Summer 2020
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COVID in
Fresno
County
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Summer 2020
VOLUME 5, NUMBER 2 • SUMMER 2020
{FEATURES}
14 18 20 22 27 28 38 Summer 2020
CITY THAT NEVER SLEEPS PETITION TO MAYOR LEE BRAND WE HAVE OUR GUARDS UP
{DEPARTMENTS} 6
PRESIDENT’S MESSAGE
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EDITOR’S MESSAGE
10 CHSU UPDATE 54 CLASSIFIEDS
STRUGGLED THROUGH COVID
55 IN MEMORIUM
STEVEN N PARKS LEADERSHIP AWARD RESPONDING TO COVID UCSF FRESNO GRADUATES
CENTRAL VALLEY PHYSICIANS
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From The Executive Director
STOP, DROP, AND ROLL… you learn that term as a
NICOLE BUTLER
kid if for some reason you are on fire. You know, so the flames are smothered and not fed to become bigger. That term has come to mind about 100 times in past months. Obviously I was not on fire, but I spent a majority of the day with a ton of fire balls in the air wondering which ones were most important and accurate. Wondering which ones to keep burning and which ones needed to be stomped out. COVID is the fire balls being shot at me and before I made decisions, I really tried to stop, drop, and roll.
I knew in the back of my mind that if there was one time Fresno Madera Medical Society could prove their worth it would be during a crisis. Heck we are defined as a professional organization developed to promote high standards in medical education and practice, science, and ethics. Working to promote and protect the interests of our physician members. When the pandemic started that weighed on me for weeks, I didn’t want to fail my members. Our whirlwind started early with a lot of questions and requests from physicians that required us to step up and outside our comfort zone. For example if someone would have said we would be sourcing PPE materials 6 months ago I would have laughed. But there we were, sourcing and working with several partners to develop and purchase PPE materials for the Valley. Stacy worked long hours on the GuardsUP face shield program finding volunteers for production, getting prototypes approved and helping with the distribution. We delivered thousands of face shields to health care facilities and professionals within weeks. The community stepped- up and the response was incredible, there would have been no way we could have delivered that amount of supplies without the funding from community members wanting to support the healthcare industry and the the physicians wanting to ensure colleagues on the frontlines were safe. As of today, FMMS has distributed 30,000 pieces of PPE to hospitals and physician offices and raised over $14,000 in funds to secure the items that we couldn’t get donated. All of this was going on top of regular business. At one point during shelter in place, I told my husband that I had calls and communication with CMA, FCDPH, AMA, CMS and CDPH all in one day. As exhausting at that sounds, it was those calls and emails that provided us valuable information and answers we needed to ensure we were feeding the correct information to our physicians about everything from telemedicine, staffing, loans, PPE, etc. We wanted to make sure the information was timely and valuable so physicians to make informed decisions on patient care, staff. Lastly, I want personally congratulate Dr. Rais Vohra for receiving this year’s Key to the City for Fresno County. I talked to Dr. Vohra almost daily and every time I received an immediate and pleasant response from him. Let me remind you that Dr. Vohra was appointed Interim Health Officer for the Fresno County Department of Public Health in JANUARY, around 8 weeks before a national pandemic was announced. He is the definition of “hit the ground running”. Well-deserved Dr. Vohra.
PRESIDENT Alan Birnbaum, MD PRESIDENT-ELECT Don Gaede, MD VICE PRESIDENT/ TREASURER Christina Maser, MD PAST-PRESIDENT Cesar A. Vazquez, MD BOARD OF GOVERNORS Janae Barker, DO, Shamsuddin Khwaja, MD, Katayoon Shahinfar, MD, John Moua, MD, Pamela Kammen, MD, Ravi Rao, MD, Sonia Shah, MD, Marina Roytman, MD, Jesus Rodriguez, MD, Greg Simpson, MD, Brent Kane, MD, Jai Uttam, MD, CMA Trustee; Ranjit Rajpal, MD CENTRAL VALLEY PHYSICIANS EDITOR Farah Karipineni, MD MANAGING EDITOR Nicole Butler ASSISTANT EDITOR Don Gaede, MD EDITORIAL COMMITTEE Farah Karipineni, MD - Chair, Chang Na, MD Roydon Steinke, MD, Cesar Vazquez, MD Hemant Dhingra, MD, Nicole Butler, Trilok Puniani, MD Alan Birnbaum, MD, Alya Ahmad, MD FAAP CREATIVE DIRECTOR www.sherrylavonedesign.com CONTRIBUTING WRITERS Alan Birnbaum, Malissa Trenholm, Stacy Woods, Erin Kennedy, Nicole Butler, Farah Karipineni, MD, MPH, Millie Thao and Anthony Molina CONTRIBUTING PHOTOGRAPHERS Erin Kennedy, Nicole Butler, Stacy Woods, CHSU Staff, Anthony Imirian CENTRAL VALLEY PHYSICIANS is produced by Fresno Madera Medical Society PLEASE DIRECT ALL INQUIRIES AND SUBMISSIONS TO: Central Valley Physicians 255 W. Fallbrook, Suite 104 Fresno CA 93711 Phone: 559-224-4224 • Fax: 559-224-0276 Email Address: nbutler@fmms.org MEDICAL SOCIETY STAFF Executive Director, Nicole Butler Membership and Events Manager, Stacy Woods
Sincerely,
Nicole Butler
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FMMS Joy of Medicine www.FMMSJoy.org
It’s Ok To Ask For
Help RESILIENCY CONSULTATIONS The Fresno Madera Medical Society recognizes the overwhelming stresses and immense workloads that physicians face today. Stress, anxiety, depression and grief are common, but they can be managed. Resiliency Consulta�ons can provide relief, an increased ability to cope, healing and an opportunity for personal growth. FMMS sponsors up to four (4) annual sessions with approved and ve�ed providers confiden�ally, conveniently and FREE to physicians living and prac�cing in Fresno and Madera Coun�es. Par�cipa�ng in a Joy of Medicine Resiliency Consulta�on is completely confiden�al. Neither FMMS, your employer, nor the California Board of Medicine will be no�fied if you choose to par�cipate. Par�cipa�ng providers offer a wide range of appointment �mes that strive to accommodate the unique and busy schedules of physicians. Providers are paid by FMMS directly, discreetly and anonymously. Insurance will not be asked for or billed. Physicians have the op�on of extending their par�cipa�on at their own expense a�er the fourth visit. It’s OK to ask for help! Call today to schedule a free Resiliency Consulta�on and begin the process of reconnec�ng to your Joy of Medicine.
RECONNECT TO YOUR
Joy of Medicine
SCHEDULE ROUBICEK and THACKER 559-323-8484 2020 AN Summer APPOINTMENT
CENTRAL VALLEY PHYSICIANS 5 County Call and identify yourself as a physician practicing in Fresno or Madera
A message from our President > Alan M. Birnbaum, MD
COVID-19
ABOUT THE AUTHOR Alan M. Birnbaum, MD, is boardcertified in Adult Neurology and is with Spruce Multispecialty Group. Dr. Birnbaum is currently Medical Director of the Saint Agnes Medical Center Stroke Program and a Board Member of Fresno Madera Medical Society.
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As Summer 2020 ascends, two crises crowd us, origins separate but synergistic. Dating the local onset of the COVID-19 pandemic proves problematic, but I choose January 24, 2020, when our Interim Fresno County Health Officer issued, even before cases emerged on our shores, a “2019 Novel Coronavirus Update,” that recognized the threat even when fewer than 900 cases had been reported from Wuhan City in mainland China. Rais Vohra, MD, read the viral weather report correctly, though our county did not see its first cases until March. Alas, public awareness and acceptance of the threat then did not emerge for eight weeks, when Governor Gavin Newsom issued California “shelter in place” orders that proved only partially effective. Such restrictions now are being rescinded despite Central California still daily reporting 53 new COVID-19 cases. Every day I follow statistics posted by Dr. Vohra and his staff, and share them plus related calculations with a group of colleagues. Locally we have fared better than the Bay Area, surely better than Los Angeles, and far better than especially New York City, where at the peak, overwhelmed hospitals struggled to provide care to those stricken, We could have done better. We had the medical knowledge, yet national health policy failed to respond rapidly enough to avert our deteriorating situation. The USA +remains the nation with the greatest number of cases and sadly the most deaths. As of this writing, the US exceeds two million infections with deaths passing 114,000. In California alone we have 136,323
Summer 2020
infected and 4,766 fatalities. Worse, as states re-open, recurrent upward spikes emerge. Among those most aff licted have been Americans figuratively further wounded by the Minneapolis
Minister, Helen Clark, who observed that Ardern “doesn’t preach at them; she’s standing with them.” With that, Kiwis accepted a rapid, severe lockdown, reaching a blunted disease peak by early April, with only a handful of fatalities. That success was aided further by a continuing border closure to China in early February, then Could we have done better? Alas, national to all foreigners by mid-March, enhanced leadership of old white men voicing denial by expanded testing and contact tracing, cost us valuable time responding to the and supported by 84-88% approval of a consensus approach agreed upon by all New waves of virus assaulting us from across the Zealand parliamentary parties. “We united Pacific, and from poorly monitored air traffic in unprecedented ways to crush the virus,” over the Atlantic to our east coast. Ardern Monday advised a press conference in Wellington, confirming that social distancing was ended, so “We now have a crime that ignited the “Black Lives Matter” movement. head-start on our economic recovery.” African-Americans and Hispanics had already been Contrast that with the feeble federal response in economically impacted by pandemic mitigation measures. our country. We saw only hesitant acceptance of expert Unemployment and illness form a potent substrate for the threat of physical peril. Complicating that now are widespread “We now have a head-start on our economic demonstrations which, masks or not, recovery.”- Ardern Monday disrupt social distancing tenuously holding the pandemic in check. Could we have done better? Alas, national leadership of old white men voicing denial cost us valuable time responding to the waves medical opinion from Drs. Birx, Fauci and others, mitigated of virus assaulting us from across the Pacific, and from fortunately by many Governors who acted vigorously. So poorly monitored air traffic over the Atlantic to our east as summer ascends, we still face many months of social coast. management, until an effective vaccine emerges. Fresno Better was possible, as several nations demonstrated. County continues to see 53 new cases of COVID-19 a Look at New Zealand, a nation led by a female Prime day, no downturn yet emerging. With a stronger national Minister not yet forty years old, mother of an infant approach, by now that could have been far less. daughter; she is a leader who rapidly recognized and Consider a conservative personal response to any “reaccepted the threat, then mobilized her nation to an opening.” Heed your personal risk and that of your family. effective response that as of this week includes NO active Counsel your patients similarly. cases. Who is that masked man? Alas, it is you, and I! Prime Minister Jacinda Ardern, per The Atlantic, “may be the Most Effective Leader on the Planet.” Uri Friedman Alan M. Birnbaum, MD relates that she “is forging a path of her own. Her leadership President, Fresno-Madera Medical Society style is one of empathy in a crisis that tempts people to fend for themselves.” He quotes former New Zealand Prime
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A message from our Editor > Farah Karipineni, MD, MPH
Living in Uncertain Times We continue to live in uncertain times. COVID has far from disappeared, and for most of us, our lives continue to be shadows of what we used to call normal. Unfortunately, what has not changed is the societal issues that plague us even under the best of circumstances—issues like brutality against African Americans, intimate partner violence, and migrant children falling ill in detention to name just a few. No, COVID did not dampen these issues; the pandemic may have diverted our attention, but these atrocities are f lourishing in its wake.
ABOUT THE AUTHOR Farah Karipineni, MD, MPH, is board certified in General Surgery and fellowship trained in Endocrine Surgery. She is currently practicing in Fresno as an Assistant Clinical Professor for UCSF. Dr. Karipineni earned her medical degree from University of California, Irvine School of Medicine. Her residency in General Surgery was completed at Albert Einstein Medical Center, and she completed her fellowship in Endocrine Surgery at Johns Hopkins School of Medicine. Dr. Karipineni has been published in journals including The American Surgeon, the International Journal of Surgery, and the Journal of Surgical Education.
