HomeMy WebLinkAboutMINUTES - 12082015 - C.13RECOMMENDATION(S):
Approve the appointments, reappointments, privileges, advancements, department changes, voluntary resignations
and updated OB/GYN privileges as recommend by the Medical Staff Executive Committee, at their November 16th
meeting, and by the Health Services Director.
FISCAL IMPACT:
Not applicable.
BACKGROUND:
The Joint Commission on Accreditation of Healthcare Organizations has requested that evidence of Board of
Supervisors approval for each Medical Staff member will be placed in his or her Credentials File. The above
recommendations for appointment/reappointment were reviewed by the Credentials Committee and approved by the
Medical Executive Committee.
CONSEQUENCE OF NEGATIVE ACTION:
If this action is not approved, Contra Costa Regional Medical Center and the Contra Costa Health Centers' medical
staff would not be appropriately credentialed and not be in compliance with the Joint Commission on Accreditation of
Healthcare Organizations.
APPROVE OTHER
RECOMMENDATION OF CNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
Action of Board On: 12/08/2015 APPROVED AS RECOMMENDED OTHER
Clerks Notes:
VOTE OF SUPERVISORS
AYE:John Gioia, District I Supervisor
Candace Andersen, District II
Supervisor
Mary N. Piepho, District III
Supervisor
Karen Mitchoff, District IV
Supervisor
Federal D. Glover, District V
Supervisor
Contact: Anna Roth, 370-5101
I hereby certify that this is a true and correct copy of an action taken and entered on the minutes of the Board
of Supervisors on the date shown.
ATTESTED: December 8, 2015
David Twa, County Administrator and Clerk of the Board of Supervisors
By: June McHuen, Deputy
cc: T Scott , M Wilhelm, Sana Salman
C. 13
To:Board of Supervisors
From:William Walker, M.D., Health Services Director
Date:December 8, 2015
Contra
Costa
County
Subject:Medical Staff Appointments and Reappointments – November 2015
CHILDREN'S IMPACT STATEMENT:
Not applicable.
ATTACHMENTS
OB-GYN privledges
Attachment
MEC Recommendations – November 2015 Definitions: A=Active
C=Courtesy Aff=Affliate P/A= Provisional Active P/C= Provisional Courtesy Page 1
A. New Medical Staff Members
Sara Abdijadid, DO Psychiatry/Psychology
Joachim Raese, MD Psychiatry/Psychology
Selamawit Tarekegn, MD Hospitalist
B. New Teleradiologist Staff Members
James Fernandez, MD
C. Application for Moonlighting Privileges
Christy Martinez, MD Family Medicine
D. Request for Additional Privileges
Brenda Reilly, MD Emergency Medicine
Paul Manaut, NP Family Medicine
Gina Medina, FNP Family Medicine
Brandon Vance, MD Psychiatry/Psychology
E. Request to change Primary Department
Original Department Requesting Department
Lawrence Burchett, MD Family Medicine Obstetrics & Gynecology
F. Advance to Non-Provisional
Hala Abdelaziz, MD Pathology A
Ashley Ballard, DO Hospitalist A
Urmila Bajpai-Pillai, MD Internal Medicine A
Alice Del Rosario, MD Psychiatry/Psychology C
Maura Daly, LM Obstetrics & Gynecology Aff
Alexandra Duque-Silva, MD Pediatrics A
Nikki Ha, NP Family Medicine Aff
Anita Heart, MD Family Medicine A
Jessica Kim, MD Hospitalist A
Diane Kwan, MD Surgery C
Sara Richey, MD Family Medicine A
Emma Swan, MD Hospitalist A
Lawrence Thompson, MD Pathology C
Ian Wallace, MD Family Medicine A
