December 2015 - California ACEP
Transcription
December 2015 - California ACEP
lifeline DECEMBER 2015 a forum for emergency physicians in california PEDIATRIC Merry-Go-Rounds Page 10 TABLE OF CONTENTS | 4 10 4 PRESIDENT’S MESSAGE 6 ADVOCACY UPDATE 10 GUEST ARTICLE 12 PERSONAL STORY 16 ANNOUNCEMENTS 17 UPCOMING MEETINGS & DEADLINES 2015 ACEP Council Review PEDIATRIC Merry-Go-Rounds California ACEP Board of Directors & Lifeline Editors Roster 2014-15 Board of Directors Marc Futernick, MD, FACEP, President Lawrence Stock, MD, FACEP, President-Elect Aimee Moulin, MD, FACEP, Vice President Chi Perlroth, MD, FACEP, Treasurer Vikant Gulati, MD, Secretary Michael Osmundson, MD, MBA, FACEP, Immediate Past President John O. Anis, MD, FACEP Rodney Borger, MD, FACEP, At-Large Kevin Jones, DO Stephen Liu, MD, FACEP John Ludlow, MD, MBA Cameron McClure, MD, FACEP Valerie Norton, MD, FACEP Mark Notash, MD, FACEP Maria Raven, MD, MPH, FACEP Vivian Reyes, MD, FACEP Eric Snyder, MD, FACEP Sybil Zachariah, MD, CAL/EMRA President Advocacy Fellowship Aimee Moulin, MD, FACEP, Director John Coburn, MD, Advocacy Fellow Nicolas T. Sawyer, MD, MBA, Advocacy Fellow Lifeline Medical Editor Richard Obler, MD, FACEP, Medical Editor Lifeline Staff Editors Elena Lopez-Gusman, Executive Director Ryan P. Adame, MPA, Deputy Executive Director Lucia Romo, Education Coordinator Kelsey McQuaid, MPA, Government Affairs Associate 18 CAREER OPPORTUNITIES DECEMBER 2015 Index of Advertisers Anaheim Regional Medical Center Page 18 Emergency Groups’ Office (EGO) Page 11 Emergency Medical Management Associates (EMMA) Page 9 Emergency Medicine in Yosemite Page 14 Emergency Medical Society of Orange County Page 18 Emergency Physicians Management Page 18 Independent Emergency Physicians Consortium (IEPC) Page 9 Kaiser Permanente Page 18 MMC Emergency Physicians Medical Group Page 18 Newport Emergency Medical Group Page 18 Ohio ACEP Emergency Medicine Board Review Courses Page 14 Salinas Valley Memorial Healthcare Page 18 Sharp Grossmont Hospital Page 18 St. Jude Medical Center Page 18 WELCOME Derin D Allard Roger Baril Joshua J Baugh MD Crystal N Brown MD new members! Jonathan B Cooper-Sood MD Shahrouz S Dadfarin MD Cherlin Johnson MD Stephanie Lauw MD Evan Laveman Aaron G Pannier MD Vineet Sharma Daniel E Sotelo Leon Kyle Suen 100% GROUPS Central Coast Emergency Physicians Loma Linda Emergency Physicians Tri-City Emergency Medical Group Emergent Medical Associates Napa Valley Emergency Medical Group Emergency Medicine Specialists of Orange County Newport Emergency Medical Group, Inc at Hoag Hospital University of California, Irvine Medical Center Emergency Physicians Front Line Emergency Care Specialists Pacific Emergency Providers, APC DECEMBER 2015 | 3 PRESIDENT’S MESSAGE | By Marc Futernick, MD, FACEP 2015 ACEP Council Review I just returned from Boston where I attended ACEP’s annual Council and Scientific Assembly. The Council is our Colleges legislative body, which is made up of representatives from all 53 ACEP Chapters plus ACEP Sections, and other interested organizations like EMRA and CORD. Ideally, the Council decides what ACEP should do, and the Board and staff have the task of strategizing and executing the plan. As you get closer to ACEP, the incredible scope of activities and initiatives becomes apparent. The Council’s job is to determine the direction this giant ship should be heading. Most members have never attended Council to see our democracy in action. It is an interesting and valuable experience, and it’s one of the benefits of joining the California ACEP Board. As a Director of our large and powerful state chapter, serving as a Councillor affords you a significant voice in one of the most influential advocacy organizations in medicine. I think the format of the meeting is very effective in its ability to clearly communicate the will of the Council. It is methodical and detail oriented, as well as open, spontaneous, and, at times, rather spirited. Each state chapter is allotted one Councillor for every 100 members, which is yet another reason to make sure that you renew your membership and help make our California voice even larger. Past Presidents of the College also get to join the delegation and provide “counsel” in that they may speak on the floor, although they do not vote (unless named as a Councillor). Each section of ACEP is also afforded representation, as well as the Emergency Medicine Residents Association, the Society of Academic Emergency Medicine, and the Council of Residency Directors. In all there were 375 Councillors this year, a number that continues to steadily rise. California boasts 28 Councillors, plus our dedicated Alternates, two Past ACEP Presidents - Drs. Richard Stennes and Larry Bedard - and one Past ACEP Council Speaker - Dr. Mike Bresler - all three of whom are also past Chapter Presidents; we boast the largest delegation each year, thanks to all of you who support us. Council is held on Saturday and Sunday, just prior to Scientific Assembly, and also includes the election of the next in line for President, the new Board of Directors members (staggered 3 year terms), and the Council Speaker and Vice Speaker, who run the meetings. Although I don’t have as much experience as many members of our delegation (which included about 15 past chapter or national presidents), I think Kevin Klauer has done a terrific job as Speaker the past 2 years, keeping the meeting lively and (somewhat) entertaining, but also moving along at a good pace. Here is how it actually works. Individual Councillors, state chapters, and ACEP sections are able to submit resolutions to the Council in advance of the meeting. These are all analyzed by ACEP staff, and that information is sent out to all of the Councillors, including costs of implementation, feasibility, previous actions taken or in process, as well as general background information on the topic. This compendium is quite extensive and there are usually about 40 resolutions. This is circulated to all of the Councillors by e-mail and group discussion is encouraged prior to the meeting to clarify, optimize, or simply debate the suggested action. The live Council process begins on Saturday when we break into sections to have detailed open discussion of each resolution. The section meetings are run by selected leaders, and the Councillors may go between the meetings to express their thoughts on any of the resolutions. Specifics are debated, sometimes including detailed word-smithing. At the end of the day, the Council leadership makes suggestions for various amendments to the resolutions, as well as recommendations for adoption or rejection based upon the apparent will of the Councillors from the day’s discussion. On Sunday morning, all the Councillors meet together to discuss each resolution. Fortunately, many are adopted or rejected by unanimous consent based on the earlier day’s testimony. Only the contentious issues are debated (for the most part). These resolutions can be amended, reworked, or significantly altered on the fly, based on the will of the Council, who votes for each change and then for the final resolution. In this manner, the nitty gritty of specific wording is addressed, as well as the overall concept and intent of the action to be taken. It can be an arduous process, but everyone is afforded the opportunity to speak, and then a decision is made by the entire body. I apologize for the lengthy explanation of the process, but I find it interesting and effective; hopefully knowing more about how it works will induce more members to get involved. The resolutions begin with commendation awards and memorials, and it is nice to have a few minutes to recognize so many selfless and worthwhile contributions on the part of emergency physicians. The first section of debated resolutions relate to the bylaws and rules of the organization. A resolution was adopted that will double EMRA’s respesentation from 4 to 8 Councillors based on the increased size of the Council since they were granted 4 members many years ago, and based on pure numbers the resident membership overall would command many more seats. Another resolution attempts to tackle the problem of unethical expert witness testimony against emergency physicians by allowing ACEP to censure non-members when their review of expert testimony is found to be unethical, as well as to report these physicians directly to their medical specialty society and medical board. In the Practice section, the California Chapter sponsored a resolution asking ACEP to work directly with the American College of Radiology to create best practice guidelines for the timely communication of critical imaging findings, and this was adopted. Other adopted items included enabling access to epinephrine for anaphylaxis outside of health care settings, asking ACEP to work directly with other stakeholders to endorse and facilitate the use of ketamine for analgesia in the ED, the creation of drug detox guidelines, and education about and advocating for a national registry for POLST forms (Physician Orders for Life-Sustaining Treatments). One interesting area of debate was about the linking of financial reimbursement to patient experience surveys, which is becoming more common at the individual and group levels. This issue was referred to the ACEP Board for further evaluation, but there was plenty of sentiment in the room that financial incentives related to patient satisfaction scores may be inappropriate, and potentially harmful, in the ED