vital signs march 2012

March 2012 • Vol. 34 No. 3Official 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:

An Evening withRay Kurzweil

Physicians’Responsibilitywith PrescriptionDrug Abuse

Air Quality:Going Solar

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Vital Signs

2 MARCH 2012 / V ITAL S IGNS

VITAL S IGNS / MARCH 2012 3

Official Publication of

Fresno-Madera Medical Society

Kings County Medical Society

Kern County Medical Society

Tulare County Medical Society

March 2012Vol. 34 – Number 3

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

iHEALTH .................................................................................................................................8

An Evening With Ray Kurzweil ..................................................................................................9

DRUG ABUSE: Physicians’ Responsibilty With Prescription Drug Abuse.....................................10

DRUG ABUSE: Teenage Abuse of Prescription Drugs ...............................................................11

AIR QUALITY: Going Solar: The Good, Bad and Ugly.................................................................12

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

TULARE COUNTY MEDICAL SOCIETY.........................................................................................13

• Congratulations Mylene Rucker, MD

• Attention Physicians: Visalia Unified Needs You

• Suicide Prevention Task Force

• Tulare County Medical Society Annual Wine Social, Friday, May 4

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

• IMQ/PACE Platinum Training Program for Physican Leaders

• Membership News

FRESNO-MADERA MEDICAL SOCIETY .......................................................................................16

• President’s Message

• FMMS Educational Series

• Proper Disposal of Unwanted Medications

• Fresno County Projects Address Teen Drug Abuse

Cover photography: Foxgloveby Newton Seiden, MD

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


EDITORIAL

Tips for Dealing With WorrySteven M. Cantrell, MD

Tulare County Medical Society

Isn’t strange that we have had thousands of hours of formaleducation about how to be physicians, but little to nothing hasbeen taught to us about how to handle the worry that comes withour profession? There are always new stressors, changes,unknowns that suck enjoymentout of our lives. The ability tochannel our daily energy intoproductive tasks, instead of beingsiphoned off by the rumination,anxiety and depression that comewith worry is key to living to yourfullest potential. I would like todiscuss a few strategies that I havefound useful to stay productiveand mitigate worry.

STAY FOCUSEDDid you know that when your

mind wanders, it has a betterchance of bringing you a negativethought rather than a positiveone? By simply keeping your mindfocused on the present will go along way to avoid unpleasant andunproductive thoughts. It is easierto keep your mind from wanderingwhen you are involved in a project- especially an enjoyable one. Tryto put yourself in those situations.When you cannot, try focusing onyour surroundings. Take notice of life’s details that often gooverlooked such as the people and things around you. This willhelp keep your mind from wandering. Our feelings, both goodand bad, are a direct result of what we think. You have completecontrol over our thoughts, so choose them wisely.

TODAY IS WHAT’S IMPORTANTToday is the tomorrow we worried about yesterday. ~Author

UnknownYesterday happened, tomorrow is not here yet, so all we really

have is today. A common source of worry is using too muchmental energy on the past or future. This is not to say that youshould not plan for the future or take into consideration thingsfrom the past, but many of us spend too much time worryingabout what has happened or what could happen. Try to take theunknowns of life and put them on the back burner of your mind,instead of actively trying to play out every scenario. You will besurprised about how many times answers will come to you whenyou are able to do this.

THREE STEP STRATEGY TO AVOID WORRYHere is something you can do right now to reduce worry. Most

worry is caused by the fear of the unknown. Let me challenge youto do the following when faced with an anxiety provokingsituation.

Step 1: Ask yourself, “What’s the worst that can happen?” In other words, look for the worst case scenario ofyour current situation.

Step 2: Accept that the worst case scenario is going tohappen.

Step 3: Prepare a plan to make the best of the worst casescenario.

Once you have done these steps, there is no need to let yourmind ruminate over a situation of unknowns. You have alreadymade a plan for the worst, anything else that happens is betterthan the situation for which you are already mentally prepared.

The next time you find yourself anxious, I encourage you topractice the techniques discussed in this article. Hopefully, it willget your mind off what is troubling you, keep you productive,happy and able to better deal with the life’s worries.

YESTERDAY HAPPENED,TOMORROW IS NOT HEREYET, SO ALL WEREALLY HAVE ISTODAY. A COMMONSOURCE OFWORRY IS USING TOOMUCH MENTALENERGY ONTHE PAST OR FUTURE.


* Marsh and the Societies do not provide tax, investment or legal advice. Please consult with your professional advisors for guidance on these issues.

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CMA NEWS

JUDGE BLOCKS A 10 PERCENT REDUCTIONIN MEDI-CAL REIMBURSEMENT RATEOn Tuesday, February 1, 2012, U.S. District Court JudgeChristina Snyder issued a final order enjoining the State ofCalifornia from implementing a 10 percent cut to the Medi-Calreimbursement rate.

Last spring, the California Legislature passed and GovernorJerry Brown signed Assembly Bill 97, which authorized up to a 10percent Medi- Cal reimbursement rate cut for physicians,hospitals, dentists, pharmacists and other Medi-Cal providers.Federal approval was required before the state could implementits proposed cuts. The Centers for Medicare & Medicaid Services(CMS) approved the state plan amendment in December 2011.

The California Medical Association (CMA), CaliforniaDental Association, California Pharmacists Association,National Association of Chain Drug Stores, CaliforniaAssociation of Medical Product Suppliers, AIDS HealthcareFoundation and American Medical Response filed the lawsuitagainst the U.S. Department of Health and Human Services andthe California Department of Health Care Services in November2011, with financial support from the California Academy ofFamily Physicians and the Osteopathic Physicians & Surgeons ofCalifornia.

CMA believes that the information supplied by the state toCMS did not measure whether and how a patient’s access to carewould be impacted or otherwise take into consideration, asrequired by law, the costs to provide the care.

