august 19-september 1, 2014 section b

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

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)


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)



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.” �




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




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)

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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


1_LBBJ_August19_SectionB_LBBJ MASTER LAYOUT 8/18/14 9:46 AM


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)



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)



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

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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)



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. �

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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)


august 19-september 1, 2014 section b

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