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20090130 Health Care2.qxp by ldd0229


									        San Diego
        Health Care
          Supplement to:

                                                                                                                                          Friday, January 30, 2009 / Vol. 124, No. 22

Wireless health care growing industry, source of future jobs
   By PADMA NAGAPPAN                   independently, through wire-        dent and co-founder of the            explore the many opportuni-           lic, was founded in San Diego           Philometron , an early-stage
     Special to the Daily Transcript   less sensors that inform them       WLSA, which was formed in             ties to use wireless technolo-        in 1999 and still houses its            company working on distrib-
   Advances in wireless tech-          about       movements        and    2005.     The     organization        gies to advance the delivery of       research unit here, although it         uted wireless human sensing
nology have made it possible           changes in their blood pres-        brings together all the key           health care. The organization         has shifted its headquarters to         technology.
to transmit data from remote           sure, etc.                          players in one place, to create       works to close the gap                Conshohocken, Penn.                       Awarepoint has developed a
locations, free consumers who             At the center of this exciting   partnerships, licensing deals         between wireless information             It developed a mobile car-           radio frequency (RFID) tech-
were tethered to old-fash-             new field that affords increased    and financing.                        technologies commonly used            diac outpatient telemetry               nology and real-time location
ioned communication devices            mobility and freedom to                “Important activity was tak-       in other industries and the           device that provides real-time          system for hospitals and
and open up a whole new field          patients and continuous moni-       ing place all over the world in       systems used by health care           monitoring and round-the-               patients; and Santech, a start-
— wireless technology for              toring for physicians and care-     this space, and to place San          facilities and the pharmaceu-         clock analysis and response             up focusing on weight man-
health care.                           givers is the industry organiza-    Diego on the map, we needed           tical sector.                         for patients, who could be at           agement, uses an accelerome-
   The convergence of these            tion Wireless Life Sciences         to connect the various stake-            Developments in wireless           home, traveling or at work.             ter in tandem with a GPS and
two areas has enabled medical          Alliance, which helps compa-        holders. I contacted Qual -           devices for health care have             Other companies involved             heart rate monitor to track the
staff to remotely monitor the          nies leverage San Diego’s           comm, Motorala and others             heated up in recent years, and        in advancing wireless health            patient’s location, activity
vital signs of patients with           advantage wireless technology       and we set up the WLSA annu-          San Diego is now home to              care technology include Vocel,          level and their daily diet.
chronic ailments or those              as well as life sciences.           al summit,” said Sobrian, who         roughly 30 companies in this          which developed the Pill
recovering from surgery who                                                spearheaded the initiative.           fledgling industry.                   Phone medication reminder;                ViSi from Triage Wireless
can now be discharged earlier.              The facilitator                   The WLSA facilitates the              CardioNet         (Nasdaq:         Triage Wireless , which is                Triage, founded in 2004,
It also facilitates caregivers to       Camille Sobrian, COO of            opportunity for life sciences         BEAT), the first company in           working on a noninvasive vital
keep track of seniors who live         CONNECT, is also the presi-         and wireless companies to             this emerging field to go pub-        signs monitoring device; and                  See Wireless on 6

                                                                                                                                                         Saving primary care
                                                                                                                                                         medicine, the foundation of a
                                                                                                                                                         rational health care system
                                                                                                                                                          By JOSEPH E. SCHERGER                the primary care level is lost.
                                                                                                                                                           San Diego County Medical Society    NPs and PAs are part of the
                                                                                                                                                            The collapse of primary            solution in primary care, but
                                                                                                                                                         care medicine has been in             there remains a critical need
                                                                                                                                                         the news for several years,           for primary care physicians.
                                                                                                                                                         and the problem is getting               The history of primary
                                                                                                                                                         worse. Recently, only 2 per-          care medicine has several
                                                                                                                                                         cent of today’s medical stu-          ups and downs over the past
                                                                                                                                                         dents indicated they wanted           50 years. Prior to and after
                                                                                                                                                         to go into primary care.              World War II, most physi-
                                                                                                                                                         Training programs in pri-             cians were general practi-
                                                                                                                                                         mary care are closing. Two            tioners (GPs). The 1960s
                                                                                                                                                         hospitals in Phoenix in the           saw the first “age of special-
                                                                                                                                                         past month have indicated             ization,” and very few med-
                                                                                                                                                         they would no longer train            ical students became GPs. In
                                                                                                                                                         family physicians. Most resi-         1969, a new specialty, family
                                                                                                                                                         dency positions in general            practice, was born, and
                                                                                                                                                         internal medicine and fami-           there was a resurgence in
                                                                                                                                                         ly medicine are filled with           the 1970s as family practi-
                                                                                                                                                         doctors educated in other             tioners replaced GPs as the
                                                                                                                                                         countries.                            new breed of family doctor.
                                                                                                                                                            Yet primary care is the               FPs experienced a decline
                                                                                                                                                         foundation of any rational            in the 1980s similar to today,
                                                                                                                                                         health care system. Studies           as high-tech medicine began
                                                                                                                                                         have shown that the overall           to flourish and many spe-
                                                                                   Photo: Ben Benschneider (Southwest Washington Medical Center)
                                                                                                                                                         health of a population                cialist incomes became
Daylight in the patient’s room enhances patient comfort and promotes healing while adding to the sustainability of the facility.
                                                                                                                                                         depends more on primary               much greater than those of
                                                                                                                                                         care than the number of               FPs and general internists.

Daylighting in the health care environment                                                                                                               specialists. Preventive medi-
                                                                                                                                                         cine and common health
                                                                                                                                                         problems are best treated in
                                                                                                                                                                                               Internal medicine is the
                                                                                                                                                                                               largest specialty in medi-
                                                                                                                                                                                               cine, yet in the 1980s and
                                       the need for pain medication.       tions such as The Center for          pain and took 22 percent less           primary care, saving the              today the great majority of
 How sustainability                    Here in California and in           Health       Design      (CHC)        analgesic medication per hour,          more serious and unusual              internists subspecialize into
can improve lighting,                  many other states, code             ( have           resulting in 20 percent less            problems for specialists.             fields that have higher
                                       requirements and mandates           analyzed several patient sce-         pain medication costs.                     If not physicians, who will        incomes, such as cardiology,
 hospital operations,                  for LEED and other sustain-         narios as it relates to daylight        Effects of day and night on           fill the gap in primary care?         gastroenterology and der-
  patient outcome                      able design measures require        in hospitals. Their findings,         infants: Preterm infants who            Nurses have stepped up and            matology.
                                       attention and detail to how         along with numerous other             were exposed to a night/day             created programs to train                FPs and general internists
       By DENISE FONG                  daylighting can be positively       studies that have been con-           pattern of light spent more             primary care nurse practi-            made a comeback in the
       and JEFF HANKIN                 deployed. The results are bet-      ducted, show the benefits of          time sleeping, less time eating,        tioners (NPs). Physician              1990s with the beginning of
                Sparling               ter facilities, improved finan-     daylight in the healing process.      gained more weight, spent               assistants      (PAs)    have         managed care (HMOs).
  Daylight is often linked to          cial performance, happier              Sunlight and pain medica-          fewer days on ventilation and           emerged and are providing             HMOs looked at FPs and
sustainability as a key design         employees and healthier             tion: In a recent study, 89           phototherapy, and displayed             primary care in many set-             general internists as “gate-
element that provides many             patients.                           patients undergoing elective          enhanced motor coordination,            tings. However, NPs and               keepers” and realized lower
benefits. Exposure to daylight                                             cervical and lumbar spinal            compared to infants who were            PAs work best when they               health care costs if everyone
in the health care environ-                  Benefits of daylight          surgery were assigned to both         exposed to constant light and           work with physicians as               had to be seen by a primary
ment has long been linked                        on patients               sunny and shady rooms fol-            noise. It is important to note          “physician extenders.” When           care physician (PCP) before
with patient wellness and staff           Evidence-based design has        lowing their operations.              that intense light may be a             NPs and PAs work alone in             being allowed to see a spe-
satisfaction, and new research         shown how natural light             Patients who were exposed to          danger to the developing reti-          primary care, quality may             cialist. PCPs are FPs, gener-
suggests that lighting can             affects patient health and well-    46 percent higher intensity           nas of premature infants; this          suffer and the efficiency of
improve sleep patterns of eld-         ness. To promote research-          sunlight experienced less per-                                                treating most problems at                  See Medicine on 6
erly patients, and even reduce         informed design, organiza-          ceived stress, reported less               See Daylighting on 2