Con t a c t : M i c h e l l e R u b a l c a v a , 9 1 6 - 5 5 1 - 2 5 4 3 o rm r u b a l c a v a@ cman e t . o r g .

CMA PRESENTS FINAL ARGUMENTSIN NURSE ANESTHETISTS RULINGThe California Medical Association (CMA) and the CaliforniaSociety of Anesthesiologists (CSA)l delivered their finalarguments against a 2009 ruling by former Governor ArnoldSchwarzenegger that effectively allowed nurse anesthetists toadminister anesthesia unsupervised by a physician. Thearguments were heard on February 14, and the court will have 90days after the oral argument to issue an opinion. The appeal raises

questions about how to protect patients undergoing surgery, andthe ability of physicians to provide quality medical care.

Background: In June 2009, Schwarzenegger joined 15 othergovernors in opting out of a federal regulation requiringparticipating Medicare hospitals to ensure that physicianssupervise nurse anesthetists who administer anesthesia.Schwarzenegger said he opted out to increase access to anesthesiaservices in rural and underserved areas.

In February 2010, CMA and CSA filed a lawsuit challengingthe former governor’s decision to opt out of the physiciansupervision requirement. However, a San Francisco SuperiorCourt judge refused to block Schwarzenegger’s decision andallowed nurse anesthetists to continue practicing independently.

Contact: Long Do, 916-551-2556 or [email protected].

RESERVE YOUR SEAT IN THE HIGHLY ACCLAIMEDPHYSICIAN STAFF LEADERSHIP PROGRAM• Three-day leadership program: March 8-10, 2012Coronado Island (San Diego)Hotel accommodations: Special rate atthe Coronado Island Marriot Resort & Spa.The acclaimed 2nd Annual Stepping Up to Leadership –IMQ/PACE Platinum Training Program for Physician Leaderswill provide physicians with the skill sets they need to effectivelylead their medical staffs. It will feature dynamic speakers rangingfrom Diane Kenny, a recognized leader in helping companieseffect behavioral change, to nationally recognized facilitators andmedical staff leaders with extensive leadership experience.The program addresses the most challenging decisions facingmedical staff leaders, such as rehabilitating an impaired ordisruptive physician; conducting effective meetings; improvingcommunication; and using data to support better decision-making about quality, patient safety and privileges

For information and reservations, contact Leslie Anne Iacopi,Program Administrator at 415-882-5167 or [email protected].

PROBLEMS GETTING PAID?The California Medical Association’s Center for Economic

Services provides direct reimbursement assistance to CMAphysician members and their office staff.

Reimbursement Help Line 888-401-5911: One-on-oneeducational and reim burse ment assistance to physician mem bersand their staff

Practice Empowerment: Tools and resources to empowerphysician practices

Seminars and toolkits for physicians and their staffExperienced Staff: Staffed by practice management experts

with a combined experience of over 125 years in medical practiceoperations

Need help? Contact CMA’s reim bursement experts at 888-401-5911 or [email protected].

MARCH WEBINARS: March 7: Managing Difficult Employees and Reducing

Conflict in the PracticeMarch 21: HIPAA Update 2012: Are you compliant with

HIPAA? Contact: CMA’s member help center, 800-786-4262 [email protected].

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


iHEALTH NEWSReprinted with permission from iHEALTHBeat

KAISER PERMANENTE LETS MEMBERSACCESS HEALTH DATA VIA SMARTPHONEKaiser Permanente announced that about nine million Kaisermembers now can use mobile phones to access their electronichealth information, Healthcare IT News reports (Monegain,Healthcare IT News, 1/24).

Members with Android smartphones can use a no-cost mobileapplication to access their electronic health records from Kaiser’ssystem. Members with other types of smartphones can accesstheir health data through a mobile-optimized version of KaiserPermanente’s website (Dolan, MobiHealthNews, 1/24).

The Android app and mobile-optimized website allow users to:• Access diagnostic information; • Email with physicians; • Obtain lab results; and • Order prescription refills (Walsh, CMIO, 1/24).Kaiser plans to release an iPhone version of its smartphone

app in the coming months (Goedert, Health Data Management,1/24).

Read more: http://www.ihealthbeat.org/articles/2012/1/24/kaiser-permanente-lets-members-access-health-data-via-smartphone.aspx#ixzz1ljaD5Iyz

LARGE INSURERS INVEST IN MOBILE HEALTH APPSTO BOOST PATIENT WELLNESSLarge insurers are investing in mobile health applications thatfocus on patients’ diagnoses and wellness, American Medical Newsreports.

Several insurers recently have announced investments andpilot projects related to mobile health apps, including:

• Aetna, which acquired iTriage, a maker of an app thatallows users to check their symptoms against commondiseases and learn more about diagnoses;

• UnitedHealth Group, which launched a series ofpartnerships with mobile health technology companies; and

• WellPoint and Verizon Wireless, which launched a pilotprogram that links patients and health coaches throughsmartphones.

The insurers said that although they are developing morecomplex apps, they are not trying to replace physicians withmobile health apps. Instead, they want to help patients discernwhether a physician’s care is necessary, and then connect themwith a doctor through mobile technology, according to AmericanMedical News.

Read more: http://www.ihealthbeat.org/articles/2012/1/24/large-insurers-invest-in-mobile-health-apps-to-boost-patient-wellness.aspx#ixzz1ljalMZNz

EXPERTS DEBATE DOCTOR-PATIENT EMAILING, USE OF UNIVERSAL PATIENT IDSIn a recent Wall Street Journal special section on health care,experts debated various health care issues, such as whetherphysicians should email with patients and whether the U.S.should implement universal patient identifier numbers.Should Physicians Email With Patients?