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Most disturbing is the most recent rash of senseless African American killings of George Floyd, Breonna Taylor, and Ahmaud Arbery. It is important to note that while these have been highly publicized incidents, they are tragically not the only ones, nor do they represent an increasing trend. Rather, thanks to smartphones and social media, some of these killings are now being recorded and the world is forced to bear witness. But it is not enough to simply bear witness. As an American citizen, I am appalled at my own ignorance. I am ashamed that it has taken me this long in my life to really contemplate what it means to be Black in America. What it means to be married to a Black man, or to raise a Black son, when—per the documentary 13th—1 in 3 of that demographic will be imprisoned in their lifetime for something that would not require incarceration for any other race. Or, worse, they can be murdered for no crime at all, other than being alive and Black. As a physician, I cannot sit back and watch. As a small act of truth-telling and solidarity, I have taken to wearing a Black Lives Matter (BLM) mask everywhere I go. The different reactions to my mask, both in and out of clinical settings, are very telling. So is the reaction to my yard sign, which has been repeatedly stolen and even replaced with a dissenting sign. How can a statement so simple spark so much contention? A patient of mine asked,
Summer 2020
Why is it important to you to proclaim that Black lives As an American citizen, I am appalled at my own matter?”; I told her that as a ignorance. I am ashamed that it has taken me this physician and an American, I must stand with those long in my life to really contemplate what it means whose lives are endangered to be Black in America. simply by the color of their skin, and no one in America, historically or currently, To those who argue this, educate yourself. Racism is so has been so systematically widely integrated and accepted in our culture that we don’t mistreated as African Americans. This is not an issue that even know that empty words like “colorblind” are actually is simply in vogue; it is a constant root of evil in our society. complicit. To not educate ourselves on our own implicit Let us just contemplate what Black people endure on a daily biases is to be complicit. Only by facing the atrocities of basis if a simple statement on a yard or a mask about them how racism has been institutionalized over time in our mattering is so unbearable. country and ingrained into the fabric of society—and medicine—can we realize that until this problem is People have many counterarguments to the statement that addressed, our Black patients will continue to suffer, and we Black lives matter. Some cite the imperfect sociopolitical will never ALL be free. movement. Others state that “All Lives Matter” and it is wrong to focus on one race. Still others defensively wonder For resources on being an ally: why we should care about racism when Black on Black crime is so prevalent. • E ducate yourself on White privilege. It applies to races other than Whites; for instance, model minorities
Summer 2020
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benefit from their stereotype being “just another Asian doctor” and not “just another Black criminal”
action items on their agendas. Participate in these committees.
• F ollow the #BlackInTheIvory threat on Twitter to educate yourself on the micro- and macroaggressions Black academics face daily.
•V isit HYPERLINK “http://whitecoats4blacklives.org” whitecoats4blacklives.org to learn about this grassroots movement by medical students.
•A mplify voices of Black colleagues; seek conversations that may be uncomfortable but lead to increased awareness of their experiences and how to bring about change.
* Watch and read. Netf lix has a solid Black Lives Matter collection. Put books like “How To Be an Antiracist,” “White Fragility,” “Stamped from the Beginning” on your reading list.
• E ducate yourself on racial diversity data in your medical system for residents, faculty and allied health professionals. Patients need health care providers who look like them.
•H ave age-appropriate discussions with your children about racial justice. These may be uncomfortable discussions; recognize that many children growing up in America do not have the luxury of age-appropriate introductions to the topic of racial inequality.
•U rge your respective professional and subspecialty societies to make diversity and racial justice major
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PHOTO COURTESY OF CHSU.
BY RICHELE KLEISER
CHSU Offers Local Valley Students More Opportunities to Pursue Health Care Education Healthy Eating Leads to Healthy People Learn How a Local Medical School Incorporates Nutrition into their Curriculum The Valley’s new medical school welcomes their inaugural class of 75 students in July and is eager to teach nutrition as an integral part of the curriculum. California Health Sciences University College of Osteopathic Medicine (CHSU-COM) is passionate about teaching healthy eating, wellness and nutrition to both their students as well as to the local community. CHSU-COM medical students will learn the basics of nutrition through team-based learning applications, case studies, and hands-on cooking classes. Through training
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in basic nutrition and culinary medicine, they learn to think of disease prevention and management through the lens of lifestyle intervention. Students will specifically learn healthy cooking methods, delicious recipes for the promotion of overall health as well as prevention and management of chronic conditions such as: • High blood pressure • Diabetes • Food allergies • Celiac disease
Summer 2020
PHOTO COURTESY OF CHSU.
The CHSU medical school features an on-site, teaching and demonstration kitchen. The kitchen is outfitted with Whirlpool appliances, food preparation areas, and multiple cameras and viewing screens so culinary techniques can be demonstrated for a large class or recorded for future class review. This unique facility will also host hands-on cooking and demonstration classes for the community to learn about how to cater their diet to help combat obesity, diabetes, and other diseases. Future plans also include forming student interest groups for those that may want to learn from each other, having local chefs lead guest presentations, and offering educational sessions to physicians and other health care providers to earn Continuing Medical Education (CME) credits. John Graneto, DO, MEd, Dean of the College of Osteopathic Medicine says, “It is our responsibility to educate our students and the community about healthy eating and nutrition, we have the power to change eating habits and enable people to live longer and healthier lives.” He adds, “With the large abundance of locally available fresh produce, I am excited to partner with our farmers and use home-grown fruits and vegetables to highlight the agriculturally rich and diverse Central Valley area.” Meet CHSU-COM’s Nutrition and Culinary Medicine Faculty Team: Emily Johnston, PhD, MPH, RDH - Assistant Professor, Biomedical Education Dr. Johnston is a registered dietitian, holds a doctoral degree in nutrition and is currently pursuing a Culinary Medicine Specialist certification. With extensive experience in teaching culinary medicine classes to medical students and residents, she leads the CHSU-COM culinary medicine classes. Summer 2020
Samuel Kadavakollu, PhD, MSc - Associate Professor, Biomedical Education Dr. Kadavakollu directs the biochemistry course where the metabolism of nutrients is taught in detail. Drs. Kadavakollu and Johnston are working closely to ensure that nutrition is integrated into the biochemistry topics that appear throughout the curriculum. Sara Goldgraben, MD, MPH, MBA - Assistant Professor, Specialty Medicine Dr. Goldgraben is a board-certified preventive medicine and public health physician who will be teaching hands-on classes in the teaching kitchen. Nutrition is an integral component of prevention, and students will learn about this, as well as other behaviors, like smoking cessation and physical activity in their coursework. Avtar Nijjer-Sidhu, PhD, RD - Assistant Professor, Primary Care Dr. Nijjer-Sidhu holds a doctoral degree in nutrition sciences and teaches the CHSU Health Systems Science course. She guides medical students to develop quality improvement initiatives for federally qualified health centers to improve health outcomes. Dr. Nijjer-Sidhu has taught cooking classes in the community and at food banks to expand upon community health and wellness through healthy eating. For more information about CHSU-COM and the nutrition program, visit osteopathic.chsu.edu.
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LOCAL HEALTHCARE HEROES IN THE CITY THAT
NEVER SLEEPS
BY MILLIE THAO
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New York City, The Big Apple, one of the most affluent cities in the world, was recently in the headlines riddled with demise, disease and COVID-19.
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To twin brothers, Garrett and Kyle Hicks, it was a city they had never stepped foot in. As a critical care nurse practitioner from the Central Valley, Garrett says he was contacted by a recruiter saying there was a need for his assistance. Twenty-four hours later he was on a plane heading to New York with only a phone number and hospital address in hand. His brother Kyle, studying for his nurse practitioner exam, would follow him two weeks later to help in the fight against the coronavirus. "I kept seeing on the news," said Garrett. "They really needed help. It was a true crisis and I thought, with my background in critical care, I could really go there and help. I'm young and healthy. I knew what needed to be done." Garrett and Kyle grew up in Clovis, California, and attended Buchannan High School where they were first involved in an EMT program that launched their careers in emergency medicine and critical care. The twins' mom, also a nurse practitioner, had her reservations about them leaving, but understood their reasoning. "My parents were apprehensive, they didn't feel it was worth the risk, but ultimately they were supportive," said Garrett. They gave their current jobs notice that they were taking an extended leave and booked a one-way ticket to New York. On the plane, Garrett was one of six passengers. When landing, Garret says, "the airport was dismal. There was absolutely nobody there. I was afraid I wasn't going to be able to find an Uber to take me to the hospital." Upon arriving at the hospital, Garrett
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not a way to prepare for this. The virus showed that we have a systemwide lack of resources and training to address issues like this." Garrett and Kyle say this experience has taught them more about medical management, ICU ventilated patients, managing Extracorporeal Membrane Oxygenation (ECMO) patients and more about Acute Respiratory Distress Syndrome (ARDS). They currently are still in New York and report that the situation is improving weekly and the access to resources is increasingly better. They plan to stay as long as they are needed, but eventually will come home to the Central Valley.
was granted emergency credentials. He worked in a makeshift ICU alongside a podiatry resident, who had no experience in critical care. He was provided one N95 mask and was told to use it for five days. At one time, he recalls there were more than 54 ventilated patients in a hospital that normally housed 14 ICU beds. They used a Post Anesthesia Care Unit (PACU), an open room, and filled it with COVID-19 patients. "The supplies were scarce. We were using a ventilator that was meant for short-term use, maybe a few hours. It was repurposed and used for 4 weeks," Garrett said. "There was
AJIT RAI, MD, ANESTHESIOLOGIST, DIDN'T TELL HIS PARENTS HE WAS LEAVING FOR NEW YORK. RAI HAD TRAINED IN THE CITY AND WHEN HE HEARD HIS COLLEAGUES WERE OVERBURDENED AND OVERWORKED DUE TO COVID-19, HE WAS EAGER TO HELP. "My colleagues told me about the horrors they were experiencing in New York City hospitals," Rai said. "With elective surgeries ceasing, I felt an obligation to help." Rai took a leave of absence from his anesthesia practice in Fresno for a total of eight weeks, but it wasn't Rai's first time on the front lines. He previously worked for Doctors Without Borders in the Middle East, providing care for war wounded refugees fleeing Iraq, Syria, Palestine, and Yemen. "When my parents found out, they were emotional at first," said Rai. "But they know me. They've grown accustomed to
"THE SITUATION WAS FAR WORSE THAN I EXPECTED. I'VE DONE HUMANITARIAN WORK ACROSS THE GLOBE AND I'M USED TO SEEING RESOURCE DEPLETION, BUT NEVER DID I THINK I'D BE EXPERIENCING THIS IN ONE OF THE MOST AFFLUENT CITIES IN THE WORLD." - AJIT RAI, MD
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my adventures." Like the Hicks twins, Rai found himself in a resource depleted environment. Upon his arrival, he was given one N95 mask and was told to make it last. "The situation was far worse than I expected. I've done humanitarian work across the globe and I'm used to seeing resource depletion, but never did I think I'd be experiencing this in one of the most affluent cities in the world," Rai said. With his experience, Rai staffed the ICU and was on the emergency response team. Rai recalls over a 24hour period, putting 18 patients on life support. "Although the situation was dreary, what was most impressive was how resourceful everyone became," Rai said. "People repurposed their primary skill set. For instance, there were dermatologists, who didn't have critical care experience, asking how they could help. So, they stepped in and participated in end of life conversations with family members. This alleviated us to move on to other patients in need." Rai states he has an obligation as a young, healthy physician to provide aid wherever it is needed most. "Just like you want your most experienced orthopedic surgeon replacing your knee, you want the most experienced COVID doctor taking caring of your loved one," said Rai. "There is value in continuity and expertise." Rai is currently back home in Fresno, but plans to continue to provide care in any outbreak areas throughout the country and the world.
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A PETITION TO MAYOR LEE BRAND AND THE CIT Y OF FRESNO As more people are walking and biking during the COVID-19 pandemic, traffic speeds are up, and collisions are also up. While we are re-opening the city, many people are still encouraged to stay close to their homes and are more dependent than ever on the existing infrastructure in their neighborhoods, and there is an urgent need for safe, socially distanced access to businesses for curbside pickup and dining.
marked disparities in basic transportation infrastructure, inequities which exist to this day, it is imperative to invest equitably and ensure we're addressing the needs of our most vulnerable populations. The BPAC taskforce has proposed that at least one or two projects per Council district be implemented so as to provide access to safe active transportation infrastructure in all areas of Fresno.
Many other large cities in California have responded to the COVID-19 crisis by augmenting safer active transportation opportunities for their residents, so-called “Slow Streets.” These often include the use of temporary, low-cost pop-up projects with low-cost “soft” street closures using simple devices such as cones, sawhorses with signage, and inactivation of manually operated buttons on cross walk signals.
In developing and adapting the slow streets projects, creative community engagement strategies ought to be employed to provide ongoing feedback. Consideration for connectivity to schools and places of employment should be emphasized and pedestrian and bicyclist safety be prioritized for travel with reduced traffic speeds on crowded corridors.
Therefore, the City of Fresno’s Bicycle Pedestrian Advisory Committee’s Slow Streets Task Force, with the support of the US Green Building Council of Central California, Every Neighborhood Partnership, numerous other professional, community and faith-based organizations and individuals, is petitioning Mayor Lee Brand and the City of Fresno to address the increased active transportation needs of the public during the COVID-19 pandemic. We are writing to urge Mayor Lee Brand and members of the Fresno City Council to direct City Staff to explore ways to increase active transportation opportunities in Fresno, and to appoint a temporary working group to work with City Staff in the coming weeks and months, in order to develop a comprehensive City of Fresno COVID-19 active transportation rapid response strategy. Such a strategy would promote safe active transportation options for essential travel, and allow people to safely walk, run, and bike in their neighborhoods. Given that decades federal and local policies have left Fresno's low-income communities of color with
Summer 2020
Lastly, potential COVID-19 relief funding for such projects ought to be explored and included in upcoming budget discussions. In the interim, we are requesting that any existing and available City of Fresno assets be leveraged to fast track temporary, low-cost projects, and any city-imposed permitting fees and processes be minimized or suspended. Increasing access to safe active transportation infrastructure creates space for social distancing, allows for healthful exercise, helps balance inequities in access to green space, improves air quality, reduces speed on the streets, and prevents speed related accidents. Anthony Molina, M.D., Chair, City of Fresno Bicycle Pedestrian Advisory Committee Slow Streets Task Force Laura Gromis, , Executive Director, US Green Building Council of Central California Germán Quiñonez, Neighborhood Development Director, Every Neighborhood Partnership
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We have our
GuardsUP!
