I`ve had the privilege of being part of this incredible center

later still striving to stay on the front lines of radiation oncology
treatment delivery.”
Photo by Vinit Satyavrata, Pure Light Photography
Hematology/Oncology
Another step along the collaborative treatment path is with the
Hematology/Oncology Department focusing on both blood disorders and cancer treatment.
Under the direction of Santa Barbara Hematology Oncology
Medical Group physicians Drs. Fred Kass, Tom Woliver, Donna
Walker, Dan Greenwald and Alan Bryce, patients receive expert
care with treatment plans designed for the specific medical, psychological, social and logistical needs of each person.
“With the arrival of our newest medical oncologists, Drs. Dan
Greenwald and Alan Bryce, we are proud to offer incredible expertise in the areas of lymphoma and myeloma,” says Dr. Kass.
Always on the leading edge of innovation, medical oncology at
Cancer Center of Santa Barbara features targeted therapy. This
personalized treatment regimen is based on the molecular and genomic features of the individual’s tumor. One of the most impressive
outcomes of this program is the effective treatment of the cancer.
“Ultimately, the real mission has to be the nuts and bolts of
providing topnotch care,” explains Dr. Kass. “But the fun part of
our job is knowing that we’re part of an entity that has been able to
redefine the scope of cancer care and dramatically broaden what
both doctors and patients should consider an integral part of healing.”
Therapeutic services are provided in chemotherapy suites under
the care of highly skilled and compassionate nursing teams. Cristine
Fernandez, physician assistant, complements the teams.
Clinical Research Coordinator, Alexis Langston-Cooper
“I’ve had the privilege of being part of this incredible center for
nearly 25 years,” says Dr. Weisenburger, “and continue to be impressed with the degree of dedication to our mission statement by
every member of this team.
“The Cancer Center started 60 years ago with the dream of
Dr. Henry Ullmann, Lillian Converse’s physician, who wanted to
buy the latest equipment, and here we are more than a half-century
Fred Kass, M.D.,
hematology/medical oncology
Photos by M. Bradley Elliott
Pawan Gupta, M.D.,
nuclear medicine
6 | central coast/ventura county m.d. news
october 2009
Pushing the Envelope — Saving Lives
Hope is the life vest we all cling to, whether dealing with cancer
or any other life-threatening event. And while every component
of Cancer Center of Santa Barbara is focused on providing services
that foster that hope, perhaps one of the most aggressive is research.
Cancer Center of Santa Barbara’s research program, under the
direction of Dr. Kass, supports advances in the fight against cancer, posing the question, “What if?” Tirelessly, they explore new
possibilities through three primary areas of involvement: clinical
William Pace, M.D.,
nuclear medicine
W. Warren Suh, M.D., M.P.H.,
radiation oncology
Central Coast/Ventura County Edition | October 2009
VOL. 2, NO. 10
High-Tech,
High-Touch
A Legacy of Care: Cancer Center
of Santa Barbara
Feature
Advances in Oncology
Document Management
Solutions 101
Evaluation of
Arterial Perfusion
Going Beyond Expectations
to Meet Health Care Standards
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contents
VOL. 2, NO. 10
OCTOBER 2009
4 COVER STORY
HIGH-TECH,
HIGH-TOUCH
2
from the publisher
9
current topics
12 hospital rounds
Established 60 years ago, the Cancer
Center of Santa Barbara is built on a
rich heritage of community support and
cutting-edge technology. It continues
to be in the vanguard of prevention,
diagnosis and care for thousands every
year. Just as the quiet city of Santa
Barbara boasts small-town “friendly”
of pathways that lead to the cancer, and
as well as big city art and
culture, the
finding effective ways to prevent it. That’s
we’re really
trying to
do: find small
Cancer Center, while what
keeping
pace
with
molecules, like rexinoids, that have few
or
no
side
effects.
We
can
potentially
give
some of the largest andsuchmost
highly
drugs to healthy individuals to help
prevent cancers.”
regarded cancer research/treatment
treatIng focused
centers in the world, remains
chemo-reLated InfectIons
primarily on the patient.Patients undergoing chemotherapy are at
gy
DEPARTMENTS
Photo by Vinit Satyavrata, Pure Light Photography
3
Evaluation of
Arterial Perfusion
high risk for contracting infections, which
can range from uncomfortable to fatal.
“ I n recent
years, there has
been a shift in
the field of cancer t reat ment
to higher rates
of f u n g a l i n fections,” says
David Fisk,
David Fisk, M.D.
M.D., infectious
disease specialist at Sansum Clinic in Santa Barbara,
CA, and clinical assistant professor at
the University of Southern California
Department of Medicine. “For example,
when patients receive chemo for acute
myeloid leukemia [AML], their risk of
fungal infections becomes very high.
These invasive fungal infections, such
as aspergillus, are an increasing cause of
morbidity and fatality for many patients.
Fortunately, in the past four or five years,
there has been significant advancement
and evolution in medications for these
chemotherapy patients — medications
with fewer side effects.”
One such medication is posaconazole.
According to a recent publication in the
New England Journal of Medicine, posaconazole has shown to be effective in treating
patients with AML-related fungal infections. It also can prevent fungal infections
in patients with prolonged neutropenia
when used prophylactically — only taking
14 patients to prevent one fungal infection. Posaconazole has also been the only
drug to have significant success at being
ON THE Cover
Dr. Thomas Weisenburger with patient
Judith Kauffman
10
10 feature
Advances in Oncology
kin cancer. They then used this model
n combination with cultured epithelial
cells to examine and test vitamin-A-like
mall molecules, called rexinoids, as
nhibitors of KLF4 both in epithelial cell
ransformation assays and in the mouse
model. Rexinoids prevented skin tumor
nitiation caused by KLF4 expression in
keratinocytes. Interestingly, although
KLF4-induced malignant transformaion can be prevented by rexinoids,
Dr. Ruppert’s laboratory showed that
everal other oncogenes were not affected
by rexinoids, identifying rexinoids as
elective inhibitors of KLF4.
“The more we learn about cancer,
he more opportunities we’ll have
o find a method of prevention,” says
Dr. Ruppert. “We tend to think in terms
of treating cancer, but in the long run,
he real impact will be the identification
New discoveries and techniques in
the field of oncology lead us closer to
determining ways in which to prevent
or delay cancer’s progression. Take a
look at groundbreaking discoveries
related to oncogenes, chemotherapyrelated infections and advances in
the management of HIV-associated
malignancies.
15
Document Management
Solutions 101
J. Michael Ruppert, M.D., Ph.D.
4
Dr. J. Michael Ruppert with researcher Dr. Lingzhi Liu in the laboratory.
effective against the very rare, but very
deadly, mucormycosis. Other drugs, such as
Neulasta (pegfilgrastim), actually improve
white blood cell counts, thereby fending off
infections from the beginning.
