Valley Physicians Recognized for life-saving protocols, programs

Valley Physicians Recognized for Life-Saving Protocols, Programs

By Farin Jacobsen

Three local legendary physicians accepted accolades during the Fresno Madera Medical Society Installation and Awards Gala on Friday, Nov. 19, surrounded by their peers, colleagues and mentors. One created today’s emergency medical services system in Fresno County when there wasn’t one, another created a pediatric oncology program at Valley Children’s when there wasn’t one, and the third led local healthcare systems in responding to an unprecedented global pandemic. Dr. Gene Kallsen at UCSF Fresno and Dr. Vonda Crouse at Valley Children’s received lifetime achievement awards and Dr. Rais Vohra was recognized with a special projects award for his COVID-19 response.

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Vonda Crouse, MD

Back when the north end of State Route 41 ended at Bullard Avenue, and Valley Children’s hospital was at Shields and Millbrook avenues in Fresno, a local pediatric oncology program was nonexistent.

“Yes, we had kids that had cancer, but oncology was all administered by adult oncologists,” explained Dr. David Hodge, a recently retired local pediatric surgeon. “And there's a world of difference between treating adults and treating children with cancer.”

Dr. Vonda Crouse came to work for Valley Children’s in 1987 and changed all of that, establishing the hospital’s pediatric oncology program.

“I think it's one of the best programs that Children's has to offer,” said Dr. Hodge, who worked alongside Dr. Crouse for decades. “It has made it such that many, many children have not had to leave the Valley to get the care that they need.”

Dr. Crouse was recognized with a Lifetime Achievement Award from Fresno Madera Medical Society at its annual awards banquet.

Dr. Crouse has led the fight against pediatric cancer for the past four decades, starting with a fellowship in pediatric hematology/oncology at Children's Hospital Los Angeles. She was a pediatric oncologist at The Children's Hospital in Denver and assistant professor of pediatrics at the University of Colorado Health Sciences before joining Valley Children’s.

Vinod Balasa, medical director for Valley Children's Cancer and Blood Disorders Center has worked with Dr. Crouse for the last 10 years and heads the program she started.

“She started out being the only physician to care for children with cancer when there were no physicians anywhere up and down the Valley to do that,” Dr. Balasa said. “And for many, many years, she either worked alone or just with one person being on call every night, taking care of these children, and she worked tirelessly.”

In her acceptance speech, Dr. Crouse recalled the early days of her career in Fresno when Woodward Park Drive-In stood on Blackstone north of Herndon, long since replaced by Costco.

“When I was on call so much at the very beginning, I could go over there (to the drive-in movies) and we could take the kids and the dogs and my beeper, and it didn't matter,” she said. “I could make phone calls and it was all very good; (I would) only miss half the movies.”

In those days, there was no department of pediatric hematology or pediatric oncology at Valley Children’s, Dr. Crouse explained.

“I was really grateful for the commitment that Valley Children's had made at that time in the 80s to increase the number of pediatric subspecialists,” she said, remembering that patients would have to be rescheduled when thick Valley fog would prevent UCSF doctors from driving down to see them in special clinics.

“When I came to Fresno I was the first board certified pediatric hematologist oncologist with CCS privileges, and now we are 12,” she said.

Dr. Balasa noted that Dr. Crouse is also the hospital’s principal investigator for Children's Oncology Group,

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which researches and develops oncology treatments.

“Through that she’s ensured that children here in the Central Valley are able to receive the same state-of-the-art treatment that they could get anywhere else in the world,” Dr. Balasa said. “She's truly been dedicated to this work. I'm very lucky and honored to be associated with her and to be able to work with her and I'm hoping to do so for many more years to come.”

Yvonne Wood, now the Throughput Manager at Valley Children's, was a brand new nurse taking care of oncology patients at Valley Children’s in 1990 when she met Dr. Crouse.

“I think that we're all better for knowing Dr. Crouse,” she said. “She's quiet. She's so smart. She was ahead of her time.”

“If we were going to call her and wake her up in the middle of the night for something, we better know what was going on, what we thought was going on, what we thought should happen next, and why,” Wood said. “And if we're wrong, that was okay; she would teach us and she loves to teach. … She never got mad. She was just there to grow the world.”

Dr. Crouse graduated from USC School of Medicine in 1974, at a time when only 9 percent of students in medical school were women, radiologist Dr. Bonna Rogers- Neufeld told the crowd when she introduced Dr. Crouse at the awards ceremony. “It was difficult to get into medical

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school but it was also difficult to get a job even if you did get out.”

In a career that has so far spanned four decades, with 35 years at Valley Children’s hospital, Dr. Crouse’s work has included “many clinical trials and hundreds of papers cited all over the world,” Dr. Rogers-Neufeld said.