Pfizer’s CEO makes big play with $68 billion Wyeth deal
        By LINDA A. JOHNSON                     With it come a trove of vaccines,          Kindler, a 53-year-old Harvard                 in July 2006.                                    “It was a moderate-risk, high-
              The Associated Press            biotech drugs, veterinary medicines       Law School graduate and former                      By then, investors were starting             probability-of-success type of deal,”
   TRENTON, N.J. — Jeff Kindler               — and consumer health products,           legal clerk to U.S. Supreme Court                 to look ahead to the “patent cliff ”           he said. Heupel would rather have
took over as chief executive of drug-         many as well known as those it gave       Justice William J. Brennan Jr., has               when generic competition would                 seen Kindler show “longer-term
maker Pfizer Inc. (NSYE: PFE) in              up, including Wyeth’s Chap Stick,         an unusual pedigree for a pharma-                 hit Lipitor, the cholesterol treat-            vision” by buying technology-driven
August 2006, just in time to sign             Centrum vitamins and Advil and            ceutical CEO.                                     ment that is the world’s top-selling           biotech companies with greater
off on his predecessor’s $16.6 bil-           Anacin pain relievers.                       He worked as a partner at law                  drug and the source of $1 out of               growth prospects than Wyeth.
lion deal to sell off all its iconic con-       “He’s done a lot of things in his       firm W i l l i a m s a n d C o n n o l l y , as   every $4 that Pfizer makes. That’s               Monday’s news obscured “dire”
sumer health brands, from                     short tenure,” said Edward Jones          General Electric ’s (NYSE: GE) top                now expected in November 2011,                 numbers in Pfizer’s quarterly earn-
Listerine to Sudafed — to become a            analyst Linda Bannister, from cre-        lawyer and as a vice president for                and six other drugs with sales total-          ings reports, from a big net income
pure pharmaceutical company.                  ating stand-alone business units          McDonald’s Corp. (NYSE: MCD),                     ing more than $4 billion are expect-           drop and weak profit forecast to a
   After 2 1/2 years of layoffs, paring       with more accountability to               where he was general counsel and                  ed to face generic competition that            slashed dividend and huge layoffs,
research operations and other                 restructuring research and develop-       then president of some of its restau-             year and the next.                             noted Heupel.
restructuring, Kindler’s first bold           ment to get out of areas where            rant brands, including Boston                       Acquiring Wyeth will get Pfizer                “We won’t know whether it’s a
step — an answer to investor                  Pfizer doesn’t have a competitive         Market and Chipotle Mexican Grill.                past the Lipitor loss and was the              good deal until we get a few years
demands to take action ahead of a             advantage.                                He became Pfizer’s general counsel                right choice among large pharma-               out and see how well they’ve inte-
2011 revenue crash — is to spend                “He’s taken the steps that he           and an executive vice president in                ceutical companies, said David                 grated,” Heupel said. “That’s what
four times as much to rediversify             needed to take internally to get the      2002, moved up to vice chairman                   Heupel, health-care portfolio man-             we’re going to have to grade him on
the company by acquiring rival                right structure in place” to make         and head of corporate affairs in                  ager at Thrivent Large Cap Growth              a year or two down the road.”
Wyeth.                                        the big deal, she said.                   2005, and then was tapped as CEO                  Fund.                                                   Source Code: 20090130crk
2                                                   FRIDAY, JANUARY 30, 2009 •         San Diego Health Care • THE DAILY TRANSCRIPT
Close-up: Jason Howe

Awarepoint CEO finds growing market for its location systems
       By ERIN BRIDGES                  “My daily life has been real-      In about eight days,               ing initiative, we can track          Howe also focuses on build-
         The Daily Transcript        ly going and assessing the         Awarepoint can outfit a 1.2           daily living of people at home,”   ing and maintaining a good
   To say Jason Howe and his         market and out there evangel-      million-square-foot hospital.         Howe said. “We can monitor         corporate culture. He holds
team at Awarepoint Corp.             izing for the space, meeting       The company’s closest com-            how often they are eating,         Friday town hall meetings and
have been busy this year             with customers and making          petitor, he said, estimated it        sleeping, bathing or using the     provides employees with
would be an understatement.          sure the team is on track,” he     would take eight months to            toilet.”                           lunch, institutes programs for
   Howe, chief executive officer     said.                              cable it.                                Family members will be able     continued learning, and pro-
for the company, racked up              The company installs and           “In eight months, we saved         to monitor these actions from      vides corporate membership
more than 430,000 miles              maintains its RTLS in the          somebody’s life,” Howe said.          home, giving senior citizens       at a fitness gym.
domestically in 2008 rallying        roughly 30 to 40 hospitals that    “And we did it at so much less        freedom and independence              Employees are expected to
interest in the company and its      already have it. And so far it     cost.”                                while also ensuring their          work long hours, but Howe
product while understanding          has been a successful system.         One reason Howe can keep           health and well-being.             also expects them to have fun.
what the market needs, what is          “They built something that      the cost down is that every-             Moving forward into the            “Your job is to have fun
working and what is not.             really makes a difference,”        thing can be monitored from           new year, Howe will be focus-      here,” he said. “If you’re not
   In November, he announced         Howe said. “Even though we         San Diego.                            ing on where the company           having fun, you’re not produc-
the company raised $13.3 mil-        have great financial outcomes,        And the payment plan               needs to be in the health care     tive. If you’re not having fun
lion in a Series D round of          we’ve had amazing clinical         makes the product more                market and continue to build       and we can’t find a way, this
venture capital financing led        outcomes.”                         appealing to facilities, he said.     a strong team.                     isn’t the place for you.”                        Jason Howe
by Cardinal Partners and                In at least three cases, the       “We’ll outfit a hospital in an        “My first job is hiring great      Howe views everyone at
joined by Venrock and exist-         system saved lives at an Army      amount of days, and we don’t          people,” he said. “I’m a lot       Awarepoint as his customer,             teamwork.
ing investor Avalon Ventures.        medical center.                    charge them until they’re sat-        more average than the              and has an open-door policy.               The last part is important to
   The funds will help                  “We were able to get an         isfied it’s working,” he said.        smartest bear, but I hire really      “If I am ensuring that               the company’s success, which
Awarepoint fuel its growth           infusion pump out of service       “Then we charge per asset per         well.”                             they’re successful, Awarepoint          includes four patents and fil-
and meet the demand for real-        that was providing 10 times        month. We don’t hold them to             While the product contin-       will be,” he said. “My manage-          ings for another 16.
time location systems (RTLS)         the medicine necessary,” he        long-term contracts.”                 ues to gain popularity and the     ment style is one of giving peo-           Though Howe is the big
in both domestic and interna-        said. “It already led to the          Right now, the company             company grows, Howe said he        ple a lot of autonomy. I wel-           man in charge, he certainly
tional markets. The company’s        demise of one soldier and was      focuses on acute care facilities,     does not expect the San Diego      come mistakes, as long as               doesn’t try to take all the cred-
technologies can improve hos-        about to be used on another.”      but plans to move into more           work force to increase to more     they’re made only once.”                it. He knows it’s far from a
pital process management by             Not only is the Awarepoint      long-term and assisted living         than about 50 people. The             Howe said a culture has              one-man show.
offering location and move-          product successful, it also can    facilities.                           new money was in part to           been instituted at the compa-              “Teamwork is how we get it
ment information to remotely         be implemented significantly          “What really floats my boat        draw new engineering talent        ny that they call A-POINT:              all done.”
monitor equipment and peo-           faster than a competitor’s         is that as the population ages,       and to get more service people     accountability, passion, objec-      
ple.                                 product, Howe said.                and with the independent liv-         in the field.                      tivity, integrity, novelty and              Source Code: 20090130cre

