latest updates on private payer policies andreimbursement

Transitioning to ICD-10-CM: 1pm-4pm• Common concerns for ICD-10-CM conversion• Creating a timeline for conversion• Documentation requirements

Location: Bella Pasta RestaurantCost: $130 for one session$240 for two sessions

Exclusive offering for FMMS members’ staffInformation: 559-224-4224 X 112

or [email protected]

2012 FMMS Educational SeriesAs a member benefit, a series of Financial Education classes willbe offered to FMMS members beginning in March. Classes willbe held on the last Wednesday and Thursday of March, April,May and June to be repeated August, September, October andNovember at 6 pm at the Medical Society offices.

Topics to include (but not limited to and subject to change): • Introduction to Investing• Investment Fundamentals • Estate Planning/Conservation• Understanding Social Security and Medicare• Taxation Basics/StrategiesCheck future issues of Vital Signs, the FMMS website and your

email for specific topics and dates. For more information, pleaseemail [email protected].


Kern

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

President’s Message

JOEL R. COHEN, MD

“We must hang together or assuredly we will all hang separately” – Ben Franklin

These immortal words ring as true today as they did 200 years ago, even more so now in medicinein the Golden State. In many ways, medicine is changing and we, as physicians, must close ourranks if we are to survive this transition intact, just as Ben Franklin and his compatriots did. Beloware a number of simple steps that we can take to help do this, as an organization and as individuals.We should all commit to do these each day.

We must support one another professionally... If you see a colleague in need, offer to help; it is always good to improve outcomes, for patients

and for our colleagues. And under the rare circumstances of physician wellness, the MedicalSociety has resources and referrals to help, but it takes the care of a colleague to say something.

We must support each other socially…I will commit now to sponsor an Alliance social event with each one of our general membership

meetings; I will ask for an Alliance leader to attend our Board meetings. I will explore venues inwhich our local physician community can learn from experts in services that we all use routinely,information technology, insurance, banking and the like.

We must grow our membership…Policy leaders will only listen to our voice if we speak for many. Each one of us should identify

at least one new member this year and hand them an application. In this way, we all benefit,including the new member who benefits from reduced membership rates, all the CMA activitiesand perks, etc. Keep in mind that we all do share many least common denominators, such as thedesire to practice the best quality medicine possible, to improve patient outcomes, to besurrounded by a plethora of services to offer our patients, to be able to pay off our massive studentand practice debts, to be more free of payer over site, and to be less burdened by redundantregulations, etc. It is certain that all physicians in the community do benefit from a growing androbust medical society.

These are tough times and the way to survive as a group and to prosper together, is to pulltogether. I look forward to seeing many new faces at each one of our meetings this year.

Ravi Patel, MD Named Recipient of OutstandingContribution to the Community Award

by Portia Choi, MD

Ravindranath (Ravi) Patel M.D. received the Outstanding Contributions to the CommunityAward for Kern County Medical Society in 2011. The medical community and even a localtelevision news station were there to honor him.

Dr. Patel began his solo practice over 25 years ago with two employees, one nurse and onereceptionist. His practice has grown to 220 staff with 15 physicians at the Comprehensive Bloodand Cancer Center (CBCC), a center that he founded and where he is the current managingdirector. He has additional staff globally, particularly in India.

Dr. Patel was born in Johannesburg, South Africa, the son of a homemaker and a gold miningequipment company department manager. He and his mother went to India to care for his elderlygrandfather. There he went to college and medical school. Dr. Patel completed fellowship inHematology/Oncology at Loyola University, Stritch School of Medicine; and board certified by the

Please see Ravi Patel, MD on page 16


Linda P. Veneman, MDPathology/Clinical/AnatomicPathology

Physicians Automated Lab2801 H Street, 93301-1913661-325-0744 / FAX: [email protected] Degree: Loma Linda U

1975IM Internship/Residency: Loma

Linda U 1976-1979Rheumatology Fellowship: Loma

Linda U 1979-1981Clinical/Anatomic Pathology

Training: Loma Linda U 1983-1987

Cytopathology Training: OliveView Medical Center 1990-1991

Board Certified:Pathology/Internal Medicine

The following physicians’ names,etc. are being published incompliance with the KCMSConstitution & Bylaws. BoardCertification will be listed only ifthe physician has been certifiedby a Specialty Board recognizedby the American Board ofMedical Specialists, as approvedby the American MedicalAssociation.

