Thursday, March 22, 2018


Prescription Drug Abuse – What to Look For

By Ann Whitehead, JD, RN
Vice President of Risk Management & Patient Safety Cooperative of American Physicians, Inc.

The Centers for Disease Control and Prevention (CDC) has classified prescription drug abuse as an epidemic. A staggering statistic from the National Drug Abuse Institute reveals prescription drugs are the second most abused drug, behind marijuana, by seniors in high school. The CDC finds overdoses from prescription painkillers resulted in more deaths in 2010 than heroin and cocaine combined.1

Prescription drug abuse affects all age, race, gender, and socioeconomic classes. Here are two examples: the patient on an antidepressant prescribed by his psychiatrist was also taking a narcotic prescribed by an orthopedist. In a drug-induced haze, the man threw himself down a flight of stairs, breaking his neck; or the 83-year-old patient who recently came to the office for morphine who later tested positive for cocaine. Both patients create liability and treatment issues for their physicians. 

Although many types of prescription drugs are abused, there is currently a growing, deadly epidemic of prescription painkiller abuse. Nearly three out of four prescription drug overdoses are caused by prescription opioid painkillers. The U.S. Drug Enforcement Administration (DEA) and the California Department of Justice are aggressively prosecuting individuals who prescribe opioids illegally and those who operate “pill mills.” Physicians face challenges when trying to spot the patient who may be abusing prescription drugs or possibly improperly sharing them with others. The following are some suspicious behaviors that may raise the red flag. 

The patient may:

• Refuse to grant permission to obtain old records or communicate with previous physicians.
• Demonstrate reluctance to undergo comprehensive histories, physical examinations, or diagnostic testing, especially urine drug screenings.
• Request specific drugs (often because of the higher resale value of brand names).
• Profess multiple allergies to recommended medications.
• Resist certain treatment options.
• Threaten doctors or display anger during visits.
• Consistently target appointments at the end of the day or during off hours.
• Repeatedly lose prescriptions.
• Request escalation in dosages.
• Demonstrate noncompliance with prescription instructions.

A helpful tool for physicians is the “Opioid Overdose Toolkit: Information for Prescribers” recently released by the Substance Abuse and Mental Health Services Administration (SAMHSA).2 This guide offers tips on safe prescribing and preventing opioid overdose including: assessment, state drug monitoring programs, medication selection, prescription writing tips, use of naloxone, and deciding when to stop opioid.

Lastly, if you get a call from the DEA or local law enforcement, contact the CAP Hotline for assistance.

For more information about CAP, or to request additional information or risk management publications, please contact us at:, or call 800-356-5672. You can also visit our website at:

1 Centers for Disease Control and Prevention (CDC). CDC grand rounds: Prescription drug overdoses – A U.S. epidemic. MMWR Morb Mortal Wkly Rep.2012; 61(1):10-13.
2 Substance Abuse and Mental Health Services Administration. SAMHSA Opioid Overdose Toolkit” Information for Prescribers. HHS Publication No. (SMA) 13-4742. Rockville, MD: Substance Abuse and Mental Health Administration, 2013.

OCMA Selects Credential Protection LLC as Preferred Business Partner

Southern California tech company will assist OCMA physician members in battling and improving their online reviews and cyber reputation.

Irvine, Calif., Nov. 4, 2013 - The Orange County Medical Association is pleased to announce another benefit of membership. The OCMA has designated Credential Protection LLC (CP) to assist members in protecting and improving their online reputation.
OCMA members may receive complimentary consultations and discounted rates on every reputation and review package that Credential Protection offers.
The company was born from the mind of a practicing physician who received some negative reviews before opening his practice! Dr. Doan set out to create a solution for physicians to combat negative reviews without compromising their ethics or costing them their valuable time. "The solution to pollution is dilution." According to Andrew Doan, M.D., PhD, founder and managing partner of Credential Protection. "I chose the name because we spend so much time earning our credentials only to have them smeared online from a couple of angry people with an ax to grind. It seemed like happy patients wouldn't review me even though I handed out campaign cards in the office. So my staff came up with a creative and honest way to give our happy patients a voice online, and this is still the backbone of CP's system. It's really cool to watch it grow and help other physicians."
Credential Protection offers a unique and effective way to harvest reviews and get them online for your marketing benefit. CP also offers a suite of other services to help you challenge negative reviews on other sites, track your reputation and grab more spots in the SERP (search engine results pages) for your practice.
"No Black hat SEO or astroturfing here," said Daniel Hunt, CEO of Credential Protection. "We have trademarked the Verified Review®. The only certifiably authentic review from your patients that can be digitized and optimized to the front page of the search engines. Many companies offer to place reviews out there on the web for you, but we actually oversee a medical review site with over 20,000 unique visitors a month. Moreover we keep a physical copy of each review our doctors send us. Every review must be signed by the patient and legible to be verified.  Every year we add about 12,000 of these reviews to our website... that's a lot of filing."