Takenori Watanabe, MD Family Medicine A
Katherine Winter, MD Hospitalist A
Sonya Wyrobek, RN, CNM Obstetrics & Gynecology Aff
G. Biennial Reappointments
Victoria Agnost, MD Pediatrics A
Hugo Altamirono, MD Anesthesia C
Michael Baker, MD Surgery A
Margarita Berrios, MD Pediatrics A
Jafar Bozorgmehr, MD Psychiatry/Psychology C
MEC Recommendations – November 2015 Definitions: A=Active
C=Courtesy Aff=Affliate P/A= Provisional Active P/C= Provisional Courtesy Page 2
Lawrence Burchett, MD Obstetrics & Gynecology C
Doreen Fukushima, MD Psychiatry/Psychology C
Kimberley Haglund, MD Hospitalist A
David Hearst, MD Family Medicine A
Stephen Kalkstein, MD Family Medicine C
Ronald Leon, MD Psychiatry/Psychology C
Michael Levin, MD Psychiatry/Psychology A
David Marinoff, MD Obstetrics & Gynecology C
Daniel May, MD Psychiatry/Psychology C
Thomas McCoy, MD Emergency Med A
David Pepper, MD Family Medicine A
Lisa Rodelo, MD Obstetrics & Gynecology A
Joan Roux, MD Pediatrics C
Brian Thomas, MD Psychiatry/Psychology A
Priyanka Tulshia, MD Hospitalist C
Dawn Wadle, MD Family Medicine A
H. Biennial Renew of Privileges
Heather Cedermaz, NP Family Medicine
Catherine Kissinger, NP Family Medicine
Chere Sealey, NP Family Medicine
Cynthia Williams, CNM Obstetrics & Gynecology
J. Voluntary Resignations
Karl Adler, MD Psychiatry/Psychology
Dan Barrett, DO Psychiatry/Psychology
Sara Chan, DDS Dental
Kulmeet Dang, MD Emergency Medicine
Robert Davies, MD Internal Medicine
David Gurley, MD Emergency Medicine
Larry Kean, MD Psychiatry/Psychology
Benjamin Ordaz, MD Family Medicine
Shobha Sharma, DO Internal Medicine
David Solomon, MD Family Medicine
Contra Costa Regional Medical Center
Ob/Gyn Privileges Request Form
Practitioner Name: _________________________________________
D CA Lic.N/A N/A
C 10
1 case in
last 2
yrs.
U 15
5 cases
in
last 2
yrs.
D CA Lic or DDS
or DMD N/A N/A
C CA Lic or DDS
or DMD 5 N/A
U CA Lic or DDS
or DMD 10
2 cases or
orientatio
n in last 2
yrs.
D CA Lic.N/A N/A
U CA Lic.10
2 cases
in last 4
yrs.
D CA Lic.N/A N/A
U CA Lic.3 N/A RequestedANE
3
ANE
CC
DEN
DIA EME
FAM
GER
HOSP
MED
OBG
PED
SGN
Moderate (Conscious) Sedation*
Does NOT include use of ketamine or
propofol.
CA Lic. and
Airway
Mgmt. skills
(ANE11 or
inservice) Training/ Education
D= With Direct Supervision
C= With Consultation
U= Unrestricted
Obstetrics and Gynecology Current Competence Departments (s) NumberPrivilege Descriptions D/C/U ExperienceANE
DEN
OBG
SGN
ANE
5 Nitrous Oxide.
OBG MED
12 Rigid Sigmoidoscopy. GrantedD= Denied P= Pending CNM=Criteria Not MetANE CC
EME
HOSP IM
PED
OBG
SGN
ANE
11 Endotracheal Intubation*
* Separate proctoring required
OB/GYN REV Updated NOV 2015 Page 1 of 11
Contra Costa Regional Medical Center
Ob/Gyn Privileges Request Form
Requested Training/ Education
D= With Direct Supervision
C= With Consultation
U= Unrestricted
Obstetrics and Gynecology Current Competence Departments (s) NumberPrivilege Descriptions D/C/U Experience GrantedD= Denied P= Pending CNM=Criteria Not MetC CA Lic.N/A N/A
U CA Lic.30
10 cases in
last 4 yrs.
or
completion
of Planned
Parenthood
Prenatal
Privileging
C CA Lic. & U
OBG 1 N/A N/A
U CA Lic. & U
OBG 1 30
10 cases
in last 4
yrs.
C CA Lic.N/A N/A
U CA Lic.30
10 cases
in last 2
yrs.