Daylighting                                                             Medicine and business: Strange bedfellows
       Continued from Page 1         ronments more cost effectively
should be considered in the          and minimize energy use and              By TOM GEHRING                  force and as community lead-       pullback) and extraordinary             the ‘70s is gone, and he’s
design of NICUs.                     waste,     many      incentives       San Diego County Medical Society   ers who deeply care about the      debt      (usually     between          never coming back. As every-
   Effect of sunlight on infants:    through state and national           The fundamental tension             public good, we cannot accept      $200,000 and $250,000 for               one seeks to reduce the
A study of infants who were          organizations now exist to         between the Hippocratic               an imbalance between the           physicians graduating from              expense of health care, com-
born before, during and after        assist health care designers.      Oath and the realities of eco-        ethos of healing and harsh         residency programs), mean               petition for the shrinking
awnings were built on a facili-      Regulations such as California     nomics are at the center of           economic realities. Yet it         that San Diego County is los-           compensation dollar within
ty’s obstetric ward windows          Title 24 and programs such as      nearly every significant issue        seems the pendulum has             ing badly in the race to recruit        the physician community
over a four-month period             the U.S. Green Building            in health care today. I joke          swung toward appeasing the         new physicians. For more                increases. This has a number
revealed that exposure to nat-       Council’s LEED initiative all      with my physician, when we            demands       of   economics,      than 10 years, a past presi-            of unwelcome consequences.
ural daylight through glass          encourage the use of daylight-     are alone in the exam room,           resulting in an unsustainable      dent of the San Diego County            Small or solo physician prac-
windows may reduce the rate          ing methods and controls.          that there are two unseen             trajectory for both physicians     Medical Society (SDCMS)                 tices, who cannot compete
of neonatal jaundice.                Many power utility companies       presences tugging her in              and patients.                      and the only specialist in her          with their large group
                                     and both public and private        opposite           directions:          So what does the future          field for a significant portion         brethren, are becoming rarer,
              Design                 energy conservation organiza-      Hippocrates, who laid down            hold for patients in San Diego     of North County, has been               particularly in the more
   Patient rooms have signifi-       tions offer research, planning,    the fundamental principles of         County?                            unable to recruit a younger             urban portions of San Diego
cant opportunity for daylight        modeling and often financial       healing over two millennia              The waits will get longer.       doctor to join her practice;            County. Health insurance
design. The configuration of the     assistance to projects utilizing   ago, and Adam Smith, the              There are multiple data            she just can’t pay the young            plan reimbursements are con-
room elements and the ceiling        effective daylighting pro-         Scottish preacher who articu-         sources that suggest while the     physician enough. Not sur-              tinuing to ratchet down,
heights are key to successful        grams.                             lated the basics of economics         overall number of San Diego        prisingly, it takes a long time         requiring physicians to see
daylight design. Patient rest-                                          about two centuries ago.              County physicians is ade-          to be seen in her office.               more patients, and therefore
rooms near the core walls rather               Conclusions              Every     physician     today,        quate, there are many geo-            The macroscopic result is            spend less time with those
than the exterior walls allows         Effective daylighting strate-    whether a solo practitioner in        graphic and specialty areas        obvious: The data from                  patients. A recent article in
for better daylight penetration      gies help to create a healthy      Alpine or one of more than            where San Diego County is          SDCMS’s 2007 Workforce                  The Wall Street Journal high-
but must be balanced with clin-      and sustainable environment        500 Kaiser Permanente                 unable to recruit and retain       and Compensation Survey                 lighted the use of out-of-town
ical requirements to see into the    for patients and staff.            physicians, has to deal with          an adequate supply of physi-       indicates that a number of              locum tenens, or physician
rooms. Keeping the ceilings and      Evidence-based         research    the tension between healing           cians. The average middle-         specialties, and some primary           temps, to handle shortfalls.
windows high at the perimeter        shows that time-tested light-      and economics. More impor-            income wage earner is              care physicians, are experi-               Good luck with that visit to
contributes to enhanced day-         ing strategies such as daylight-   tantly, every patient in San          unsympathetic to physicians        encing longer and longer                the emergency room. The fed-
light. Glare control is necessary    ing reduce cost and mainte-        Diego County is affected,             making “less than they             waits.                                  eral mandate — referred to by
for both optimum examination         nance, produce energy savings      whether they know it or not.          should,” but the harsh reality        Finding a doctor who takes           the acronym EMTALA — that
visibility and patient comfort. It   and lead to enhanced patient         So why must San Diego               is that physician reimburse-       Medicare, Medi-Cal or any               all patients must be assessed
can be achieved using a variety      comfort and recovery times.        County’s business leaders care        ment in San Diego County is        other government program                and stabilized in the emer-
of solutions from window cov-                                           about San Diego County                well below average. “Move to       will get harder. As the overall         gency room is laudable. But
erings, to passive light control        Fong, IALD, LEED AP and         physicians being pulled in            Montana, double your pay,” is      cost of health care continues           the tension between wanting
features in the architecture, to     Hankin, P.E., LEED AP are          two diametrically opposed             an appealing recruiter come-       to increase — now more than             to provide emergency care
motorized blinds.                    principals with Sparling, a        directions? As individuals,           on.                                16 percent of GDP and more              regardless of the ability to pay
                                     specialty consulting and elec-     who sooner or later will need           Low reimbursements, cou-         than $2.2 trillion annually —           and the harsh reality that
    Incentivizing daylighting        trical engineering firm.           a physician, as business lead-        pled with high housing costs       everyone seeks to cut costs.            both physicians and hospitals
    To build health care envi-           Source Code: 20090130crb       ers requiring a healthy work          (even in light of the current      Those that cannot bargain on            cannot work for free, coupled
                                                                                                                                                 an equal footing lose in the            with the unwillingness of
                                                                                                                                                 negotiating room.                       health insurance plans to pay
                                                                                                                                                    For example, the federal             for delivered services, will
                                                                                                                                                 government has held physi-              result in fewer physicians in
                                                                                                                                                 cian Medicare reimburse-                the emergency room (particu-
                                                                                                                                                 ments essentially flat for the          larly specialists), fewer emer-
                                                                                                                                                 last nine years, even before            gency rooms and more
                                                                                                                                                 factoring in inflation. Why?            patients.
                                                                                                                                                 To hold down costs. How?                   What to do? I wish there
                                                                                                                                                 Because you can’t bargain               were a simple remedy, but the
                                                                                                                                                 with the Feds — it’s take it or         sad fact is there is no silver
                                                                                                                                                 leave it. While inflation-              bullet and no magic potion.
                                                                                                                                                 adjusted reimbursements are             The Obama administration,
                                                                                                                                                 down, and costs are up, it is           led on the health care front by
                                                                                                                                                 not surprising that physicians          former Sen. (and soon to be
                                                                                                                                                 are increasingly unwilling to           Health Czar) Tom Daschle,
                                                                                                                                                 take on Medicare patients.              will attempt to address the
                                                                                                                                                 Given the burgeoning elderly            issue. For a detailed descrip-
                                                                                                                                                 population and the reduced              tion of where the Obama
                                                                                                                                                 number of physicians willing            administration thinks we are,
                                                                                                                                                 to see Medicare patients, the           and how it thinks we got here,
                                                                                                                                                 prospects are not good if you           review the first three parts of
                                                                                                                                                 are a Medicare patient. And             Daschle’s book, “Critical.” His
                                                                                                                                                 the problem is dramatically             answer is, interestingly, not
                                                                                                                                                 worse for state programs like           more money. His answer is a
                                                                                                                                                 Medi-Cal and county pro-                smarter and more efficient
                                                                                                                                                 grams such as CMS.                      way of using the same amount
                                                                                                                                                    Marcus Welby, the avuncu-            of money.
                                                                                                                                                 lar and kindly TV doctor of                For at least the last decade,
                                                                                                                                                                                         physicians and hospitals have
                                                                                                                                                                                         been asked to accept lower
                                                                                                                                                                                         and lower government and
                                                                                                                                                       The Daily                         health insurance reimburse-
                                                                                                                                                                                         ments, in the face of increas-
                                                                                                                                                       Transcript                        ing expenses and simultane-
                                                                                                                                                                                         ous demands for increased
                                                                                                                                                        Founded April 3, 1886
                                                                                                                                                                                         quality, while still seeing the
                                                                                                                                                  ROBERT L. LOOMIS, Publisher
                                                                                                                                                                                         uninsured for free. This tra-
                                                                                                                                                                                         jectory defies economic reali-
                                                                                                                                                        George Chamberlin,               ty and is at odds with the
                                                                                                                                                         Executive Editor
                                                                                                                                                         Joseph Guerin, Editor
                                                                                                                                                                                         Hippocratic Oath. The solu-
                                                                                                                                                 Richard Spaulding, Real Estate Editor   tion that we develop — and
                                                                                                                                                        Jennifer Chung Klam,             we must develop a solution
                                                                                                                                                        Special Sections Editor
                                                                                                                                                                                         soon — must balance the
                                                                                                                                                      Tracye Grimes, Web Editor
                                                                                                                                                                                         principles of the Hippocratic
                                                                                                                                                          Ellen C. Revelle,              Oath and the laws of econom-
                                                                                                                                                         Publisher Emerita
                                                                                                                                                       San Diego Daily Transcript
                                                                                                                                                            P.O. Box 85469                 Gehring is executive direc-
                                                                                                                                                       San Diego, CA 92186–5469          tor and CEO of the San Diego
                                                                                                                                                            (619) 232-4381
                                                                                                                                                        Web site:
                                                                                                                                                                                         County Medical Society.
                                                                                                                                                                                           Source Code: 20090130crd
                                                 FRIDAY, JANUARY 30, 2009 •     San Diego Health Care • THE DAILY TRANSCRIPT                                                                                3

