Medical Staff Voice – June 21, 2021

JW Moore Tuesday, Noon, CME Conference “Reefer Madness 2021- Cannabinoids & Psychosis.”

Joseph Pierre, M.D., Psychiatrist, and Health Sciences Clinical Professor of Psychiatry & Behavioral Sciences at David Geffen School of Medicine, UCLA, will present a lecture on “Reefer Madness 2021- Cannabinoids & Psychosis.” At the end of the conference, the learner should be able to: 1) List the cannabinoid medications approved by the FDA & their indications, 2) Describe the evidence to support the use of cannabinoids for the treatment of pain, and 3) Describe major risk factors associated with cannabinoid use.

The conference will take place on June 22, 2021, at noon, via ZOOM. This activity qualifies for AMA PRA Category 1 Credit™ & AOA Category 1-A credit.

If you would like to attend this meeting, please contact CME Coordinator Erin Parker at eparker@cmhshealth.org or 805-948-5638, and an invite with a link to the meeting will be emailed to you.

CMH Cafe Main Dish Station Closed

Food and Nutrition Services at CMH is experiencing staffing challenges. In an effort to maintain patient care, the main dish station closed effective 4/21/21. The grill and Jack & Olive will continue to be available. We appreciate your patience and support during this time and look forward to the day when we are able to provide full services!  

Jordan Dennis, MS, RD
Sr. Director of Food and Nutrition
CMHS

Clinical Documentation Pearls by Dr. Scott Goodfriend

When diagnosing AKI/ARF, please document if ATN is the likely etiology.

Special Lecture on Patient Engagement in the Prevention of Diagnostic Errors

COVID Delta Variant vs. Vaccination Rate

The UK has warned the US 3 times. We’re 1 for 2 so far. 1. Covid is coming. Response: “It won’t happen here” X 2. Alpha variant. Response: Solid vaccination campaign, a bump instead of a surge ✓ 3. Delta variant. Response is lacking any sense of urgency to date. – Eric Topol, M.D.

CMHS Weekly Medical Staff Calendar – June 21 – 25

MondayTuesdayWednesdayThursdayFriday
12:00pm EMPOWER - Teams12:00 pm JWM Education Conf – Zoom

5:30 pm CMHS Credentials Cmte- Teams

5:30 pm Surgery Committee – BR & Teams
12:00 pm General CA Conf – BR7:00am HIM Cmte - Teams

12:15pm Cath Conference – BR & Teams 1

2:00 pm Patients as Partners in Improving Diagnosis: What if? - Zoom
12:00 pm CME Cmte - Zoom

Final Thoughts

“Love and compassion are necessities, not luxuries. Without them humanity cannot survive.”
– Dalai Lama

Keep the faith,

Stan Frochtzwajg, M.D.
Chief Medical Officer

Community Memorial Health System
sfrochtzwajg@cmhshealth.org
www.cmhshealth.org/voice – Medical Staff Voice Blog link

Tracey Shoop – Physician Liaison – tshoop@cmhshealth.org & (805) 490-3860
Megan O’Neill – Business Development Manager – moneill@cmhshealth.org & (805) 207-8216
Scott Goodfriend, M.D. – Physician Advisor – sgoodfriend@cmhshealth.org & (805) 701-3514
Medical Staff Office – (805) 948-5662

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New Surgical Scheduling Requirements – Medical Staff Voice – Special Edition

CMHS is instituting the following process for booking cases with the new requirements beginning July 1, 2021

Our new process is intended to improve three specific areas of need: 1) Patient satisfaction through appropriate and timely disposition, 2) Patient safety, by preventing unnecessary prolongation of hospitalization, and 3) Economic solvency through reduction of denials.

As part of a major CMHS initiative to help reduce revenue loss/denials, which are in the millions of dollars, we are asking for your cooperation in providing additional information that will have a significant impact on reducing these losses. The expectations from the health plans to get approval for surgical procedures is quite different for the Hospital from what they expect from physician offices.

If CMHS does not have an authorization prior to the procedure it will likely get denied. In order to obtain a proper authorization from the plans, the Hospital is quite dependent on the information we receive from your offices to get that approval.

Thus, CMHS will institute the following process for booking cases with the new requirements beginning July 1, 2021.

  • Cases booked 14 days or more prior to the requested date of surgery will require the following three pieces of information in order to schedule a requested procedure/surgery:
    • Authorization #
    • ICD-10 of the procedure
    • CPT codes used to obtain the Authorization codes
  • Cases booked within 14 days of surgery will NOT require this information in order to schedule the procedure/surgery, as these will be considered urgent/emergent cases. However, CMHS will need this information prior to performing the case. If it becomes problematic we will revisit the 14 day allowance.

We have already reached out to several offices to see how this might work and to date have received positive feedback. CMHS believes this is a reasonable request since it is required information for the physician to get their authorization as well. Currently, we are working on making available to your offices an online tool that can help with researching both CPT/ICD-10 codes.

Additionally, we are offering a coding hotline for your convenience. Alisha Cardoza, Coding Manager, can be reached at 805-948-5356. Voicemails will be returned within 24 hours.

Please feel free contact me at 805.948-5003 with questions.

Thank you for your support.

Jim Corwin, CFO
CMHS

Information Systems Updates

PatientKeeper (PK) ePrescribe Disabled

CMH will be disabling ePrescribe for PK starting Wednesday, 6/16 at 1100 PST. An issue has been discovered that can result in medication errors and eRX will be disabled until resolved. Discharge Medication Reconciliation should still be completed but prescriptions will need to be hand-written.

Downtime Tonight for some CMHS Software

On 6/17/21, beginning at 12:05 am, we will have two hours of downtime to allow for security patching of the following application servers: Dragon, DrFirst, FormFast, iPeople, Pandora, PeriGen / PeriWatch, Picis, Pyxis (supply station), Sentry7. Thank you for your patience.

Stan Frochtzwajg, M.D.
Chief Medical Officer

Community Memorial Health System
sfrochtzwajg@cmhshealth.org
www.cmhshealth.org/voice – Medical Staff Voice Blog link

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Medical Staff Voice – June 14, 2021

JW Moore Tuesday, June 15, 2020, CME Conference “The Biopsychosocial Model – A Concept for All of Medicine”

Robert Rubin, M.D., Ph.D., Psychiatrist and Associate Director of the Psychiatry Residency Program at Community Memorial Health System and Ventura County Medical Center, will present a lecture on “The Biopsychosocial Model- A Concept for All of Medicine.” At the end of the conference, the learner should be able to: 1) Articulate the reasons for assessing psychosocial dimensions of illness, 2) Assess one’s own psychological state while providing patient care, and 3) Identify psychological traits in patients that can frustrate diagnosis and thwart treatment.