“Though there have been great advances
in the treatment and prevention of fungal
infections in cancer patients, it’s important
for oncologists and infection specialists
to work collaboratively when caring for
patients,” says Dr. Fisk. “Working in
conjunction with one another will maximize the potential benefits of these new
infection-fighting drugs for our patients.”
cancer PreventIon through
hIv testIng, care and research
“HIV patients are at extremely high
risk of developing a variety of cancers,
such as Kaposi’s sarcoma, non-Hodgkin’s
lymphoma and rectal cancer,” says
Dr. Fisk. “Expanded HIV testing programs and early access to HIV treatment
can significantly reduce the risk of HIVassociated malignancies by preventing
the profound immunosuppression that
comes with advanced AIDS.”
Dr. Fisk is participating in a Massachusetts
General Hospital study looking at acute
HIV infection and the initial changes it creates within the immune system.
“The hope is that by observing the
changes within the body and initiating
antiviral therapy during the earliest stages
of HIV — before standard HIV antibody
tests are positive — we can dramatically
slow the progression of HIV and learn new
targets for HIV therapy, preventing cancer
and other complications years later,” says
Dr. Fisk. n
central coast/ventura county m.d. news
october 2009 | 1
from the publisher
Welcome to the Cancer Update issue of M.D.
News Central Coast/Ventura County.
This month I am proud to feature, as our cover
subject, the Cancer Center of Santa Barbara.
I know you will find that the Cancer Center
of Santa Barbara is an amazing place, with many
compassionate and dedicated people providing
diagnosis, treatment and prevention of cancer in
the spirit of continuing advancement and understanding. It is comforting to know there is such a
wonderful place so close to home. I greatly appreciate having had the opportunity to meet so many
of the dedicated people who make the Cancer
Center of Santa Barbara such a great resource for
the Central Coast. Thank you to all of those who Your M.D. News Publisher in Auburn,
Thought of the month: “Don’t
helped make it possible to bring this story to our CA.
throw away the old bucket until you
readers.
know whether the new one holds
A special thanks to Chris, Daniella and all the water.” — Swedish proverb
staff at Surf Media for their tireless devotion in helping to bring this story to fruition.
Also included in this issue: “Evaluation of Arterial Perfusion: Is It Adequate for Wound
Healing?” By Dr. Millington; “Document Management Solutions 101” from Lynda
Shoemaker, CEO, Central Coast Record Storage, and much more.
Thanks, once again, to all of those whose talents are splashed among these pages and to
all of you for your continued support of M.D. News Central Coast/Ventura County.
Be sure to check out our new web site at http://ccvc.mdnews.com. Please forward your
comments and suggestions to me, at [email protected]. They are always welcome.
Please also show your support to our advertisers with your referrals and business. Thank you!
Health and happiness,
Central Coast/Ventura County Edition
Publisher: Loretta McCarney
Photographer: Vinit Satyavrata, Pure Light
Photography; M. Bradley Elliott
Contributing Writers: Susan Cushing, Lynda
Shoemaker, Dr. J. Thomas Millington
Chief Executive Officer: David McDonald
President: Tony Young
Chief Operating Officer: Ann Farmer
Chief Financial Officer: Webster Andrews
Executive Vice President of Business
Development: Jason Provonsha
Executive Vice President of Creative Services:
J. Kevin Tugman
Vice President of Marketing Development:
Jason Skinner
Vice President, MIS: Eric Hibbs
Managing Editor: Hillary Myers
M.D. News Founder: Robert J. Brennan
Market Development Managers:
Steve Abercrombie, Jared Barnes, Betsy Skiles
Closing Administrators: Joanna Nash, Bill Staley
Vice President of Creative Services:
Tyler Hardekopf
Design Production Manager: Tanna Kempe
Editorial Manager: Shannon Wisbon
Production Specialist Manager: Brenda Holzworth
Creative Services: Kenny Bump, Breanna Fellows,
Kristen Gantler, Amelia Gates, Lana May,
Jodi Nielsen
Controller: Grady Oakley
Financial Services: Julie Churay, Doug Condra,
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Manager of Human Resources: Carrie Hildreth
Loretta McCarney
Publisher
M.D. News is published by Sunshine Media, Inc.,
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Reproduction in whole or in part without written
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2 | central coast/ventura county m.d. news
october 2009
Printed on post-consumer recycled
paper using soy-based inks.
05-812
Evaluation of Arterial Perfusion
Is It Adequate for Wound Healing?
By Dr. J. Thomas Millington
More than 8 million Americans are
affected by peripheral arterial occlusive
disease (PAOD). The presence of PAOD
can significantly inhibit the ability of lower
extremity ulceration to heal. It has been
well established that an oxygen tension of at
least 33 mmHg is necessary for fibroblasts to
produce collagen and wound matrix, leukocytes to phagocytize bacteria, angiocytes to
produce new endothelium, etc. Clinicians
must be able to recognize wounds whose
healing potential is compromised by PAOD
if the revascularization can be undertaken
before tissue loss progresses to the point
that preservation is not an option.
Patient Evaluation
History: The presence of risk factors for
PAOD should alert the clinician to the possibility of an arterial insufficiency component
that may adversely affect wound healing.
These factors include diabetes, coronary
artery disease, hyperlipidemia, cigarette
smoking and hypertension.
Symptoms of intermittent claudication
should increase the physician’s suspicion
of PAOD. Classically, claudication pain
or cramping occurs repeatedly in the
posterior calf after walking approximately
the same distance and is relieved by rest.
Claudication pain may also occur in the
posterior thigh, buttock or hip and, rarely,
in the foot.
Ischemic rest pain occurs in an advanced disease state. This is severe pain,
typically located in the dorsal aspects
of the toes and distal forefoot. This occurs most frequently at night when the
extremities are elevated in bed. The pain
is reduced with dependency, and affected
patients will often hang their leg over the
side of the bed or get up to walk in an effort to relieve the pain.
Current wound care regimens and the
clinical response should be reviewed, as
reasonable regimens with increasing tissue loss should also alert the clinician that
a vascular etiology should be considered.
If the patient has a history of revascularization with a lack of response to treatment,
reassessment of the revascularization for
technical adequacy should be carried out.
Physical examination: Findings upon
examination include atrophic skin changes,
with thin, taut and shiny skin of the lower
extremity. Thinning or actual hair loss over
the distal third of the leg and the foot will
typically occur. The skin may be cool to the
touch, pale or even mottled, while toenails
become thick and dystrophic.
PAOD-affected extremities may display Buerger’s sign, characterized by
dependent rubor and pallor with elevation
from chronic dilatation of the vascular
bed. This sign is due to loss of vasomotor control of the microcirculation and
is seen in cases of advanced ischemia.
This indicates inadequate perfusion for
healing. It can also be seen in patients
with peripheral neuropathy who have lost
control of the microcirculation as a result
of autonomic nerve dysfunction unrelated
to ischemia. It should also not be confused
with cellulitis, which is typically associated with concomitant swelling, warmth
and tenderness.
Ischemic ulcerations tend to occur over
the distal portion of the toes or forefoot,
spontaneously at pressure points or as the
result of relatively minor trauma. They
are typically found on the dorsum of the
foot, heel and the metatarsal heads, the
tips of the toes or the bunion area. Initially
they may have irregular edges but tend
to become “punched out” in appearance
with chronicity. They are usually small
and round with smooth, well-demarcated
edges. The wound base may have pale
granulation tissue or even be a pale gray
color. The wound can be covered by white
fibrinous tissue or a dry, necrotic eschar.
