august 19-september 1, 2014 section b
DESCRIPTION
The Business Journal presents its Health Care Quarterly and a focus on women in business.TRANSCRIPT
An organ is delivered to an operating roomwhere surgeons are to perform a life-changing procedure on a recipient selectedby matching blood type, the amount of timethe patient has waited for the organ and theseverity of illness, among other factors.More than 123,000 people are waiting fororgan transplants across the United States.According to the nonprofit, OneLegacy, thefederally designated organ procurementorganization for Southern California, anaverage of 18 patients die every day wait-ing for organ transplants. (Photograph byLife Connection Of Ohio)
Health Care Quarterly
Health Care Quarterly
Inside This Issue• Organ Transplants• The ACA And Emergency Rooms• Improvements To Pediatric Services• News In Brief
1_LBBJ_August19_SectionB_LBBJ MASTER LAYOUT 8/17/14 3:28 PM Page 1
HEALTH CARE QUARTERLY2-B Long Beach Business Journal August 19-September 1, 2014
� By SAMANTHA MEHLINGER
Senior Writer
M ore than 123,000 people in
the United States are waiting
for organ transplants.
Californians make up nearly a fifth of this
figure, with almost 22,000 people on the
national organ transplant waiting list as of
August 8. With that list continually grow-
ing, doctors and nonprofit organ procure-
ment organizations are working regionally
and nationwide to increase organ donations
and decrease deaths among patients who
had to wait too long for transplants.
Most patients on the national waiting list
need kidney transplants, and more than
18,000 of those people are in California,
where the wait time for kidneys is longer
than in any other state, according to Tom
Mone, CEO of OneLegacy, the nonprofit
organ procurement organization selected
by the federal government to oversee organ
donations in the Southern California
seven-county metropolitan region. The
organization serves 19.5 million people –
the largest donation service area in the
country, Mone said.
The wait time for kidneys in California
is between five to 10 years, according to
Mone. “One [reason] is that we have large
urban areas, and large urban areas tend to
have a lot of diseases that are related to
lower incomes such as diabetes and
dietary issues,” he said of the cause for the
state’s long wait time.
“The top causes of renal [kidney] disease
are high blood pressure and diabetes, and as
those become more common and as people
are living longer, the need for transplants
increases,” Dr. Raj Mittal, general and liver
surgeon at Lakewood Medical Center, told
the Business Journal. These diseases are
often caused by lifestyle habits such as poor
nutrition or overeating, he explained.
Another cause for California’s long wait
time for kidneys is simply that Californians
live longer than people in other states, which
means less opportunities for after-death
organ donations, Mone said, citing data
from the California Department of Health
Services and the Center for Disease Control.
“The death rate in California is about a third
lower than the rest of the country,” he noted.
Currently, about 75 percent of people
who are eligible to donate at the time of
their deaths do so, but even if 100 percent
of people in California donated at death
there still would not be enough organs to
go around, Mone said.
People who need kidney transplants are
able to wait for longer periods of time for
transplants than those who need other
organs because renal disease may be
treated with dialysis, a process through
which a machine performs the function of
kidneys by cleaning harmful waste from
blood. Still, long wait times are detrimen-
tal for these patients. “You can imagine if
you are waiting for eight years for a kidney
transplant; a lot can change in the course
of that time,” Mittal said. “Sometimes peo-
ple go on the wait list and they are no
longer good candidates when the time
comes to get an organ,” he explained. In
the case of kidney transplants, “There is a
high mortality of patients on dialysis on
the waiting list for transplants,” he added.
“The longer you wait the worse it is for
your chances to survive until you get an
organ,” Mone said. “When you have to wait
five to 10 years, people are going to die
while they are waiting.”
Anne Stamm, a Long Beach resident and
liver transplant recipient, is a living example
not only of how organ donations can save
lives, but of how long wait times for trans-
plants put people at greater risk of death.
Stamm waited nine years for a trans-
plant after being diagnosed with a rare
liver disease in 1992. “Slowly but surely I
started developing all the symptoms of
liver failure . . . I had severe jaundice,”
she said. “A year prior to my transplant I
was told I was not sick enough to go on
the waiting list.” She reflected, “It was
almost like, how sick do I have to be?”
Stamm did not receive a transplant until
she entered the hospital with liver failure
so severe that her other organs began to
fail, too.
“When I received my transplant I would
have had two weeks to live,” she said.
Calling the organ donation she received
“the gift of life,” she said it has been 12.5
years since her transplant and she contin-
ues to be healthy.
Organ transplant recipients are deter-
mined by individual transplant centers
where the surgeries are performed, Mone
said. “Each transplant center evaluates
patients who come to them with organ fail-
ure and determine whether they are good
candidates based on that center’s medical
criteria,” he explained. “[Transplant cen-
ters] make their own medical decisions
based on what they are comfortable with
from a medical standpoint.” He continued,
“Some may for instance say, ‘We will only
transplant liver patients with Hepatitis once
and will not do a re-transplant.’ Others will
re-transplant as many times as needed.”
Mone said some transplant centers’ strin-
gent requirements lead to wasted opportu-
nities for organ transplants.
“We waste some organs. We don’t trans-
plant them because the transplant centers
are held to outcome standards . . . that are
probably too high,” he said. “There is a
growing sense that we are a little arbitrary
in what our outcome goals are . . . That is
probably an area for a lot of research in the
next five years.”