The conference will take place on June 15, 2021, at noon, via ZOOM. This activity qualifies for AMA PRA Category 1 Credit™ & AOA Category 1-A credit.

If you would like to attend this meeting, please contact CME Coordinator Erin Parker at eparker@cmhshealth.org or 805-948-5638, and an invite with a link to the meeting will be emailed to you.

Medical Staff Voice Live: Episode 12 with Dermatologist and Mohs surgeon Dr. Michael Trauner

In the Season One finale of the Community Memorial Health System Medical Staff Voice Live, Chief Medical Officer Dr. Stan Frochtzwajg sits down with Dr. Michael Trauner. Dr. Trauner is a dermatologist who specializes in the early identification and treatment of skin cancer and Mohs Surgery. Dr. Frochtzwajg and Dr. Trauner discuss the types of patients and conditions Dr. Trauner treats, as well as his love of fitness, family, food, and Duke basketball!
Click on this link to watch the 7 minute YouTube video: YouTube video

Opioid and appropriate consults protocol by Dr. Chris Kerrigan

Click on the following link for this valuable PDF: Tips for patients establishing care on chronic opioids for pain

New Laboratory Swab for Cultures – ESWAB

The laboratory recently did a validation on a different swab—the ESWAB.  This swab can be used for both Aerobic and Anaerobic cultures.  It has proven to give a better recovery of all organisms.  With our other swabs, specifically the anaerobic glass tube, we often would get subpar samples with the glass already broke.

Our validation was very successful and showed at least a 2X higher recovery of organisms when using the ESWAB.

Collection of the sample is still the same.

Laboratory always recommends that if you are collecting fluid and tissue it should be put into a sterile container and taken to the microbiology department for immediate processing.

Clinical Documentation Pearls by Dr. Scott Goodfriend

Please don’t forget to document skin ulcers and note whether or not they are present on admission.

More evidence that telehealth is here to stay

recent study (www.kff.org) by the Kaiser Family Foundation shows that Medicare beneficiaries embraced telehealth during the COVID-19 pandemic.

About half (45%) of Medicare patients whose primary care clinician offered telehealth visits reported having one during the summer or fall of 2020. That represented 27% of the nation’s 55.3 million Medicare beneficiaries (33% of all beneficiaries said they did not have a telehealth visit even though their primary care clinician offered them, and 40% said either their primary care clinician didn’t offer telehealth or they didn’t know if they did).

There was one major caveat, however, that could have implications for post-pandemic telehealth usage. A majority (56%) of Medicare beneficiaries who reported having a telehealth visit during that time period said it had been an audio-only telephone call — which is currently not covered as telehealth outside of the COVID-19 public health emergency. The share of those who reported audio-only visits was higher among patients age 75 and older, as well as rural patients. This suggests that technological literacy and lack of access to reliable broadband internet may be obstacles to telehealth uptake if audio-only coverage is discontinued post-pandemic.

The American Academy of Family Physicians and other groups are advocating for lasting changes to telehealth regulations, including that Medicare continue to cover audio-only evaluation and management visits after the pandemic.

CMHS Weekly Medical Staff Calendar – June 14 – 18

MondayTuesdayWednesdayThursdayFriday
12:00 pm Cancer Cmte - BR

5:15 pm QA & Improvement Cmte (Teams)
10:00am Infection Control Committee - Teams

12:00 pm JWM Education Conf – Zoom

4:30 pm Anesthesia Cmte - BR & Teams
7:45 am- Pediatrics Cmte/Neonatal Cmte (BR/Teams)

12:00 pm General CA Conf – BR

12:00pm UR Committee

Final Thoughts

“How do you listen? Do you listen with your projections, through your projection, through your ambitions, desires, fears, anxieties, through hearing only what you want to hear, only what will be satisfactory, what will gratify, what will give comfort, what will for the moment alleviate your suffering? If you listen through the screen of your desires, then you obviously listen to your own voice; you are listening to your own desires.
– Jiddu Krishnamurti

Keep the faith,

Stan Frochtzwajg, M.D.
Chief Medical Officer

Community Memorial Health System
sfrochtzwajg@cmhshealth.org
www.cmhshealth.org/voice – Medical Staff Voice Blog link

Tracey Shoop – Physician Liaison – tshoop@cmhshealth.org & (805) 490-3860
Megan O’Neill – Business Development Manager – moneill@cmhshealth.org & (805) 207-8216
Scott Goodfriend, M.D. – Physician Advisor – sgoodfriend@cmhshealth.org & (805) 701-3514
Medical Staff Office – (805) 948-5662

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Medical Staff Voice – June 7, 2021

JW Moore Tuesday, Noon, CME Conference -“How to Deal with Difficult & Disparaging Patients: Hints and Tips.”

Joseph Vlaskovits, M.D., Psychiatrist, Forensic Psychiatrist & Addiction Medicine Specialist, will present a lecture on “How to Deal with Difficult & Disparaging Patients: Hints and Tips.” At the end of the conference, the learner should be able to: 1) Reflect on and learn methods to ensure that one is not a major contributor to the difficult and disparaging patient, 2) Identify strategies to maintain professional behavior when dealing with unreasonable patient requests and demands, and 3) Recognize one’s own emotions and the barriers they create when dealing with challenging patient encounters.

The conference will take place on June 08, 2021, at noon, via ZOOM. This activity qualifies for AMA PRA Category 1 Credit™ & AOA Category 1-A credit.

If you would like to attend this meeting, please contact CME Coordinator Erin Parker at eparker@cmhshealth.org or 805-948-5638, and an invite with a link to the meeting will be emailed to you.

Medical Staff Voice Live: Episode 11 with General Surgeon Dr. Joseph Eisner

As a general surgeon, Southern California native and NYU graduate Dr. Joseph Eisner is trained to operate on “everything but the brain and bones.” In episode 11 of the Medical Staff Voice Live, Dr. Eisner chats with Community Memorial Health System Chief Medical Officer Dr. Stan Frochtzwajg about his special interest in laparoscopic and minimally invasive procedures, his unique approach to hemorrhoid treatment, his love of surf, and what he enjoys about living in Ventura County. Link to YouTube interview

Updated CMHS Personal Protective Equipment Guidelines

Based on the low community burden of COVID-19 and in alignment with public health recommendations, Community Memorial Health System no longer requires the universal use of eye protection for patient care.

