Board of Directors Agenda Packet

BOARD OF DIRECTORS AGENDA PACKET

June 12, 2017

BOARD OF DIRECTORS

Dara Czerwonka, MSW, Chair Jeffrey D. Griffith, EMT-P, Vice Chair Raymond McCune, RN, Secretary Jerry Kaufman, PTMA, Treasurer Hans Christian M. Sison, LVN, Director Douglas Moir, MD, Director Joy Gorzeman, RN, MSN, MBA, Director

Robert A. Hemker, President and CEO

Regular meetings of the Board of Directors are usually held on the second Monday of each month at 6:30 p.m., unless indicated otherwise. For an agenda, locations or further information call (760) 740-6375, or visit our website at www.palomarhealth.org

MISSION STATEMENT

The Mission of Palomar Health is to: Heal, comfort, and promote health in the communities we serve

VISION STATEMENT

Palomar Health will be the health system of choice for patients, physicians and employees, recognized nationally for the highest quality of clinical care and access to comprehensive services

VALUES

Compassion - Providing comfort and care Excellence - Aspiring to be the best Integrity - Doing the right thing for the right reason Service - Serving others and our community Teamwork - Working together toward shared goals Trust - Delivering on promises

Affiliated Entities

*Palomar Medical Center Escondido * Palomar Medical Center Downtown Escondido * Palomar Medical Center Poway *Palomar Health Foundation * Palomar Home Care * Arch Health Partners *Palomar Health Development, Inc.* North San Diego County Health Facilities Financing Authority* *San Marcos Ambulatory Care Center * Villa Pomerado * Palomar Health Source*

POSTED TUESDAY, ` JUNE 6, 2017

BOARD OF DIRECTORS MEETING AGENDA Monday, June 12, 2017 Palomar Health Downtown Campus Special Start Time - 6:00 p.m. Graybill Auditorium 5:30 Dinner buffet for board members and invited guests 555 East Valley Parkway Escondido, CA 92025

PLEASE TURN OFF CELL PHONES OR SET TO SILENT MODE UPON ENTERING MEETING ROOM Form A Time Page Target I. CALL TO ORDER 6:00 II. ESTABLISHMENT OF QUORUM 2 6:02 III. ADJOURNMENT TO CLOSED SESSION 2 6:04 A. Pursuant to California Government Code Subdivision (a) of Section 54956.9 30 6:34 Conference with Legal Counsel – Existing Litigation - Quarterly Claims/Risk Management Report IV. RE-ADJOURNMENT TO OPEN SESSION 1 6:35 V. ACTION RESULTING FROM CLOSED SESSION, IF ANY - 3 6:38 VI. OPENING CEREMONY 2 6:40 A. Pledge of Allegiance VII. PUBLIC COMMENTS1 15 6:55 VIII. * MINUTES (ADD A) 3 6:58 A. Special Board Education Session - May 8, 2017 (Pp17-27) 1 B. Board of Director's Meeting - May 8, 2017 (Pp28-35) 2 IX. * APPROVAL OF AGENDA to accept the Consent Items as listed (ADD B) 5 7:03 A. Approval of Revolving, Patient Refund & Payroll Fund Disbursements – April 2017 (P37) 1. Accounts Payable Invoices $54,486,140.00 2. Net Payroll $15,062,556.00 Total $69,548,696.00 B. April 2017 and YTD 2017 Board Financial Report (Pp38-53) 3 C. Executed, Budgeted, Routine Physician Agreements (Pp54-58) 4 X. PATIENT FIRST A. Patient First - Tina Pope, District Manager Service Excellence 5 7:08 XI. PRESENTATIONS (ADD C) A. Partnership for a Healthier America & Palomar Health - Jim Metzger, Director Hospitality 10 7:18 Services (Pp60-66) XII. REPORTS (ADD D) A. Medical Staffs *1. Palomar Medical Center Escondido (PMCE) - Franklin Martin, M.D. 5 7:23 A. Credentialing and Reappointments - PMCE (Pp68-81) 5 B. Modification to the Department of Radiology Privilege Checklist – PMCE 6 (Redline pages 82-95) (Clean pages 96-109) C. Modification to the Cardiothoracic Surgery Physician Assistant Checklist – PMCE 7 (Redline pages 110-113) (Clean pages 114-117) D. Modification to the Corporate Health Nurse Practitioner Checklist – PMCE / PMCP 8 (Redline pages 118-122) (Clean pages 123-127) E. Modification to the Emergency Medicine Physician Assistant Checklist – 9 PMCE / PMCP (Redline pages 128-132) (Clean pages 133-137) Form A Medical Staffs (continued) Time Page Target 10 F. Modification to the Acute Care Physician Assistant Checklist – PMCE / PMCP (Redline pages 138-141) (Clean pages 142-145) G. Modification to the Orthopaedic Surgery Physician Assistant Checklist - 11 PMCE / PMCP (Redline pages 146-150) (Clean pages 151-155) H. Modification to the Radiology Physician Assistant Checklist - PMCE / PMCP 12 (Redline pages 156-158) (Clean pages 159-161) 13 *2. Palomar Medical Center Poway (PMCP) - Charles Callery, M.D. 5 7:28 A. Credentialing and Reappointments (Pp162-163) 14 B. Modification to the Department of Radiology Privilege Checklist – PMCP (Redline pages 164-166) (Clean pages 167-169) B. Administrative 1. Chair of the Palomar Health Foundation - Tom Silberg 5 7:33 A. Grateful Cardiovascular Patient Story Video 5 7:38 2. Chair of the Board - Dara Czerwonka 5 7:43 3. President and CEO - Robert Hemker 10 7:53 A. Emergency Loan Fund Procedure - Lucidoc 10548 (ADD E) (Redline pages 171-180) (Clean pages 181-190) B. Palomar Medical Center Downtown Campus Sale XIII. INFORMATION ITEMS A. ACHD Update Report for May 2017 (separate attachment or handout based on availability) XIV. * APPROVAL OF BYLAWS, CHARTERS, POLICIES, RESOLUTIONS (ADD F) 5 15 7:58 (Discussion by exception) Item Type Board Committee Action A. Media Relations Policy Community Relations Approval (Redline pages 192-193) (Clean pages194-195 ) XV. COMMITTEE REPORTS (ADD G) 10 8:08 A. Audit & Compliance Committee - Dara Czerwonka, Committee Chair (P197) B. Community Relations Committee - Doug Moir, Committee Chair (P198) C. Finance Committee - Jerry Kaufman, Committee Chair (P199) D. Governance Committee - Jeff Griffith, Committee Chair (no meeting in May) E. Human Resources Committee - Hans Sison, Committee Chair (no meeting in May) F. Quality Review Committee - Joy Gorzeman, Committee Chair (Pp200-202) G. Strategic & Facilities Planning Committee - Ray McCune, Committee Chair (P203) XVI. BOARD MEMBER COMMENTS/AGENDA ITEMS FOR NEXT MONTH 5 8:13 XVII. ADJOURNMENT TO CLOSED SESSION 2 8:15 A. Pursuant to Health & Safety Code §32106 – Report Involving Trade Secret Concerns Potential New Program (estimated disclosure date: June 30, 2017) 30 8:45 B. Pursuant to Health & Safety Code §32106 – Report Involving Trade Secret Concerns Potential New Program (estimated disclosure date: December, 2017) 20 9:05 XVIII.RE-ADJOURNMENT TO OPEN SESSION 1 9:06 XIX. ACTION RESULTING FROM CLOSED SESSION, IF ANY 3 9:09 1 XX. PUBLIC COMMENTS 15 9:24 XXI. FINAL ADJOURNMENT 1 9:25

"In accordance with the ADA (Americans with Disabilities Act) please notify us at 760-740-6375 48 hours prior to the meeting so we may provide reasonable accommodations"

* Asterisks indicate anticipated action. Action is not limited to those designated items.

1 5 minutes allowed per speaker with a cumulative total of 15 minutes per group. For further details & policy, see Request for Public Comment notices available in meeting room. Minutes Special Board Education Session Monday, May 8, 2017

TO: Board of Directors

MEETING DATE: Monday, June 12, 2017

FROM: Debbie Hollick, Board Assistant

Background: The minutes from the Monday, May 8, 2017 Special Board Education Session are respectfully submitted for approval.

Budget Impact: N/A

Staff Recommendation: Recommendation to approve the Monday, May 8, 2017 Special Board Education Session minutes.

Committee Questions:

COMMITTEE RECOMMENDATION:

Motion:

Individual Action:

Information:

Required Time:

1 Minutes Board of Director’s Meeting Monday, May 8, 2017

TO: Board of Directors

MEETING DATE: Monday, June 12, 2017

FROM: Debbie Hollick, Board Assistant

Background: The minutes from the Monday, May 8, 2017 Board of Director’s meeting are respectfully submitted for approval.

Budget Impact: N/A

Staff Recommendation: Recommendation to approve the Monday, May 8, 2017 Board of Director’s meeting minutes.

Committee Questions:

COMMITTEE RECOMMENDATION:

Motion:

Individual Action:

Information:

Required Time:

2 April 2017 & YTD FY2017 Financial Report

TO: Board of Directors

MEETING DATE: Monday, June 12, 2017

FROM: Board Finance Committee Monday, June 5, 2017

BY: Jerry Kaufman, PT MA Chair, Board Finance Committee

Background: The Board Financial Report (unaudited) for April 2017 and YTD FY2017 (per pages 38 to 53) is submitted for the Board’s approval.

Budget Impact: N/A

Staff Recommendation: Approval

Committee Questions:

COMMITTEE RECOMMENDATION: The Board Finance Committee recommends approval of the Board Financial Report (unaudited) for April 2017 and YTD FY2017. Approval recommended 5 to 0 by the Committee; Board Members 2 to 0. Absent: 1 Board Member

Motion: X

Individual Action:

Information:

Required Time:

Form A - Financial Report 3 Executed, Budgeted, Routine Physician Agreements Board Summary Report

TO: Board of Directors MEETING DATE: Monday, June 12, 2017 FROM: Board Finance Committee Monday, June 5, 2017 BY: Jerry Kaufman, PT MA Chair, Board Finance Committee Background: The following Executed, Budgeted, Routine Physician Agreements became effective as noted below:

PHYSICIAN/GROUP TYPE OF AGREEMENT March 2017  Medical Director Informatics  Bret Ginther, MD Program – PMC Escondido May 2017  Medical Director for Medical  Amanda Caparso, MD Oncology and Medical Surgery (8E and 9E) – PMC Escondido

The standard Form A and Abstract Table for each are attached.

Staff Recommendation: Approval

COMMITTEE RECOMMENDATION: The Board Finance Committee recommends approval of the Executed, Budgeted, Routine Physician Agreements as presented. Approval recommended 5 to 0 by the Committee; Board members 2 to 0; Absent 1 Board Member

Motion: X

Individual Action:

Information:

Required Time:

4 Palomar Medical Center Escondido Medical Staff Credentialing Recommendations

TO: Board of Directors

MEETING DATE: June 12, 2017

FROM: Frank Martin, M.D., Chief of Staff, Palomar Medical Center Escondido

Background: Credentialing Recommendations from the Medical Executive Committee of Palomar Medical Center Escondido.

Budget Impact: None

Staff Recommendation:

Committee Questions:

COMMITTEE RECOMMENDATION: Approval

Motion:X

Individual Action:

Information:

Required Time:

Form A 5 Palomar Medical Center Escondido Medical Staff Privilege Checklist

TO: Board of Directors

MEETING DATE: June 12, 2017

FROM: Frank Martin, M.D., Chief of Staff Palomar Medical Center Escondido

Background: The Radiology Clinical Privilege checklist was modified to reflect changes in the number of required examinations for maintaining privileges in Cardiac CT Angiography and Acute Stroke Therapy.

Budget Impact: None

Staff Recommendation: Recommend Approval

Committee Questions:

COMMITTEE RECOMMENDATION:

Motion:X

Individual Action:

Information:

Required Time:

Form A 6 Palomar Medical Center Escondido Allied Health Professional Privilege Checklist

TO: Board of Directors

MEETING DATE: June 12, 2017

FROM: Frank Martin, M.D., Chief of Staff Palomar Medical Center Escondido

Background: The Physician Assistant Clinical Privileges – Cardiothoracic Surgery was modified to reflect the new facility name. No other changes were made.

Budget Impact: None

Staff Recommendation: Recommend Approval

Committee Questions:

COMMITTEE RECOMMENDATION:

Motion:X

Individual Action:

Information:

Required Time:

Form A 7 Palomar Medical Center Escondido/Palomar Medical Center Poway Allied Health Professional Privilege Checklist

TO: Board of Directors

MEETING DATE: June 12, 2017

FROM: Charles Callery, M.D., Chief of Staff Palomar Medical Center Poway Frank Martin, M.D., Chief of Staff Palomar Medical Center Escondido

Background: Modification of the Nurse Practitioner (NP) Clinical Privileges – Corporate Health to remove the requirement for a Masters Degree in Nursing, as this is included in the requirement for certification as a Nurse Practitioner, to increase the timeframe within which certification may be obtained, and to update facility titles.