30,000 PIECES OF PPE TO FRESNO AND MADERA COUNTY As the Shelter in Place order became official and hospitals started admitting patients affected by COVID 19, it soon became clear that on-hand inventories of personal protective equipment were not sufficient to keep up with the growing demand. Along with toilet paper, paper towels and hand sanitizer, face shields, N95 Masks and surgical masks were quickly “out of stock�. Anticipating the need would be great; Fresno Madera Medical Society researched ways to help supply our local doctors with the necessary PPE to handle the pandemic. The GuardsUp! Campaign kicked off to help raise funds to offset costs and the search for suppliers began. With traditional channels back logged, FMMS turned to alternative suppliers. MakerSpaces across the world had begun brainstorming solutions as to how they might produce PPE on a small scale for their local physicians, first responders and communities. Local creatives in downtown Fresno, including Mark Jackson
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at the Pi Shop, Derek Payton at Root Access and Janelle Ozeran at Fresno IdeaWorks were already studying designs of 3D printed face shields shared by other makers and enlisting an army of volunteers to assist in production. Prototypes were created and taken to Fresno County Public Health for Dr. Rais Vohra’s input. Within days the first shields were rolling off the assembly line and into local hospitals. The Pi Shop produced heavy duty, laser cut face shields while Fresno IdeaWorks focused on 3D versions and Root Access dedicated their resources to the production of cloth masks. A few miles away at Career Technical Education Charter High School (CTEC), Director Jon Delano and Advanced Manufacturing Teacher Brian Emerson filled their days monitoring 29 3D printers and working with MakerBot, the printer manufacturer, to streamline design and maximize efficiency to allow for roundthe-clock production. Additional donations of PPE for GuardsUP came from Central Valley Community Foundation; Riley’s Brewing in Madera, Ford Motor Company Foundation, tieks by Gavrieli (shoe company) and Traveler Surf Club (clothing). This grass-roots community effort is responsible for 30,000 pieces of PPE added to inventories in Fresno and Madera Counties and a shining example of the resourcefulness, compassion and humanity in the Valley. The need continues. Donations to GuardsUp! are still being accepted with one hundred present of funds raised going toward the effort to supply physicians with the protection they need to continue to care for those affected by COVID 19.
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Total funds raised to date and $14,000.00 LISTED BELOW ARE ALL OF THE DONORS.
Amitabh Goswami, MD Don H Gaede, MD Glenn Hananouchi. MD
Organization Donations from:
Mary Hansen
CalViva Health
Susan Hill
Central Valley Community
Pamela Kammen, MD
Foundation
Hanna Krebs
CTEC Fresno County Office of
Patrick MacMillian, MD
Education
Anna Marie Gonzalez, MD
Fresno Madera Medical
Pio Martin
Society Alliance
Christina Maser, MD
Fresno Madera Medical
John Moua, MD
Society Foundation
William Podolsky, MD
Ford Motor Company
Bonnie Polson
Foundation
Richard Polson
IdeaWorks Fresno
Sharon Pryor
Jewish Federation of Central
Laura R Martinez
California
Randy Rebella
Riley's Brewing
Charlaine Roberto
Root Access
Marina Roytman, MD
The PiShop
Jennifer Russell
tieks by Gavrieli
Marcia Sablan, MD
Tiger Livy Productions
Anthony Sablan
Traveler Surf Club
Lara Safadi
Sumera Hayat, MD
Susan Sanders
Personal Donations from:
Laura Sanford
Roberta Alexander
Judith Saunders
Mark Alson, MD
David A. Schools
Cecilia Alvidrez
Katayoon Shahinfar, MD
Loren Alving, MD
Cynthia Sinclair
Balwinder Bains
Alan Sortor, MD
Jacques Benninga
Sean Tower, MD
Michael Chakov
Jai Uttam, MD
Lisa Chun
Ko Vang
Pam White
Maria Vargas
Terril Efird, MD
Kent Yamaguchi, MD
Ahmad Emami, MD
Vendetta Yenter
Lorrae Emory
Michael Yezbick
JoAnne Sargent
Karen English Vickie Fouts
Thank you to all that
Byron Fox
donated to the GuardsUP
Kristen Garneau
program. CENTRAL VALLEY PHYSICIANS
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Struggled through
COVID
and how we are recovering: Local scenarios By Malissa Wade
Just like there are two sides to a coin, there are always two sides to a story. While small businesses and individuals have been affected by COVID-19, many private physician practices have also been challenged to stay afloat. Nationally and even here locally, physicians have had to quickly pivot their entire business models to provide telemedicine care over the phone or via the internet, while at the same time manage worried staff members
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and struggle with an extreme shortage in Personal Protective Equipment (PPE). Although many local physician offices faced challenges, a silver lining was revealed. Here are two different local perspectives and scenarios.>>
Summer 2020
Impact
in the waiting room, the office closed and we switched back to telehealth. We then fully opened again on May 10.” Conversely, some practices actually benefitted from the rapid change, particularly California Pain Consultants in Fresno, Calif., owned and operated by Amitabh U. Goswami, DO, MPH. “We weren’t tremendously impacted,” Dr. Goswami says. “I thought that things became a bit easier without the stress of seeing so many patients on a given day. We were quickly able
According to the California Medical Association’s COVID-19 Physician Financial Health Survey, 95 percent of physician practices statewide are worried about their financial health due to the COVID-19 public health emergency. Practice revenue statewide has declined by 64 percent since March 1, 2020, and 75 percent of practices are experiencing a revenue decline of 50 percent or greater. Specifically to the Central Valley and coastal areas, the survey found that “We weren’t tremendously impacted. I thought that things physicians ranked financial assistance (64 percent), temporary housing (58 became a bit easier without the stress of seeing so many percent), and PPE (55 percent) as the patients on a given day. We were quickly able to transition most important resources they need. to a telemedicine-based practice where I can still interact Additionally, virtually all practices (95 percent) reported a substantial decrease with my patients.” - DR. GOSWAMI in patient volume while practice revenue has declined by an average of 58 percent. Practices have had to implement multiple, drastic measures to to transition to a telemedicine-based practice where I can still stay viable: interact with my patients.” • 4 1 percent of practices have had to lay off or furlough Dr. Goswami says his practice never closed and was physicians/staff. considered essential because the objective and goal was to help • 59 percent of practices have reduced physician/staff hours. offload the local hospital ERs, ORs and urgent cares from a • 27 percent have had to cut physician and staff salaries. possible influx of patients with chronic pain problems. • 9 percent have had to close their practice temporarily. “For me, patient volume increased because I was able treat more people via telemedicine,” Dr. Goswami says. “I don’t have Due to an increased uncertainty and worry among his office physician assistants or nurse practitioners in my practice so I staff once the statewide order to close was mandated, Praveen was able to personally video chat with more people in one day Buddiga, MD, FAAAAI, of Family Allergy Asthma Clinic in rather than taking time to go from room to room in my office.” Fresno, Calif., closed his practice on March 15, 2020. Thankfully, Dr. Goswami says the Centers for MediCare & “I have a small one-physician practice with seven employees,” Medicaid Services (CMS) bills telemedicine the same as an inhe says. “I could see worry on most of their faces, so we shut person visit. However, the amount of procedures he performed down for 10 days and I had to switch to telehealth to maintain at hospitals and surgery centers decreased. continuity of care for our patients.” “The biggest thing that slowed down was the procedures Dr. Buddiga says performing consults over the phone was I performed,” he says. “Most patients were interested in initially a big change, although manageable. The transition procedures during COVID; however their family members was most challenging for the MediCare and MediCal patient were more cautious. I carefully continued with elective pain population due to lack of access to computers, so telephone procedures. It was essential to keep an increase of patients out consults were more successful in these cases. of the hospitals in order to allow them to focus on potential “There was a decrease in patient calls over a period of time COVID-19 patients.” because most patients did not want to do telehealth,” he says. After 10 days of closure, Dr. Buddiga’s practice opened again for two weeks – until Coronavirus cases started aggressively rising. With change, there are always challenges to overcome. While “That was around the time when the daily mortality rate in many physician practices, institutions and hospitals across New York City was almost in the thousands,” he says. “For the the country faced difficulties securing PPE and masks, it was protection of my staff as well as patient-to-patient interactions no different for our health care entities in the Central Valley.
Challenges
Summer 2020
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in their cars rather than in the waiting room. In addition to these physical changes, physicians are also facing problems with the revenue cycle due to confusion in billing and coding for telemedicine. “We still don’t know yet if insurance companies cover telemedicine, so it’s a double edge sword,” Dr. Buddiga says. “Initially, some patients’ insurances were OK and some were not prepared. The computer system basically was not ready to understand our billers who were inputting codes for telemedicine so it was rejected initially, but after eight weeks it improved once the computers were updated. This also led to an enhanced administrative burden of billing most of the telehealth visits over again. Generally, every practice saw an increase in no-shows and a decrease of patient volume. Some practices’ patient volume dropped 60 percent. Hopefully in the next few months we will see it improve because change in volume directly correlates to the revenue cycle.” For Dr. Buddiga, lack of securing PPE was another significant factor as to why his business had to close. “A big challenge and frustration is lack of PPE because it went so fast and it wasn’t available to immediately deliver, which is a major reason why I closed initially,” he says. “Still today, when I go online to order PPE, it’s very hard to find N95 masks and I have to be very careful where I order from, secondary to artificial price elevation and long delays in delivery.” Luckily, the Fresno Madera Medical Society stepped in to help many physician practices like Dr. Buddiga and Dr. Goswami’s by delivering masks at no cost. “When patients came in we took the appropriate precautions and care for them and staff – this is where the Fresno Madera Medical Society was very instrumental in helping us continue,” Dr. Goswami says. Dr. Buddiga says another issue was creating and regulating a social distancing plan so that very few people are in the waiting room at once. Patients are instructed to call upon arrival and to sit in their car until their appointment time rather than in the waiting room. Dr. Goswami says there were several challenges mandated from the City of Fresno. His practice changed the way people entered the building by placing signs on the floor and on chairs to designate the appropriate six-feet social distance. Still today, his staff also performs patient temperature checks before they enter, as well as conduct a Centers for Disease Control and Prevention (CDC)-provided COVID questionnaire in person and over the phone before scheduled appointment times. Masks are provided to patients who don’t have them and family members and visitors are instructed to wait for patients
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A helping hand
“Small group practices have only one source of income and that’s inflow of patients – and when your patients don’t come to you, it’s basically shut down mode,” Dr. Buddiga says. “As doctors or health professionals, there should be some sort of leniency and accommodation to both public and private loans to continue to maintain payroll during a time like this.” Luckily, the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) provided a $377 billion stimulus package for small businesses that also included private physician practices. The package provided relief under a number of various Small Business Administration (SBA) programs. According to the CMA, the fallout from this crisis has threatened to fundamentally alter California’s health care delivery system, not just during the 2020 COVID-19 outbreak, but for years to come. CMA’s COVID-19 Physician Financial Health Survey highlights the immediate need for financial assistance for physician practices. Specifically for the Central Valley and coastal areas, the survey found that more than half of practices (60 percent) applied for a loan created by the CARES Act. “My practice was blessed with the Department of Health and Human Services (HHS) stimulus relief funds given to providers who see MediCare patients, and on top of that, we qualified for the Paycheck Protection Program (Triple P Loan) from the SBA to keep my staff on board so we could keep operations going,” Dr. Goswami says. Dr. Buddiga was also granted the HHS loan for small businesses, which kept his business afloat.