Roundtable discussion

Keeping up with expenses: Health care costs hit providers hard
      By THOR KAMBAN               even hundreds of millions of
         BIBERMAN                  dollars the health care
        The Daily Transcript
                                   providers must “eat” and still
   The financial markets are       manage to keep the doors
not only taking their toll on      open.
workers and those who might           Bardin said the Scripps
have to let them go; health        health care system spent $240
care providers are getting         million in what it calls “com-
slammed as well.                   munity benefit” expenses last
   The state of the health care    year. While some of these
industry was the topic of a        expenses are due to such fac-
recent roundtable discussion       tors as community outreach,
at The Daily Transcript offices    Bardin said 75 percent to 80
and     hosted      by   Waste     percent of those expenses are
Management           Healthcare    due to unreimbursed costs.
Solutions.                            Most of the unreimbursed
   Michael Bardin, a Scripps       expenses are not a result of
Health spokesman, said he          the completely uninsured, but
has put the brakes on the bulk     due to inadequate reimburse-
of his health care system’s cap-   ments by Medicare and Medi-
ital projects until the markets    Cal.
improve.                              As noted by Zara Marselian,
   “This affects every campus      CEO       of    La    Maestra
that Scripps operates,” Bardin     Community Health Centers ,
said. “It’s not that we have                                                                                                                                                    All photos: J. Kat Woronowicz
                                   unreimbursed expenses can
given up on these projects, but                                     Representatives from the local health care industry said they now face tough choices about what their facilities can do without in
                                   hit community clinics hard as
they have been slowed down.”                                        these tough economic times.
   One project that could be          “We got no money from the        “If you’re talking about the   when a job is lost, he said.         Gary Rossio of the VA San        were or higher.
impacted is a proposed $203        state at all last year,”         cost of health care, what is        Hospitals in California have     Diego Healthcare System said          With the economy the way
million renovation and expan-      Marselian said. “We have 98      that?” said Julie Adamik,         another problem. By 2013,          that up until recently, con-       it is, Tam said this might be
sion at Scripps Mercy              sites in the county and          Employee Benefits Training        their facilities must be seismi-   struction costs led to the cost    the time to renegotiate some
Hospital in Hillcrest. The         patients either don’t have       and Solutions president and       cally sound. While many            of seismic retrofits increasing    upcoming construction con-
upgrades would double the          insurance or can’t even pay      CEO. “It’s so ambiguous and       health care systems are simply     at the rate of 1.5 percent per     tracts.
size of the emergency room,        the sliding scale they have to   confusing.”                       building new facilities, others    month.                                “Do we need to rebid the
and the intensive care unit        pay.”                               Adamik cited the case of a     must retrofit. Either way, with      Steel and concrete costs         work? That’s a question we
would be enlarged as well.            The nonprofit La Maestra      routine colonoscopy done in       capital markets in flux, this      have actually settled some-        have to ask,” Tam said.
   Bardin said plans are still     Community Health Centers,        the same hospital and another     could quickly become an            what in recent months, but        
moving ahead for the Scripps       which provides job training      done a year later. The medical    unfunded mandate.                  labor costs are still where they       Source Code: 20090130cra
Cardiovascular Institute that      and meals as well as health      bill had more than doubled
would be constructed on the        care,     experiences     some   from close to $2,000 to more
campus of the Scripps              80,000 visits annually.          than $4,000.
Memorial Hospital in La               La Maestra has been able to      “We need more transparen-                                Roundtable Participants
Jolla. The project, which          garner enough funds to build     cy,” Adamik said.
gained a $30 million Howard                                                                                  Julie Adamik, President & CEO                          Gary J. Rossio, Former CEO
                                   a 32,000-square-foot LEED           She added that higher co-
Charitable Foundation Grant                                                                              Employee Benefits Training and Solutions                 VA San Diego Healthcare System
                                   (Leadership in Energy and        payments and deductibles
two years ago, isn’t cheap. A      Environmental Design) Gold       have been another part of the
2007 report pegged the cost at                                                                           Michael Bardin, Corporate Senior Director         Steven Scott, Vice President & General Manager
                                   building being constructed       scenario and, again, people               for Government/Public Affairs                        Anthem Blue Cross of California
$430 million for a facility that   near its Fairmont Street head-   often can’t pay.
would include 168 inpatient                                                                                           Scripps Health
                                   quarters in City Heights.           Steven Finden, a Barney &                                                             Michael Simonsen, Director of Public Affairs
beds among other functions.           Marselian said patients       Barney insurance broker, said                   Kim Bond, President                        San Diego Medical Services Enterprise
   Dr. David Tam, Pomerado         often wait so long for what      while the managed care system                  Mental Health Systems
Hospital chief administrative      would have been routine care     has worked reasonably well for                                                           Dr. David Tam, Chief Administration Officer
officer, said his Palomar          that they end up flooding        decades, as health insurance                   Steve Finden, Principal                          Palomar Pomerado Hospital
Pomerado Health System is          emergency rooms when the         costs shift from the employer                     Barney & Barney
already faced with cost over-      situation becomes dire. That,    to the employee, many people                                                                    Sheila S. Trexler, Shareholder
runs at its more than $800         she said, makes everyone’s       are finding they may be able to               Ron Hesley, President                                      Neil Dymott
million, 333-bed Palomar           health care more expensive,      insure themselves but not their             Burnham Insurance BB & T
Hospital being constructed         and could be deadly.             dependents.                                                                                    Tim Tucker, District Manager
along Citricado Parkway in            “Many people are going           “A lot can’t afford depend-                 Zara Marselian, CEO                                  Waste Management
Escondido. Now with capital        without preventative care,”      ent contributions,” Finden             La Maestra Community Health Centers                     Healthcare Solutions (sponsor)
markets the way they are, Tam      Marselian said.                  said. This is especially true
has had to determine what the         Marselian said in some
hospital could do without.         cases hospitals become so full
   “Do we change the healing       that they go on bypass, and
gardens? We have to look at        ambulances must go to anoth-
what we can do to cut costs,”      er facility. She recalled that
he said.                           happening at the Sharp
   Healing gardens may be          Hospital in Chula Vista.
important for speedier recov-         “What if someone in Alpine
eries, but hospitals have a        has a heart attack and
much more fundamental need         Grossmont Hospital is on
— survival. The California         bypass?” she asked.
Hospital Association reports a        Another issue is that
73 percent increase in unre-       charges can vary widely for
imbursed costs in the state in     seemingly comparable proce-
the past year. That may mean       dures completed within a year
tens of millions of dollars or     of each other.

Tim Tucker, left, district manager of Waste Management
Healthcare Solutions.

Dr. David Tam, chief administration officer of Palomar
Pomerado Hospital.
4                                                               FRIDAY, JANUARY 30, 2009 •              San Diego Health Care • THE DAILY TRANSCRIPT

                                                                                                       Listed by Number of Licensed Beds

                                                        # of Licensed Beds          # of Staff       # of Nurses
                                                                                    Specialists                                                                                                                                             Year
                         Address                                                                                      Annual Local Gross                                                                                                                  Year
                                                        # of Staffed Beds                                                                              Specialty Services Offered                      Executive(s) & Title(s)           Established
                        Phone, Fax                                                  # of Staff          # of              Revenue                                                                                                                      Established
                                                                                                                                                                                                                                        in San Diego
                           URL                                                      Physicians        Employees
                                                         # of Acute Beds

        Scripps Mercy Hospital*                                 700
        4077 Fifth Ave.                                                                 n/a               936                                 Trauma, cardiovascular, neurology, neuro-
                                                                                                                                                                                               Chris Van Gorder, President/CEO;
    1   San Diego CA 92103                                      450                                                      $1,771,153,858       surgery, stroke, oncology, bariatric and general
                                                                                                                                                                                               Tom Gammiere, Chief Executive
                                                                                                                                                                                                                                           1924            1890
        (619) 294-8111, (619) 686-3530                                                 1,300             2,527                                surgery, orthopedics, spine services                                         650

                                                                540               650, Combines                                               Level 1 trauma center, regional burn center,
        UCSD Medical Center, Hillcrest                                              Hillcrest,            800                                 multi-organ transplant program, cancer center,
        200 W. Arbor Drive                                                          Thornton                                                  cardiology, pediatrics, women’s services, child
    2   San Diego CA 92103                                      540
                                                                                  1,065 Combines
                                                                                                                                              and adolescent health, Alzheimer’s disease
                                                                                                                                                                                              Richard Liekweg, CEO                         1966            1966
        (800) 926-8273, (619) 543-3781                                                                    n/a
                                                                                     HIllcrest,                                               research center, senior behavioral center,                                         N/A                  Thornton                                                 neonatal intensive care

        Sharp Grossmont Hospital                                446                                                                           Behavioral health, cancer treatment, cardio-
        5555 Grossmont Center Drive                                                     509              1,170                                vascular, emergency and critical care center,
                                                                                                                         $435,418,000                                                             Michele Tarbet, CEO; Kari                             1991 (this
    3   La Mesa CA 91942                                        434
                                                                                                                          (fiscal year)
                                                                                                                                              hyperbaric oxygen therapy, orthopedics, reha-
                                                                                                                                                                                                  Cornicelli, CFO
        (619) 740-6000, (619) 461-7191                                                  644              2,887                                bilitation, robotic survey, sleep disorders clinic,                                           358                                                                           skilled nursing/hospice, women’s health

                                                                397                                                                                                                               Dr. Arthur A. Gonzalez,
        Tri-City Medical Center                                                                                                               Cardiovascular, stroke assessment and care,
                                                                                        431               710                                                                                     President/CEO; Suellyn Ellerbe,
        4002 Vista Way                                                                                                                        center for wound care hyperbaric medicine,
                                                                                                                                                                                                  COO/CNE; Allen Coleman, VP,
    4   Oceanside CA 92056                                      330                                                      $924,992,071         wellness center, orthopaedic center, general
                                                                                                                                                                                                  Strategic Services; Robert
                                                                                                                                                                                                                                           1961            1961
        (760) 724-8411, (760) 940-5792                                                  550              2,284                                and specialty surgery, family birth center, radi-
                                                                                                                                                                                                  Wardwell, CFO; Debbie King, VP,                                      291                                                                           ology

                                                                392                                                                                                                               Arthur M. Flippin, M.D., Medical
        Kaiser Foundation Hospital
                                                                                        500              1,700                                Blood donor center, labor and delivery, NICU,       Director; Nathaniel L. Oubre Jr.,
        4647 Zion Ave.
                                                                                                                                              PICU, ICU, head and neck surgery, neuro-            Sr .VP/Exec. Director; Chris
    5   San Diego CA 92120                                      392                                                            n/a
                                                                                                                                              surgery, oncology research center, genetics,        Crisafulli, Medical Group
                                                                                                                                                                                                                                           1967            1967
        (619) 528-5000, (619) 528-7535                                                13,729             7,330                                cancer registry                                     Administrator; Barbara Grimm,                                392                                                                                                                               Medical Group Administrator

        Sharp Chula Vista Medical Center                        343
                                                                                        361               645                                 Bloodless medicine, cancer care, emergency,
        751 Medical Center Court
                                                                                                                         $240,979,000         heart care, hospice, orthopedics, rehab, skilled Christopher Boyd, CEO; Rick King,                        1989 (this
    6   Chula Vista CA 91911                                    343
                                                                                                                          (fiscal year)       nursing, weight-loss (gastric bypass, lap band), CFO
        (619) 482-5800, (619) 482-3535                                                  490              1,503                                women’s and infant’s services                                           243

                                                                334                                                  $666,687,000 (fiscal     Cancer treatment, emergency department,
        Sharp Memorial Hospital
                                                                                        880              1,019       year), (includes Sharp   heart, vascular and thoracic surgery/services,
        7901 Frost St.
                                                                                                                      Mary Birch Hospital     robotic-assisted surgery, home care, hospice,
    7   San Diego CA 92123                                      334
                                                                                                                      for Women, Sharp        orthopedics, physical rehabilitation, multi-
                                                                                                                                                                                                  Tim Smith, CEO                           1955            1955
        (858) 541-3400, (619) 541-3514                                                  992              2,674          Mesa Vista and        organ transplant, weight-loss (bariatric) sur-                                           286                                                  Sharp Vista Pacifica)    gery, wound and ostomy outpatient center

        Palomar Medical Center                                  319
                                                                                        321               843                                 Trauma center, emergency department, cardio-
        555 E. Valley Parkway
                                                                                                                                              vascular, oncology, general medical/surgical
    8   Escondido CA 92025                                      420                                                            n/a
                                                                                                                                              services, birth center, neonatal ICU, pediatric
                                                                                                                                                                                              Michael Covert, President/CEO                1950            1950
        (619) 739-3000, (760) 739-2180                                                  515               n/a                                 unit                                            413