In one opinion article, Joseph Kvedar — founder and director

of the Center for Connected Health in Boston — argues thatemail communication could improve the quality of care patientsreceive. He writes that email helps him build trust with patientsbecause it “gives my patients a sense of direct access to me. Itsends a message that I care and that I’m available to answerquestions in a timely manner.”

Kvedar argues that concerns that emailing with patients willlead to privacy violations are “overblown” because privacy can beprotected with email encryption or secure messaging portals. Headds, “I believe that patients understand the risks of emailcommunication, and are willing to bear those risks in exchangefor the more timely, useful and personal care that email can helpbring about.”

Meanwhile, Sam Bierstock — founder and president of healthIT consulting group Champions in Healthcare — argues thatemail is “no way to practice medicine.” He writes that onlinecommunication could “diminish the quality of care delivered”because it does not allow health care providers to interpret bodylanguage and tone, which can be important when treatingpatients.

In addition, Bierstock argues that “email is a treasure chest formalpractice attorneys” because lawyers could question whether adoctor offered a sufficient response to a patient’s email orresponded in a timely manner (Kvedar/Bierstock, Wall StreetJournal, 1/23).Should All PatientsHave a Universal ID Number?

In a second opinion article, University of MassachusettsMedical School Chancellor Michael Collins argues that theabsence of a uniform system for linking patients to their medicalrecords has “created a sea of unrelated patient-identity numbersthat are bogging down our medical-records systems.”

To address the problem, Collins recommends theimplementation of a universal patient identifier that “seamlesslyconnects a person to all of his or her records.” He outlines waysto keep a universal patient identifier system secure and calls forCongress to fund research into such systems.

Meanwhile , Deborah Peel – founder of Patient Privacy Rightsand leader of the Coalition for Patient Privacy – argues that auniversal patient identifier system would allow the “governmentand corporations to exploit the single biggest flaw in health caretechnology today: Patients can’t control who sees, uses and sellstheir sensitive health data.”

She writes that universal patient identifiers would “onlyexacerbate” existing health data security issues because it wouldallow someone to use a single number to access a patient’s entiremedical record. Peel adds that the “best way to share sensitivehealth information is to build electronic records systems wherepatients are in control of their own medical records, notgovernment and industry” (Collins/Peel, Wall Street Journal,1/23).

Read more: http://www.ihealthbeat.org/articles/2012/1/24/experts-debate-doctorpatient-emailing-use-of-universal-patient-ids.aspx#ixzz1ljb7V12Y


As one of the leading inventors of our time, Ray Kurzweil has been described as “the restless genius” by the Wall Street Journal and “the ultimate thinking machine” by Forbes. He 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, and the first music synthesizer capable of recreating the grand piano and other orchestral instruments. Among his many honors, he has received the National Medal of Technology, was inducted into the National Inventor’s Hall of Fame. and has received 19 honorary Doctorates and honors from three U.S. presidents. Mr. Kurzweil’s latest book, The Singularity is Near, was a New York Times best seller, and has been #1 on Amazon in both science and philosophy. Well known for predicting the future of artificial intelligence and the human race, Mr. Kurzweil 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

6:00pm: RECEPTION • 7:00pm: DINNER • 7:30pm: PRESENTATION

May 11, 2012Fresno ConventionCenterNew Exhibit Hall

presents

Inventor, Scientistand Futurist

An Evening withRAY KURZWEIL“2045: The Year ManBecomes Immortal”

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Single tickets and tables available.

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

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continued on next page

Recently I had the good fortune to be on a rather long flight tothe Caribbean. Among the reading selections was the December2011 issue of Discover magazine, which had a brief summary of aJournal of Pediatrics September 2011 article documenting a 101percent increase in ER visits for accidental ingestions ofmedications by children under the age of five between 2001 and2008 and which coincides with a near doubling of oxycodoneprescriptions and a 559 percent rise in methadone prescriptionsbetween 2000 and 2007.

It struck me that, as physicians, we are expected to get ourpatients to say “yes” to drugs... at least to prescription drugs whenappropriate. The pace of today's medical practice can be achallenge for us to do all the right things we learned in our last riskmanagement seminar – such as getting an informed consent formedication. When prescribing a medication I typically tell thepatient:

1) To take their medication as directed.

2) To let me know if they believe the dosage is insufficient tomanage their problem.

3) They must not attempt to enhance the potency of theirmedication by "borrowing" the medication of a friend orfamily member (or by using alcohol and/or illicit drugs).

4) They must tell each doctor they see which medications theyare taking (including over-the-counter medications).

5) When using analgesics they are not to use the medication todull the pain enough to engage in physical activities that willonly aggravate their condition. Furthermore, I monitor foruse beyond the expected duration of the pain, the use of everlarger amounts of medication, and reports of potentialwithdrawal symptoms when they try to stop taking theirmedication.

However, reality is very different. Every day I have patients reactto my pursuit of informed content for medications with surprise andsuspicion because “I've never had any other doctor do this.” Howoften do we see non-compliance or find out that our patientbelieved “if a little is good then more is better?” Even so, wegenerally trust our patients. We recognize them as a partner in theirown health care- someone who has far more to lose than we do ifthey are not both forthcoming and compliant.

If we tell a patient to use acetaminophen for pain, how often dowe tell them about the potential consequences of taking more thanfour grams per day? When they show up in the clinic with elevatedliver enzymes what do we do? We treat them and we educate them.In other words, we recognized that there was more medicine to bepracticed when we discovered the problem.

Why then do so many of us feel betrayed by the patient whenwe discover that they took a prescription for a scheduled drug andare now found to be abusing it? Granted, their presentation can bemore devious (doctor shopping, lying, and manipulative behavior).