The process for receiving a transplant
varies by organ. For kidneys, a donor and
recipient must have compatible blood types
and antigens, proteins found on cells that
may cause an organ to be rejected if it does
not match the recipient’s proteins. Six anti-
gens are measured for compatibility, and
With Long Organ Transplant Wait Times Statewide, Organizations Seek To Boost Donations
Medical personnel transport donated organs to their respective recipients. Depending on organ type,the time between donation and surgery may be between four to 48 hours, according to Tom Mone,CEO of OneLegacy, the nonprofit organ procurement organization for the seven-county SouthernCalifornia region. Organs are stored in coolers for preservation and are sometimes flushed withchemicals to keep them viable for as long as possible between the time of donation and transplantsurgery. (Photograph provided by OneLegacy)
1_LBBJ_August19_SectionB_LBBJ MASTER LAYOUT 8/17/14 3:28 PM Page 2
HEALTH CARE QUARTERLYAugust 19-September 1, 2014 Long Beach Business Journal 3-B
drugs may be taken to prevent the body
from rejecting kidneys with some mis-
matched antigens, Mone explained. If all
six antigens between donors and recipients
match, those recipients automatically get
that organ regardless of where they are on
the waitlist, he said.
Size is another key factor for any organ
donation. “If you are a child, you cannot
have an adult organ in most cases,” and
vice versa, Mone said. However, in some
instances adult kidneys may be trans-
planted in children because the body
adjusts to the larger organ over time.
Similarly, children’s kidneys may be
transplanted in adults because after trans-
plantation the kidneys usually grow, he
explained.
Another factor is age. While there is no
official age regulation, most transplant
centers nationwide only accept organs
from donors who are under 75 years old,
Mone said, while in California the donation
age cap is typically 70.
“There are a lot of us in the organ pro-
curement world who believe we are wast-
ing opportunities to extend the lives of
people who are older through what would
be a successful transplant of an older
organ, and there is probably some opportu-
nity to improve there,” he said. In Europe,
for example, organs from donors aged as
old as 90 have been placed in recipients
who are similar in age, he pointed out.
For kidneys, whoever has waited the
longest typically receives a transplant first,
although some other medical factors are
considered, Mittal said. The waiting list for
livers differs in that the sickest patients get
the organs first, he explained. Livers are
the second most common organ transplants
in the country, with about 15,778 people
currently on the national waiting list. The
waiting list for lungs is also mostly need-
based, while the waiting list for hearts
favors patients who have waited longer.
Dr. James Leo, chair of Long Beach Memorial Medical Center’s organ donor council, raises a Donate Life flag on the hospital’s flagpole.The flag is raised every time an organ or tissue donation is made and flies for eight days, symbolizing how one organ donor may saveup to eight lives. Donate Life California is a nonprofit organization overseeing the organ, eye and tissue donation registry statewide.(Photograph by the Business Journal’s Thomas McConville)
(Please Continue To Next Page)
1_LBBJ_August19_SectionB_LBBJ MASTER LAYOUT 8/17/14 3:28 PM Page 3
HEALTH CARE QUARTERLY4-B Long Beach Business Journal August 19-September 1, 2014
Living DonationsLiving donations have the most promise
for reducing the kidney transplant wait
list, Mone said. People have two kidneys
yet only need one, so kidneys are the only
whole-organ donation able to be given by
live donors. For this reason, doctors and
organ procurement organizations like
OneLegacy encourage living donations.
Donate Life America, a nonprofit alliance
of national organizations aiming to
encourage organ and tissue donations,
recently started a website, www.livingdo-
nationcalifornia.org, where people regis-
ter to be living donors. “The website has a
great deal of information on living dona-
tion and how it might work for you,”
Mone said.
“Living donations are becoming more
and more common,” Mittal said, noting that
in some of the country’s regions live dona-
tions make up 20 percent of kidney trans-
plants. The surgery to remove kidneys is
done through a minimally invasive tech-
nique that ensures a fairly speedy recovery
time and minimal scarring. “In many cen-
ters we’re doing the surgery . . . through a
keyhole incision and taking it out through a
bikini incision very low on the abdomen so
it doesn’t leave terrible scars,” he
explained. Living donors earn the benefit
of automatic placement at the top of the
organ donation waiting list should they
ever need an organ themselves, he said.
Mittal, who taught for several years at
New York University before moving to
California last month, said he taught a sim-
ple lesson to encourage his students to reg-
ister as organ donors.
“I asked how many people in the class-
room would like to have an organ transplant
if they needed it to save their lives, and pretty
much everybody raised their hands. Then I
asked everybody to raise their hands if they
were registered donors, and usually just two
or three hands went up,” he said. The exer-
cise reflects the large disparity between the
number of available organs and the number
of people waiting for them, he said.
Doctors and organ procurement organi-
zations have encouraged living donations
through kidney chains, which begin when
an organ recipient has a willing donor who
is not a compatible match. The organ pro-
curement organization representing that
patient’s region then looks for a similar sit-
uation where another patient has a donor
who is not a match. The organization essen-
tially swaps the respective donors to match
up with the correct recipients. As many as
60 people may be involved in these organ
donation swaps, Mone said. “The creation
of these kidney chains has been the one
most significant innovation that has gotten
more people transplants and is helping to
reinvigorate living donation,” he said.