        Scripps Memorial Hospital La Jolla                      307
        9888 Genesee Ave.                                                               n/a               978                                 Trauma, cardiovascular, neurosurgery, neurolo-
                                                                                                                                                                                               Chris Van Gorder, President/CEO;
    9   La Jolla CA 92037                                       281                                                      $1,291,327,276       gy, radiation oncology, orthopedics, obstetrics,
                                                                                                                                                                                               Gary Fybel, Chief Executive
                                                                                                                                                                                                                                           1924            1924
        (858) 626-4123, (858) 626-6122                                                  800              2,569                                bariatric, general surgery, gastroenterology                                         293

        Paradise Valley Hospital                                301
        2400 E. Fourth St.                                                              225               419
 10     National City CA 91950                                  301                                                            n/a            General acute care hospital                         Luis Leon, PA-C, Ph.D., CEO              1904            1904
        (619) 470-4321, (619) 470-4282                                                  300              1,515                          301

                                                                261                                                                                                                               Kathleen A. Sellick, President/CEO;
        Rady Children’s Hospital
                                                                                        353              1,077                                Cardiology, cardiovascular surgery, dermatol-       Dr. Irvin Kauffman, Chief Medical
        3020 Children’s Way
                                                                                                                                              ogy, orthopedics, transplant, autism, hematol-      Officer/Sr. VP, Hospital Affairs;
 11     San Diego CA 92123                                      270                                                     $1,082,261,681
                                                                                                                                              ogy/oncology, neontology,                           Marj Peck, VP, Patient
                                                                                                                                                                                                                                           1954            1954
        (858) 576-1700, (858) 966-4957                                                  653              3,617                                allergy/asthma/immunology, craniofacial             Services/CNO; Meg Norton, Sr.                                           261                                                                                                                               VP/COO; Roger Roux, Sr. VP/CFO

                                                                204                                                                           Cardio-pulmonary services, complementary
        Sharp Coronado Hospital
                                                                                        252               126                                 and alternative therapies, emergency depart-
        250 Prospect Place
                                                                                                                          $61,848,000         ment, home care, hospice, long-term care,         Marcia Hall, CEO; Susan Stone,                          1994 (this
 12     Coronado CA 92118                                       175
                                                                                                                           (fiscal year)      orthopedics, outpatient behavioral health,        RN, MSN, CNO, COO
        (619) 522-3600, (619) 522-3782                                                  268               578                                 rehabilitation, vision-saving laser treatment for                                            46                                                                           glaucoma

        Sharp Cabrillo Skilled Nursing Center                   180
        3475 Kenyon St.                                                                 891               24
                                                                                                                                              Skilled nursing, senior resources, rehabilitation,
 13     San Diego CA 92110                                       86                                                            n/a
                                                                                                                                              outpatient surgery, eye center
                                                                                                                                                                                                 Daniel Gross, CEO                         1958            1958
        (619) 221-3400, (619) 221-3509                                                 1,073              n/a                                            10

        Scripps Green Hospital                                   173
        10666 N. Torrey Pines Road                                                      n/a               468
                                                                                                                                              Cardiovascular, oncology, orthopedics, neurolo- Chris Van Gorder, President/CEO;                          1991 (this
 14     La Jolla CA 92037                                       168                                                      $877,801,890
                                                                                                                                              gy, neurosurgery                                Robin Brown, Chief Executive
        (858) 455-9100, (858) 554-6869                                                  n/a              1,277                                          173

        Sharp Mary Birch Hospital For Women                     169                                                  $666,687,000 (finan-
        3003 Health Center Drive                                                        501               603          cial data reported Labor and delivery, mother and infant care,
                                                                                                                                                                                                                                                        1992 (this
 15     San Diego CA 92123                                      169                                                  (and audited) annual- neonatal intensive care unit, robotic gyneco-          Mary Henrikson, CEO                      1955
        (858) 939-3400 (619) 541-4165                                                   619               914        ly as a part of Sharp logic surgery, services for women of all ages                                           169                                                   Memorial Hospital)

                                                                149                                                   $666,687,000 (fiscal
        Sharp Mesa Vista Hospital                                                                                                             Adult psychiatric, child and adolescent psychi-
                                                                                        143               152         year) (financial data
        7850 Vista Hill Ave.                                                                                                                  atric, chemical dependency, cognitive therapy Kathleen Lencioni, CEO; Michael
                                                                                                                     is reported and audit-                                                                                                             1998 (this
 16     San Diego CA 92123                                      149
                                                                                                                     ed annually as part of
                                                                                                                                              program, dual recovery program, eating disor- Plopper, M.D., Chief Medical                   1955
        (858) 694-8300, (858) 278-5920                                                  171               504                                 ders treatment, electroconvulsive therapy,      Officer
                                                                                                                         Sharp Memorial                                             0                                                                           older adult psychiatric services

        Scripps Memorial Hospital Encinitas                     138
        354 Santa Fe Drive                                                              n/a               408
                                                                                                                                              Rehabilitation, orthopedics, spine, neurology,      Chris Van Gorder, President/CEO;                      1978 (this
 17     Encinitas CA 92024                                      124                                                      $469,527,231
                                                                                                                                              stroke care, cardiology, obstetrical                Carl Etter, Chief Executive
        (760) 753-6501, (760) 633-7356                                                  550              1,159                                         138

                                                                 119              Combined with                                               Level 1 trauma center, regional burn center,
        UCSD Thornton Hospital, La Jolla                                          UCSD Medical            147                                 multi-organ transplant program, cancer center,
        9300 Campus Point Drive                                                      Center                                                   cardiology, pediatrics, women’s services, child
 18     La Jolla CA 92037                                        119
                                                                                  Combined with
                                                                                                                                              and adolescent health, Alzheimer’s disease
                                                                                                                                                                                              Richard Liekweg, CEO                         1993            1993
        (619) 543-6163, (619) 543-5423                                                                    n/a
                                                                                  UCSD Medical                                                research center, senior behavioral center,                                      119                 Center                                                   neonatal intensive care

        Pomerado Hospital                                       107
        15615 Pomerado Road                                                              0                n/a                                 Emergency department, outpatient surgery
 19     Poway CA 92064                                            0                                                            n/a            center, general medical/surgical, birth center,     Michael Covert, President/CEO            1970            1970
        (858) 613-4000, (858) 613-4764                                                  n/a               750                                 neonatal ICU                                              0

        Sharp Vista Pacifica Hospital                            16                                                  $666,287,000 (finan-
        7989 Linda Vista Road                                                            21                6          cial data reported Chemical dependency, substance abuse treat-
                                                                                                                                                                                                                                                        1998 (this
 20     San Diego CA 92111                                       14                                                  and audited annually ment programs, continuing care (after inpa-             Dan Valentine, Director                  1955
        (858) 637-6920, (858) 637-6959                                                   24                21          as part of Sharp   tient care) programs, family care program                                             0                                                   Memorial Hospital)

* Figures include Scripps Mercy Hospital, Chula Vista location, 435 H St.
Data Source: The Hospitals and their Web sites. Listed by Number of Licensed Beds. This is a partial list; a more complete listing can be found at N/A: Not Applicable, n/a: not available, wnd: would not disclose. It is not the intent
of this list to endorse its participants, nor to imply that a company’s size or numerical rank indicates its quality or service. We reserve the right to edit listings or to exclude a listing due to insufficient information. The following hospitals did not repond
to our survey: VA San Diego Healthcare, Alvarado Hospital, Bayview Hospital and Mental Health, Naval Hospital-Camp Pendelton, Naval Medical Center, San Diego Hospice/Hospital, Kindred Hospital, Villa View Community, Fallbook Hospital, Kindred
Hospital. Compiled by Robin Scott, Last updated 1/2009.
                                                     FRIDAY, JANUARY 30, 2009 •     San Diego Health Care • THE DAILY TRANSCRIPT                                                                                  5

