Medical Society of Tulare and Kings Counties
Fall Newsletter
The Medical Society would like to thank each of you for your support this year. It has been wonderful to see so many of you engaged in trying to make a difference in our community. We have had great turn outs to each of our Seminars, Socials, Volunteer projects like High School Physicals, Happy Feet events, Samaritan Center and the newest being Street Medicine. We are a small area but our efforts are huge when it comes to our community.

As we come to end of our year, we are focused on how we can build our membership. This year we have grown from 217 members to 245 members. That is a great increase that could only be contributed to the work and dedication you give to your society. Your efforts have not gone unnoticed. Your continued support is going to help us continue to grow which leads to more and more support for you.

The Medical Society Staff
TCMS representing Tulare and Kings Counties at CMA’s 148 th House of Delegates!

by Kunal Sukhija MD
The end of October was scary for two reasons. Of course the ghouls, ghosts, and ghastly figures reared their heads for a very chilling Halloween season this year. However, we sometimes forget about a deeper and more sinister beast - the near daily legislative and public health threats to our patients and our way of practice. To that extent our elected delegates and alternates volunteered their time to attend CMA’s 148 th House of Delegates on October 26 th and 27 th to debate and discuss the major issues facing the house of medicine in California. Dr. Ralph Kingsford (Board of Trustees, District VI), Dr. Robert Allen (Delegate), Dr. Mark Tetz (Delegate), Dr. Roger Haley (Delegate), Dr. Kunal Sukhija (CALPAC Board District VI, Alternate) along with Stephanie Amaral (TCMS CEO) joined District VI and over 500 physicians this year in Anaheim to weigh in on these important issues.

This year the House was focused on four specific topics:

·          Cannabis: While this has come up before as a major issue, recent regulatory changes and legalization of recreational use have affected many of our practices. Delegates weighed in on public health impacts of recreational cannabis use, public health protection mechanisms, federal legalization, data-acquisition and surveillance strategies, the need for low-obstacle high-quality research, and truthful marketing and advertising practices.

·          Homelessness: This is a crisis facing not only our home here in Tulare and Kings counties, but all of California and the rest of the nation. Delegates were clear that stable and affordable housing is an essential community priority and an important social determinant of health. Evidence-based solutions were discussed to address health-care focused outcomes affected by homelessness

·          Augmented Intelligence: Delegates enjoyed expert-driven lectures and panels on this impending wave of technological advancement within our profession, and spear-headed pragmatic policy solutions to address many issues. AI will affect physician medical decision making, create new liabilities and privacy concerns, and may generate technologically disruptive processes. It’s important that these new technologies augment a physician-led healthcare delivery system.

·          Adverse Childhood Experiences: ACEs have a strong and life-long correlation to a number of health, social, and behavioral problems. The delegates learned from experts in the field about ways to incorporate research, data-collection methods, and ACE screening practices into our routine care.
Additionally, the house welcomed its newly elected presented Dr. Peter Bretan (who graciously visited us mid-October during our Fall General Session for a riveting speech and Q&A session). He has a very inspirational story. From growing up as a farm laborer to becoming an accomplished bay area Renal Transplant Surgeon, he understands the various specters plaguing patients and physicians from achieving health and delivering healthcare, respectively. A contentious race for the Vice-Speaker position was ultimately won by Dr. Jack Chou, who practices family medicine in Baldwin Park. 

Janus Norman, CMA Senior Vice President, gave a thrilling legislative update. The team has been extremely busy in 2019 fighting for legislation to decrease administrative burden (AB 149 Cooper, AB 744 Aguilar-Curry) and to stop legislation that would drive up costs (AB 1404 Santiago). The CMA has worked hard to pass legislation to alleviate burdens associated with mandatory CURES database searches. Victories in the form of defeated legislation include preventing laws to change prescription labeling requirements, preventing increases in CA physician licensing fees, and preventing laws to publicly disclose physician reimbursement and contracted rates. There are so many more legislative victories to list here, but it’s an exhaustive document. Ideally, this sheds light on the behemoth effort required on a daily basis to simply allow us to take care of patients.

Our Medical Society and the CMA need your help. Participation, either through direct action or financial contribution, is a required part of our profession in my opinion. Laws and policies are being drafted every day that have the potential to put more middlemen between us and our patients. We need more members, we need a louder voice, and we need to work together . The clinic-based physician needs to understand the plight of the hospital-based physician, and vice-versa. The sub-specialist needs to understand the plight of the generalist, and vice versa.

The only way we can guarantee that our patients get what they need is by working together to fix the problems facing our profession. Remember, we are all physicians, and we are duty-bound to help all of our patients. So encourage your physician friend to come to the meetings, encourage your partner to join the medical society, and encourage yourself to stay empathetic of your physician neighbor. Together we can continue to be healthcare leaders of our beautiful community! 
Happy Feet
By: Rachelle Yellin and Christian Tagle
This past October, the third Happy Feet event was held at the Samaritan Center Free Clinic in Visalia. Through the efforts of the Samaritan Center, Kaweah Delta, A.T. Still
University-Visalia CHC, the Medical Society of Tulare and Kings Counties, and several other community partners, over fifty homeless and/or underserved individuals received
much needed healthcare, prescriptions, and education.

