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lifeline
a forum for emergency physicians in california
JUNE 2012
Emergency Physicians
Need to Get Some Drug Rehab
Page 12
TABLE OF CONTENTS |
4 9 10 12
4 President’s Message 16 ANNOUNCEMENTS
6 PRESIDENT-ELECT’S MESSAGE 18 SCIENTIFIC ASSEMBLY
9 PrACtiCE MAnAgEMEnt CoMMittEE 19 ULTRASOUND WORKSHOP
Core Measures
20 CAREER OPPORTUNITIES
10 CUres
Despite Early Flaws, CUrES Proves invaluable 21 UPCOMING MEETINGS & DEADLINES
in Preventing Prescription Drug Abuse
12 CUres
Emergency Physicians need to get Some
Drug rehab
California ACEP
Board of Directors &
Lifeline Editors Roster
2011-12 Board of Directors
Peter Sokolove, MD, FACEP, President
Andrew Fenton, MD, FACEP, President-Elect
Tom Sugarman, MD, FACEP, Vice President
Paul Christensen, MD, FACEP, Treasurer
Michael Osmundson, MD, FACEP, Secretary
Andrea Brault, MD, FACEP, Immediate Past President
Yasmina Boyd, DO
Mathew Foley, MD, FACEP
Marc Futernick, MD, FACEP
Gary Gechlik, MD, FACEP
Alfred Joshua, MD, CAL/EMRA Representative
Cameron McClure, MD
Aimee Moulin, MD, FACEP
Leslie Mukau, MD, FACEP
Mark Notash, MD
Bing Pao, MD, FACEP
Chi Perlroth, MD
Larry Stock, MD, FACEP, At-Large
Andrea Wagner, MD, FACEP
Advocacy Fellowship Program
Mary Bing, MD, Advocacy Fellow
Mathew Foley, MD, FACEP, Advocacy Fellowship Director
Lifeline Medical Editors
Mathew Foley, MD, FACEP, Medical Co-Editor
Richard Obler, MD, FACEP, Medical Co-Editor
Lifeline Staff Editors
Elena Lopez-Gusman, Executive Director
Ryan P. Adame, MPA, Deputy Executive Director
Lucia Romo, Education Coordinator
Callie Hanft, Program Associate
WELCoME new members!
H. Michael Boulton, MD Harriette E. Lewis, MD Gregory Robert Rosellini, MD Mandana A. Toole, DO
David Anthony Chen, MD Maria Loza-Gomez, MD Aminatu J. Shehu, MD Griffeth W. Tully, MD
Eric Ernster, MD Richard Clive Lynton, MD Noushafarin Nounou Taleghani, MD Christopher Walker, MD
Patrick Ignacio, MD Wilfred Martin Rico, MD Sarah Taylor, MD Brad Whiting, MD
Thomas Joon Lee, MD Jeff D. Rodgerson, MD Casey J. Toole, MD Jeffrey J. Zielinski, MD
100% GROUPS
Central Coast Emergency Physicians Newport Emergency Medical Group, Inc. at
Emergency Medicine Specialists of Hoag Hospital
Orange County Pacific Emergency Providers, APC
Front Line Emergency Care Specialists Tri-City Emergency Medical Group
Loma Linda Emergency Physicians University of California Irvine Medical Center
Napa Valley Emergency Medical Group Emergency Physicians
JUNE 2012 | 3
PrESiDEnt’S MESSAgE |
The Year in Review
By Peter Sokolove, MD, FACEP
What a Year It Has Been!
It’s hard for me to believe that in less than six weeks my term as Chapter President will come to an end. It seems like the Newport Beach
Scientific Assembly was only a few months ago, and we were planning an ambitious agenda for this year. Now our final board meeting
in Monterey is rapidly approaching, where I will have the honor of passing the gavel to our President-Elect, Andrew Fenton. Not only is
Andrew an excellent leader, but I am proud to say that he was one of our UC Davis residents when I was the program director. But before
passing the gavel, I wanted to briefly review some of California ACEP’s initiatives and accomplishments of this past year.
Let’s start on the legislative front. The distribution of Maddy Fund dollars. Because 2552 to eliminate a proposed mandatory
year began with a most important each county has their own methodology reporting requirement to law enforcement
accomplishment. On June 30th, 2011 and system for collecting and dispersing when an emergency physician suspected
Governor Brown signed the state budget these funds, previously it was easy for a patient was injured in an alcohol or drug
into law, and the Maddy EMS Fund was money to “stray” at times from its intended related motor vehicle collision. And there
left completely untouched and intact! purpose. This new law requires counties to are many more pieces of legislation that
This was the culmination of tremendous provide unambiguous, explicit reports of California ACEP has influenced this year,
efforts made by Chapter members, leaders Maddy fund collections and distributions, from injury prevention to medical liability
and staff over the previous four months, so that these essential funds continue to issues to out-of-network benefit coverage,
beginning under Andrea Brault’s term support emergency care for medically among many others.
as President. This victory reversed the indigent patients.
elimination of about $100 million in critical We continue to make progress on California
As if those accomplishments weren’t ACEP sponsored bills in the current
funding for the emergency care safety net,
big enough, California ACEP influenced legislative session. We sponsored SB 336
and this funding remains intact during the
numerous other important pieces of (Lieu and de Leon), which would require
current budget cycle.
legislation this year. We made significant hospitals to implement ED crowding plans
In addition to saving the Maddy Fund, improvements to SB 233, which addressed to proactively address this critical patient
there were other major victories that the use of non-physician providers in the ED. safety and public health issue. This bill
strengthened the Maddy fund this year. In Our amendments ensured that important has passed the Senate, and our advocacy
September 2011, Governor Brown allowed patient protections and appropriate team is engaged with discussions with
AB 412 to become law. This California emergency physician oversight were in the Department of Public Health and the
ACEP sponsored bill re-established the place. Our advocacy team killed AB 1862, Governor’s staff prior to bringing the bill to
Maddy Fund for Santa Barbara County which would have permitted the creation of a vote on the Assembly floor. We are making
– an important victory for patients and free-standing emergency departments. We great progress on AB 1803 (Mitchell),
emergency physicians in California’s Central also defeated AB 2394, which would have which protects the prudent layperson
Coast. The following month, Governor eliminated one of the two seats designated definition of an emergency for fee-for-
Brown signed California ACEP-sponsored for board-certified emergency physicians service Medi-Cal patients. After seeing the
legislation (AB 1059) that improved county on California’s Commission on Emergency uninformed and dangerous actions taken
accountability for the collection and Medical Services. Similarly, we amended AB by Medicaid regulators in other states such
4 | LIFELINE a forum for emergency physicians in california
The Maddy EMS Fund was left
completely untouched and
intact! This victory reversed
as Washington, we introduced this bill to
ensure prudent layperson protections for
On the practice management front, a new
challenge arose this year -- the proposal by
the elimination of about $100
California’s medically vulnerable patients. Catholic Healthcare West (CHW) to require
AB 1803 recently passed Assembly a number of its emergency medicine million in critical funding for
Appropriations Committee, which was a groups to double their Professional
potential major hurdle, and at the time of Medical Liability Insurance (PMLI) limits the emergency care safety
this writing moves to the Assembly floor. and contractually indemnify hospitals. This
ill-conceived proposal would raise liability net, and this funding remains
It has been an active year on the legal
premiums by 30 to 40%, make emergency
and regulatory fronts as well. Through the
physicians a target for additional lawsuits intact during the current
California Emergency Medicine Advocacy
and larger settlement demands emergency
Fund (CEMAF), we made a significant
financial contribution to support pending
physicians to, and expose emergency budget cycle.
litigation (Centinella Freeman v. La Vida)
with the goal of creating new case law
making plans liable for unpaid and
underpaid claims of their delegated payers.