Surrounding edema, inflammation and
drainage are usually minimal.
When arterial blood supply falls below
minimal tissue metabolic requirements,
dry gangrene develops. This is black with
a hard, dry texture and most frequently
occurs at the distal aspect of toes. There
is often clear demarcation between viable
and necrotic tissue. A distinctive smell of
decomposition from the affected tissue
may be present.
Peripheral pulses are diminished or
absent with PAOD. Bilateral femoral,
popliteal, posterior tibial and dorsalis
pedis pulses should be palpated and assessed for symmetry and intensity. Bruits
may be heard over the femoral arteries,
which is suggestive of occlusive disease at
or proximal to the level examined. Lower
extremity edema may interfere with an
accurate assessment of foot pulses. In
these instances, a handheld Doppler can
be used to assess the pulse quality more
accurately. Normal Doppler signal pulses
are triphasic. As arterial perfusion is
compromised, the signal becomes biphasic
and finally monophasic. Capillary refill,
another noninvasive method to assess
adequacy of arterial perfusion, involves
compressing the pad of the patient’s great
toe between the forefinger and thumb. If
the color returns to the compressed area
in three seconds or less, it is considered
normal. Longer refill times indicate
decreased perfusion.
We will continue with objective assessment of
perfusion from Dr. Millington in our November
2009 issue. n
Resource
Holtman D, Gahtn V. Peripheral Arterial Perfusion:
Is it Adequate for Wound Healing? Wounds
2008;20(8):230-235
central coast/ventura county m.d. news
october 2009 | 3
cover
story
High-Tech, High-Touch
A Legacy of Care: Cancer Center of Santa Barbara
By Susan Cushing
Built on a rich heritage of community support and cuttingedge technology, Cancer Center of Santa Barbara continues to be
in the vanguard of prevention, diagnosis and care for thousands
every year. Much like the city it serves, Cancer Center of Santa
Barbara is an incredible facility steeped in tradition as well as at
the forefront of progress.
Established some 60 years ago through a generous donation made
by local resident Elisha Converse in honor of his late wife, Lillian,
the facility has continued to grow and prosper in this same spirit
of advancing the understanding, diagnosis, treatment, cure and
prevention of cancer.
Nestled between mountains and sea, the quiet city of Santa
Barbara boasts small town “friendly” as well as big city art and culture. In much the same way, Cancer Center of Santa Barbara, while
keeping pace with some of the largest and most highly regarded
cancer research/treatment centers in the world, remains focused
primarily on the patient.
“There is a lot of dedication within this organization,” says
President Rick Scott. “Actually, 17 years ago, I inherited much of
what makes this place so special, so I feel very fortunate to have the
opportunity to be a part of all of this for so long.
“We like to say, ‘high-tech, high-touch,’ but the history of that
goes back 60 years. We have a rich history of a tremendous physician staff; right now we have physicians on staff that come to us
from Stanford, UCLA, Mayo Clinic and Harvard. Plus there’s a
real commitment by this organization to stay on the cutting edge
of technology. The most recent example of this would be our acquisition of a Novalis TX platform for image-guided radiosurgery.
That’s our 60th birthday present to the community.
Photos by Vinit Satyavrata, Pure Light Photography
Rick Scott, President, Cancer Center of Santa Barbara
4 | central coast/ventura county m.d. news
october 2009
The Novalis TX platform for image-guided radiosurgery
(IGRS) offers Cancer Center of Santa Barbara patients
fast, accurate nonsurgical treatments for cancer and
other conditions in the brain, head, neck and body. By
incorporating advanced imaging, treatment planning and
treatment delivery technologies from Varian Medical
Systems and BrainLAB, this technology enables doctors
to carry out highly precise, noninvasive IGRS procedures
quickly and with great accuracy.
IGRS involves quickly delivering precisely focused,
high-energy radiation to a localized area to destroy tumors
throughout the body that often cannot be addressed by
conventional surgery, including some malignant and benign
lesions, brain metastases, arteriovenous malformations and
other functional conditions such as trigeminal neuralgia.
“We’re very excited to bring this technology to Santa
Barbara and the Central Coast,” says Medical Director of
Radiation Oncology Thomas H. Weisenburger, M.D. “The
Novalis TX is a state-of-the-art machine that provides
capability not only for radiosurgery in the brain, but also
stereotactic body radiosurgery for lung, potentially liver
and para-spinal tumors. It provides complete radiosurgery
capabilities as well as being a very versatile machine,
allowing us to treat more standard radiation oncology
problems more efficiently and quickly, and that obviously
increases patient comfort.
“Most importantly,” he adds, “because we have this,
patients who need these types of radiosurgical techniques
will now be able to get them close to home.”
“We began 60 years ago with our benefactor providing the means
to acquire a 1-million-volt linear accelerator, which was one of only
seven in the country,” adds Scott, “and now we’re one of the first on
the West Coast to have this industry-leading technology.”
A Stellar Team
Utilizing a multidisciplinary, collaborative approach to the diagnosis and treatment of cancer, Cancer Center of Santa Barbara
takes particular pride in its ability to attract world-class doctors.
These are specialists from the world’s leading learning institutions
who bring with them not only a wealth of experience, but also the
same compassion that has been the hallmark of Cancer Center of
Santa Barbara since its inception.
Working in tandem with research, wellness and support services,
the physicians of Cancer Center of Santa Barbara are committed to
providing excellence in patient care. Guided through the diagnosis
and treatment process by an engaged and experienced group of
professionals, patients are assured a thorough understanding of
their therapy so that they might embark on their treatment course
with confidence.
Lindsay Blount, M.D.,
radiation oncology
Alan Bryce, M.D.,
hematology/medical oncology
Tammy Stockero, R.N., O.C.N., is with a patient in the infusion room.
Therapeutic services are provided in chemotherapy suites under the
care of highly skilled and compassionate nursing teams.
Nuclear Medicine
Typically, the Nuclear Medicine Department is one of the first
stops for a new patient. Nuclear medicine imaging provides a
noninvasive and usually painless evaluation of the cancer and other
medical conditions based on the biological or molecular changes of
the organ, tissue or bone.
Led by Drs. Pawan Gupta and William Pace of Nuclear Medicine
Associates, the department is comprised of highly trained technologists with over 125 years of combined experience utilizing specialized
equipment and is accredited by the Intersocietal Commission for
the Accreditation of Nuclear Medicine Laboratories.
Radiation Oncology
Recognized as one of the most sophisticated on the West Coast,
physicians from Radiation Center Medical Group Drs. Thomas
Weisenburger, Lindsay Blount, George Cheng and W. Warren Suh
lead the Department of Radiation Oncology along with a team of
highly skilled medical professionals experienced in the most advanced approaches to treatment. This quality, individualized care
continues to attract patients from the entire Central Coast.
At the helm of this vital department is Medical Director of
Radiation Oncology Thomas H. Weisenburger, M.D.