Budget Impact: None

Staff Recommendation:

Committee Questions:

COMMITTEE RECOMMENDATION: Approval

Motion:X

Individual Action:

Information:

Required Time:

Form A 8 Palomar Medical Center Escondido/Palomar Medical Center Poway Allied Health Professional Privilege Checklist

TO: Board of Directors

MEETING DATE: June 12, 2017

FROM: Charles Callery, M.D., Chief of Staff Palomar Medical Center Poway Frank Martin, M.D., Chief of Staff Palomar Medical Center Escondido

Background: Modification of the Physician Assistant Clinical Privileges – Emergency Medicine to update facility titles. No other changes were made.

Budget Impact: None

Staff Recommendation:

Committee Questions:

COMMITTEE RECOMMENDATION: Approval

Motion:X

Individual Action:

Information:

Required Time:

Form A 9 Palomar Medical Center Escondido/Palomar Medical Center Poway Allied Health Professional Privilege Checklist

TO: Board of Directors

MEETING DATE: June 12, 2017

FROM: Charles Callery, M.D., Chief of Staff Palomar Medical Center Poway Frank Martin, M.D., Chief of Staff Palomar Medical Center Escondido

Background: Modification of the Physician Assistant Clinical Privileges – Acute Care to update facility titles. No other changes were made.

Budget Impact: None

Staff Recommendation:

Committee Questions:

COMMITTEE RECOMMENDATION: Approval

Motion:X

Individual Action:

Information:

Required Time:

Form A 10 Palomar Medical Center Escondido/Palomar Medical Center Poway Allied Health Professional Privilege Checklist

TO: Board of Directors

MEETING DATE: June 12, 2017

FROM: Charles Callery, M.D., Chief of Staff Palomar Medical Center Poway Frank Martin, M.D., Chief of Staff Palomar Medical Center Escondido

Background: Modification of the Physician Assistant Clinical Privileges – Orthopaedic Surgery to update facility titles. No other changes were made.

Budget Impact: None

Staff Recommendation:

Committee Questions:

COMMITTEE RECOMMENDATION: Approval

Motion:X

Individual Action:

Information:

Required Time:

Form A 11 Palomar Medical Center Escondido/Palomar Medical Center Poway Allied Health Professional Privilege Checklist

TO: Board of Directors

MEETING DATE: June 12, 2017

FROM: Charles Callery, M.D., Chief of Staff Palomar Medical Center Poway Frank Martin, M.D., Chief of Staff Palomar Medical Center Escondido

Background: Modification of the Department of Radiology Physician Assistant Delineation of Duties to update facility titles. No other changes were made.

Budget Impact: None

Staff Recommendation:

Committee Questions:

COMMITTEE RECOMMENDATION: Approval

Motion:X

Individual Action:

Information:

Required Time:

Form A 12 13 14 Media Relations Policy (Lucidoc # 21789)

TO: Palomar Health Board of Directors

MEETING DATE: Monday, June 12, 2017

FROM: Doug Moir, MD, Chair Board Community Relations Committee

BACKGROUND: The Board Community Relations Committee reviewed and approved updates to the Palomar Health Media Relations Policy - Lucidoc #21789.

BUDGET IMPACT: None

STAFF RECOMMENDATION:

Committee Recommendation: The Board Community Relations Committee recommends approval of the Media Relations Policy Lucidoc #21789. Committee approved policy with changes with a 3-0 vote, 2 of which were board members.

Motion:

Individual Action:

Information:

ADDENDUM A

SPECIAL BOARD OF DIRECTORS EDUCATION SESSION MINUTES – MONDAY,MAY 8, 2017

AGENDA ITEM CONCLUSION /ACTION FOLLOW UP / RESPONSIBLE PARTY x DISCUSSION

I. CALL TO ORDER x The meeting – held in Conference Room E at Palomar Medical Center Poway, 15615 Pomerado Road, Poway, CA 92064, was called to order at 5:36 p.m. by Board Chair Dara Czerwonka

ESTABLISHMENT OF QUORUM

Quorum comprised of Directors Czerwonka, Griffith, Kaufman, McCune, Sison, Gorzeman, Moir Excused Absences: None

NOTICE OF MEETING

Notice of Meeting was posted at the Palomar Health Administrative Office on Tuesday, May 2, 2017 which is consistent with legal requirements.

II. PUBLIC COMMENTS

There were no public comments

III. BOARD EDUCATION SESSION Information only

A. Guiding Principles

Utilizing the attached presentation, Vice President Culture and Talent Planning Leslie Solomon provided a presentation in on Guiding Principles, highlights of which included:

X Reviewed the concept of Guiding Principles as a decision making tool and as a way to build board culture

X Discussed some of the principles that are key for Palomar Health based on our values

X Identified next steps including: Using survey monkey to finalize a set of principles and how to use them

IV. PUBLIC COMMENTS

There were no public comments

V.ADJOURNMENT

171 SPECIAL BOARD OF DIRECTORS EDUCATION SESSION MINUTES – MONDAY,MAY 8, 2017

AGENDA ITEM CONCLUSION /ACTION FOLLOW UP / RESPONSIBLE PARTY x DISCUSSION

The meeting was adjourned at 6:25 p.m. by Board Chair Czerwonka

SIGNATURES:

BOARD SECRETARY Raymond McCune, R.N.

BOARD ASSISTANT Debbie Hollick

182 Passion. People. Purpose.TM

Guiding Principles

Leslie Solomon Vice President, Culture and Talent Planning

May 8, 2017

1 1

19 Objectives

• Identify guiding principles that reflect organization values • Understand how to use guiding principles as a bridge between strategy and operations

20 Guiding Principles

• Guiding Principles describe the organization’s beliefs and philosophy ...The principles should guide what the organization does, why it does it and how. • Any principles or precepts that guide an organization throughout its life in all circumstances, irrespective of changes in its goals, strategies, type of work, or the top management

21 Building Partnership

Building partnership and shared thinking with hospital leadership

Clarifying how we translate strategy to operations

Focusing Board at Vision and Intent and Hospital Leadership at Action and Executions

22 Culture Model

Building culture at the level of the values we live and demonstrate

23 Palomar Health Values

24 Sample Culture Building Principles

• Affirm the right to health for the patient and all residents of the health district. • Patient quality outcomes are the most important consideration • Everything we do will be in the best interest of the patient; safety and quality are why we exist • Nursing/patient care philosophy is established/practiced system wide with reduced variation

25 Decisions Aligned with Mission Heal, Comfort and Promote Health in the Communities we Serve

Population Health Acute Care Disease Management Population Health Management Active but short-term A system of The health outcomes of a Comprehensive and treatment for a coordinated intervention and group of individuals, including authoritative strategies severe injury or communication for populations the distribution of such for improving the episode of illness, an with conditions in which outcomes within the group". systems and policies urgent medical patient self-care efforts are World Health that affect health care condition, or during significant”. It may reduce Organization (WHO) defined quality, access, and recovery from surgery healthcare costs and/or health in 1946 as "a state of outcomes, and that improve quality of life for complete physical, mental, ultimately improve the individuals by preventing or and social well-being and not health of an entire minimizing the effects of disease, merely the absence of disease population. usually a chronic condition, or infirmity. through knowledge, skills,

enabling a sense of control over life (despite symptoms of disease) and integrative care.

26 Sample Mission Sustaining Questions

Sample Questions • How does this build trust of the whole team? • How is this a fair deal for all participants in the system – all concerned? • How does this achieve strategy? • How does this make us more accountable? • How does this optimize span of control? • How does this action maintain and promote nursing/caregiving integrity? • What are the impacts to creating/preserving quality health services for all district residents? • How does this adhere to ethical and compliant practices for transparency and stewardship? • How were community and employees engaged in the process?

• How does this build safety for patients?

• How does this align with board stewardship and fiduciary responsibilities

Board of Directors Meeting Minutes – Monday, May 8, 2017

Agenda Item

x Discussion Conclusion/Action/Follow Up

I. CALL TO ORDER The meeting, held in Conference Room E of Pomerado Hospital, 15615 Pomerado Road, Poway, CA 92064, was called to order at 6:33 p.m. by Palomar Health Board Chair Dara Czerwonka II. ESTABLISHMENT OF QUORUM

Quorum comprised of Directors Czerwonka, Griffith, Kaufman, McCune, Sison, Gorzeman, Moir Excused Absences: None

VI. OPENING CEREMONY

The Pledge of Allegiance was recited in unison

MISSION AND VISION STATEMENTS

The Palomar Health mission and vision statements are as follows:

x The mission of Palomar Health is to heal, comfort and promote health in the communities we serve

x The vision of Palomar Health is to be the health system of choice for patients, physicians and employees, recognized nationally for the highest quality of clinical care and access to comprehensive services

NOTICE OF MEETING

Notice of Meeting was posted at the Palomar Health Administration office; also posted with full agenda packet to the Palomar Health website on Tuesday, May 2, 2016, which is consistent with legal requirements

IV. PUBLIC COMMENTS

x Rev. Beth Johnson and Yusef Miller spoke about contracts, budget and safe patient care x Joan Marie Reker, George Santiago and Sue Phillips spoke about contracts, staffing, supplies and equipment x Margie Camomile spoke about nurses, on call and cancel days

V. APPROVAL OF MINUTES

050817 Board of Director’s Meeting Minutes 28

Board of Directors Meeting Minutes – Monday, May 8, 2017

Agenda Item

x Discussion Conclusion/Action/Follow Up

A. Special Board Education Session - April 10, 2017 A. MOTION: by Director Kaufman, 2nd by Director Moir and carried to B. Regular Board of Director's Meeting - April 10, 2017 approve the April 10, 2017 Special Board Education Session minutes as written. All in favor. None opposed. No abstentions

nd B. MOTION: by Director Moir, 2 by Director Kaufman and carried to approve the April 10, 2017 Regular Board of Director's Meeting minutes as written. All in favor. None opposed. No abstentions

There was no discussion

VI. * APPROVAL OF AGENDA to accept the Consent Items as listed including – A. MOTION: by Director Kaufman, 2nd by Director Sison and carried to A. Approval of Revolving, Patient Refund & Payroll Fund Disbursements – March 2017 approve Consent Agenda Item A. as presented. All in favor. None opposed. No abstentions 1. Accounts Payable Invoices $48,692,253.00 2. Net Payroll $15,126,196.00

Total $63,818,449.00

VII. PATIENT FIRST Information Only

A. Patient First

x District Manager Service Excellence Tina Pope read a letter from a grateful patient and introduced Renee Piper, the nurse who was being honored for the outstanding care she provided. Ms. Piper shared her passion for nursing with the board

VIII. * PRESENTATIONS A. March 2017 & YTD FY2017 Financial Report x Utilizing the presentation distributed in the Finance supplement of the Monday, May 8, 2017 Board of Director's meeting agenda/packet, Executive Vice President Finance Diane Hansen shared the March 2017 & YTD FY2017 Financial Report with the board

IX. * REPORTS

A. Medical Staffs

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Board of Directors Meeting Minutes – Monday, May 8, 2017

Agenda Item

x Discussion Conclusion/Action/Follow Up

1. Palomar Medical Center Escondido i. MOTION: by Director Kaufman, 2nd by Director Moir and carried to approve the Palomar Medical Center Escondido Medical Staff i. Credentialing and Reappointments Credentialing Recommendations as presented. All in favor. None ii. Modification to the Surgical Nurse Practitioner Privilege Checklist for PMC Escondido opposed. No abstentions iii. Modification to the Department of Orthopaedic Surgery/Rehabilitation Rules and Regulations for PMC Escondido ii. MOTION: by Director Moir, 2nd by Director Kaufman and carried to

iv. Modification to the General Thoracic Surgery Clinical Privilege Checklist for PMC Escondido approve the Modification to the Surgical Nurse Practitioner Privilege Checklist for PMC Escondido as presented. All in favor. None opposed. No abstentions

iii. MOTION: by Director Moir, 2nd by Director Griffith and carried to approve the Modification to the Department of Orthopaedic Surgery/Rehabilitation Rules and Regulations for PMC Escondido as presented. All in favor. None opposed. No abstentions

iv. MOTION: by Director Moir, 2nd by Director Kaufman and carried to approve the Modification to the General Thoracic Surgery Clinical Privilege Checklist for PMC Escondido as presented. All in favor. None opposed. No abstentions

x Palomar Medical Center Escondido Chief of Staff Dr. Franklin Martin presented the Palomar Medical Center Escondido Medical Staff Executive Committee reports referenced above for review and approval

There was no discussion

2. Palomar Medical Center Poway i. MOTION: by Director Moir, 2nd by Director Kaufman and carried to

i. Credentialing Recommendations approve the Palomar Medical Center Poway Medical Staff Credentialing Recommendations as presented. All in favor. None opposed. No abstentions

x Palomar Medical Center Poway Chief of Staff Dr. Charles Callery presented the Palomar Medical Center Poway Medical Staff Executive Committee reports referenced above for review and approval

There was no discussion B. Administrative

1. Palomar Health Foundation Information only

050817 Board of Director’s Meeting Minutes 30

Board of Directors Meeting Minutes – Monday, May 8, 2017

Agenda Item

x Discussion Conclusion/Action/Follow Up

x Palomar Health Foundation Board President Tom Silberg presented highlights from the April 2017 Palomar Health Foundation Board report, which was previously forwarded to the board and distributed in hard copy at the meeting

x Noted that with the help of Director Moir and his physician colleagues, a short term, highly focused campaign to raise $600,000 for the purchase of cardiology equipment was launched in March, and has to date received almost $400,000 in cash and pledges. One of our grateful patients and most committed Foundation board members Don Belcher and his wife Marie made a $200,000 3-year pledge, requesting that we use $50,000 towards a match solicitation to inspire others to help us reach our $600,000 goal. Also wished to thank Dr. Moir for leading potential donor tours of the Cath Lab

o Chair Czerwonka requested the grateful patient video Mr. Silberg referenced in his report be shared with the board at their next meeting