We reported concerns to CMS regarding
the practices of some psychiatric receiving
facilities that deflect the transfer of psychiatric
patients. Because of this inquiry, CMS clarified
that psychiatric facilities that have capacity
cannot refuse to accept patients on a 5150 hold
who have been medically cleared in the ED. We are
actively working with Medi-Cal officials to address the
problem of inconsistent and unpredictable standards
that are often used for Medi-Cal billing audits. As result of
this dialogue, California ACEP is assisting with developing
enhanced standards. We are similarly working closely with
the Department of Public Health to safeguard the ability of
emergency physicians to use propofol for procedural sedation.
We intervened prior to the release of unnecessary and restrictive
regulations that could have placed an insurmountable burden on
providers and caused serious delays and threats to effective patient
care. Finally, we successfully advocated for maintaining California’s
Emergency Medical Services Authority (EMSA) as an independent state
agency.
JUNE 2012 | 5
PrESiDEnt’S MESSAgE |
physicians to uncovered financial losses. advise them as they consider new models
California ACEP wrote a letter of strong to expand access to care, and we continued
PrESiDEnt-ELECt’S
opposition to the President and CEO of our long-standing collaboration with CMA MESSAgE |
CHW, engaged the support of national on many important issues.
F
ACEP and the AMA and educated and
This year we made a special effort to reach or the past six years, it has been
informed our members as well as leaders of
out to our partners in care – California’s my honor to serve the members of our
other state chapters about this new threat.
emergency nurses. I was honored to attend
Chapter, from the beginning as part of
Our public relations team also was active and present at a statewide meeting of the
the first crop of California ACEP Fellows,
and highly effective this past year. We California Emergency Nurses Association
conducted media training for all board (Cal/ENA), and our organizations have since to assuming the Presidency this month.
members and had media hits in the Los forged an even closer working relationship. I consider it one the great professional
Angeles Times, Santa Cruz Sentinel, San I was absolutely thrilled to have Cal/ENA honors in emergency medicine to serve
Francisco Business Times, and Sacramento nurses join in our Legislative Leadership this accomplished organization in the role
Bee. We expanded our ED tours program Conference this year to speak with one
in which I will embark upon. To be sure,
and produced a 40th anniversary voice on important issues affecting our
there are significant changes in medicine
video documenting the history and patients, such as ED crowding. Last year Ca/
accomplishments of the California chapter. ENA opposed our sponsored ED crowding ahead, but also a great many opportunities
We developed and are now implementing legislation, but this year they support our on California ACEP’s horizon. I look forward
an innovative “State of California’s ERs” bill and are actively collaborating to help to working with our Board of Directors,
project. Funded by an ACEP chapter grant, solve this problem. Past Presidents, College leaders, and
this project will collect real-time data on the
As you can see, it was a productive year and sophisticated Staff in continuing to meet
ED conditions throughout our state that
it’s not over yet. In reality, even though my these challenges to ensure success. I
can be shared with legislators, regulators
term as Chapter president may be nearing a truly do stand on the shoulder of giants,
and the media.
close, the work of this chapter will truly never which provides a sturdy foundation for the
Within the organization, a number of end. We have a great specialty to defend,
upcoming tides of health care reform.
initiatives were begun to improve the patients that need our care and advocacy,
function and stability of our chapter. Under a healthcare system that would crumble I sincerely hope that as many members as
the leadership of Andrew Fenton, our without the service of our members,
possible will join the Board, past leadership,
chapter bylaws were thoroughly reviewed legislators whose good intentions often go
and me in Monterey to usher in the start of
and revised. In order to support our bold awry, payers who simply don’t have good
advocacy agenda the entire Board of intentions, and of course new challenges a new Board year. Again we will celebrate
Directors made personal contacts with ED that are unknown today. However, you can our organization, its outstanding educators,
groups to help expand the number that take great pride and comfort in knowing and accomplished award winners. Once
contribute to CEMAF. As a result, more that California ACEP will be there for you. again we will also gather to meet with
groups are now contributing to CEMAF Our staff and volunteer board members
friends, colleagues, and family to renew our
than ever before. are talented, hard-working and tenacious.
commitment to emergency medicine, our
I have enjoyed every moment of working
Collaboration and outreach beyond our with such an amazing team of colleagues. fellowship, and the California Chapter. n
organization was also an important goal this Most importantly, I have been immensely
past year. We engaged the WestJEM editorial — Andrew Fenton, MD, FACEP
privileged to represent California’s
board regarding the importance of advocacy emergency physicians, who are the most
and the role that their journal could play in inspiring group of physicians and friends
these efforts. We renewed our support for one could imagine. Thank you for allowing
WestJEM for another 3 years, reflecting our me to serve as president of California ACEP.
ongoing collaboration with Cal/AAEM in this It has been one of the best years of my life! n
effort. We engaged with Alameda County to
6 | LIFELINE a forum for emergency physicians in california
Moments.
The smell of lavender
on her soft baby skin.
Holding her hand
as she walks into
kindergarten.
The sweet salt
of tears as she
takes her first bow.
The adrenaline rush
of a busy ED.
Telling someone’s
family that everything
will be okay.
The moments that
mark our lives
as EM Physicians.
Live them all.
Call Ann Benson at 800-828-0898 or visit emp.com. Opportunities in 60 locations across the USA. AZ, CA, CT, HI, IL, MI, NV, NY, NC, OH, OK, PA, WV
CEMAF
Donors
The California Emergency Medicine Advocacy Fund
(CEMAF) has transformed California ACEP’s advocacy (Southern California)
efforts from primarily legislative to robust efforts in JoB oPPortUnitiES
the legislative, regulatory, legal, and through the
Emergency Medical Political Action Committee, politi- • Excellent Opportunities for Emergency
Physicians
cal arenas. Few, if any, organization of our size can boast of
an advocacy program like California ACEP’s; a program that • Very Competitive Compensation
has helped block Medi-Cal provider rate cuts, stop the $100 • Pleasant Work Environment
million raid on the Maddy EMS Fund, and fight for ED over-
crowding solutions – and that’s just the last year! The efforts • Hospitals include Arcadia Methodist &
could not be sustained without the generous support from Glendale Memorial (Top heart programs).
the groups listed below, some of whom have donated as • Available practice settings in the Greater
much as $0.25 per chart to ensure that California ACEP can Los Angeles area.
fight for emergency medicine. Thank you to our 2011-12
Contact Debbie Corn for more information.
contributors (in alphabetical order): (909) 634-3172 or fax CV to (909) 629-8755
• Acute Care Medical Group of Orange County Email: dcorn@emmamd.com
• Alvarado Emergency Medical Associates
• Antelope Valley Emergency Medical Associates
• Beach Emergency Medical Associates
• Centinela Freeman Emergency Medical Associates
• CEP America PaAC
Board EP
Revie
w
PaACE
P Boa
• Chino Emergency Medical Associates rd Rev
iew
August 9-12, 2012
• Culver City Emergency Medical Group Sept. 10-15
ABEM
ConCert Exam No
PaACEP
v.
A 7-1
• EMP
Qu
alif BEM 2
yin
g E
xam
• EMS Management
• Mills-Peninsula Emergency Medical Associates
• Montclair Emergency Medical Associates
Board Review
If you are taking the Board Certification Exam for the first time or taking
• Napa Valley Emergency Medical Group it for recertification, PaACEP’s Board Review will meet your needs
• Orange County Medical Associates • A focused 3 ½ day course—shorter than most review courses but provides the
information needed to pass the exam!
• Pacifica Emergency Medical Associates • Nationally recognized faculty, all recertified within the last four years
• Peer recommended
• Riverside Emergency Physicians • Free practice book with 1,300 questions*—Mirrors the format of the exam for
• San Dimas Emergency Medical Associates extra preparation (*newly revised for 2012)
• A great final review for those taking the recertification exam—get a last minute
• San Francisco Medical Associates, Inc. core content review
• Santa Cruz Emergency Physicians More information available online at www.paacep.org. Contact
Nancy Miller toll-free at (877) 373-6272, or email nmiller@pamedsoc.org.