Eye protection is still needed for suspected/confirmed COVID-19 patients (i.e., those on Expanded Precautions) and as Standard Precautions dictate (for anticipated splashes, sprays, etc.).

At this time, masking is still mandatory for all staff at all campuses. The Infection Prevention Department is working closely with state and local public health entities to provide timely, accurate information that is relevant to our particular community setting.

Please stay tuned for updated guidance pertaining to vaccinated and unvaccinated personnel categories.

Thank you for your patience throughout the pandemic and at all times.

Elyse Fritschel, Director of Infection Prevention
Gail Simpson, M.D., Medical Director of Infection Prevention

LAGS patients that have Gold Coast needing pain management referrals

The closure of the LAGS Pain Management Clinics two weeks ago has created a need for pain management resources. Gold Coast Health Plan Medi-Cal Managed Care has arranged assistance from UCLA and USC for supporting LAGS patients. We have been informed that the referral clinics are booked several weeks out now to get an initial appointment.

UCLA Pain Management Center

Address: 1245 16th St #225, Santa Monica, CA 90404
Phone: (310) 794-1841

Fax: (310) 319-2263

Keck Medicine of USC – USC Pain Center

Address: 1520 San Pablo St #3450, Los Angeles, CA 90033
Phone: (323) 442-6202

Fax: 323-442-6255

Gold Coast Phone number is: (888) 301-1228.

Here is also a link to their physician directory https://www.goldcoasthealthplan.org/provider-directory/?specialty

Here are the winners for last week’s Three-Minute Scholarly Summary

Results from the Annual Three-Minute Scholarly Summary, where the residents showcased their scholarly work for the medical staff.

First Place: Kristyna Fong, D.O. for her presentation on “Adverse Childhood Experiences (ACE’s) Screening.”

 Second Place: Nicole Hanson, D.O.,  Thomas Duncan, D.O, Javier Romero, M.D., and Graal Diaz, Ph.D., for their presentation on “The Effects of Matter of Balance, Stepping On, Tai Chi, and Walk With Ease programs on Measures of Balance in Older Adults.”

Third Place: Kyle Kubes D.O., Damayea Hargett M.D., Eddie McDonald D.O., Kelsey Majam, Valerie Davidson BS, and Emily Benson M.D. for their presentation  on “Postoperative Pain in Outpatient Fracture Surgery Patients.”

CLINICAL DOCUMENTATION PEARLS by Dr. Scott Goodfriend

Fractures caused by osteoporosis are coded as pathological fractures. Please link osteoporosis to the fracture when appropriate. For example: right hip fracture associated with osteoporosis. A fall in a patient with osteoporosis is much more likely to result in a fracture, thus it is considered pathological.

Coding Definitions in PatientKeeper: Found in the Left hand column under CMHS Links, then Under Coding Definitions

India Variant Shows Resistance to Antibody Drugs, Vaccines

Antibody drugs and COVID-19 vaccines are less effective against a coronavirus variant that was first detected in India, researchers say. The variant, B.1.617.2, has mutations that make it more transmissible. It is now predominant in some parts of India and has spread to many other countries.

Researchers from the Institut Pasteur and the European Hospital Georges Pompidou in Paris and at Orléans and Strasbourg Hospitals studied a B.1.617.2 variant isolated from a traveler returning from India. Compared to the B.1.1.7 variant first identified in Britain, the India variant was more resistant to antibody drugs, although three currently approved drugs still remained effective against it, they found.

Antibodies in blood from unvaccinated COVID-19 survivors and from people who received both doses of the Pfizer/BioNTech vaccine were 3-fold to 6-fold less potent against the India variant than against the UK variant and a variant first identified in South Africa, according to a report posted on bioRxiv ahead of peer review.

The two-dose AstraZeneca vaccine, which does not protect against the South Africa variant, is likely to be ineffective against the India variant as well, the authors said. Antibodies from people who had received their first dose “barely inhibited” this India variant, said study co-author Olivier Schwartz of Institut Pasteur.

The study, Schwartz added, shows that the rapid spread of the India variant is associated with its ability to “escape” the effect of neutralizing antibodies.

CMHS Weekly Medical Staff Calendar – June 7 – 11

MondayTuesdayWednesdayThursdayFriday

12:00 pm JWM Education Conf – Zoom

12:30 pm – Interdisciplinary Practice Cmte – BR

5:00 pm Medicine Cmte –BR & Teams
12:00 pm General CA Conf – BR12:00 pm to Patient Safety & Quality Committee – BR/Teams

12:15 pm Cardiac Division Cmte – NA / Teams

5:30 pm Bylaws Cmte – BR & Teams
7:30am OVCH ED Subcommittee - Teams

Final Thoughts

“Courage is the most important of all the virtues, because without courage you can’t practice any other virtue consistently. You can practice any virtue erratically, but nothing consistently without courage.”

Maya Angelou

Keep the faith,

Stan Frochtzwajg, M.D.
Chief Medical Officer

Community Memorial Health System
sfrochtzwajg@cmhshealth.org
www.cmhshealth.org/voice – Medical Staff Voice Blog link

Tracey Shoop – Physician Liaison – tshoop@cmhshealth.org & (805) 490-3860
Megan O’Neill – Business Development Manager – moneill@cmhshealth.org & (805) 207-8216
Scott Goodfriend, M.D. – Physician Advisor – sgoodfriend@cmhshealth.org & (805) 701-3514
Medical Staff Office – (805) 948-5662

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Medical Staff Voice – May 31, 2021

Tuesday, June 1stwe will not be having our usual JW Moore noon conference.

We will be holding our Annual Three-Minute Scholarly Summary, where the residents will showcase their scholarly work for the medical staff. There will be presentations from each specialty, including Internal Medicine, Family Medicine, General Surgery, Orthopedic Surgery, and Psychiatry.