The nonprofit Donate Life California, a
division of Donate Life America, runs the
state organ, eye and tissue donation registry
and actively works with regional organ pro-
curement organizations such as OneLegacy
to increase organ donations. Donate Life
started a program that enables people regis-
tering for driver’s licenses or state identifica-
tion cards to register as organ donors at the
same time. Their cards are then printed with
a pink dot, identifying them as organ donors.
Californians may also register as donors
through www.donatelifecalifornia.org.
Locally, Long Beach Memorial Medical
Center, through its partnership with
OneLegacy, was recently recognized for its
organ donation efforts with a gold medal of
honor from the U.S. Department of Health.
Memorial was one of two hospitals in Los
Angeles and Orange counties to receive the
award, which is given to hospitals with organ
donation rates that “greatly exceed national
standards,” according to a statement from the
hospital. “This recognition reflects the suc-
cess of our OneLegacy partnership and the
tremendous efforts of our hospital staff ded-
icated to saving and enhancing lives,” Diana
Hendel, PharmD, CEO of Long Beach
Memorial and its sister hospitals Community
Hospital Long Beach and Miller Children’s
& Women’s Hospital, said in a statement.
“At the end of the day our number one
goal is to end deaths on the waiting list,”
Mone said. “We’ll never end the waiting
list; there will always be somebody who
needs an organ. But if we could end deaths
on the waiting list we would be very happy.”
Whole Body DonationWhole body donation for medical
research is another option for those who
want to improve others’ lives. Science
Care, a national company with an office in
Long Beach’s Douglas Park, specializes in
whole body donation.
“It is important to realize some people
are not good candidates for organ donation
or transplant. In that case, keep in mind that
you can be a very good candidate for whole
body donations for research. It is a different
type of acceptance criteria,” Melinda
Ellsworth, director of donor services at
Science Care, told the Business Journal.
“One of the main reasons people come to
us is they are in the medical field them-
selves or they are suffering from an illness
and they are interested in furthering med-
ical research,” Ellsworth explained.
Science Care partners with universities,
medical research groups and even surgical
implementation companies, where bodies
are donated. If a donor wishes to contribute
to a specific type of research, Science Care
makes every effort to place the body in the
proper hands, she said.
Science Care’s donors have contributed
to many medical causes and research stud-
ies. In one instance, surgeons used three
bodies donated to Science Care to practice
for a complicated procedure for a military
veteran who needed half of her pelvis and
an entire leg amputated. “The surgical team
of three was able to practice for eight hours
prior to surgery to ensure it was successful
. . . It was very successful. [The veteran] is
up and walking and is able to have chil-
dren,” Ellsworth said.
Some whole body donors may also be
eligible for organ donation – it doesn’t nec-
essarily have to be one or the other,
Ellsworth said. But while the requirements
for organ donation are fairly stringent,
nearly everyone qualifies for whole body
donation, she said. “The key rule-outs right
now are contagious diseases at the time of
passing such as Hepatitis B or C,
HIV/AIDS, and maybe conditions like
syphilis or active genital herpes. The other
one would be extreme obesity, usually
folks over 300 pounds,” she said of exclu-
sionary factors for whole body donation.
Science Care covers the cost of crema-
tion, and remains are returned to families
within three to five weeks, Ellsworth said.
“If anyone is considering supporting med-
ical research or even considering crema-
tion, they should consider whole body
donation with cremation. It is such an
amazing way to give back.” �
1_LBBJ_August19_SectionB_LBBJ MASTER LAYOUT 8/17/14 3:28 PM Page 4
HEALTH CARE QUARTERLYAugust 19-September 1, 2014 Long Beach Business Journal 5-B
� By SAMANTHA MEHLINGER
Senior Writer
S earch “Affordable Care Act and
emergency rooms” on Google, and
you’ll come up with a few pages
of articles dated from the implementation
of the Affordable Care Act (ACA) in
January to this past month, all with similar
headlines: “Emergency Room Visits
Spiking,” “Emergency Visits Seen
Increasing With Health Law,” “Obamacare
Likely to Increase Emergency Room
Visits,” and so on.
Early in August, the American College of
Emergency Physicians released the results
of a member survey corroborating these
headlines. According to the organization,
nearly half of survey respondents have
already experienced more visitors in their
emergency rooms (ER) since the ACA was
implemented. A vast majority, 86 percent,
of surveyed emergency physicians nation-
wide anticipated emergency room visits to
increase in the next three years, and 51 per-
cent believed hospitals would see a reduc-
tion in payments for emergency visits,
according to the survey.
Local hospital officials weighed in on
how the ACA has impacted their emer-
gency room activity. Representatives from
two hospitals, Long Beach Memorial
Medical Center and Lakewood Regional
Medical Center, observed an increase in
ER visits since the ACA was enacted in
January, while reps from St. Mary Medical
Center reported a decrease. Opinions differ
on what changes in ER activity local hospi-
tals may experience in the long term.
“The emergency department has seen
about a 10 percent increase since the
implementation of the ACA,” Judy Fix,
RN, senior vice president of patient serv-
ices for Long Beach Memorial and Miller
Children’s & Women’s Hospital Long
Beach, told the Business Journal. “We were
expecting such an increase and our physi-
cians, nurses and staff were prepared for
this increase in patient visits,” she added.