2. Chair of the Board Information only

Palomar Health Board Chair Dara Czerwonka provided the following updates:

x Wished to acknowledge National Nurse’s Week, thanking nursing on behalf of the board for all the great work they do for our patients

x Congratulated Palomar Health Marketing department for recently winning 30 Healthcare Advertising Awards – including Best of Show for Security Officer John Johnson’s “What’s Your Passion” video

3. President and CEO Information only

In Palomar Health President and CEO Robert Hemker’s absence, Palomar Health Executive Vice President Operations Frank Beirne provided the following updates on his behalf:

x Palomar Medical Center Downtown Escondido (PMCDE) update – several months ago we began the process to sell the PMCDE campus. We had narrowed those bids to one buyer, began due diligence, and been in constant discussion with the buyer during that time. We had hoped to announce a final agreement soon; unfortunately the identified buyer has chosen not move forward with the purchase. Currently our broker is in discussion with several of the other interested bidders, and we are confident that Palomar Health will receive full value for the property. In the interim we will continue working on the thoughtful transition of services out of the PMCDE campus to our other facilities

x Palomar Medical Center Poway (PMCP) effectively completed the first of several hurdles in our accreditation process specific to PMCP. As the board is aware, we were placed under a 23 day abatement survey finding. As a result of the survey completed last week, we have successfully completed the first step in what we ultimately believe will be a 3 part process. The Joint Commission survey was focused on the Geriatric-Psychiatric Unit. The clinical and leadership issues identified during the April 10, 2017 survey were found to be in compliance with Joint Commission standards. Plans to correct the Geriatric Psychiatric Unit physical environment were considered satisfactory. Remodeling upgrades and additional safety device installation will proceed in a fashion and timeline acceptable to the Joint Commission. The surveyor was in fact able to and did both listen to and review written documentation, interview staff, conduct tracers in the unit, review the electronic medical record and assess the physical environment. Next steps – 2 surveys in front of us to complete process (46 and 60 day post survey). In the interim, PMCP’s accreditation status remains in the Preliminary Denial of Accreditation category pending the completion of these two surveys. These surveys will be unannounced and will occur sometime prior to May 26, 2017

x Wished to acknowledge publicly and to those assembled the recognition of all staff and care teams this week. National Hospital Week celebrates hospitals and the men and women who support the health and wellbeing of their communities through dedication and compassionate care from the heart. Thank you to all of the dedicated individuals, physicians, nurses, therapists, technologists, engineers, food service and environmental service workers, volunteers, managers and so many more for their contributions

X. INFORMATION ITEMS

050817 Board of Director’s Meeting Minutes 31

Board of Directors Meeting Minutes – Monday, May 8, 2017

Agenda Item

x Discussion Conclusion/Action/Follow Up

A. The April 2017 ACHD Update Report was forwarded electronically to the board members prior to the meeting

XI. *APPROVAL OF BYLAWS, CHARTERS, POLICIES

A. Establishing Board Meeting Dates Policy – Lucidoc 21793 MOTION: by Director Griffith, 2nd by Director Gorzeman and carried to B. Gifts and Donations Policy – Lucidoc 21776 approved Agenda items A. – D. as presented. Pursuant to the discussion stated below re: the Smoking in Palomar Health Facilities Policy, it will be C. Annual Financial Audit Policy – Lucidoc 21808 approved with the revision to the verbiage in Section III.A. All in favor. D. Smoking in Palomar Health Facilities Policy – Lucidoc 25912 None opposed. No abstentions

E. Confidentiality Statement Policy – Lucidoc 21799 nd F. Opening Ceremony for Board Meetings Policy – Lucidoc 21784 MOTION: by Director Griffith, 2 by Director Kaufman and carried to

G. Nursing - Chief Nurse Executive (CNE) Policy – Lucidoc 11058 return Agenda Items E. – J. to the Board Governance Committee for further review. Pursuant to the discussion stated below, Director Griffith H. Membership Organizations and Board Representations Policy – Lucidoc 21795 withdrew the first motion. A second motion was made by Director Griffith, I. Governance Policy – Lucidoc 26973 nd 2 by Director Gorzeman and carried to return only Agenda Items E. – I. J. Infection Prevention and Control Risk Assessment and Surveillance Plan – Lucidoc15412 to the Board Governance Committee for further review. All in favor. None opposed. No abstentions

nd J. MOTION: by Director Kaufman, 2 by Director Moir and carried to

approve the revisions to the Infection Prevention and Control Risk Assessment and Surveillance Plan as presented. All in favor. None opposed. No abstentions x Director McCune questioned the verbiage in the Smoking in Palomar Health Facilities policy section III.A. Revise from “…owned and leased…” to “…owned or leased…”. Remove “…or areas owned or operated by Palomar Health.” Section III.B. – Director McCune noted that the verbiage appears to imply that dialogue would need to be position-specific, i.e. “physician to physician”. Board Counsel Blaise Jackson responded that in his judgment the verbiage was generalized and not position-specific; any employee could counsel another re: the policy and their compliance with it, to which Director McCune accepted as clarification of his question

o Chair Czerwonka led discussion re: whether there were any sanctioned areas on Palomar Medical Center Escondido property where smoking was in fact allowed, of which there are not

x Chair Czerwonka queried whether the retirement of the Nursing - Chief Nurse Executive (CNE) Policy should also be vetted by the Board Audit & Compliance Committee, to which committee Chair Director Gorzeman noted that the committee was performing a crosswalk on all the elements listed in the policy to see if any should be moved to other relevant policies

x Agenda Item J. – Director Gorzeman noted there was extensive review of the plan at the Board Quality Review committee, with updates, clean up and revision being made at that time. This final version of the plan still represents all the best practices

XII. COMMITTEE REPORTS Information only

A. Audit and Compliance Committee

x Committee Chair Czerwonka shared highlights from the meeting and attached summary

050817 Board of Director’s Meeting Minutes 32

Board of Directors Meeting Minutes – Monday, May 8, 2017

Agenda Item

x Discussion Conclusion/Action/Follow Up

B. Community Relations Committee

x Committee Chair Moir shared highlights from the meeting and attached summary

C. Finance Committee

1. Supply Chain Services Update

x Committee Chair Kaufman shared highlights from the meeting and attached summary

o Director Corporate Supply Chain Steve Ellis presented an in-depth report to the committee on the rising cost of supplies, which represents the largest non-labor expenditure the organization incurs. He also noted that while supply costs continue to increase 3% to 7% per year, government reimbursements to hospitals are decreasing every year D. Governance Committee

x Committee Chair Griffith shared highlights from the meeting and attached summary

o Re: the San Diego Local Agency Formation Commission (LAFCO) discussion listed on the committee meeting summary, Chair Czerwonka was unclear as to whether the intent is to have LAFCO attendance at Palomar Health board meetings or for Palomar Health to have representation at LAFCO meetings. Director Gorzeman clarified that the latter is the case. The committee will share next steps with the board as they progress

x Committee currently in the process of updating ownership of all policies and procedures in Lucidoc; will spend second half of the year retiring unnecessary / outdated policies, as well as developing a retirement checklist to ensure that all regulatory / compliance processes are taken care of and done properly

E. Human Resources Committee

x Committee Chair Sison shared highlights from the meeting and attached summary

o Expressed his appreciation to Interim Vice President John Zubiena and Executive Vice President Finance Diane Hansen for their support in updating the Employee Emergency Loan Procedure

C. Quality Review Committee

x Committee Chair Gorzeman shared highlights from the meeting and attached summary

x Attended second BETA HEART conference, noting that excellent presentations were given on the topics “Care of the Caregiver” and “Communication and Transparency”. Staff currently working on rollout plans F. Strategic & Facilities Planning Committee

x Committee Chair McCune shared highlights from the meeting and attached summary

G. Other Committee Chair Comments or Committee Highlights

050817 Board of Director’s Meeting Minutes 33

Board of Directors Meeting Minutes – Monday, May 8, 2017

Agenda Item

x Discussion Conclusion/Action/Follow Up

There were no other committee chair comments or committee highlights

XIII. ADJOURNMENT TO CLOSED SESSION

A. Closed Session: Conference with legal counsel - review of existing litigation. City of Poway v. Palomar Health, et al. San Diego Superior Court Case No. 37-2016-00046487. Government Code §54956.9(d)(1)

B. Pursuant to Health & Safety Code §32106 – Report Involving Trade Secret. Concerns Potential New Program (estimated disclosure date: June 30, 2017)

C. Pursuant to California Government Code §54957.6 - Conference with Labor Negotiator Agency Designated Representative: Daniel Kanter of Ogletree, Deakins, Nash, Smoak & Stewart, P.C. - Employee Organizations: CNA; CHEU

D. Pursuant to California Government Code §54957(b) Public Employee Performance Evaluation - President and CEO

XIV. RE-ADJOURNMENT TO OPEN SESSION

XV. ACTION RESULTING FROM CLOSED SESSION DISCUSSION - IF ANY

A. MOTION: by Director Moir, 2nd by Director Kaufman and carried to settle the litigation involving the City of Poway. All in favor. None opposed. No abstentions

B. No action taken

C. No action taken

D. No action taken

XVI. BOARD MEMBER COMMENTS / AGENDA ITEMS FOR NEXT MONTH

There were no board member comments / agenda items for next month XVII. CONVERSATION ON GUIDANCE FOR HOW BOARD MEMBERS GET ACCESS TO INFORMATION

Item deferred to June 12, 2017 Board of Director’s meeting XVIII. PUBLIC COMMENTS

There were no public comments XIV. FINAL ADJOURNMENT

x Chair Czerwonka adjourned the meeting at 8:58 p.m.

050817 Board of Director’s Meeting Minutes 34

Board of Directors Meeting Minutes – Monday, May 8, 2017

Agenda Item

x Discussion Conclusion/Action/Follow Up

Board Secretary Raymond McCune, R.N. Signatures:

Board Assistant Debbie Hollick

050817 Board of Director’s Meeting Minutes 35

ADDENDUM B

36 37 Passion. People. Purpose.TM

Fiscal Year 2017 Financial Performance April 2017

Supplemental

Executive Title Table

Budget Cash Income Balance ER Payor Statistical Monthly Year Month Current Includes Excludes Case

Flow Year

Statements Comparison

‐

Sheets to Mix

Mix Payor

Information

‐ Statement ‐ ‐ to vs. to Text Date

G.O.

Trend G.O. Index

‐

‐ Indicators ...... Date Date

Prior

Mix

......

Bonds Bonds of

...... Financial

......

Year Statistical ......

......

‐ to Contents .. ‐ Date ...... Performance Indicators

......

Dashboard

......

Title

39 Text

16 10 15 12 14 11

8 6 7 4 5 3

2 Key Average Case Acute Inpatient Outpatient EBIDA Labor Days Key Adjusted Note: EBIDA Deliveries ER Financial Net Average ugre 1,599 Surgeries Oper. Operating Executive

Title Visits

Statistics

Volumes Income Financial

Mix Cash

Productivity

Expenses/Adj. Patient Margin

LOS Daily

Performance icags4,058 Discharges

on Income

Performance

Hand

as9,950 Days ess332 Census

Text

sh 13,491 Dschg

excludes Dashboard

Bonds

7,648,208 2,202,322 540,979 11,403 25%1.6 .6 45%1.6 13%(.9)12.74% (0.19%) 11.35% 11.16% 14.54% 0.46% 12.06% 12.52% Apr culBudget Actual 3.99 1.68 890 709 344 ‐ 7Apr 17

7,121,882 1,799,189 Month (24,375) 11,396 12,899 4,095 9,991 1,537 ‐ 3.99 1.66 848 689 427 333 ‐ ‐ 7Apr 17 to April ‐ Date

Variance 1.4)341 (19.44%) 565,354 526,326 403,133 09% 4,137 (0.90%) 04% 10,520 (0.41%) 45% 13,360 (4.59%) 03% 351 (0.30%) .6 10,800 0.06% .0 4.07 0.00% .5 859 4.95% .0 691 2.90% .0 1.66 1.20% .3 1,550 4.03% Title 40

Text

1,459,300 9,190,871 2,931,557 Prior

erAta Budget Actual Year ‐ 6Apr 16

68,115,943 17,032,884 (1,756,817) 117,229 100,836 41,871 16,472 13,180

80 0.%(.% 98.2% (2.0%) 100.0% 98.0% 9,077 7,395 3,525 113.8 3.91 1.67 332 ‐ 7Apr 17

68,507,239 15,254,249 (2,959,668) 115,481 101,235 41,493 15,549 13,114 8,579 Year 6, 4,326 131.0 3.99 1.60 970 333 ‐ 7Apr 17 ‐ to ‐

Date 1,778,635 1,202,851 (391,296) Variance 1.2)3,675 (18.52%) 05% 12,606 (0.51%) 1.% 102.5 (13.1%) 03% 103,905 (0.39%) 03% 341 (0.30%) .1 122,108 1.51% 2.01% .1 41,846 0.91% .4 15,938 5.94% .0 8,819 5.80% 4.37% .0 7,119 6.10%

74,618,196 13,925,420 2,763,327 Prior 4.03 1.60

Year 3 ‐ 16 Nonoperating Operating 2 1 Total EBIDA Net Salaries, Net Operating Adjusted Other Income Depreciation Benefits Supplies Prof Total Other Deductions Gross Property

Nonoperating Property Title Consolidated

Income noe540,979 income

patient fees

expenses

net

eeu 305,487,075 revenue operating margin

from tax

wages

tax revenue & Discharges

Expenses

Revenue revenues

purch from revenues revenue

revenues operations

revenues,

revenue

eeu (244,922,345) revenue Text

contract svcs

excludes

excludes ttmn:Month Statement:

net

G.O.

ao 27,432,772 labor G.O.