Lags Pain Management Clinics (3 in Ventura County) Closure Friday, May 14, 2021

These clinics treat upward of about 1000 patients in Ventura County for pain management and opiate prescriptions. It was mentioned that Lags attempted to contact their patients to provide a month’s supply of prescriptions and that further care should be sought through their primary care physicians. This is a public health issue and we’ve had meetings at CMHS on how to manage this sudden change in care for our patients that used the Lags Clinics services.  I’m personally aware of three opiate accidental overdoses last week, one of which resulted in a death. I’m including a link to two articles on the topic to help our physicians and advanced practice providers in caring for our patients. Link to full article

CMHS Lab Semen Analysis – Fertility and Post-Vasectomy

Did you know that we are the only hospital laboratory among the local hospitals in the 3 cities that perform semen analysis (complete and post-vasectomy)? We perform testing on the SQA-Vision. The SQA-Vision sperm quality analyzer offers a solution to subjective semen analysis, prolonged testing times and complex quality control/regulatory requirements. SQA-Visions results are both objective and standardized (between operator and between labs). The test now takes less than 2 minutes.

Testing is performed on the following days:

Tuesday           6:30-6:00

Thursday          6:30-6:00

Saturday          6:30-2:30

CLINICAL DOCUMENTATION PEARLS by Dr. Scott Goodfriend

Coding Definitions in PatientKeeper: Link to PK Coding Definition column

We’re not out of the woods yet – Remain Vigilant – Get Vaccinated!

The UK cases were down to pandemic lows until B.1.617.2 hit. This variant has the potential to do the same here and many other countries as it becomes dominant. Log plot to show directionality.  The B.1.617.2 variant has now become dominant in the UK, associated with rising hospital admissions. It’s also starting to rise in the US. While vaccinations protect against it, the 1st dose has only ~30% efficacy. – Eric Topol, M.D.


(Click on image to enlarge view)

CMHS Weekly Medical Staff Calendar – May 31 – June 4

MondayTuesdayWednesdayThursdayFriday
Memorial Day
5:30 pm MEC – BR & Teams

12:00 pm Scholarly Summary GME– Zoom
12:00 pm General CA Conf – BR 1

2:15 pm OB/GYN Cmte (BR)
12:30 pm OVCH Campus Committee- Teams4:00 pm Surgical M&M - Virtual

Final Thoughts

“Remember upon the conduct of each depends the fate of all.”
– Alexander the Great

Keep the faith,

Stan Frochtzwajg, M.D.
Chief Medical Officer

Community Memorial Health System
sfrochtzwajg@cmhshealth.org
www.cmhshealth.org/voice – Medical Staff Voice Blog link

Tracey Shoop – Physician Liaison – tshoop@cmhshealth.org & (805) 490-3860
Megan O’Neill – Business Development Manager – moneill@cmhshealth.org & (805) 207-8216
Scott Goodfriend, M.D. – Physician Advisor – sgoodfriend@cmhshealth.org & (805) 701-3514
Medical Staff Office – (805) 948-5662

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Medical Staff Voice – May 24, 2021

JW Moore Tuesday, May 25, 2020, CME Conference -“Stigma in Mental Illness.”

Leslie Horton, M.D., Psychiatrist, will present a lecture on “Stigma in Mental Illness.” At the end of the conference, the learner should be able to: 1) Analyze historical and cultural origins of stigma, 2) Identify barriers to mental health treatment, 3) Utilize tools to increase access to treatment, 4)Examine bias towards mental illness, and 5) Identify structural barriers that result in discrimination and lack of care for physicians with mental illness

The conference will take place on May 25, 2021, at noon, via ZOOM. This activity qualifies for AMA PRA Category 1 Credit™ & AOA Category 1-A credit.

If you would like to attend this meeting, please contact CME Coordinator Erin Parker at eparker@cmhshealth.org or 805-948-5638, and an invite with a link to the meeting will be emailed to you.

Lags Pain Management Clinics (3 in Ventura County) Closure Friday, May 14, 2021

These clinics treat upward of about 1000 patients in Ventura County for pain management and opiate prescriptions. It was mentioned that Lags attempted to contact their patients to provide a month’s supply of prescriptions and that further care should be sought through their primary care physicians. This is a public health issue and we’ve had meetings at CMHS on how to manage this sudden change in care for our patients that used the Lags Clinics services.  I’m personally aware of three opiate accidental overdoses last week, one of which resulted in a death. I’m including a link to two articles on the topic to help our physicians and advanced practice providers in caring for our patients. Link to full article

Medical Staff Voice Live!

What is Gynecologic Oncology? How does a physician with this specialty work with your entire care team to diagnose and treat cancer? Learn more about this unique oncology subspecialty in episode ten of the Medical Staff Voice Live featuring Dr. Sayeema Daudi!
Click this link to the YouTube Video

CLINICAL DOCUMENTATION PEARLS by Dr. Scott Goodfriend

Many comorbidities impact the hospital stay by requiring increased resources, increased severity of illness, increased mortality risk and longer expected length of stays. Unless documented-this could result in decreased reimbursement and negatively impact the physician and hospital ratings. CC’s moderately impact the hospital stay, while MCC’s significantly impact the hospital stay. By documenting these, we will be rated appropriately and receive the appropriate reimbursement for the resources used.

Coding Definitions in PatientKeeper: Link to PK Coding Definition column

EMPOWER – Movement and Breath Class

EMPOWER Committee would like to invite you to a Movement and Breath Class on Wednesday, May 26, 5:30 pm -6:30 pm on the lawn next to the ocean tower parking structure. It will be taught by one of our own – CMH staff RN, Carlee who also has a Pilates instructor certification. All levels welcome. Please bring a yoga mat.

This class is provided free for all medical staff by the EMPOWER Committee.

Thank you,
Kala Parker, M.D.

Healing Open Wounds

CMHS’ dedicated Wound Care Team is invested in daily patient care and advancing research in the field.
Caring for patients with long-term open wounds is a rewarding but little-known specialty in medicine. For CMHS nurses Daphne Hodges BScN RN CWOCN and Isabel Jimenez Pantoja RN BSN CWS, the COVID-19 pandemic that led to more hospitalized patients with a tracheostomy in their neck has allowed these veteran nurses to help many more patients while finding new ways to further improve wound care treatment. Daphne is a Certified Wound, Ostomy and Continence Nurse and CMHS’s Clinical Coordinator for Inpatient Wound and Ostomy Care. Isabel is a Certified Wound Specialist. Together, as a team, they have over 25 years of combined specialized experience. Both treat patients at Community Memorial Hospital, Ojai Valley Community Hospital and at the Continuing Care Center in Ojai. They go wherever patients need them including the emergency room, operating room and Neonatal Intensive Care Unit – wherever a patient has a difficult open wound that needs assessing or special care.Link to full article