Chris Tomongin, emergency depart-
ment director at Lakewood Regional, has
observed an increase in visits to his
department since March. “We have seen
an increase in volume of emergency
department visits as compared to a year
ago,” he said.
A lack of new primary care physicians
for increased numbers of insured
Americans may be causing the rise in vis-
its, Tomongin suggested. “With what
seems like millions more people now
insured, there hasn’t been an increase in the
number of primary care physicians taking
care of these millions more people,” he
said. According to the U.S. Department of
Health and Human Services, the number of
primary care physicians is expected to
increase 8 percent by 2020, while demand
for those physicians is projected to increase
14 percent by the same year.
“From my experience in the emergency
department, [it seems] now that these
patients have insurance they are trying to
see their designated providers; however, it
sounds like their providers are inundated
with so many patients that they can’t see
them in a timely fashion, and so [patients]
are now directed to go to the emergency
department,” Tomongin observed.
The American College of Emergency
Physicians had a similar take on increasing
ER visits. “When people can’t get appoint-
ments with physicians,
they will seek care in
emergency departments,”
President Alex Rosenau
said in a statement about
his organization’s survey.
He pointed to increased
enrollment in Medicaid,
the federal government’s
low cost health insurance
program, following the
ACA’s expansion of the
program’s coverage as another cause of
increasing patient volumes in emergency
rooms. “America has severe primary care
physician shortages, and many physicians
do not accept Medicaid patients because
Medicaid pays so low,” he said. Some
patients who are unable to find doctors
who accept their insurance may then visit
emergency rooms.
Long Beach Memorial has had more
patients with low-cost insurance visiting the
emergency room, according to Fix. “We
have seen an increase in the number of
insured patients, especially those who now
have Medi-Cal, thanks to the expansion of
eligibility and those who have been able to
access lower-cost insurance from health
insurance plans through the ACA,” she said.
Medi-Cal is California’s Medicaid program.
While more patients have visited Long
Beach Memorial’s emergency department,
After Affordable Care ActImplementation, Local Hospital RepsReflect On ER Impacts
(Please Continue To Next Page)
1_LBBJ_August19_SectionB_LBBJ MASTER LAYOUT 8/17/14 3:28 PM Page 5
HEALTH CARE QUARTERLY6-B Long Beach Business Journal August 19-September 1, 2014
particularly among those with Medi-Cal,
Fix believed the visits would eventually
decrease due to the hospital’s efforts to
match emergency room patients with pri-
mary care physicians. “We are very proud
of a program we began years ago to help
link emergency department patients with-
out a primary care physician to a doctor
who can provide continuing care, know the
patient’s medical history and more quickly
identify and treat medical conditions that
may worsen because of the lack of access
to care,” she said.
“Our own data over the last year shows
that of the 1,200 patients with whom we
made appointments with physicians, those
who continued with their new physician
were more likely to schedule a doctor’s
appointment for care rather than use the
emergency department,” Fix said. “We
believe that as more and more of the newly
insured patients are linked with a primary
care physician, they will more likely access
their doctor or an urgent care center for
minor health care needs rather than an
emergency department.”
Tomongin had a different point of view
regarding long-term trends in emergency
department patient visits. “Until there is an
answer to the increase of patient volume
and [we gain] an increased number of pri-
mary care physicians, I think unfortunately
the emergency department is going to see a
steady increase in patients,” he said.
More insured patients and not enough
primary care doctors may translate to
longer wait times for patients to make
appointments for care, which may then
cause more emergency room visits,
Tomongin explained. “If someone has a
cough or a cold they need to have examined,
they are not going to wait three months to
see their primary doctor,” he said. If a push
isn’t made to encourage more physicians to
become primary care doctors rather than
specialists, Tomongin said increased visits
to emergency rooms might translate to
increased waiting times for patients.
Harold Way, CFO of St. Mary Medical
Center, said his hospital’s emergency
department has experienced “less volume
overall” in patient visits. “What we have
seen is kind of counter to what I have read
since the Medi-Cal expansion,” he said.
“We have seen about a 5 percent decrease
in volume.” Gail Daly, COO and chief
nursing officer at St. Mary, also noted post-
ACA trends at St. Mary’s emergency
department may differ from other hospi-
tals. “We have heard within our own sys-
tem that there has been a significant
increase in volume,” she said of emergency
room visits within the Dignity Health sys-
tem of medical centers.
Perhaps there has been a decrease in
patient visits to St. Mary’s ER because
many physicians serving the medical cen-
ter already accepted lower paying insur-
ance plans, such as Medi-Cal, prior to
ACA implementation, Way theorized.
“We have historically seen a lot of Medi-
Cal patients,” he said. “I think the doctors
will just absorb the Medi-Cal patients and
we won’t see them in the emergency
department. At least that is what we have
seen in the short term,” he added. For St.
Mary, having more patients with Medi-
Cal simply means more visits are going to
be reimbursed to physicians and the hos-
pital, he explained.