Close-up: Zara Marselian
                                      HeadNorth supports spinal
La Maestra CEO serves as change agent cord injury survivors
   By JILL ESTERBROOKS               Marselian said “will improve       take out lines of credit,                                                 By RANDAL SCHOBER                  In addition, HeadNorth aims
   Special to the Daily Transcript   care delivery, expand capaci-      reduce operating hours and                                                       HeadNorth                to help and enhance the quality
   When         La    Maestra        ty to serve more clients and       put a freeze on hiring simply                                           While spinal cord injuries        of life for people faced with the
Community Health Services            have a positive impact on          to keep clinic doors open                                            may not be on the front of           daily challenges of a SCI
CEO Zara Marselian found             the area environmentally           until “our hard-earned funds                                         many people’s minds, these           through its grant programs.
out that patients at her clin-       and economically.”                 flowed again.”                                                       types of injuries happen                In 2008 the foundation
ics were having trouble put-            The new LEED-designed              Marselian is used to scrap-                                       around each of us on a daily         assisted 40 local San Diego SCI
ting food on the family table,       building project will enable       ing together grants, dona-                                           basis. According to the              survivors with more than
she opened a Food Pantry.            La Maestra to retain its           tions, government funds and                                          University       of      Alabama     $150,000 as part of its
   When it came to her atten-        position as the largest            revenue from services to                                             National Spinal Cord Injury          Response ONE and Response
tion that folks were in dire         employer in the central San        cover La Maestra’s $6.7 mil-                                         Statistical Center, there are        TWO grant programs.
need of dental work, she             Diego neighborhood with its        lion annual budget.                                                  11,000 new spinal cord injuries         The Response ONE program
found a way to provide den-          145 professional and sup-             “I always seemed to gravi-                                        every year, with an American         meets recipients during their
tistry services, too.                port staff members who             tate toward services for peo-                                        sustaining a spinal cord injury      initial and critical hospital
   And when demand for               speak 19 languages.                ple in need,” she said. “And I                                       every 49 minutes. According to       rehabilitation process immedi-
medical and social services             And the new facility could-     like challenges, so this is the                                      the university, the average cost     ately following the injury. With
kept increasing by double-           n’t come at a better time.         place to be.”                            Zara Marselian              for first year paraplegics is        the help of some of
digits year after year, she             With the county’s unem-            Marselian, 49, was born in                                        $209,074 and $470,833 for            HeadNorth’s board members
launched a $10 million capi-         ployment rate reaching 7.4         San Diego, the daughter of        ing the money to expand            quadriplegics.                       and volunteers who also are
tal campaign to consolidate          percent, La Maestra’s City         Yugoslavian immigrants.           existing programs and start           Since its inception in 2006,      paralyzed, each recipient
a labyrinth of 14 patchwork          Heights clinic, as well as            “My family might have          up new services to meet the        the HeadNorth Foundation             receives not only $1,000 to
buildings in the City Heights        those in El Cajon, National        been poor in money, but we        needs of the community.”           has raised more than $1 million      help them with immediate
neighborhood of San Diego            City and Lemon Grove, have         were very rich in cultural           Her most recent endeavors       to provide essential support         financial needs but encourage-
into one centralized loca-           been increasingly crowed           diversity,” said the graduate     have      been     establishing    and guidance to individuals          ment, resources and hope that
tion.                                with needy residents — both        of San Diego High School          micro-enterprise training          and families affected by spinal      they can continue to live fulfill-
   “It’s just the way we grow,       unemployed and the work-           and     San     Diego    State    for small home-based busi-         cord injury (SCI).                   ing lives.
meeting the needs of our             ing poor, who don’t have           University.                       nesses and cutting-edge               A large part of HeadNorth’s          The Response TWO pro-
families,” said Marselian of         insurance      through     an         Since her early teens,         telemedicine services.             mission is to support research       gram provides financial assis-
the San Diego-based organi-          employer yet earn incomes          Marselian knew she wanted            Because many of the clin-       for spinal cord injuries in the      tance to local SCI survivors
zation that provides pri-            greater than the government        to work with needy popula-        ics’ patients lack the language    hopes of finding a cure for          who continue to live with
mary, pediatric and dental           limits for assistance.             tions “who wanted to              skills or transportation need-     paralysis. To support that           paralysis. These grants are used
care, mental health counsel-            “We’ve been fielding a          improve their lot in life.”       ed to visit out-of-area special-   effort, the foundation recently      for the purchase of various
ing, and job training and            record number of requests             As a community college         ists such as ophthalmologists      pledged $975,000 to Burnham          gifts, which include converted
placement services to under-         for assistance during these        teacher in the 1970s, she saw     or podiatrists, Marselian said     Institute for Medical Research       vans, exercise equipment, voice
served, ethnically diverse           uncertain economic times           a wave of South Vietnamese        that by using cameras, com-        to support cutting-edge stem         activated software, house
individuals and families             from people who are already        immigrants who needed a           puters and TV screens, they        cell research. The funding, part     ramps, rehabilitation services,
throughout the county.               financially stressed,” said        hand, not just to learn the       can now offer real-time,           of HeadNorth’s Chronic Spinal        hand-cycles, lifts and standing
   She sees the organization         Marselian. Her clinics pri-        English language, but also to     interactive communications         Cord Injury Project, will sup-       frames. HeadNorth is dedicat-
as a “change agent.”                 marily serve the low-income        get social services and           between patients and con-          port efforts by Dr. Evan Snyder,     ed to assisting SCI individuals
   “They are the ones making         and medically underserved,         assimilate into American          sulting physicians.                stem cell program director at        to live active, enjoyable and
the change; we just help             mostly either Latino immi-         culture.                             “Telemedicine is a practi-      Burnham, and Dr. Mark                purpose driven lives.
facilitate that change and           grants or refugees from               With this in need in mind,     cal, cost-effective alternative    Tuszynski, director of the              HeadNorth was founded by
empower them by teaching             South East Asia and Africa         she later helped found La         to the more traditional face-      Center for Neural Repair at the      Eric Northbrook, a prominent
them how to ask questions            without health insurance.          Maestra as an immigration         to-face way of providing           University of California, San        member of San Diego’s real
and where to seek assis-                “With no county hospital,       amnesty and training pro-         medical care,” she said, not-      Diego, to use stem cells to treat    estate community, after he was
tance,” she said.                    our clinics serve as the safe-     gram, and then added a            ing the successful program         chronic spinal cord injuries.        injured in a motorcycle acci-
   Other changes are in the          ty net for the community,”         medical clinic in her home in     the organization currently            The Chronic Spinal Cord           dent in January 2006. The
works. With the recently             she said.                          1991.                             has with cardiologists at          Injury Project hopes to use          accident left him paralyzed
announced $1 million dona-              The jump in jobless rates          “We had nothing at the         Scripps/Mercy Hospital.            stem cells to regenerate spinal      from the chest down, yet his
tion from Kaiser Family              is just one of the many chal-      beginning, except a lot of           Other areas she’s explor-       cord neural cells, which have        spirit was unbroken. Just one
Foundation and underwrit-            lenges she’s faced in recent       need,” said Marselian, who        ing are telemedicine services      been found to develop in adult       month after his accident, in the
ing of an $18.5 million bond         months.                            has been recognized locally       for rural communities and          rats with acute spinal cord          midst of his own recovery and
initiative made possible by             If providing health care        and nationally as an ambi-        teletraining for employees at      injuries. This specific study is     rehabilitation, Northbrook,
Anthem Blue Cross, con-              for low-income and unin-           tious champion for the cause      all sites.                         unique in the nerve regenera-        along with his wife Denise and
struction can now get under          sured families weren’t chal-       of serving the uninsured.            Looking ahead, Marselian        tion research community and          close friends, established the
way for La Maestra’s new             lenging enough, last fall             During the past 18 years,      said while she is very hope-       hopes to bring light to a possi-     HeadNorth Foundation upon
34,660-square-foot “green”           during the state budget            the clinic has grown and          ful about the health care          ble cure for this type of debili-    realizing there was a great need
health care center that              impasse, she was forced to         now, along with three others      changes that might be ush-         tating injury.                       to those who suffer an SCI.
                                                                        (National City, El Cajon and      ered in by the new Obama              This is not the first time that   While Northbrook was still in
                                                                        Lemon       Grove),     serves    administration, she realizes       HeadNorth has aided UCSD’s           rehabilitation, HeadNorth’s
                                                                        65,000 patients annually          it will take time for major        Center for Neural Repair in its      first recipient was 24-year-old
                                                                        with a paid staff of 145 doc-     changes to take place.             mission to find a treatment for      Matthew Clinton, a fellow
 Waste Management’s                                                     tors, dentists, counselors,
                                                                        teachers, social workers and
                                                                                                             In the meantime, she
                                                                                                          hopes La Maestra can gain
                                                                                                                                             spinal cord injuries. In 2007,
                                                                                                                                             HeadNorth donated $50,000
                                                                                                                                                                                  patient, who was afflicted with
                                                                                                                                                                                  a rare spontaneous spinal cord
                                                                        others who speak a spectrum       the attention of the federal       to the Center for Neural             stroke that left him a ventila-
 Healthcare Solutions                                                   of languages representing
                                                                        their clients from more than
                                                                                                          government and serve as a
                                                                                                          national model for how
                                                                                                                                             Repair’s Spinal Cord Regen-
                                                                                                                                             eration Research Program,
                                                                                                                                                                                  tor-dependent quadriplegic.
                                                                                                                                                                                     Now in its third year in
                                                                        60 countries throughout the       locally based, cost-effective      which funded research into           establishment, HeadNorth will
 group enters local market                                              world.
                                                                           Marselian, who herself
                                                                                                          and highly efficient social
                                                                                                          and medical services can be
                                                                                                                                             spinal cord regeneration. Led
                                                                                                                                             by Tuszynski, the Spinal Cord
                                                                                                                                                                                  continue to grow and hopes to
                                                                                                                                                                                  help a greater number of SCI
                                                                        also speaks fluent Spanish,       delivered.                         Regeneration             Research    survivors in 2009.
    Waste Management is              The company will be the first      Italian, French and English,                                         Program conducted pre-clini-
 building a special services         to have the infrastructure to      said that while the organiza-      Esterbrooks is a San              cal research that aims to devel-       Schober is the executive
 division to help health care        offer a full range of services     tion has grown and expand-        Diego-based      freelance         op practical therapies that          director of the HeadNorth
 operations manage their con-        and provide health care facil-     ed in the last two decades,       writer.                            could lead to clinical trials for    Foundation.
 sumed materials. Waste              ities with greater efficiency,     her main goal remains “find-       Source Code: 20090130crf          spinal cord injury.                     Source Code: 20090130crh
 Management has taken the            reduced costs, more recycling
 first step toward this goal in      and better environmental
 the San Diego market with           stewardship.
 the purchase of Spectrum               Once its operations are
 Services in San Diego.              fully     functional,     Waste
    Waste Management’s goal          Management will be able to
 is to offer a combination of        provide services for hospitals,
 services to handle solid            clinics, surgery centers, phar-
 waste, recycling, medical           maceutical manufacturers
 waste, confidential docu-           and a variety of other health
 ments, universal and phar-          care operations in Southern
 maceutical waste from a sin-        California.
 gle supplier. Through its              The company also has a
 extensive resources and con-        team of subject experts from
 sulting expertise, Waste            hazardous waste, pharma-
 Management has been able            ceutical waste and recycling
 to save complex businesses          to offer state-of-the-art-knowl-
 more than $50 million. The          edge and technology to pre-
 company believes it can             serve the environment while
 bring these competencies to         cost effectively treating and
 the U.S. health care industry,      transporting these wastes.
 the largest industry in the            Waste Management cur-
 country with 18 percent of          rently manages waste for
 gross domestic product.             more than 30,000 health
    Related to these moves,          care customers, including
 Waste Management also               1,400 hospitals. With the
 recently     purchased       the    addition of these service lines
 largest medical waste treat-        and       expertise,      Waste
 ment facility in the Southwest.     Management’s goal is to
 This facility, located in           become the leading environ-
 Chambers County in south-           mental experts in the U.S.
 east Texas, will provide serv-      health care market.
 ices from Southern California          Here’s      what       Waste
 to Louisiana beginning in           Management’s Healthcare
 March       after    significant    Solutions offers:
 upgrades are completed to              1. Cost control
 meet WM’s high safety and              2. Risk management
 environmental standards.               3. Integrated solutions
    Fully 70 percent of health          4. Waste reduction
 care-generated waste is reg-           5. Managed complexity
 ular solid waste. Waste                6. Increased reuse and
 Management is in a unique           recycling
 position to use its existing           7. Optimal environmental
 infrastructure to handle this       protection
 solid waste as the company             8. Routine progress report-
 adds health care waste treat-       ing
 ment facilities. In addition,          For more information on
 Waste           Management’s        Waste Management’s Health-
 Recycle America division is         care Solutions group, visit
 the country’s largest recycler.
    Submitted by Waste Management’s Healthcare Solutions
6                                                               FRIDAY, JANUARY 30, 2009 •     San Diego Health Care • THE DAILY TRANSCRIPT