• Sherman Oaks Emergency Medical Associates
The American College of Emergency Physicians designates this live activity for a
• South Coast Emergency Medical Group, Inc. maximum of 52.75 AMA PRA Category 1 Credits™. Physicians should claim only
• Tarzana Emergency Medical Associates the credit commensurate with the extent of their participation in the activity.
Approved by the American College of Emergency Physicians for a maximum of
• Team Health 52.75 hour(s) of ACEP Category I credit.
• Tri-City Emergency Medical Group Not affiliated with ABEM or AOBEM.
• Valley Emergency Medical Associates Westin BWI Hotel, Baltimore, MD
• Valley Presbyterian Medical Associates
• West Hills Emergency Medical Associates
PrACtiCE MAnAgEMEnt CoMMittEE |
Core Measures
By Ian Kramer, MD
This article is an overview of the 2012 national outpatient Core Measure requirements
from CMS as they apply to Emergency Departments (EDs). It will identify the four
areas that will require monitoring, measurement and ultimately, improvement
in the future as there will be financial rewards and penalties from CMS. The four
topics for 2012 are as follows: Acute MI, Acute Stroke, ED Throughput, and Pain
Management for long bone fractures.
Acute Myocardial Infarction ED Throughput Departments. There is already a rich data base
on this parameter and what the Benchmarks
The Acute Myocardial Infarction core measures The third outpatient Core Measures group will be are not stated but will be considered
for Outpatients are four previous parameters is titled “ED throughput” and includes four separate from OP measures 18 and 20.
plus one new one. The measures are: areas as follows:
1. Time to Thrombolytics when given 1. OP 18 is Median time from ED arrival Median Time to Pain Management
with the goal a median time of 30 to ED Departure for Discharged ED in Long Bone Fractures
minutes from arrival of STEMI. Patients.
The final OP measure is #21 – Median Time
2. Median time of transfer to 2. OP 20 Door to Diagnostic Evaluation to Pain Management in Long Bone Fractures
another facility for acute coronary by qualified medical personnel. and applies to patients greater than 2 years
intervention with a goal of door-to- 3. OP 22 Left Without Being Seen old. It excludes patients less than 2, those
balloon of 90 minutes or less. who LWBS and those who have expired.
4. OP 19 which is Transition Record The goal is improvement in Median time
3. Aspirin at arrival with a goal of with Specified Elements Received and benchmarks will be set and financial
increase in rate, although most by Discharged Patients has been rewards/penalties to be determined later as
hospitals are at or near 100%. put on hold for this year and is not with other OP new Core Measures.
being tracked. It may be reinstated in
4. Median time to ECG with a goal of 10 the future but that has not yet been In summary, the new Outpatient Core
minutes or less. determined. Measures will operate similarly to the
5. NEW: Troponin results within 60 Inpatient Core Measures system that
minutes of arrival in the ED. This OP 18 actually breaks down the ED patients preceded its creation. The initial plan is to
is only required if the discharge to five categories – overall rate, reporting set up the measures and collect the data
diagnosis is cardiac-related by code measure, Observation Patients, Psych/ from all outpatient settings. The data will
at disposition. Mental Health Patients and Transfer Patients. be stratified and rated on a top tier versus
The goal is again a decrease in the Median overage and lower tier providers. After a trial
The first four measures restate prior time and the numbers will be collected, period of six months to a year, goals will be
requirements and will be compared against collated and a data base of top performing set that are required to be reached to obtain
the institution’s prior results and graded on EDs will be created. That performance will set payments for performance and penalties for
the basis of improvement. No decision on preliminary guidelines which will ultimately substandard performers. It is anticipated this
the amount of improvement required and affect payment/penalties in the future but will take at least a year and likely longer to
financial benefits has been determined not this year. The data is already collected by implement as it is fine-tuned. As Emergency
or provided to us yet. The new Troponin most hospital Emergency Departments and Physicians, we need to stay on top of the data
measure is going to be analyzed at six one should be able to review past as well as and do our best to improve our numbers
months and possibly at one year to stratify future performance. from baseline to meet national criteria when
payments/penalties. they are established. No one knows the
OP 20 is essentially door to provider and ultimate financial implications, but we need
provider can be a PA, NP, DO or MD in most to be ready if we are to be successful.
Acute Stroke cases. This will track time of arrival until
The second Core Measure is Acute Stroke seen by a qualified medical provider for Additionally, most hospital administrators
and there is only one outpatient measure to Discharged Patients only. The indicator is the are already monitoring any CMS
be monitored and that is: CT or MRI results Median time and again will be correlated requirements that affect payment and it
for ischemic or hemorrhagic stroke within 45 versus other facilities to set up standards of is wise to be a step ahead to protect your
minutes of ED arrival. This is a new Core Measure performance to determine future payments/ Emergency Department and its contract.
and will be treated, as Troponin, with data penalties, but not before 2013 at the soonest.
collected from all hospitals at 6 and 12 months This is a major driver for CMS and Hospital www.jointcommission.org/core_measure_
and top percentile hospitals/EDs compared Administrators will be watched closely. sets.aspx
to set new standards for performance. These www.jointcommission.org/assets/1/6/Core_
new standards will then be applied to all OP 22 is Left Without Being Seen which has
been a required data collection for a long measure_changes_1_1_2012__2_.pdf n
participants, and financial incentives will be
derived from that information. time and is monitored by most Emergency
JUNE 2012 | 9
CURES
Despite Early Flaws,
CUrES |
Proves Invaluable
Since its launch in 2009, California’s Controlled Substance Utilization Review and Evaluation System (CURES) has traveled a rocky
road. At its inception, then-Attorney General Jerry Brown promoted the system as a critical tool in fighting the growing epidemic
of prescription drug abuse. CURES, also referred to as the Prescription Drug Monitoring Program (PDMP), is an on-line database
that displays the last year of a patient’s controlled substance prescriptions. The database is large and contains over 200 million
entries of controlled substances dispensed in California.
The arrival of an easily accessible, user-friendly, real-time down of the program in November 2011, thereby disenfranchising
database to monitor the dispensing of Schedule II-IV drugs was numerous physicians and providers. In January, the state eliminated
met with enthusiasm by the emergency medicine community. the staff that operated CURES leaving only one person to maintain
Unfortunately, the earliest iterations of the program proved to be and update the program.
slow and contained outdated information. The registration process
The flaws in the system, and the subsequent impracticality of it,
was onerous, and prescribers’ passwords expired soon after being
were discussed in an April 2012 article in a New York Times entitled,
made requiring they be reset by a call to Sacramento.
“
“Meager Participation Hobbles Drug Oversight.” This article
made the unfortunate conclusion, that despite these obstacles,
CURES has helped us target certain persons with the true problem with the system and lack of participation was
prescription drug abuse problems, and it has allowed
us to treat acute pain and to prescribe opiates to most
“ because it was voluntary. “In California, the system has not put a
dent in prescription drug abuse because enrollment in the drug-
monitoring database program is optional.”2 The article included
the results of an investigation, performed by The Bay Citizen, a San
patients without reservation knowing they are truthful. Francisco bay area newspaper, that of the more than 30,000 doctors
and pharmacists in the area, only 86 were enrolled in CURES.3
The time required to enroll, to maintain an updated registration,
and to look up histories proved to be too cumbersome for many This article prompted a letter in response from California ACEP
physicians while dealing with the unyielding time pressures of a questioning the veracity of the investigation’s numbers and the
busy ED. This proved true for other providers as well. In the first year, author’s conclusion.4 Though the New York Times and Bay Citizen
of the more than 165,000 eligible providers, only 1,559 prescribers article may be dubious, its effect has been undeniable. There is
and 282 pharmacists enrolled in the program. Currently, as of April growing sentiment in Sacramento that physicians’ lackadaisical
2012, 6,755 prescribers and 1,216 pharmacists are registered.1 attitude toward curbing prescription drug abuse is hampering law
enforcement efforts in this area. This may lead to the end of the
Gov. Jerry Brown announced last year, for budget reasons, that he
was eliminating the Bureau of Narcotic Enforcement within the
Department of Justice (DOJ), which had managed the PDMP, and
2 Shoshana Walter, “Meager Participation Hobbles Drug Oversight.” The New
was cutting the DOJ budget by $71 million. These cuts led to a shut York Times, April 7, 2012.