Dr. Crouse is a member of several professional societies, including the American Academy of Pediatrics and the American Society of Pediatric Hematology and Oncology. She has published her work in professional journals, including Pediatrics and the American Journal of Epidemiology.

“In that long tenure she now is able to see the children of the children that she saved,” Dr. Rogers- Neufeld said.

Dr. Crouse is known for her dedication to Camp Sunshine Dreams, a camp that serves kids with cancer and their siblings, ages 8 to 15. The camp is staffed with nurses and doctors and the children enjoy camp activities like arts and crafts, archery, sports, music, dance, movie night, campfires, and kayaking.

Dr. Crouse is no stranger to climbing the rope ladders and shooting archery with her patients.

“She spends her entire day out and about, driving kids around on golf carts if they can’t walk very well,” Wood recalled. “She's out taking pictures all day long … she’s amazing.”

George the giraffe was chosen as Valley Children’s mascot because giraffes have the largest heart of all land

animals. People who have worked with or have been cared for by Dr. Crouse would argue that the size of her heart would rival George’s.

“She just loves,” Wood said. “Her heart is so big for these kids and what they do. She loves to see them do well. That's the goal, right? To get them well — healthy and well and out of the hospital. So to be at camp and to see them playing and normal and with their siblings, that's her, that's her thing; she just wants everyone to be well and happy.”

With more than 30 years' clinical experience in pediatric oncology, she has treated more than 3,000 children diagnosed with cancer. And she keeps tabs on many of them. “Her mind is a steel trap” for her patients, Wood said. “I can talk about kids that I knew back in 1990 that I took care of and she'll know what they're doing. She'll know if they're married, if they have kids, what they're up to.”

If other staff hears anything about former patients — “her kids” as Wood calls them — Dr. Crouse loves to hear about it. “They’re her world,” Wood said. “It’s amazing to me how she can remember. She knows their diagnosis. She knows how old they are. She knows where they are, what they're doing. She loves everyone.”

Parker Fritsch has been Dr. Crouse’s patient since his acute lymphoblastic leukemia diagnosis and bone marrow transplant in 2008. His fondest memories with Dr. Crouse are from his years at Camp Sunshine Dreams.

“Her camp name is Crush,” he said. “We got her a golf cart and it was yellow and white and we put big stickers on it and it said ‘The Crush Mobile’ … I just love seeing her face as she smiles driving around the kids down to the lake or over to the campfire. Just seeing Dr. Crouse’s smile as she's up there being part of that community, it's amazing that oncology has brought all of us together up there and she is, without a doubt, a key member of that staff.”

“Dr. Crouse has done so much for the community in Fresno and the oncology community out of Valley Children's that it's really hard to put a label on what her biggest accomplishment would be,” Fritsch said. “I think that just being there for her patients, whether it be up at Camp Sunshine Dreams … or being in the hospital, Dr. Crouse is 100 percent on board for her patients’ health and for her patients’ well being. It doesn't matter what time of day or night, Dr. Crouse is always going to be there and that, to me, is her greatest accomplishment.”

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Lifetime Achievement: Gene W. Kallsen, MD

It might be taken for granted that a person can call 911 in Fresno County and an ambulance staffed with a well-trained paramedic will show up in less than 10 minutes to take them to the hospital.

But someone had to put that Emergency Medical Services system in place, and that person was Dr. Gene Kallsen.

Dr. Kallsen, known as the father of EMS in Fresno County, became the county’s first EMS medical director in 1981 and recently retired from a medical career spanning five decades, including four decades teaching.

He was honored with a Lifetime Achievement Award from Fresno Madera Medical Society.

“Dr. Kallsen has his fingerprints on every aspect of this EMS system,” said Todd Valeri, president and CEO of American Ambulance.

“I think that anybody who dials 911 for a medical emergency in Fresno today has an expectation of quality, has an expectation that their call when received at the dispatch center will be appropriately triaged, and that the closest, most appropriate ambulance is going to respond,

that the paramedics and EMTs who arrive on scene are going to be trained and competent, and that they're going to interface with local hospital staff to make sure that patients receive the best care possible,” he said. “I can tell you that wasn't always the case.” In the mid-1970s when emergency medicine had still not been recognized as a medical specialty, Dr. Kallsen applied to UCSF Fresno’s Emergency Medicine residency. Back then, EMS was a “disjointed system,” Valeri said. There were four ambulance companies on rotation, so the closest ambulance was not sent to each call, which lengthened response times — and it was not guaranteed that a paramedic would be in each ambulance.

Dr. Kallsen completed his residency in 1979, the same year the American Board of Emergency Medicine was approved, and began making changes in how EMS was run in the county.

“He, along with other key stakeholders, got together and said we're going to run Fresno County where the ambulance closest to you is going to come to you, and it's going to be a really well run EMS dispatch center,” said Dr. Danielle Campagne, vice chief of emergency medicine at UCSF Fresno. “Those amazing contributions really shaped what we do today and we don't even think about all the forethought he put into creating our community as we live today.”