setting. The final section of resolutions is in the area of Advocacy and Public Policy. Again, California’s sponsored resolution, which would create and promote standard information for Health Information Exchanges, was adopted. Other notable adopted resolutions involved addressing drug shortages, electronic nicotine delivery devices, health care integration and care coordination, proper reimbursement for ED Ultrasound, and the promotion of drug take-back programs. As you can see from this quick overview, the breadth of areas addressed at the Council is impressive, and also included other important issues, including: fair payment, GMEC funding, continuous certification, ED boarding, and telemedicine in the ED. The process is open, allowing individuals to advocate for action by the College on items of importance to practicing emergency physicians. The best way to affect change in our practice environment is to support those advocating for you, and to get personally involved. I want to thank you for your membership, and for the honor and privilege of representing your interests. Please share your thoughts and concerns with us. We encourage your direct engagement with the chapter. n Marc DECEMBER 2015 | 5 ADVOCACY UPDATE | Legislative Year in Review The first year of the two year legislative session ended in September and the deadline for Governor Brown to act on legislation was in October. This year the Chapter took official positions on more than 70 bills! We had tremendous success on a number of bills, as described below. There are still a number of high profile bills and issues that were held over until next year, let alone the new bills that will be introduced in 2016. The Chapter was busy defending emergency medicine in the legislature this year, and there is still more work to be done in 2016! CALIFORNIA ACEP TRACKED LEGISLATION AB 53 (C. Garcia) – Support – This bill establishes requirements for securing children under the age of 2 in rear-facing child seats in vehicles. The bill was signed by the Governor. report. We asked to clarify first responders did not include emergency physicians. The author took our amendment. The bill was later held on the Assembly Appropriations Committee Suspense File. AB 59 (Waldron) – Support – This bill would expand implementation of Laura’s Law by requiring counties to implement the program if they have available funding. The bill was held in the Assembly Judiciary Committee. AB 319 (Rodriguez) – Support – This bill would require schools to provide comprehensive cardiopulmonary resuscitation (CPR) and automatic external defibrillators (AED) training to students as part of a physical education or other course required for high school graduation. The bill was held on the Assembly Appropriations Committee Suspense File. AB 172 (Rodriguez) – Support – This bill would increase the penalties for assault and battery committed against a physician, nurse, or other health care worker in the emergency department. The bill was vetoed by the Governor. AB 174 (Gray) – Support – This bill would appropriate $1.2 million from the General Fund to the Regents of the University of California for allocation to the University of California, Merced’s San Joaquin Valley Program in Medical Education (PRIME). The bill was held on the Senate Appropriations Committee Suspense File. AB 225 (Melendez) – Oppose – This bill would reduce the use of gun violence restraining orders by making the penalty for a false claim a felony. The bill was held in the Assembly Public Safety Committee. AB 299 (Brown) – Support if Amended – This bill would require first responders to drownings to fill out a AB 366 (Bonta) – Support – This bill was originally drafted to increase Medi-Cal provider rates to Medicare levels. The bill was gutted in the Assembly Appropriations Committee to instead conduct a study looking at provider rates and access to care. The bill was held on the Senate Appropriations Suspense File. AB 430 (Hernandez) – Oppose Unless Amended – This bill would require a LEMSA to do an independent assessment of the trauma system once every five years. We asked for an amendment to have the assessment done once every 10 years. The author’s office indicated they would take our amendment prior to the bill being held on the Assembly Appropriations Committee Suspense File. 6 | LIFELINE a forum for emergency physicians in california AB 510 (Rodriguez) – Support – When introduced, this bill would require the Office of Emergency Services to conduct a comprehensive review of California’s 911 communications system. It was later amended to instead use historical empirical call data to determine the most efficient way to route 911 calls. The bill was held in the Senate Energy, Utilities, and Communications Committee. AB 521 (Nazarian) – Watch (Original position was Oppose) – This bill would require an HIV test be offered to any patient in the emergency department who had blood drawn. The bill was placed on the Assembly Appropriations Suspense File for its high cost. The Appropriations Committee did pass the bill but included amendments limiting the offering of the HIV test only when the patient in the emergency department who had blood drawn was admitted into the hospital. We continued to work with the author and he agreed to a further amendment that the offering of the test would occur after the patient leaves the emergency department and has been admitted into the hospital. The bill was vetoed by the Governor. AB 533 (Bonta) – Oppose – This bill would prohibit balance billing for out-of-network non –emergency services, establish a payment of 100% of Medicare for out of network non-emergency services, and establish an IDRP. We were able to have emergency services exempted from the bill. We continued to be strongly opposed due to the precedence of the solution in AB 533 and the impact the bill would have on on-call physicians. The bill did not pass off the Assembly Floor when it came back for concurrence. AB 579 (Obernolte) – Oppose – This bill would allow for free standing emergency departments. The bill was sponsored by CHA. The bill was never heard in Assembly Health so it is now a two year bill. AB 604 (Olsen) – Oppose – When introduced, this bill would permit individuals to ride motorized skateboards, traveling upwards of 20 miles per hour, in bike lanes. We felt there were insufficient safety requirements to protect against increased speeds and close proximity to motor vehicles. At the end of session, the bill was amended to include a helmet requirement and an age restriction. The bill was signed by the Governor. AB 611 (Dahle) – Oppose – This bill would allow boards other than the Medical Board to access the CURES database when a board is investigating one of its licensees for suspected drug abuse. The bill was never heard in committee. AB 637 (Campos) – Support – This bill allows a nurse practitioner or a physician assistant to sign a completed Physician Orders for Life Sustaining Treatment form. The bill was signed by the Governor. AB 679 (Allen) – Support – This was an end of session gut and amend bill to extend by an additional six months the deadline for physicians to sign up for CURES. The bill was signed by the Governor. AB 741 (Williams) – Support – This bill would expand the definition of social rehabilitation facility to include residential facilities that provide services to children or adolescents with a mental illness. The bill was held in the Senate Human Services Committee. AB 768 (Thurmond) – Support – This bill prohibits the use or possession of smokeless tobacco products on the playing field of a baseball stadium during a professional baseball game or practice. The bill was signed by the Governor. AB 791 (Cooley) – Support – This bill would create the opportunity for Medi-Cal patients to securely complete an online advance health care directive form, print and sign the form, and upload the signed form to be displayed to authorized users. The bill was held in the Assembly Health Committee. AB 847 (Mullin) – Support – This bill would require the California Department of Health Care Services to submit a proposal to participate in the federal demonstration programs to improve mental health services. The bill was held in the Senate Health Committee. AB 850 (Ridley-Thomas) – Oppose – This bill would require hospitals to take certain steps to address situations where a patient presents in the hospital with any symptoms of illness consistent with a virulent aerosol transmissible disease, such as the Ebola virus. These steps include isolating the patient and providing personal protection equipment (PPE) and a powered air purifying respirator (PAPR). This bill was never heard in the policy committee. AB 858 (Wood) – Support – This bill would add marriage and family therapists to the list of health care professionals covered at a federally qualified health center (FQHC) or rural health clinic (RHC). This bill was vetoed by the Governor. AB 861 (Maienschein) – Support – This bill would require the Department of Health Care Services (DHCS) to apply to the federal Secretary of Health and Human Services (HHS Secretary) for a competitive federal grant under the Protecting Access to Medicare Act of 2014, if the Department received a planning grant to develop the proposal. If California received the competitive federal grant, the bill would require participating counties to direct a portion of the funds freed up by the enhanced federal funding toward providing supportive housing for homeless with mental