CMHS Weekly Medical Staff Calendar – May 24 – 28

MondayTuesdayWednesdayThursdayFriday
7:30 am COVID19 Update for Medical Staff - Teams
8:30 am ED Division – BR/Teams

12:00 pm Board of Trustees – BR

12:00 pm General CA Conf – TBD

5:30 pm CMHS Credentials Cmte- Teams

5:30 pm Surgery Committee – BR & Teams
12:00 pm Bioethics Committee – Teams7am HIM Cmte – Teams

12:15pm CMHS Cath Conference – BR / Teams

4:30 pm COVID19 Task Force Meeting - Teams

Final Thoughts

“Anger is a symptom, a way of cloaking and expressing feelings too awful to experience directly – hurt, bitterness, grief, and, most of all, fear.”
– Joan Rivers

Keep the faith,

Stan Frochtzwajg, M.D.
Chief Medical Officer

Community Memorial Health System
sfrochtzwajg@cmhshealth.org
www.cmhshealth.org/voice – Medical Staff Voice Blog link

Tracey Shoop – Physician Liaison – tshoop@cmhshealth.org & (805) 490-3860
Megan O’Neill – Business Development Manager – moneill@cmhshealth.org & (805) 207-8216
Scott Goodfriend, M.D. – Physician Advisor – sgoodfriend@cmhshealth.org & (805) 701-3514
Medical Staff Office – (805) 948-5662

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Medical Staff Voice – May 17, 2021

JW Moore Tuesday, Noon, CME Conference -“The Primary Care Physician’s Guide to the Depressed Patient.”

Ronald Pollack, M.D., Psychiatrist, will present a lecture on “The Primary Care Physician’s Guide to the Depressed Patient.” At the end of the conference, the learner should be able to: 1) Diagnose major depressive illness, 2) Therapeutically manage clinical depression, 3) Evaluate the genetic tendencies toward the development of major depressive illness, 4) Contrast substance-induced depression illness from those unrelated to substance abuse, and 5) Assess the effects of insomnia on the treatment of depression.

The conference will take place on May 18, 2021, at noon, via ZOOM. This activity qualifies for AMA PRA Category 1 Credit™ & AOA Category 1-A credit.

If you would like to attend this meeting, please contact CME Coordinator Erin Parker at eparker@cmhshealth.org or 805-948-5638, and an invite with a link to the meeting and instructions on how to join will be emailed to you.

Quarterly CMHS General Medical Staff Meeting Tomorrow Night

Physician Forum – Friday, May 21, 2021, 12:15 pm

Medical Staff Voice Live! – Dr. Omid Fatemi interview

Did you know that with today’s advanced technology and the expertise of heart specialists like Community Memorial Health System’s Dr. Omid Fatemi, valve replacements and other structural heart procedures can be done minimally-invasively? In Episode Nine of the Medical Staff Voice Live!, CMHS Chief Medical Officer Dr. Stan Frochtzwajg sits down with Dr. Fatemi to discuss the rapidly growing structural heart program at Community Memorial Hospital in Ventura, and why you don’t need to go to a major metropolitan health system to get the advanced heart care and highly-experienced doctor you’re looking for. Link to YouTube video interview

Documentation Improvement Pearls by Dr. Scott Goodfriend, Physician Advisor

This and other clinical documentation tips can be found in PatientKeeper under coding definitions as seen in the attached column.

WHO declares COVID-19 variant from India ‘variant of concern’

A more transmissible COVID-19 variant that first emerged in India, known as B.1.617, is now a global “variant of concern,” the World Health Organization said during a May 10 news conference.

WHO previously listed the variant as a “variant of interest.” The elevated classification to one of concern indicates the variant is more contagious, causes more severe illness, and more resistant to preventive measures, vaccines or therapeutics, according to the agency.

The WHO issued a follow-up statement after the news conference in response to some media outlets misinterpreting information about the strain evading vaccine protection, clarifying that “COVID-19 vaccines remain effective at preventing disease and death in people infected with this variant,” based on current data.

Preliminary studies have shown B.1.617, which has three sublineages, to be more transmissible, Dr. Maria Van Kerkhove, technical lead for the WHO’s COVID-19 response, said during the news conference, CNBC reports.

“As such, we are classifying this as a variant of concern at the global level,” Dr. Van Kerkhove said. “Even though there is increased transmissibility demonstrated by some preliminary studies, we need much more information about this virus variant in this lineage in all of the sublineages, so we need more sequencing, targeted sequencing to be done,” adding that additional information about the variant would be released May 11 as part of the WHO’s weekly pandemic situation report.

The WHO’s other “variants of concern” are B.1.1.7, which emerged in the U.K., B.1.351, first detected in South Africa, and P.1., which was first identified in Brazil.

The global reclassification of the B.1.167 variant, which has spread to the U.S., was not reflected by the CDC as of May 10. The CDC currently classifies the strain as a “variant of concern” in the U.S.
5/10/21

Bridges to Resilience! – Impacts of Adverse Childhood Experiences (ACEs)
– Sharon Elmensdorp, Ph.D. Program Director, Help Me Grow Ventura County

I’m so pleased to share that registration is open for Bridges to Resilience! Our live, virtual event focuses on educating and increasing awareness about the widespread impacts of Adverse Childhood Experiences (ACEs) and provides hopeful strategies to build resilience within our communities and system of care.

Wednesday June 9, 2021
8am – 3pm

CME/CE credits available. AMA PRA Category 1 Credit™ has been approved for this activity. The SB County Consortium for CME is accredited by the CMA to provide continuing medical education for physicians. Continuing education credit has been approved for LMFTs, LCSWs, LPCCs, and/or LEPs as required by the Board of Behavioral Sciences

REGISTER HERE! Registration closes June 3rd at midnight.

 Join keynote speaker Robert F. Anda, MS, MD, and experts in the field of trauma and resilience, and connect for an interactive program designed to facilitate strong connections between medical providers and community partners with the goal of improving life outcomes for children, youth and families throughout the Central Coast.

Please see the attached flyer and visit https://www.bridgestoresilience.com/ for more information.