Summer 2020
says will continue to be followed throughout the rest of the year. “The good that has come out of this is we are now prepared for sudden changes to patient flow,” Dr. Buddiga adds. “We have adapted and learned. Telehealth has improved in terms of access to care – just because you can’t come in, you can still get access to care.” Dr. Goswami agrees in that there is a silver lining amidst the pandemic craze. “I was able to pay rent and pay my staff salary during this “I reassure my patients that this is actually a very safe time,” Dr. Buddiga says. “It helped significantly because I time to have procedures done because hospitals have didn’t have to furlough staff.” implemented the same policies as my office, but at an even What it looks like today more stringent level,” he says. “They perform temperature As of early June 2020, Dr. Buddiga says his practice volume checks, surveys and cleanings two-to-three times over is still slowly picking up as patients feel more comfortable between each case in the ORs, so I tell my patients it’s actually one of the best times to get procedures done.” “My practice was blessed with the Department of Health Dr. Goswami is planning to adhere to social distancing and Human Services (HHS) stimulus relief funds given to measures until August, but that providers who see MediCare patients, and on top of that, they are taking it month-bywe qualified for the Paycheck Protection Program (Triple P month. Only new patients are seen in person while all followLoan) from the SBA to keep my staff on board so we could up visits are conducted via keep operations going.” - DR. GOSWAMI telemedicine. “I think that telemedicine is a blessing in disguise,” he says. visiting doctor offices. “There’s a paradigm shift in the way we think about treating “Patient volume is currently down 40 percent because of patients today. We are able to treat them within telemedicine no-shows, uncertainty of the pandemic and whether or not just as well as in person – but the question is whether patients think they should come to their appointments,” he insurances will pay to further expand the role it plays in says. “But if particular patients are really not well in terms of health care today.” breathing I ask them to come in to the office to be seen while What can be done in the future? wearing a mask. All of my staff members also wear complete “Amid confusion and panic, there is a light at the end of PPE throughout the entire patient interaction.” the tunnel that is hard to see,” Dr. Goswami says. “We need a Dr. Buddiga anticipates his practice will continue social beacon of light for our families, patients and community, and distancing precautions throughout the summer and until if no one knows who to turn to, we have to become our own the end of the year. Patients are asked to call the office to beacon of light for others.” alert the staff they are have arrived for their appointment Within the beginning stages of the Coronavirus pandemic once they park in the parking lot, a protocol that Dr. Buddiga unfolding in the Central Valley and beyond, there was much
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confusion from all levels of the government and health care experts. “The outcome of this pandemic lifted the veil on our unpreparedness,” Dr. Buddiga says. “It showed how unprepared we were as a country. It was hard initially getting a solid, consistent message out due to a level of unpreparedness and uncertainty among Coronavirus taskforce leadership, the FDA and the CDC. In terms of messaging, everybody was on their own. If we can learn anything from this, we should have a national emergency management allocation of PPE and other necessities for small health care facilities and private health care practices that care for over 80-90 percent of patients in America.” Dr. Buddiga says he received guidance from the Fresno Madera Medical Society, California Medical Association and American Medical Association, as well as from the California Public Health Department, however the messaging is still changing every day. The local Medical Society was open to physicians as an access point, but he feels next time there
should be more help available. Additionally, Dr. Goswami feels there should be town hall meetings or gatherings to provide an overview of the different types of physician practices in the Central Valley so public health and government officials can better understand different practice needs. “We are all collectively moving towards the same goal, but as individuals, we all have different needs,” Dr. Goswami says. “We are on individual islands trying to stay afloat as the water is rising. With the help of the Fresno Madera Medical Society, along with our local government and public health department, we can collectively be better prepared for the next event that occurs.” “Hopefully there is a re-awakening of the value of health care providers in our community,” he continues. “We tend to overlook health care systems when things are running well. The real need is for good doctors, nurses, medical assistants, office staff, and administrators to work together. The recent clash between the pandemic and the public over issues directly related to concepts of social distancing and wearing masks underscore the important role that physicians play INC. beyond providing A REGISTRY & PLACEMENT FIRM direct clinical care. Many of us became physicians to improve the health of our Nurse Practitioners ~ Physician Assistants communities, so I hope we can continue to be positive role models for others to trust and follow.” *This article was written in early June 2020 – some information may have changed since publication and Locum Tenens ~ Permanent Placement due to the rapidly changing COVID-19 Voice: 800-919-9141 or 805-641-9141 pandemic.
Tracy Zweig Associates Physicians
FAX: 805-641-9143
tzweig@tracyzweig.com www.tracyzweig.com
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Summer 2020
The Fresno Madera Medical Society was honored to present the 2020
Steven N. Parks, MD, LEADERSHIP AWARD TO
TA R A B R A H , M D .
Dr. Brah came to Fresno from University of Miami Leonard M. Miller School of Medicine for her Obstetrics and Gynecology residency. We hope that she will return to the area once she has completed her Minimally Invasive Gynecologic Surgery Fellowship at Johns Hopkins Hospital in Baltimore, Maryland. Dr. Brah was selected by the FMMS Board of Governors from nominations submitted by facility from UCSF Fresno. Brah was nominated for her leadership as the administrative chief resident during the academic year and her ability to manage the resident daily and call schedule with several challenges within the department. These accomplishments alone made her stand out, but when you then add her response to the current COVID crisis, her performance as a Chief Resident truly stood above. “Tara was able to be a steady voice for resident concerns, fears and a driving force for changes to the schedule which better protected residents from the risk of exposure by creating clinical teams that decreased exposure by covering a limited number of clinical environments in a given week. These were major changes to our departmental function but she did it quickly and efficiently.� Stated Christopher Downer, MD, Program Director for OBGYN Residency Brah was recognized during the UCSF Fresno commencement ceremony and was presented with a plaque and a monetary award.
Tara Brah, MD
Summer 2020
Dr. Parks was known for his vision, leadership and guidance, during his 35 years of practice in Fresno, Dr. Parks made many outstanding contributions to the medical community, the profession, the Fresno Madera Medical Society and other professional organizations. His dedication and commitment to medicine continue through this leadership award, which was established by the medical society to recognize and encourage excellence in leadership development within organized medicine by residents and fellows and serves to stimulate similar efforts by other physicians in training.
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COVID
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Summer 2020
6ft
Responding to
COVID in
Fresno
County 6ft
FRESNO COUNTY IS IN THE COVID-19 “GOLDILOCKS ZONE” – JUST THE RIGHT SIZE TO MOUNT AN EFFECTIVE RESPONSE AGAINST THE CORONAVIRUS THAT HAS SWEPT ACROSS THE GLOBE IN SIX SHORT MONTHS, SAID RAIS VOHRA, M.D., WHO HAS BEEN LEADING THE FIGHT AGAINST THE DEADLY VIRUS FOR THE COUNTY’S 1 MILLION RESIDENTS. >>
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The county is big enough to have the necessary skills, knowledge and resources, but not too big for those in the battle to be able to pick up the phone and connect quickly on problems, explains Fresno County’s interim Public Health Officer. “What has allowed us to be efficient and get stuff done is the kind of intimacy you get in a town that’s not any bigger or any smaller than Fresno,” said Dr. Vohra, who is the current medical director for the Fresno/ Madera Poison Control Division, an emergency physician at Community Regional Medical Center and a UCSF Fresno faculty member.
Dr. Robin Linscheid Janzen, US Reprehensive James Costa and Public Health Officer Dr. Rais Vohra volunteering their time at a local Surveillance Testing for COVID
While cases locally continue to steadily climb, the hospitalization rate among those testing positive for the novel SARS-CoV-2 has remained under 10% and the mortality rate is 2%, with 57 deaths in Fresno County as of mid-June. So far, Fresno County has avoided the public health issues of bigger locales like Los Angeles, Santa Clara and San Francisco counties, with area hospitals continuing to have the capacity for COVID-19 patients. Dr. Vohra ticks off a few more things that have made the difference: county supervisors who listened, provided resources, and supported an early declaration of a healthcare emergency; the City of Fresno’s early shelter in place order; an agile, seasoned public health team; and a mumps outbreak in the jail that gave the county a road map to follow for congregate settings. David Pomaville, director of Fresno County’s Public Health Department, agreed that previous experience with smaller disease outbreaks were helpful. But he also credits Dr. Kenneth Bird, the previous county health officer, for laying the groundwork with his “Eight Pillars of Public Health”. Dismal healthcare ratings for Fresno County had spurred Dr. Bird to pick up his pen and urge others to do something about it. Dr. Bird explained that while good health depends on access to social/economic opportunities, quality schooling, safe neighborhoods and workplaces, a clean environment, and quality social interactions/relationships, those things need support from every part of the community to ensure they happen. “It didn’t take long for me to go to that ‘Pillars of Health’ and get all these sectors actively engaged and involved in this pandemic,” said Pomaville. “We went to our schools. We started to work closely with the local business community. We went to all our local government partners to establish lines of communications. We went to the medical community to have discussions about what they needed to be prepared. We went to media and set up a
Clovis Community Medical Center Emergency Department
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Summer 2020
Dr. Jeffrey Thomas discussing national COVID cases at the CMC COVID command center in Downtown Fresno.
structured communications system. You can’t just look to one sector to solve the crisis.” Pomaville added, “I certainly have learned in all my years of handling crises, I don't try – at all, ever – to do everything.”
Cooperation and relationships key to slowing COVID-19 spread Dr. Vohra had just stepped into his role as interim health officers a few months before COVID-19 hit, while Pomaville had been through three different boards of county supervisors in his years as the public health department’s top administrator. Their combined experiences worked to bring people together quickly and early to respond to COVID-19. “While he may have leaned on me for some of the inner workings of government, I have definitely leaned on him for his expertise about local healthcare systems and his credibility in the medical community,” Pomaville said of Dr. Vohra. In January, Pomaville’s team was warily watching the news of a novel coronavirus killing people in China, knowing it could jump across oceans with ease and land in Fresno. By February SARS-CoV-2 showed up in a Seattle nursing home. Soon after it arrived in San Jose and San Francisco. “We had
Summer 2020
really prepared our board (of supervisors) and talked to them about what our triggers would be to declare a public health emergency,” Pomaville said, listing the triggers as community transmission, multiple cases and COVID-19 deaths. Pomaville helped walk Dr. Vohra through the steps, helping prepare proclamations way ahead of when they would need to ask the county board to vote on it. By March 15 Fresno County had two positive COVID-19 cases, both men who had contracted it while travelling outside the country. Some in the community thought it was too early to react, but larger studies showed regions that responded early with shelter in place orders had fewer deaths and less impact on their hospitals. Fresno County’s state of emergency declaration, unanimously approved on March 17, allowed the public health department to bypass procurement rules and the required government bidding process to quickly get supplies and equipment. It freed Vohra and Pomaville to pursue state and local emergency funding. It also allowed county workers to be deployed from their usual jobs into roles responding to the health crisis. So librarians became call center staff and environmental health inspectors became contact tracers. “The culture change that happened was amazing,” Dr. Vohra
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said. “It was like someone flipped a switch.” Pomaville praised county supervisors’ support: “They don’t just give us a free pass. But they welcome us to challenge them to think things through differently and not just tell them what they might want to hear. I know that there have been struggles in other counties.” Vohra agreed, “The supervisors are not biologists. They’re not trying to know anything about medicine. And they gave us the complete benefit of the doubt” when asked for an emergency declaration. That respect and trust is mutual. Board of Supervisors Chairman Buddy Mendes told the Fresno Bee he appreciated that Dr. Vohra was still working shifts in a hospital: “He works in the real world. He seems very practical … you get the real story from him.” By March 18, Fresno Mayor Lee Brand had issued a shelter in place order for the city and a day later the whole State of California followed, shutting down most businesses and prohibiting any gathering larger than 10 people.
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Key to cooperation were the conversations public health was having with different sectors of the community to educate, explain – and then ask for cooperation. The approach depended on relationships and compromises rather than heavy-handed regulation. Being able to call on community partners helped Fresno County overcome the fact that it has been without its own public health lab since it was destroyed following an October 2018 water main break. Public health had been relying on outside labs in neighboring counties and large commercial laboratories. Those resources were strained with coronavirus and results were slow in getting back to Fresno. “We had the equipment salvaged… so I approached Dr. Castro at Fresno State and asked if they had a physical space that we could set up and do testing in,” described Pomaville. “He got right on it. I can remember working over a weekend with him and his team and we identified a great spot. We set up a laboratory that’s been running ever since.”
Summer 2020
Rapport with courts and jail staff was solidified during a January mumps outbreak in the Fresno County Jail. The viral infection flare-up set the county up for continued successful disease containment and prevention inside the downtown Fresno facility. When 11 inmates in the jail’s North Annex tested positive for mumps, public health worked quickly to implement contact tracing and testing to quarantine 300 inmates, limit interaction with the courts and then offer immunizations to staff and inmates. “Mumps was our dry run for the current virus in the jail,” Dr. Vohra said. “That was a really good rehearsal for us because we were able to use almost all of our processes and structures we had put in place for the coronavirus. That’s why you don’t hear about outbreaks there like other jails. The sheriff is very supportive. It’s always helpful when you can just pick up the phone and have a conversation.”
Shifting knowledge, resources challenged public health response
“ THE SUPERVISORS ARE NOT BIOLOGISTS . THE Y ’ RE NOT TRYING TO KNOW ANY THING ABOUT MEDICINE. AND THE Y GAVE US THE COMPLETE BENEFIT OF THE DOUBT”
Public health officials have drawn heavily on past experiences, not just locally with mumps, but also their preparations during a 2014-15 California measles outbreak and a 2013-14 Ebola flare-up that ravaged parts of West Africa. But they have been frustrated with the unique challenges presented by COVID-19: constantly shifting health recommendations, politicization of the public health response and the rampant spread of misinformation. COVID-19 was first reported to the World Health Organization (WHO) on Dec. 31, 2019. Chinese officials say they discovered the respiratory virus in November 2019. And while medical researchers and physicians treating patients are collaborating worldwide, much is still being discovered about this novel coronavirus. “I remember being here late at night typing up guidance for my nurses and then an email pops
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up with new changes,” said Mary Morrisson, a supervising public health nurse who has headed communicable disease investigations for years. “I had just written up four pages of guidelines. I just threw up my arms. It was either laugh or cry.” Recommendations and regulations from state, federal and global health organizations not only were rapidly changing in the first weeks of the pandemic, said Morrisson, but they often contradicted each other. “It’s been mixed messages,” agreed David Luchini, assistant director of Fresno County Public Health. “WHO says something that causes confusion with the public and then the CDC says something different. And we’ve got the state with different recommendations. It’s been really hard to align our practices with these.” But even worse has been the polarized public response, he asserted. “In 27 years in public health I will say this has been the most politicized infectious disease crisis I have ever been in. When wearing masks to protect people from a disease is a political thing, that’s a problem. And when people say that we’re faking the numbers, that’s a problem. We’ve had comments coming in to our social media posts saying that public health was making it up and that the local hospitals and doctors were complicit.”