illness. This bill was vetoed by the Governor. AB 911 (Brough) and SB 787 (Bates) – Oppose Unless Amended – These bills would allow for a freestanding emergency department at the site of Saddleback Memorial – San Clemente. Both bills were held in their respective Health Committees. We are still working with the author and other stakeholders on this topic. AB 1027 (Gatto) – Oppose – This bill would allow a health insurer to disclose information to a consumer about contracted rates for a procedure, upon request. The bill was held in the Assembly Health Committee. AB 1086 (Dababneh) – Support – This bill would require Knox-Keene regulated health care service plans to honor assignment of benefit agreements, allowing payments to go directly to providers and removing patients from the process when these agreements are in place. The bill was held in the Assembly Health Committee. AB 1162 (Holden) – Support – This bill would require tobacco cessation services to be a covered benefit under the Medi-Cal program. This bill was vetoed by the Governor. AB 1177 (Gomez) – Oppose (Original position was Oppose Unless Amended) – This bill eliminates the requirement for clinics to have a written transfer agreement with a local hospital. We have been working with the author and sponsor, Planned Parenthood, on our proposed amendments. CMA also offered amendments to take portions of the existing written transfer agreement template created by the Department of Public Health. CMA’s amendments were taken, but we still had concerns and moved to an Oppose position. The bill was signed by the Governor. AB 1193 (Eggman) – Support – This bill would require counties to go through an “opt out” process as it relates to implementing Laura’s Law. The bill was held on the Assembly Appropriations Suspense File. AB 1194 (Eggman) – Support – The bill allows for an individual to consider available relevant information about the historical course of the person's mental disorder when determining if a person is a danger (criteria for a "5150" involuntary hold), if that individual concludes that the information has a reasonable bearing on the determination. The bill was signed by the Governor. AB 1223 (O’Donnell) – Watch (Original position was Oppose) – This bill would have allowed patients being transported to the emergency department to be taken to an alternate destination if it was determined the patient had a “minor injury”. The bill would have also allowed clinics accepting uninsured patients with “minor injuries” to apply to the Maddy Fund for reimbursement. The bill was significantly amended to define wall time and removed both of the provisions mentioned above. The bill was signed by the Governor. AB 1264 (Medina) – Support – This bill would allow the purchaser or lessee of a new motor vehicle, model year 2017 or later, to voluntarily register an emergency medical contact in the VinECON database at the point of sale. Hospitals would be able to access the VinECON database to assist in contacting the agent, surrogate, or family member of a victim of a motor vehicle accident. The bill was held in the Assembly Transportation Committee. AB 1300 (Ridley-Thomas) – Co-Sponsor – This bill would make a number of changes to the laws regarding 5150 holds. These changes include authorizing emergency physicians to write and release 5150 holds. The bill was held on the Assembly Appropriations Suspense File. Subsequent to that action there have been a number of stakeholder meetings to discuss various concerns with the bill. AB 1305 (Bonta) – Support – This bill prohibits any individual with family coverage to have a maximumout-of-pocket limit or deductible that is more than the maximum-out-of-pocket limit or deductible limit for individual coverage under the health plan contract. This bill was signed by the Governor. AB 1386 (Low) – Support – This bill would allow an authorized entity to receive a prescription for an epinephrine auto-injector and to use it during an emergency situation. DECEMBER 2015 | 7 ADVOCACY UPDATE | The bill would also provide liability protections. The bill was held in the Assembly Business and Professions Committee. AB 1396 (Bonta) – Support if Amended – This bill would increase the California Tobacco Tax to $2.00 per pack and allocate funding to different funds, including the Breast Cancer Fund and California Children and Families First Trust Fund. Due to the direct effect that smoking-related diseases have on California’s emergency departments, we ask that SB 591 be amended to allocate a portion of the funds to the Maddy Fund. The bill was held in the Assembly. AB 1434 (McCarty) – Support – This bill would close the existing loophole that allows Anthem Blue Cross and Blue Shield to choose their regulator and would make the DOI the sole regulator for PPO products. The bill was held in the Assembly Revenue and Taxation Committee. AB 1485 (Patterson) – Oppose Unless Amended - This bill would prohibit the Department of Health Care Services (DHCS) from using the location of a radiologist as a condition of approving Medi-Cal provider enrollment or reimbursement for radiology services provided to MediCal beneficiaries undergoing imaging procedures, if the radiologist meets certain requirements. We asked to have vague intent language taken out and the author amended the bill to remove that language. The bill ended up not being heard in the Assembly Appropriations Committee. SB 4 (Lara) – Support – This bill requires undocumented individuals under 19 years of age enrolled in Medi-Cal to be enrolled in full scope Medi-Cal benefits. The bill was signed by the Governor. SB 19 (Wolk) – Support – This bill creates a 5 year electronic POLST registry pilot program under the supervision of EMSA. Through work with various interested parties, EMSA will set up various pilot programs to make POLST information available electronically and sharable between different providers and networks within a specific geographic region. The bill was signed by the Governor. SB 22 (Roth) – Support – This bill would establish the California Medical Residency Training Fund, which would establish and fund residency positions located in medically underserved areas of California. The bill was held on the Senate Floor. SB 131 (Cannella) – Support – This bill would appropriate $1.8 million from the General Fund to the Regents of the University of California for allocation to the University of California, Merced’s San Joaquin Valley Program in Medical Education (PRIME). The bill was held on the Senate Appropriations Committee Suspense File. SB 137 (Hernandez) – Support – This bill requires a health plan or insurer to make available a provider directory, which includes information on contracting providers, including those accepting new patients. This bill prohibits a provider directory from including information on a provider that does not have a current contract with the plan or insurer. The bill was signed by the Governor. SB 289 (Mitchell) – Support – This bill would requiring health plans to reimburse contracted physicians and non-physician health care providers for telephonic and electronic patient management services. The bill was held on the Senate Appropriations Suspense File. SB 140 (Leno) – Support – This bill would add electronic cigarettes (e-cigarettes) to the definition of a tobacco product in the Stop Tobacco Access to Kids Enforcement (STAKE) Act and extend current restrictions and prohibitions against the use of tobacco products to electronic cigarettes. The bill was held in the Assembly Governmental Organization Committee. SB 296 (Cannella) – Support – This bill would create a set of statewide Medi-Cal service billing documentation requirements for providers of specialty mental health services, reducing time providers spend on paperwork. The bill was held in the Senate. SB 145 (Pan) – Watch (Original position was Oppose) – This bill would have restricted the practice of emergency medicine by stating that if a patient in the emergency department has a blood alcohol level of .08 or higher they could not be discharged or transferred from the emergency department. We worked closely with the author’s office to propose amendments to remove any reference to a blood alcohol level. We changed our positon to Watch. The bill was gutted at the end of session to renew the Robert F. Kennedy Farm Workers Medical Plan. SB 151 (Hernandez) – Support – This bill would raise the minimum legal smoking age from 18 to 21; and conform existing law regarding the purchasing, selling, and enforcement of tobacco and tobacco products to reflect the new age limit. The bill was held in the Assembly Governmental Organization Committee. SB 243 (Hernandez) – Support – This bill would raise Medi-Cal provider rates to Medicare levels. The bill was held on the Senate Appropriations Suspense File. SB 260 (Monning) – Support – This bill would require County Organized Health Systems (COHS) to be licensed under the Knox-Keene, affording COHS patients the same appeal rights as other Medi-Cal patients. The bill was held in the Assembly. SB 275 (Hernandez) – Oppose Unless Amended – This bill would require data being reported to OSHPD by healthcare facilities on patient encounters to include physician identifier information. We asked the author to de-identify the physician information. We had multiple meetings with the author’s office and stakeholders. No commitments were made by the author to include our amendment. The bill was held in the Assembly Health Committee. SB 277 (Pan) – Support – This bill removes the religious exemption for mandatory vaccines for school children. The bill was signed by the Governor. 