Best regards,
Sharon
Planning Team Member, Bridges to Resilience Conference

CMHS Weekly Medical Staff Calendar – May 17 – 21

MondayTuesdayWednesdayThursdayFriday
7:30 am COVID19 Update for Medical Staff - Teams

12:00 pm Cancer Cmte – TBD
12:00 pm Finance Cmte – BR

12:15 pm Pharmacy & Therapeutics Cmte – Teams

4:30 pm Anesth Dept – BR/Teams

6:00 pm Quarterly General MS - Teams
7:45 am- Pediatrics Dept - Teams

12:15 pm OB/GYN Dept – BR/Teams
12:00 pm Radiation Safety/Radiology Division – NA / Teams

12:00 pm Utilization Management NA (back)

12:15 pm Inpatient Medicine Division – BR / Teams
7:30am OVCH ED Subcommittee - Teams

Final Thoughts

“Breathe. Let go. And remind yourself that this very moment is the only one you know you have for sure.”
– Oprah Winfrey

Keep the faith,

Stan Frochtzwajg, M.D.
Chief Medical Officer

Community Memorial Health System
sfrochtzwajg@cmhshealth.org
www.cmhshealth.org/voice – Medical Staff Voice Blog link

Tracey Shoop – Physician Liaison – tshoop@cmhshealth.org & (805) 490-3860
Megan O’Neill – Business Development Manager – moneill@cmhshealth.org & (805) 207-8216
Scott Goodfriend, M.D. – Physician Advisor – sgoodfriend@cmhshealth.org & (805) 701-3514
Medical Staff Office – (805) 948-5662

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LAGS Pain Management Program/Clinics Closed – Medical Staff Voice Special Edition – May 16, 2021

Lags Pain Management Clinics (3 in Ventura County) Closure Friday, May 14, 2021

These clinics treat upward of about 1000 patients in Ventura County for pain management and opiate prescriptions. It was mentioned that Lags attempted to contact their patients to provide a month’s supply of prescriptions and that further care should be sought through their primary care physicians. This is a public health issue and we’ve had meetings at CMHS on how to manage this sudden change in care for our patients that used the Lags Clinics services.  I’m including two articles on the topic to help our physicians and advanced practice providers in caring for our patients. 

Lags Pain Management Clinics Closed – CFH Memo

We have recently learned that LAGS Pain management will be closing this week and wanted to notify you as soon as we confirmed the closing.

We anticipate that CFH and the County clinics will be seeing an influx of patients requesting Pain Management services, especially if you are the Primary Care Provider. We ask for your help in evaluating and treating those patients for whom you are their PMD.

To assist with this transition period, I have attached:

1.      CFH Guidelines for treating pain – Opioid Prescribing Guidelines

2.      Opioid taper guidelines – Pocket Guide_ Tapering Opioids for Chronic Pain

3.      Prescribing Guidelines Video https://web.microsoftstream.com/video/d356083b-40e4-4cfd-81a4-4034e73b4487

Please remember that all treatment starts with proper evaluation and diagnosis of the pathology leading to pain. An honest discussion of treatment options rarely includes long term full agonist opioids as evidence-based treatment. Moreover, patients struggling to wean off opiates should be assessed for some level of an Opioid Use Disorder and may benefit from a conversion Buprenorphine treatment to treat both pain and the underlying use disorder.

We continue to receive referrals to Addiction Medicine for “opiate weaning” and “pain management”, or with the expectation of continued prescribing of full agonist opioid therapy (Oxycodone, Norco, etc.). Referrals to Addiction Medicine should be for Substance Use Disorder and a documented conversation about risks, benefits and options should be in the chart.

However, there are cases of patients who are Dependent on Benzodiazepines or Opioids who do not meet criteria for a Moderate or Severe Use Disorder.  Patients who are opioid dependent and would like to transition to Buprenorphine (Suboxone) for treatment of their dependence and chronic pain may be referred to Dr. Kerrigan.  Patients struggling to taper off of benzodiazepines may be referred to Dr. Kerrigan to Transition to a long acting benzodiazepine (Valium/Librium) in order to ease the taper while starting safer non-addictive alternatives.  It should be expressed clearly to the patient that Dr. Kerrigan will not be providing full agonist opioids.

In addition, Dr. Wang is ready to receive patients where procedural interventions to relieve pain may be indicated. As with Addiction Medicine, “opiate weaning” is not an appropriate referral.

Please remember patients who are physically dependent on opioid pain medicines and suddenly have these medicines discontinued, or the dose rapidly decreased, can experience serious withdrawal symptoms, uncontrolled pain, psychological distress and suicide.

Although no standard opioid tapering schedule exists that is suitable for all patients, I have attached The Pocket guide CDC Guidelines on tapering Opioids to assist with a tapering schedule.

We are very appreciative to those of you who are M.A.T. certified. Providing Suboxone is going to be a valuable resource during this time. As you are aware, the first year of the waiver providers are limited to treating up to 30 patients. Please review your status as to the total number of patients you are eligible to treat. If you are interested in training, please inform administration and we will walk you through the process including the recent updates in federal guidelines making it easier to prescribe Suboxone.

Thanks!

A. Jaime Lara, MD
Medical Director
Ambulatory Medicine – North Region
CFH/CMHS

Abrupt closure of Lags Medical Clinics leaves patients without care or referralsSacramento Bee

Stephanie Bjorge needs a fentanyl patch to manage her chronic pain. But she and hundreds of other patients are scrambling after the medical clinic that treats them abruptly closed its doors.

Lags Medical Clinics, which operates about 23 clinics throughout California – including two in Modesto – are shutting down, leaving patients without referrals, records or treatment plans.

No explanation for the closures was provided. The Bee reached out to the founder and CEO, Dr. Francis Lagattuta, but he did not respond. Lagattuta holds a license to practice medicine in California.

Doctors who do not provide notice to their patients before terminating their medical care could receive disciplinary action from the California Medical Board for patient abandonment.

The medical board states that to reduce the liability of patient abandonment and minimize disruption of care, “the physician terminating the physician-patient relationship should notify patients sufficiently in advance.”

Although the time required isn’t specified, the California Medical Association recommends that physicians provide patients with enough written notice to allow them time to find alternative care and to obtain their medical records.

Lags Medical Clinics provided a range of services but their primary focus was treatment of chronic pain. They have locations in California, Nevada, Florida and Delaware.

A former medical staff member in Modesto, who did not want her name published, was tearful when she described the surprise about the clinic’s closure and her heartbreak for her patients being left without a care plan.

She said, “Patients should contact their health plans,” so there are no interruption in their treatments.

Phone calls to several of the Northern California locations were answered by a recording stating the office was closed, without any additional information.

A staff member at the Lompoc location answered the phone and said that all the sites would be closed by Friday. She said she didn’t know the reasons but thought it was related to Medicare.