3 Shoshana Walter, “System to Curb Abuse of Prescription Painkillers Goes
Unused,” The Bay Citizen, April 8, 2012.
1 Shoshana Walter, “System to Curb Abuse of Prescription Painkillers Goes 4 Andrew Fenton MD, “Many Doctors Use Prescription Database,” The Bay
Unused,” The Bay Citizen, April 8, 2012. Citizen, April 12, 2012.
10 | LIFELINE a forum for emergency physicians in california
in Preventing Prescription
Drug Abuse By Andrew Fenton, MD, FACEP
CURES/PDMP, but would more likely result in mandatory enrollment Disease Control and Prevention, eleven people die every day in
in the program as part of physician licensure and certification. There California from prescription drug overdoses. As stewards of public
has also been discussion of a requirement that all physicians sign a health, we have a responsibility to act on behalf of our patients and
form they reviewed the database before prescribing any Schedule our communities.
II through Schedule IV meds.
As a signal of the Chapter’s commitment to the importance of
Despite its ongoing funding and staffing issues, current Attorney CURES, and in answer to Attorney General Harris’ call to action,
General Kamala Harris has recommitted the DOJ to the program. At the Chapter will host DOJ staff in an exhibit booth at the Scientific
the California Medical Association’s recent Legislative Leadership Assembly & Ultrasound Workshop in Monterey (June 21-23, 2012)
Conference, Harris said she moved the database to another part to facilitate physician participation in CURES by allowing for real-
of her department where it will be better protected from future time registration. Attendees can complete the on-line registration
budget cuts. The system has been updated and password resets and print the application at home (or at a computer kiosk we will
are now simpler (allowing for reuse of the same password during a set up in the booth). Along with the application, bring to Monterey
reset). She highlighted the importance of CURES to physicians and a copy of your drivers license (or passport), copy of DEA certificate,
investigators, noting that providers have accessed the database and copy of medical license. A notary will be on-hand to notarize
more than 1 million times. The PDMP has helped law enforcement the documents to complete the application, and the Chapter will
close several high profile “pill mills” and played a critical role in the provide a pre-stamped envelope for you to return your completed
investigations of the deaths of Michael Jackson and former Playboy application. When you get home you will receive an e-mail with a
Playmate Anna Nicole Smith, among others. link to your password so you can begin using the system.
Attorney General Harris then issued a challenge to physicians: to If you have not yet enrolled with CURES now is the time to do it.
enroll in the program, to use the database, and finally to push for
HErE iS HoW:
continued funding so that the system remains viable. California
1
ACEP is committed to promoting California’s CURES as a voluntary Complete the on-line registration at:
program that can prove invaluable as a tool in preventing https://pmp.doj.ca.gov/pmpreg/.
prescription drug abuse. Personally, my ED physician colleagues
and I use the CURES program on a daily basis. It has helped us
target certain persons with prescription drug abuse problems, and
it has allowed us to treat acute pain and to prescribe opiates to
2 Complete the application by submitting notarized
copies of signed application, Government ID, DEA
Certificate, and Medical License to:
most patients without reservation knowing they are truthful. This
California Department of Justice
reassurance is the effect of the program that I have found to be
Law Enforcement Support Program
most satisfying to my clinical practice.
Attn: PDMP registration
In the state of Washington, they have instituted a goal to sign up P.o. Box 160447
75% of emergency physicians into their own prescription drug Sacramento, CA 95816
3
monitoring program. I believe the same goal is obtainable for
Or, bring the above-required documentation with you
California. Overdoses, mostly from prescription drugs, have now
to Monterey to register on-site. n
become the No. 1 cause of accidental deaths in the United States,
surpassing motor vehicle accidents. According to the Centers for
JUNE 2012 | 11
CUrES |
Emergency Physicians
Need to Get Some Drug Rehab By Roneet Lev, MD, FACEP
Do you ever come to work and
fatigued by patients’ demands
for drugs?
The conversation generally goes like this:
Patient: “I usually get OxyContin 80 mg 60 tablets.”
Me: “I will give you 15,”
Patient: “But Dr. Nice always give them to me,” or “My doctor is
out of town,” or “My prescription was stolen,” or “I know my rights.”
And finally, “OK, twenty tablets, my final offer, and this will be the
last time.”
S
ometimes, after a long and expensive work up: labs, CTs and x-rays, you find out the
real reason the patient came to the ED was just for the Vicodin prescription, then as the
parting gift after waiting so long: “Oh Doc, can you make that Percocet, Vicodins don’t
work for me.” Sure, but I wish you just told me that 4 hours ago!
Look at the patients in triage and you will find that the patient with legitimate potential
cardiac chest pain eloped and wouldn’t wait, yet the frequent flyer drug-seeker will stay in
that waiting room for 8 hours or however long it takes. This part of emergency medicine
is exhausting, unsatisfying, and if it seems that there are more and more of these types of
patients, you are right: there are more patients like this.
The Centers for Disease Control and Prevention (CDC) has declared the prescription drug
abuse problem an epidemic. Sadly, we - the physician and medical community - contributed
to the epidemic. We helped create it, and now we are the ones who need to get some
drug rehab before we can lead our nation into recovery. First say: “I am a doctor and I have
contributed to the Epidemic of Prescription Drug Abuse.” Now let’s go through the 12 steps
program for recovery.
12 | LIFELINE a forum for emergency physicians in california
StEP 1 StEP 3 • In San Diego the number of deaths
from all types of overdoses exceed
the Decade of Pain Control and the Misuse and Abuse of Pills motor vehicle collisions and are
research We demanded more pain management and second only to heart disease.
Let’s understand how we got to this with that came more pills and more abuse.
• 2008 data reflects 36,450 drug
predicament. You have been trained and Who needs cocaine and heroin when you
overdoses nationwide, with 14,800
encouraged to treat pain. You are criticized can get oxycodone?
from opioid pain relievers and 20,044
if you don’t. from other prescriptions.
• Prescription medications are the
• 1997 — The American Academy second most abused drug after
• There are 100 drug overdose deaths a
of Pain Medicine and the American marijuana.
year, a number that has tripled since
Pain Society teamed up to develop 1990.
guidelines for opioid use in chronic • In 2009 more than 16 million
pain. Americans reported using
• Deaths related to opioid analgesics
prescription medications such as
are 1.93 times more than that of
• 2001 — The Clinton administration painkillers, tranquilizers, or stimulants
cocaine and 5.38 times as the number
declared January 1, 2001 as the for non-medical purposes.
of heroin.
Decade of Pain Control and Research
and the Joint Commission presented • 1/3 of people age 12 and older
• California has 10.4 drug overdose
pain management standards. who use drugs illegally began with
deaths per 100,000 in 2008;
prescription drugs for non-medical
nationwide this number highest
• 2002 — California passed AB use.
in New Mexico (27) and lowest in
487 establishing a task force that Nebraska (5.5).
developed guidelines for all patients • 2.7% of 8th graders, 7.7% of 10th
with pain. graders and 8% of 12th graders
• For every death there are 32 ED visits,
have abused Vicodin for non-
130 people who are abused or who
• 2005 — California eliminated medical purposes in the past year.
are dependent, and 825 people who
triplicate prescriptions and created The numbers are slightly less for
are non-medical users.
a change to tamper resistant forms. OxyContin.