Physicians’ Responsibility with Prescription Drug AbuseBradley T. Wajda, DO

Esano LLCAdult Psychiatry, Child Psychiatry, and Substance Abuse Treatment

DRUG A BUS E

Yet I see many patients who are denied any further prescription forscheduled medication or they are simply terminated fromtreatment altogether. Without exception, every physician I haveever spoken to about this regarding a mutual patient has citedliability concerns.

I will be the first to say that I am not an attorney; however, itcertainly seems to me that liability was an issue in the abovedescribed acetaminophen scenario as well. It is my opinion that toabruptly deny the refill of a scheduled medication or to terminatethe doctor-patient relationship may well incur a greater liability.As physicians we need to realize (as with the acetaminophen case)that we have just as much medicine to practice to help our patientsolve their substance use disorder as we practiced while accom -panying them to that point of developing a substance use disorder.

The real reason for this article is to remind us to maintain thedelivery of good patient care AFTER we find out that our patientnow has a prescription substance abuse problem. In my experience,the majority of the time the patient is discharged from carewithout a specific referral. They are often left without pre -scriptions, treatment recommendations, or even an explanation ofwhat to expect (such as what withdrawal symptoms may occur).

This scenario often leads to the first illicit use of drugs andwhere they will buy it from other (as-of-yet undiscovered) abusingpatients or they will find the street equivalent. The discharge of apatient found to be abusing their prescription represents a tragicoutcome- that of a missed opportunity to provide appropriatecontinuity of care for a newly discovered (and recognized) medicalproblem of the substance use disorder. Furthermore, this tragicoutcome (in my opinion) could be construed as patientabandonment in the face of the aforementioned newly discoveredmedical problem.

As medical professionals we strive to provide the best carepossible and the reality is that the best care is often only as good asour documentation in the event of a poor outcome. For thisreason, we all practice some degree of defensive medicine. Thisshould not be overlooked in cases of prescription abuse. Obviousareas of potential liability in the event that the patient is simply“cut off” from treatment or their prescription would be whenwithdrawal can be life threatening (such as benzodiazepinewithdrawal).

Any consideration of treatment options begins with definingthe extent of the problem. The following table is used extensivelyon different sites on the internet including the site for theCalifornia Society of Addiction Medicine. This simply andsufficiently summarizes the DSM IV criteria for dependence vs.abuse without the excessive detail included in the more recentDSM IV-TR (see chart next page).

Certain medications which are prone to abuse create morecomplex clinical issues. One popular medication is Soma(carisoprodol). It is a non-controlled skeletal muscle relaxant


whose active metabolite is meprobamate, a Schedule IV controlledsubstance. Although several case reports have shown thatcarisoprodol has abuse potential, it continues to be widelyprescribed. Biopsychiatry.com reports that a significant percentageof the physician population is unaware of the potential ofcarisoprodol for abuse and of its metabolism to meprobamate, acontrolled substance. Another popular medication is Ultram(tramadol). Withdrawal from tramadol includes both opiatewithdrawal and SSRI (selective serotonin reuptake inhibitor)withdrawal.

Once you have defined the substance use disorder, then it isnecessary to determine treatment. There are many possibilitiesincluding (but certainly not limited to): Buprenorphine,Methadone, Naltrexone, benzodiazepine taper, barbiturate taper,non-narcotic detoxification, Cognitive Behavioral Therapy, 12step programs, and residential treatment.

What is most important is that you use interventions that youare comfortable with and deem to be the best course of actionBUT collaborate with the many resources available to providesupport services and accountability. Make specific referrals.Involve the family whenever possible, and if you are treating theproblem on your own – don't hesitate to refer at the first sign of atreatment failure.

LOCAL RESOURCES FOR REFERRALS:Central California Recovery1100 W Shaw Ste 130 Fresno 93711, 559-681-1947

Central Valley Recovery Services Inc.320 W. Oak Ave., Visalia 93291, 559-625-2995www.CVRSHome.org

Comprehensive Addiction Programs2445 W. Whites Bridge Ave., Fresno 93706, 559-264-5096www.CAPRehab.org

Kings View Substance Abuse Treatment Program-Tulare County559 E. Bardsley Tulare 93274, 559-688-7531www.KingsView.org

Prescription Abusers In Need (PAIN)An educational and referral service dedicated to assisting thosesuffering from prescription drug abuse and addiction as well as theirfamilies. 83 E. Shaw Ave., Ste. 204, Fresno 93710, 559-579-1551www.GotPainUSA.com

DRUG A BUS E

• Tolerance (marked increase in amount;marked decrease in effect)

• Characteristic withdrawal symptoms;substance taken to relieve withdrawal

• Substance taken in larger amount andfor longer period than intended

• Persistent desire or repeatedunsuccessful attempt to quit

• Much time/activity to obtain, use,recover

• Important social, occupational, orrecreational activities given up orreduced

• Use continues despite knowledge ofadverse consequences (e.g., failure tofulfill role obligation, use whenphysically hazardous)

• Recurrent use resulting in failure tofulfill major role obligation at work,home or school

Abuse(1 or more in a 12-month period)

• Symptoms must never have metcriteria for substance dependence forthis class of substance.

• Recurrent use in physically hazardoussituations

• Recurrent substance related legalproblems

• Continued use despite persistent orrecurrent social oar interpersonalproblems caused or exacerbated bysubstance

Continued from page 10

The Teenage Abuse ofPrescription Drugs

Alice DanielCalifornia Healthline Regional Correspondent

Teenage prescription drug abuse is on the rise in California,so much so that a California Department of Educationsurvey assessing student well-being included questionsabout it for the first time in its last statewide report.

The California Healthy Kids Survey collects data on 9thand 11th grade students’ attitudes, experiences andbehaviors that are related to school and learning.Questions cover topics such as violence and harassment,family and school support networks, safety, physical andmental health, and substance abuse.