8 | LIFELINE a forum for emergency physicians in california SB 299 (Monning) – Support – This bill exempts health care providers submitting a Medi-Cal provider application package from the current notarization requirements, if that provider enrolls electronically. The bill was signed by the Governor. SB 323 (Hernandez) – Oppose – This bill would permit nurse practitioners (NP) to practice independently, if the NP has met specified requirements, including possessing liability insurance and national certification. The bill was defeated in the Assembly Business and Professions Committee. SB 482 (Lara) – Oppose – This bill would require prescribers to consult the Controlled Substances Utilization Review and Evaluation System (CURES) prior to prescribing a Schedule II or III drug to a patient for the first time and delayed implementation of this requirement until the Department of Justice (DOJ) certified that the CURES database is ready for statewide use. The bill was held in the Assembly. SB 483 (Beall) – Oppose – This bill would define observation services as only lasting 24 hours and would define observation units. In the Senate Health Committee the Committee pushed amendments into the bill saying observation units would not include emergency departments. This amendment helped address some of our concerns, but not enough to remove our opposition. The bill was later held on the Senate Appropriations Committee Suspense File. SB 518 (Leno) – Support – This bill would recognize the Trauma Recovery Center at San Francisco General Medical Center, University of California, San Francisco as the State Pilot Trauma Recovery Center (State Pilot TRC) and require the California Victim Compensation and Government Claims Board to use the extremely successful Integrated Trauma Recovery Services model developed by the State Pilot TRC when it awards grants to trauma recovery centers. The bill was held on the Assembly Appropriations Committee Suspense File. SB 538 (Block) – Oppose – This bill would provide an expansion of the scope of practice for naturopathic doctors. Specifically, this bill would allow NDs to prescribe Schedule V drugs and drugs that are not classified on the DEA schedule, without physician supervision. The bill died in the Assembly Appropriations Committee. SB 591 (Pan) – Support if Amended – This bill would increase the California Tobacco Tax to $2.00 per pack and allocate funding to different funds, including the Breast Cancer Fund and California Children and Families First Trust Fund. Due to the direct effect that smoking-related diseases have on California’s emergency departments, we ask that SB 591 be amended to allocate a portion of the funds to the Maddy Fund. The bill was held in the Senate. SB 614 (Leno) – Support – This bill would require the Department of Health Care Services (DHCS) to establish a program for certifying peer and family support specialists (PFSS) and to allow DHCS to seek any federal waivers or state plan amendments to implement the certification program. The bill was held in the Assembly. SB 658 (Hill) – Watch (Original position was Oppose Unless Amended) – The intent of the bill is to reduce barriers for businesses placing AEDs in their business. Specifically, the bill removes the requirement for businesses to have a medical director. As originally drafted, the bill eliminated the immunity provisions for physicians who may be involved with the placement of the AED. We felt the immunity provisions were still important because a business may still want to have a physician involved. The author accepted our amendment to add the immunity language back into the bill. We moved to a Watch position. The bill was signed by the Governor. SB 738 (Huff ) – Support – This bill provides that an authorizing physician and surgeon will not be subject to professional review, be held liable in a civil action, or be the subject of criminal prosecution for issuing a prescription or order for an epinephrine auto-injector, unless the physician or surgeon's issuance constitutes gross negligence or willful or malicious conduct. The bill was signed by the Governor. ABX2 6 (Cooper) and SBX2 5 (Leno) – Support – These bills would add electronic cigarettes (e-cigarettes) to the definition of a tobacco product in the Stop Tobacco Access to Kids Enforcement (STAKE) Act and extend current restrictions and prohibitions against the use of tobacco products to electronic cigarettes. The bills remain in the healthcare special session. ABX2 7 (Stone) and SBX2 6 (Monning) – Support – These bills would remove many (but not all) exemptions in existing law that allow tobacco smoking in certain indoor workplaces and expand the prohibition on smoking in a place of employment to include owneroperated businesses. The bills remain in the healthcare special session. ABX2 8 (Wood) and SBX2 7 (Hernandez) – Support – These bills would raise the minimum legal smoking age from 18 to 21; conform existing law regarding the purchasing, selling, and enforcement of tobacco and tobacco products to reflect the new age limit; and clarify that these provisions are not intended to prohibit a local government from imposing a more restrictive legal age to purchase or possess tobacco products. The bills remain in the healthcare special session. ____________________________________ The Chapter monitors and works on hundreds of bills each year. If you have any questions about the legislation mentioned here, or in general, please email us at info@californiaacep.org. n Southern California JOB OPPORTUNITIES • Excellent Opportunities for Emergency Physicians • Very Competitive Compensation • Hospitals include Arcadia Methodist & Glendale Memorial (Top heart programs). • Available practice settings in the Greater Los Angeles area. Contact Debbie Corn for more information (909) 634-3172 or email CV to dcorn@emmamd.com DECEMBER 2015 | 9 GUEST ARTICLE | PEDIATRIC Merry-Go-Rounds This article has been re-printed and edited with the permission of Dr. Dieckmann. VOLUME 6 ISSUE 3, JULY, 2015 By Ron Dieckmann MD, MPH, VEP Director of Pediatrics Professor Emeritus of Emergency Medicine and Pediatrics, UCSF VEPeds Vignettes: CURIOUS CASE RECORDS of KIDS in VEP EDs Sudden collapse in a young girl A 7 year old girl is brought to the ED by 911 because of sudden collapse while playing soccer. The child’s initial field rhythm was ventricular tachycardia, which converted to normal sinus rhythm after a single defibrillation at 2 watt secs/kg. In the ED, the child was alert with normal signs. The exam was normal, and no cardiac murmur was heard. Her ECG is shown below. The child was transferred to a pediatric ICU and discharged the following day on a beta blocker. Congenital Long QT Syndrome Editor’s Note Sudden collapse in children and adolescent athletes is a rare but highly dramatic event. In young patients without congenital cardiac disease who have been previously well but experience sudden syncope, seizures or cardiac arrest, there is a limited differential diagnosis. In the ED, there are three major etiologies to consider: Congenital Long QT Syndrome (LQTS), hypertrophic cardiomyopathy (HOMC), and Brugada Syndrome. The history, physical exam and ECG will usually distinguish between these possibilities. In this child, who had a negative toxicology screen and normal electrolytes, the ECG findings strongly support the diagnosis of LQTS. These three conditions are all potentially life threatening, but the patient may be completely unaware that a time bomb is ticking away. 10 | LIFELINE a forum for emergency physicians in california LQTS is a usually autosomal dominant hereditary disorder characterized by prolonged ventricular repolarization and prolongation of the QT interval on ECG and episodes of polymorphic ventricular tachycardia. Syncope and sudden death are major risks. There are three main genotypes. LQTS can also be acquired through electrolyte disorders, by poisoning or exposure to a multitude of drugs, and with increased intracranial pressure. The ECG is characteristic, often showing markedly prolonged QT interval, but an exertional ECG may be necessary to unmask the abnormality in a child with a normal rest ECG. Treatment with beta blockers is highly effective for the most common genotypes, along with exercise modification, and avoidance of medications known to prolong QT. An implantable cardioverterdefibrillator (ICD) may be indicated in high-risk patients. Hypertrophic cardiomyopathy (HOCM) HOCM is the most common cause of sudden death in athletes. It is usually idiopathic but may have an autosomal dominance pattern of inheritance. Family history is often positive for syncope and sudden death. The exam shows a harsh systolic murmur similar to aortic stenosis. The murmur increases with standing or expiration and decreases with squatting. Ventricular dysrhythmias are the usual cause of death. Treatment is with beta blockers, calcium channel blockers or an ICD. Brugada Syndrome Brugada syndrome is a genetic syndrome or channelopathy associated with sudden death from ventricular dysrhythmias in young and otherwise healthy children, adolescents and adults who have structurally normal hearts. The diagnosis is made by ECG. There are three primary types. Dysrhythmic events and symptoms typically occur at night, while resting or sleeping, when febrile, and after large meals, but rarely during exercise. The exam is usually normal and