Thursday, October 30, 2014

San Francisco Medical Society Blog


Providing news to the San Francisco Medical Community.

SFDPH Health Advisory: Recognizing and Handling Suspect Ebola Cases in Outpatient Settings

The first imported case of Ebola in the USA was not initially recognized upon presentation to a health care facility in Texas. Despite enhanced airline screening procedures, other persons with Ebola may enter the USA and become ill.

All health care facilities (clinics, offices, etc.) should be prepared to identify potential cases of Ebola and to handle such patients safely and expediently.


The incubation period for Ebola is a maximum of 21 days; persons whose last potential Ebola exposure was more than 21 days prior are no longer considered at risk. Symptoms include fever, vomiting, abdominal pain, diarrhea, headache, myalgia, and unexplained bleeding. Transmission is via direct contact with bodily fluids of a symptomatic, infected person, or via contact with a contaminated object. Asymptomatic individuals are not infectious.

Currently Ebola virus transmission is known to be occurring in the West African countries of Sierra Leone, Liberia, and Guinea.

Click here to view the SFDPH Health Advisory issued on October 27, 2014.

In-Person Screening

Establish processes to routinely and immediately ask every person entering a facility about compatible symptoms and exposure history. Post signs at entry points, but do not rely on signage alone. Suspect Ebola virus in persons who answer “yes” to BOTH questions listed below.

  1. Do you currently have fever, weakness, vomiting, diarrhea, stomach ache, muscle ache, or headache or have you been bleeding without knowing why?
  2. In the past 3 weeks have you been in Sierra Leone, Liberia, or Guinea in West Africa, or have you had contact with a person known or suspected to have Ebola?

Handling a Suspected Ebola Patient at Your Facility

For any patient who answered “yes” to BOTH questions, please follow these general recommendations, customizing them for your particular facility if necessary.

  • Immediately isolate the patient in a private room with closed door. Have the patient don a face mask.
  • Do not take vital signs or examine the patient. Avoid contact with the patient and his/her secretions, maintaining a distance of at least 3 feet at all times.
  • To maximize patient cooperation, inform the patient that further medical assistance is on the way.
  • If the patient is medically unstable or experiencing a life-threatening emergency: dial 911 and advise the operator that Ebola is suspected. Then contact SFDPH Communicable Disease Control Unit (CDCU) 24/7 at (415) 554-2830, and follow instructions to reach the On-Call Physician.
  • If the patient is medically stable: contact SFDPH Communicable Disease Control Unit (CDCU) 24/7 at (415) 554-2830 and follow instructions to reach the On-Call Physician. CDCU will assist with assessment of the patient and situation, and will arrange for transport to a hospital if needed.
  • Staff should not enter the patient room and should leave the door closed. If absolutely necessary to open the door or enter the room, only staff trained in proper donning and doffing of personal protective equipment (PPE) should do so, and only after donning appropriate PPE.
  • Before anyone leaves the area, record the name, address, and home/work/cell phone numbers for all persons (staff, patients, and visitors) present at the facility that could have had contact with the patient or with his/her bodily fluids, and inform them that they may be contacted by CDCU.
  • Clinic personnel should not attempt to clean or disinfect the facility. Discuss cleaning with SFDPH.

Resources for Medical Providers

CDC Ebola Information for Healthcare Providers:

SFDPH Ebola Information:

SFDPH Health Alerts:

SFDPH Website:

11/5 CMS Provider Call: ICD-10 Transition

With less than a year remaining to transition to ICD-10, the Centers for Medicare & Medicaid Services (CMS) is hosting a call to give insights into implementation issues, opportunities for testing, and available resources. A question and answer session will follow the presentations.

Wednesday, November 5

10:30 am PST (1:30 pm EST)

Click here to register for the CMS National Provider Call.

CMS experts will discuss:

  • National implementation of ICD-10
  • Medicare Fee-For-Service testing
  • Partial code freeze and annual code updates
  • Home health conversions
  • Claims that span the implementation date

Medical coders, physicians, physician office staff, nurses and other non-physician practitioners, provider billing staff, health records staff, vendors, educators, system maintainers, laboratories, and all Medicare providers are encouraged to participate on the call.

Click here to register or for more information.