D
CA Lic.
Recommend
NRP
certification
30 N/A
U
FP or OB
Recommend
NRP
certification
50 8 cases in
last 2 yrs.
D CA Lic.N/A N/A
U CA Lic.30
8 cases
in last 4
yrs.
FAM
OBG
OBG
5
Antepartum Fetal Heart Rate
Monitoring.
OBG OBG
3
Outpatient Management of Routine
Gynecological Problems, such as
vaginitis, contraception, pelvic pain,
uterine bleeding and management of
most complex gynecological problems
such as ectopic, adnexal mall, severe
PID, Mole, etc. (For OB specialists
w/o General Medicine Training).
FAM
OBG
OBG
4
Antepartum, Intrapartum and Postpartum
management of Pregnancy with minor
complications (such as mild pre-
eclampsia, prior cesarean section),
Uncomplicated Vaginal Delivery (such as
amniotomy, episiotomy, second degree
laceration repair and manual removal of
placenta), and Initial Newborn Orders
FAM
OBG
OBG
1
Outpatient Management of Low Risk
Prenatal Patients.
FAM
OBG
OBG
2
Outpatient Management of High Risk
Prenatal Patients.
* Separate proctoring required
OB/GYN REV Updated NOV 2015 Page 2 of 11
Contra Costa Regional Medical Center
Ob/Gyn Privileges Request Form
Requested Training/ Education
D= With Direct Supervision
C= With Consultation
U= Unrestricted
Obstetrics and Gynecology Current Competence Departments (s) NumberPrivilege Descriptions D/C/U Experience GrantedD= Denied P= Pending CNM=Criteria Not MetD CA Lic.N/A N/A
U CA Lic.10
4 cases
in last 2
yrs.
D FP or
OB/GYN N/A N/A
U FP or
OB/GYN 6
1 case in
last 2 yrs.
or
inservice
D FP or
OB/GYN N/A N/A
U FP or
OB/GYN 6
1 case in
last 2 yrs.
or
inservice
C CA Lic.N/A N/A
U CA Lic.10
1 case in
last 2
yrs.
D FP or
OB/GYN N/A N/A
C FP or
OB/GYN 10 N/A
U FP or
OB/GYN 15 2 cases in
last 2 yrs.
OBG OBG
7 Amniocentesis
OBG OBG
8 External Version
FAM
OBG
OBG
9 Induction or Augmentation of Labor.
FAM
OBG
OBG
10
Repair of 3rd Degree, 4th Degree, or
Cervical Lacerations
FAM
HOSP
OBG
OBG
6
Basic 3rd Trimester Obstetrical
Ultrasound Including: Viability,
Placenta Location, Fetal Number, and
Amniotic Fluid Assessment, EFW,
and Cervical Length
* Separate proctoring required
OB/GYN REV Updated NOV 2015 Page 3 of 11
Contra Costa Regional Medical Center
Ob/Gyn Privileges Request Form
Requested Training/ Education
D= With Direct Supervision
C= With Consultation
U= Unrestricted
Obstetrics and Gynecology Current Competence Departments (s) NumberPrivilege Descriptions D/C/U Experience GrantedD= Denied P= Pending CNM=Criteria Not MetD FP or
OB/GYN N/A N/A
C FP or
OB/GYN 10 N/A
U FP or
OB/GYN 20
2 cases or
ALSO
course in
last 2 yrs.
D FP or
OB/GYN N/A N/A
C FP or
OB/GYN 10 N/A
U FP or
OB/GYN 20
2 cases or
ALSO
course in
last 2 yrs.
D FP or
OB/GYN 15 N/A
C FP or
OB/GYN 30 N/A
U FP or
OB/GYN 50
8 cases
in last 2
yrs.
D FP or
OB/GYN 10 N/A
C FP or
OB/GYN 15 N/A
U FP or
OB/GYN 20
4 cases
in last 2
yrs.