Courtney (left) and Jasmine (right) are registered nurses in the emergency department at Community Regional Medical Center. This was their new reality as RN’s and the frontline faces of COVID. Testing patients and working with physicians and other healthcare staff ensuring patients are cared for and safe.
What’s added to the mistrust has been the rush from some commercial health companies to offer quick virus and anti-body tests, as well as the boasting by some countries about mass testing in short periods of time. People wonder why tests have been so restricted and slow locally, said Pomaville. “When we talk about the 20,000 tests we've done in the last 14 days, it’s the gold standard virus test … There's a lot of different testing methodologies and approaches that are out there that have had more questionable results from a public health perspective,” Pomaville explained. Luchini may have one of the toughest jobs in this crisis as the liaison officer, dealing with public complaints and inquiries, answering
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Summer 2020
questions from businesses wanting to open up, and meeting regularly with schools, community groups, faith-based organizations and local government representatives. “We’re stuck in the middle. One of our biggest challenges is trying to find the right balance,” he said. “We have some parts of the community say we’re being too assertive, too aggressive in locking down too many things. And some say we’re not doing enough … We see studies that say we probably saved a lot of lives by jumping in early and shutting things. And then another study will say by shutting down too long we may be doing damage mentally for other people with the social isolation.” During threetimes-a-week Zoom conferences with media, Dr. Vohra has tried to help the public make sense of the shifting health recommendations and understand how COVID-19 is spread and attacks the body. He’s also tried to dispel myths about politics playing into health recommendations or resource allocations.
and engage them. But I need to find partners who can reach out to other groups in the rural communities and especially to underserved groups like farmworkers.” Those groups need to be armed with education to help protect themselves and slow the coronavirus spread, he said.
Light staffing hasn’t been intentional, Vohra thinks: “Sometimes you succeed yourself out of a job because you do things so well after a while people stop valuing what you provide because it's just part and parcel of what they’ve come to expect. Vaccination of the public, clean water, clean air, these are all things that are public health victories. But no one really credits public health for doing it. Then when there’s a crisis, people “ I KNOW HOW TO TALK TO DOCTORS ask ‘Where's public health?’ and say ‘They're LOCALLY AND ENGAGE THEM. BUT not doing their job.’ Well it's because they I NEED TO FIND PARTNERS WHO were underfunded and CAN REACH OUT TO OTHER GROUPS undervalued for a long time.” IN THE RURAL COMMUNITIES AND
ESPECIALLY TO UNDERSERVED
Nimble adaptation required stay ahead of GROUPS LIKE FARMWORKERS .” COVID-19 Staff and supplies may have been limited, but Fresno County’s Department of Public Health has a huge storehouse of Tight resources and staff have also challenged public health’s expertise, adaptability and support of other county staff, response, said Rose Mary Rahn, the public health nursing acknowledges its newest member. “This team is really a smart, director and director of the county’s Maternal, Child and agile, flexible, expert team,” Dr. Vohra praised. “This team Adolescent Health. “Public Health has not always been the has been really resilient … and we were able to recruit from most well-funded entity. It isn’t like we had a whole team of departments that shut down.” investigators on standby when this hit,” she said. “In the old days we used to keep staff that would work on projects and Veteran nurse Rahn said that response has been key. “I’m could be deployed for that.” amazed at how we all came together. All of us mobilized and jumped right in … I’ve taken brand new nurses and thrown And in the old days, Rahn observed, everyone kept stockpiles them into complex disease investigation.” of supplies around. “But now we have these real time deliveries with food, business supplies and we have seen the real impact The challenge has been the continuing stress of doing new of that as well in public health,” Rahn said. And when the work long-term and the constant adjustments, Morrison said. whole world needed the same supplies of testing chemicals, “We’ve been working day and night and weekends to do our respiratory equipment and personal protection for clinicians best to contain this and flatten the curve. We’re asking people and no one had warehouses set aside of those supplies, it to change how they think and what they’re doing and they’ve exacerbated the health crisis. really had to adapt quickly,” she said. “Then the next week things have changed again. This is a really new virus and in “I do wish we had a bit deeper bench,” Dr. Vohra said of the January we really didn’t know anything about it.” public health resources. “I know how to talk to doctors locally
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But by late February, Pomaville said, they knew enough to get ready. Their department assembled into an incident crisis command structure – weeks ahead of the county’s public health emergency declaration. Responsibilities were shifted, training started on how to track diseases and isolate those exposed. “Today, we’ve got about 100 people doing medical investigation and contact tracing,” he described. “They’re from a variety of different places in our public health nursing and we’ve been borrowing our environmental health specialists to do this since they haven’t been needed to inspect tattoo parlors or things like that.”
pandemic has been figuring out new ways to work together “The silver lining for this crisis so far has been the cross training of staff and community partnerships,” Luchini said. “We’re trying to develop even more partnerships with community organizations to help us with contact tracing. We think CBO’s can do a better job, because they have strong trust with certain neighborhoods and communities and can play a critical role there.”
Readying for the next wave
Public health will likely lean on community partners even more in the coming months, Luchini predicted. “We know Environmental health inspectors are also working as liaisons in a pandemic you have a second wave,” Rahn elaborated. with Fresno County’s “Different communities 15 cities to ensure local – Hmong, migrant governments are getting farmworkers, some rural “ WE ARE CREATING SYSTEMS THAT good information and pockets – haven’t really help with some large been as educated or felt ARE WORKING BET TER AND NOW employers and reopening this yet. We know some of businesses, said workforces are going WE’ RE STARTING TO GET IN THIS Pomaville. He’s also to be hot spots. I’m RHY THM. I THINK WE CAN SUSTAIN been able to augment hopeful people maintain the county workforce by vigilance.” THIS FOR A WHILE. THIS IS NOT A hiring people from related SPRINT; IT’ S A MARATHON.” sectors. “We actually Dr. Vohra is starting hired 15 paramedics from to enlist community American Ambulance to leaders from underserved do contact tracing. We areas to do televised wanted to give them really good knowledge of public health and radio public service announcements on remaining issues and they saw a significant slowdown in their work so vigilant, maintaining social distancing and mask wearing. they were available,” he explained. He’s looking to hire licensed “We’re piloting this, but I’m hoping it will last beyond this vocational nurses from schools next. pandemic. That will be the real gain is if we build on these relationships.” Pomaville explained: “We already trust their work …we can bring them on quickly, they can work with us for a couple of Readying for the second wave will require more months in the summer and then when they go back to their surveillance, contact tracing and testing. Currently, school job they've got that knowledge and understanding Pomaville said high volume testing sites, like the one at of disease outbreaks. We hope they’ll be our frontlines, so if Fresno City College, are run by an outside lab and they’re COVID-19 crops up in a kindergarten class then they're going doing up to 100 tests a day with about a 4% positive to be the ones that will have the expertise to initiate contact rate. Those sites are testing even asymptomatic people. tracing and educate parents.” Pomaville’s aiming to get similar testing up and running in western Fresno County. As everyone else did, the county learned how to transition to work remotely via laptops and change policies to allow more Increasing testing is great, but there needs to be more employees to work from home, Rahn said “We are creating coordination to operationalize and make sure testing data systems that are working better and now we’re starting to get in is used quickly. “One of the critical failures we have had is this rhythm and I think we can sustain this for a while… This the timeliness of getting a positive report in our hands and is not a sprint; it’s a marathon.” the disjointed reporting systems that we have in the county and state,” he said. “There’s work to do to streamline those Both Morrisson and Luchini agreed one of the big gains in this functions so if somebody’s tested in a private office or a
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hospital the report gets to us right away. We’re still seeing delays getting tests through the state’s reporting system and then down to us.” Dr. Vohra is bringing on help for the continuing response. When UCSF Fresno pulled residents out of clinical rotations for their safety and to conserve PPE, Dr. Vohra brought on as many as he could to help in the public health department. One of those, Sukhjit Dhillon, M.D., just finished her residency and is joining the department as deputy health director. Morrisson is already thinking ahead to how to mobilize vaccination clinics for nearly a million people when the COVID-19 vaccine is developed and available. “We’ve done drive through flu vaccination clinics, so I think we know how to do it,” she said. “I think this is just going to become one more of those diseases we have to manage as part of our regular routine.” The whole team figures along with a surge in COVID-19 cases they’ll also begin to see other diseases like measles resurface and chronic health challenges such as diabetes become worse. “We understand these other diseases have not gone away. They’ve been kind of driven underground to some extent, but they’re going to come back and bite us,” Dr. Vohra said. “But at the same time we now have a stronger, more agile structure to address these other issues.”
biggest lessons for us is that public health is a critical piece of our overall health system.” Pomaville’s not so sure that lesson has been absorbed by the general public. “I think the light bulb has come on for some of our government partners,” he said. “And I think that’s more meaningful right now. “I believe our school administrators have a far better understanding of what a robust public health department needs and how we can work together on things,” Pomaville said. “I believe that our law enforcement and fire agencies have a much better understanding of us. And I believe that our local elected officials have gotten incredible insight into public health so they are armed with good information to ask good questions to really understand how public health is funded and how we leverage it as we go forward.” Dr. Vohra said before the expected surge of COVID-19 cases to come, “It’s time to take a breath take a look around and say ‘Okay, what’s the lessons that we've learned? How can we sustain this going forward?’ Because we have such a strong public presence right now and we really can capitalize on this energy and this momentum.”
Hope for Fresno County’s public health future COVID-19’s hardships have also spawned community connections and lessons that promise a brighter public health future for the region, said veterans in Fresno County’s department. For Rahn the COVID-19 crisis “has reinvigorated my passion for public health … I’ve also learned how important relationships are. I knew that before, but I really saw it in this crisis.” Morrisson agreed, “We as a community and health department banded together to fight. I feel like we bonded through this and I think we will come out stronger on the other end.” She added, “And the
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2020
UCSF FRESNO
PHYSICIANS
GRADUATING
DURING COVID-19 PANDEMIC This year the UCSF Fresno commencement looked was very different, a virtual celebration from more than 100 medical residents and fellows. Many of the graduates will stay in the Central Valley to care for patients, teach future physicians or continue their medical education. “Regardless of their specialty or sub-specialty, these newly minted physicians and health care providers share the common bond of confronting a novel new disease and as a result, adapting to new ways of learning and caring for patients during the COVID-19 pandemic,” said Michael W. Peterson, MD, associate dean at UCSF Fresno. “They are entering the workforce at a time when they are needed most. We are pleased to have helped them fine tune their skills and to see the physicians they are today.”
UCSF Fresno 2020 Graduation Highlights: • 7 0% of residents and fellows completing training in the Department of Emergency Medicine are staying in the Central Valley to provide care. • 4 4% of residents and fellows completing training in the Department of Family and Community Medicine are staying in the region. •A ll three fellows in the Hospice and Palliative Medicine (HPM) program are staying in the Valley. Two are joining the HPM faculty at UCSF Fresno. • 4 4% of internal medicine residents (categorical) are staying in the Valley • 5 0% of residents completing training in the Department of Pediatrics are staying in the region • 6 3% of all graduates are staying in California to provide care or continue their education
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This year’s graduating class includes:
underserved patients in the Central Valley and the proximity to family in LA also played a part in moving to Bakersfield.”