The Centers for Medicare & Medicaid Services is the federal agency responsible for the administration of Medicare and Medicaid federal insurance programs, including the billing and financial aspects of providing medical care under those programs.

In 2018, CMS terminated the Medicare provider status to the Lags Surgery Center in Oxnard, stating the site was not in compliance with regulatory requirements for an ambulatory surgery center with Medicare. The clinic continued to provide pain management services, according to their website.

Dr. Ed Balbas, one of the physicians listed at the Modesto site, has a previous felony conviction for insurance fraud. He also has a 2017 limitation on his California medical license, including that he cannot practice solo and requires oversight for patient billing.

IMPACT ON PATIENTS

Bjorge, a chronic pain patient at the Lags Stockton location, said she received a text on Thursday morning from her nurse practitioner notifying her about the closure. The text said she would receive a one month’s supply of her pain medications and that she should contact her other doctors for ongoing care.

Bjorge said she has chronic pancreatitis, which has required four surgeries in the past year, use of a feeding tube for nutrition and causes her debilitating pain.

“This is unbearable pain. I need heavy medications, including a fentanyl patch,” said Bjorge.

She said she was a Lags Clinic patient years ago for chronic back pain, but reported them to the authorities for unhygienic conditions, verbally abusive staff and lack of attention from medical staff. She said she didn’t want to return to Lags Clinics with her current illness and that the clinic staff did not want her back, but it was the only nearby location that accepted her insurance.

“The next closest option for me is in San Francisco,” said Bjorge, “There are no options. There’s nothing for us in the valley. This is catastrophic for us.”

For help with ongoing care, Lags Clinic patients can reach out to their primary care doctor or health insurance plan to find an alternative source of care.

ChrisAnna Mink, M.D.
Sacramento Bee
May 15, 2021

Link to full article

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Medical Staff Voice – May 10, 2021

JW Moore Tuesday, Noon, May 11, 2020 CME Conference – “Elements of a Good Psych Evaluation Incorporating Motivational Interviewing Techniques.”

Ronda Doonan, Psy.D., Psychologist, will present a lecture on “Elements of a Good Psych Evaluation Incorporating Motivational Interviewing Techniques.” At the end of the conference, the learner should be able to: 1) Apply MI-based open-ended questions to enhance clinical interview for mental health diagnosis, 2) Increase utilization of item specific responses on mental health screening tools, and 3) Incorporate screener responses with patient-specific contextual information to more accurately assess patient’s treatment needs.

The conference will take place on May 11, 2021, at noon, via ZOOM. This activity qualifies for AMA PRA Category 1 Credit™ & AOA Category 1-A credit.

If you would like to attend this meeting, please contact CME Coordinator Erin Parker at eparker@cmhshealth.org or 805-948-5638, and an invite with a link to the meeting and instructions on how to join will be emailed to you.

Quarterly CMHS General Medical Staff Meeting

Medical Staff Voice Live! – Dr. Art Flynn interview

Welcome to Episode Eight of the Medical Staff Voice Live! This week, CMHS Chief Medical Officer Dr. Stan Frochtzwajg sits down with one of Ventura County’s best plastic surgeons and reconstructive specialists, Dr. Arthur Flynn. Dr. Flynn shares his background, training, and special interest in breast reconstruction following mastectomy and aesthetic facial surgery. Learn more about Dr. Flynn and his love of surfing, cycling, and Fiji in this special episode! Click this link to the YouTube Video

Hospital Week Celebration at CMH and OVCH (click on any image to enlarge it in a separate window)

Physician Forum – May 21, 2021

CMHS WELLNESS AND FITNESS CENTER IS NOW OPEN!

New Home For External Web Links in PK – Thursday, 5/13/21

In an effort to clean up the “Center Pane” in PatientKeeper where various external links are currently displayed, we are moving these into a sub-folder that will be called “CMHS Links” on 5/13. Once you click on this new button, you will be presented with a separate window where you can select any of the external links you currently access from the center pane
Ocean Tower Computer Downtime for Windows Update

Computers in the Ocean Tower will be updated based on the last digit of their hostname. Since this particular update can take as long as 1 hour to complete we will be updating 10% of the computers at a time according to the schedule below. The hostname can be found in the upper right-hand corner of the desktop. Ideally staff should save their work and proactively restart using the pop-up window that will display for twenty-four hours.

Group 7

  • 5/9– 1:05 am: Windows update notification displays. Users have the option to update immediately.
  • 5/10– 1:05 am: Update force starts on any computers not manually updated.

Group 8

  • 5/11 – 1:05 am: Windows update notification displays. Users have the option to update immediately.
  • 5/12 – 1:05 am: Update force starts on any computers not manually updated.

Group 9

  • 5/13 – 1:05 am: Windows update notification displays. Users have the option to update immediately.
  • 5/14 – 1:05 am: Update force starts on any computers not manually updated.

Urge Congress to correct unjust denial of public service loan forgiveness benefits

The California Medical Association (CMA) is asking all physicians to contact their Members of Congress to urge them to cosponsor HR 1133, the “Stopping Doctor Shortages Act.” We need to enlist every California Representative as a cosponsor to show Congressional leadership the urgent need to sustain a physician workforce and protect patient access to care in California.

The bill provides a technical fix to the federal Public Service Loan Forgiveness (PSLF) program, which allows physicians who “work in” a non-profit hospital or clinic for 10 years to have their education loans forgiven. Unfortunately, when the U.S. Department of Education wrote the implementing regulations, they narrowed the regulations to require physicians to be directly employed. Because state laws in California and Texas prohibit most hospital employment of physicians, our physicians were unintentionally excluded from the program. Physicians in all other 48 states participate in the program.

The fix in HR 1133 will allow California and Texas physicians to fully participate in PSLF Program. Legislation is necessary because federal regulators under both the Obama and Trump Administrations have not been willing to reopen the regulations related to the PSLF program.

Please urge your Member of Congress to cosponsor HR 1133, the “Stopping Doctors Shortages Act,” today.

For background and more information, read our news story here.