OBG OBG
15
Postpartum Tubal Ligation, or Mini
Laparotomy Tubal Ligation, including
Umbilical Hernia repair when
appropriate (without mesh)
FAM
OBG
OBG
11 Vacuum-Assisted Delivery*
OBG OBG
12 Forceps Assisted Delivery*
OBG OBG
14
Cesarean Section, Repair of Uterine
Laceration*
* Separate proctoring required
OB/GYN REV Updated NOV 2015 Page 4 of 11
Contra Costa Regional Medical Center
Ob/Gyn Privileges Request Form
Requested Training/ Education
D= With Direct Supervision
C= With Consultation
U= Unrestricted
Obstetrics and Gynecology Current Competence Departments (s) NumberPrivilege Descriptions D/C/U Experience GrantedD= Denied P= Pending CNM=Criteria Not MetD FP or
OB/GYN N/A N/A
C FP or OB/GYN
& "U" OBG14 5 N/A
U FP or OB/GYN
& "U" OBG14 10
2 cases
in last 2
yrs.
FAM
HOSP
OBG
OBG
18 U
CA Lic. and
Company
Training
N/A N/A
D CA Lic.N/A N/A
U CA Lic.5 N/A
D CA Lic.N/A N/A
U CA Lic.5
1 case in
last 2
yrs.
D CA Lic.N/A N/A
CA Lic.
50 cases or
30 cases
with formal
course
5 cases
in last 2
yrs.
OB/GYN N/A
5 cases
in last 2
yrs.
OBG OBG
17
Intrapartum Management of Multiple
Pregnancy
Nexplanon Insertion and Removal.
FAM
HOSP
OBG
OBG
19 IUD Insertion.
OBG
19B
Suction Endometrial Biopsy
Hysterosalpingogram and Sono
Hysterogram (insertion of catheter
only)
Colposcopy, Cervical Biopsy and
Endocervical Curettage.
U
FAM
HOSP
OBG
OBG
19A
OBG
* Separate proctoring required
OB/GYN REV Updated NOV 2015 Page 5 of 11
Contra Costa Regional Medical Center
Ob/Gyn Privileges Request Form
Requested Training/ Education
D= With Direct Supervision
C= With Consultation
U= Unrestricted
Obstetrics and Gynecology Current Competence Departments (s) NumberPrivilege Descriptions D/C/U Experience GrantedD= Denied P= Pending CNM=Criteria Not MetD CA Lic.N/A N/A
C CA Lic.10 N/A
U CA Lic.20
1 case in
last 4
yrs.
D FP or
OB/GYN N/A N/A
C FP or
OB/GYN 10 N/A
U
FP or
OB/Gyn &
"U" OBG 22
20 4 cases in
last 2 yrs.
D FP or
OB/GYN N/A N/A
C FP or
OB/GYN 20 N/A
U FP or
OB/GYN 30 4 cases in
last 2 yrs.
D FP or
OB/GYN N/A N/A
C FP or
OB/GYN 20 N/A
U FP or
OB/GYN 30
8 cases
in last 2
yrs.
Laparotomy for Ectopic Pregnancy,
Salpingoophorectomy, Abdominal
Hysterectomy, Cesarean
Hysterectomy, Myomectomy,
Repair of Bladder Rent,
Lymphadenectomy, Appendectomy,
Incisional Hernia Repair, Umbilical
Hernia Repair, etc.*
OBG OBG
22
Diagnostic D&C, incomplete or
missed Abortion, D&C for retained
placenta postpartum, and endometrial
ablation
OBG OBG
23 Abortion First Trimester*
OBG OBG
24 Abortion Second Trimester*
OBG OBG
25
* Separate proctoring required
OB/GYN REV Updated NOV 2015 Page 6 of 11
Contra Costa Regional Medical Center
Ob/Gyn Privileges Request Form
Requested Training/ Education
D= With Direct Supervision
C= With Consultation
U= Unrestricted
Obstetrics and Gynecology Current Competence Departments (s) NumberPrivilege Descriptions D/C/U Experience GrantedD= Denied P= Pending CNM=Criteria Not MetD FP or
OB/GYN N/A N/A
C FP or
OB/GYN 5 N/A
U FP or
OB/GYN 10
1 case in
last 2
yrs.