Way and Daly believed the current post-
ACA implementation trends of lower
patient volumes should continue in the
years to come. Adding more facilities to
service the growing number of insured
patients may also help reduce emergency
room visits. “We have some plans to
expand our outpatient clinic footprint both
on campus and potentially offsite that
would help give [outpatient] access to
patients,” Way said.
Lakewood Regional may also expand its
resources to accommodate the growing
number of insured patients, Tomongin said.
“There have been talks about expanding
the emergency department. The hospital is
looking towards continually enhancing its
facilities and possibly improving patient
care that way,” he said. �
Dr. Chris Tomongin, emergency department director at Lakewood Regional Medical Center, has observed an increase in patient volume in his departmentsince the Affordable Care Act was implemented in January. Because the number of primary care physicians is not growing to meet the rising number ofinsured patients, those who are unable to find timely care from primary physicians are likely to continue visiting the emergency room for non-emergentissues, he explained. (Photograph by the Business Journal’s Thomas McConville)
Christine Eusoof-Alviz, RN, is director of emergency services at St. Mary Medical Center in DowntownLong Beach. The hospital’s emergency department, shown behind her, has experienced a decline inpatient volume since the Affordable Care Act was implemented in January, according to St. MaryCOO Gail Daly and CFO Harold Way. (Photograph by the Business Journal’s Thomas McConville)
Need a great doctor?
Check out our website to find a doctor in your area...
www.ProHealthPartners.com
1_LBBJ_August19_SectionB_LBBJ MASTER LAYOUT 8/18/14 9:45 AM Page 6
HEALTH CARE QUARTERLYAugust 19-September 1, 2014 Long Beach Business Journal 7-B
� By SAMANTHA MEHLINGER
Senior Writer
P ediatric patients in Long Beach,
South Bay and Orange County
are now receiving more advanced
and specialized medical treatment as well
as more accessible and convenient care
thanks to recent innovations and partner-
ships between local hospitals.
The nonprofit MemorialCare Health
System has been working to provide better
access to and coordination of care for pedi-
atric patients in the region, through hospi-
tal partnerships, new technology and surgi-
cal techniques, improved hospital proce-
dures and expanded facilities.
Hospital PartnershipsExpand Access To Care
One way MemorialCare has improved
access to pediatric medical care is through
partnerships among its regional hospitals.
In late July, the health care system
announced a partnership in which inpa-
tients at Torrance Memorial Medical Center
– a hospital much smaller than the three-
hospital system in Long Beach, which
includes Miller Children’s & Women’s
Hospital Long Beach, Community Hospital
Long Beach and Long Beach Memorial
Medical Center – have access to pediatric
specialists at Miller Children’s.
“In the South Bay they have a lot of gen-
eral pediatricians and . . . they don’t have
enough pediatric specialists,” Dr. Divya
Joshi, chief medical officer at Miller
Children’s, told the Business Journal.
“Here we have maybe 90-plus pediatric
specialty physicians,” she said. “What this
new link means is that there is now a for-
mal agreement that, if children hospitalized
at Torrance Memorial need a pediatric spe-
cialist, there is a direct link to the pediatric
specialty group here at Miller’s that will
provide those services pretty much instan-
taneously,” she explained. “What it would
mean for children in the South Bay is, if
they are hospitalized in Torrance and need
a pediatric pulmonologist, they won’t have
to come all the way here.”
Craig Leach, president and CEO of
Torrance Memorial, said in a statement that
Miller Children’s has had a strong role in
caring for pediatric patients in Torrance
over the years. “The physicians at Miller
Children’s are highly skilled in their sub-
specialties and care for some of the most
complex pediatric care cases,” he stated.
“This partnership is the perfect way to
ensure that care not only continues, but
expands during a particularly challenging
time in health care.”
Beginning this September, Miller
Children’s is also partnering with Orange
Coast Memorial Medical Center, a
MemorialCare hospital located in
Fountain Valley, to provide better access
to pediatric care for Orange County resi-
dents. In this partnership, children who
visit the emergency room at Orange Coast
are going to have access to pediatric
physicians at Miller Children’s through
telemedicine – live video feed between the
hospitals, Joshi said.
Orange Coast lacks pediatric physicians
in its emergency department, Joshi said.
Local Pediatric Patients Benefit From Better Access To, And Quality Of Care From, Advanced Technologies
(Please Continue To Next Page)
1_LBBJ_August19_SectionB_LBBJ MASTER LAYOUT 8/18/14 9:46 AM Page 7
HEALTH CARE QUARTERLY8-B Long Beach Business Journal August 19-September 1, 2014
Starting in September, if a pediatric patient
comes through the emergency room at
Orange Coast, a physician there may call
Miller Children’s and a pediatrician will
appear on a screen. The pediatrician would
be able to see the patient and converse with
Orange Coast staff and the patient’s family,
Joshi explained. The technology may also
come in handy in Miller Children’s partner-
ship with Torrance Memorial, she added.
New Medical Technology AndTechniques Advance Pediatric CareMiller Children’s & Women’s Hospital
has begun implementing new treatments
for its pediatric patients through recently
developed technology, medical treatments
and surgical techniques.
One of the newest technologies available
through Miller Children’s is helping chil-
dren with debilitating conditions to walk
and move more easily, according to Joshi.