The last survey conducted also asked specific questionsabout the use of prescription painkillers and otherprescription drugs, such as barbiturates.

According to the 2008-2010 statewide survey, 17% of11th graders and 13 percent of 9th graders reported theyhad used prescription painkillers to get high at least once.It also showed that 10 percent of 11th graders and 7% of9th graders reported they had tried barbiturates ortranquillizers at least once.

The National Survey on Drug Use and Health indicatesthat among 12- to 13-year-olds, prescription medicationsare the drug of choice, over even alcohol or marijuana.

PAINKILLER PRESCRIPTIONSUP TENFOLD IN CALIFORNIA

In 2009, more than two billion prescription painkillerswere prescribed in California alone, a tenfold increasecompared with 2000, according to the Bureau of NarcoticEnforcement at the California Department of Justice.

Nationally, one in five teens say they can getprescription drugs in less than an hour and 70 percentreport getting them from their own home, family or friends,

Dependence(3 or more in a 12-month period)

Please see Teenage Prescription on page 12


As some of you may know, I added solarpanels to my home in 2008. I have been verypleased with the performance and savings Ihave experienced from this investment.Now I am informed that there will be anadditional benefit derived from thispurchase. As California moves to a carboncap and trade system my solar electric systemgives to me carbon credits, which I can sell.I am also informed that there are companiesbeing formed to act as brokers within this carbon trading market.For a small fee I can register with one of these brokers who willthen market my carbon credits.

So in addition to the already existing financial incentives ofa PG & E. rebate, a federal tax credit, and reduce utility bills,solar electric systems now provide the owners with a salablecommodity of carbon credits. I would expect that as the overallcap for carbon emissions decreases with time, the value of thesecarbon credits will increase.

However, this market creates a moral and environmentaldilemma. If I enter the carbon market I make it easier forpolluting industries to postpone their cleanup. If, on the otherhand, I stay out of of the market, I deprived myself of an

A I R Q U A L I T Y

Going Solar: The Good, Bad and UglyMichael DeLollis, MD

additional source of income. At this point we are still a few yearsaway from the a meaningful carbon market so the decision canwait. I am currently leaning towards staying out of the market.At the same time I am hoping that this additional incentive willprovide the needed stimulus for additional people to go solar. I look forward to following these developments.

Michael DeLollis,MD

according to the National Survey on Drug Use and Health.The same survey reports that the average family has 10 to 15

prescription drugs that they haven’t disposed of or used up.“Almost without exception, the adolescents that come to us

get the drugs from friends and family,” said Dale White, presidentof the not-for-profit Central California Recovery in Fresno, adrug treatment center. White says he primarily sees teenagersaddicted to opiates, such as Vicodin and OxyContin, andbenzodiazepines, such as Xanax and Valium.

“It’s become the desirable way to get high in school. Withalcohol, you can smell it. With prescription drugs, they only getcaught if they can’t wake up,” said White. “Kids are very crafty.They carry a second cell phone and they can take the battery outand there’s enough room for two OxyContin pills to fit in.”

He’s also concerned about kids when they graduate from highschool and no longer have consistency and structure. “That’swhen the wheels fall off, kids start to steal and sell drugs andsome desperately switch to heroine,” White said. “It’s a hugeconcern.”

HOW PHYSICIANS CAN HELP• Determine what medicines have been in the house and howthey are stored before pre scribing certain drugs

• Record how often a patient asks for refills• Encourage patients to avoid stockpiling medicines and storethem safely. Instruct them to promptly and properly dispose ofany unused medicines

• Speak to all patients and parents about prescription drug abuse– illegal drugs and alcohol are not the only threats

• Teach patients and parents how to watch for negative sideeffects of a prescribed drug and what to do if this is suspected.

Teenage Prescription


Bought fromfriend or relative

Took fromfriend orrelative w/o askingBought from drug dealer

Other source

From one doctor

Free from friend or relative56%

18%

8%

4%5%

9%

SOURCE OF PAIN RELIEVERS FOR MOST RECENTNONMEDICAL USE AMONG PAST YEAR


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, MDRoger Haley, MD

John 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

Congratulations Mylene Rucker, MDSubmitted by Kweku Middleton

Dr. Mylene Rucker was among several professionals who were recentlyrecognized by the Soroptomist Club of Visalia for her community servicethroughout recent years. This award of “Making a Difference in theCommunity” was such an honor, one she well earned, and one that she isvery proud of. Even through her own struggles at times, she has been persistentwith her efforts to make a difference in our community with devotion andcommitments to her patients, to those less fortunate, and to those in need.Among her credits include her humanitarian trip to Haiti in 2010 to care forthe sick and injured after the devastating earthquake that destroyed much of thecountry. It was a grueling journey to get there and back (over two days eachway), accommodations were barely adequate, and she worked almost around the clock for two weeksto assist those who needed a hand, and to heal those she could. In 2005 she founded a non-profitorganization named “Sister Friends”. Her efforts, along with a membership of women, worked tireslyto hold events to educate and empower the women of our community to have a betterunderstanding of the importance of better health and wellness for themselves and their loved ones.Sponsoring many fund raising events, they often raised monies to donate profits to the organizationsin our community such as the Battered Women’s Shelter, Victory Outreach Rehabilitation Program,Mothering Heights for Women and Children, and the Lighthouse Rescue Mission of Tulare. In2009, she established a community garden in the area next to her Visalia clinic for the purpose ofgrowing vegetables during the summer months. Many local organizations are given the food grownin the garden throughout the summer to help feed those in need in our community. She has alsoincorporated programs within her clinic to educate and council at risk teens of the importance offamily planning, and of making better decisions. Dr. Rucker has often taken her staff, alongwith medical evaluation equipment, to the small rural community of Allensworth, south of Pixley,who for years has had no medical clinic for its residents. She has set up a day clinic to evaluate andtreat those without insurance as a courtesy to those in need. Congratulations Dr. Rucker, and mayyou continue to be such a compassionate and devoted asset to our community.