The strategic business partnership with Credential Protection reinforces OCMA's commitment to bring added value to its members by aligning with companies who offer business practice expertise, allowing physicians to focus their attention on patient care.

About Credential Protection
Credential Protection is a young tech company based in Temecula, California enjoying its third year in business.  It was awarded a top 5 spot in the Vator Splash Los Angeles competition for tech start up companies in 2012. Credential Protection's SEO team is Google Adwords and Analytics certified as of June 2013.  Its designers are Adobe Certified (ACA & ACE) in Photoshop, Illustrator and Indesign.

ATTN OCMA Members: Amendment to Bylaws for Review

Dear OCMA Membership,



The Bylaws Committee of the Orange County Medical Association has been meeting over the last year and a half for the purpose of carefully reviewing and updating the organization's by-lawsThe revisions have been approved by the Board of Directors and now need to be approved by the general membership. Therefore, for the next two months (November and December 2013) you may review the revised Bylaws by clicking here. These proposed changes will be available for review until December 31, 2013.

Please submit any comments in writing via email to or mail to 17322 Murphy Avenue, Irvine, CA 92614 and indicate whether you approve the changes.

OCMA Member Profile: Theodore Benderev, M.D.

World Vasectomy Day (WVD), which took place on Friday, October 18, 2013, is the largest male-oriented global family planning event. The goal was to perform 1,000 vasectomies by at least 100 doctors across 25 countries in 24 hours. 


OCMA member Theodore Benderev, M.D., founder of, led the charge for World Vasectomy Day in Southern California. In honor of this international day, Dr. Benderev has submitted an educational piece on the No-Needle No-Scalpel Vasectomy (below).

The No-Needle No-Scalpel Vasectomy

"As Good as it Gets"

About Vasectomy Surgery 
The No-Scalpel Vasectomy was brought over from China in 1987. A procedure that was initially thought to be "gimmicky", the minimally invasive technique with minimal manipulation of tissue via special instrumentation was studied and found to indeed reduce the risk of bleeding and infection. In the hands of experienced surgeons, this sometimes challenging surgical procedure can be done through a 1 cm opening usually in less than 15 minutes. Though vasectomy has been the number one procedure performed on men in the U.S. (500,000/yr), there are twice as many tubal ligations done. Not surprising, nightmare stories of inadequate anesthesia have kept more men from taking the lead in permanent sterilization. 
That was so until approximately 10 years ago when a high powered anesthetic jet spray was found to provide superior deep local anesthesia without a needle - hence, a virtually pain free experience for the patient. 

As with nearly all surgical procedures, experience of the surgeon correlates with success. The smoothness and confidence of the surgeon is particularly important when men are awake and someone is working on a part of the body that men are hard-wired to protect. Combine the anxiety of the man with a Cremaster muscle that pulls the testicles out of harm's way (think George Castanza in Seinfeld) and within easy reach of the surgeon and one understands that the words "gentle and efficient technique" have a special meaning with vasectomies.
What issues must be considered? 
Before each vasectomy, there is a consultation session with the patient and, preferably, with their partner to fully discuss the pros and cons of a vasectomy. The great benefit of a vasectomy is that the only better form of contraception is abstinence. Patients are thrilled with the freedom from contraception - fondly called "The Bedroom Bonus". The risks, though uncommon in experienced hands, are bleeding, infection and pain.
What is the patient to expect post-operatively?