D FP or
OB/GYN N/A N/A
C FP or
OB/GYN 5 N/A
U FP or
OB/GYN 10 4 cases in
last 2 yrs.
D FP or
OB/GYN N/A N/A
C FP or
OB/GYN 20 N/A
U
FP or OB
/GYN &"U"
OBG 25
30 6 cases in
last 2 yrs.
D FP or
OB/GYN N/A N/A
C FP or
OB/GYN 5
2 cases
in last 2
yrs.
U FP or
OB/GYN 10
2 cases
in last 2
yrs.
D FP or
OB/GYN N/A N/A
C OBG 29A 5
2 cases
in last 2
yrs.
U OBG 29A 10
2 cases
in last 2
yrs.
OBG
29A
OBG OBG
29B
• For Diagnosis or
• Lysis of Adhesion or
• Removal of Foreign Body
Diagnostic Hysteroscopy
Operative Hysteroscopy*
• Myomectomy
• Polypectomy
• Removal of Uterine Septum
• Etc.
OBG
OBG OBG
26
Incision and Drainage Vaginal or
Vulvar Abscess or Cyst,
Hymenotomy, Colpotomy, Bartholin's
Gland Cystectomy, Vaginal Septum
Repair, Partial Vulvectomy, Cervical
Cerclage and Culdocentesis, etc.
OBG OBG
27 Cervical Cone Biopsy and, LEEP
OBG OBG
28
Basic Laparoscopy (Diagnostic,
Sterilization, Lysis of Adhesions)*
* Separate proctoring required
OB/GYN REV Updated NOV 2015 Page 7 of 11
Contra Costa Regional Medical Center
Ob/Gyn Privileges Request Form
Requested Training/ Education
D= With Direct Supervision
C= With Consultation
U= Unrestricted
Obstetrics and Gynecology Current Competence Departments (s) NumberPrivilege Descriptions D/C/U Experience GrantedD= Denied P= Pending CNM=Criteria Not MetD FP or
OB/GYN N/A N/A
C FP or
OB/GYN 20 N/A
U FP or
OB/GYN 30
2 cases
in last 2
yrs.
D FP or
OB/GYN N/A N/A
C
"U" Privileges
in OB /GYN 25
and 28
10 N/A
U
"U" Privileges
in OB /GYN 25
and 28
20
8 cases
in last 2
yrs.
D FP or
OB/GYN N/A N/A
C
FP or OB/GYN
& Laser
Training or
Laser Training
During
Residency
5 N/A
U
FP or OB/GYN
& Laser
Training or
Laser Training
During
Residency
10 1 case in
last 2 yrs.
C CA Lic.N/A N/A
FP or OB N/A
20 cases
in last 2
yrs.
CA Lic.50
20 cases
in last 2
yrs.
FAM
HOSP
OBG
OBG
34
Caring for and Discharging
uncomplicated Post Partum Patients
(for providers w/o delivery privileges).U
OBG OBG
33
Laser used for treatment of lower
female genital tract
OBG OBG
32
Advanced Laparoscopy
(Cystectomy, Salpingoophorectomy,
Appendectomy, Hysterectomy)*
OBG OBG
30
Laproscopic Assisted Vaginal
Hysterectomy
* Separate proctoring required
OB/GYN REV Updated NOV 2015 Page 8 of 11
Contra Costa Regional Medical Center
Ob/Gyn Privileges Request Form
Requested Training/ Education
D= With Direct Supervision
C= With Consultation
U= Unrestricted
Obstetrics and Gynecology Current Competence Departments (s) NumberPrivilege Descriptions D/C/U Experience GrantedD= Denied P= Pending CNM=Criteria Not MetD N/A N/A
C 10 2 cases in
last 2 yrs.
U 20 8 cases in
last 2 yrs.
C FP or
OB/GYN N/A N/A
U FP or
OB/GYN N/A
1 yr. in
last 4 yrs.
and 20 hrs
of
Primary
Care
CME in
last 2 yrs.
D FP or
OB/GYN N/A N/A
U FP or
OB/GYN 10
4 cases
in last 2
yrs.