MyleneRucker,MD

CALLING ALL TULARE COUNTYMEDICAL SOCIETY MEMBERS

Visalia Unified High Schools Need You!Here’s your chance to volunteer for a great cause!

Once again the Tulare County Medical Society is assisting the high schools in theVisalia Unified School District to provide annual sports physicals for athletes. In thepast many of you have graciously agreed to participate in the event and we would liketo ask you to do so again. We have scheduled two days of physicals with two highschools each day.

SAVE THE DATE!For more information, or to volunteer for this meaningful project, please contact:

Thelma Yeary, TCMS at 559-627-2262 or [email protected]

May 9, 201212:00pm - 3:00pmSchools on this date:

Mt. Whitney High SchoolGolden West High School

May 16, 201212:00pm - 3:00pmSchools on this date:Redwood High School

El Diamante High School


Tulare & Kings Suicide Prevention Task ForceKathryn Hall, MD

It has been a privilege to serve on the Tulare County Suicide Prevention Task Force (SPTF) during thepast two years. The SPTF is chaired by Cheryl Lennon-Armas, LMFT, of Tulare Youth Service Bureauand Karen Haught, MD, MPH, of the Tulare County Health Department; SPTF Coordinator NoahWhitaker does an amazing job. All of the members are so committed to promoting the health of ourcommunity. The task force includes voting representatives from the following groups: education,medicine, veterans, faith-based organizations, law enforcement, youth, aging, LGBTQ (lesbian, gay,bisexual, transgender, questioning), media, survivors of suicide and loss, mental and behavioral healthproviders, consumers and family members. The SPTF recently expanded to include Kings County.There are nonvoting members as well, and members of the public are welcome to attend the meetingsheld from 8-10am on the third Thursday of odd months. Subcommittees include Professional Practices& Training, Awareness & Events Committee, and a subcommittee on the Family Acceptance Project.

During 2011 Tulare County had 38 deaths by suicide, compared to 43 in 2010 and 40 in 2009. KingsCounty had nine deaths in 2011 and comparable numbers in the two prior years. Suicide deaths weremore common in males, while phone calls to the Poison Control Center regarding intentional orsuicidal poisonings were more common for females.

The SPTF has sponsored and continues to offer a variety of training opportunities. QPR (Question,Persuade and Refer) is a short online training available at no charge to lay people or professionals toteach them how to recognize those at risk for suicide, how to intervene, and how to refer to anappropriate resource. For those interested in more depth, Applied Suicide Intervention Skills Training(ASIST) sessions are two days long and teach suicide prevention and intervention to the general publicas well as professionals. More than 350 people have been through ASIST training by the SPTF in thepast 18 months, and SPTF has also sponsored ASIST Training for Trainers. In June, 2011, there weretwo sessions of two-day Dialectical Behavioral Therapy training by Lane Pederson, Psy.D. to helpclinicians work with clients with personality disorders, suicidality, eating disorders, addictions, andother mental illnesses. The SPTF has also paid for attendees at Psychological Autopsy Training.Customized training lasting 15 minutes to two hours on Suicide Prevention Basics has been providedto a variety of groups. Contact the SPTF through the website www.sptf.org for further information onany of these trainings.

The SPTF also provides a grief & bereavement voucher program designed to pay for short-termintense early intervention services to reduce the risk of suicide in those who have experienced a suicideloss. More clinicians are urgently needed to participate in the voucher program. The Resources tab onthe SPTF website has information on how to apply to accept vouchers.

The most visible of the SPTF’s activities has been the Festival of Hope held at the Tulare OutletCenter in September, 2010, and in October, 2011. This included a chalk art festival with professional,amateur team, and children’s chalk drawings, entertainment with dancers, drummers, and many livemusical groups. Resource and information booths handed out information on suicide prevention,mental health and other topics to hundreds of attendees.

Many copies of the Hope Comic Book commissioned by the SPTF have been given to young peoplein the county. Cards with the National Suicide Prevention Lifeline and the Trevor Project Lifelinephone numbers, pens, sunflower seeds (the sunflower is the logo for the SPTF) and otherinformational/promotional items have also been distributed. The Survivors of Suicide Loss is a peersupport group that meets monthly to help survivors cope with the ongoing issues of loss. The TrevorProject has continued to provide programs to support LGBTQ youth. The recent tragic loss of a localTrevor Project intern has increased the commitment to reduce stigma and risk for that community.

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, MDYing-Chien Lee, MD

Bo Lundy, MDMichael MacLein, MD

Kenny 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

Tulare Kings

Please see Suicide on page 18

Save the Date: Friday, May 4TULARE COUNTY MEDICAL SOCIETY

Annual Wine Social6:30-8:30PM • Chinese Cultural Center, Visalia


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

IMQ/PACE Platinum Training Program for Physician LeadersAs a new or experienced medical staff leader, you have probably recognized that you need skillsyou were not taught in medical school. These include the ability to build consensus amongdepartments, to navigate legal challenges and to hold critical conversations concerning animpaired colleague, as well as how to run a productive committee meeting, link PI data withprivileging decisions, or manage a physician who exhibits disruptive behavior.

Stepping Up To Leadership: IMQ/PACE Platinum Training Program for Physician Leaders is youropportunity to hone your skills and develop new expertise. Through presentations and interactivesessions with experienced physician leaders, you can learn what works for others and exploresolutions and creative approaches to resolving the problems encountered in leading a medical staff.