George Cheng, M.D., Ph.D.,
radiation oncology
Daniel Greenwald, M.D.,
hematology/medical oncology
Photos by M. Bradley Elliott
Transcendent Technology
The arrival of Novalis TX is just the most recent addition to
Cancer Center of Santa Barbara’s powerful arsenal of innovative
and ever-evolving technology. With three superbly staffed medical
departments, each is ever vigilant, acutely aware of the newest,
most effective therapy and technology.
“Our nuclear medicine department was one of the first in
California to have a dedicated PET scanner, and well before its time,”
Scott points out. “Our commitment to remaining at the forefront
of cancer care means that the Cancer Center will continue to carefully evaluate new technology and upgrade or add equipment which
holds significant promise.”
In addition to the recently acquired Novalis TX, emerging
technology at Cancer Center of Santa Barbara includes intensitymodulated radiation therapy, image-guided radiation therapy,
positron emission tomography (PET), PET/computed tomography
(CT), PET mammography, gamma cameras and dynamic-single
photon emission CT cardiac imaging.
central coast/ventura county m.d. news
october 2009 | 5
later still striving to stay on the front lines of radiation oncology
treatment delivery.”
Photo by Vinit Satyavrata, Pure Light Photography
Hematology/Oncology
Another step along the collaborative treatment path is with the
Hematology/Oncology Department focusing on both blood disorders and cancer treatment.
Under the direction of Santa Barbara Hematology Oncology
Medical Group physicians Drs. Fred Kass, Tom Woliver, Donna
Walker, Dan Greenwald and Alan Bryce, patients receive expert
care with treatment plans designed for the specific medical, psychological, social and logistical needs of each person.
“With the arrival of our newest medical oncologists, Drs. Dan
Greenwald and Alan Bryce, we are proud to offer incredible expertise in the areas of lymphoma and myeloma,” says Dr. Kass.
Always on the leading edge of innovation, medical oncology at
Cancer Center of Santa Barbara features targeted therapy. This
personalized treatment regimen is based on the molecular and genomic features of the individual’s tumor. One of the most impressive
outcomes of this program is the effective treatment of the cancer.
“Ultimately, the real mission has to be the nuts and bolts of
providing topnotch care,” explains Dr. Kass. “But the fun part of
our job is knowing that we’re part of an entity that has been able to
redefine the scope of cancer care and dramatically broaden what
both doctors and patients should consider an integral part of healing.”
Therapeutic services are provided in chemotherapy suites under
the care of highly skilled and compassionate nursing teams. Cristine
Fernandez, physician assistant, complements the teams.
Clinical Research Coordinator, Alexis Langston-Cooper
“I’ve had the privilege of being part of this incredible center for
nearly 25 years,” says Dr. Weisenburger, “and continue to be impressed with the degree of dedication to our mission statement by
every member of this team.
“The Cancer Center started 60 years ago with the dream of
Dr. Henry Ullmann, Lillian Converse’s physician, who wanted to
buy the latest equipment, and here we are more than a half-century
Fred Kass, M.D.,
hematology/medical oncology
Photos by M. Bradley Elliott
Pawan Gupta, M.D.,
nuclear medicine
6 | central coast/ventura county m.d. news
october 2009
Pushing the Envelope — Saving Lives
Hope is the life vest we all cling to, whether dealing with cancer
or any other life-threatening event. And while every component
of Cancer Center of Santa Barbara is focused on providing services
that foster that hope, perhaps one of the most aggressive is research.
Cancer Center of Santa Barbara’s research program, under the
direction of Dr. Kass, supports advances in the fight against cancer, posing the question, “What if?” Tirelessly, they explore new
possibilities through three primary areas of involvement: clinical
William Pace, M.D.,
nuclear medicine
W. Warren Suh, M.D., M.P.H.,
radiation oncology
Photo by M. Bradley Elliott
research, basic science research and education.
From molecular level research in the laboratory, to new drug
therapies in the clinic, to educational programming that reports
on the latest findings in cancer research, Cancer Center of Santa
Barbara is on par with the best facilities in the world.
As part of a strong research and trials network, Cancer Center
of Santa Barbara has participated in more than 230 clinical trials to
date, partnering with national cooperative groups, private research
networks such as UCLA’s Translational Oncology Research Institute
and major pharmaceutical and biotech companies.
“We truly are ‘fighting the good fight,’” observes Research
Manager Barbara Conviser, M.P.H. “If you want to talk about the
war on cancer, the front line is clinical research! Because without
being able to test new agents in humans, we cannot move forward.
“Of course, we actively support all research,” she clarifies.
“While basic research is not what we do here at the Cancer Center,
we partner with the University of California – Santa Barbara by
providing grants from our research endowment fund to facilitate
and foster that work.”
Focused on Cancer — Centered on You
It’s more than a clever marketing slogan; these words are at the
Photos by M. Bradley Elliott
Donna Walker, M.D.,
hematology/medical oncology
Thomas Weisenburger, M.D.,
radiation oncology
Photo by Vinit Satyavrata, Pure Light Photography
Nutrition, exercise and other Wellness Programs have become a
major component of Cancer Center of Santa Barbara’s mission.
Wellness Program
heart of what makes Cancer Center of Santa Barbara so unique.
“Treating the whole person is integral to our success,” Scott
points out. “There’s so much more to oncology care than just
technology. Of course, the best treatment is important to us, but
we also understand that it’s a journey — a journey where we serve
as guides. A cancer diagnosis impacts every aspect of a patient’s life
and that of their family. Our comprehensive approach addresses
not only the immediate medical care with superb doctors,
Thomas Woliver, M.D.,
innovative research and evolvhematology/medical Oncology
ing technology, but also their
emotional, psychological and
even financial needs.”
Two essent ia l components to this philosophy are
the Wellness and Support
Services departments.
Wellness
Nearing two decades of affiliation with Cancer Center
of Santa Barbara, Dr. Kass
has served in various capacities, including his dual roles as
central coast/ventura county m.d. news
october 2009 | 7
complementary medicine services such as yoga, exercise, nutrition,
art therapy and healing touch.”
“We know that finding answers to cancer-related questions can
be overwhelming,” Brown acknowledges. “Our multimedia Cancer
Resource Library, staffed by trained professionals, is a unique,
one-stop shop for patients, their family members and health care
professionals to find the support, answers and resources they need.”
Other critical components include cancer education, prevention
and community outreach. Cancer Center of Santa Barbara’s outreach
programs, which serve over 1,400 community members annually,
are primarily focused on, but not limited to, the early detection and
prevention of colon and skin cancer.
Photo by M. Bradley Elliott
Support Services
“Obviously, cancer impacts lives in a multitude of ways,” notes
Support Services Manager Mary Solis, L.C.S.W. “We are here to
offer emotional and practical support for patients, their families
and their friends.”
Solis and her team do this through a variety of grounded programs, including support groups and counseling that have grown
out of the day-to-day needs of their patients.
Solis, who was recently honored as the National Oncology Social
Worker of the year in Washington, DC, says some of the most
successful programs were inspired by patients she’s worked with.
“These support services are offered at no charge to anyone in
our community who is touched by cancer, not just Cancer Center
patients,” she explains.
Peggy Gayda, RT (T), Radiation Therapist. Heart felt dedication
is the essence of the Cancer Center of Santa Barbara
hematologist/oncologist as well as Medical Director of Research
and Wellness.