2 Bonds

Bonds

Levy

Interest Apr culBudget Actual 58,891,919 60,564,730 61,094,241 (2,978,010) 8,905,013 1,316,667 4,145,566 2,725,833 2,202,322 6,598,798 9,083,937 529,511 ‐ 25%1.6 0.46% 12.06% 12.52% 7Apr 17 4,058

‐

(240,080,434) 298,150,184 57,232,903 58,069,750 25,506,348 59, (3,140,231) 1,316,667 3,326,235 4,410,370 9,287,159 6,867,704 7,835,087 1,799,189 032,092 962,342 (24,375) ‐ ‐ 7Vlm aeEfAta ugtVariance Budget Actual Rate/Eff Volume 17 4,095 to ‐ Date

aineVrac Dollars/Adjusted Variance Variance Apr (1,659,016) (1,069,926) (4,841,911) (1,926,424) 2,062,149 2,494,980 7,336,891 (432,831) 600,402 162,221 565,354 264, 203,222 268,906 403,133 Title ‐ 17 41 804 (37) Text

(2,693,909) 2,169,225 (533, (524,684) 517,123 230,460 (16,256) 30,054 39,849 83,913 62,053 70,793 (8,695) 379)

10,030,800 (2,176,139) (7,011,136) (2,156,884) (1,140,719) 2,595,528 3,019,664 (424,136) 570,348 224, 119,309 206,853 419,389 955

(60,355.43) 15,055.26 14,512.55 14,924.77 75,280.21 1,021.58 6,760.17 2,238.53 1,626.12 2,194.43 671.72 130.49 542.71

(58,627.70) 14,415.65 13,976.29 14,180.65 72,808.35 1,077.01 6,228.66 2,267.93 1,677.09 1,913.33 812.27 235.00 439.36

Discharges

(1,727.73) 2,471.86 (536.26) (531.51) (281.10) (104.52) 639.61 140.55 744.13 103.35 55.43 29.40 50.97 4 Total Operating EBIDA 2 1 Income Other Salaries, Adjusted Nonoperating Net Property Supplies Benefits Operating Depreciation Prof Gross Net Deductions Other Total

Nonoperating Property Title Consolidated

Income noe(1,756,817) income

patient fees

expenses

net

eeu 3,090,160,239 revenue operating agn1.6 13%(0.19%) 11.35% 11.16% margin

from tax

wages

tax revenue Discharges &

Expenses

Revenue revenues

purch from revenues revenue

revenues operations

revenues,

revenue

eeu (2,489,475,973) revenue Text

contract svcs

excludes ttmn:Year Statement:

excludes

net

G.O.

ao 264,206,515 labor G.O.

2 Bonds

Bonds

Levy

Interest 593,240,238 100,286,151 600,684,266 610,273,122 (31,956,368) Apr culBudget Actual 13,166,667 17,032,884 32,640,769 85,320,229 41,373,625 69,412,949 9,588,856 ‐ 41,871 7Apr 17 ‐toDate

(2,443,703,817) 3,036,895,020 588,227,387 258,554,016 101,140,995 593,191,203 603, (31,380,587) 35,021,736 13,166,670 15,254,249 80,482,840 68,924,287 44,103,513 10,290,433 (2,959,668) 481,636 ‐ 41,493 7Vlm aeEfAta ugtVariance Budget Actual Rate/Eff Volume 17

Variance (45,772,156) Apr 53,265,219 (5,012,851) (5,652,499) (4,837,389) 6,791,486 2,380,967 1,202,851 1,778,635 2, 7,493,063 (575,781) (488,662) (701,577) 729,888 854,844 Title ‐ 17 42 378 Text (3)

(22,262,069) 27,666,024 (5,358,734) (2,355,419) 5,497,700 5,403,954 (319,047) (401,782) (627,898) (733,196) (921,391) 138,966 93,746 Variance

(23,510,087) 25,599,195 (3,297,080) (4,104,193) 1,293,786 2,700,014 3, 1,639,669 1,776,235 2,089,109 (795,323) 345,883 131, 139,236 670

(59,455.85) 14,575.08 14,168.28 73,801.92 14,346.07 6,310.01 1,657.78 2,037.69 2,395.12 779.56 988.12 406.79 229.01 Dollars/Adjusted

(58,894.36) 14,544.18 14,176.55 73,190.54 14,296.18 1,062.91 6,231.27 1,661.11 1,939.67 2,437.54 844.04 367.63 248.00

Discharges

(561.49) 611.38 (78.74) (98.02) (18.99) 64.48 30.90 74.79 39.16 42.42 49.89 8.26 3.33 5 EBIDA Other Total 2 1 Nonoperating Net Income Operating Adjusted Property Salaries, Benefits Operating Supplies Gross Prof Net D Deductions Other Total

Nonoperating Property epreciatio Title

income

patient fees Current Consolidated

expenses

eeu 3,090,160,239 revenue operating margin

from t tax

wages

tax revenue Discharges &

Expenses Revenue revenues

n purch from revenues revenue

revenues operations

revenues,

revenue

eeu (2,489,475,973) revenue Text

contract svcs

excludes

excludes vs.

net

G.O.

ao 264,206,515 labor G.O. Prior

2 Bonds

Bonds

Levy

Current Interest

Year 593,240,238 610,273,122 100,286,151 600,684,266 (31,956,368) Apr 41, 13,166,667 32,640,769 17,032,884 85,320,229 69,412,949 (1,756,817) 9,588,856 373,625 11%1.4 (1.58%) 12.74% 11.16% ‐ 41,871 7Apr 17

erPrior Year ‐toDate

(2,321,684,371) 2,896,085,865 571,630,078 585,555,498 252,241,229 574,401,494 (23,745,423) 44,121,085 32,942,109 12,583,330 13,925,420 68,964,583 80,414,096 92,946,976 11,154,004 2,763,327

‐ Year 41,846 6Vlm aeEfAta ugtVariance Budget Actual Rate/Eff Volume 16

(167,791,602) 194,074,374

(21,610,160) (11,965,286) Change 24,717,624 26,282,772 (8,210,945) (4,520,144) (4,906,133) (7,339,175) (1,565,148) 2,747,460 3,107,464 (448,366) 301,340 583,337 Title 43

25 Text

(1,387,041) 1,730,205 (341,508) (150,696) 349,828 343,164 (26,359) (19,681) (41,201) (48,042) (55,529) 8,319 6,664 Variance

(166,404,561) 192,344,169 (21,268,652) (11,814,590) 24,367,796 25,939,608 (4,858,091) (7,283,646) (1,571,812) 2,773,819 3,099,145 (407,165) 321,021

(59,455.85) 14,168.28 14,575.08 73,801.92 14,346.07 6,310.01 1,657.78 2,037.69 2,395.12 988.12 779.56 406.79 229.01 Dollars/Adjusted

(55,481.63) 13,660.33 13,993.11 69,208.19 13,726.56 1,054.37 6,027.85 1,648.06 1,921.67 2,221.17 787.22 332.78 266.55

Discharges

(3,974.22) 4,593.73 (507.96) (282.17) (116.03) (173.95) 581.97 619.51 (37.54) 66.25 74.02 (9.72) 7.67 6 Total Income Prof Other Adjusted Operating Supplies Property Nonoperating Gross Depreciation Deductions Salaries, 2 1 Net Benefits Net EBIDA Other Total Operating

Nonoperating Property

patient income fees

expenses

net Title

revenue

operating margin

from tax

Income Consolidated

wage

tax revenue & Discharges

Revenue

Expenses revenues

purch

from revenues revenue

revenues operations

s revenues,

revenue

eeu (244,166,166) revenue

svcs co

excludes

excludes ntract

net

G.O.

Text

ao 26,016,323 labor G.O.

2 Bonds

ttmn:Monthly Statement: Bonds

Levy

Interest 302,990,296 59,496,792 10,917,291 58,824,130 60,576,869

(2,756,943) 1,080,077 3,518,969 8,008,721 4,044,005 1,316,667 Jul 6,991,483 1,752,739 (360,199) 05%1.2 .4 10%90%1.2 28%1.8 12.84% 10.98% 12.82% 11.52% 9.05% 11.06% 9.24% 10.82% 10.53% ‐ 6Aug 16 4,090

(254,079,635) 314,586,441 59,677,717 10,623,575 26,135,256 60,506,806 61,548,539 (3,371,864) 1,870,822 3,034,617 8,636,452 4,048,607 1,316,667 7,199,210 1,041,733 (184,375) ‐ 4,345 6Sep 16

(245,187,165) 302,988,142 58,108,479 10,749,349 25,339,745 57,800,977 58,828,548 (3,463,516) (1,426,780) 3,217,252 7,823,688 4,064,669 1,316,667 6,913,776 1,027,571 720,069 ‐ 4,152 6Oct 16

(241,739,056)

301,959,331 59,300,500 10,181,013 26,518,830 60,220,275 61,188,621 (3,260,757) 3,329,426 8,160,816 4,078,854 1,316,667 1,888 7,031,561

968,346 (55,969) Trend ‐ 6Nov 16 4,115 , 121

(237,171,379)

296,757,233 59,202,435 26,755,906 59,585,854 60,480,172 (3,727,051) (1,132,647) 3,329,834 9, 8,307,005 4,081,797 1,316,667 1,277,737 6,851,284 876,609 894,318 ‐ 4,088 6Dec 16 Title

(254,578,361)

316,951,558 61,655,034 10,833,329 26,987,683 62,373,197 63,367,064 (2,944,193) 44 3,833,855 8,933,096 4,276,326 1,316,667 1,712,030 6,790,745

993,867 Text 84,504 ‐ 4,277 6Jan 16

(

319,645,648 258,105,966) 60,238,179 27,046,216 61,539,682 62,234,711 (2,596,269) 3,279,578 8,588,590 4,253,060 1,996,532 1,316,667 7,521,644 9, 549, 695,029 716,930 ‐ 7Feb 17 4,455 091

(240,320,213) 295,943,976 55,828,958 24,745,387 55,623,763 56,610,227 (3,137,883) (1,039,947) 3,257,166 8,315,699 4,258,234 6,207,043 1,316,667 9,045,430 781,269 986,464 ‐ 3,852 7Mar 17

(269,2

332,850,541 60,840,227 27,228,397 63,644,852 64,344,129 (3,719,880) 3,114,240 9,641,149 4,122,507 7,307,407 3,503,902 1,316,667 9,426,527 1,100,689 699,277 05 ‐ 4,439 17 ,689)

(244,922,345)

305,487,075 58,891,919 27,432,772 60,564,730 61,094,241 (2,978,010) Apr 2,725,833 8,905,013 4,145,566 6,598,798 2,202,322 1,316,667 9,083,937 540,979 529,511 12.52% ‐ 17 4,058

‐ ‐ May ‐ .0 0.00% 0.00% 7Jun 17 ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ 17 ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐

(2,489,475,973)

3,090,160,239 Fiscal 593,240,238 100,286,151 264,206,515 600,684,266 610,273,122 (31,956,368) 32,640,769 85,320,229 41,373,625 69,412,949 17,032,884 13,166,667 (1,756,817) 2017 9,588,856

11.16% Year 41,871 7 South Kaiser Co Consolidated Surgeries North Total North Consolidated Consolidated Consolidated Consolidated South Consolidated South South Consolidated Consolidated Observation Average North South South ot 3,139 North Adjusted Consolidated North Surgeries Average South South Surgeries North North Patient North nsolidated

Surgeries

Title Average

Days

Length Daily Statistical

CVS ‐ Inpatient ‐ Outpatient ‐ Discharges

Acute ‐ Discharges

Census

Daily Cases

Stay Consolidated ‐

Census Only Acute ‐

Only Acute ‐

Text

Jul

‐ 10,228 Indicators 6Aug 16 4,090 1,563 1,110 80 2,073 8,155 4.03 4.02 4.03 844 330 703 453 699 945 150 303 694 400 263 ‐ .84 16 16 67

10,427 ‐ 1,212 4,345 1,716 3,403 6Sep 16 2,142 68.42 8,285 3.96 4.36 3.86 504 918 336 781 926 181 639 323 737 458 267 ‐ 17 17 69

‐ 1,119 4,152 1,614 9,841 3,219 6Oct 16 1,954 68.60 7,887 3.92 4.07 3.88 495 846 328 755 920 158 337 688 650 418 263 ‐ 13 13 65

‐ 6Nov 16 1,152 4,115 1,659 9,910 3,208 2,065 62.35 7,845 3.91 4.31 3.81 507 919 320 729 889 175 332 744 645 397 253 ‐ 11 67 11

‐ 1,229 4,088 1,695 9,579 3,179 1,801 77.33 7,778 6Dec 16 3.81 3.76 3.82 46 930 319 747 899 165 301 765 677 446 259 ‐ 18 60 18 6