Post operative pain is so uncommon that patients frequently forget that they have limitations and must remember to restrict their activity for the first few days after the procedure. In general, when patients have the procedure done on a Friday, they usually return to work on Monday. By the beginning of the second week, they can usually return to normal activity, except that sex without contraception must wait until at least one negative semen analysis. 
What if there is a change of mind?

While vasectomies can be reversed in most cases during the first few years postoperatively, assurance must be obtained by the surgeon in the pre-operative consultation that the couple is in full agreement for permanent contraception. Despite excellent vasectomy reversal surgical technique and artificial reproductive technologies, in the 5-10% of couples who choose reversal later, there are cases when pregnancy may be difficult to achieve. 

 Dr. Theodore Benderev founded 17 years ago and was the first known urologist to perform the No-Needle No-Scalpel Vasectomy in California. Dr. Benderev has performed over 2000 of these procedures. In addition, he has developed numerous surgical techniques and technologies with over 35 patents in various areas of urology. A board-certified urologist, he practices primarily in Mission Viejo and is a Clinical Professor in the Department of Urology at UCI.  Besides his focus on vasectomies, Dr Benderev is Board sub-certified in Female Pelvic Medicine and Reconstructive Surgery and is Medical Director of the Incontinence and Pelvic Support Institute.
 Dr. Benderev is a graduate of University of Maryland. He completed his urology residency training at Northwestern University in Chicago to prepare for an academic career. After a period as faculty member at UCI, he established a specialized center in south Orange County that to this day retains that special personal attention from each of his specially trained staff. 
A resident of Orange County since 1985, Dr. Benderev raised his family here and enjoys hiking and biking for leisure. When not on call, he looks forward to working about his cabin in Mariposa. 

Please contact Dr. Benderev at 888-VASECTOMY (or 949-364-4400) for any further information

OCMA continues to profile and highlight our valued members. These profiles provide a forum for physicians to share information among their colleagues. It is important for members to be aware of one another. Maintaining a close community of engaged physicians is beneficial for both OCMA and the medical community.  This is open to any current OCMA member. If you are interested in submitting an article and profile, please contact: 
Ashley Buchwald, OCMA Marketing/Communications Coordinator at or (949) 398-8100 ext. 105. You may also contact Holly Appelbaum, Managing Editor, OCMA Bulletin, at or (949) 398-8100 ext 106.

National Prescription Drug Take-Back Day is This Saturday

It's Time to Get Rid of Expired, Unused and Unwanted Medications

The next National Prescription Drug Take-Back Day is Saturday, October 26th from 10:00 am - 2:00 pm.  It is sponsored by the U.S. Drug Enforcement Administration (DEA) in an effort to help prevent prescription drug abuse and diversion. The majority of abused prescription drugs are obtained from family and friends, including from the home medicine cabinet.
This service is free and anonymous - encourage your patients to dispose of their unwanted medications on Saturday, October 26th.  
There are 30 collection sites in Orange County: 

Aliso Viejo



Buena Park

Corona Del Mar

Costa Mesa


Dana Point

Fountain Valley



Garden Grove

Huntington Beach


La Habra

Laguna Beach

Laguna Hills

Laguna Niguel

Lake Forest

Mission Viejo

Newport Beach





San Clemente

San Juan Capistrano

Santa Ana

Seal Beach



Yorba Linda

To find the location of a Take Back collection site near you visit the DEA website at or call (800) 882-9539.

CMA launches Covered California Provider Education Program

The California Medical Association (CMA) and the CMA Foundation have been awarded a $1.5 million grant from Covered California, the state's new health benefit exchange. The grant application was submitted in partnership with the Latino Physicians of California, the American Academy of Pediatrics and a number of CMA's component medical societies.
The grant is being used to establish the CMA's "California Health Benefit Exchange Outreach and Education Program." The goal is to help medical professionals across the state and their health care teams to educate their patients about the new coverage options available through Covered California and the financial assistance available to help pay for them. The program will focus more intensive outreach to physicians working in communities with a large number of consumers eligible for Covered California.
Physicians are powerful and effective messengers to deliver information to patients. We will be working to educate not only physicians, but also the office and health care teams that support physician practices. We will work with registered nurses, medical assistants, nurse practitioners, physician assistants, office managers and other physician practice staff in the targeted geographic areas that have the highest number of newly eligible exchange enrollees. All staff working in a practice or clinic will have an opportunity to learn more about Covered California insurance plans to fully utilize their skills and potential in educating patients about exchange eligibility and enrollment.