This is when we started writing for
Percocet, before we couldn’t do so
without a triplicate. StEP 4 StEP 6
the ED Visits Pills Come From Doctors
Your patient does not always use the
StEP 2 They say the entire world’s a stage and those
in the ED have a front seat. The problems
prescriptions you write. Some pills get
the number of Pills out there in society are reflected in our patient
shared or sold. The DEA has noticed that
when looking at prescribing patterns it can
The CDC quotes a tenfold increase in the population.
tell which prescriptions were written by
number of opioid prescriptions in the past 10 emergency physicians based on the number
years. The Decade of Pain Control followed • In 2009, there were 2.1 million ED
visits attributed to drug misuse and of pills prescribed. The DEA says 20 pills is the
by a decade of prescription addiction. average. This is a good practice. We always
abuse, according to the DAWN Report
(Drug Abuse Warning Network). want our patients to follow-up, so they do
• From 1997 to 2007 the mg per person
not need a big supply, plus, acute pain does
of opioids increased from 74 mg to
not require a long supply. Of course, you will
369 mg - a 402% increase.
StEP 5 use your judgment. You can prescribe 5 or
10 pills, but rarely more than 30. Don’t forget
• In 2009 retail pharmacies sold 257 Deaths
million prescriptions for opioids that Motrin and Tylenol are good analgesics.
compared to 174 million in 2000. This When you are writing a prescription for
Vicodin or Percocet for the chronic or • Most prescribers of pain medications
is a 48% increase.
addicted pain patient, or when it’s just are primary care physicians, followed
• California has sold 6.2 kg of easier to write the prescription rather than by internists, dentists, and orthopedic
prescription painkillers per 10,000 have an argument, ask yourself if you are surgeons.
people in 2011; nationwide this contributing to the epidemic of prescription
• For ages 10-19, dentists write
number is highest in Florida (12.6) drug abuse. Have any of your prescriptions
prescriptions for the most narcotics,
and lowest in Illinois (3.7). resulted in someone’s untimely demise?
followed by primary care and
• Americans are 4.6% of the world • Opioid overdose is now the leading emergency physicians.
population and consume 80% of cause of unintentional deaths in the
the global opioid supply, 99% of the United States.
hydrocodone supply, and 2/3 of the
world’s illegal drugs.
JUNE 2012 | 13
CUrES |
• People who abuse prescription
drugs say they get it from their
4. Unwillingness to try non-opioid
treatments. StEP 10
friends (55%), their doctor (17.3%), California response
purchased from friend or relative 5. Engaging in doctor shopping
California has developed its own prescription
(11.45), stole it (4.8%), or bought from activities.
drug-monitoring program called CURES,
a stranger (4.4%). Controlled Substance Utilization Review
6. Complaining of medical condition
with lack of pathology. and Evaluation System. It was under
threat for loss of funding, but it is up and
StEP 7 running in 2012. When you complete an
recognize Patients At risk
StEP 8 application you can be a few clicks away
from seeing prescription patterns for your
Always do a full history and physical and government response patients. Look at the different names of
don’t cut corners in your medical decision-
With a declaration of an epidemic, the Drug providers, the number of prescriptions, and
making. Don’t jump to conclusions and label
Enforcement Agency and Health and Human dates of prescriptions. Sometimes you will
someone a drug seeker before having your
Services department have developed a find different listed addresses. It makes it
facts straight and rule out objective disease.
coordinated federal plan to deal with the very easy to spot the doctor shopper or a
We all know about the case of the repeat
growing problem of prescription drug abuse dishonest patient.
back pain patient who ends up having an
epidural abscess or the headache patient and recognized that physicians prescribing
is part of the problem. The CDC lists 5 Ask your patient: “When did you get your last
who has a bleed. However, after doing your prescription?” If they tell you not for many
medical assessment you can recognize corrective recommendations:
months, but they indeed had one filled a
patients who are at risk for addiction and week ago, they are committing a federal
1. Prescription drug monitoring
abuse. The CDC list them as: crime. You are not the police, but you can
programs.
fight crime by documenting in your medical
1. The Doctor Shopper. The patient who
2. Patient review and restriction record a good medication history and time
is getting multiple prescriptions from
programs. the patient said they received their most
multiple providers.
recent prescription.
3. Heath care provider accountability.
2. The High Dose User and Multiple
CURES is not perfect. It does not include VA
Drug User. 4. Laws to prevent prescription drug patients or government patients. It also lags
abuse and diversion. in time, so at best you will see prescriptions
3. Low Income and Rural Areas. In a study
in Washington state, 45% of deaths within the last 2 weeks. However it is a tool to
5. Better access to substance abuse be used for optimal prescribing judgment.
from prescription drugs were people treatment.
on Medicaid. Rural counties have
If a DEA agent calls you about a patient you
twice as many deaths as big cities.
saw, do not be alarmed. You do not need to
4. More men than women die from StEP 9 call your lawyer or malpractice carrier. You are
overdoses and more middle age Understanding Chronic Pain not under investigation. You are being called
as a witness, or victim for a patient that may
adults. treatment
have tricked you into writing a prescription
5. American Indians and Alaska Natives According to the American Pain Society used for abuse. It will take 5 or 10 minutes of
have the highest death rate at 1:10 opioids alone are rarely effective in treatment your time to say “Yes I wrote this prescription,”
compared to Whites at 1:20 and of chronic pain. Opioids can be ineffective and “No I would not have written it if I knew
Blacks at 1:30. and unsafe and may lead to addiction or that he already had 5 other prescriptions
abuse. Treatment of chronic pain requires recently,” or “Yes that was a legitimate
The California DEA website identifies the a multidisciplinary approach including indication for that prescription.” Be helpful to
following red flags for suspicion of drug a combination of medications, stress these agents. The people they arrest or fine
abuse and fraud. management, relaxation, exercise, physical and forced into drug treatment programs and
therapy, massage, and other modalities. It is many are thankful in the long run.
1. Patient requesting specific controlled also rare to obtain more than 50% reduction
substances. of chronic pain with narcotics. It is likely
that patient in the ED with chronic pain
2. Repeatedly running out of medication is violating their pain contracts with their
early. doctor or clinic.
3. Unscheduled refills requested.
14 | LIFELINE a forum for emergency physicians in california
Th e Ce nters fo r Di se as
e Co nt ro l
StEP 11 repeat narcotic prescriptions from
the emergency department for the an d Preven tio n (CDC)
ha s
regional Efforts same medical condition. Repeat
de cla re d th e pres cr ip
There have been community wide efforts prescriptions should be obtained by tio n dr ug
in limiting prescription drug abuse from their medical follow up physicians or ab us e problem an ep ide
clinic. m ic. Sadl y,
the emergency departments. The Cherry
we - th e ph ys ici an an
Hill Emergency Department in Seattle d medica l
developed “The Oxy Free ED”. A summary of commun it y - co nt rib
their guidelines was published in the March StEP 12 uted to th e
individual Effort. Learn to Say no. ep ide m ic. We he lpe d cr
2011 edition of EMRAP. Here is a summary. eate it, an d
It is not easy to say no to patients. It is much no w we are th e ones
1. ED physicians do not prescribe w ho ne ed to
Schedule II controlled substances easier and much faster to say, “Here are your ge t some dr ug re ha b
20 Vicodins” and move onto the next patient. be fo re we ca n
2. Patients with chronic pain will not If you do this, you are called the “Candy Man.”. lead ou r natio n in to re
Patients learn who you are and seek you out. co ve ry.
receive IV or IM opioids
“Is Dr. Jones working today?” If your entire
3. A government-issued ID is required department is like that while the hospital
for all narcotic prescriptions next door developed a Narcotic Guideline
policy, then your entire department will
4. You will be photographed for the see more of these patients. Your ED is now
medical record if you have a pain “Candy Land.”
related complaint and do not have
an ID Learning how to say no or having a serious
discussion with your patients does not come
5. They will not replace lost or stolen naturally to us. This is the toughest part of Remember that you can always contact
prescription for controlled substances the physician rehab. But you can do it. Learn your local DEA office and report possible
to say some of the following sentences. prescription fraud.
6. They will not prescribe additional
pain medications after the first visit or • “When you have a chronic pain Now you can join your proud colleagues
if they already received medications condition your prescriptions need who can say that they are one-month
from another doctor or ED. to be regulated and coordinated by clean and sober from prescription refills for
a single clinic or doctor. We cannot chronic pain.