The main focus of this event included diabetes, hypertension, and podiatric health as these aspects of medicine commonly plague this particular population with a multitude of issues and complications. In efforts to combat them, screenings for diabetes and hypertension were offered, and if an abnormality was identified, the patient was directed to the Samaritan Center for further counseling and management. Additionally, each patient received education that focused on these conditions including overviews, complications, treatment, and prevention. Patients were also offered foot cleanings and screenings during which time providers were able to offer management and follow up as dictated by exam. Each patient that was seen was provided with a medical “goodie bag” containing anti-fungal ointments, Band-Aids, socks, shoes, a toothbrush, toothpaste and floss, and of course, a hot meal was provided as well.

The success of this event can be directly linked to the generosity of a variety of local
community partners who donated their knowledge, experience, and time. Of these
include Omni Family Health, SIREN, Tulare Works, Safe Link Wireless, Tulare County
Healthcare Center, Tulare County AOD, The Source, and Tulare County Public Health
Communicable Diseases. Through the assistance of these organizations, patients were
able to receive their flu vaccine, obtain HIV testing and counseling if desired, complete
an application for Medi-Cal, and if qualified, obtain a new cell phone.

Since May of this year, three events of this similar nature have been held, allowing over
200 medically underserved patients to receive long overdue healthcare. These events
would not have been possible without the collaborative efforts of our community
partners. We are incredibly grateful to all those who have donated their time and
resources as well as financial support as it is truly incredible to see a community come
together to help their members in need.

Currently, our next event is slated to take place as a part of Project Homeless Connect
in January of 2020. Should you be interested in donating or getting involved, please
contact Christian Tagle, OMS-III, at
CMA to organize physician volunteers for wildfire response
Across California, Governor Gavin Newsom has declared a state of emergency in response to the Kincade and Tick Fires that have destroyed structures, threatened homes and forced the evacuation of tens of thousands of residents.

In collaboration with the Governor’s office, the California Medical Association (CMA) is calling on physicians across the state to provide care to those affected by the wildfires. If you are willing and able to volunteer your services, please fill out this Google Form , in its entirety.

In the coming days and weeks, we’ll contact all submitters with volunteer opportunities. Residents of these areas need your help, and we request your thoughtful consideration of the impact you could have by volunteering. Thank you in advance for your consideration and service.

Fall General Meeting
The Medical Society welcomed Dr. Peter Bretan, Incoming CMA President
Watsonville Urologist and Transplant Surgeon Installed as CMA President

Peter N. Bretan, Jr., M.D., a urologist and kidney transplant surgeon who gave up his Bay Area practice to serve patients at a safety net hospital in Watsonville., was elected as the 152nd president of the California Medical Association. Dr. Bretan is the first Filipino-American physician to serve as president.

“The most important goal, not just in this year of my presidency, but always, is to take back our profession by enabling physicians to lead the struggle to protect, expand and make universal access to health care for all of our patients in California,” said Dr. Bretan. “If we are successful in this state, it will lead the way for sustainable universal health care for all of America.”

Dr. Bretan is the founder and CEO of LifePlant International, a charitable organization that furnishes lifesaving transplants in developing countries, for which he was recognized by the American Medical Association with the Benjamin Rush Award for Citizenship and Community Service. Dr. Bretan has also provided care around the world on medical missions.

“I grew up as a child farm laborer, and I know what it is to be without adequate health care. My greatest motivation is in service to give back to society for my good fortune,” said Dr. Bretan.

After years of practice in Marin and Sonoma counties, Dr. Bretan now provides urologic and laparoscopic surgical care at a safety net hospital in Santa Cruz County. Most of his patients speak no English and have no medical insurance.

“My presidency will be dedicated to giving these patients, and the millions of hard-working Californians like them, a voice,” said Dr. Bretan. “We have an incredible opportunity to boldly change the way health care is delivered. We know that to best serve patients, health care must be physician-led.”

Dr. Bretan has served as a CMA trustee and delegate, and is a three-time county medical society president. He is the current president of the California Urological Association and serves as an adjunct clinical professor at Touro University, where he has taught classes in health care policy for the past 16 years.

Dr. Bretan earned his B.S. degree in physiology from UC Berkeley and his medical degree from UC San Francisco, where he completed residencies in general surgery and urology, as well as a fellowship in radiology. He also completed a fellowship at The Cleveland Clinic Foundation in transplantation and renovascular surgery. Dr. Bretan is a member of the San Francisco Marin Medical Society and the Mendocino-Lake County Medical Society.
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