Sukhjit Dhillon, MD, is completing a four-year
Nicholas Artinian, MD, is the first in his family to go to college and to become a physician. Dr. Artinian is completing training in UCSF Fresno’s three-year Family and Community Medicine Residency Program. But he wasn’t always sure of which path to pursue in medicine. During his third year of medical school, the Los Angeles area native enjoyed all his general rotations. After completing a rotation in Family and Community Medicine, however, he realized everything he enjoyed about the other rotations was included in the training of a family physician. “Training at UCSF Fresno has been an amazing experience due to all the knowledgeable and eager-to-teach physicians across all specialties,” said Dr. Artinian. “As a family medicine resident, we get to experience different fields of medicine and every positive encounter has shaped how I practice medicine.” His parents, who themselves did not finish high school, worked tirelessly to provide for he and his sister, Dr. Artinian said. He graduated from Ferrahian High School in Encino, California, earned his undergraduate degree at UC Santa Barbara and medical degree at St. George's University. His sister will graduate from veterinary school in Arizona this year. Dr. Artinian spends his spare time with family and friends, playing soccer with the UCSF Fresno resident team and exercising. After graduation, he plans to practice in Bakersfield and Tehachapi with Kaiser Permanente as an outpatient physician. “Over the past five years, I had the pleasure of helping patients from Stockton to Fresno while in medical school and residency, respectively,” said Dr. Artinian. “These positive, long-lasting experiences influenced my desire to care for
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residency training program in Emergency Medicine at UCSF Fresno and will stay on as Emergency Medicine faculty after graduation. Fresno is home, said Dr. Dhillon, and I am excited and grateful to work at the same place that trained me. Born in Punjab, India, she lived in various states in India before moving to Fresno as a teen. She attended Buchanan High School in Clovis and received a bachelor’s degree of science in Biomedical Physics from Fresno State. She earned both a master’s in biomedical sciences and a medical degree at Chicago Medical School. Dr. Dhillon said there were instances in India when her family could not afford quality care, and that motivated her to
become a physician who advocates for patients. “Emergency medicine allows me to do that. I get to take care of patients regardless of their ability to pay and I can be there during their most vulnerable time.” She considers herself fortunate to have matched with UCSF Fresno’s Emergency Medicine Program. It’s one of strongest programs throughout the county, she added. “I love the people who I work with here — co-residents, physicians, nurses and other staff members. Everybody is extremely supportive and always there to help you in any way possible,” said Dr. Dhillon. “I get to take care of the sickest in the community while working with amazing group of people.” Her path to becoming a physician was not easy. Dr. Dhillon
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admits to struggling with self-doubt. It’s something she continues to work on, she said. “I think the whole journey to becoming a physician has been an important part of my life and is something that I look back at and am very proud of it,” she said. “When I think of the future and what will make me happy, I think of doing a job that I love (which I already am) and finding ways to give back to community.” Dr. Dhillon has given back to the community. At the start of the COVID-19 pandemic, she worked with Rais Vohra, MD, UCSF Emergency Medicine faculty member and Interim Health Officer at the Fresno County Department of Public Health. Dr. Dhillon wrote various guidelines and protocols using Centers for Disease Control and Prevention recommendations, such as testing criteria, risk assessment tool, and screening guidelines for health care and non-health care workers. She continues to help at the health department as time allows and hopes to continue that work after graduation. In her spare time, Dr. Dhillon enjoys relaxing on the couch, talking to her cat, Rosie (who she is sure understands every word she says), and visiting, hiking, camping and taking pictures at many state and national parks with her husband, Dan. “I would have never made it this far without the support of my family, friends and mentors,” said Dr. Dhillon. “I am very fortunate to have a very strong support system.”
A self-described "Navy Brat,” Ryan Howard, MD, says he views the label as a term of endearment and that it means he’s from all over. Dr. Howard is completing a fellowship, advanced training beyond residency, in Hospice and Palliative Medicine (HPM) in the Department of Family and Community Medicine at UCSF Fresno. Hospice and
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Palliative Medicine is a sub-specialty that focuses on end-of-life care, including symptom management and relief of suffering. Patients with very serious illnesses are among the most vulnerable patient populations and their families are often equally as vulnerable, he said. He chose to complete a fellowship in Palliative Medicine because of the serious need for such care providers in the region. All three of the graduating Hospice and Palliative Medicine fellows are staying in the Central Valley. Two of them are joining the HPM faculty at UCSF Fresno. Working alongside faculty is the best part of training at UCSF Fresno, Dr. Howard said. They are passionate about the specialty of medicine in which they work. They are excellent educators and lead by example. After graduation, Dr. Howard will serve as Medical Director of Kaweah Delta Hospice and Palliative Medicine Services in Visalia. “Working to aggressively control previously unmanageable symptoms and providing empathetic and compassionate care to folks nearing the end of their lives is just something I felt called to do,” Dr. Howard said. “I am honestly humbled by the grace and courage so many families demonstrate in order to help and allow their loved ones to die peacefully. I wake up and go to work every day just hoping to make a positive impact on the lives of my patients and their families.” He and wife, Michelle, enjoy Visalia, the farm country and abundance of fresh fruit, especially at the Saturday farmer’s market. The absence of traffic and friendly neighbors also are appreciated. The Howards own land near Three Rivers, which they are developing. They often camp and enjoy the nearby great outdoors with their dogs Jack and Tibby. In his spare time, Dr. Howard enjoys playing golf. He and Michelle enjoyed working on their property during the statewide shutdown. They cleared walking paths to the river and constructed an orchard. When the pandemic subsides, they hope to travel more. His parents currently reside in the Charleston, South Carolina, area where he lived for a period while growing up. He also lived in San Diego and Orlando, Florida. He graduated from Stratford High School in Goose Creek, South Carolina, and attended the University of North Florida in Jacksonville, on a baseball scholarship. He worked as an EMT in Florida while spending time with his brother and niece. Then earned a medical degree from Florida State University College of
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Medicine, which has a strong mission to provide service to the underserved and to educate physicians to work in rural areas. He completed residency training in Family and Community Medicine at the University of Arizona. After residency, he worked as a hospitalist at Kaweah Delta and was honored to receive the Outstanding Physician of the Year Award for Compassionate Care. Dr. Howard gives thanks to his wife for her support during his fellowship and residency training. She is my rock, he said. “I’m very fortunate to have her love and support.”
Visalia native Christina Patty, MD, is completing a three-year residency training program in Family and Community Medicine at UCSF Fresno. After graduation, she plans to serve her home community at Visalia Medical Clinic where she was a patient growing up. Dr. Patty chose family medicine because of the relationships she’s able to build with patients over many years. She says the specialty also allows her to pursue many interests and it is never boring. The best aspect of training at UCSF Fresno is full spectrum training in both rural and urban settings, she said. It’s allowed her to learn from some of the best doctors in the Valley. She spends off-time with her two-year old son and husband, Rafael Martinez, MD. Dr. Martinez completed training in Family and Community Medicine at UCSF Fresno last year. He now works for United Health Centers in Parlier. Dr. Martinez and Dr. Patty met in high school and went to prom together. The couple is expecting baby number two in the near future. A graduate of Redwood High School in Visalia, Dr. Patty completed her bachelor’s at California State University, Long Beach and earned a medical degree from Universidad
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Autonoma de Guadalajara. “My path to becoming a physician in the Valley has been even more rewarding because I’ve shared my journey with my husband all the way from high school through residency,” said Dr. Patty.
Her parents came to the U.S. from El Salvador to give her and her brothers a chance at the “American Dream.” Fast forward to today and Ivett Garcia Renteria, MD, MPH, is finishing up a final year at UCSF Fresno as chief resident in the Department of Pediatrics. She completed three years of pediatric residency training at UCSF Fresno last year and stayed to give back to her residency program and continue her medical education. “I wanted to help provide leadership, grow my teaching skills as an attending physician in a supportive environment, learn administrative skills in an academic setting and be involved in training the future of medicine by educating medical students and residents,” said Dr. Renteria. After graduation, she will join the Department of Pediatrics as faculty at UCSF Fresno and see patients as a pediatric hospitalist and general outpatient pediatrician. “The reason I was initially drawn to the Valley is the same reason that I decided to stay, said Dr. Renteria. “I want to care for the underserved Hispanic population and provide health education to those who are underserved and empower them to take control of their child's health care needs. The best part of training at UCSF Fresno has been the people, the people she trained with, her mentors and the children and families she is privileged to care for, she said.
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When not working, she enjoys outdoor adventures with her husband and 17-month old son. A first-generation college graduate, Dr. Renteria attended Glendale Adventist Academy, graduated from UC Irvine, earned a master’s in public health from USC and a medical degree from St. George’s University. Dr. Renteria credits her success to her parents. The fact that I was able to accomplish my dream of becoming a pediatrician is all owed to them, she said. “They worked hard for me to get to where I am today. I will be forever grateful for their support, love and dedication to me becoming a pediatrician.”
Manavjeet Sidhu, MD, MBA , is completing a four-year emergency medicine residency program at UCSF Fresno as a chief resident. Now, Dr. Sidhu, who grew up in the San Fernando Valley, is trading one Valley for another. After graduation, he will start as Chief of the Fresno VA Medical Center Emergency Department. In addition, he will stay on at UCSF Fresno as emergency medicine faculty. “I plan to stay in Fresno following residency, though I am not originally from this area,” said Dr. Sidhu. “I want to give back to the city that trained me. There’s a personal satisfaction that comes from providing care in a medically underserved community.” In addition, he is looking forward to serving veterans, teaching residents clinically and continuing as a practicing physician. As a child, Dr. Sidhu enjoyed experimenting with
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intricate toys and electronics — taking things apart, learning how they work, and then re-assembling them or fixing them if they were broken. That passion led to him becoming a physician. The human body is one of the most complex machines of all, he said. The opportunity to practice and develop skills in multiple aspects of medicine and to treat patients irrespective of gender or age sparked his interest in emergency medicine. Dr. Sidhu chose to train in emergency medicine at UCSF Fresno because the program offers a unique training experience given the patient volume, diversity of patient population, variety of pathology, and abundance of procedures. In addition, faculty, staff, and fellow residents foster a positive environment, he said. He attended Van Nuys High School, graduated from UCLA and earned a medical degree and Master of Business Administration as part of a joint program at New York University where he’s also a faculty member. Obtaining an MBA gave him the opportunity to appreciate medicine from a different perspective, he said, and facilitated his ability to start and consult for multiple health care related companies, including ContagiEND Solutions, which aims to mitigate human error through innovative medical devices. The company was recognized by both the medical device community and Forbes Magazine. Its work has recently come to the forefront in the fight against COVID-19. Dr.Sidhu also serves on the board of other health care ventures, with the goal of using technology at the bedside to allow physicians to provide the best possible care. In his spare time, he enjoys golfing, f lying, scuba diving, and traveling with friends and family. Some of his interests outside of clinical medicine include advising for medical start-ups, health care finance and medical correspondence reporting. Earlier this year, he worked with ABC News in Manhattan, producing medical segments for World News Tonight, Good Morning America and Nightline. “It is difficult to envision what the pinnacle (of my career) will be,” said Dr. Sidhu. “But I would like to make a lasting, positive impact on the community. Though the future is unknown, what I do know is that I will enjoy the journey.”
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ACUTE CARE SURGERY FELLOWSHIP MOHAMMAD FAIYAZ SHAIKH, MD UC Irvine School of Medicine Dr. Shaikh is looking forward to practicing Acute Care Surgery.
CARDIOVASCULAR DISEASE FELLOWSHIP AMARBIR SINGH BHULLAR, MD Government Medical College – Amritsar Dr. Bhullar will begin a Clinical Cardiac Electrophysiology Fellowship at Zucker School of Medicine at Hofstra/Northwell at Lenox Hill Hospital Program AMIR NAJAFI, DO Touro University Nevada College of Osteopathic Medicine Dr. Najafi will begin an Interventional Cardiology Fellowship at Kaiser Medical Center in Los Angeles, California. UDAY GAJJANDRA SANDHU, MD St. George's University School of Medicine Dr. Sandhu will begin a Heart Rhythm Electrophysiology Fellowship program at Oregon Health & Science University in Portland, Oregon.
GASTROENTEROLOGY FELLOWSHIP NASIR HALIM, MD St. George's University School of Medicine Dr. Halim will begin an Advanced Endoscopy Fellowship at Harbor-UCLA Medical Center in Los Angeles, California. CHANDRAPRAKASH UMAPATHY, MD Kilpauk Medical College Dr. Umapathy has accepted a GI faculty position with the University of Texas Health San Antonio Long School of Medicine.
HEMATOLOGY/ONCOLOGY FELLOWSHIP HUGO AKABANE, MD University of Sao Paulo Dr. Akabane has accepted a position at LSU in Shreveport, Louisiana. MIR MAHAMED ALI, MD Deccan College of Medical Sciences Dr. Ali has accepted a position at Advocate Medical Group in Chicago, Illinois.
INFECTIOUS DISEASES FELLOWSHIP BOR-HAN CHIU, DO Touro University California College of Osteopathic Medicine Dr. Chiu will join a private practice in Los Angeles, California. CHIBONG ALEX YU, DO Western Uniersity of Health Sciences/College of Osteopathic Medicine of the Pacific - California Dr. Yu will practice infectious disease medicine in Los Angeles, California.
HOSPICE AND PALLIATIVE MEDICINE FELLOWSHIP DUMINDRA DE ALWIS GURUSINGHE, MD UC Davis School of Medicine Dr. Gurusinghe will join the UCSF Fresno Family Medicine Department as faculty. RYAN HOOD HOWARD, MD Florida State University College of Medicine Dr. Howard has accepted the position of Medical Director of Hospice and Palliative Medicine at Kaweah Delta Healthcare District. He has founded a private practice in Visalia, California called Howard Hospice and Palliative Care. REGINA LAICO, MD Albany Medical College of Union University Dr. Laico will be practicing Palliative Medicine and Emergency Medicine in the Central Valley.
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INTERVENTIONAL CARDIOLOGY FELLOWSHIP
SLEEP MEDICINE FELLOWSHIP
H KIRAN KUMAR REDDY, MD St. George's University School of Medicine Dr. Reddy will begin an Endovascular Intervention Fellowship at Columbia University Medical Center in New York.
CHLOE CONNOLLY BRANDOW, DO Arizona College of Osteopathic Medicine of Midwestern University Dr. Brandow’s plans are undecided at this time.
MATERNAL CHILD HEALTH FELLOWSHIP ANDREA NAOMI HEYN, MD Loma Linda University School of Medicine Dr. Heyn will be practicing full spectrum Family Medicine with surgical obstetrics.