In San Diego the Emergency Medicine write you for any prescriptions, but
Oversight Commission has developed a rEFErEnCES:
we are certainly able to help your
different Narcotic Prescription Guideline. pain today.”
It has been distributed to each ED and is San Diego EMoC
posted on the ED’s web site. The guideline www.sdcms.org/san-diego-county-
• “We will give you a prescription
also includes a phone contact and email to emergency-medical-oversight-commission/
today, but we will be documenting
the local DEA agent if they suspect narcotic san-diego-county-emergency-medical-
in the medical records that we will no
fraud. The San Diego DEA has presented oversight
longer write for narcotic prescriptions
informative lectures about the prescription from the emergency department.” Physician Scripting for narcotic
drug problem with a local perspective. These
Prescriptions — contact ACEP
guidelines state the following: • “It is not good medical care to have
your condition treated by different national institute on Drug Abuse
1. Patients who have established chronic doctors and clinics.” www.drugabuse.gov
pain conditions and have a medical
home should not receive narcotic • “The DEA tracks all narcotic Center Disease Control
prescriptions form the emergency prescriptions. I can get in trouble for www.cdc.gov/homeandrecreationalsafety/
department and are encouraged to writing such prescriptions.” rxbrief n
obtain a new prescriptions or refills
by their physician or clinic. • “I see that you were just given
prescription for (name medication)
2. Patients who received a recent on (state all dates). The DEA regulates
prescription for narcotics as these medications. Unfortunately I
determined by the hospital’s medical cannot write for any further narcotic
records, health plan records, or prescriptions.”
CURES database should not receive
JUNE 2012 | 15
AnnoUnCEMEntS |
newly-eleCted direCtors of photographs, documents, and nearly 100 hours of interviews
The 2012 Chapter Board E-lection was a resounding success, with and videos documenting the Chapter’s impressive history of policy
more candidates and ballots cast than any election in the last five achievements from 1971 to 2011. The centerpiece of the project
years! A hearty congratulations to the following Directors-elect: is the 30 minute DVD in this month’s issue of Lifeline. Please take a
Yasmina Boyd, DO* half-hour to watch the DVD’s documentation of the contributions
that your support, and the support of the members over the years,
Stephen Liu, MD
have enabled the Chapter to make. These contributions have
Cameron McClure, MD made lasting impacts on the lives of everyday Californians, and
Leslie Mukau, MD, FACEP* indeed thanks to our Chapter’s influence, on the lives of everyday
Michael Osmundson, MD, FACEP* Americans. Here’s to another forty years!
Eric Snyder, MD, MS, FACEP CaliFornia aCeP sPonsored CoUrses
Lawrence Stock, MD, FACEP*
LiVE ConFErEnCES
Directors-elect will be officially seated as members of the California ACEP’s Annual Scientific Assembly & Ultrasound
board upon conclusion of the Board meeting on June 20, 2012 Workshop*
in conjunction with the Scientific Assembly in Monterey. Their June 21-23, 2012 Hyatt Regency Monterey
terms will end upon adjournment of the Board meeting held in Monterey, California
conjunction with the 2014 Scientific Assembly. Info: (916) 325-5455 www.californiaacep.org
*Incumbent
California ACEP’s 36th Annual Emergency Medicine in
the Cali40rnia ProjeCt: Forty years oF CaliFornia Yosemite Conference
aCeP history
January 16-19, 2013 Yosemite Lodge
2011 marked the Chapter’s 40th Scientific Assembly as well as
its 40th anniversary. In celebration of this milestone, the Chapter Yosemite, California
commissioned: “The Cali40rnia Project: Forty Years of California Info: (916) 325-5455 www.californiaacep.org
ACEP History”, which was partially supported by a $13,500 Chapter
Grant from ACEP. This project involved the collection of thousands
California ACEP
16 | LIFELINE a forum for emergency physicians in california
ANNOUNCEMENTS
CaliFornia aCeP jointly-sPonsored CoUrses endUring Materials - online CMe
Jointly sponsored by California ACEP and the American College of
Patient Safety risk Solutions* Enduring Materials - Webinar
Emergency Physicians
Info: www.psrisk.com
Advanced Wilderness & Expedition Provider (AWEP)*
• Teamwork and Communications in Emergency Medicine
August 20 – 26, 2012 Squaw Valley, California
• The Dilemma of the Psychiatric Patient in the Emergency
Info: (888) 995-3088 www.wilderness-medicine.com Department
26th Annual Wilderness Medicine, Big Sky* • Treating Stroke in the ED; and the Standard of Care Is…
July 25-29, 2012 Big Sky, Montana the Center for Medical Education, inc.* Enduring Materials -
Info: (888) 995-3088 www.wilderness-medicine.com Internet Subscriptions
Info: www.ccme.org
the national Conference on Wilderness and travel Medicine,
Squaw Valley* • August 2012, Risk Management Monthly/Emergency
Medicine
August 22-26, 2012 Lake Tahoe, California
Info: (888) 995-3088 www.wilderness-medicine.com SonoSim* Enduring Materials - Computer Software (Modules)
Info: (310) 315-2828 www.sonosim.com
Wilderness and travel Medicine* (international)
• SonoSim Ultrasound Training Solution
1. June 9 – 15, 2012 Mt. Shasta and Klamath
River, California *Approved for AMA PRA Category I CreditsTM
2. Aug. 31– Sept. 7, 2012 Anchorage, Alaska
3. Aug. 31– Sept. 10, 2012 Chamonix, France
4. Sept. 23 – Oct. 1, 2012 Marseilles, France
5. Sept. 24 – Oct. 5, 2012 Bhutan
6. Sept. 30 – Oct.14, 2012 Arusha, Tanzania
7. Oct. 15 – 29, 2012 Arusha, Tanzania
8. Oct. 28 – Nov. 7, 2012 Cuzco, Peru
9. Jan. 12 – 19, 2013 Beqa, Fiji
10. Jan. 14 – 25, 2013 Calafate, Argentina
11. Jan. 14 – 23, 2013 San Jose, Costa Rica
12. Jan. 23 – Feb. 6, 2013 Arusha, Tanzania
13. Jan. 26 – Feb. 3, 2013 Futaleufu, Chile
14. Jan. 26 – Feb. 3, 2013 Palau, Micronesia
15. Feb. 3 – 10, 2013 Antigua, Guatemala
16. Feb. 25 – March 10, 2013 Antarctica
17. March 31 – April 17, 2013 Kathmandu, Nepal
Info: (888) 995-3088 www.wilderness-medicine.com
JUNE 2012 | 17
SCiEntiFiC ASSEMBLY |
IC P
thUrsday, jUne 21, 2012 TIFBLORKSHO
N DW
Y
E M
7 - 8 am registration + Continental Breakfast CISSAEOUN 2012 nterey
S TR S 3, Mo ia
AUL 21-2 ncy liforn
0.0 CME hours R
G
.O
EP
8 - 9 am Pediatric Literature: the Best Articles & C
ne ge Ca
A
IA ™
Re y,
(s)
of the Last 10 Years Ju N dit
tt re R re
O IC
a e F y
Hy ont
or
Ramon Johnson, MD, FACEP A
LI
C
at
eg
22
M .C
1.0 CME hours 1-
A
PR 23 e 2
W A 1- n
M 2
W rA e : Ju
fo un p
W ed
: J ho