“Nutrition, exercise and other wellness programs have really become such major components of the Cancer Center’s mission,” says
Dr. Kass. “And I get the pleasure of being involved and developing
those kinds of programs, which is an aspect of my job I truly love.
“The Wellness Program has had such a profound impact on patients
with cancer,” he continues. “I think it’s important to note that the program was created in part through the inspiration of a patient of mine
who, through her battles with cancer, created the Cancer Well-Fit
Program for patients undergoing cancer treatments. Not only has this
understandably had a tremendous impact on patients, helping them stay
healthy through the rigors of treatment, but it’s also influenced doctors
in our perception of how to keep patients healthy during therapy.”
Christine Brown, M.S., R.D., who has served as the Wellness
Manager for more than 10 years, is committed to helping those
living with cancer optimize their wellness by achieving a calmer
mind, a healthier body, a strengthened immune system and a
renewed capacity to cope.
“This piece of the puzzle, if you will, is just as critical as any other
component here at the Cancer Center,” says Brown. “What ‘wellness’ provides is a sense of empowerment. Wellness is something
patients can choose to do for themselves to enhance their health
and recovery. This includes a wide range of activities, classes and
8 | central coast/ventura county m.d. news
october 2009
Heartfelt Dedication
“The essence of the Cancer Center of Santa Barbara is its big
heart,” says Scott. “When you come to work every day and focus
on the patient, it makes it a wonderful job. But that big heart also
refers to this community, which has continued to generously support and grow this facility.”
Director of Development Art Merovick agrees. “Talking to people
about the cause of the Cancer Center is not a difficult job,” he says.
“In fact, I am often amazed at the compassion and generosity of those
who contribute to ensure the Cancer Center goes on providing this
caliber of cancer care. I think it’s an expression of confidence in
amazing physicians, Rick and our entire team, and we will make
sure we live up to that.”
Cancer Center of Santa Barbara is a nonprofit cancer diagnostic and
treatment center that remains
the only institution in Santa
Barbara with a longstanding,
reliable commitment to cancer
care for everyone in its community, regardless of their ability
to pay. Cancer Center of Santa
Barbara is located at 300 West
Pueblo Street, Santa Barbara,
CA 93105. For more information
please call (805) 682-7300 or
visit www.ccsb.org. n
current topics
The Importance of a Sick Day Policy
When a physician becomes ill, taking a
sick day can make it difficult for office staff
to manage the patient load. Here are some
things to consider when instituting a sick
day policy.
Whether the physician is part of a solo
or multiphysician practice, having a sick
day policy in place can help ensure things
run smoothly when a physician is out of
the office. A successful policy can lessen
the amount of appointments a physician
may need to catch up on when he or she
returns to work.
Assessing Appointments
When a physician is unavailable to come
in, it’s important to scan the list of patient appointments and determine which
patients can wait, who needs immediate
attention and who can be seen by a midlevel health care professional such as a nurse
practitioner or physician’s assistant. For
example, if the patient has a long history
and is coming in for a regular checkup to
discuss multiple issues, it would probably
be best for this person’s appointment to be
rescheduled since the physician is familiar
with the patient’s history. On the other
hand, a patient needing acute care for a
minor illness could easily be seen by a
midlevel professional.
If the physician is unable to assist in determining the urgency of the patient case load,
a nurse practitioner or physician’s assistant
can also help determine which patients
need to be seen as soon as possible. Using
midlevel staff members can help reduce the
number of patients that need to be rescheduled for when the physician returns.
On occasion, there might be early appointments that cannot be cancelled ahead
of time; a physician might have to come in
for an hour to handle these appointments
before taking the rest of the day off.
Staff Support
Once the appointments have been
and cannot be seen by their regular
physician, patients can utilize other options, such as going to a walk-in clinic or
the emergency room.
sorted, it is vital that all available staff
members make calls to cancel or reschedule patients as soon as possible.
It’s also important to be upfront with
patients about the situation. Patients
will be much more understanding
about office wait times and rescheduling their appointments if they are
properly informed.
Some solo practitioners may find it
beneficial to work out an agreement with
neighboring physicians where they may
cover each other’s patients in times of
emergencies or sick days. In these cases
however, caution and mutual respect for
the other’s practice should be utilized as
imposing several unscheduled patients on
another practice could result in problems
for both practices.
If patients need immediate care
Compensating Time Off
Finally, as part of a sick day policy,
physicians need to address how their
time off will be compensated, as well
as how the physician’s unmet duties will
be handled. This is especially important
in multiphysician practices. Each group
practice’s policy should determine if a
physician will make up his or her on-call
hours with the person that managed
his or her patients or if the physician
is relieved of those appointments. This
will also be dependent on whether
the physician is paid via salary or fee
for service. n
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w w w. t r a c y z w e i g . c o m
central coast/ventura county m.d. news
october 2009 | 9
Oncology
Advances in
N
ew discoveries and techniques
in the field of oncology lead us
closer to determining ways in
which to prevent or delay cancer’s progression. In this article, we take a look
at groundbreaking discoveries related to
oncogenes, chemotherapy-related infections and advances in the management of
HIV-associated malignancies.
According to the American Cancer
Society (ACS), over the past 15 years, cancerrelated mortality has declined by anywhere
from 1% to 2% per year. This translates to
approximately 650,000 deaths that have been
prevented or delayed, thanks to continuous
research and new advances in treatment. In
this feature, M.D. News examines some of the
latest breakthroughs in cancer research.
IdentIfIcatIon and
PreventIon: KLf4
A professor of biochemistry, J. Michael
Ruppert, M.D., Ph.D., at West Virginia
University’s Mary Babb Randolph Cancer
Center, has been working for more than
10 years on the role of the KLF4 gene in
tumors such as breast cancer. In 1999,
Dr. Ruppert and his team further developed
a technique known as expression cloning, describing the first use of epithelial
cells — the cell type of origin of common
adult cancers such as breast cancer — as a
host for expression cloning. Their research
discovered and identified KLF4/GKLF as a
novel oncogene.
1 0 | central coast/ventura county m.d. news
“With expression cloning, you’re expressing genes in a cell and asking the cell to
tell you which genes may cause cancer in human cells,” says Dr. Ruppert. “Through this
process, we were able to identify KLF4/
GKLF as an oncogene. Now we have gone
from identifying KLF4 as an oncogene to
studying the mechanism of transformation
in the lab, in order to potentially identify
new prevention or treatment strategies.”
from then to now
A decade later, the Dr. Ruppert laboratory continues to study the KLF4 pathway
as it relates to prevention of tumor initiation
and malignant transformation.
“Genes such as KLF4 represent busy
signaling intersections, with many different
pathways and cellular processes impacting
KLF4 and vice versa. Since 1999, we’ve
gone on to show that the KLF4 is regulated
in most human breast cancers,” explains
Dr. Ruppert. “It appears to predict outcomes in patients with breast cancer as a
single biomarker prognostic. Eventually, it
may be used alone or in combination with
other biomarkers to identify cancers that
are more or less aggressive, or to predict
a better therapy. Since some patients may
actually be overtreated, markers like KLF4
can be employed to sort out patients that
need more or less aggressive therapy.”