Title 10,099 ‐ 1,179 4,278 1,661 3,273 6Jan 16 1,935 67.23 8,164 3.78 3.63 3.81 881 326 763 996 164 318 717 665 445 482 263 ‐ 45 17 62 17 Text

10,480 ‐ 7Feb 17 1,178 4,455 1,035 1,645 3,404 2,051 75.77 8,429 3.80 3.63 3.85 889 338 743 181 286 708 705 457 467 272 ‐ 13 66 13

‐ 1,078 3, 1,495 9,451 3,008 7Mar 17 1,844 75.75 7,607

3.97 4.06 3.94 820 338 659 827 162 255 658 662 404 417 272 852 ‐ 16 66 16

10,871 ‐ 1,299 1,002 1,050 1,825 3,374 17 2,141 70.32 8,730 4,439 3.93 3.74 3.98 351 806 202 324 800 690 482 526 282 ‐ 17 69 17

‐

Apr ‐ 17 1,178 1,599 9,950 3,149 1,837 75.60 8,113 4,058 3.95 3.99 3.99 88 332 709 899 142 279 738 660 430 421 270 ‐ 10 61 10 0

May ‐ 7Jun 17 ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐

‐ 17

‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐

Fiscal 072017 2017 100,836

11,734 16,472 32,356 19,843 80,993 41,871 erBudget Year 7,395 9,386 1,680 3,058 7,249 6,692 4,337 4,738 72.17 8,929 3.94 3.90 3. 332 148 148 266 ‐ 65 91

101,235 10,656 10,610 15,549 30,883 23,507 77,728 41,493 6,970 1,814 3,079 6,677 6,975 3,891 4,893 87.40 8,491 4.00 3.98 3.99 333 256 8 ‐ 88 77 88 North Trauma Co South Consolidated North Deliveries Consolidated Total South Consolidated South North Trauma Consolidated Outpatient ot 7,343 North Consolidated Consolidated Sout South South Consolidated ER ER North South North North ER South North

nsolidated Admissi Conversion Visits h

ER Title

Statistical Admissions

Cases Visits

(includes o

Registrations ns

(includes

(ER (includes

Admission Trauma)

Trauma

Trauma) (includes

Outpatient ‐ Text as

& % Inpatient ‐

‐

Adm

age Lab) Jul

of issions)

Only ‐ 12,660 10,964

ER 6Aug 16 1,377 9,587 5,317 2,603 2,328 8,361 1,102 7,259 26 33 28 28 30 45 44 29 35 26 .%0.0% 0.0% 12.6% 13.5% 12.9% 14.4% 14.5% 13.0% 12.8% 12.8% 13.3% 12.6% 10. 32 41 36 36 39 54 51 36 40 34 .%0.0% 0.0% 13.4% 14.0% 13.6% 15.1% 15.4% 13.9% 13.6% 13.6% 14.1% 13.2% Indicators 140 103 103 103 264 3 140 275

‐ ‐

Visits) Only 6 6% 7

13,774

12,431 10,778 ‐ 6,147 1,653 6Sep 7,627 16 3,010 1,325 9,421 2,682 8,096 09 03 05 01 14 23 08 20 00 .%0.0% 0.0% 10.0% 12.0% 10.8% 12.3% 11.4% 10.1% 10.5% 10.3% 10.9% 154 256 154 353 328 ‐ ‐ 89 97 89

13,203 11,698 10,205 ‐ 5,901 1,493 6Oct 16 7,302 2,835 8,863 1,201 2,543 7,662 156 282 156 373 292 ‐ ‐ 51 91 51

13,210 10,852 ‐ 6Nov 16 5,873 1,393 7,337 9,459 2,656 8,196 1,113 2,376 7,083 124 268 124 356 280 ‐ ‐ 81 88 81

12,706 11,039 ‐ 5,774 1,436 6,932 9,603 2,580 8,459 1,175 2,319 7,284 6Dec 16 104 156 106 228 104 156 334 261 ‐ ‐

Title 12,346 10,283 12,021 ‐ 5,640 1,738 6Jan 16 6,706 2,940 9,081 1,402 2,604 7,679 136 240 136 330 336 ‐ ‐ 46 96 90 96 Text

‐ 13 10,608 12,390 7Feb 17 6,126 1,782 7,532 3,076 9,314 1,404 2,698 7,910 ,658 118 291 118 389 378 ‐ ‐ 88 98 88

10,216 11,732 12,246 ‐ 5,737 1,516 7Mar 17 6,509 2,781 8,951 1,215 2,480 7,736 107 159 252 107 159 330 301 ‐ ‐ 78

10,986 12,699 14, ‐ 6,700 1,713 17 7,399 3,166 9,533 1,334 2,787 8,199 101 161 283 101 161 349 379 099 ‐ ‐ 66

‐

Apr 11,403 12,532 ‐ 17 5,765 1,433 6,767 2,692 9,970 8,711 1,165 2,424 7,546 123 281 123 344 268 ‐ ‐ 70 63 70 May ‐ 7Jun 17 ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐

‐ 17 ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐

Fiscal 072017 2017 101,695 117,229 130,434

58,980 15,534 71,454 28,339 88,890 12,436 25,241 76,454 erBudget Year 33 12.5% 13.3% 09 10.2% 10.9% 14 1,427 2,645 1,427 3,525 3,098 0 13.3% .0% 880 890 890 ‐ ‐

115,481 145,391 10 51,105 14,417 94,231 29,683 85,798 11,397 26,663 74,401

1,426 1,081 3,245 1,426 4,326 3,020 1,064 910 910 9 ‐ ‐ May‐ Mar PY Nov ‐ Aug Dec‐ Title Feb Sep Apr Oct Jun Jan ao Mix Payor Jul

AVG ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ 17 17 16 17 17 17 17 16 16 16 16 16 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% MEDICARE

Text 0 0 0 0 50% 40% 30% 20% 10% 22% 23% 23% 23% 23% 24% 24% 24% 24% 25% 26% MCAR

MGD MEDI 14% 14% 13% ‐ 15% 15% 14% 14% 14% CAL 14% 14% 15% MCAL 8% 8% 8% 7% 7% 7% 7% 7% 8% 6%

MGD 7% Title

47 Text 14% 14% 15% 15% 16% 15% 14% SELF 15% 14% 16% 15%

PAY 2% 60 1% 2% 0% 1% 2% 1% 2% 2% 0 0 0 100% 90% 80% 70% % 1% 2% MGD

CARE 21% 21% 21% 21% 21% 20% 21% 22% 21% 22% 19% CAP COV 14% ‐ 14% CA 15% 14% 14% 14% 12% 13% 14% 13% 14% OTHER 2% 2% 2% 2% 2% 2% 2% 2% 2% 1% 4% 1% 3% 3% 2% 2% 2% 2% 2% 2% 1% 1% 10 May‐ PY Mar Nov ‐ Aug Dec‐ Feb Sep Apr Oct Jun Jan Title Jul ao Mix: Payor

AVG ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ 17 17 17 17 16 16 16 16 17 17 16 16 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0%

Text 15% 15% 15% 16% 16% 16% 16% 16% 16% 18% 18% 0 0 0 0 0 60 50% 40% 30% 20% 10% MEDICARE Emergency 12% 12% 12% 11% 12% 13% 12% 13% 13% MCAR 13% 13%

MGD 8% 8% 8% 10% 9% 8% 8% 7% 7% 8% MEDI 7%

‐ Department CAL

MCAL Title 22% 23% 23% 22% 24% 48 21% 23% 23% 23%

MGD 22% Text 23% SELF

PAY 5% 4% 4% 4% 5% 3% 4% 0 0 0 100% 90% 80% 70% % 4% 4% 5% MGD 3%

CARE 25% 25% CAP 24% 24% 24% 25% 23% 25% 24% 25% 24% COV ‐ CA OTHER 7% 8% 8% 7% 8% 7% 8% 7% 8% 8% 8% 2% 2% 1% 2% 1% 2% 1% 2% 1% 5% 4% 2% 4% 3% 3% 3% 3% 3% 3% 1% 1% 0% 11 Case Consolidated Consolidated Consolidated South South ot 1.60 North North South Case Case North

Mi Mix Mix Title Case x

Index Index Index

Medicare ‐ (excludes

Deliveries)

Only Text Mix

Jul ‐ 6Aug 16 1.56 1.70 1.82 1.41 1.60 1.60 1.72 1.9 0 Index

‐ 6Sep 16 1.43 1.63 1.24 1.49 1.78 1.60 1.47 1.66 1.84

‐ 6Oct 16 1.42 1.64 1.38 1.70 1.64 1.67 1.42 1.62 1.63

‐ 6Nov 16 1.44 1.65 1.28 1.56 1.80 1.72 1.47 1.67 1.84

‐ 6Dec 16 1.46 1.66 1.32 1.60 1.81 1.79 1.50 1.67 1.82

Title ‐ 6Jan 16 1.45 1.66 1.28 1.54 1.73 1.69 1.49 1.69 1.75 49 Text

‐ 7Feb 17 1.44 1.65 1.35 1.62 1.76 1.69 1.47 1.66 1.78

‐ 7Mar 17 1.69 1. 1.32 1.58 1.69 1.61 1.52 1.72 1.72 48

‐ 17 1.72 1.50 1.60 1.81 1.73 1.62 1.75 1.84 1.60

‐

Apr ‐

17 1.68 1.38 1.58 1.85 1.69 1.49 1.70 1.93 1.47 May ‐ 7Jun 17 ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ 17 ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐

Fiscal 072017 2017

erBudget Year 1.67 1.35 1.59 1.77 1.68 1.50 1.69 1.80 1.47

12 1.60 1.36 1.58 1.68 1.62 1.46 1.61 1.70 1.44 Title

Text Supplemental

Title

50 Text

Information 13 Est. Prepaid Inventories Net Total Investment Deferred Total Cash Patient Cash Allowance Total Property, Accumulated Construction Net Othe Total Assets Current Total Restricted Other Non Restricted Board Balance Consolidated

third accounts property, ‐

Current on marketable cash non restricted assets current

non designated Title

Accounts Assets expenses hand

party ‐

financing

plant ‐ current

& other assets on cu

related cash

Assets rrent

in assets receivable

depreciation

accounts plant

settlements

& assets process

securities

equivalents Receivable

qimn 1,552,583,613 equipment assets

assets

costs

& companies

qimn 1,073,600,111 equipment Sheet: Text

Excludes 1,261,327,038 1,618,099,778 (185,901,436) (507,727,974) 146,367,131 177,816,913 128,405,538 33 356,772,740 Apr 11,071,531 49,411,375 85,146,039 93,482,007 28,744,472 28,470,063 64,664,809 3,366,443 8,234,563 4,621,987 4,476,894 2,268,567 9,916,160 347,135 ‐ 7Mar 17

1,553,147,679 1,077,214,169 1,254,486,109 1,634,191,663 (183,740,057) (504,422,730) 141,306,694 187,979,627 126,622,181 325,046,7 379,705,555 17,817,842 10,965,413 61,357,446 85,035,485 83,836,401 28,489,220 53,532,984 13,210,372 29 8,425,607 3,448,687 4,951,367 G.O. ,956,430 346,986 ‐ 7Jun 17 51

1,550,569,348 1,109,235,284 1,240,874,305 1,614,320,498 Bonds (233,393,656) (469,321,465)

128,416,388 217,568,428 158,093,733 361,810,044 373,446,193

10,230,071 59,474,695 69,360,186 54,635,429 27,987,402 54,289,124 6, 5,069,126 3,792,499 3,850,907 6,150,096 012,084 346,304 ‐ 16

‐ Title

51 Text Long Other Total Accrued Accrued Accrued Est. Total Accounts Total General Liabilities Current Current Other Board Total Restricted Unrestricted Bonds

third

Term current liabilities/fund fund long

current LT designated &

Liabilities portion

T 23,613,834 21,263,434 interest PTO payroll Fund contracts

lia

party aal 25,793,790 payable

term balance for Liabilities b ilities

liabilities

liabilities other Balance

settlements

liabilities of

aal 11,033,610 payable

payable bonds

purpose

aac 1,618,099,778 balance

154,898,323 885,004,847 578,196,609 578,017,357 856,187,649 Apr 45,888,339 13,515,000 13,790,316 28,470,063 179,252 347,135 ‐ 7Mar 17

1,634,191,663 171,481,501 884,560,704 577,959,120 854,257,287 578,149,458 48,030,154 28,723,064 23,190,062 19,285,551 29,542,996 13,515,000 29,956,430 9,194,675 190,338 346,986 ‐ 7Jun 17

1,614,320,498 148,407,913 888,307,566 577,470,070 887,961,262 577,605,018 40,948,574 22,544,029 26,123,487 39,142,968 11,525,000 3,996,782 4,127,074 134,948 346,304 ‐ 16 14 ‐ Patient Net Inventories Total Est. Prepaid Allowance Investment Net Other Total Cash Cash Current Assets Deferred Othe Property, Construction Total Total Accumulated Total Restricted Restricted Non Board Balance Consolidated

third accounts property, ‐

Current marketable on cash assets restricted non current

non designated Title

Accounts

Assets expenses hand

party ‐ financing

plant ‐ current

& other assets on cu

related cash

Assets in

rrent assets receivable

depreciation accounts plant

settlements

& process assets

securities

Receivable equivalents

qimn 1,552,583,613 equipment assets

assets

costs companies &

qimn 1,073,600,111 equipment Sheet: Text

Includes 1,291,378,498 1,647,065,877 (185,901,436) (507,727,974) 3 146,367,131 177,816,913 128,405,538 120,449,380 355,687,379 Apr 11,071,531 28,744,472 85,146,039 32,268,567 49,411,375 91,632,182 28,470,063 3,366,443 4,621,987 8,234,563 7,560,981 8,830,798 347,135 ‐ 7Mar 17