CDC Issues New Ebola Guidelines to Protect Health Professionals

The Centers for Disease Control and Prevention (CDC) Monday released tightened guidance on use of personal protective equipment (PPE) for U.S. health care workers to ensure they are better prepared to treat Ebola patients.

The guidance focuses on specific PPE health care workers should use and offers detailed, step-by-step instructions for how to put the equipment on and take it off safely.

The enhanced guidelines center on three principles:

  • All health care workers undergo rigorous training and are practiced and competent with PPE, including taking it on and off in a systemic manner.
  • No skin is exposed when PPE is worn.
  • All workers are supervised by a trained monitor who watches each worker taking PPE on and off.

The guidance reflects recent experience from safely treating patients with Ebola at Emory University Hospital, Nebraska Medical Center, and National Institutes of Health Clinical Center.

Click here to view the CDC guidelines on PPE usage for health care workers treating Ebola patients.

Click here for the CDC fact sheet on the updated changes in the PPE guidance

California Issues Report Cards for HMOs, PPOs and Large Medical Groups

The California Office of the Patient Advocate released the 2014-2015 “California Health Care Quality Report Cards” that rate health plans and medical groups on a four-star scale.

The report cards allow consumers to compare the quality of care that more than 16 million commercially insured consumers receive from the state’s 10 largest HMOs, 6 largest PPOs, and more than 200 medical groups. The data for the report cards is drawn from claims data and patient surveys for 2013.

Although the report cards are usually published annually in January, officials have changed the release date so it would coincide with the fall open enrollment period for many Californians and their families, including those purchasing coverage through Covered California, the state's health benefit exchange. Covered California's next open enrollment period runs from November 15 to February 15. The report cards are part of a larger national push to bring greater transparency to the health care industry and help consumers choose services that best fit their needs.

Click here to access the California Health Care Quality Report Cards.

Click here to view the report card for large medical groups in San Francisco.

SFMS, Community and Education Leaders Highlight Negative Health Effects of Soda and Sugary Beverages

Health, education, and community leaders met at the Chinatown YMCA to discuss Proposition E, San Francisco’s proposed soda tax.

Supervisor Eric Mar, one of the lead sponsors for Proposition E, expressed his concern for the growing Type 2 diabetes epidemic, with soda and sugary beverages as a leading cause. “I want to help people have a better understanding of why Proposition E is on the ballot, and why this is specifically about soda and sugary beverages,” said Supervisor Mar. “These drinks are having a disproportionately negative impact on public health,” he continued. “Mexico’s soda tax is working. Consumption of soda and sugary beverages is down 10% and people are making healthier choices.

SFMS was one of the earliest endorsers of Proposition E and has continued to support Yes on E. San Francisco Medical Society President Lawrence Cheung, MD has testified in favor of Proposition E at numerous hearings and community meetings, explaining how our bodies process liquid sugar differently. “The liquid sugar in these sodas and sugary beverages isn’t processed the same way by our bodies as foods,” he explained. “For Asians Americans, the risk for Type 2 diabetes is higher than the general population. We need both education and incentives for people to make healthier choices.” He continued, “Type 2 diabetes impacts every system in the body, and is a major health public health problem.

San Francisco Board of Education Commissioner Rachel Norton expressed how the revenue from Proposition E would benefit children. “Proposition E will bring more physical education to our schools, and help expand the new school lunch program that is getting healthier foods— that kids will eat—onto their plates, and so much more.

A tax of $0.02/oz on the distribution of soda and other sugar-sweetened beverages in San Francisco is estimated to generate up to $54 million annually, which will be legally dedicated to fund active recreation and nutrition programs in schools, parks, and recreation centers; food access initiatives, drinking fountain and water bottle filling stations; and dental health services.

Researchers at UCSF have been at the epicenter of the research linking sugary beverages with the diabetes epidemic and other health ailments, as well as the role of tax policy in reducing consumption. In addition to SFMS, many local organizations have endorsed Yes on E including the North East Medical Services, San Francisco Community Clinic Consortium, California Dental Hygienists’ Association, San Francisco Dental Hygienist Society, San Francisco Dental Society, San Francisco Board of Education, San Francisco PTA, United Educators of San Francisco, San Francisco Food Bank, Parents for Public Schools, and many more.

Click here for more information on the research and supports the soda tax.

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