After showing KLF4 was regulated in
breast cancer, Dr. Ruppert and his team
developed a rapid-onset mouse model of
october 2009
skin cancer. They then used this model
in combination with cultured epithelial
cells to examine and test vitamin-A-like
small molecules, called rexinoids, as
inhibitors of KLF4 both in epithelial cell
transformation assays and in the mouse
model. Rexinoids prevented skin tumor
initiation caused by KLF4 expression in
keratinocytes. Interestingly, although
KLF4-induced malignant transformation can be prevented by rexinoids,
Dr. Ruppert’s laboratory showed that
several other oncogenes were not affected
by rexinoids, identifying rexinoids as
selective inhibitors of KLF4.
“The more we learn about cancer,
the more opportunities we’ll have
to find a method of prevention,” says
Dr. Ruppert. “We tend to think in terms
of treating cancer, but in the long run,
the real impact will be the identification
J. Michael Ruppert, M.D., Ph.D.
of pathways that lead to the cancer, and
finding effective ways to prevent it. That’s
what we’re really trying to do: find small
molecules, like rexinoids, that have few
or no side effects. We can potentially give
such drugs to healthy individuals to help
prevent cancers.”
treatIng
chemo-reLated InfectIons
Patients undergoing chemotherapy are at
high risk for contracting infections, which
can range from uncomfortable to fatal.
“ I n recent
years, there has
been a shift in
the field of cancer t reat ment
to higher rates
of f u n g a l i n fections,” says
David Fisk,
David Fisk, M.D.
M.D., infectious
disease specialist at Sansum Clinic in Santa Barbara,
CA, and clinical assistant professor at
the University of Southern California
Department of Medicine. “For example,
when patients receive chemo for acute
myeloid leukemia [AML], their risk of
fungal infections becomes very high.
These invasive fungal infections, such
as aspergillus, are an increasing cause of
morbidity and fatality for many patients.
Fortunately, in the past four or five years,
there has been significant advancement
and evolution in medications for these
chemotherapy patients — medications
with fewer side effects.”
One such medication is posaconazole.
According to a recent publication in the
New England Journal of Medicine, posaconazole has shown to be effective in treating
patients with AML-related fungal infections. It also can prevent fungal infections
in patients with prolonged neutropenia
when used prophylactically — only taking
14 patients to prevent one fungal infection. Posaconazole has also been the only
drug to have significant success at being
Dr. J. Michael Ruppert with researcher Dr. Lingzhi Liu in the laboratory.
effective against the very rare, but very
deadly, mucormycosis. Other drugs, such as
Neulasta (pegfilgrastim), actually improve
white blood cell counts, thereby fending off
infections from the beginning.
“Though there have been great advances
in the treatment and prevention of fungal
infections in cancer patients, it’s important
for oncologists and infection specialists
to work collaboratively when caring for
patients,” says Dr. Fisk. “Working in
conjunction with one another will maximize the potential benefits of these new
infection-fighting drugs for our patients.”
cancer PreventIon through
hIv testIng, care and research
“HIV patients are at extremely high
risk of developing a variety of cancers,
such as Kaposi’s sarcoma, non-Hodgkin’s
lymphoma and rectal cancer,” says
Dr. Fisk. “Expanded HIV testing programs and early access to HIV treatment
can significantly reduce the risk of HIVassociated malignancies by preventing
the profound immunosuppression that
comes with advanced AIDS.”
Dr. Fisk is participating in a Massachusetts
General Hospital study looking at acute
HIV infection and the initial changes it creates within the immune system.
“The hope is that by observing the
changes within the body and initiating
antiviral therapy during the earliest stages
of HIV — before standard HIV antibody
tests are positive — we can dramatically
slow the progression of HIV and learn new
targets for HIV therapy, preventing cancer
and other complications years later,” says
Dr. Fisk. n
central coast/ventura county m.d. news
october 2009 | 11
hospital rounds
Arroyo Grande Community
Hospital News
AGCH Five-Year Anniversary
Celebration
Arroyo Grande Community Hospital
(AGCH) will be hosting its five-year anniversary celebration at the hospital on
October 2, 2009, from 11 a.m. to 2 p.m.
For more information, please visit www.
arroyograndehospital.com and click on
“AGCH 5 year celebration.”
AGCH Annual Health Fair
AGCH will hold its annual Health Fair
Saturday, October 24 from 9 a.m. to 1 p.m.,
in front of the hospital. Featured will be a
farmer’s market of locally grown produce
and Eufloria roses.
Booths will offer information about the
services offered by the hospital as well as
other nonprofit health care agencies. Also
represented will be the city’s fire department, San Luis Ambulance, DARE program
with AGPD, low-cost blood tests (full lipid
panel), skin cancer screenings, flu shots and
much more.
For details, contact Anna Scott at (805)
473-7695.
AGCH Free Senior Health
Education Events
AGCH is offering several free senior health
education events. The first, a Senior Healthy
Life Style Luncheon, will be held October
22, 2009, at noon in the AGCH Annex A.
Information will be presented about Medicare
“D” with Napoleon Ruiz of HICAP and their
new Congestive Heart Failure program with
Jean Raymond, R.N.
The next two events will be held at 12
noon on Tuesday, November 17, 2009, and
Thursday, December 10, 2009. Space is limited. Reservations are required.
To reserve your seat, call AGCH Community
Educator Roberta Alderete at (805) 473-7662.
New Radiologist Joins
Staff at CMH Breast
Center
Radiologist Kristina Jong has joined the
Community Imaging Medical Group at
Community Memorial Hospital (CMH),
where she will concentrate her practice on
breast imagining and further development
of the breast MRI program.
Dr. Jong will work alongside Wook Chong,
M.D., and Priscilla Wong, M.D., to create
a team of board-certified experts in breast
imaging at the Breast Center of CMH — the
only comprehensive breast center in West
Ventura County.
Dr. Jong earned her medical degree at the
University of California–Davis in 2001, and
completed a diagnostic radiology residency
at Santa Barbara
Cottage Hospital
in 2006. She then
pursued specialized
training in breast
imaging (including Breast MRI) at
Stanford University.
After finishing her
Breast Imaging fel- Dr. Kristina Jong
lowship, she joined
the staff at Stanford Hospital and Clinics as an
assistant clinical professor. She has since relocated to the Santa Barbara area, but remains
on the adjunct clinical faculty at Stanford.
Community Imaging Medical Group offers
outpatient and inpatient diagnostic imaging and
procedures, including MRI, computed tomography, ultrasound and radiography. To reach their
department or the Breast Center at CMH, call
(805) 652-5011.
French Hospital Medical
Center News
FHMC Volunteer Guild
Awards Scholarships
The French Hospital Medical Center
(FHMC) Volunteer Guild is proud to award
three scholarships to students pursuing careers in nursing. Tara Cochran, Hanna Smith
and Jennifer Watson, currently second-year
nursing students at Cuesta College, were all
awarded $500 to help further their education.