Valeri recalled his first experiences with Dr. Kallsen in the quality assurance realm, when Dr. Kallsen directly mentored paramedics to help them improve the services they offered.

“Dr. Kallsen was very serious. In fact, many of us young paramedics were a little intimidated,” Valeri said. “However, getting to know him and work alongside and to be taught by him, I really got to see his passion for prehospital care and his deep concern for patients. He just simply wants us to all do our best in that environment and he demanded that.”

Dr. Campagne admired that Dr. Kallsen always leads by example.

“He is cool as a cucumber. He is so calm. He's so kind. He's very compassionate,” she said. “As a resident in training watching him as faculty, he was always my favorite

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person to watch because he's always very calm under fire… I always felt like I wanted him to be my doctor if I was ever injured and I want to be a physician just like him.”

Dr. Kallsen was recognized for building the emergency medicine program at UCSF from 11 faculty and 18 residents up to 34 faculty and 40 residents. An endowed chair at UCSF Fresno was named in his honor in 2015.

“Gene knows not only how to do, but also how to teach,” noted Dr. Alan Kelton, Chief of General Medicine Division at UCSF Fresno in his introduction of Dr. Kallsen at the awards banquet. “He's taught well over 270 emergency medicine residents, but really he's taught hundreds more, OB, surgery, internal medicine, family practice, so many have learned from him, and so many have benefited.”

Dr. James Comes, Chief of Emergency Medicine at UCSF Fresno also recognized the impact Dr. Kallsen had shepherding the emergency medicine program into what it is today.

“We have faculty that have expertise in toxicology and wilderness medicine, and ultrasound and hospice and palliative medicine and critical care and pediatrics and law,” he said. “I mean, could you imagine what our community would be like if we didn't have the training programs that we have here today? And (Dr. Kallsen) is instrumental in that space.”

Dr. Kallsen humbly accepted his Lifetime Achievement Award, but only after commending his fellow healthcare workers on their frontline battles with the COVID-19 pandemic.

“First, I want to say something about the heroes who have been going to work for the last 18 months,” he said, choking up. “I haven't had to face this pandemic as most of you have. I’m very proud of what you've done.”

Dr. Kallsen said it was serendipitous timing that steered the trajectory of his career in emergency medical service.

“I am forever grateful for the dumb luck of my time,” he said. “You know, you couldn't have planned for the specialty that you've trained in to become a specialty within a month from the time you're finished residency. You just couldn't plan that.

“You couldn't plan that within a year after that the EMS legislation for the state finally went into law, and all of a sudden every county had to have an EMS medical director, and all of a sudden the state had to have an EMS commission. To get to be on the ground floor, there was the opportunity that just fell in my lap.”

His colleagues would argue that it is more than luck and opportunity that led Dr. Kallsen to a long, impactful emergency medicine and teaching career — it was his willingness and ability to lead, make decisions, and foster collaboration.

Dr. Campagne recalled the years of her residency

UCSF Fresno EM Residency - 1984 during which

University Medical Center was a county-run hospital and Community Medical Center downtown was a private hospital.

“(Dr. Kallsen) was really instrumental in that merger and bringing County medicine and community hospital together,” she said. “I couldn't imagine now not having this giant regional trauma center that has all these specialties together. I think that is a perfect example of him always thinking 20 or 40 years in the future to make our community a better place to live.

“Without him I think our community would not be what it is today.”

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Special Project - Covid Response: Rais B. Vohra, MD

For the last 20 years, Fresno Madera Medical Society has honored annually a physician who has been involved in a special project that affects Valley residents, patients, and the community as a whole.

This year, the recipient was honored for an effort in a project he never asked for nor expected: becoming the face of the local fight against the COVID-19 pandemic.

Dr. Rais Vohra, an emergency room physician, medical educator at UCSF Fresno, and head of the region’s Poison Control Center, was hired as Interim Health Officer for Fresno County Department of Public Health just a few months before COVID-19 hit the county.

When accepting his special project award, Dr. Vohra recalled being asked what he pictured himself doing in 10 years on his first day in Fresno about a decade ago.

“My answer was not, you know, ‘I want to be burned in effigy by the most privileged and misinformed members

of our society during a global pandemic.’ That was not my answer. But here we are,” he said, as the banquet hall erupted in laughter.

David Pomaville, former Director of Public Health for Fresno County, hired Dr. Vohra in October 2019 and knew he was going to be a great fit based on his experience and ability to communicate warmly and effectively.

“His talent with regard to the ability to distill complex medical topics into small bite-sized pieces that people can understand is one of his greatest gifts,” Pomaville said.

Dr. Vohra also comes up with quotable phrases, which he would display on a whiteboard in the health department’s conference room.