1,077,214,169 1,279,626,087 1,661,853,048 1,553,147,679 (183,740,057) (504,422,730) 187,979,627 141,306,694 126,622,181 325,04 105,611,701 382,226,961

17,817,842 10,965,413 28,489,220 61,357,446 15,731,778 85,035,485 75,308,285 2 8,425,607 8,316,045 3,448,687 9,956,430 G.O. 346,986 ‐ 7Jun 17 6 ,751

Bonds 1,109,235,285 1,268,416,926 1,641,983,225 1,550,569,348 (233,393,656) (469,321,465) 217,568,428 128,416,388 158,093,733 361,810,044 373,566,299 10,230,071 27,987,402 59,474,695 78,426,883 69,360,186 78,080,579 6, 5,069,126 3,792,499 7,602,073 6,270,202 012,084 346,304 ‐ 16

‐ Title

52 Text Accrued Accrued Total Other Est. Accrued Liabilities Long Othe Current Accounts Current Total Total Board General Bonds Total Restricted Unrestricted

third

Term current fund liabilities/fund long

current LT designated &

portion Liabilities

PTO interest arl 21,263,434 payroll Fund contracts

lia

party aal 25,793,790 payable

term balance for Liabilities bilities

liabilities

liabilities Balance other

settlements

liabilities of

payable

payable bonds

purpose

aac 1,647,065,877 balance

1,193,350,819 1,193,171,567 165,492,705 288,222,352 259,405,154 Apr 14,520,864 45,888,339 23,613,834 13,790,316 20,622,127 28,470,063 179,252 347,135 ‐ 7Mar 17

1,661,853,048 1,191,394,964 1,191,585,302 181,188,944 289,078,802 258,775,386 11,794,990 23,190,062 48,030,154 28,723,064 19,285,551 20,622,127 29,542,996 29,956,430 190,338 346,986 ‐ 7Jun 17

1,641,983,225 1,179,916,997 1,180,051,945 158,900,154 303,031,126 302,684,822 10,130,054 22,544,029 40,948,574 26,123,487 16,014,260 39,142,968 3,996,782 134,948 346,304 ‐ 16 15 ‐ Cash Consolidated Title

Flow

Text

Statement CASHAND CASH EQUIVALENTS - End of period CASHAND CASH EQUIVALENTS- Beginning of period INCREASENET (DECREASE) IN CASHAND CASH EQUIVALENTS in used and capital Net related financing cash activities Debt Term Long of Payments debt of issuance from Net Proceeds paid Revenue Interest Bond paid Interest Bond G.O. Distributions Fund Trust Redevelopment sale on asset Proceeds equipment and plant property of Acquisition CASHFLOWS FROM CAPITALAND RELATED FINANCING ACTIVITIES: activities financing non-capital from provided Net cash Taxes of District Receipt Bond of G.O. TaxesReceipt CASH FLOWS FROM NON-CAPITAL FINANCING ACTIVITIES: activities by)investing (used provided from Net cash Investment in affiliates investments on (Loss) Income investments of sales Net (purchases) CASH FLOWS FROM INVESTING ACTIVITIES: activities operating by) (used from provided Net cash liabilities current Other payors third-party due amounts settlement Estimated compensation Accrued payable Accounts assets current other and expenses Prepaid Inventories receivables other and Tax Property receivable Patient accounts and liabilities: assets in operating Changes debts bad for Provision Expense Depreciation from activities: operating provided cash net to assets net in change Adjustments reconcile to operations from Income (Loss) CASH FLOWS OPERATING FROM ACTIVITIES:

Title

53 Text 1,4,7)(10,063,320) (11,946,071) 1,2,3)(12,334,302) (16,621,036) 1,0,8)(27,362,540) (16,202,586) (139,696,502) (16,573,523) 50937140,455,482 15,019,377 9413549,411,375 59,474,695 49,411,375 61,357,446 11835 (12,878,130) (1,178,305) 37926 (13,349,178) (3,749,206) 18443 (45,196,138) (1,824,453) 43074 (54,583,765) (4,300,764) 31398 31,678,106 (3,183,968) p -17 Apr ,6,3 30,817,252 9,264,936 ,4,6 41,373,625 4,145,566 ,0,2 17,032,884 2,202,322 ,0,5 (3,790,247) 2,401,656 ,9,0 17,038,798 5,190,100 ,7,3 13,778,454 4,074,836 6271 (11,434,640) (632,791) 12,439,175 (3,994,925) (481,349) (982,256) 7963 36,633,017 (759,673) 1018 (17,058,117) (150,148) (106,118) 6,9 2,029,879 568,598 1,8)(12,349,956) (11,086) 221 (9,672,043) (2,271) 0 0 0 TD YT (163,496) (841,460) 749,789 552,338 16

Palomar Health Director, Medical Informatics Bret Ginther, M.D.

TO: Board Finance Committee

MEETING DATE: Monday, June 5, 2017

FROM: Prudence August Vice President, Information Technology

Background: This contract is for the Medical Director of Informatics position.

Budget Impact: Within budget

Staff Recommendation: Approval

Committee Questions:

COMMITTEE RECOMMENDATION:

Motion:

Individual Action:

Information:

Required Time:

Form A - Informatics.doc 54 PALOMAR HEALTH – AGREEMENT ABSTRACT Section Reference Term/Condition Term/Condition Criteria TITLE Medical Director Informatics Program

AGREEMENT DATE May 8, 2017

PARTIES Palomar Health and Bret Ginther, M.D.

PURPOSE Hospital requires physician leadership and support for the management, supervision and direction of the medical administrative operations of the Informatics Program

Exhibit A SCOPE OF SERVICES Per duties defined in Exhibit A of the contract

PROCUREMENT  Request For Proposal X Discretionary METHOD §12 TERM May 8, 2017 – February 2018

RENEWAL N/A

§13 TERMINATION Without cause by either party with 30 days’ prior written notice With cause as delineated in the agreement

FAIR MARKET X YES  NO – DATE COMPLETED: 03/2016 VALUATION §11 COMPENSATION Paid hourly within 60 days from receipt of Physician’s timesheets. METHODOLOGY

BUDGETED X YES  NO – IMPACT:

EXCLUSIVITY X NO  YES – EXPLAIN:

JUSTIFICATION The Medical Director of Informatics is a vital role in support of effective selection, implementation, use, and benefits realization of clinical information systems. The Medical Director of Informatics operates at a critical nexus, bridging the gap between practicing clinicians and the IT department. AGREEMENT NOTICED X YES  NO Methodology & Response: Posted online

ALTERNATIVES/IMPACT N/A

Duties  Provision for Staff Education  Provision for Medical Staff Education  Provision for participation in Quality Improvement  Provision for participation in budget process development COMMENTS

APPROVALS REQUIRED  VP  CFO  CEO  BOD Committee Finance  BOD

TO: Board Finance Committee

MEETING DATE: Monday, June 5, 2017

FROM: Maria Sudak, DHA, RN Vice President Palomar Medical Center Escondido

BACKGROUND: Historically, Palomar Health has contracted with Medical Directors that are required by Title XXII or other licensing and accrediting bodies with a limited scope of duties and responsibilities. There is a growing body of literature to suggest that nurses and physicians leading together can improve clinical operations and patient outcomes. High-performing organizations have moved away from the traditional nurse/physician roles and responsibilities and have redesigned them to achieve a new level of collaboration, mutual respect, and trust (Baldwin, Dimunation, & Alexander, 2011; Burroughs, 2012). To that end, Palomar Health has created nursing and medical director dyads for all of the nursing units at Palomar Medical Center Escondido. These dyads lead their clinical units in all phases of clinical operations including, but not limited to:

• See EXHIBIT A (attached)

The following physician has been contracted to provide Medical Director services for the Med Onc/Med Surg (8E & 9E) Units:

• Amanda Caparso, MD

BUDGET IMPACT: A fair market value assessment was conducted in April 2017 by Gallagher Benefit Services, Inc., for the above-referenced Medical Directorship, and the contract is valued accordingly. This contract was budgeted in the FY17 Operating Budget.

STAFF RECOMMENDATION: Approval

COMMITTEE QUESTIONS:

COMMITTEE RECOMMENDATION:

Motion:

Individual Action:

Information:

Required Time:

56 PALOMAR HEALTH – AGREEMENT ABSTRACT Section Reference Term/Condition Term/Condition Criteria TITLE Medical Director Agreement – Dr. Amanda Caparso

AGREEMENT DATE March 1, 2017

PARTIES Dr. Amanda Caparso and Palomar Health

Recitals A- PURPOSE Medical Director for Medical Oncology and Medical Surgery (8E D and 9E). Physician leadership and support.

§1 SCOPE OF SERVICES Medical Director Duties and Services

PROCUREMENT  Request For Proposal X Discretionary METHOD §13 TERM One-year – end date 3/2/18

RENEWAL N/A

§13 TERMINATION Without cause upon thirty (30) days’ prior written notice

FAIR MARKET X YES  NO – DATE COMPLETED: APRIL 13, 2017 VALUATION §11 COMPENSATION Monthly payment based on an hourly rate, documented by Time METHODOLOGY Log BUDGETED X YES  NO – IMPACT:

EXCLUSIVITY  NO  YES – EXPLAIN:

JUSTIFICATION Medical Director Dyad partnerships are structured to enhance the patient’s care experience and staff engagement.

AGREEMENT NOTICED  YES X NO Methodology & Response:

ALTERNATIVES/IMPACT

Duties  Provision for Staff Education  Provision for Medical Staff Education X Provision for participation in Quality Improvement  Provision for participation in budget process development COMMENTS

APPROVALS REQUIRED X VP  CFO  CEO  BOD Committee ______ BOD

57 58

ADDENDUM C

59 Passion. People. Purpose.TM

Partnership for a Healthier America & Palomar Health

Jim Metzger | Director of Hospitality Services Kathryn Vasaeli | RD | Program Manager 1.7

1 1

60 What do we know about our population? Community Employee lead to 4 diseases 35% have less than • cancer optimal health • heart disease & stroke • type 2 diabetes • lung disease 28,000 50% of deaths in San Diego employee/employee 57% in N. San Diego County dependent prescriptions were filled in 2015

3 lifestyle behaviors • limited physical activity 85,000 hours of • poor diet unscheduled PTO • tobacco use

61 Partnership for a Healthier America Initiatives

Label all items Offer health promoting entrees and side dishes

Fruits & vegetables 10% of total food purchase Healthier food on advertising

Offer 1 children’s wellness meal Review high-fat cooking methods

Healthier food within 5 feet of cash registers Offer 3 adult wellness meals Healthier beverage 80% of (One at each meal service) total beverage purchase

62 Translating knowledge into action

“Tasty” Style Videos

Cooking Series

Collateral

Food and Position Statement

63 Commitments Chef Inspired Preserve Plant-Centric Honest Enlighten

64 We have a powerful opportunity

Multi Component Approach

Upstream Guiding Principle

Midstream Education

Downstream Community

ADDENDUM D

Palomar Medical Center Escondido 2185 Citracado Parkway Escondido, CA 92029 (442) 281-1005 (760) 233-7810 fax Medical Staff Services

May 25, 2017

To: Palomar Health Board of Directors

From: Franklin Martin, M.D., Chief of Staff Palomar Medical Center Escondido Medical Executive Committee

Board Meeting Date: June 12, 2017

Subject: Palomar Medical Center Escondido Credentialing Recommendations

I. Provisional Appointment (06/12/2017 – 05/31/2019) Brummel, Jared A., D.O., Orthopaedic Surgery Crawford, Michael J., D.P.M., Podiatry Dao, Marc K., M.D., Internal Medicine Green, Nella L., M.D., Infectious Disease Hanrahan, Nicole F., M.D., Physical Medicine/Rehab Hazelwood, Kyle J., M.D., Orthopaedic Surgery Koumjian, Michael P., M.D., Cardiothoracic Surgery Reuther, Marsha S., M.D., Otorhinolaryngology Tseng, Warren H., M.D., General Surgery

II. Advance from Provisional to Active Category Aranha, Neil A., M.D., Anesthesiology (06/12/2017 – 04/30/2018) Bailey, Erica L., M.D., Emergency Medicine (06/12/2017 – 04/30/2018) Branch, Candice M., Internal Medicine (06/12/2017 – 11/30/2018) Johnson, Ebunoluwa O., M.D., Emergency Medicine (06/12/2017 – 05/31/2018) Li, Yan (Peter), M.D., Anesthesiology (06/12/2017 – 09/30/2017) Miniel, Nicholas J., M.D., Emergency Medicine (06/12/2017 – 08/31/2018)

III. Change from Active to Courtesy Category Buccigrossi, David E., M.D., Internal Medicine/Geriatric Medicine

IV. Change from Active to Affiliate Category Dao, Loan, M.D., Family Practice Pearson, Jeffrey, D.O., Family Practice Peters, Vanessa, M.D., Family Practice Tordilla, F. Omar, M.D., Family Practice