Manufactured by medical device company
Bioness, the L-300 Pediatric Foot Drop
System is a lightweight functional elec-
tronic stimulation device that attaches to a
patient’s foot and leg, sending electrical
impulses into abnormally functioning mus-
cles to help them function more normally,
according to Bioness Director of
Rehabilitation Technology Joel Behnke.
Miller Children’s began offering the tech-
nology in January to patients with condi-
tions such as spinal cord injuries and cere-
bral palsy, a movement disorder of the
nervous system.
“Cerebral palsy patients have an inability
to lift their foot up while walking, which
causes them to trip and fall,” Behnke said.
A gait sensor, easily affixed to any part of
a child’s foot, detects when a patient’s heel
lifts off the ground and sends a signal to a
cuff attached to the patient’s leg, stimulat-
ing the muscles and lifting the foot off the
ground, he explained. A pocket-sized con-
trol unit allows patients to adjust the inten-
sity of the impulses. The system, approved
by the U.S. Food and Drug Administration
in 2012, was the first functional electronic
stimulation system to be approved for pedi-
atric use, Behnke said.
“It is absolutely mind-boggling,” Joshi
said of the technology’s successful results
in pediatric patients. “They can go to
school, get on a school bus, go play with
their friends, walk the dog and even do
chores,” she said. “Social interaction and
participation is a huge component of ado-
lescence and pre-teen development, and the
idea of using technology in order to fully
experience that is something we really
stress,” Behnke said.
Other new treatments have been imple-
mented at Miller Children’s in the past
year, including a new technique available at
the Pediatric Food Allergy Clinic, which is
able to completely eradicate food allergies
in some children, according to Joshi. She
compared the technique to a psychological
treatment for patients with phobias, in
which patients are exposed to their fears
incrementally to help them recover entirely,
or at least learn to live with their phobias.
“Imagine you are afraid of spiders . . .
You might see a film of a spider, and then
there would be a spider at the end of the
room and then at the end of the treatment
you sleep with the spider,” Joshi said. “We
do the same thing with food. You figure out
somebody has an allergy to peanuts, so you
take the chemical that is responsible for the
allergic reaction and you give it to the per-
son in microscopic amounts. If they handle
that well, you give it to them more and more.
Over the course of time, the body kind of
gets used to it and doesn’t have an allergic
response anymore,” she explained. Thanks
to this treatment, “50 percent of the children
seen here for food allergies actually leave
our center not allergic anymore,” she said.
The allergy treatment has only been avail-
able for a year at the hospital and already the
waiting time for the program is three months,
Joshi said. Soon, the hospital is going to dou-
ble its resources for the treatment to reduce
the waiting period, she noted.
In addition to implementing new treat-
ments and technologies, Miller Children’s
is also “at the cutting edge” in terms of sur-
gical procedures, according to Dr. Fombe
Ndiforchu, medical director of general
pediatric surgery at the hospital. While
minimally invasive surgery – which
involves three or four 0.25- to 1.5-centime-
ter incisions – has been available as a tradi-
tional surgery alternative for about 15 to 20
years, hospital surgeons are now practicing
single-incision procedures in pediatric
patients for abdominal surgeries such as
appendectomies, Ndiforchu said.
Rather than making three or four inci-
sions to insert surgical instruments and a
camera, in a single-incision procedure all
these instruments are inserted through one
cut, Ndiforchu explained. “The instru-
ments are fairly small and have different
lengths,” enabling dexterous surgeons to
maneuver multiple instruments without
them colliding. The patient’s abdomen is
inflated with carbon dioxide so the sur-
geons may see their work more easily, since
the abdomen remains closed except for one
small incision, he noted.
“The patients are able to recover faster.
They require less pain medication and their
gastrointestinal functions return faster,”
Ndiforchu said of single-incision surgeries.
Less anesthesia is needed for these surger-
ies in comparison to traditional open sur-
geries, and an added benefit is minimal
scarring, he said. All this equates to shorter
hospital stays, he added.
Better Coordination Of CareIn addition to implementing new tech-
nology and treatments, the MemorialCare
Health System hospitals in Long Beach are
working to improve hospital procedures
and expand facilities to better coordinate
pediatric patient care.
One simple way the hospital is now
improving communication among families,
patients and hospital staff is by installing
white boards in every inpatient room. “On
the board is the name of the doctor and the
nurse, the time for [the doctor’s patient]
rounds, the plan for the day and what
exactly needs to happen for the child to be
Seventeen-year-old Brennan Korshavn is assisted by Carol Iannessa, a physical therapist, at the pedi-atric rehabilitation center within Miller Children’s & Women’s Hospital. Korshavn is being familiar-ized with the Bioness L-300 Foot Drop System, a functional electronic stimulation device that sendselectrical impulses signaling the muscles in his leg to lift his feet, helping him walk. Sensors insidehis shoes alert the stimulation device on his legs to send the impulse when his heels lift off theground. (Photograph by the Business Journal’s Thomas McConville)
1_LBBJ_August19_SectionB_LBBJ MASTER LAYOUT 8/17/14 3:28 PM Page 8
HEALTH CARE QUARTERLYAugust 19-September 1, 2014 Long Beach Business Journal 9-B
able to go home,” Joshi said. “I think that
has made a huge difference because it
empowers the family to really participate in
care,” she added.