Regional Outreach

The California Health Benefit Exchange Outreach and Education Program will have four regional Provider Educators, with one assigned to each of the following regions: 1) Fresno, Kern, Tulare and Kings Counties; 2) San Diego, Riverside and San Bernardino Counties; 3) Los Angeles and Orange Counties; and 4) San Joaquin, Santa Clara, Alameda and Contra Costa Counties. For those practices in regions not listed, CMA Foundation staff will provide outreach and education. 

Educational Strategy

The educational strategy will be a multifaceted approach that factors in the different physician practice environments and incorporates multiple strategies to communicate with the physicians and their health care teams. The approach will incorporate group learning sessions, focus groups, educational print medium and one-on-one "touches" supported by newsletters, webinars and e-communication.
We will develop learning communities of grantees, sub-grantees and other interested partners to share challenges and best practices and to help us use resources as effectively as possible.
Our strategy will also include the following: 

  • Identify the gaps in physician knowledge about the exchange and design educational messaging to address those gaps.
  • Create a master list of existing regularly held meetings of the association members and partners so that we can utilize the already built network and standing meeting schedule
  • Establish lesson plans to ensure consistency in presentations.
  • Identify physician champions to be trained to educate their peers and other health care professionals and staff.
  • Establish a Physician/Health Care Worker Subcommittee to provide message testing, guidance and input on presentations and one-on-one education.
  • Make resources available through the physician practice to patients, helping them understand Covered California.
  • Develop a physician toolkit comprised of essential outreach materials for physician champions and their health care teams to give to patients.
  • Work with hospitals and health plans to book training and education sessions in hospital grand rounds, regularly scheduled patient-support focused meetings and medical staff meetings.


For the full Covered California Grant Newsletter, click here.

For a list of Health Benefit Exchange resources available to physicians, click here.

All resources are available on the CMA website at

OCMA members may contact Physician Advocate Mitzi Young with questions about Covered California and the Health Benefits Exchange at (888) 236-0267 or

Call to Action from CalOptima Regarding Duals Demonstration

Dear Orange County Physicians:

CalOptima is measuring physician interest in a direct contract model for the dual-eligible demonstration that will launch in Orange County in April, 2014.  If there are not enough physicians interested in the direct contract model, it may be difficult for the CalOptima board of directors to support the model.  See the "Call to Action" below that CalOptima issued to the physician community.  As always, if you have any questions or comments, please contact us.


Thomas C. Kockinis, MD                                                   Robert McCann, MHA

President                                                                           CEO / Executive Director


Thinking About the Duals Demonstration? 
We Want to Hear From You!

The time for you to respond is now! The CalOptima Board of Directors is exploring the interest level of a direct contracting option with CalOptima for Cal MediConnect (also called the Duals Demonstration). Based on the interest level of the Orange County physician community, the CalOptima Board may grant authority to make this new option available.
If approved, the direct network will be based on managed care principles, providing support for your patients who may be difficult to manage through: coordinated care, case management, physical and mental health coordination, as well as home and community-based support services.
We need to hear from physicians who are interested in contracting directly with CalOptima, as the window for measuring interest is narrowing. In order for the model to be viable, a substantial number of physicians need to indicate their desire to participate. Currently, we do not have enough physicians displaying an interest to proceed with this option.
Orange County is one of eight California counties selected to participate in Cal  MediConnect. With Cal MediConnect, Medicare patients who are 21 years of age or older receiving full Medi-Cal benefits will have the option to transition from fee-for-service Medicare to this Duals Demonstration no sooner than April 1, 2014.
If you are a provider interested in directly contracting with CalOptima for this demonstration, please contact our Provider Relations department at 714-246-8600 or to let your voice be heard and receive additional information about your contracting options. 