m ks
9 - 10 am radiology in Children p ro
v
ro
Ap in P und
ra or
g W
o
Maureen McCollough, MD, FACEP
a
M ltras
U
1.0 CME hours
10 - 10:30 am Break + Visit Exhibit Hall
0.0 CME hours
10:30 - 11:30 am Preparing Your ED for Children Friday, jUne 22, 2012
During Disaster
Ramon Johnson, MD, FACEP 10:30 - 11:30 am orthopedic Pearls and Pitfalls
1.0 CME hours Greg Hendey, MD, FACEP
1.0 CME hours
11:30 - 12:30 pm Cutting-Edge Ultrasound in the
Emergency Care of infants & Children 11:30 - 12:30 pm trauma in Pregnancy
Stephanie Doniger, MD, FACEP Susan Promes, MD, FACEP
1.0 CME hours 1.0 CME hours
12:30 - 2 pm Visit the Exhibit Hall 12:30 - 2 pm Visit the Exhibit Hall
2 - 4 pm LLSA 1 - 8 pm residents Case Challenge
Gus Garmel, MD, FACEP David Barnes, MD, FACEP
2.0 CME hours All Residents must register
Separate fee required
6:30 - 9 pm President’s gala + Awards Ceremony
2 - 5 pm Pediatric Simulation Lab $99 per person; includes reception,
Madhu Hardasmalani, MD program & three course meal
3.0 CME hours
Separate fee required satUrday, jUne 23, 2012
2 - 5 pm research Forum 7 - 8 am registration + Continental Breakfast
Matthew Lewin, MD, PhD, FACEP 0.0 CME hours
3.0 CME hours 8 - 9 am Current Medical Legal issues Facing
Separate registration required; Free Emergency Medicine Physicians
5:30 - 9 pm trainor Lecture + opening reception John C. Moorhead, MD, FACEP
Free to all registered attendees & guests 1.0 CME hours
9 - 10 am iD Medicolegal Pitfalls
Friday, jUne 22, 2012 Fred Abrahamian, DO, FACEP
7 - 8 am registration + Continental Breakfast 1.0 CME hours
0.0 CME hours
10 - 10:30 am Break + Visit Exhibit Hall
8 - 9 am trauma Literature Update 0.0 CME hours
SV Mahadevan, MD, FACEP
10:30 - 11:30 am Cardiology Pitfalls
1.0 CME hours
Matthew Strehlow, MD, FACEP
9 - 10 am trauma tricks of the trade 1.0 CME hours
Michelle Lin, MD
11:30 - 12:30 pm round table Discussion
1.0 CME hours
John C. Moorhead, MD, FACEP,
10 - 10:30 am Break + Visit Exhibit Hall Fredrick Abrahamian, DO, FACEP
0.0 CME hours & Matthew Strehlow, MD, FACEP
1.0 CME hours
18 | LIFELINE a forum for emergency physicians in california
| ULtrASoUnD WorKSHoP
thUrsday, jUne 21, 2012 satUrday, jUne 23, 2012
5:30 - trainor Lecture + All day Medicolegal track -
9 pm opening reception Day 3 of Main Program
Free to all registered (Only $50 for Ultrasound
P’S ANNUAL
attendees + guests Workshop Registrants)
CALIFORNIA ACE
SCIENTIFIC ASSEMBLY
Saturday, June 23, 2012 -
Friday, jUne 22, 2012 Sunday, June 24, 2012
&
WORKSHOP
8- DVt/Aorta
8:45 am Warren Wiechmann, MD 8 - 9 am optional: Current
0.75 CME hours Medical Legal issues
8:45 - Echo Facing Emergency
9:45 am Seric Cusick, MD Medicine Physicians
June 21-23, 2012 John C. Moorhead, MD,
1.0 CME hours
Hyatt Regency Monterey FACEP
Monterey, Califo jUne
thUrsday,rnia 21, 2012 9:45 - Pass the Pointer 1.0 CME hours
WWW.CALIFORNI
AACEP.ORG 10 am All Instructors
8- Course introduction 0.25 CME hours 9 - 10 am optional: iD Medicolegal
8:15 am Chris Fox, MD, FACEP Pitfalls
& Rustygory I Credit(s)™
Approved for AMA PRA
Cate Oshita, MD 10 - Break + Visit Exhibit Hall Fred Abrahamian, DO,
21-22
3; Ultrasound Workshop: June 10:30 am 0.0 CME hours
Main Program: June 21-2 FACEP
8:15 - Physics
8:45 am Jimmy Hwang, MD, FACEP 10:15 - Lab 1.0 CME hours
0.5 CME hours 11:45 am All Instructors 10 - Break + Visit Exhibit Hall
1.5 CME hours 10:30 am 0.0 CME hours
8:45 - trauma: FASt Exam
9:45 am Rusty Oshita, MD 11:45 - Lunch Break + Visit 10:30 - optional: Cardiology
1.0 CME hours 1 pm Exhibit Hall 11:30 am Pitfalls
9:45 - Pass the Pointer 1 - 2 pm Pelvic Matthew Strehlow, MD,
10 am Rusty Oshita, MD Chris Fox, MD, FACEP FACEP
0.25 CME hours 1.0 CME hours 1.0 CME hours
10 - Break + Visit Exhibit Hall 2- rush 11:30 - optional: round table
10:30 am 0.0 CME hours 2:30 pm Rusty Oshita, MD 12:30 pm Discussion
0.5 CME hours John C. Moorhead, MD,
10:15 - Lab FACEP,
11:45 am All Instructors 2:30 - Pass the Pointer Fredrick Abrahamian, DO,
1.5 CME hours 2:45 pm All Instructors FACEP
0.25 CME hours & Matthew Strehlow, MD,
11:45 - Lunch Break + Visit
2:45 - Lab FACEP
1 pm Exhibit Hall
4:15 pm All Instructors 1.0 CME hours
0.0 CME hours
1.5 CME hours
1- rUQ
1:45 pm Warren Wiechman, MD 4:15 - Politics/Credentialing
0.75 CME hours 4:45 pm Chris Fox, MD, FACEP
0.0 CME hours
1:45 - Procedure
2:25 pm Laleh Gharahbaghian, MD 4:45 - round table Discussion
0.5 CME hours 5:15 pm All Instructors
0.5 CME hours
2:25 - Soft tissue
2:55 pm Philip Perera, MD, FACEP 6:30 - President’s gala +
Description:0.5 CME hours 9 pm Awards Ceremony
$99 per person; includes
2:55 - Pass the Pointer reception, program &
3:10 pm All Instructors three course meal
0.25 CME hours
3:10 - Lab
5 pm All Instructors
1.75 CME hours
JUNE 2012 | 19
CArEEr oPPortUnitiES |
remain true to Your oath Los Angeles, CA the Watsonville Emergency
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partnership opportunities available. If group at our hospital for over 30
Part Time opportunity. Candidates must you are Board Certified/prepared, please
be Board Certified/Board Eligible EM, IM, years. We are a well respected group
send your resume to Michael Stephen, and serve on most committees at the
FP, or PD emergency medicine trained MD, Director of Emergency Services,
physicians with current emergency hospital. The shifts are 8-9 hours with
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medicine experience to provide services California.
within a low acuity, level III ED to military is available based on hours worked.
active duty, their family members, and Call 310-900-4534, fax to 310-900-8287, or Must be BC/BE in emergency medicine.
veterans. The ED averages 40 patients e-mail MikeStephen@dochs.org. New adult hospitalist and pediatric
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possess a minimum of 2 years of ED ex- established ER physician group seeking
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ED). Current licensure in any one of the Interested physicians E-mail your CV and for service.
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Focus Requirements: ability to perform
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to adult. Must be board certified or board
eligible.
Contact: Jeanette Harden, phone: 714-602-
2400 or email: jharden@ynuc.us.
20 | LIFELINE a forum for emergency physicians in california
| CALiForniA ACEP UPCoMing MEEtingS & DEADLinES
For more information on upcoming meetings, please e-mail us at
info@californiaacep.org; unless otherwise noted, all meetings are held
via conference call.