ECG is distinct (see below), which shows a pseudo right bundle branch block pattern in V1 and V2. The only effective treatment is an ICD. n Questions Corner Do dystonic reactions indicate overdose of a medication? No. 70 % of dystonic reactions occur when the child has had a correct dose of medicine. Drugs in the ED that most commonly cause dystonia are antiemetics (e.g., metoclopramide), antipsychotics (e.g., haloperidiol), antiepileptics (e.g., phenytoin), and sedatives (e.g., lorazepam). These can be terrifying experiences for the child and parent, and the actual mechanism still remains unclear. Fortunately, there is a highly effective treatment that is readily available in all EDs—the H1 antagonist diphenhydramine (Benadryl). Administer the dose at 1 mg/kg IV ideally, but the drug can be given PO or IM if a slower onset of action is acceptable. Be sure to consider other possibilities of apparent dystonia, such as conversion reaction, deep space abscesses in the neck, seizures, meningitis and recreational drug abuse. Clinically trained team Billing management services All of our clients are references Reimbursement coding by registered nurses C O N TA C T Andrea Brault M.D., MMM, FACEP (877)346-2211, ext. 278 | andrea@emergencygroupsoffice.com 180 Via Verde Suite 100 | San Dimas, California 91773 DECEMBER 2015 | 11 Lois PERSONAL STORY | Dr. Norton treated Lois in August of 2013 and graciously agreed to have her account published. During my ER shift today, in room 10, there was a thin homeless woman. She was covered in a film of grime, but she had a smile. “My feet hurt, doctor,” she told me. “I’ve been walking a lot, looking for sanctuary. The government has been trying to steal my creativity for years, but I’ve been guarding my poems. They want to kill me for my poems, but I won’t let them.” She was holding a small notebook with a beautiful flowery cover, in shades of pink and magenta. She was writing on the creamy pages in small, neat cursive. As far as I could tell, it was her only possession that was not filthy. “That’s so cool that you write poetry,” I told her. “That will be your legacy.” “Yes!” She beamed. “How nice that you understand!” I examined her. Her feet were sore and blistered, but nothing more. She looked healthy, and at peace. “Do you want to see our psychiatric team?” I asked her. “Oh, no, I don’t need them,” she replied. “I’m fine.” “Would you like a shower?” “That would be great!” “Would you like a meal?” “That would be lovely.” “Would you like something for pain, for your feet?” “That would be wonderful.” “Is there anything else we can do for you?” “No, that sounds just perfect. That’s all I need.” “It was nice to meet you. You are a beautiful soul,” I said, and turned to go. “Doctor, would you like me to read you a poem?” “I would like that more than anything, but I have patients waiting to see me. Maybe I’ll come back in a bit, after I get caught up, and you could read me one then?” “Would you like me to write one for you while you go see those other patients?” “That would be fantastic if you would write a poem for me! Thank you so much.” “Do you want to pick a topic, or should I just look into your soul?” “I would love it if you would look into my soul,” I said, and I meant it. Thirty minutes later, she passed me in the hall as she was walking with a nurse to the discharge area. “Doctor,” she smiled, “Here is the poem I wrote for you.” 12 | LIFELINE a forum for emergency physicians in california THE POET She handed me an unblemished, creamy page, torn from her notebook. On it was this poem: For Mercys Foot Doctor Today a foot doctor approached me She seemed to have a halo that said you at this moment are the exact right company We talked a little bit about my legacy And I said I hope in the future for the doctor and the patient it can be a great game of candy kiss monopoly called a glory story of poetry Of course she admired my filthy dirt She said congradulations you have been promoted to Grade A Self Worth She said simply all you need is a shower And you will have unlimitless Candy kiss flower power By Lois August At the bottom of the page it said: “I will be seeking Sanctuary Until the right person shows me my gods mercy.” “This is a great poem,” I told her. “You have made my day.” And then I showed the poem to the nurses, and I put it in my pocket, and I told the people whom I love most about it. I read it to my family at dinner. And then I said to them, “I have the best job in the world.”. n THE OHIO ACEP EMERGENCY MEDICINE BOARD REVIEW COURSE 2016 FEBRUARY Newport Beach Marriott Hotel & Spa Newport Beach, California February 8 - 12, 2016 FOR MORE INFORMATION ON LOCATIONS & ACCOMMODATIONS: WWW.OHACEP.ORG/EMRHOTEL COMPREHENSIVE. RELEVANT. ESSENTIAL COURSE AGENDA February 8 - Day 1 (7 am - 8:05 pm) Orientation/Test Taking Psychology Endo, Metabolic & Nutritional Disorders I & II Renal/GU Emergencies Hematologic Disorders Infectious Disorders I & II Cardiovascular Disorders I & II ECG Review February 9 - Day 2 (7:30 am - 7:10 pm) Nervous System Disorders Cardiovascular Disorders III & IV Geriatrics Cutaneous Disorders I & II Abdominal & Gastrointestinal Disorders I & II Ear, Nose , Throat & Dental Disorders Comprehensive Rapid Review February 11 - Day 4 (7 am - 7:10 pm) e-Learning Review (Trauma Focus) Pediatric Medical Illnesses I & II Pediatric Surgical Illnesses Pediatric Rapid Review Rapid Fire Board Prep II Oncologic Emergencies Musculoskeletal Illnesses Obstetrical Disorders Psychobehavioral Disorders Emergency Medicine Immersion Rapid Review February 12 - Day 5 (7 am - 5:25 pm) e-Learning Review (Pediatrics Focus) Female Urogenital Disorders Toxicologic Emergencies I & II Thoracic Respiratory Disorders I & II Toxicologic Emergencies III Toxicology Rapid Review Thoracic Respiratory Disorders III Clinical Pharmacology I & II February 10 - Day 3 (7:30 am - 7:15 pm) Traumatic Disorders Traumatic Disorders C-Spine Ocular Emergencies Pelvic, Back & Lower Extremity Musculoskeletal Injuries Rapid Fire Board Prep I Environmental Emergencies I & II Ultrasound in EM Upper Extremity Musculoskeletal & Hand Injuries Trauma & Environmental Rapid Review TRUSTED FACULTY REGISTRATION INCLUDES Eric Adkins, MD, FACEP, MSc Thoracic Respiratory Disorders I-III COURSE MATERIAL • Extensive Daily Course Syllabus. A powerful, comprehensive tool for review. Printed and electronic web-based versions provided. Brian Browne, MD, FACEP Cutaneous Disorders I & II Ken Butler, DO, FACEP Ear, Nose, Throat and Dental Disorders, Pelvic, Back & Lower Extremity Musculoskeletal Injuries Ann Dietrich, MD, FACEP E-Learning Review • Pre, Post & Daily Tests totaling over 400 questions. • Key Facts (50+ pages) to reinforce key concepts of Emergency Medicine. Covering 26 topics this is the perfect tool for every stage of your review process. • Online access to Ohio ACEP’s Pharmacology/Toxicology Case Studies workbook with 60 cases for review. ONLINE STIMULI & E-LEARNING WEB SITE (WWW.OHACEP-ELEARNING.ORG) Fred Hustey, MD, FACEP Endocrine, Metabolic & Nutritional Disorders I & II Colin Kaide, MD, FACEP, FAAEM Renal/GU Emergencies, Hematologic Disorders Randall King, MD, FACEP Orientation, Test Taking Psychology, Traumatic Disorders C-Spine, Musculoskeletal Illnesses, Rapid Reviews Nicholas Kman, MD, FACEP Environmental Emergencies I & II • Web access to 1,400+ full color diagnostic photos, radiographs and ultrasounds, complete with case questions organized into 23 categories. • Case questions e-mailed periodically to guide your studies before attending the course. ADDITIONAL REVIEW OPPORTUNITIES • Focused, team led rapid review and . • Faculty reviews of select cases and images from Ohio ACEP’s online stimuli Web site. COURSE EXTRAS Joseph Martinez, MD, FACEP, FAAEM Abdominal & Gastrointestinal Disorders I & II, Comprehensive Rapid Review, Ocular Emergencies Amal Mattu, MD, FACEP Cardiovascular Disorders I-IV, ECG Review, Nervous System Disorders, Geriatrics Michael McCrea, MD, FACEP, FAAEM Pregnancy Disorders, Psychobehavioral Disorders, Urogenital Disorders Ryan Mihata, MD, MPH, CPE, FACEP Clinical Pharmacology I & II Michael Omori, MD, FACEP Infectious Disorders I & II Laura Sells, MD, FAAP, FACEP Pediatric Medical Illnesses I & II, Pediatric Surgical Illnesses, Pediatric Rapid Review Ramin Tabatabai, MD, FACEP Oncologic Emergencies Jerry Tasset, MD, PhD, FACEP Toxicologic Emergencies I-III, Toxicologic Rapid Review Howard Werman, MD, FACEP Upper Extremity Musculoskeletal & Hand Injuries, Trauma & Environmental Emergency Rapid Review Sandra Werner, MD, RDMS, FACEP Traumatic Disorders, Rapid Fire Board Prep I & II, E-Learning Review, Ultrasound in Emergency Medicine • A continental breakfast will be available to those staying at the hotel. • Complimentary Wi-Fi access in guest rooms at the hotel. WHO SHOULD ATTEND? Residents preparing for an inservice or qualifying exam! Individuals looking for a comprehensive review of Emergency Medicine! Advanced practice providers who treat urgent medical conditions! Those seeking a valuable CME resource! CME ACCREDITATION These activities have been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint providership of the American College of Emergency Physicians and Ohio ACEP. The American College of Emergency Physicians is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. THE OHIO ACEP EMERGENCY MEDICINE BOARD REVIEW The American College of Emergency Physicians designates this live activity for a maximum of 50 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Approved