Join us March 8-10, 2012 on Coronado Island for the physician training program that last year’sparticipants described as: “extremely useful”, “timely, relevant and informative”, and “a programevery physician leader should attend.”

Contact Leslie Anne Iacopi at 415-882-5167 or [email protected].

President’s Message

JOEL R. COHEN, MD

MUSINGS ABOUT MY IN-BASKET … WHAT WILL THE FUTURE BRING?

My in-basket is bursting at the seams with e-mails from various committees, PACs and the CMA.Each one has a message about what is happening now, what occurred yesterday and what it means…and sometimes, what to do about it. Wouldn’t it be nice to instead get a message about what willhappen, what lies ahead. There are occasional glimpses….

One e-mail today had a very small note about pending federal legislation to regulate licensing andpractice of interstate tele-medicine. Who would have imagined that doctors from far away would be,one day, treating our patients here? How would this work? In the future, will we need to develop theseskills ourselves in order to maintain our practices? How would we do this?

Another e-mail urges us all to contact our representative asking that money cut from or left overin the military budgets be shifted to fund the SGR, Medicare and Medi-Cal. In the future, will ourpractice incomes be even more closely tied to the largess of Congress and the absence of militaryconflict? Can we change this by doing something now?

One e-mail makes note of the fact that national health care reform is already underway andAccountable Care Organizations (ACOs) are forming up. Will these be managed by physicians? Willwe end up employed by hospital chains or insurance companies who are currently moving to positionthemselves as the owners and managers of these ACOs? What sort of physicians will become valuablein the new paradigm of medical practice? Will you be one of them? Do we need a local ACO?

I would encourage all the KCMS members to be aware of and engaged, especially in theseconversations (and I feel strongly that physician managed ACO’s must be in our future.) Join theKCMS and encourage your colleagues to do the same. I’ve received e-mails about the state ofmedical practice, morale among physicians and wellness. These issues will all impact our futures.Predicting the future is only half the battle… changing it, is the other half. There are some thingsthat we must do now to affect this....

Are you now connected? In the past, this meant with family, community and colleagues. It nowmeans EHRs, cloud services, smart phones, and the like. Are you? Are you engaged? In the past this may have meant locally, with your ears perked up and listening,sitting in committee meetings, doing peer review and the like. It now means, are you involved in theorganizations that can influence the future, that can lend support through the transition to the futureand can represent your interests in changing that future? Are you?

The local KCMS and the CMA are these societies…. Are you involved? Are you dreaming? Every billionaire that I know is always thinking of what is coming, not what

is past. Where will you be? How will you practice? How will we all survive? I know that we can build the KCMS to help with all of these… drop by, pick up an application

packet for your colleague, get involved… we will build a future together that we can all enjoy.


Fresno-Madera

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, MDHemant Dhingra, MD

Ujagger-Singh Dhillon, MDWilliam 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-electDon 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

At the time of writing this article, it’s not known what will happen with the SGR 27.4 percentphysician fee payment cuts. It’s also not known how the Supreme Court will decide on the legality ofthe Health Care reform mandate that everyone should purchase health Insurance, so the misterycontinues…

Interesting reading from the AMA American News Magazine, 1/9/12. Physicians earn nearly perfectratings from patients on line. An interview of 15,000 patients showed that 70 percent earned a perfect10, and the overall average was 9.3. The survey rated attitude, thoroughness, communication, waitingtime, etc.

For the doctor that is contemplating to work for a hospital, it’s mentioned that there are seven areasthat could be land mines if not carefully thought. They are the job description, restrictive covenants,outside activities, payment recoupment, tail coverage, call coverage and contract termination. For adetail reading go to the magazine. Victoria S Elliot’s article is a must read for those doctors.

Congratulations to our Immediate Past President Dr. Oscar Sablan, on his appointment to theMedical TAC by Dr. Steven Larsen, MD, chair of the Board of the CMA. (Task Advisory Committee,TAC). CMA established TAC to study and develop policy that CMA can seek to implement to ensurethat the Medi-Cal program has the necessary resources and program structure to provide Medi-Calpatients equal access to health care.

Continuing with our general membership meetings’ more social agenda, we had on February 1 acomedian that gave us his monologue. It was well attended.

Coming up on Friday, May 11, Dr. Raymond Kurzweil will give us a lecture that should provokequite a debate and be very interesting: “2045: the year man becomes immortal.” We have signed acontract and are taking care of the details. There will be 100 tables of 10 that can be purchased, andthey are already going fast. Please see the ad on page 9 of this issue.

President’s Message

SERGIO D. ILIC, MD

2012 FMMS Educational SeriesAs a member benefit, a series of Financial Education classes will be offered toFMMS members and their guests during the months of March, April, Mayand June – repeating in August, September, October and November. In orderto allow members more flexibility, classes will be offered on both the lastWednesday and Thursday evenings of these months beginning at 6 pm with light food and beverages.

March 28 and 29: “Investment Basics” conducted by Eric Van Valkenburg and Amy Nuttall-Zwaan, Financial Consultants with Central Valley Physician Benefits.

• Investment fundamentals, effects of inflation and compounding• Understanding risk tolerance• The relationship between risk and reward• Understanding different types of investments, as well as the advantages and disadvantages of each• Developing an investment strategy and allocation of investments in line with your objectives• Challenges facing investors todayAll classes will be held at the Medical Society office at 1040 E. Herndon Ave. #101, (NE corner of

First and Herndon). Space is limited so please reserve your spot as soon as possible by contacting theMedical Society at 559-224-4224, ext. 118 or 112 or at [email protected].

Future topics to include: • Estate Planning/Conservation • Taxation Basics/Strategies • Understanding Social Security and Medicare Please check future issues of Vital Signs, the FMMS website and your email for specific topic and

content and relative dates.