Pomaville’s favorite Dr. Vohra quote: “Your chance of being affected by misinformation is far more likely than being infected with COVID-19.”

Keeping the public informed and protected is top

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priority for Dr. Vohra; he holds weekly Zoom conferences with media partners to keep everyone up to date on the county’s COVID-19 statistics and responses.

When Dr. Vohra was encouraged to take a break from work to spend time with his family at the beach, Pomaville was left to organize the weekly media briefing. He brought in six physicians who each gave a presentation.

At the end of it, one of the presenters asked, “So it took six physicians to come in and do what Dr. Vohra does in one meeting,’” Pomaville recalled. “And that’s Dr. Vohra. He’s able to work so effectively across a broad number of topics and build confidence with his peers and with the public.”

Throughout the pandemic, Pomaville recalled Dr. Vohra working at the public health department and then working a shift in the Community Regional Medical Center emergency room.

“It was so important and so impactful during the pandemic for us to have somebody working on the frontlines in medicine, providing treatment to patients and getting that reality back to us at public health,” he said. “You might think that that's a given that we know and understand what's happening in the medical community, but making that connection was so powerful.”

Dr. Vohra is known for bringing his calm demeanor to every conversation and communicating effectively with the

media, medical providers and government officials, said Joe Prado, Interim Assistant Director at Fresno County Public Health.

“Dr. Vohra has this unique talent. He knows how to write a prescription for the entire County of Fresno population. He knows exactly where we need to be and where we need to go,” Prado said.

Dr. Vohra’s public health team has worked tirelessly to bring local agencies together to collaborate throughout the pandemic in a region that is largely agricultural and medically underserved.

Prado recalled a story from the first week COVID-19 vaccines were approved. It was unclear how many doses would be available to Fresno County and who would be eligible for them.

Prado came to Dr. Vohra and said they needed to take a risk, a word that made the interim health officer sit up in his seat and ask what risk needed to be taken.

“We need to start figuring out how to vaccinate our farmworker population,” Prado said he told Dr. Vohra. “Dr. Vohra immediately looked me straight in the eye and said ‘Let’s do it. Let’s go for it.’”

Dr. Vohra’s energy to say yes to serving vulnerable populations motivated discussions and quick action, Prado said.

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“We ended up being a model for the state of California on how to vaccinate the farm worker population,” he said. “We really helped to demystify how to run a medical clinic. It doesn't have to be a medical provider. We had farmers running medical clinics.

“Dr. Vohra supporting that from the very beginning really helped to encourage our entire community ‘we've got this.’ Just know that we have to work outside our norm to be able to do this.”

Dr. Vohra’s team spirit and positive attitude helped inspire leaders at Sierra Pacific Orthopedic Center — which isn’t traditionally public health-focused — to pitch in and make the community safer.

Rick Lembo, Director of Sports Medicine at SPOC, was inspired to set up a mass vaccination site after his own positive COVID swab.

After a Sunday meeting with the public health department, SPOC gathered the assets and logistics to open its parking lot by Wednesday to start vaccinating thousands of Fresno County residents.

“One thing I learned throughout this and that I admire the most was (Dr. Vohra’s) sense of reassurance, whether it be to health care providers, his fellow providers, to the general public, or in the media,” Lembo said. “He continued to always show resolve and common sense through a very, very tumultuous time. Very clearly he spoke of what's going to happen, what needs to happen and what else we can expect.”

Dr. Robin Linscheid Janzen said Dr. Vohra brought her onto the team at the public health department about six months into the COVID-19 pandemic and she has been able to see firsthand how he steers people toward goals while making them feel comfortable and heard.

“He's good at seeing the whole big picture but also empowering people to kind of take those steps to get to that goal of making our county healthier,” she said.

“We've had disaster after disaster with COVID and then Creek Fire and he's just really been able to provide that reassuring leadership and direction for the County to provide services to those in need.

“He has done a great job of really partnering with community based organizations, with providers, community members, our schools, our faith based community, to really keep them all informed and utilize

them as resources to help the county be healthier, and to stay safe during COVID.”

As expected by his colleagues, Dr. Vohra accepted the award not just for himself, but on behalf of everyone working with him in public health, the frontline heroes, and those he has gotten to know through Zoom calls during social distancing in the past two years.

“I've had the privilege to lead the pandemic response and the health department, and to have this very special role which I've never, ever in my wildest dreams, thought that I would ever have,” he said. “So I feel really honored. To be recognized in this way by my peers and by my mentors and colleagues, is really special and I'm very touched. I'm also very humbled because I know that this award is not just for me, but for really the whole team and the network that we've had to become in order to take care of our patients and to take care of ourselves.

“We've all had the patience and goodwill to stick with each other and really just learn from each other and cover each other's blind spots.”

Dr. Vohra and his family in Yosemite

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