New Members

DECEMBER 2011Active.......................................250Resident Active Members ...........1Active/65+/1-20hr .......................5Active/Hship/1/2 Hship...............0Government Employed................6Multiple memberships..................1Retired........................................61Total .........................................324New members, pending dues .......8New members, pending application .....................0Total Members.........................332

Membership Recap

American Board ofInternal Medicineand specialized inHematology/On -col ogy.

In honoring Dr.Patel, a colleaguestated “Dr. Patelhas been an enor -mous asset to Bakersfield and Kern County. Not only is he anexcellent, caring and compassionate physician, he is a trueinnovator. He has succeeded in developing the largest freestanding, non-academic cancer facility on the West Coast.”Dr. Patel’s goal is to provide to each patient both establishedcancer treatment and more advanced treatments throughclinical research trials. The center has many “firsts” in KernCounty such as Intensity Modulated Radiation Therapy(IMRT), CT Positron Emitting Technology (PET), stem celltransplants, cutting edge clinical trials, plasmapheresis,outpatient prostate brachytherapy and most recently theCyberknife. CBCC participated in clinical trials for manynew and exciting drugs to treat cancer, medications that arenow routinely used. One example was the Herceptin trialswith Dr. Slamon at UCLA, a life-saving option for manywith Her- 2 positive breast cancer, and is now used routinely.Another example was Erbitux that was first used in trials atCBCC in 2003 for colorectal cancer patients who had failedmany therapies. Patients flew from other parts of USA toreceive access to this trial in Bakersfield. CBCC hasparticipated in research leading to the approval of such novelcancer drugs as Gleevec, Tykerb, Avastin, Vidaza, Afinitor,Tarceva, Faslodex, Trisenox, Procrit, Aranesp, Neupogen,Neulasta, Nexavar, and Xalkori. The center currently hastrials for both chemotherapy and targeted-therapy inlymphoma, breast, colon, lung, esophageal, gastric, lung,ovarian, prostate and pancreatic cancer.

Additionally, the Center offers modalities for healing thewhole patient, including the spiritual and emotional aspect.It offers integrative health modalities such as meditation,relaxation techniques, and therapeutics modalities. It hasprograms into the community and hosts support groups forcancer patient and their families such as “Look Good FeelBetter Program”, “Man to Man” and “Women to Women.”

Dr. Patel is involved in training other physicians. He is anAssistant Clinical Professor of Medicine at the University ofCalifornia at Los Angeles (UCLA); and involved with theresidents at Kern Medical Center. He has received manyawards including the HOPE (Hematology Oncology PracticeExcellence) Award, and the Excalibur Award from theAmerican Cancer Society. Additionally, his CBCCfoundation supports community wellness projects.

Ravi Patel, MD

Continued from page 15 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

Gail LockePhysician Advocate

Thelma YearyExecutive Assistant

and

Certified Medical Coder Course and ExamThe Tulare County Medical Society (TCMS) is pleased to announce a second 5-week/5 Fridays

coding and certification course for qualified physician’s office staff. The Certified Medical Coder(CMC)® is a certification designed for physician-based coding intermediate level professionals withat least one-year coding and reimbursement experience. Experienced individuals, able to demonstrateby exam a superior level of physician-based coding knowledge, are awarded the CMC certification.The certification becomes a currency that validates personal achievement, demonstrates a person’scommitment to the profession, improves employer confidence, and can help guard the practiceagainst fraud and abuse. This course is also the ideal preparation for 2013 ICD-10.

Time: 8:30 a.m. 4:30 p.m. each FridayWhen & Where: 5 Fridays; March 2, 9, 16, 23 – March 30 (Exam)

Sequoia Regional Cancer CenterCurriculum Material: • Medical Terminology for Diagnostic/Procedural Coding;

• ICD-9-CM Diagnostic Coding• CPT Procedural Coding;• Ancillary Services & Advanced Coding

Course Cost: $750 for TCMS/CMA members/staffContact: Gail Locke, TCMS to register or for more information on

2012 Certified Medical Coding Course, 734-0393, [email protected].

Hurry, seating is very limited!

encourage you all to watch and I think youcan recommend it to your staff and patients.Access it by going to the You Tube site andtype the following into search – HealthReform Explained Video: “Health ReformHits the Main Street.”

There was a fascinating presentation onthe new issues of discovery related tomalpractice cases when the records areelectronic. A lot of information is embeddedin the systems, which is discoverable inlawsuits. These issues relate to times anddates when documents were created andreviewed – or altered. Plaintiffs’ attorneys arevery savvy. There have already been lawsuitsthat relate to the mixing up of electronicmedical records. One of the cases presentedwas an error that simply related to the factthat one physician had not signed offproperly before another signed on!