by the American College of Emergency Physicians for a maximum of 50 hours of ACEP Category I credit. WWW.OHACEP.ORG/EMREVIEW CEMAF Donors ANNOUNCEMENTS | The California Emergency Medicine Advocacy Fund (CEMAF) has transformed California ACEP’s advocacy efforts from primarily legislative to robust efforts in the legislative, regulatory, legal, and through the Emergency Medical Political Action Committee, political arenas. Few, if any, organization of our size can boast of an advocacy program like California ACEP’s; a program that has helped block Medi-Cal provider rate cuts, stop the $100 million raid on the Maddy EMS Fund, and fight for ED overcrowding solutions – and that’s just the last year! The efforts could not be sustained without the generous support from the groups listed below, some of whom have donated as much as $0.25 per chart to ensure that California ACEP can fight for emergency medicine. Thank you to our 2014-15 contributors CALIFORNIA ACEP SPONSORED CONFERENCES • Emergency Medicine in Yosemite*, January 13-16, 2016 Yosemite, CA • The Ohio ACEP Board Review*, February 8-12, 2016 Newport Beach, CA (in alphabetical order): • • • • • • • • • • • • Alvarado Emergency Medical Associates Antelope Valley Emergency Medical Associates Beach Emergency Medical Associates Berkeley Emergency Medical Group CEP America Chino Emergency Medical Associates Coastline Emergency Physicians Medical Group Culver City Emergency Medical Group Eden Emergency Medical Group EMP Management Group Grossmont Emergency Medical Group Hollywood Presbyterian Emergency Medical Associates • Mills Peninsula Emergency Medical Group • Montclair Emergency Medical Associates • Napa Valley Emergency Medical Group • Orange County Emergency Medical Associates • Pacific Emergency Providers • Pacifica Emergency Medical Associates • Riverside Emergency Physicians • San Dimas Emergency Medical Associates • San Francisco Emergency Medical Associates, Inc. • Sherman Oaks Emergency Medical Associates • South Coast Emergency Medical Group, Inc. • Tarzana Emergency Medical Associates •TeamHealth • Tri-City Emergency Medical Group • Valley Emergency Medical Associates • Valley Emergency Physicians • West Hills Emergency Medical Associates 16 | LIFELINE a forum for emergency physicians in california ENDURING MATERIALS - ONLINE CME SonoSim®* Enduring Materials - Computer Software (Modules) Info: (310) 315-2828 www.sonosim.com • SonoSim® Ultrasound Training Solution Aorta/IVC: Core Clinical Module • SonoSim® Ultrasound Training Solution Bladder: Core Clinical Module • SonoSim® Ultrasound Training Solution FAST Protocol: Core Clinical Module • SonoSim® Ultrasound Training Solution Fundamentals of Ultrasound: Core Clinical Module • SonoSim® Ultrasound Training Solution Intestinal/Biliary: Core Clinical Module • SonoSim® Ultrasound Training Solution Musculoskeletal: Core Clinical Module • SonoSim® Ultrasound Training Solution Ocular: Core Clinical Module • SonoSim® Ultrasound Training Solution Rapid Ultrasound in Shock: Core Clinical Module • SonoSim® Ultrasound Training Solution Soft Tissue: Core Clinical Module • SonoSim® Ultrasound Training Solution Vascular Access: Core Clinical Module *Approved for AMA PRA Category I CreditsTM | CALIFORNIA ACEP UPCOMING MEETINGS & DEADLINES For more information on upcoming meetings, please e-mail us at info@californiaacep.org; unless otherwise noted, all meetings are held via conference call. DECEMBER 2015 10th at 10 am 11th at 10 am Government Affairs Committee Conference Call Member Services Committee California Call 24th – Jan. 1st Winter Holiday Chapter Office Closed 31st FACEP Application Deadline DECEMBER 2015 SUN MON TUES WED THURS FRI SAT 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 JANUARY 2016 SUN MON TUES WED THURS JANUARY 2016 FRI SAT 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Emergency Medicine in Yosemite Yosemite, CA 17 18 19 20 21 22 23 24 25 26 27 28 29 30 14th at 10 am Government Affairs Committee Conference Call 31 15th at 10 am Practice Management Committee Conference Call 12th at 9 am Reimbursement Committee Conference Call 13th – 16th 22nd at 10 am Member Services Committee Conference Call FEBRUARY 2016 4th Board of Directors Meeting Sacramento, CA 8th – 12th Ohio Chapter Board Review Course Newport Beach, CA FEBRUARY 2016 SUN MON TUES WED THURS FRI SAT 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 DECEMBER 2015 | 17 CAREER OPPORTUNITIES | ANAHEIM, CALIFORNIA: Anaheim Regional Medical Center’s Democratic ED Physician group has immediate part time/full time positions available for BC / BE Emergency Physicians. We have a busy, high acuity department with 44,000 annual visits. Shifts are 9-10 hours long with night shift/holiday differential and double coverage during peak hours. We offer a competitive salary, paid malpractice and full partnership opportunities. Interested physicians E-mail your CV and references to vijay4@aol.com, amit4ten@aol.com or call us at 714-999-5112. CENTRAL COAST: MMC Emergency Physicians Medical Group at Marian Regional Medical Center-Santa Maria-seeking a qualified BC/BE Emergency Physician to join a stable, independent, single hospital, democratic group. Partnership opportunity available in this well-supported ED with growing census of >80,000 visits/year. New hospital/new ED opened in 2012. Practice alongside experienced colleagues at a STEMI receiving center, a Level III Trauma Center and a certified Stroke Center that offers 24/7 in-house hospitalists, OB laborists and intensivists in addition to a NICU, peds hospitalists and FP residents. Live on the beautiful Central Coast, anywhere from San Luis Obispo to Santa Ynez/Solvang, with easy commutes to work and easy access to beaches/ mountains/wine country along with all types of outdoor recreation. This is the job your residency director told you to find. For more details, contact David Ketelaar, MD at dketelaar62@gmail.com Phone (805) 440-0837 FULLERTON, CALIFORNIA: Join our ED team in beautiful north OC at St Jude Med Ctr. Our 36 bed state of the art ED serves >60K pts/yr with 54 hrs MD, 44 hrs PA and 100% scribe coverage per day, 9 hr shifts. We have held this stable contract for >36 years, have excellent back-up, 24hr in house Critical Care, OB, neonatologist and hospitalists. We are a STEMI receiving center and “Advanced Comprehensive Stroke Center” and provide excellent compensation with night differential. EM BC/BE mandatory. Interested physicians send CV to kohparker23@yahoo.com LOS ANGELES-CULVER CITY: Southern California Hospital at Culver City Rare opportunity to join a Westside LA ER group. Group seeks BC/BE emergency physician to work Part-Full Time as an independent contractor. Excellent compensation with malpractice paid. Nine hour shifts with PA double coverage. 90% nights already covered! Remodeled ER, Computerized Charting and PACS! Email CV and references to cclark@epmgt.org. Phone 951-898-0823. NEWPORT BEACH, CALIFORNIA: Newport Emergency Medical Group (NEMG) is accepting applications for an Emergency Physician position which will open in September, 2015. NEMG provides Emergency Physician staff for the Hoag Hospitals in Newport Beach and Irvine. Extremely stable group practicing at Hoag for 34 years. New group members gain financial and scheduling parity after three years. Competitive reimbursement. Contact Ray Ricci, MD at rayriccimd@cox.net. To advertise with Lifeline and to take advantage of our circulation of over 3,000 readers, including Emergency Physicians, Groups, and Administrators throughout California who are eager to learn about what your business has to offer them, please contact us at info@californiaacep.org or give us a call at (916) 325-5455. 18 | LIFELINE a forum for emergency physicians in california NORTHERN & CENTRAL CALIFORNIA: Kaiser Permanente is looking for excellent BE/BC Emergency Medicine physicians interested in full time or less than full time position with dynamic physician group throughout Northern and Central California. The Permanente Medical Group, Inc. offers: • Competitive salary • Recruitment bonus • Mortgage loan program (approval required) • Comprehensive benefits package, including excellent retirement plans • Malpractice insurance coverage • Cutting-edge technology TPMG, Inc. allows you to combine a medical practice of which you can be proud and a quality of life you deserve. To apply, send your curriculum vitae to Narlyn Villaruel at Narlyn.Villaruel@kp.org or call (800) 777-4912. http://physiciancareers-ncal.kp.org RIVERSIDE, CALIFORNIA: PARKVIEW MEDICAL CENTER: Great opportunity to join a 14 year ER group. Group seeks BC/BE Emergency Physician to work Part/Full Time as an independent contractor. Excellent Top Tier Compensation based on productivity with malpractice paid. Ten hour shifts with MD double coverage and 12 Hour PA. Computerized equitable shift scheduling. Efficient Computerized Charting and PACS! Soon to break ground on New Emergency Department. Email CV and references to cclark@repmg.com | Phone (951) 898-0823 SAN DIEGO, CALIFORNIA: Grossmont Emergency Medical Group has an immediate opportunity for a Board Certified or Board Prepared emergency physician. Both part time and full time positions are available in busy, high acuity department with annual visits >100K. Emergency Department is in new "state of the art" Critical Care Center with computerized tracking system and physician order entry. Shifts are 8 hours with 88 physician hours /60 mid-level provider hours of coverage daily. Come live and work in America's Finest City. E-mail CV and references to erwin.handley@gemg.net SANTA CRUZ/MONTEREY BAY/SALINAS, CALIFORNIA: Salinas Valley Memorial Healthcare System’s (SVMHS) well-established democratic emergency medicine group is seeking part-time/full-time applicants to staff a busy, high acuity emergency department with approximately a 60K annual volume (STEMI/ Stroke receiving hospital). SVMHS is located in Salinas, California but most of our physicians/PAs live in Santa Cruz area or Monterey/Carmel. We use EMR/ CPOE with assistance of medical scribes. Must be BC/BE Emergency Medicine. Competitive salary/benefits. 