MEDICAL EDUCATION FELLOWSHIP JESSICA KIMI FUJIMOTO, MD New York Medical College Dr. Fujimoto will join the UCSF Fresno Emergency Medicine Department as faculty
PULMONARY AND CRITICAL CARE FELLOWSHIP ELLIOT YI JANG HO, DO Western University of Health Sciences/College of Osteopathic Medicine of the Pacific - California Dr. Ho will begin an Interventional Pulmonology fellowship at The University of Chicago in Illinois JOHN TIMOTHY MCCLAIN, MD Michigan State University College of Human Medicine Dr. McClain has been assigned to be medical director of the US Air Force's biocontainment training program at the University of Nebraska in Omaha, Nebraska. SARI UMEKAWA, MD Jichi Medical University School of Medicine Dr. Umekawa has accepted a position with Pulmonary Critical Care Group at Queens Medical Center, in Honolulu, Hawaii.
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SURGICAL CRITICAL CARE FELLOWSHIP JAMIE TUNG, MD Tufts University School of Medicine Dr. Tung will practice trauma surgery in California’s San Francisco Bay Area.
WILDERNESS MEDICINE FELLOWSHIP WILLIAM CHIANG, MD State University of New York Downstate Medical Center College of Medicine Dr. Chiang has accepted a position with Seattle Emergency Physician Services at Swedish Hospital in Seattle, Washington.
EMERGENCY MEDICINE LEAH M. BAUER, MD University of Michigan Medical School Dr. Bauer will join the UCSF Fresno Emergency Department as faculty SUKHJIT K. DHILLON, MD Chicago Medical School at Rosalind Franklin University of Medicine & Science Dr. Dhillon will join the UCSF Fresno Emergency Medicine Department as faculty. SETH EIDEMILLER, MD University of Nevada School of Medicine Dr. Eidemiller’s plans are undecided at this time. STEPHEN DUNCAN HAIGHT, MD State University of New York at Buffalo School of Medicine and Biomedical Sciences Dr. Haight will begin a clinical ultrasound fellowship at the University of Arizona
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WHITNEY JOHNSON, MD Georgetown University School of Medicine Dr. Johnson will begin an EMRAP Medical Editing Fellowship at the University of Southern California in Los Angeles, California.
DEBRA AMY CHENG, DO Nova Southeastern University College of Osteopathic Medicine Dr. Cheng will practice Family Medicine in California’s San Francisco Bay Area.
MICHAEL DAVID KUKURZA, MD Creighton University School of Medicine Dr. Kukurza will practice Emergency Medicine in Pittsburgh, Pennsylvania.
KRISTINE NICOLE VINA JUGO, DO Western University Health Sciences/College of Osteopathic Medicine of the Pacific - California Dr. Jugo will practice Family Medicine in Torrance, California.
MIRANDA LEWIS, MD University of Washington School of Medicine Dr. Lewis will begin an EMS fellowship at the University of Washington. MICHAEL STEPHEN PAGE, MD Keck School of Medicine of the University of Southern California Dr. Page has accepted a position with Kaiser in Walnut Creek, California. FRESHTA MINA SAHAK, MD Creighton University School of Medicine Dr. Sahak will begin a Global Health and Emergency Ultrasound fellowship at UC Davis in California. MANAVJEET SINGH SIDHU, MD New York University School of Medicine Dr. Sidhu will be starting as Chief of the Fresno VA Emergency Department and will join the UCSF Fresno Emergency Department as Per-Diem faculty.
FAMILY AND COMMUNITY MEDICINE NICHOLAS NERCES ARTINIAN, MD St. George's University School of Medicine Dr. Artinian will practice Family Medicine in Bakersfield, California. TIMOTHY WILL CHRISTOPHER BASS, MD UC Irvine School of Medicine Dr. Bass will practice Family Medicine in Potosi, Missouri.
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KEVIN KALEKA, MD Ross University School of Medicine Dr. Kaleka has accepted a position with United Health Centers AN XUAN NGUYEN, DO Touro University Nevada College of Osteopathic Medicine Dr. Nguyen has accepted a position with The Vancouver Clinic in Vancouver, Washington. LUC-HA HOANG NGUYEN, MD American University of the Caribbean School of Medicine Dr. Nguyen has accepted a position with Memorial Care Medical Group in Los Angeles, California CHRISTINA MARIE PATTY, MD Universidad Autonoma de Guadalajara School of Medicine Dr. Patty has accepted a position with Visalia Medical Clinic in Visalia, California. JASBIR SINGH, MD Ross University School of Medicine Dr. Singh has accepted a position with Sutter Health. VIOLETTA SULEYMANOVA, MD Ross University School of Medicine Dr. Suleymanova will practice locums in California. PHUOC DINH THANH VU, DO Touro University Nevada College of Osteopathic Medicine Dr. Vu will practice Family Medicine in Northern California.
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REBECCA WATERS, MD Ross University School of Medicine Dr. Waters has accepted a position with United Health Centers.
JOE DARRYL HUGO BAAL, MD UCSF School of Medicine Dr. Baal will begin a Diagnostic Radiology residency at UCSF in California.
INTERNAL MEDICINE (PRELIMINARY)
PAIGE MCCALL DYREK, DO Western University of Health Sciences/College of Osteopathic Medicine of the Pacific - California Dr. Dyrek will begin a Physical Medicine and Rehabilitation residency at Stanford University in California.
SIMA DHARMESH AMIN, MD Texas A&M Health Science Center College of Medicine Dr. Amin will be pursuing an advanced program at the University of Alabama, Birmingham. AHMED NABIH AWAD, DO Lake Erie College of Osteopathic Medicine Dr. Awad will begin a Diagnostic Radiology residency at Cook County hospital in Chicago, Illinois.
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AUSTIN BENES HOPPER, MD UC San Diego School of Medicine Dr. Hopper will begin a Radiation Oncology residency at UC San Diego in California JENNY QIN HU, MD UC San Diego School of Medicine Dr. Hu will begin an Ophthalmology residency at UC San Diego in California.
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GRACE YAEEUN KIM, MD Mayo Clinic Alix School of Medicine Dr. Kim will begin a Dermatology residency at the Mayo Clinic in Rochester, Minnesota. CHRISTOPHER NG, MD Saint Louis University School of Medicine Dr. Ng will begin a Physical Medicine and Rehabilitation residency at the Medical College of Wisconsin in Milwaukee, Wisconsin. TONY DUY NGUYEN, MD UC Irvine School of Medicine Dr. Nguyen will begin a Physical Medicine and Rehabilitation residency at UC Irvine in California. CLEMENT TIEN VINH TRAN, MD California Northstate University College of Medicine Dr. Tran will begin a Diagnostic Radiology residency at New York Presbyterian-Columbia University in New York, New York.
INTERNAL MEDICINE (CATEGORICAL)
MAY SIN ANDREA KAM, DO Western University of Health Sciences/College of Osteopathic Medicine of the Pacific - California Dr. Kam will be practicing hospitalist medicine in Southern California. SHIRLEY KIM, DO Arizona College of Osteopathic Medicine of Midwestern University Dr. Kim will begin an Internal Medicine Chief Resident position at UCSF Fresno. MATTHEW HYUN JOON LEE, DO Philadelphia College of Osteopathic Medicine Georgia Campus Dr. Lee will practice Internal Medicine in California. APRIL MACALE MANALAYSAY, DO Des Moines University College of Osteopathic Medicine Dr. Manalaysay has accepted a hospitalist position with Kaweah Delta Medical Center in Visalia, California.
AMANI ABDUL RAHEEM ELGHAFRI, MD Dubai Medical College for Girls Dr. Elghafri will practice Internal Medicine in Texas.
HUMZA SALEEM MAQBOOL, MD Dow Medical College Dr. Maqbool has accepted a position with Providence Seaside Hospital in Oregon.
KEVIN GANDHI, DO Western University of Health Sciences/College of Osteopathic Medicine of the Pacific - Oregon Dr. Gandhi has accepted a Hospitalist position with Adventist Health Sonora in Sonora, California.
DIANA JAMPOL MOERS, DO Western University of Health Sciences/College of Osteopathic Medicine of the Pacific - California Dr. Moers will practice Internal Medicine in California.
SHAVETA GUPTA, MD Kasturba Medical College - Manipal Dr. Gupta will begin a Sleep Medicine Fellowship at UCSF Fresno.
OGOCHUKWU CHIDOZIE MOLOKWU, MD American University of Antigua College of Medicine Dr. Molokwu will begin an Internal Medicine Chief Resident position at UCSF Fresno.
MOHAMMAD HASHMI, DO New York Institute of Technology College of Osteopathic Medicine Dr. Hashmi will begin a Cardiovascular Disease Fellowship at UCSF Fresno.
TANNER ROSS MORTENSON, DO A.T. Still University Kirksville College of Osteopathic Medicine Dr. Mortenson will begin an Internal Medicine Chief Resident position at UCSF Fresno.
DINITHI KETAGODA IDDAWELA, MD American University of Antigua College of Medicine Dr. Iddawela will begin an Internal Medicine Chief Resident position at UCSF Fresno
SEHREEN MUMTAZ, MD Aga Khan University Medical College Dr. Mumtaz has accepted a Hospitalist position in Jacksonville, Florida.
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CENTRAL VALLEY PHYSICIANS
Summer 2020
CHARNJEET SINGH SANDHU, MD American University of Antigua College of Medicine Dr. Sandhu will begin a Cardiovascular Disease Fellowship in Reading, Pennsylvania. ANGELA SEHGAL, MD Kasturba Medical College - Manipal Dr. Sehgal has accepted a Hospitalist position in Iowa. ANDREW HIROSHI SUMIDA, DO Western University of Health Sciences/College of Osteopathic Medicine of the Pacific - California Dr. Sumida will practice Internal Medicine in California. ANTHONY RYAN TABET, DO A.T. Still University School of Osteopathic Medicine in Arizona Dr. Tabet has accepted a position at UCLA in California MIRA TADROS, DO Touro University California College of Osteopathic Medicine Dr. Tadros will begin a Sleep Medicine Fellowship at Stanford University in California. TIGRAN TIRATURYAN, MD St. George's University School of Medicine Dr. Tiraturyan will be joining Benchmark Physicians in Glendale, California. LU ZHAO, DO Kansas City University of Medicine and Biosciences Dr. Zhao has accepted a hospitalist position with Kaweah Delta Medical Center in Visalia, California
INTERNAL MEDICINE (CHIEFS) PHUONG KIM DANG, MD Ross University School of Medicine Dr. Dang has accepted a Hospitalist position at Kaiser Permanente in Roseville, California. WILLIAM PATRICK KELLEY JR., DO Touro University California College of Osteopathic Medicine
Summer 2020
Dr. Kelley has accepted a position with VA Hospital in Fresno, California. BRADEN LIND, MD State University of New York Upstate Medical University Dr. Lind will join the UCSF Fresno Internal Medicine Department as faculty. DANIEL REID SIMS, DO Arizona College of Osteopathic Medicine of Midwestern University Dr. Sims will begin a Hematology and Oncology Fellowship at UCSF Fresno.
OBSTETRICS/GYNECOLOGY TARA KAUR BRAH, MD University of Miami Leonard M. Miller School of Medicine Dr. Brah will begin a Minimally Invasive Gynecologic Surgery Fellowship at Johns Hopkins Hospital in Baltimore, Maryland. SUSAN CHEUNG, DO Kansas City University of Medicine and Biosciences Dr. Cheung has accepted a position with Kaiser Permanente in Fresno, California. CLARA GEORGINA LEE, DO Western University of Health Sciences/College of Osteopathic Medicine of the Pacific - California Dr. Lee will practice Obstetrics and Gynecology medicine in California. LIHONG MO, MD Peking University Health Science Center Dr. Mo will begin a Maternal Fetal Medicine Fellowship at UC Davis in California
ORAL AND MAXILLOFACIAL SURGERY (OMFS) MICHAEL EDWARD DAETWYLER, DDS Indiana University School of Dentistry Dr. Daetwyler will join a private practice in Fort Collins, Colorado.
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SLOAN L. REHDER, DMD University of Nevada, Las Vegas School of Dental Medicine Dr. Rehder will join a private practice in Charleston, South Carolina. WEI-YU TANG, DMD A.T. Still University, Arizona School of Dentistry & Oral Health Dr. Tang will join a private practice in California’s San Francisco Bay Area.
ORTHOPAEDIC SURGERY JOSHUA BRICE, MD UCSF School of Medicine Dr. Brice will begin an Adult Reconstruction fellowship at Northshore University Health System in Evanston, Illinois. MICHAEL LEE JERNICK, MD Saint Louis University School of Medicine Dr. Jernick will begin a Sports Medicine fellowship at Congress Medical Association in Pasadena, California. GEOFFREY ROHLFING, DO University of North Texas Health Science Center/ Texas College of Osteopathic Medicine Dr. Rohlfing will begin an Adult Reconstruction fellowship at The Ohio State University Wexner Medical Center in Columbus, Ohio.
PEDIATRICS RAMIN AZHIR, MD St. George's University School of Medicine Dr. Azhir will join UCSF Fresno Pediatrics Department as faculty. MING CAI, MD National University of Ireland Galway School of Medicine Dr. Cai will join UCSF Fresno Pediatrics Department as faculty.