CMHS Weekly Medical Staff Calendar – May 10 – 14

MondayTuesdayWednesdayThursdayFriday
7:30 am COVID19 Update
for Medical Staff - Teams
10:00 am Audit & Compliance Cmte – BR

5:00 pm Medicine Cmte – BR & Teams 12:00 pm General CA Conf – TBD
7:30am COVID19 Update for Medical Staff (Teleconferenced)

12:30 pm Family Medicine Cmte –Teams
12:00 pm to Patient Safety & Quality Committee– Zoom

12:15 pm Cardiac Division Cmte – NA / Teams

4:30 pm COVID19 Task Force Meeting - Teams

5:30 pm Orthopedic Division – BR /Teams
7:30am OVCH ED Subcommittee - Teams

Final Thoughts

“If your compassion does not include yourself, it is incomplete”
– Jack Kornfield

Keep the faith,

Stan Frochtzwajg, M.D.
Chief Medical Officer

Community Memorial Health System
sfrochtzwajg@cmhshealth.org
www.cmhshealth.org/voice – Medical Staff Voice Blog link

Tracey Shoop – Physician Liaison – tshoop@cmhshealth.org & (805) 490-3860
Megan O’Neill – Business Development Manager – moneill@cmhshealth.org & (805) 207-8216
Scott Goodfriend, M.D. – Physician Advisor – sgoodfriend@cmhshealth.org & (805) 701-3514
Medical Staff Office – (805) 948-5662

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Medical Staff Voice – May 3, 2021

JW Moore Tuesday, Noon, CME Conference -“Personality Disorders.”

Ron Bale, Ph.D., Psychologist, will present a lecture on “Personality Disorders.” At the end of the conference, the learner should be able to: 1) Recognize patients with personality disorders, 2) Recognize and manage the “vortex,” and 3) Recognize and manage one’s own reactions to patients with personality disorders.

The conference will take place on May 4, 2021, at noon, via ZOOM. This activity qualifies for AMA PRA Category 1 Credit™ & AOA Category 1-A credit.

If you would like to attend this meeting, please contact CME Coordinator Erin Parker at eparker@cmhshealth.org or 805-948-5638, and an invite with a link to the meeting and instructions on how to join will be emailed to you.

CME Quarterly Focus

We are thrilled to announce this quarter’s major area of focus: essential elements of behavioral and mental health for practicing clinicians. Over the next three months, we will be using our JW Moore Grand Rounds Tuesday noon series to update our medical staff on conditions such as depression, anxiety disorders, care of the ‘difficult’ patient,  personality disorders and the unfortunate stigma of mental illness still present in society.

Recent studies have confirmed that the COVID pandemic has only exacerbated these problems and we believe a thorough review of these common disorders will be both helpful and timely for our physicians.

This series will be highlighted by many of our own superb clinicians who practice and teach in our developing psychiatry residency program: Drs. Joe Vlaskovits, Leslie Horton, Robert Rubin, Ron Bale, Ronda Doonan and Ron Pollock.
This series began last week with a review of Anxiety Diseases by Dr. Steven Schandler. It will continue tomorrow, April 27, when we present an approach to addressing the distressing situation when patients with real life-threatening diseases refuse all life-saving treatments.

We hope you find this quarterly series helpful to your practices, and, as always, we very much appreciate your engagement and involvement in enhancing CME at CMHS.
– Dr. James Hornstein

National Nurses Day is May 6, 2021

Please join us in honoring our dedicated nurses on May 6th and acknowledge them for their vital role within our Healthcare System.  May 6th marks the beginning of National Nurses week which ends on May 12, the birthday of Florence Nightingale. Thank you CMHS nurses for your hard work long hours and dedication to our community!

Dr. Scott Goodfriend – CMHS Physician Advisor – CDI Expert

In Episode Seven of the Medical Staff Voice Live, Community Memorial Health System Chief Medical Officer Dr. Stan Frochtzwajg introduces us to Dr. Scott Goodfriend. Dr. Goodfriend fills a VERY unique role as a Physician Advisor at CMHS. Learn more about his role, as well as his interests and hobbies, in this episode!
Link to YouTube video interview

COVID-19 Memorial – A Week of Remembrance

Neurology at Santa Rosa Center for Family Health

Welcome our new Neurologist, Dr. Rajeswari Ananda, who will be coming to our Santa Rosa clinic on Wednesday, starting May 5th. She will see patients in the clinic and via Telehealth. Dr. Ananda is currently accepting referrals. She specializes in general neurology and movement disorders.

Ocean Tower Computer Downtime for Windows Update

Computers in the Ocean Tower will be updated based on the last digit of their hostname. Since this particular update can take as long as 1 hour to complete we will be updating 10% of the computers at a time according to the schedule below. The hostname can be found in the upper right-hand corner of the desktop. Ideally staff should save their work and proactively restart using the pop-up window that will display for twenty-four hours.

Group 4

  • 5/3 – 1:05 am: Windows update notification displays. Users have the option to update immediately.
  • 5/4 – 1:05 am: Update force starts on any computers not manually updated.

Group 5

  • 5/5 – 1:05 am: Windows update notification displays. Users have the option to update immediately.
  • 5/6 – 1:05 am: Update force starts on any computers not manually updated.

Group 6

  • 5/7 – 1:05 am: Windows update notification displays. Users have the option to update immediately.
  • 5/8– 1:05 am: Update force starts on any computers not manually updated.

Group 7

  • 5/9– 1:05 am: Windows update notification displays. Users have the option to update immediately.
  • 5/10– 1:05 am: Update force starts on any computers not manually updated.

CMHS Weekly Medical Staff Calendar – May 3 – 7

MondayTuesdayWednesdayThursdayFriday
7:30 am COVID19 Update
for Medical Staff - Teams
5:30 pm MEC –Teams & BR12:00 pm General CA Conf – TBD

12:15 pm OB/GYN Cmte – NA
(front/Teams)
12:30 pm OVCH Campus
Committee- Teams

5:15 pm Ethical Allocation of Scarce
Resources Triage Team (Teams)
4:00 pm Surgical
M&M - Virtual

Final Thoughts

“The weak can never forgive. Forgiveness is the attribute of the strong.”
~Mahatma Gandhi

Keep the faith,

Stan Frochtzwajg, M.D.
Chief Medical Officer

Community Memorial Health System
sfrochtzwajg@cmhshealth.org
www.cmhshealth.org/voice – Medical Staff Voice Blog link

Tracey Shoop – Physician Liaison – tshoop@cmhshealth.org & (805) 490-3860
Megan O’Neill – Business Development Manager – moneill@cmhshealth.org & (805) 207-8216
Scott Goodfriend, M.D. – Physician Advisor – sgoodfriend@cmhshealth.org & (805) 701-3514
Medical Staff Office – (805) 948-5662

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