Material was presented regarding causesfor malpractice claims settlements and onceagain, one of the key issues noted wasFAILURE of communication of informationfrom doctor to doctor and failure tocommunicate results/information to thepatient. This issue is highlighted in plaintiffattorneys’ educational material to otherlawyers where they point out that although ajury may not understand technical andscientific information, they will understand a“failure to communicate.”

In our coming future, we will have moreelectronic record keeping and this will giveopportunity for more tracking of our resultsand outcomes. This will produce a lot of datathat will likely lead to reimbursementguidelines. If you thought Big Brother hadn’tarrived – forget about that! Not only has hearrived — he has moved into your house.

If you would like more informationregarding the seminar, please contact me [email protected].

NORCAPContinued from page 9


Classifieds

MEDICAL OFFICES

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

FOR LEASE1902 B Street – 1,695 sf.

2701 16th St. – 2,4002007 17th Street – 5,090 rsf.

4817 Centennial Plaza Way – 2,370 rsf.1311 Columbus St. – 4,400 sf.

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

2204 “Q” Street – 2,894 rsf.4040 San Dimas St. – 2,035 rsf.

9300 Stockdale Hwy. – 3,743 - 5,378 rsf.9330 Stockdale Hwy. – 1,500-7,700 rsf.

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

2731 H Street – 1,400 sf.3941 San Dimas Street – 3,959 rsf.

SUB-LEASE4100 Truxtun Ave. – Can Be Split

Medical Records & OfficesSprinklered – 4,764 usf. • Adm. & Billing – 6,613 rsf.

DENTAL OFFICE FOR SALE2023 Brundage Lane – 3,500 sf.

FOR SALECrown Pointe Phase II – 2,000-9,277 rsf.

Meridian Professional Center – 1,740-9,260 rsf.2000 Physicians Plaza – 17,939 sf. gross9900 Stockdale Hwy. – 2,000-6,000 rsf.

Fresno Women’s Medical Group welcomesboard certified OBG, Preti Srivatsa, MD andboard certified FM, Robin Linscheid, MD.Accepting new patients & most insurance. Call559-322-2900 for appointments. Rare opening for a new client. Medical Billingservice. Professional, precise, collection experts.559-499-1233, [email protected] Psychiatry Clinic: A sliding feescale clinic operated by the UCSF Fresno Dept. ofPsychiatry at CRMC M-F 8am-5 pm. Call 320-0580.

High quality medical suite on NE corner ofPalm/Barstow. Approx. 2,030 sf, 4 exam rms. 2offices, lg. reception area. Available Jan. 2012.Excellent move-in incentives. Call Justin or Garryat 559-449-2424. www.russellgsmithinc.com.Medical office space, 3,000-7,000 sf in primelocation near Fresno Surgical Hospital.Negotiable rates. Call 559-273-0600.

Established IM and CD group seeks F/T physi-cian. Ancillary services on site. Located adjacentto SAMC. Excellent opportunity for new andestablished practices. Call Kim at 559-435-2633or 559-289-5535.

ANNOUNCEMENT FOR LEASE OR SALE

PHYSICIAN/PROVIDED WANTED

CME Activities

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/3 lines* $30.*Three lines are approximately 40 to 45 characters per line. Additional words are $1 per word.Contact the Society’s Public Affairs Department, 559-224-4224, Ext. 118.

Guide to Breastfeeding Infants with Special Needs – February 2, 201211:30am-4pm; UCSF-Fresno Center; Credit: pending; Fee: N/C;Contact: 559-459-1777.

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

Our passion protectsyour practice

STRENGHTEN YOUR PRACTICE AT NORCALMUTUAL.COM

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

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O

R V

ERY

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ED 28IN A ROW OF A.M. BEST “A” (EXCELLENT) RATING

YEAR

S

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To make a calculated decision on medical liability insurance, you need to see how the numbers stack up—and there’s

nothing average about NORCAL Mutual’s recent numbers above. We could go on: NORCAL Mutual won 86% of its

trials in 2010, compared to an industry average of about 80%; and we paid settlements or jury awards on only 12%

of the claims we closed, compared to an industry average of about 30%.* Bottom line? You can count on us.

*Source: Physician Insurers Association of America Claim Trend Analysis: 2010 Edition.

vital signs feb 2012

Documents

fresnomadera medi calsociety

mdmanaging editor

presidents message ravi

ital s ignsvital s igns

ray kurzweilovital signs2

mdroydon steinke

prahalad jajodia

po box