Eric Van Valkenburg and Amy Nuttall-Zwaan are Registered Representatives with and securities offeredthrough LPL Financial. Member FINRA/SIPC.


Fresno-Madera

Fresno CountyProjects AddressTeen Drug AbusePROJECT TARGETS SCHOOLS,COMMUNITIESFresno County has the only compre -hensive, community-based pro gram forcombating youth and prescription drugabuse in the state, said Rolando Valero,program manager for the Lock It UpProject. The project is part of the not-for-profit California Health Collaborative andis funded by the Fresno CountyDepartment of Behavioral Health.

Lock It Up targets communities inFresno County with high rates ofprescription drug abuse, including Clovis,Coalinga and Parlier, which have higherpainkiller use rates than the statewideaverage.

One goal of the project is to stress theimportance of locking up prescriptiondrugs. The project’s Pharmacy Initiative,for instance, provides independentpharmacies with informational flyers thatwarn parents about the dangers ofprescription drugs and how to correctlydispose of or lock up drugs at home.Pharmacies also sell medicine lock boxesthat cost about $15 each.

ßAlliance With Women’s Initiative

The Lock It Up project has also formedan alliance with the Fresno CountyWomen’s Initiative, a United Wayprogram. The Women’s Initiativepartnered with the Fresno CountySheriff ’s Office to create safe drop offboxes for people to discard prescriptiondrugs.

There are currently seven locked dropboxes in Fresno County. Since they wereset up this summer, approximately 240pounds of prescription drugs have beendropped off in two of the boxes, one inClovis and the other at the Fresno CountySheriff ’s Office, said Jose Flores, a captainin the Sheriff ’s Office and the mayor ofClovis.

Read more: http://www.californiahealthline.org/features/2012/fresno-p r o j e c t s - a d d r e s s - t e e n - d r u g -abuse.aspx#ixzz1lii5yRkU

Dispose of unused, expired, orunwanted medications at these safedrop-off sites, no questions asked:

Clovis Police Department1233 5th StreetClovis, CA 93612(559) 324-2400

Fresno Co. Sheriff’s Office2200 Fresno StreetFresno, CA 93721(559) 488-3939

Fresno County Jail1225 M StreetFresno, CA 93721(559) 488-2590

Fresno State UniversityPolice Department2311 E Barstow AveFresno, CA 93740(559) 278-8400

Mendota Police Department1000 Airport Blvd Ste. AMendota, CA 93640(559) 655-9120

To date almost 1,000 pounds of medicationshave been collected.

For more information: healthcollaborative.orgfor the latest list of sites

Or properly dispose of your medications at home with these steps:1. DO NOT FLUSH OR POUR unused medications down the toilet or drain.2. Put medications into a sealable bag or a disposable container with a lid.3. Add water to dissolve the medication then mix with something like dirt,cat litter, or coffee grounds. Bag it or wrap the mixture and place in thetrash.

4. Conceal or remove any personal information on drug containers beforeplacing in the trash.

For more information on disposal contact: (559) 221-6315

LOCK IT UPCLEAN IT OUTDROP IT OFF

Parlier Police Department8770 S Mendocino AveParlier, CA 93648(559) 646-6600

Orange Cove Police Department550 Center StreetOrange Cove, CA 93646(559) 626-5106


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, 1,000 sf up to 2,500 sf atNE corner of First & Herndon and NW corner ofFirst & Bullard, starting at $1 psf ++ by owner.Call 559-449-7668 or 559-284-2625.1050 E. Almond, Madera; Former medical clinic.Approx. 2,650 sf. Adjacent to MCH. Availablenow. Call Dustin at 559-447-6292. Grubb &Ellis/Pearson Comm. 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.

Cardio Metabolic Risk Symposium: Treatment of the High Risk Patient with Low HDL-c – March 17, 2012

Time: 7:30am-3:30pm; Location: SAMC; Credit: 6 hours; Fee: N/C; Contact: 559-450-7566 or [email protected]

Aging and Dementia – March 22, 2012Time: 6-8pm; Location: SAMC; Credit: 1.5 hours; Fee: N/C; Contact: 559-450-7566 or [email protected]

Sleep Disorders – June 2, 2012Time: 8am-12pm; Location: SAMC; Credit: 3.5 hours; Fee: N/C;

Contact: 559-450-7566 or [email protected]

From May 14-18, 2012, the SPTF willhelp sponsor a series of talks by CaitlinRyan, Ph.D., nationally and inter -nationally known for her research andwork with LGBT youth and their families.Dr. Ryan is the director of the FamilyAcceptance Project at San FranciscoState University. The Tulare CountyMedical Society and Kaweah DeltaHealth Care District will sponsor“Critical Role of Families in ReducingRisk & Promoting Well Being forLesbian, Gay, Bisexual, Transgender(LGBT) Children & Youth” for medicaland mental health professionals from 6-8pm on Wednesday, May 16, in the BlueRoom at Kaweah Delta Hospital. To

RSVP for this please call Nador Ramirezat 559-624-2595 or Cheryl Smit, RN,CME coordinator at 559-624-2133. Forinformation on Dr. Ryan’s upcoming talkswith faith leaders, parents and educators,please contact Kathryn Hall, MD, at 559-738-7508, [email protected] [email protected],

For more information on the Tulare &Kings Counties Suicide Prevention TaskForce, check out the website atwww.sptf.org or find us on Facebook atwww.facebook.com/hope.sptf. For urgenthelp, call the National SuicidePrevention Lifeline at 800-273-TALK(8255) or for LGBTQ youth the TrevorLifeline at 866-488-7386.

Kathryn Hall, MD, Tulare CountyMedical Society representative to theTulare & Kings Counties SuicidePrevention Task Force

Suicide


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

CALL 1-800-652-1051 . OR VISIT US AT NORCALMUTUAL.COM

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