2-year partnership track with FT employment. Enjoy where you work, enjoy where you play! Interested applicants please send your CV to mnavarromd@gmail.com SOUTHERN CALIFORNIA – ORANGE COUNTY: Full time and part time independent contracting emergency physicians needed for high volume, high acuity practices. Chest Pain Center, Stroke Center, Pediatric Level II trauma center - large independent group with forty years of clinical excellence for two acute care facilities. Expanding group needs BC/BE emergency physicians and pediatric emergency physicians. Excellent compensation, malpractice paid, scribes, midlevel providers, 8 – 9 hour shifts, excellent call panel coverage. Email CV and references to EMSOC@emsoc.net, fax to 714-543-8914 ?? ? e e s s r r u ? u e o e o s c s c r r u S cliliscst:ot:ou TTTTLLLeLvvrsididSSS I I n n a a I I r o t: n n s rs rs f li e e a a g LLooRRREEooEFFFookkoffffffeerseiirsrsnnthththththeegeeefofofofofolllloollfllllwwooooinwinwwgingininrCgCggaaCCCliliafoafoalililirnrnfofofoiaiarnrnrnppiaiaiaroropppvvroroididroevrsidelirsst:list: M MRREEFFooffffeersrs EEM M EM Fast Response Response School SchoolofofHealth HealthCare CareEducation Education FastDubnoff, Response School ofofHealth Care Response School Health CareEducation Education Lisa MICP/RN, Paramedic Director Lisa Dubnoff, MICP/RN, Paramedic Director Dubnoff, Paramedic Director Lisa Dubnoff, MICP/RN, Paramedic Director Lisa Dubnoff, MICP/RN, Paramedic Director 2075 Allston Way, Berkeley, CA 94704 2075 Allston AllstonWay, Way,Berkeley, Berkeley,CA CA94704 94704 Allan Hancock Hancock College College 2075 Allston Way, 2075 Allston Way, Berkeley, Berkeley,CA CA94704 94704 Phone: Phone: (510) 809-3646 809-3646 Hancock College Allan Hancock College American Health Education, Inc Mike Mike DeLeo, DeLeo, EMT EMT–– Course CourseCoordinator Coordinator Phone: (510) 809-3646 809-3646 628-5876 Fax; (866) 628-5876 Mike EMT –– Course Mike DeLeo, EMT Course Coordinator PerryS. Hookey, EMT-P 800 800 S.DeLeo, College, College, Santa Santa Maria, Maria,Coordinator CA CA93454 93454 Fax; (866) 628-5876 628-5876 Email: ldubnoff@fastresponse.org ldubnoff@fastresponse.org Email: ldubnoff@fastresponse.org 800 S. College, College, Santa 800 S. Santa Maria, CA93454 93454 7300B Amador Plaza Maria, Road, CA Dublin, CA 94568 Phone: (805) 878-6259 878-6259 Email: ldubnoff@fastresponse.org Email:www.fastresponse.org ldubnoff@fastresponse.org Web: www.fastresponse.org 878-6259 Phone: (805) 878-6259 Phone: (800) 483-3615 Fax: (805) 922-5446 922-5446 Web: www.fastresponse.org www.fastresponse.org (805) 922-5446 Fax: 922-5446 Email: info@americanhealtheducation.com Linda University UniversityMedical MedicalCenter Center Loma Loma Linda Email: Email: Mikedeleo52@msn.com Mikedeleo52@msn.com LomaJones, Linda University Medical Linda UniversityAssistant MedicalCenter Center Email: Mikedeleo52@msn.com Email: Mikedeleo52@msn.com Web:www.hancock.cc.ca.us www.americanhealtheducation.com Lyne Administrative Assistant Lyne Administrative Web: www.hancock.cc.ca.us Jones, Administrative Assistant Lyne Administrative Assistant www.hancock.cc.ca.us Web: www.hancock.cc.ca.us Department Department ofof Emergency EmergencyMedicine Medicine American MedicalResponse Response(AMR) (AMR) American Medical Department Department ofof Emergency Emergency Medicine Medicine 11234 11234 Anderson Anderson A108, Loma 92354 AndersonSt., St., A108, Loma Linda, Linda, CA 92354 Medical Response (AMR) American Medical Response (AMR) Ken Bradford, Operations Bradford, Operations Operations 11234 11234 Anderson Anderson St., A108, A108, Loma Loma Linda, Linda, CA 92354 92354 Phone: Phone: (909) 558-4344 558-4344 xx 00 Bradford, Operations Ken Bradford, Operations 841 Latour Court, Court, Ste 841 Latour Ste D, D, Napa, Napa, CA CA94558-6259 94558-6259 94558-6259 Phone: (909) 558-4344 558-4344 xx 00 Fax: (909) 558-0102 558-0102 841 Latour Latour Court, Court, Ste 841 Ste D, D, Napa, Napa, CA CA94558-6259 94558-6259 Phone: 953-5795 Phone: (707) 953-5795 Fax: (909) 558-0102 558-0102 Email: Email: LJones@ahs.llumc.edu LJones@ahs.llumc.edu LJones@ahs.llumc.edu (707) 953-5795 Phone:ken.bradford2@gmail.com 953-5795 Email: Email: ken.bradford2@gmail.com ken.bradford2@gmail.com Email: Email:www.llu.edu LJones@ahs.llumc.edu LJones@ahs.llumc.edu Web: www.llu.edu Email: ken.bradford2@gmail.com Email: ken.bradford2@gmail.com Web: www.llu.edu www.llu.edu A Work Safe Environment Environment Medic Ambulance Medic Ambulance Work Safe Environment A SafeEMTP Environment Steve Bristow, Bristow, EMTP Medic Ambulance Ambulance Perry Hookey, EMTP, Education Perry Hookey, EMTP, EducationCoordinator Coordinator James Pierson, EMT-P Bristow, EMTP Steve Bristow, EMTP 3140 Aldridge 3140 Aldridge Way, El AldridgeWay, El Dorado DoradoHills, Hills,CACA95762 95762 PerryCouch Hookey, EMTP, Education Coordinator Perry Hookey, EMTP, Education Coordinator 506 Couch Street, Vallejo, CA 506 Vallejo, CA94590-2408 94590-2408 3140 Aldridge Aldridge Way, 3140 Way, ElEl Dorado DoradoHills, Hills,CACA95762 95762 Phone: (925) 708-5377 708-5377 Phone: 506 Couch Vallejo, CA 94590-2408 506 Couch Street, Vallejo, CA 94590-2408 Phone: (707) 644-1761 644-1761 (925) 708-5377 Phone:worksafeenvironment@yahoo.com 708-5377 Email: Email: worksafeenvironment@yahoo.com worksafeenvironment@yahoo.com 644-1761 Phone: (707) 644-1761 Fax: (707) 644-1784 644-1784 Email: worksafeenvironment@yahoo.com Email: worksafeenvironment@yahoo.com Web: www.worksafeenvironment.com www.worksafeenvironment.com 644-1784 Fax: (707) 644-1784 Email: Email: perry@medicambulance.net Email: perry@medicambulance.net jpierson@medicambulance.net www.worksafeenvironment.com Web: www.worksafeenvironment.com Email:www.medicambulance.net perry@medicambulance.net Email: perry@medicambulance.net California EMS Academy California EMS Academy Web: www.medicambulance.net Compliance Training California EMS Academy California EMS Academy www.medicambulance.net Web: www.medicambulance.net Nancy Black, Course Coordinator Nancy Black, RN, RN,EMS Course Coordinator Jason Manning, Course Coordinator Napa Napa Valley Valley College College Nancy Foster Black, RN, Course Coordinator Nancy Black,City RN,Blvd Course Coordinator 1170 City #107, Foster CA 1170 Blvd #107, Foster City, City,95709 CA94404 94404 Valley College Napa Valley College 3188 Foster Verde Robles Drive, Camino, CA Gregory Rose, Co-Director Gregory EMS Co-Director Rose, EMS 1170 Foster City Blvd #107, Foster City, CA 94404 1170 Foster City Blvd #107, Foster City, CA 94404 Phone: (866) 429-5895 577-9197 577-9197 Gregory Rose, EMS Gregory Rose, EMSCo-Director Co-Director Phone: (916) 2277 Napa Highway, Napa 2277 Napa Highway, Napa CA CA 94558 94558 (866) 577-9197 Phone: 577-9197 Fax: (650) 701-1968 701-1968 2277 Napa Highway, Napa 2277 Napa Highway, Napa CA CA 94558 94558 Fax: (916) 256-4301 Phone: Phone: (707) 256-4596 256-4596 (650) 701-1968 Fax: 701-1968 Email: Email: nancy@caems-academy.com Phone:grose@napavalley.edu (707) 256-4596 256-4596 Email: nancy@caems-academy.com Kurgan911@comcast.net Email: Email: grose@napavalley.edu grose@napavalley.edu Email: nancy@caems-academy.com Email: nancy@caems-academy.com Web: www.caems-academy.com www.caems-academy.com Email: grose@napavalley.edu Email:www.winecountrycpr.com grose@napavalley.edu Web: www.winecountrycpr.com www.caems-academy.com Web: CSUSwww.caems-academy.com Prehospital Education Program Web: www.winecountrycpr.com www.winecountrycpr.com Compliance Training Compliance Training Derek Parker, Program Director NCTI Instruction NationalCollege CollegeofofTechnical Technical Instruction NCTI –– National Technical Instruction Compliance Training Compliance Training Jason Manning, EMS Coordinator Manning, EMSCourse Course Coordinator NCTI Rohrabaugh, ––E. National College ofofTechnical National College TechnicalInstruction Instruction 3000 State University Drive East, Napa Hall, Sacramento, CA Lawson Lena Course Stuart, CEN, EMT-P Lawson E. Stuart,RN, RN, CEN,Manager EMT-P Manning, EMS Course Coordinator Jason Manning, EMS Course Coordinator 3188 Verde Drive, Camino, Camino,CA CA95709 95709 3188 Verde Robles Robles Drive, Lawson E. RN, CEN, EMT-P Lawson E. Stuart, Stuart, RN, CEN, EMT-P 95819-6103 333 Sunrise Ave Suite 500, Roseville, CA 95661 Lena Rohrabaugh, Course Manager Rohrabaugh, Course Manager 3188 Drive, Camino, Camino,CA CA95709 95709 3188 Verde Verde Robles Drive, Phone: 429-5895 (916)Robles 429-5895 Rohrabaugh, Course Manager Lena Rohrabaugh, Course Manager Office: (916) 278-4846 Phone: (916)Ave 960-6284 x 105 333 Sunrise Ave Suite500, 500, Roseville,CA CA95661 95661 333 Sunrise Suite Roseville, Phone: 429-5895 (916) 429-5895 Fax: 256-4301 (916) 256-4301 333 Ave Suite500, 500, Roseville,CA CA95661 95661 333 Sunrise Ave Suite Roseville, Mobile: (916) 316-7388 Fax: Sunrise (916) 960-6296 960-6284 xx 105 Phone: (916) 960-6284 105 Fax: 256-4301 (916) 