"Risk Tip" from The Doctors Company - Be Aware of Risks for BRCA-Based Breast Cancer

Avoid Missed or Delayed Diagnosis by Being Aware of Risks for BRCA-Based Breast Cancer

Recent news coverage has brought BRCA gene-based breast cancer into the spotlight. Actress Angelina Jolie's decision to get a preventive double mastectomy after testing positive for the BRCA gene may cause patients to ask physicians if they are at risk. Physicians should be aware of the risk factors for BRCA gene-based cancer in order to identify those who need testing and to avoid delayed or missed diagnosis.
A recent malpractice case highlights the failure of missing an early diagnosis. A 33-year-old woman had two female relatives, including her mother, who had breast cancer in their forties. At 31, she began getting annual screening mammograms, which showed dense breasts. She complained of a small palpable mass. However, no mass was seen on a mammogram, and the diagnosis was fibrocystic changes. No additional tests were ordered. Within six months, the mass was enlarging, and she was diagnosed with infiltrating ductal cancer that had advanced from a Stage I to a Stage III. Based on her history, she should have been tested for the BRCA mutation and given various treatment options. Additionally, no ultrasounds or MRIs were done, which possibly could have detected the cancer at an earlier treatable stage.
A woman's risk of developing breast and/or ovarian cancer greatly increases if she inherits a BRCA1 or BRCA2 gene mutation. Widespread screening is not required because together these mutations account for only 5-10 percent of breast cancers. Those with the BRCA1 mutation have a 55-65 percent chance of developing breast cancer by age 70, and those with the BRCA2 mutation have a 45 percent chance. Women have about a 2 percent chance of getting ovarian cancer, but if they have a BRCA2 mutation, that risk increases to 40-60 percent.
Physicians should watch for the following BRCA mutation risk factors and discuss genetic testing with patients at risk:

  • Maternal or paternal blood relatives with breast cancer diagnosed before the age of 50.
  • Certain cancers in a patient's family, such as pancreatic, colon, or thyroid.
  • Both breast and ovarian cancer in a patient's family, especially in one individual.
  • Women in a patient's family with cancer in both breasts.
  • Patient with Ashkenazi Jewish heritage.
  • A male in the patient's family with breast cancer.     
  • Relative with BRCA1 or BRCA2 mutation.

If the patient does test positive for the BRCA mutation, it is essential to remind her that this does not indicate she will get cancer. Patients can reduce risks of cancer with prophylactic surgery, hormonal treatment, and lifestyle changes.
Contributed by The Doctors Company. For more patient safety articles and practice tips, visit

ALERT: You May have Automatically been Contracted into an Exchange Plan

Open enrollment began October 1st for Covered California (California's Health Benefits Exchange). The OCMA has received many calls from members confused as to whether they are contracted to see these patients. 

Many doctors were automatically put into contracts, and are unaware that they are on the plan directory for exchange plans with payers. These physicians have to opt out of that part of their contract if they do not wish to participate in the Exchange. The easiest way to confirm your participation is by calling the provider relationship department of the three plans in Orange County who are contracted to see Exchange patients.  

  • Anthem Blue Cross:  (855) 238-0095
  • Blue Shield Of California:  (800) 258-3091
  • HealthNet:  (800) 641-7761

For additional questions about Covered California or any practice management issue, OCMA / CMA members may call OCMA Physician Advocate Mitzi Young directly at (888) 236-0267 or

OCMA Internist and Addiction Specialist Receives Gary Nye, MD Award

Max A. Schneider, M.D., an Orange County internist and addiction specialist, was given the Dr. Gary Nye Award at the 2013 at the California Medical Association (CMA) House of Delegates held this weekend in Anaheim. The award is given annually to a CMA member physician who has made significant contributions toward improving physician health and wellness.

Dr. Schneider for over 40 years has helped educate medical students, residents and physicians on addiction as a disease and the specific risks it poses for physicians. 

He was instrumental in establishing addiction medicine as part of the medical school curriculum at University of California, Irvine School of Medicine.

Dr. Schneider helped establish the concept of physician well-being committees and has served on the well-being committees for the Orange County Medical Association, St. Joseph’s Hospital, Children’s Hospital of Orange County and Chapman Hospital.

A fellow and past president of the American Society of Addiction Medicine, he also is past chairman of the Board of Directors of the National Council on Alcoholism and Drug Dependence and has served as a consultant to the Drug and Alcohol Advisory Committee of the U.S. Food and Drug Administration.

Dr. Schneider graduated from the University of Buffalo, School of Medicine in 1949. He practiced internal medicine in his native Buffalo for 11 years until 1964 and since 1964 has practiced in Orange County.

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