JUNE 2012
SUN MON TUES WED THURS FRI SAT
JUNE 2012 JUlY 2012
1 2
4th at 2:30 pm Practice Management 1st State Constitutional
Committee Deadline: California
Fiscal Year 2012-13 3 4 5 6 7 8 9
5th Presidential Primary
Begins
Election 10 11 12 13 14 15 16
2nd at 2:30 pm Practice Management
15th State Constitutional
Committee
Deadline: Last Day to 17 18 19 20 21 22 23
Pass State Budget 4th independence Day
(Chapter Office Closed) 24 25 26 27 28 29 30
20th at Chapter Board of
11:00 am Directors (Chapter 10th at reimbursement
Office Closed) 9:00 am Committee
Hyatt Regency
19th at government Affairs JUlY 2012
Monterey Hotel & Spa,
10:00 am Committee
Monterey SUN MON TUES WED THURS FRI SAT
21st – 22nd Ultrasound Workshop AUGUST 2012 1 2 3 4 5 6 7
(Chapter office
Closed) 6th at 2:30 pm Practice Management
Committee 8 9 10 11 12 13 14
Hyatt Regency
Monterey Hotel & Spa, 7th at 1:30 pm Emergency Medicine
Monterey 15 16 17 18 19 20 21
research & Education
21st – 23rd Scientific Assembly Foundation
22 23 24 25 26 27 28
(Chapter Office Closed) 22nd – 24th Chapter Board of
Hyatt Regency Directors retreat
Monterey Hotel & Spa, 29 30 31
Le Rivage Hotel,
Monterey Sacramento
22nd at Emergency Medicine
1:30 pm research & Education
24th at Chapter Board of AUGUST 2012
11:00 am Directors
Foundation Le Rivage Hotel, SUN MON TUES WED THURS FRI SAT
Hyatt Regency Sacramento
Monterey Hotel & Spa, 1 2 3 4
Monterey 31st Legislative Deadline:
Last Day to Pass Bills 5 6 7 8 9 10 11
22nd at California Emergency
3:00 pm Medicine Advocacy
Fund 12 13 14 15 16 17 18
Hyatt Regency
Monterey Hotel & Spa, 19 20 21 22 23 24 25
Monterey
22nd at Emergency Medicine 26 27 28 29 30 31
4:00 pm Political Action
Committee
Hyatt Regency
Monterey Hotel & Spa,
Monterey
30th State Constitutional
Deadline: California
Fiscal Year 2011-12
Ends
JUNE 2012 | 21
WWW.CALIFORNIAACEP.ORG
JANUARY 16-19, 2013
YOSEMITE LODGE AT THE FALLS
AND THE AHWAHNEE HOTEL
YOSEMITE NATIONAL PARK, CA
Looking for an ITLS course?
EMREF offers the following California providers list:
Allan Hancock College ETS – Emergency Training Services NCTI
Mike DeLeo, EMT – Course Coordinator Mike Thomas, Course Coordinator National College of Technical Instruction
800 S. College 3050 Paul Sweet Road Lawson E. Stuart, RN, CEN, EMT-P
Santa Maria, CA 93454 Santa Cruz, CA 95065 Lena Rohrabaugh, Course Manager
Phone: (805) 878-6259 Phone: (831) 476-8813 333 Sunrise Ave Suite 500
Fax: (805) 922-5446 Toll-Free: (800) 700-8444 Roseville, CA 95661
Email: Mikedeleo52@msn.com Fax: (831) 477-4914 Phone: (916) 960-6284 x 105
Web: www.hancock.cc.ca.us Email: mthomas@emergencytraining.com Fax: (916) 960-6296
Web: www.emergencytraining.com Email: jlcasa@caltel.com
American Medical Response (AMR) Web: www.ncti-online.com
Ken Bradford, Operations Fast Response School of Health Care Education
841 Latour Court, Ste D Erick Weldon, Director of Academics Oakland Fire Department
Napa, CA 94558-6259 2075 Allston Way Sheehan Gillis, EMT-P, EMS Coordinator
Phone: (707) 953-5795 Berkeley, CA 94704 47 Clay Street
Email: ken.bradford2@gmail.com Phone: (510) 809-3648 Oakland, CA 74607
Fax; (866) 628-5876 Phone: (510) 238-6957
A Work Safe Environment Email: eweldon@fastresponse.org Fax: (510) 238-6959
Steve Bristow, EMTP Web: www.fastresponse.org Email: sean@baycj.com
3140 Aldridge Way
El Dorado Hills, CA 95762 Loma Linda University PHI Air Medical, California
Phone: (925) 708-5377 Medical Center Graham Pierce, Course Coordinator
Email: worksafeenvironment@yahoo.com Lyne Jones, Administrative Assistant 801 D Airport Way
Web: www.worksafeenvironment.com department of Emergency Medicine Modesto, CA 95354
11234 Anderson St., A108 Phone: (209) 550-0884
California EMS Academy Loma Linda, CA 92354 Fax: (209) 550-0885
Nancy Black, RN, Course Coordinator Phone: (909) 558-4344 x 0 Email: gpierce@philhelico.com
1098 Foster City Blvd., Suite 106 PMB 608 Fax: (909) 558-0102 Web: www.phiwestcoast.com
Foster City, CA 94404 Email: LJones@ahs.llumc.edu
Phone: (866) 577-9197 Web: www.llu.edu Riggs Ambulance Service
Fax: (650) 701-1968 Greg Petersen, EMT-P
Email: nancy@caems-academy.com Medic Ambulance Clinical Care Coordinator
Web: www.caems-academy.com Perry Hookey, EMTP, Education Coordinator 100 Riggs Ave.
506 Couch Street Merced, CA 95340
California EMS Education and Training Vallejo, CA 94590-2408 Phone: (209) 725-7010
Eric Spoonhunter, EMTP, Program Director Phone: (707) 644-1761 Fax: (209) 725-7044
PO Box 1146 Fax: (707) 644-1784 Email: Gregp@riggsambulance.com
Bishop, CA 93515-1146 Email: perry@medicambulance.net Web: www.riggsambulance.com
Phone: (888) 519-8890 Web: www.medicambulance.net
Fax: (888) 519-8479 Santa Rosa Junior College
Email: espoonhunter@mac.com Mendocino Lake Community College Public Safety Training Center
Web: www.cemset.org Patrick Magee, MA, EMT-P Bryan Smith, EMT-P, Course Coordinator
1000 Hensley Creek Road 5743 Skylane Blvd.
Compliance Training Ukiah, CA 95482 Windsor, CA 95492
Jason Manning, EMS Course Coordinator Phone: (707) 467-1047 Phone: (707) 836-2907
3188 Verde Robles Drive Fax: (707) 467-1011 Fax: (707) 836-2948
Camino, CA 95709 Email: pmagee@mendocino.edu Email: medic9001@comcast.net
Phone: (916) 429-5895 Web: www.mendocino.edu Web: www.santarosa.edu
Fax: (916) 256-4301
Email: Kurgan911@comcast.net Napa Valley College WestMed College
Cori Carlson, EMS Director Brian Green, EMT-P
CSUS Prehosptial Education Program 2277 Napa Highway 5300 Stevens Creek Blvd., Suite 200
Derek Parker, Program Director Napa CA 94558 San Jose, CA 95129-1000
3000 State University Drive East Phone: (707) 256-4596 Phone: (408) 977-0723
Napa Hall Email: CCarlson@napavalley.edu Email: jonesds777@hotmail.com
Sacramento, CA 95819-6103 Web: www.winecountrycpr.com Web: www.westmedcollege.com
Office: (916) 278-4846
Mobile: (916) 316-7388 Northern California Medical Education
dparker@csus.edu Scott Rebello, Course Coordinator
www.cce.csus.edu/exchange 6617 Madison Avenue, #12
Carmichael, CA 95608
Phone: (916) 724-0830
Email: 2coolrns@starband.net
Web: NorCalMedEd@comcast.net
EMREF is a proud sponsor of
California ITLS courses
Please call 916.325.5455 or E-mail Lucia Romo: lromo@californiaacep.org for more information.
lifeline
California Chapter, American
PRSRT STD
US POSTAGE
College of Emergency Physicians PAID
1020 11th Street, Suite 310 CPS
Sacramento, CA 95814
cAliforniA
Acep’S AnnUAl
Scientific
ASSASmbdyorkShop
e UnlW
o
& Ultr
rey, CA
June 21-23, 2012 | Monte
Category I Credit(s)™
approved for AMA PRA
acep.org
www.california