The Volunteer Guild selected the recipients
based on their remarkable academic standing
and a personal essay detailing how the scholarship would aid their education and help them
pursue a career as a nurse. The Volunteer Guild
hopes that the students receiving the aid will
consider working for FHMC after graduation.
The FHMC Volunteer Guild is a charitable
organization comprised of 82 hospital volunteers. The Volunteer Guild operates the FHMC
gift shop and participates in book sales to raise
money for donations to FHMC and the local
community. Recently, the Volunteer Guild
has donated money to hospital renovations in
the lobby, surgery waiting room and chapel.
For more information on the Volunteer Guild or to
become a volunteer, visit www.frenchmedicalcenter.org.
FHMC Patient
Advisory Council
F H MC is proud to announce the
1 2 | central coast/ventura county m.d. news
october 2009
hospital rounds
development of the Patient Advisory Council
(PAC). The objective of the PAC is to create
an environment where patients and providers
can openly discuss the barriers and opportunities for a higher quality of patient care
and develop better programs in the hospital.
The PAC is a cooperation of patients
and staff and is currently focusing on the
Outpatient Radiology Department. It recently held its first meeting and will meet once a
month for five months to develop a strategy
to increase patient satisfaction. The PAC will
then move their focus to other programs at
FHMC and will develop tactics and tools to
foster a more positive patient experience.
The PAC at FHMC is comprised of eight
members, three former patients from the
community, Father Russell Brown from the
Mission De Telosa, Steven Goodman, M.D.,
Lisa Adams, R.N., Radiology Manager Greg
Blishak and FHMC Director of Profession
Services Ken Hritz.
All 41 Catholic Healthcare West (CHW)
Hospitals have started a PAC in the past month.
CHW hopes that collaboration between
patients and staff will create programs with
utility and a better overall patient experience.
For more information on the FHMC PAC, contact Ken Hritz at (805) 542-6300 or visit www.
frenchmedicalcenter.org.
Marian Employees Donate
More Than 165 Backpacks
to Local School Districts
To ensure every child has a good start
this school year, Marian Medical Center
employees have again generously given to
support Marian’s third annual Pack to School
Backpack Program. Employees surpassed
this year’s goal, donating more than 165
backpacks filled with school supplies. Some
departments such as Marian Home Care and
Hospice rallied co-workers to the cause,
setting a department record by contributing
more than 45 backpacks to the program.
“The Pack to School Backpack program
has grown in popularity over the years, and
our employees say it’s one of their favorite
community outreach programs,” says Jean
Sysak, R.N., 2North-Telemetry Director
Jean Sysak, R.N., 2North-Telemetry
Director and committee chair for the
Pack to School Backpack Program, and
Anthony Taylor, Marian’s Assistant Food
Services Director, standing within all of the
backpacks donated by Marian employees.
and committee Chair for the Pack to School
Backpack Program. “With more than 165
backpacks donated, there is no question that
Marian employees are committed to supporting our local schools.”
Partnering with Marian in the backpack
Coastal Radiation Oncology
Medical Group
Coastal Radiation Oncology Group’s network of radiation
oncology centers offers advanced treatment options for cancer
patients in San Luis Obispo, Santa Barbara, and Ventura Counties,
including Intensity-Modulated Radiation Therapy (IMRT) and
Image-Guided Radiation Therapy (IGRT), integrated with leading
treatment planning software. Our board certified physicians provide
expert, compassionate care, and we are dedicated to providing
state-of-the-art cancer treatment options delivered in an
atmosphere of openness, honesty, caring, and emotional support
by a team of clinical experts.
San Luis Radiation
Oncology Center
100 Casa Street, Suite C
San Luis Obispo, CA 93405
(805) 541-1932
Jonathan R. Stella, M.D.
Jeffrey S. Gilroy, M.D.
www.sanluisradiation.com
Santa Maria Radiation
Oncology Center
314 S. Stratford Ave.
Santa Maria, CA 93454
Phone: (805) 925-2529
Sheri Marquez, M.D.
Case Ketting, M.D.
www.santamariaradiation.com
www.coastalradiationoncology.com
Cabrillo Radiation
Oncology Center
2841 Cabrillo Drive
Ventura, CA 93003
Phone: (805) 648-5191
Thomas D. Fogel, M.D.
Jeffrey M. Rodnick, M.D.
www.cabrilloradiation.com
Templeton Radiation
Oncology Center
274 Heather Court, Suite A
Templeton, CA 93465
(805) 434-1859
James E. Longo, M.D.
www.templetonradiation.com
State of the Art Technology
for Quality Cancer Care
central coast/ventura county m.d. news
october 2009 | 13
hospital rounds
program are Cuyama Joint Unified School
District, Guadalupe Union School District,
Orcutt Union School District and Santa
Maria-Bonita School District. On Tuesday,
August 25, representatives from the local school districts delivered the donated
backpacks and supplies from Marian to their
appropriate locations.
The Pack to School Backpack program
is one of many community outreach programs sponsored by Marian’s Philosophy
Enhancement Committee, an employee
group dedicated to serving employee’s needs
and those of the community.
For more information about Marian’s Pack to
School Backpack Program, please call Marian
Communications at (805) 739-3580. For more
information about Marian Medical Center or
Catholic Healthcare West, visit www.marianmedicalcenter.org.
Sierra Vista Regional
Medical Center News
Sierra Vista Regional
Medical Center Hosts
‘Topping Off Ceremony’
Sierra Vista CEO Candy Markwith (right)
autographs the final steel beam along with
SLO County Supervisor James Patterson.
Hospital administrators, local dignitaries
and the work crews all autographed the final
steel beam before it was lifted into place.
Sierra Vista Regional Medical Center
hosted a “Topping Off Ceremony” to commemorate the placement of the final steel
beam in its new $12 million, 45,000-squarefoot medical office building. The Sierra Vista
Medical Office Building will be substantially
completed by the end of the year with physicians expected to move in by February 2010.
When completed, the building, which is approximately 50% preleased, will house about
20 physician offices.
With Sierra Vista’s commitment to employ
local labor whenever possible, the construction
1 4 | central coast/ventura county m.d. news
has created about local 70 local jobs since last
May. The steel was fabricated and supplied by
Templeton Steel of Paso Robles.
The “topping off” ceremony is a long-held
tradition when erecting a steel structure. The
final steel beam is autographed by the work
crews and hospital administration and then
hoisted into place. The builder, R.L. Shaw,
also has a long-held tradition that originated
years ago by Scandinavians who believed their
god lived in trees. Early Scandinavians would
place the top-most branches of trees that were
cut for lumber atop their completed buildings.
They believed this prevented incurring the
wrath of both their gods and the souls of men,
since man’s soul was believed to originate in
trees and return to them.
For the Sierra Vista Medical Office Building,
a tree was affixed to the last steel beam and
hoisted up with it. Once in place, the tree was
taken down to the ground to be planted in the
building’s landscaping when it’s complete.
Sierra Vista Regional
Medical Center Receives
ACR Accreditation
Sierra Vista Regional Medical Center is the
only hospital in San Luis Obispo County that
has been awarded a three-year term of accreditation in ultrasound, breast ultrasound and
computed tomography as the result of a recent
survey by the American College of Radiology.