OC hospital says                            Lean: It’s a lifestyle                                                     Medicine
                                                                                                                             Continued from Page 1          physician is critical as the        ment.
it’s corrected                                                                                                                                              director of this team.                 Medicare and other health
                                            change, not a ‘fad diet’
                                                                                                                       al internists or pediatricians
                                                                                                                       for children.                           The medical home model           insurance plans are seriously
patient problems                                                                                                          Americans were not happy
                                                                                                                       being forced to always get
                                                                                                                                                            has emerged to improve
                                                                                                                                                            health care and increase its
                                                                                                                                                                                                considering a major change in
                                                                                                                                                                                                the financing of health care to
                                                 Source: Childs Mascari Warner    spearhead the process and to         their care through a PCP, and        efficiency by lowering costs        support the growth of the
          The Associated Press                             Architects
                                                                                  help stay focused on change.         managed care declined in the         while at the same time              medical home model. Rather
   ORANGE,        Calif.    —                 Fad diets come and go, but             • Start with a small proj-        late 1990s as HMOs opened            increasing the quality of care.     than traditional fee-for-serv-
University of California,                   the tried and true way to fit-        ect, or even part of a project,      up direct access to specialists.     When greater resources are          ice practice that only rewards
Irvine Medical Center said it               ness is a change in lifestyle.        but just start, even if you          The     Preferred     Provider       placed into prevention and          physicians for doing things,
has submitted a plan to cor-                The same principle stands             don’t feel fully prepared to         Organization (PPO) has               managing chronic problems,          payment would be made for
rect dozens of patient care                 for health care design and            dive in.                             become the most popular              the overall costs of care go        the coordination of care by
problems that threaten to                   construction. Implementing               • Get everyone involved           insurance model, where peo-          down as the rates of major          the physician and team. The
cost it millions of dollars in              lean principles is not a              during the construction              ple may choose primary care          problems decline. Recent evi-       medical home payment would
Medicare funding.                           quick-fix      solution,   but        phase — this includes the            or specialty physicians in an        dence has shown a decline in        incentivize the team to reach
   After an October inspec-                 requires first a shift in men-        client, staff and contractors.       organized network of physi-          heart attacks in a population       out and coordinate care in
tion, federal regulators                    tality and a mindset that                • Eliminate “silo” think-         cians agreeing to accept dis-        through a reduction in ciga-        ways that do not require
issued a 127-page report cit-               accepts growth and change.            ing. As a core group, map            counted rates for their servic-      rette smoking — still the most      patient visits, such as over the
ing dozens of examples of                   Just like with a fitness plan,        processes to determine               es.                                  common cause of heart dis-          telephone and through secure
problems with patient care                  the key is tailoring the right        value, identify potential               The current decline in pri-       ease and cancer. When a pop-        online        communication.
or hospital procedures.                     lean plan for a project. The          points of waste and develop          mary care has now lasted a           ulation of diabetics is better      Quality outcomes of care to
   The U.S. Centers for                     key lies in figuring out where        efficient ways to improve            decade, and a critical short-        controlled, the costs of care go    populations become the new
Medicare and Medicaid                       to start, how to keep it              with the idea of enhancing           age of primary care physi-           down as there are fewer com-        financial incentive.
Services sent a letter to the               going, and what “lean” really         the quality of care.                 cians is looming. Starting           plications of the disease, such        Will the medical home
teaching      hospital    last              means in each setting. You               • Think about planning in         salaries in primary care are         as kidney failure, heart            model cause a resurgence in
month, ordering it to submit                do not have to be an expert           new ways.                            going up, but there are not          attacks, loss of vision and         interest in primary care
a plan for correcting the                   to begin integrating lean                • Implement an integrat-          enough physicians coming             amputations of limbs.               among today’s medical stu-
problems or risk losing its                 into your processes.                  ed form of agreement.                out of the pipeline to fill open        The medical home uses a          dents? It is too early to tell.
patient care funding.                                                                Lean is a lifetime commit-        positions. Something needs to        team approach to care with          But the buzz has captured
   The problems were fixed                          What is lean?                 ment, and is not effective           happen to rescue primary             information systems that help       national attention, and sup-
before the hospital submit-                   The lean process, original-         unless it remains a priority,        care medicine.                       all the professionals coordi-       port for the medical home is
ted its plan, said Dr. David                ly championed by Toyota               just like a diet or a fitness           The American population is        nate care with informed and         likely to be a part of the
Bailey, UCI’s vice chancellor               Production System (TPS),              program.                             aging, and chronic health            activated patients. Electronic      Obama         administration’s
for health affairs.                         has been a well-known phi-                                                 problems such as hyperten-           health records (EHRs) allow         health care reforms. There is
   “These were all things                   losophy in the manufactur-              As co-founders of the              sion, diabetes, heart disease        for a flow of information           a critical need to lower health
that were fixable and cor-                  ing arena for decades. Lean           Southern California chap-            and even obesity eat up most         where all the caregivers have       care costs, and the efficiencies
rectable,” Bailey said. “We                 thinking is based on the              ters     of    the      Lean         health care costs and cause          the same information to work        of the medical home offer a
really believe that we offer                ideals of driving out waste           Construction       Institute,        the most serious problems,           from, and best practice clini-      way to do this and improve
outstanding health care . . .               and ultimately providing              Childs Mascari Warner                like heart attacks and heart         cal guidelines are imbedded         the health of the population.
and we don’t want to see one                maximum value for the cus-            Architects     and      BSD          failure. Chronic health prob-        in the patient information.
slip-up for any patient.”                   tomer. While the lean con-            Builders,    along      with         lems are best treated early by       With emerging personal                Scherger, M.D., M.P.H., is
   Jack      Cheevers,       a              cept isn’t new, its application       Professor Colin. T. Milberg          primary care physicians. A           health     records     (PHRs),      chair of the San Diego County
spokesman for the Medicare                  in health care operations,            with SDSU, are bringing              new model of chronic illness         patients are able to get            Medical                Society
centers regional office in                  design and construction is            lean to Southern California          care has emerged based on a          involved in their own care          Communications Committee
San Francisco, said the                     on the cutting edge.                  health care design and con-          team of health professionals         much like people today are          and editor of San Diego
agency was still reviewing                                                        struction.                           engaging with a population of        able to get involved with their     Physician magazine.
the plan.                                        Where do you start?               Source Code: 20090130crn            patients, but the primary care       money and travel manage-              Source Code: 20090130crc
   “Once     it’s   approved,                 The key to implementing
there’ll be another inspec-                 lean is a solid understanding
tion,” he said.
   Among other things, fed-
                                            of its core principles, com-
                                            bined with a company cul-
                                                                                        Continued from Page 1             Comparable            existing    hospitals and emerging com-         tion devices that seniors can
eral inspectors found that                  ture that is willing to accept                                             devices tighten on the arm           panies, showing them how to         use while living independent-
                                                                                  developed a continuous moni-
four patients had suffered                  new ideas and make changes.                                                and take the patient’s blood         integrate wireless technology       ly is a huge growth area.
                                                                                  toring, noninvasive device for
bedsores; the hospital did                  Though many are familiar                                                   pressure every 20 to 30 min-         with health care, Sobrian said.     These       devices      include
                                                                                  measuring blood pressure on
not have enough nurses to                   with concepts of lean, they                                                utes, using the same technolo-       Intel has also been actively        reminders to take drugs and
                                                                                  ambulatory patients.
provide one-on-one care to                  reach a roadblock in taking                                                gy utilized by a doctor’s office,    involved and is working on          monitoring of vital signs and
                                                                                    Angel funds helped get
children in the newborn                     the first steps to implement                                               according to Watlington.             advancing wireless technology       movements.
                                                                                  Triage started, and the com-
intensive care unit; and                    these ideas for a specific                                                    “It’s invasive, the cuff has to   for the industry.                      “The challenge lies in get-
                                                                                  pany recently concluded a sec-
nurses adjusted doses of                    project or process. Below is a                                             be inflated and it is not con-         “Activity in this sector falls    ting the seniors to adapt to
                                                                                  ond round of Series B funding
insulin or other drugs with-                brief list of steps that can                                               tinuous. Triage was conceived        into two areas — medical            the technology. Innovators
                                                                                  for $20 million, led by
out doctor approval or hos-                 begin the lean process.               Qualcomm (Nasdaq: QCOM).             to develop a continuous, non-        devices that monitor, measure       often develop a gadget with-
pital protocol.                               • Establish an action
                                                                                  Other investors included Intel       invasive device that does not        and transmit data; and cell         out thinking about who will
   Source Code: 20090121ch                  group or lean committee to
                                                                                  (Nasdaq: INTC), Sanderling           require inflation and allows         phones that monitor, transmit       use it. In the hospital environ-
                                                                                  Ventures and 3 Eye.                  patients to be ambulatory,” he       data as well as advice to the       ment, the challenge is in
                                                                                    “In 2007, our attention            said.                                patient,” said Sobrian. “It         achieving accuracy, reliability
                                                                                  switched to monitoring all of                                             could be anything from a            and economies of scale. Our
    The Daily Transcript presents:                                                                                             Qualcomm’s role              refrigerator that stores blood      technology summit this year
                                                                                  the vital signs, not just BP
                                                                                  (blood pressure), which is the          Both     Watlington       and     and transmits supply-level          will focus on consumer tech-
    American Heart Association                                                    Holy Grail, the last vital sign      Sobrian            highlighted       data, to a wireless bandage         nology adoption and the
                                                                                  that could not be measured           Qualcomm’s involvement in            that can monitor blood pres-        growth of the industry,”
    Go Red for Women                                                              wirelessly. ViSi, our device,
                                                                                  will be worn on the body.
                                                                                                                       this emerging field.
                                                                                                                          “They are very visionary
                                                                                                                                                            sure and heart rate.”
                                                                                                                                                              RFID is helpful for patients
                                                                                                                                                                                                Sobrian said.
                                                                                                                                                                                                   According to Watlington,
                                                                                  Sensors process the signs and        that way,” said Watlington.          with Alzheimer’s, who tend to       the next generation of devices
    March 13, 2009                                                                transmit them wirelessly,” said      Triage has been working with         wander and get lost. The            will be so advanced that they
                                                                                  Triage CEO Tom Watlington.           Qualcomm in placing a                tracking technology can also        will not even require the tiny
                                                                                    Triage will submit the             modem inside their device so         be used on hospital equip-          wires now used to apply sen-
                                                                                  device for FDA approval at the       that it can transmit data            ment in the area of loss pre-       sors to the body.
                                                                                  end of this year and hopes to        directly. “The system can send       vention, Sobrian pointed out.          “We are very fortunate to be
                                                                                  bring it to market in the first      a warning to the health care                                             in San Diego, with companies
                                                                                  half of next year. It is initially   provider, who can then ask                    Future trends              like Qualcomm. It’s a very
                                                                                  intended for in-hospital use         the patient to come in for              Sobrian said the future          rich, entrepreneurial environ-
                                                                                  by patients who are not in the       tests.”                              holds big opportunities in the      ment. There is a growing pres-
                                                                                  ICU or CCU, but a consumer              Activity in this field began      pharmaceutical area.                ence of medical device inno-
                                                                                  version will be developed later      ramping up in 2005, which               “Right now, clinical trials      vation. This is definitely a
                                                                                  for patients to use in their         spurred the need for the             are conducted on paper, with        growth area for the city, since
                                                                                  homes.                               WLSA. Sobrian recalled that          patients recording in a diary,      this is a perfect place for
                                                                                    “If a patient’s condition is       about half a dozen health care       and there are pitfalls to this      progress to occur and will be a
                                                                                  deteriorating, if their BP is        firms, including Sharp, Kaiser       system with false reporting.        source of future jobs,”
                                                                                  going down, it will monitor          Permanente and Scripps,              Having data transmitted wire-       Watlington said.
                                                                                  and send data to the nurse in        were spending millions of dol-       lessly helps identify potential
                                                                                  charge. It will allow patients       lars going digital and search-       new solutions and negative            Nagappan is a San Diego-
                                                                                  to leave hospitals earlier and       ing for wireless technology.         effects quickly.”                   based freelance business
                                                                                  still     be       monitored,”          At     the    same      time,        In the consumer market,          writer.
                                                                                  Watlington said.                     Qualcomm was meeting with            monitoring and communica-             Source Code: 20090130crg