V. Additional Privileges Chennamchetty, Vijay, M.D., Psychiatry x Telepsychiatry Greenstein, Joshua, M.D., Nephrology x Internal Medicine Core Privileges Helvink, Badalin, M.D., Psychiatry x Telepsychiatry Hidy, Benjamin, M.D., Psychiatry x Telepsychiatry

VI. Leave of Absence Mitchell, Deborah M., M.D., Anesthesiology (Effective 05/09/2015 – 12/31/2017)

VII. Change from Active to Retired Category Greb, David C., M.D., Family Practice (Effective 06/23/2017)

VIII. Voluntary Resignation Chen, Nancy P., M.D., Dermatology (Effective 05/03/2017) Dutta, Raja, M.D., Psychiatry (Effective 05/01/2017) Hayes, Richard L., M.D., Internal Medicine (Effective 06/30/2017) LaRocque, Todd, M.D., OB/GYN (Effective 05/02/2017) Signer, Stephen, M.D., Psychiatry (Effective 06/30/2017) Stigen, Theresa L., M.D., OB/GYN (Effective 05/12/2017 ) Williams, Rhonda, M.D., Psychiatry (Effective 05/11/2017)

IX. Allied Health Professional Appointment (06/12/2017 – 05/31/2019) Beseke, Kristin L., F.N.P., Family Nurse Practitioner (Sponsors: Dr. Conrad, Dr. Bower) Spindler, Drew W., P.A.-C., Physician Assistant (Sponsors: Dr. Lin, Dr. Huang, Dr. Mumtaz)

X. Allied Health Professional Resignation Fox, Lauren N., P.A.-C., Physician Assistant (Effective 05/16/2017

XI. Reappointment Effective 07/01/2017 – 08/31/2017 Kadesky, Yale M., M.D. Plastic Surgery Dept of Surgery Active

Reappointment Effective 07/01/2017 – 10/31/2017 Wilensky, Jonathan S., M.D. Plastic Surgery Dept of Surgery Active

Reappointment Effective 07/01/2017 – 02/28/2019 Sebiane, Maria G., M.D. Pediatrics Dept of Pediatrics Active

Reappointments Effective 07/01/2017 – 06/30/2019 Bahmanpour, Kaveh, M.D. Geriatric Medicine Dept of Family Med Active Cohen, Brad S., M.D. Orthopedic Surgery Dept of Ortho/Rehab Active Delgado, George, M.D. Family Practice Dept of Family Med Active (Change from Courtesy to Active Category) Greenstein, L. Richard, M.D. Anesthesiology Dept of Anesthesia Active Harrison, Terry A., M.D. Gynecologic Oncology Dept of OB/GYN Courtesy Harvey, Norah M., M.D. Orthopaedic Surgery Dept of Ortho/Rehab Active How, John D., M.D. Emergency Medicine Dept of Emergency Med Active Jenson, Peter M., M.D. Family Practice Dept of Family Med Affiliate

Reappointments Effective 07/01/2017 – 06/30/2019…..Continued

Kadden, Mark L., M.D. Gastroenterology Dept of Medicine Active Karippot, Anoop, M.D. Psychiatry/Sleep Medicine Dept of Psychiatry Active Khoe, Jennifer L., M.D. General Surgery Dept of Surgery Active Le, Brian B., M.D. Ophthalmology Dept of Surgery Courtesy (Change from Active to Courtesy Category) Lee, Andy Y., M.D. Internal Medicine Dept of Medicine Active (Change from Courtesy to Active Category) Lieu, Dale K., M.D. Infectious Disease Dept of Medicine Active Mofid, M. Mark, M.D. Plastic Surgery Dept of Surgery Active Mulvihill, Daniel F., M.D. Cardiovascular Disease Dept of Medicine Active Schneider, Stephen D., M.D. Pediatrics Dept of Pediatrics Active Schoellerman, Manal M., M.D. Diagnostic Radiology Dept of Radiology Active Schultz, James H., Jr., M.D. Family Practice Dept of Family Med Active Stein, Robert M., M.D. Cardiovascular Disease Dept of Medicine Active Taller, Janos, M.D. General Surgery Dept of Surgery Active Yashar, Arnold A., M.D. Orthopaedic Surgery Dept of Ortho/Rehab Active

XII. Allied Health Professional Reappointment Effective 07/01/2017 – 06/30/2019 Fitzgerald, Adam W., P.A.-C. Physician Assistant Dept of Ortho/Rehab AHP (Sponsors: Dr. Young for Kaiser Orthopaedic Surgeons) Hustosky, David A., P.A.-C. Physician Assistant Dept of Ortho/Rehab AHP (Sponsors: Drs. B. Cohen, Owsley, Knutson, Arush Patel, Barba, Taghavi) Inocelda, Andrew G., P.A.-C. Physician Assistant Dept of Medicine AHP (Sponsors: Dr. Sahagian for the Neurology Center) Pregerson, Heather A., P.A.-C. Physician Assistant Dept of Radiology AHP (Sponsors: Dr. Nicpon for San Diego Imaging) Ray, Jennifer M., N.N.P. Neonatal Nurse Practitioner Dept of Pediatrics AHP (Sponsors: Dr. Golembeski for Children’s Specialists of San Diego) Winick, Matthew, P.A.-C. Physician Assistant Dept of Ortho/Rehab AHP (Sponsors: Drs. Brad Cohen, Paul D. Kim, Langford, Leon for NCWS, Milling, Jeff Smith, Gandhi)

Certification by and Recommendation of Chief of Staff As Chief of Staff of Palomar Medical Center Escondido/Palomar Medical Center Escondido Downtown, I certify that the procedures described in the Medical Staff Bylaws for appointment, reappointment or alteration of staff membership or the granting of privileges and that the policy of Palomar Health’s Board of Directors regarding such practices have been properly followed. I recommend that the action requested in each case be taken by the Board of Directors.

70 Drew W. Spindler, PA-C Page 1 of 1 PALOMAR HEALTH ALLIED HEALTH PROFESSIONAL APPOINTMENT June 2017

PERSONAL INFORMATION

Provider Name & Title Drew W. Spindler, PA-C Palomar Health Facilities Palomar Medical Center Escondido

SPECIALTIES/BOARD CERTIFICATION

Specialties Physician Assistant - Certified 2003

ORGANIZATIONAL NAME

Name Physician Assistant Specialists-CA, Inc.

EDUCATION/AFFILIATION INFORMATION

Education Information D'Youville College, NY From: 08/01/2000 To: 05/17/2003 Physician Assistant

Employment Physician Assistant Specialists - California, Inc. Physician Assistant From: 01/02/2016 To: Present

Current Affiliation Information Riverside Community Hospital, CA Garfield Medical Center, CA St. John’s Regional Medical Center, CA Pomona Valley Hospital Medical Center, CA St. Joseph Hospital, CA St. Jude Medical Center, Fullerton, CA Mission Hospital Medical Center - M Viejo, CA

71 Kristin L. Beseke, FNP Page 1 of 1 PALOMAR HEALTH ALLIED HEALTH PROFESSIONAL APPOINTMENT June 2017

PERSONAL INFORMATION

Provider Name & Title Kristin L. Beseke, FNP Palomar Health Facilities Palomar Medical Center Escondido Palomar Medical Center Poway

SPECIALTIES/BOARD CERTIFICATION

Specialties Family Nurse Practitioner - Certified 2016

ORGANIZATIONAL NAME

Name Palomar Health Expresscare

EDUCATION/AFFILIATION INFORMATION

Education Information Loyola University, Illinois From: 05/12/2013 To: 12/21/2013 Bachelor of Science in Nursing

Chamberlain College of Nursing, IL From: 01/01/2014 To: 06/26/2016 Master of Science in Nursing

Employment Palomar Health Registered Nurse From: 08/01/2010 To: Present

Palomar Health / Expresscare and Corporate Health Family Nurse Practitioner From: 04/16/2017 To: Present

Current Affiliation Information None

72 Warren H. Tseng, M.D. Page 1 of 1 PALOMAR HEALTH PROVISIONAL APPOINTMENT June 2017

PERSONAL INFORMATION

Provider Name & Title Warren H. Tseng, M.D. Palomar Health Facilities Palomar Medical Center Escondido

SPECIALTIES/BOARD CERTIFICATION

Specialties Surgery, General – Certified 2013 Surgery, General/Oncologic - Certified 2015

ORGANIZATIONAL NAME

Name Kaiser Permanente

EDUCATION/AFFILIATION INFORMATION

Medical Education Information University of Kansas From: 05/01/2002 To: 05/31/2006 Doctor of Medicine Degree

Internship Information University of California, Davis General Surgery From: 07/01/2006 To: 06/30/2007

Residency Information University of California, Davis General Surgery From: 07/01/2007 To: 06/30/2012

Fellowship Information University of Texas M.D. Anderson Cancer Center Surgical Oncology From: 07/01/2012 To: 06/30/2014

Current Affiliation Information Kaiser Permanente, San Diego

73 Marsha S. Reuther, MD Page 1 of 1 PALOMAR HEALTH PROVISIONAL APPOINTMENT June 2017

PERSONAL INFORMATION

Provider Name & Title Marsha S. Reuther, MD Palomar Health Facilities Palomar Medical Center Escondido Palomar Medical Center Poway

SPECIALTIES/BOARD CERTIFICATION

Specialties Otolaryngology - Certified 2016

ORGANIZATIONAL NAME

Name California Head and Neck Specialists

EDUCATION/AFFILIATION INFORMATION

Medical Education Information Saint Louis University School of Medicine From: 08/15/2004 To: 05/17/2008 Doctor of Medicine Degree

Internship Information UCSD Medical Center Otolaryngology From: 07/01/2008 To: 06/30/2009

Residency Information UCSD Medical Center Otolaryngology From: 06/23/2008 To: 06/30/2015

Fellowship Information Medical College of Georgia at Augusta University Laryngology From: 07/01/2015 To: 06/30/2016

Current Affiliation Information Sharp Memorial Hospital Scripps Memorial Hospital, La Jolla Scripps Memorial Hospital, Encinitas

74 Michael P. Koumjian, M.D. Page 1 of 1 PALOMAR HEALTH PROVISIONAL APPOINTMENT June 2017

PERSONAL INFORMATION

Provider Name & Title Michael P. Koumjian, M.D. Palomar Health Facilities Palomar Medical Center

SPECIALTIES/BOARD CERTIFICATION

Specialties Surgery, Cardiothoracic - Certified 1986, Recertified 2014

ORGANIZATIONAL NAME

Name Michael P. Koumjian, M.D.

EDUCATION/AFFILIATION INFORMATION

Medical Education Information Rutgers Medical School From: 06/01/1974 To: 06/30/1977 Doctor of Medicine Degree

Internship Information Naval Medical Center, San Diego General Surgery From: 07/01/1977 To: 06/30/1978

Residency Information Naval Medical Center, San Diego General Surgery From: 09/01/1979 To: 08/31/1983

Naval Medical Center, San Diego Cardiothoracic Surgery From: 09/01/1983 To: 08/31/1985

Fellowship Information Oregon Health Sciences University Cardiovascular Surgery From: 08/10/1987 To: 02/09/1988

Current Affiliation Information El Centro Regional Medical Center Paradise Valley Hospital Sharp Grossmont Hospital Sharp Memorial Hospital, Chula Vista Scripps Mercy Hospital, San Diego Scripps Mercy Hospital, Chula Vista

75 Kyle J. Hazelwood, M.D. Page 1 of 1 PALOMAR HEALTH PROVISIONAL APPOINTMENT June 2017

PERSONAL INFORMATION

Provider Name & Title Kyle J. Hazelwood, M.D. Palomar Health Facilities Palomar Medical Center Escondido Palomar Medical Center Poway

SPECIALTIES/BOARD CERTIFICATION

Specialties Orthopaedic Surgery - Certified 2014

ORGANIZATIONAL NAME

Name San Diego Arthroscopy & Sports Medicine

EDUCATION/AFFILIATION INFORMATION

Medical Education Information Loyola University, Illinois From: 08/01/2003 To: 06/30/2007 Doctor of Medicine Degree

Internship Information N/A Residency Information University of Chicago From: 07/01/2007 To: 06/30/2012 Orthopaedic Surgery

Fellowship Information San Diego Arthroscopy & Sports Medicine From: 08/01/2016 To: Present Sports Medicine

Current Affiliation Information West Valley Hospital, AZ USAF Hospital Luke AFB, AZ

76 Nicole F. Hanrahan, MD Page 1 of 1 PALOMAR HEALTH PROVISIONAL APPOINTMENT June 2017

PERSONAL INFORMATION

Provider Name & Title Nicole F. Hanrahan, MD Palomar Health Facilities Palomar Medical Center Escondido Palomar Medical Center Poway

SPECIALTIES/BOARD CERTIFICATION

Specialties Physical Medicine & Rehab – Not Certified

ORGANIZATIONAL NAME

Name Post-Acute Physicians of California, Inc

EDUCATION/AFFILIATION INFORMATION

Medical Education Information University of Illinois From: 08/01/2007 To: 05/31/2011 Doctor of Medicine Degree

Internship Information Georgetown University Medical Center Internal Medicine From: 07/01/2011 To: 06/30/2012

Residency Information Georgetown University Medical Center Physical Medicine/Rehab From: 07/01/2012 To: 06/30/2015

Fellowship Information Georgetown University Medical Center Cancer Rehabilitation From: 07/01/2015 To: 06/30/2016