Dr. Chen will practice medicine as a Pediatric Hospitalist. OZGE CANSIN DOGAN, MD St. George's University School of Medicine Dr. Dogan will practice medicine as a Pediatric Hospitalist. KALI ROSE HOCKETT, MD University of Sydney Dr. Hockett will join the UCSF Fresno Pediatrics Department as faculty. ALICIA HUANG, DO Touro University Nevada College of Osteopathic Medicine Dr. Huang will be working as a Pediatric Hospitalist in Los Angeles, California. MELISSA MEILIEN JASINTO, MD St. George's University School of Medicine Dr. Jasinto will begin a Cardiology Fellowship at Virginia Commonwealth University in Richmond, Virginia. KEVIN KING, MD St. George's University School of Medicine Dr. King will join the UCSF Fresno Pediatrics Department as Chief Resident. VINAY KUMAR, MD St. George's University School of Medicine Dr. Kumar will practice medicine as a Pediatric Hospitalist. CINDY MAI NGUYEN, DO Touro University California College of Osteopathic Medicine Dr. Nguyen will join the UCSF Fresno Pediatrics Department as Chief Resident. JASMIN ALINE PERSCH, MD Johannes Gutenberg University of Mainz Faculty of Medicine Dr. Persch will be working as a Hospitalist at Lurie Children‘s Hospital in Chicago, Illinois.
SHIDONG CHEN, MD University of Arkansas College of Medicine
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CENTRAL VALLEY PHYSICIANS
Summer 2020
ZANEB SYED, DO Western University of Health Sciences/College of Osteopathic Medicine of the Pacific - California Dr. Syed will practice medicine in pediatric outpatient primary care in California’s San Francisco Bay Area. IVETT RENTERIA, MD St. George's University School of Medicine Dr. Renteria will join the UCSF Fresno Pediatrics Department as faculty. DAVID HANYONG YI, DO University of North Texas Health Science Center/ Texas College of Osteopathic Medicine Dr. Yi will join the UCSF Fresno Pediatrics Department as Faculty.
PSYCHIATRY STEPHANIE YOONJU HAN, MD UCLA David Geffen School of Medicine Dr. Han will begin a child and adolescent psychiatry fellowship at UCLA Semel Institute for Neuroscience and Human Behavior in Los Angeles, California. TEJAS YOGESH CHHAYA, DO Western University of Health Sciences/College of Osteopathic Medicine of the Pacific - California Dr. Chhaya will be practicing outpatient psychiatry with Riverside University Health System in Jurupa Valley,California. NIKOLAY DIMITROV, MD Keck School of Medicine at the University of Southern California Dr. Dimitrov will be practicing inpatient psychiatry with the VA Central California Healthcare System in Fresno, California. JASMINE MALIKA SINGH, DO Touro University California College of Osteopathic Medicine Dr. Singh will join a private practice in Santa Monica, California.
Summer 2020
SURGERY DOMENECH ASBUN, MD Ross University School of Medicine Dr. Asbun will begin a Minimally Invasive Surgery Fellowship at Mayo Clinic in Jacksonville, Florida. HUNTER DAVID BENVENUTI, MD New York Medical College Dr. Benvenuti will begin a Plastic Surgery Fellowship at Long Island Plastic Surgery Group in Long Island, New York. HUY HOANG, MD UC Davis School of Medicine Dr. Hoang will begin a Minimally Invasive Surgery Fellowship at Advanced Laparoscopic Surgery Associates in Fresno, California. SEAN MESHKIN, DO Western University of Health Science Dr. Meshkin will begin an Acute Care/Trauma Surgery Fellowship at Stanford University in Palo Alto, California. CONGRATULATIONS TO GRADUATES OF THE UC SAN JOAQUIN VALLEY PROGRAM IN MEDICAL EDUCATION (SJV PRIME). We are proud to recognize these medical school graduates and celebrate their future training in residency: Jose Acosta, MD David Araiza, MD Tyler Carcamo, MD Brandon Croft, MD Sydney Espiritu, MD Lorena Garcia, MD Daisy Manzo, MD Enid Picart, MD UCSF FRESNO IS A PROUD PARTNER IN SJV PRIME, WHICH TRAINS OUTSTANDING PHYSICIANS AND PATIENT ADVOCATES FOR THE VALLEY.
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PUT YOUR MEMBERSHIP TO WORK! When you join the Fresno Madera Medical Society, you join the California Medical Association as well. Together FMMS-CMA can help with the success of your practice. Your annual dues can be more than offset when using membership services and discounts, and you get personal assistance with practice management and payment recovery issues to improve your bottom line. Join the FMMS to be a better leader for your staff and patients, and to amplify your voice to influence policy and legislation. The FMMS brings together an active community of physicians in order to improve the larger community. Our mission is physician-driven, and we want to help you solve your biggest practice management issue. Join the FMMS today!
BENEFIT Automobile & Homeowners Insurance
Breadcrumb Cybersecurity
CAP Cooperative of American Physicians
Car Rentals
Classified Ads CME Certification & Tracking CME Seminars
Confidential Hotline
Consultancy Services Driving Emblem
Insurance
MACRA Assistance 52
Save up to 8% more.
CONTACT Mercury Insurance Group (866) 602-5259 www.mercuryinsurance.com/cma
Discountd rates on all penetration testing, vulnerability assiessments and HIPPA/MACRA MIPS SRA Programs
Jennifer Guidry (559) 578-4800 www.breadcrumbcyber.com
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Albert Malasig (650)543-2185 www.CAPphysicians.com
Save up to 25% on car rentals for business or personal travel.
Avis (800) 786-4262 www.cmanet.org/groupdiscounts
Free classified ads in Central Valley Physicians
FMMS: (559) 224-4224
Discounted CME courses to help physicians maintain their licenses, and easy tracking of course credit.
Institute for Medical Quality (IMQ) (877) 880-1335 imq.inreachce.com
FMMS is an accredited provider for Continuing Medical Education providing free and low cost seminars for members.
FMMS: (559) 224-4224 www.fmms.org
Confidential support and assistance to physicians affected by substance abuse, or an emotional or physical problem.
CMA: (650) 756-7787 www.cmanet.org/resources/confidential-assistance
Discount on hourly consulting fee for practice assessments, valuation, brokerage, partnerships, etc.
Practice & Liability Consultants (415) 764-4800 www.practiceconsultants.net
CHP approved emblem provides physicians expemption from speeding laws when en route to an emergency
FMMS (559) 224-4224
Discounts on medical, workers’ comp, dental, disability, long-term care, level term life & business overhead expense.
Mercer (800) 842-3761 www.mercer.com
Free tool kit on quality measures & online tool to create custom MIPS plan.
FMMS (559) 224-4224
CENTRAL VALLEY PHYSICIANS
Summer 2020
BENEFIT
CONTACT
Up to 89% off the cover price of hundreds of magazines for your home, office, and waiting and patient rooms.
Consumer Subscription Services (800) 289-6247 www.cmanet.org/magazines
Medical IDs
Discounts on 24-hour emergency identification and family notification services.
MedicAlert Foundation (800) 253-7880 www.medicalert.org/cma
Medical Office Services
Discounts on medical billing. No upfront costs. 1st month free and 2nd month 1/2 price.
Rita Nye (559) 359-6170 www.medicalbillingmos.com
Messaging App
Free secure messaging app for physician-to-physician/care team communication.
DocBookMD www.cmanet.org/docbookmd
Notary Services
Need a document notarized? Members can receive free Notary Services at the FMMS office.
FMMS 255 W Fallbrook Ave Suite 104 (559) 224-4224
Save up to 80% on office supplies and more.
Staples Advantage (800) 786-4262 www.cmanet.org/staples
CMA’s 24-hour Physicians Confidential Assistance hotline. Free and will not result in any form of disciplinary action.
Completely Confidential Doctor - Doctor Assistance (650)756-7787
Help for practices of all sizes: legal handbooks, practice mgmt. guides, patient education materials, etc.
CMA Resource Library www.cmanet.org/resource-library
Magazine Subscriptions
Office Supplies
Physician Assistance
Practice Resources
Premier Valley Bank
Local bank offering comprehensive banking solutions that help make the job of managing finances easier
Premier Valley Bank www.premiervalleybank.com
Regency Investment Advisers
Financial advisors offering services in investment management, financial planning and retirement plans.
Stephen Guinn (559) 438-2640 www.regencyinvests.com
Get paid: members receive one-on-one assistance. We have recouped $16 million from payors in the last 10 years.
FMMS: (559) 224-4224 CMA: (888) 401-5911
15% discount on tamper-resistant security prescription pads and printer paper.
RxSecurity (800) 667-9723 www.rxsecurity.com/cma-order
Discounts on website design packages, including mobile-friendly design.
Mayaco (209) 957-8629 www.mayaco.com/physicians
Reimbursement Assistance Security Prescription Pads Website
For information on becoming an FMMS Business Partner call 559-224-4224
Summer 2020
CENTRAL VALLEY PHYSICIANS
53
CL
DS
F I S IE S A
PHILLIPS TC-30 Page Writer With high-tech
Â
very durable Mobile Stand. This machine has a new replacement harness. Price, including stand $2500
ELLMAN Surgitron
MEDICAL EQUIPMENT FOR SALE. MIDMARK 622 Power Table High/Low -This table is less than ten years old and in excellent condition except vinyl top is marked with ink pen. Price: $2500
MIDMARK 404 Exam Table Standard modern
style exam table with new vinyl top that is replaceable with different colors. Price: $750
MIDMARK 271 Matching Air-Lift Stool - Price: $75
FFPF EMC With ELLMAN Vapor-Vac II Vacuum With Mobile Stand Price, including stand & vacuum $3000
MILTEX SURGICAL INSTRUMENTS
Thousands of dollars of surgical instruments for minor surgery. 50% Replacement Cost Contact: Michael S. Stubblefield, M.D. at 559-284-1246 or email: msstubblefield@icloud.com
PEDIGO Mayo Stands (2) - Price: $50 each
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CENTRAL VALLEY PHYSICIANS
Summer 2020
In Memoriam
In Memoriam THEODORE LITTLEFIELD, MD August 4, 1932 - April 27, 2020
Theodore Littlefield, 87 years old, formerly of Caruthers, CA, went to sleep with Our Lord at the Vitas Center at Baylor Medical Center in Carrollton, Texas on April 27, 2020. He is survived by his wife of 64 years, Atherlyn Littlefield, his children David Littlefield, Frederick Littlefield, Steven Littlefield and Linda Littlefield, brother John Littlefield, and sister Dorothy Hunter, grandchildren Danielle Cuzze, Frederick Littlefield, Thomas Littlefield and Rebekah Littelfield, as well as many others who loved him. He was born on August 4, 1932 in New
London, CT to parents Frederick Bracy Littlefield and Elizabeth Sallie (Huff) Littlefield. He attended Atlantic Union College for his undergraduate degree and graduated from Loma Linda University School of Medicine in 1956. He dedicated his life to healing others in a long career practicing medicine. Dr. Littlefield was a member of Fresno Madera Medical Society for 55 years.
BRIAN JAY GINSBURG, MD December 31, 1931- May 19, 2020
Brian Jay Ginsburg passed away peacefully at the age of 88 on May 19 with family by his side. Brian was born in Fresno, California on December 31, 1931 to Clara and Hy Ginsburg. At the urging of his sister, Betty Lee Wapner, Brian met the love of his life Myrna Rose on a blind date in 1953. They would go on to marry and have 3 wonderful children, Debie, Suzie, and David. Brian attended Fresno State for his undergraduate degree (he was a proud alumnus and served as a former president of the Alumni Association and the Bulldog Foundation). The son of a doctor, Brian went on to attend the University of Southern California for his medical degree. He cared for many patients in the community as a surgeon and family doctor for over 50 years and performed disability reviews as a medical consultant for the State of California. He also served as the flight surgeon for the 194th fighter wing of the Air National Guard. An avid sports fan all his life, Brian helped assure Fresno’s sports teams
Summer 2020
were always supported and he served as the team doctor for the Falcons hockey team and several local football teams. Dr. Ginsburg served as the race track physician at the annual Big Fresno Fair and also was a member of the medical ski patrol at China Peak and a founding member of the Western Medical Society of Ski Physicians. He made many happy memories at ballparks throughout the state with his family, especially for his three beloved grandsons. He is preceded in death by his wife Myrna and daughters Debie and Suzie. He is survived by his son David and his wife Barbara; his sister, Betty Lee and her husband Mel, nephews Larry and his wife Maria, and Terry and his wife Chanel, and grandsons Kevin, Gregory and his wife Samantha, and Estevan. Dr. Ginsburg was a member of Fresno Madera Medical Society for 49 years.
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Our providers make house calls Urgent Care is more convenient than ever. Now, you can stay home, stay safe and get the medical care you need with Saint Agnes Video Visit. From your tablet or smartphone, you can chat with one of the same urgent care providers you would usually see in-person – and for the same cost as your regular urgent care co-pay. And did we mention, there’s no waiting. To make an appointment, call (559) 450-SICK (7425). When it’s time for your visit, you’ll receive a link to initiate your video visit. There’s no download or special app required. It’s health care made easier.
Online and on time ...Health care designed with you in mind.
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Minor injuries and pain Insect bites
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Skin and nail problems Mild stomach problems
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Saint Agnes Urgent Care samc.com/Urgent-Care
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CENTRAL VALLEY PHYSICIANS
Summer 2020