The hospital also recently began requiring
physicians to commit to specific time frames
for patient rounds, Joshi said. “The way
rounds used to work is that at random times
the doctor would come into your room and
would tell you the plan and then leave again.
Then a nurse would come in and might say
something, and then another doctor might
come in and have no idea what the first doc-
tor said . . . It was just a mess,” she recalled.
“It has taken some time to convince physi-
cians to commit to a time for rounds because
the universe doesn’t revolve around them, it
revolves around the patient and they need to
be somewhat flexible in their time,” she said,
adding that so far the new procedure for
rounds has been working out well.
The hospital is also working to improve
coordination of care by expanding its facil-
ities. A new facility combining the pedi-
atric neurology and nephrology depart-
ments is opening in January of 2015, Joshi
said. These fields, which deal in neurolog-
ical and kidney issues, are often interre-
lated, so having a center where the two
departments are combined should ensure
better coordination of care between a
patient’s physicians since they are going to
be steps from one another rather than in
separate buildings, she explained.
Miller Children’s sister hospital,
Community Hospital Long Beach, is also
soon to be home to a new facility benefit-
ing pediatric patients, Joshi noted. “We
will have in the very near future at
Community Hospital an inpatient adoles-
cent psych unit,” she said. Although one in
five children has a mental condition, find-
ing mental health care for children is often
difficult, she said. As a result, “What we
have found is we get children into our
emergency department who are out of con-
trol; sometimes they threaten to kill them-
selves or their parents,” she explained.
The children’s hospital is to work directly
with the inpatient psychiatry facility at
Community Hospital to ensure that
whichever doctor attends to a patient initially
in emergency is the same doctor who cares
for that patient both for inpatient and follow-
up outpatient care, Joshi said. She estimated
the facility would be open within a year.
Also in the works is a new pediatric cam-
pus where many outpatient pediatric physi-
cians and specialists are to be housed in one
location to better coordinate care among
multiple doctors and to make treatment more
convenient for patients and their families,
according to Joshi. The idea, in the works for
about two-and-a-half years, was sparked
because many patients at Miller’s see three to
five physicians, all with differing special-
ties, on a regular basis, she explained. “The
idea is to have all those specialists and all
those services in one building so that the
family only comes once,” she said.
MemorialCare is still searching for a
location for the facility, although Joshi
said, “we are hopefully close to clinching
the deal on one of the locations.” �
Dr. Divya Joshi, chief medical officer at Miller Children’s & Women’s Hospital Long Beach, interactswith two of the hospital’s pediatric cancer patients, seven-year-old Ava Valdez (right) and three-year-old Jacob Delacruz. According to Joshi, the hospital has access to some of the most recent pediatriconcology treatment protocols through a partnership with the National Children’s Oncology Group.The hospital sends the group research data about the treatment of its pediatric patients to helpadvance cancer research, she said. (Photograph by the Business Journal’s Thomas McConville)
1_LBBJ_August19_SectionB_LBBJ MASTER LAYOUT 8/17/14 3:28 PM Page 9
HEALTH CARE QUARTERLY10-B Long Beach Business Journal August 19-September 1, 2014
Molina Names New Chief MedicalOfficer – Dr. Keith Wilson, M.D., has been
named chief medicalofficer for LongBeach-based MolinaHealthcare, Inc., ahealth plan provideroffering plansthrough Medicaid,Medicare and stateinsurance market-places. He has served
as the company’s vice president of clinicalservices for Molina Medical Group andAmerican Family Care since 2013. “Dr.Wilson’s track record in leading physicianpractices and caring for sicker patients, inaddition to his managed care experience,will be invaluable,” Terry Bayer, COO ofMolina Healthcare, said in a statement.Wilson previously served as president andCEO of Talbert Medical Group before thegroup merged with HealthCare Partners,after which he became HealthCare’sregional medical director. He studiedchemistry and chemical engineering as anundergraduate at the University ofSouthern California and earned his M.D. atHoward University College of Medicine inWashington, D.C. His medical residencywas at King-Drew Medical Center in LosAngeles. Currently, he is a boardmember ofthe Financial Solvency Standards Board forthe California Department of ManagedCare, a fellow of the American College ofObstetrics and Gynecology, a committeemember of the California Association ofPhysician Groups and a member of theAmerican Medical Association, NationalMedical Association and Orange CountyMedical Association. (Photograph providedby Molina Healthcare)
Readmission Innovator – Debbie Rivet,case management director at LosAlamitos Medical Center (LAMC), hasearned a Readmission Innovator awardfrom the National ReadmissionPrevention Collaborative, a volunteerorganization formed to share best practice
case studies amonghealth care industryleaders. “This pres-tigious award wasearned by Debbie’stenacious efforts todecrease patientreadmissions byworking with skillednursing facilities,
home health providers and other localagencies,” Karen Games, LAMC collabo-rative care director, said in a statement. In2011, Rivet formed the regionalPreventing Readmissions Collaborativefor Southeast Los Angeles County andNorth Orange County professionals. Thegroup’s membership has since tripled. Thecollaborative focuses on education ofhealth care workers, reducing hospitalreadmissions and improving the quality ofpatient care. In a statement, Rivet saidearning the Readmission Innovator award“shows that we are making a difference inour community.” (Photograph provided byLos Alamitos Medical Center)LBUSD Alumni Earn Nursing
Certificates Through Goodwill SOLAC– A Goodwill Serving the People ofSouthern Los Angeles County (SOLAC)program that trains low-income students toearn certified nurse assistance certificatesis graduating its first class on August 22.The class of 10 students is made up of for-California State University, Long Beach
Reach Higher…
r
Offered in a �exible format
Care Administration
Master’ …with a
ehgiHh caeR
…
September 20, 2
Come join us on
are held monthly.