The accreditation gives assurance to patients
that hospital staff and equipment have passed
rigorous evaluation and demonstrates the
hospital’s commitment to quality patient care.
The ACR awards accreditation to facilities
for the achievement of high practice standards
after a peer-review evaluation. Evaluations are
conducted by board-certified physicians and
medical physicists who are experts in the field.
They assess the qualifications of the personnel
and the adequacy of the facility equipment.
The surveyors report their findings to the
ACR’s Committee on Accreditation, which
then provides the facility with a comprehensive report on its practices.
The ACR is a national organization serving more
october 2009
than 32,000 diagnostic and interventional radiologists, radiation oncologists and nuclear medicine
and medical physicists with programs focusing
on the practice of medical imaging and radiation
oncology and the delivery of comprehensive health
care services.
For more information about Sierra Vista Regional
Medical Center, visit www.sierravistaregional.com.
Twin Cities Community
Hospital Welcomes New
Chief Nursing Officer
Paula Moore
Twin Cities Community Hospital welcomes Ms. Paula Moore, who has accepted
the role of Chief
Nursing Officer.
Pau la comes to
Twin Cities from
450-bed Doctors
Medical Center in
Modesto, where
she served most
recently as the assistant chief nursing Paula Moore
officer. Paula brings
with her 20 years of progressive nursing
and leadership experience that also includes serving as Doctors Hospital’s Chief
quality officer, accreditation and compliance officer and director of the McHenry
Surgery Center.
“Paula brings extensive leadership experience and enthusiasm for assuring Twin Cities
excels at providing quality care and service
to our patients,” says Rick Lyons, Chief
Executive Officer for Twin Cities.
“The Twin Cities medical staff and our
patients depend on excellence in nursing care.
We believe Paula Moore is a visionary leader
who will work closely with our medical staff
to provide quality nursing care and extraordinary patient service,” says Chief of Staff Mark
Kowall, M.D.
Paula obtained her Bachelor of Nursing
degree from the University of San Francisco
and is currently completing her Master of
Nursing and Healthcare Systems Management
at Loyola University–New Orleans. Paula
is also a member of the Association of
California Nurse Leaders and the American
Organization of Nurse Executives.
To learn more about Twin Cities Hospital, visit
www.twincitieshospital.com. n
Document Management Solutions 101
Designing and Implementing Your Records Management Manual
By Lynda Shoemaker, C.E.O. Central Coast Record Storage, Inc.
A records management manual is the key
element necessary in organizing and maintaining your records in a defined, consistent
and repeatable manner throughout your
company. The goals of records management
and retention are the same, irrespective of the
type of company or business you operate. All
businesses have the same basic categories of
documents: administrative, financial, operational and industry specific. The goals should
be focused on three main areas:
•All records are easily identifiable by type
and content.
•All records are easily located and available
when needed.
•All records are maintained, purged and
destroyed in a consistent and accountable
manner.
The records management manual is divided
into sections that individually address each of
these goals. Because records management is
constantly evolving and changing as new laws
and updated methods are implemented, you
will need a format that allows for the addition
of new documents and removal of the outdated documents. The best format is a three-ring
binder clearly divided into sections.
Section one would include your policies
and procedures, department responsibilities
and chain of command. Section two should
be devoted to the record retention schedule.
Section three should include instructions
for document maintenance scheduling and
necessary transmittal forms and a list records
placed in storage. The maintenance schedule
should include daily, weekly, monthly and
semi-annual or annual activities. Section
four should include instructions for certified
destruction and applicable transmittal and
authorization forms, as well as a listing of records destroyed (including destruction date).
A fifth section could be added that would
contain department-specific communications and updates. However, this should not
be a catch-all section, and should be cleared
on a regular basis as superseding documents
are available.
Establishing a Routine
Maintenance Schedule
A routine schedule, clearly defined and
functional for your working environment,
sounds like an easy task. Establishing the
schedule is easy — following the schedule is
not! We all wish that there was enough time
in the day to accomplish assigned activities,
but in today’s multitasking environment,
time runs out and we find ourselves with
stacks of paper still staring at us at the end
of the day. File maintenance is the last thing
we want to think about. But following a
schedule will actually allow you work more
efficiently and, in most cases, reduce the
amount of records retained.
Focus on the life cycle of the records that
are compiled: The “document” is the original paperwork; related documents become
the “working” files; related working files are
combined with the “active” files; and related
active files become the final “record.” Your
maintenance schedule should reflect each
cycle.
The daily schedule involves document
maintenance. Ideally, this is an ongoing
process throughout the day. You receive
a document, decide the action necessary
— immediate action, end of week, end of
month, etc. — and place in the appropriate
file. Working files may be more generic in
nature than the files that become the final
record. Examples of working files would
be correspondence, invoices, patient reports and pending action. (A “file” is not
a stack on your desk!) If necessary, take a
few minutes at the end of the day to file
your documents. If you file temporary correspondence, memos and reference notes
in the file, these can be addressed in the
weekly maintenance.
The weekly schedule involves file maintenance. At the end of the week, working files
should be reviewed and moved to active files.
Those documents would be moved to the pertinent active file. Non-essential documents
such as duplicates, reminder notes, etc.,
should be discarded for recycling or shredding
based on the level of confidentiality.
The monthly schedule involves moving
central coast/ventura county m.d. news
october 2009 | 15
active files to the final record. The final
record should reflect the category and
assigned retention period based on your
retention schedule. At this point, all duplicate, redundant or non-essential documents
should be removed. Depending on space
allocation, the records may be stored in file
cabinets or boxes. Records with ongoing
activity should remain in file cabinets, while
completed projects with no anticipated
additions can be boxed. Boxes should be
clearly and concisely labeled according to
record category, sub-category, date and/or
alpha range and retention period.
Semi-annual or annual scheduling will
depend on the size of your facility and
storage space. On-site storage should be
reserved for records that need to be accessed on a routine or ongoing basis. A large
clinic or medical practice may find it necessary to move records off site on a quarterly
or bimonthly basis, whereas a small office
may purge on an annual basis. With any
schedule, the process is two-fold: moving
from on-site to off-site storage and destroying outdated records. While most offices
have a method of storing their records, the
destruction phase is often overlooked. We
lapse into the “out of sight, out of mind”
mode. Retention of outdated records is not
only costly, but it could impact your business if legal discovery issues arise.
Each step of the maintenance schedule will
keep your office focused on the goals of record management: maintaining records that
are identifiable, accessible and destroyed in a
consistent and accountable manner.
If you would like information on how Central
Coast Record Storage, Inc. can assist your office with
the development of a records management program
or to schedule a free on-site consultation, contact
us at (805) 227-4700. If there are topics relating
to document management that you would like to see
addressed in this column, we would welcome those
suggestions and requests. Please e-mail them to me
at [email protected]. n
advertisers’ index
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J. Thomas
Millington, MD... Inside Front Cover
Mission Linen
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Pueblo Radiology Medical Group....16
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Radiology
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Tracy Zweig Associates Inc..............9
Wallace Home Medical
Supplies............. Inside Front Cover
1 6 | central coast/ventura county m.d. news
october 2009
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