D FP or
OB/GYN N/A N/A
U OB/GYN
20 or female
pelvic med.
&
reconstructive
surg. or
urogynecolog
y & pelvic
reconstructive
surg.
Fellowship
6 cases
in last 2
yrs.
OBG OBG
38
Advanced Urogynecology*:
Including sacral spinous fixation,
repeat repairs of vaginal prolapse, use
of mesh or other grafts, abdominal
sacrocolpoplexy, rectovaginal or
vesiculovaginal fistulas, etc.
OBG OBG
36
Outpatient Care of Women over 12
yrs. Old including Health Care
Maintenance (For OB/GYN Staff
without General Outpatient Privileges
MED1 & MED2).
OBG OBG
37
Basic Urogynecology*:
Including transvaginal and
transobdurator suburethral slings;
repair of cystocele, rectocele, and
entercele; perineoplasty; retropubic
urethropexy; and LeForte
colopocleisis
FAM
HOSP
OBG
OBG
35
CA Lic. and 4
hrs. training in
residency or
ultrasound
course
Basic 1st and 2nd Trimester
Ultrasound for Dating, Viability, and
Location of Pregnancy.
* Separate proctoring required
OB/GYN REV Updated NOV 2015 Page 9 of 11
Contra Costa Regional Medical Center
Ob/Gyn Privileges Request Form
Requested Training/ Education
D= With Direct Supervision
C= With Consultation
U= Unrestricted
Obstetrics and Gynecology Current Competence Departments (s) NumberPrivilege Descriptions D/C/U Experience GrantedD= Denied P= Pending CNM=Criteria Not MetD FP or Surg N/A N/A
C FP, Surg, or
OB/GYN 5
2 cases
in last 2
yrs.
U SURG or
OB/GYN 10
6 cases
in last 2
yrs.
D FP or
OB/GYN
Essure
Training
Course or
Equiv.
N/A
FP or
OB/GYN
3 cases,
Essure
Training
Course, &
OBG 29A
1 case in
last 2
yrs.
FP or
OB/GYN
Essure
Training
Course, &
OBG 29B
1 cases
in last 2
yrs.
OBG OBG
43 U CA Lic.10 N/A
FAM
HOSP
OBG
SGN
SGN
1 U CA Lic.20 N/A
D CA Lic.N/A N/A
U CA Lic.5
2 cases
in last 4
yrs.
D CA Lic.N/A N/A
U CA Lic.5
biopsies
2 cases
in last 4
yrs.
U
Bedside Testing in OB/GYN (POCT):
KOH & Saline Prep, Vaginal pH, Fern
Test & Amniotest, Pregnancy Test &
Urine Dipstick.
FAM
HOSP
IM OBG
PATH
SGN
SGN
7 FNA - Fine Needle Aspiration.
Surgical Assisting.
FAM
HOSP
IM OBG
PATH
SGN
SGN
26 Core Needle Biopsy.
OBG OBG
39 Small and Large Bowel Surgery
OBG OBG
40 Essure Privileges
* Separate proctoring required
OB/GYN REV Updated NOV 2015 Page 10 of 11
Contra Costa Regional Medical Center
Ob/Gyn Privileges Request Form
Requested Training/ Education
D= With Direct Supervision
C= With Consultation
U= Unrestricted
Obstetrics and Gynecology Current Competence Departments (s) NumberPrivilege Descriptions D/C/U Experience GrantedD= Denied P= Pending CNM=Criteria Not MetD FP, OB or
SURG N/A N/A
C FP, OB or
SURG 10 N/A
U FP, OB or
SURG 10
4 cases
in last 2
yrs.
_________________
I certify that I have reviewed the Contra Costa Regional Medical Center Privilege Criteria, and that
I meet the specified criteria for education/training, experience, and current competence for the
privileges that I have indicated above.
_________________
Date
Date
OBG
SUR
SUR
6 Cystoscopy*
___________________________________
Signature of Requesting Practitioner
___________________________________
Signature of Department Chairperson
* Separate proctoring required
OB/GYN REV Updated NOV 2015 Page 11 of 11