Free information
face-to-face clas
with both online and
at (800) 963-22
or call us today to RSVP
www.ccpe.csulb.
Register online a
StainrofilaC oL, ytisrevinUetaSt hcaeBg no
Kent Clayton, pictured at right, was recently named CEO of LosAlamitos Medical Center (LAMC), replacing former CEOMichele Finney, who departed to join Tenet Healthcare’sAbrazo Health System in Arizona. Prior to taking on his newrole at LAMC, Clayton served as CEO of Placentia-LindaHospital in Placentia, California, for 10 years. There, he over-saw the development of new clinical programs, five new outpa-tient centers, expansion of the emergency room and other proj-ects. Clayton comes to LAMC at a time when it is undergoingfacility expansions. A new three-story, 70,000-square-foot med-ical office building (pictured) for physician practices is openingin the fall on Katella Avenue next to LAMC’s Total Care Pavilion.A new catheterization laboratory is also under construction at the hospital. When completed, the state-of-the-art facility will enable physicians to perform electrophysiology procedures to diagnose issues in the heart andneuro-interventional procedures for diagnosing and treating vascular disorders, according to Todd Silver,catheterization lab supervisor, pictured at left. (Photographs by the Business Journal’s Thomas McConville)
Los Alamitos Medical Center Getting New Facilities; Clayton Named CEO
(Continue To Top Of Next Page)
1_LBBJ_August19_SectionB_LBBJ MASTER LAYOUT 8/17/14 3:28 PM Page 10
HEALTH CARE QUARTERLYAugust 19-September 1, 2014 Long Beach Business Journal 11-B
mer Cabrillo, Jordan and PolytechnicHigh School students who participated inhealth care academies at their schools,which qualified them for the program.The Long Beach Unified School Districtbegan the academies last year to encour-age low-income students “who did notnecessarily have college plans butdemonstrated an interest in working inthe health care field” to pursue theirgoals, according to a statement from
Goodwill SOLAC. The students partici-pate in the certified nurse assistant train-ing program free of charge. “Once ourstudents become certified nurse assis-tants, they are eligible to get training as alicensed vocational nurse,” Susan Gavel,director and instructor for the programsaid in a statement. The graduation cere-mony on August 22 takes place at 10 a.m.at Goodwill SOLAC’s Long Beach head-quarters, 800 W. Pacific Coast Hwy. �
1-877-422-2270www.cambrianhomecare.com
Caregivers at Your Door
Solutions for All Ages
®
NO MINIMUMSNO DEPOSITS
NO CONTRACTSNO WORRIES
Molina Healthcare Opens Senior Resource CenterOn August 20 at 2 p.m., Molina Healthcare is hosting a free community grand opening for itsnew Senior Resource Center at College Medical Center, 2776 Pacific Ave. Molina Healthcareprovides health plans through Medicaid, Medicare and other state insurance marketplaces. Aweek before the center opened, Dr. Jennifer Zweig, family medicine residency director andclinic director at College Medical Center (left), and Dr. Martha Bernadett-Molina, executive vicepresident of Molina HealthCare, paid a visit to the Senior Resource Center’s gardening area,one of several free resources available there. In addition to gardening, the center provides localseniors with free access to health education and exercise classes, painting, a library of booksand DVDs, television and a computer lab. The goal of the center is to help seniors “take anactive role in maintaining their health and wellbeing,” according to Molina Healthcare.(Photograph by the Business Journal’s Thomas McConville)
Local OrthodontistMark GarlingtonRated Among Top 1 Percent Of InvisalignProvidersWorldwideLong Beach-based orthodontistDr. Mark A. Garlington, D.D.S.,has been identified as one of thetop 1 percent of Invisalignproviders worldwide by the man-ufacturer of the product, a clearmouthpiece used as an alterna-tive to traditional braces. Theranking was based onGarlington’s experience, knowl-edge and the number of cases he has successfullytreated, according to Invisalign. “He averagesmore than 200 Invisalign patients a year, meaninghe’s got the experience and expertise patients cantrust,” John Ramko, Invisalign regional develop-ment manager, said in a statement. “Achievingelite top 1 percent worldwide means that I am inthe upper echelon of orthodontics providingInvisalign, and that achievement validates my commitment and passion for orthodontics,” Garlingtonstated. Garlington has 28 years of experience as an orthodontist, and has been using Invisalign inhis practice since 2000. He earned a bachelor’s degree from the UCLA and his D.D.S. from USC.His Long Beach office is located at 5479 E. Abbeyfield St., Suite 1, where he may be reached at562/439-4553. (Photographs by the Business Journal’s Thomas McConville)
1_LBBJ_August19_SectionB_LBBJ MASTER LAYOUT 8/17/14 3:29 PM Page 11
1_LBBJ_August19_SectionB_LBBJ MASTER LAYOUT 8/17/14 3:29 PM Page 12