256-4301 Email: Kurgan911@comcast.net Email: Kurgan911@comcast.net 960-6284 xx 105 Phone: (916) 960-6284 105 Email: Email: jlcasa@caltel.com 960-6296 Fax: (916) 960-6296 Email: Kurgan911@comcast.net Email: dparker@csus.edu Kurgan911@comcast.net 960-6296 Fax: 960-6296 Web: www.cce.csus.edu CSUS PrehospitalEducation EducationProgram Program CSUS Prehospital Web:(916) www.ncti-online.com Email: jlcasa@caltel.com Email: jlcasa@caltel.com CSUS Prehospital Education Program CSUS Parker, Prehospital Education Email:www.ncti-online.com jlcasa@caltel.com Email: jlcasa@caltel.com Derek Program Director Program Director Program Web: www.ncti-online.com Oakland Fire Department EMS Academy Parker, Program Director Derek ProgramDrive Director www.ncti-online.com 3000 State University East, CACA Web: www.ncti-online.com 3000 State University Drive East,Napa NapaHall, Hall,Sacramento, Sacramento, Sheehan Gillis, EMT-P, EMS Coordinator Fire Department Department Oakland Fire Nancy Black,University RN, Course Coordinator 3000 State University Drive East, Napa Hall, Sacramento, CA 3000 State Drive East, Napa Hall, Sacramento, CA 95819-6103 95819-6103 FireEMT-P, Department Oakland Fire Department 47 Clay Street, Oakland, CACoordinator 74607 Sheehan Gillis, EMS Gillis, EMT-P, EMS Coordinator 1170 Foster City Blvd #107, Foster City, CA 94404 95819-6103 95819-6103 Office: (916) 278-4846 278-4846 Gillis, EMT-P, Sheehan Gillis, EMT-P,EMS EMS Coordinator Phone: 238-6957 47 Clay(510) Street, Oakland, Oakland, CA CACoordinator 74607 74607 Phone:(916) (866) 278-4846 577-9197 Office: 278-4846 Mobile: Mobile:(916) (916) 316-7388 316-7388 47 Street, Oakland, Clay Oakland,CA CA74607 74607 Fax: (510) 238-6959 Phone: (510) 238-6957 238-6957 Fax: (650) 701-1968 Mobile:dparker@csus.edu (916) Mobile: (916) 316-7388 316-7388 Email: Email: dparker@csus.edu Phone: (510) 238-6957 238-6957 Email: sean@baycj.com Fax: (510) 238-6959 238-6959 nancy@caems-academy.com Email:www.cce.csus.edu dparker@csus.edu Email: dparker@csus.edu Web: www.cce.csus.edu Fax: (510) 238-6959 238-6959 Web: http://www.oaklandnet.com/fire/ Email: Email: sean@baycj.com sean@baycj.com www.caems-academy.com www.cce.csus.edu Web: www.cce.csus.edu Email: sean@baycj.com Email:http://www.oaklandnet.com/fire/ sean@baycj.com ETS – Emergency Emergency Training TrainingServices Services Web: http://www.oaklandnet.com/fire/ Emergency Services Emergency Training Services Web: http://www.oaklandnet.com/fire/ http://www.oaklandnet.com/fire/ ETS –Thomas, Emergen cy Training Services Mike Course Coordinator Mike Thomas, Course Coordinator Mike Thomas, Thomas, Course Coordinator Thomas, Course Coordinator Mike Course Coordinator 3050 Paul Sweet 3050 Paul Road, Santa Cruz, Cruz, CA CA 95065 95065 3050 Sweet Road, Cruz, CA CA 95065 95065 3050 Paul Paul CA Paul Sweet Road, Santa Cruz, 95065 Phone: (831) 476-8813 476-8813 Phone: (831) 476-8813 Phone: (831) 476-8813 Toll-Free: (800) 700-8444 Toll-Free: (800) 700-8444 Toll-Free: (800) 700-8444 Toll-Free: 700-8444 Fax: (831)(800) 477-4914 477-4914 Fax: (831) 477-4914 (831) 477-4914 Email: mthomas@emergencytraining.com Email: mthomas@emergencytraining.com Email: mthomas@emergencytraining.com Email::www.emergencytraining.com mthomas@emergencytraining.com Email mthomas@emergencytraining.com Web: www.emergencytraining.com Web: www.emergencytraining.com www.emergencytraining.com Medical,California California PHI PHI Air Air Medical, Medical, PHI PHI Air Air Medical, Medical,California California Pierce, Course Coordinator Graham Course Coordinator Graham Pierce, Pierce, Course Coordinator Graham Pierce, Course Coordinator Graham Pierce, Course Coordinator 801 DD Airport AirportWay, Way, Way,Modesto, Modesto, Modesto, CA CA95354 95354 95354 801 Airport CA 801 DD Airport Airport 550-0884 Way, 801 Way, Modesto, Modesto,CA CA95354 95354 Phone: Phone:(209) 550-0884 Phone: (209) 550-0884 550-0884 550-0885 Fax: (209) 550-0885 Fax: (209) 550-0885 550-0885 Email: gpierce@philhelico.com Email: gpierce@philhelico.com Email: gpierce@philhelico.com Email:http://www.phiairmedical.com/ gpierce@philhelico.com Web: http://www.phiairmedical.com/ Web: http://www.phiairmedical.com/ http://www.phiairmedical.com/ Ambulance Service Riggs Riggs Ambulance AmbulanceService Service Riggs Ambulance Ambulance Service Greg Petersen, EMT-P, Clinical Petersen, EMT-P,Service ClinicalCare CareCoordinator Coordinator Greg Clinical Care Coordinator Petersen, EMT-P, Clinical Care Greg Petersen, EMT-P, CareCoordinator Coordinator 100 Riggs Ave, CA 100 Riggs CA 95340 95340 Riggs Ave, Merced,Clinical 100 Riggs Ave, Merced, CA 95340 100 Riggs CA 95340 Phone: 725-7010 Phone:(209) 725-7010 Phone: (209) 725-7010 725-7010 Fax: (209) 725-7044 725-7044 Fax: (209) 725-7044 725-7044 Email: Email: Gregp@riggsambulance.com Gregp@riggsambulance.com Email: Gregp@riggsambulance.com Email:www.riggsambulance.com Gregp@riggsambulance.com Web: www.riggsambulance.com Web: www.riggsambulance.com www.riggsambulance.com Rocklin Fire Department Rocklin Fire FireDepartment Department Rocklin Fire Department Fire Department Chris Wade, Firefighter/Paramedic Chris Wade, Firefighter/Paramedic Wade, Firefighter/Paramedic Chris Wade, Firefighter/Paramedic Chris Wade, Firefighter/Paramedic 4060 Rocklin Rocklin,CA 4060 Rocklin Road, Rocklin Road, Rocklin, CA 95677 95677 4060 Rocklin Rocklin 625-5311 Road, Rocklin, 4060 Rocklin,CA CA95677 95677 Phone: Phone:(916) 625-5311 (916) 625-5311 Phone: 625-5311 725-7044 Fax: (209) 725-7044 725-7044 Fax: (209) 725-7044 Email: Chris.Wade@rocklin.ca.us Email: Chris.Wade@rocklin.ca.us Chris.Wade@rocklin.ca.us Email: Chris.Wade@rocklin.ca.us Email: Chris.Wade@rocklin.ca.us Web: www.rocklin.ca.us www.rocklin.ca.us www.rocklin.ca.us Web: www.rocklin.ca.us Rural Metro Metro Ambulance Rural MetroAmbulance Ambulance Rural Metro Ambulance Rural Metro Ambulance Brian EMT-P Brian Green, Green, EMT-P EMT-P Brian Green, EMT-P Brian Green, EMT-P 1345 1345 Vander Vander 95112 VanderWay, Way, San San Jose, Jose, CA CA 95112 95112 1345 Vander Vander Way, 1345 San Jose, CA 95112 95112 Phone: 645-7345 Phone:(408) 645-7345 Phone: (408) 645-7345 645-7345 Fax: (408) 275-6744 275-6744 Fax: (408) 275-6744 275-6744 Email: Email: brian.green@rmetro.com brian.green@rmetro.com Email: brian.green@rmetro.com Email: brian.green@rmetro.com Web: www.rmetro.com www.rmetro.com Web: www.rmetro.com www.rmetro.com Santa Rosa Junior College Public Safety Santa Rosa RosaJunior JuniorCollege CollegePublic PublicSafety Safety Santa Rosa Junior Rosa JuniorCollege CollegePublic PublicSafety Safety Training Center Training Center Training Center Training Center Bryan Bryan Smith, Smith,EMT-P, EMT-P,Course CourseCoordinator Coordinator Course Coordinator BryanSkylane Smith, Course Bryan Smith,EMT-P, EMT-P, CourseCoordinator Coordinator 5743 CA 95492 5743 Blvd, Windsor, CA 95492 Skylane Blvd,Windsor, 5743 Skylane Windsor, CA 5743 Skylane Blvd, Windsor, CA95492 95492 Phone: 836-2907 Phone:(707) 836-2907 (707) 836-2907 Phone: 836-2907 Fax: (707) 836-2948 836-2948 836-2948 Fax: (707) 836-2948 Email: medic9001@comcast.net Email: medic9001@comcast.net Email:www.santarosa.edu medic9001@comcast.net Email: medic9001@comcast.net Web: www.santarosa.edu www.santarosa.edu Web: www.santarosa.edu WestMed WestMed College College WestMed WestMed College Brian Green, EMT-P Brian Green,College EMT-P EMT-P BrianStevens Green, EMT-P Brian Green,Creek EMT-P 5300 Stevens 5300 Suite 200, San CA 95129-1000 Stevens CreekBlvd., Blvd.,Suite Suite200, 200,San SanJose, Jose,CA CA95129-1000 95129-1000 5300 Stevens Creek Blvd., Suite Suite200, 200, San Jose, CA CA95129-1000 95129-1000 5300 Stevens Phone: 977-0723 Phone:(408) 977-0723 977-0723 Phone:jonesds777@hotmail.com (408) 977-0723 Email: Email: jonesds777@hotmail.com Email: jonesds777@hotmail.com Email: jonesds777@hotmail.com Web: www.westmedcollege.com www.westmedcollege.com www.westmedcollege.com Web: www.westmedcollege.com www.westmedcollege.com Verihealth/Falck Northern California Ken Bradford, Training Coordinator 2190 South McDowell Blvd, Petaluma, CA 94954 Phone: (707) 766-2400 Email: ken.bradford@falck.com Web: www.verihealth.com Search upcoming courses: courses:http://cms.itrauma.org/CourseSearch.aspx http://cms.itrauma.org/CourseSearch.aspx Search for for upcoming http://cms.itrauma.org/CourseSearch.aspx upcoming courses: courses:http://cms.itrauma.org/CourseSearch.aspx http://cms.itrauma.org/CourseSearch.aspx Search for upcoming EMREF EMREF is isaaproud proudsponsor sponsorofofCalifornia CaliforniaITLS ITLScourses. courses. EMREF is EMREF isaaproud proudsponsor sponsorofofCalifornia CaliforniaITLS ITLScourses. courses. Pleasecall call916.325.5455 916.325.5455or Please call 916.325.5455 Please or Please Please call call916.325.5455 916.325.5455or E-mail Romo: lromo@californiaacep.org for information. E-mail Lucia Romo: lromo@californiaacep.org information. E-mail Lucia Romo: lromo@californiaacep.org more information. E-mail E-mail Lucia Romo: Romo:lromo@californiaacep.org lromo@californiaacep.orgfor more information. information. lifeline PRSRT STD US POSTAGE California Chapter, American College of Emergency Physicians PAID CPS 1121 L Street, Suite 407 Sacramento, CA 95814 OHIO ACEP EMERGENCY MEDICINE BOARD REVIEW COURSE THE OHIO ACEP EMERGENCY MEDICINE BOARD REVIEW OHIO ACEP IS EXCITED TO ANNOUNCE A NEW DATE & LOCATION IN PARTNERSHIP WITH CALIFORNIA ACEP! February 8 - 12, 2016 Newport Beach, CA Approved for AMA PRA Category 1 Credits TM. 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