    Go Red For Women is the American Heart Association’s nationwide
    movement that celebrates the energy, passion and power women have to
                                                                                    Gilbane completes Stephen Birch Healthcare Center at Sharp Memorial Hospital
    band together and wipe out heart disease. Thanks to the participation of           Serving as construction          has the most modern, patient-       Services;    EAR      Quality      Swisslog; TMAD Taylor &
    millions of people across the country, the color red and the red dress have     manager at risk, Gilbane            focused health care delivery        Inspection Services; Earl          Gaines; Tower Glass; Tri-
    become linked with the ability all women have to improve their heart            Building Co. has completed          system in the county and in the     Composites; EDCO Disposal          County Insulation; Valley Crest
    health and live stronger, longer lives.                                         construction on the new             country,”       said      Sharp     Corp.; Fuller Electric; GEM        Landscape         Development;
                                                                                    315,000-square-foot, 334-           Memorial Hospital CEO               Mechanical; Hasson; Hill-          Washington Iron Works;
    The Daily Transcript at is proud to sponsor the Go Red for
                                                                                    bed health care facility at         Daniel Gross.                       Rom; ISEC; JD2; Johnson            West-Tech Contracting; and
    Women luncheon and a special spotlight on the American Heart
                                                                                    Sharp Memorial Hospital, offi-         A highlight of the Sharp         Maintenance; KPFF; Lerch,          Yardley Zaretsky.
    Association on Friday, March 13, 2009.
                                                                                    cially named the Stephen            project is the large-scale steel    Bates and Associates; Letner          Gilbane Building Co. is
    Include your company’s message in this special issue distributed at the         Birch Healthcare Center.            reinforcement and steel beams       Roofing Co.; Martin &              ranked as the No. 9 health
    luncheon on March 13, 2009. Don’t miss this exciting opportunity to             Gilbane’s Southern California       utilized to meet California         Ziemniak;        McDonough         care builder in the nation by
    support heart health education.                                                 office, based in San Diego,         building code and OSHPD             Construction Rentals; MDI;         Engineering News Record.
                                                                                    managed the preconstruction         regulations to guarantee the        Mid Canada Millwork; Morley        The firm provides a wide
                                                                                    and construction efforts.           structure is seismically secure.    Construction Co.; National         range of services and pro-
    Contact or 619.232.4381 today!                                      The new facility proudly         The new tower has 612 tons of       Electric Works; NBBJ; OCB          grams that focus on the health
                                                                                    houses private patient suites       reinforcing rebar in the walls      Reprographics; OTIS; Pacific       care     market,        including
    Ad space closes: March 5, 2009                                                  featuring a three-zoned lay-        and foundation.                     Air Care; Pacific Coast            Healthcare Cost Advisor,
    Artwork due: March 9, 2009                                                      out     giving     caregivers,         Gilbane wishes to thank all      Cleaning; Pacific Coast Steel;     Healthcare         Center      of
                                                                                    patients and visitors personal      of the firms that contributed to    Poliform USA; Prime Tile;          Excellence, Transition Plan-
      The Go Red for Women Lucheon, themed around sisterhood and                    space with a comfortable            the successful expansion of         ProSpectra Contract Flooring;      ning     and      Management,
      inspiration, is a life-changing experience that focuses on three areas to     sleeping area for a visiting        Sharp Memorial Hospital:            Rotech Consulting; Ruckle          Building Information Modeling
      support the fight against heart disease in women: heightening                 family member. The new              ABKJ Structural; Allstate           Construction; Schuff Steel         and Interdisciplinary Docu-
      awareness of the issue, creating a passionate call-to-action, and             tower includes a surgery cen-       Services        Environmental;      Pacific; Shadpour Consulting       ment Coordination.
      generating funds to support education and research.
                                                                                    ter, specialized designs for        American Labor Pool; AO             Engineers;    Shannon       &         Gilbane (www.gilbaneb-
      This event is designed to be both social and educational; it is an            orthopedics, cardiac surgery,       Reed       &     Co.;     Basile    Wilson; Sharp Memorial    provides a full
      opportunity to raise awareness of heart disease in women and a                neurotrauma and transplan-          Construction;       Bergelectric    Hospital; Sideplate; Siemens       slate of facilities-related serv-
      chance to empower women to take charge of their own heart health.             tation; a new main entrance         Corp.; Bradshaw Engineering;        Building Technologies; Sim J       ices for clients in the educa-
      Visit for more information.                                 and lobby as well as                Brady Co.; Business Cleaning        Harris; Simplex Grinnell; Site     tion, health care, life sciences,
                                                                                    enhanced admitting and              Co.; California Sheet Metal         Workshop;           Southern       convention/cultural, govern-
                                                                                    scheduling areas.                   Works; Coast Environmental;         California Soils & Testing;        ment, sports/recreation and
                                                                                       “Sharp Memorial Hospital         Diamond          Environmental      Standford Sign & Awning;           criminal justice markets.
                                                                                                                 Submitted by Gilbane Building Co.

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