Current Affiliation Information None

77 Nella L. Green, M.D. Page 1 of 1 PALOMAR HEALTH PROVISIONAL APPOINTMENT June 2017

PERSONAL INFORMATION

Provider Name & Title Nella L. Green, M.D. Palomar Health Facilities Palomar Medical Center Escondido Palomar Medical Center Poway

SPECIALTIES/BOARD CERTIFICATION

Specialties Internal Medicine – Certified 2012 Infectious Disease - Certified 2015

ORGANIZATIONAL NAME

Name Mission Infectious Diseases Consultants

EDUCATION/AFFILIATION INFORMATION

Medical Education Information Northwestern University Medical School, MD From: 09/01/2005 To: 05/14/2009 Doctor of Medicine Degree

Internship Information Harbor/UCLA Medical Center Internal Medicine From: 06/24/2009 To: 06/23/2010

Residency Information Harbor/UCLA Medical Center Internal Medicine From: 07/01/2010 To: 06/30/2012

Fellowship Information UCSD Medical Center Infectious Diseases From: 07/01/2013 To: 06/30/2016

Current Affiliation Information Veterans Administration, San Diego

78 Marc K. Dao, M.D. Page 1 of 1 PALOMAR HEALTH PROVISIONAL APPOINTMENT June 2017

PERSONAL INFORMATION

Provider Name & Title Marc K. Dao, M.D. Palomar Health Facilities Palomar Medical Center Escondido

SPECIALTIES/BOARD CERTIFICATION

Specialties Internal Medicine - Certified 2005, Recertified 2015

ORGANIZATIONAL NAME

Name Graybill Medical Group

EDUCATION/AFFILIATION INFORMATION

Medical Education Information Medical College of Wisconsin From: 08/01/1998 To: 05/17/2002 Doctor of Medicine Degree

Internship Information N/A Residency Information St. Louis University Medical Center From: 08/01/2002 To: 07/31/2005 Internal Medicine

Fellowship Information N/A Current Affiliation Information Lompoc Valley Medical Center Sharp Memorial Hospital Seton Healthcare Family, TX

79 Michael J. Crawford, DPM Page 1 of 1 PALOMAR HEALTH PROVISIONAL APPOINTMENT June 2017

PERSONAL INFORMATION

Provider Name & Title Michael J. Crawford, DPM Palomar Health Facilities Palomar Medical Center Escondido

SPECIALTIES/BOARD CERTIFICATION

Specialties Podiatry – Not Certified

ORGANIZATIONAL NAME

Name Kaiser Permanente

EDUCATION/AFFILIATION INFORMATION

Medical Education Information California College of Podiatric Medicine at Samuel Merritt From: 08/01/2008 To: 05/18/2012 Doctor of Podiatric Medicine

Internship Information N/A Residency Information Scripps Mercy Hospital, San Diego From: 06/24/2012 To: 06/24/2015 Podiatry

Fellowship Information N/A Current Affiliation Information Kaiser Permanente, San Diego

80 Jared A. Brummel, D.O. Page 1 of 1 PALOMAR HEALTH PROVISIONAL APPOINTMENT June 2017

PERSONAL INFORMATION

Provider Name & Title Jared A. Brummel, D.O. Palomar Health Facilities Palomar Medical Center Escondido

SPECIALTIES/BOARD CERTIFICATION

Specialties Orthopaedic Surgery - Certified 2015

ORGANIZATIONAL NAME

Name Graybill Medical Group

EDUCATION/AFFILIATION INFORMATION

Medical Education Information Lake Erie College of Osteopathic Medicine - Bradenton, DO From: 09/01/2003 To: 06/10/2007 Doctor of Osteopathic Medicine Degree

Internship Information Riverside County Regional Medical Center Transitional From: 07/01/2007 To: 06/30/2008

Residency Information Riverside County Regional Medical Center Orthopaedic Surgery From: 07/01/2008 To: 06/30/2012

Fellowship Information The Hughston Foundation, Columbus, GA Sports Medicine From: 08/01/2012 To: 07/31/2013

Current Affiliation Information Northside Hospital, GA West Georgia Hospital, GA Midtown Medical Center, GA Hughston Surgery Center, GA Jack Hughston Memorial Hospital, AL

81 Palomar Medical Center Escondido – Department of Radiology Request for Clinical Privileges

Requested by: ______Print Name

Privileges Requested (Choose One): ______1) Consulting Only – May request Interpretation- Teleradiology Bundle ______2) Request privileges from the following bundles

Category I Usually reserved for physicians who did not complete a residency-training program. Category II Usually reserved for physicians who completed residency training program and are board certified. Category III Usually reserved for physicians who are board certified Category IV Usually reserved for physicians who have completed a fellowship Note: Categories and Minimum numbers of cases are outlined in more detail within the Privilege Checklist Policy.

COGNITIVE BUNDLES Requested Action

Category Yes No Yes No Other III Interpretation (Imaging) – In Hospital Diagnostic Radiology including CT; Ultrasound; Nuclear Medicine; MRI III Cardiac CT Angiography (criteria attached) III Interpretation – Teleradiology Diagnostic Radiology including CT; Ultrasound; Nuclear Medicine; MRI; Plain Radiography III Admission of Patients

PROCEDURAL BUNDLES Requested Action

Category Yes No Yes No Other IV Diagnostic Angiography IV Non-Vascular Interventional; Radiofrequency Ablation (non cardiac) IV Peripheral Percutaneous Transuluminal Angioplasty and Associated Peripheral Vascular Interventions (Criteria Attached); TLA; Fibrinolysis; Stents; Embolization; IVC Filters; Abdomino-Thoracic Stent Grafts; Central Venous Access

82 Department of Radiology – Request for Clinical Privileges Page 2

Requested Action

Category Yes No Yes No Other IV Spine Interventional Radiology Percutaneous Vertebroplasty; Placement of Spinal Cord Stimulators; Balloon Assisted Vertebroplasty (Kyphoplasty) (Criteria Attached) III Miscellaneous Guided Biopsies; Small Bore Chest Tubes; Guided Needle Aspirations; Epidural Blood Patches; Stereotactic Breast Biopsies; Lumbar Puncture III Nuclear Medicine Therapy III Surgery Assist for Combined Surgery/Interventional Radiology Procedures Neurointerventional Radiology IV Endovascular Surgical Neuroradiology (Criteria Attached) IV Acute Stroke Therapy (Criteria Attached) Radiation Oncology III Linear Accelerator – External Beam Radiation III Stereotactic Radiosurgery (Criteria Attached) III High Dose Rate Gynecologic Brachytherapy (Criteria Attached) III High Dose Rate Breast Brachytherapy (Criteria Attached) III Percutaneous Interstitial Radioactive Seed Implantation of the Prostate via Transperineal Approach Conscious Sedation Privileges: Must be requested by completing the separate Sedation Checklist.

Privileges Requested By: ______Date:______Signature

Recommendation by Chairman of the Department: ______Date:______Signature

Approved Board of Directors 09/13/201006/12/2017

83 Department of Radiology – Request for Clinical Privileges Page 3

BLANK PAGE TO SLIP CONSCIOUS SEDATION IN –

84 Department of Radiology – Request for Clinical Privileges Page 4

Privileging Criteria for Cardiac CT Angiography Source: ACR Practice Guidelines Revised 10/01/2006

The radiologist who supervises and interprets cardiac CT examinations should meet the following criteria for calcium scoring:

By virtue of experience and residency training, which has included cardiac anatomy and CT physics, a board-certified radiologist is qualified to perform calcium scoring of coronary arteries. It is expected that board-certified radiologists will be familiar with the indications and techniques for, as well as the interpretation of, coronary artery calcium scoring. The radiologist should meet the following criteria for cardiac CT (not including examinations performed exclusively for calcium scoring: 1. Certification in radiology or diagnostic radiology by the American Board of Radiology, the American Osteopathic Board of Radiology, the Royal College of Physicians and Surgeon of Canada, or Le College des Medecins du Quebec and have supervised and interpreted 50 cardiac CT cases, excluding those performed exclusively for calcium scoring, in the past 36 months. OR Completed an Accreditation Council for Graduate Medical Education (ACGME)-approved radiology residency program and have supervised and interpreted 50 cardiac CT cases, excluding those performed exclusively for calcium scoring, in the past 36 months.

AND 2. Completed at least 30 hours of category I continuing medical education in cardiac imaging, including cardiac CT, anatomy, physiology, and/or pathology or documented equivalent supervised experience in a center actively performing cardiac CT.

Maintenance of competence.—All radiologists performing cardiac CT examinations should demonstrate evidence of continuing competence in the interpretation and reporting of those examinations. If competence is assured primarily on the basis of continuing experience, a minimum of 75 25 examinations, excluding those performed exclusively for calcium scoring, every 3 years is recommended in order to maintain the radiologist’s skills.

Continuing medical education.—The radiologist’s continuing medical education should be in accordance with the "ACR Practice Guideline for Continuing Medical Education (CME)" of 150 hours of approved education every 3 years, and should include continuing medical education in general and in cardiac CT as is appropriate to the radiologist’s practice needs.

85 Department of Radiology – Request for Clinical Privileges Page 5

Palomar Medical Center PERIPHERAL, PERCUTANEOUS TRANSULUMINAL ANGIOPLASTY AND ASSOCIATED PERIPHERAL VASCULAR INTERVENTIONS

I. The Practitioner Practitioners who perform angioplasty of the peripheral vessels should have a thorough understanding of the clinical manifestations and natural history of peripheral and renovascular occlusive disease. They should be knowledgeable in the alternative therapies that are available including their risks and benefits. They should be competent to interpret diagnostic peripheral angiographic examinations and competent to perform arteriographic procedures via percutaneous approaches. In addition, the complex nature of angioplasty procedures requires further training beyond that necessary for routine diagnostic angiography. To assure the experience and competence needed to perform successful angioplasty, the physician should meet the following minimal criteria:

a) Completion of an approved diagnostic radiology residency program. b) Additional experience including one of the following: 1. One-(1) or two-(2) years post-residency training in percutaneous interventions, which includes participation in a substantial number of peripheral angioplasty procedures and stents, or 2. One hundred-(100) peripheral angiograms and participation in a minimum of fifty- (50) peripheral angioplasty procedures and ten-(10) thrombolytic cases (at least half of these procedures as primary operator) under the direct supervision of a physician who already meets these criteria, with documented success and complication rates within accepted limits.

c) If new device or endovascular procedure, the practitioner needs to document the appropriate criteria above and both of the following: 1. The number of hours of didactic training as recommended by the manufacturer specific to the device or procedure. 2. The performance of two–(2) hands on cases under the direction of a practitioner qualified to use the device or procedure.

II. Maintenance of Privileges: The practitioner should be competent in the recognition and initial management of complications specific to peripheral angioplasty. The physician should participate in continuing medical education activities and available continuing institutional QI programs that monitor indications, success rates and complications, as well as demonstration courses and visiting fellowships and perform at least twenty-five-(25) exams in a two-(2) year period in order to maintain competency. For abdominal thoracic stent, at least five-(5) exams must be performed in a two-(2) year period to maintain competency.

86 Department of Radiology – Request for Clinical Privileges Page 6

Privileging Criteria for Endovascular Surgical Neuroradiology

Scope of Practice

This document refers to necessary training for Endovascular Surgical Neuroradiology procedures, including: endovascular therapy for intracranial aneurysms, endovascular treatment of cerebral arteriovenous malformations, endovascular therapy for intracranial arteriovenous fistulas, endovascular management of head, neck, and spinal cord vascular lesions, endovascular therapy for intracranial vascular occlusive disease, and other complex cerebrovascular diseases.

Education

MD or DO degree from an accredited institution or equivalent.

Training

Proper training includes both basic and ad advanced components.

Basic Training

1. Successful completion of an accredited residency (Board eligibility or Board certified) in Diagnostic Radiology, which includes four years of experience, training and supervision in diagnostic neuroimaging, and completion of a 1 year post graduate fellowship in Neuroradiology in an ACGME accredited program, or equivalent, or: 2. Successful completion of an ACGME accredited residency (BE or BC) in Neurosurgery, which includes five years of experience, training, and supervision in diagnostic neuroimaging. 3. The above training should include a year providing experience and training in cerebral angiography performance and interpretation in an ACGME-approved program, to serve as the prerequisite year for Advanced Training. This experience should include 100 cerebral angiograms procedures, with indications, success, complications detailed, according to published Quality Improvement Guidelines.

Advanced Training

Minimum 1-year fellowship in Endovascular Surgical Neuroradiology that meets and/or reflects the training requirements for performance and interpretations set forth by a national multidisciplinary council and the ACGME.

Experience

In the absence of formal advanced training as detailed above, qualifying training and experience would include: 1. Successful completion of an accredited residency (Board Eligibility or Board certified in Diagnostic Radiology and completion of a 1 year post graduate fellowship in Neuroradiology in an ACME accredited program, or equivalent, or: 2. Successful completion of an ACGME accredited residency (BE or BC) in Neurosurgery (BE or BC) or equivalent

With participation in 50 Endovascular Surgical Neuroradiology procedures, under the supervision of a director who otherwise qualifies as a Program Director under the Program Requirements for Residency Education in Endovascular Surgical Neuroradiology.

87 Department of Radiology – Request for Clinical Privileges Page 7

And:

3. Performance of 80 Intracranial Endovascular Surgical Neuroradiologic procedures as primary operator, with record of indications, success, complications, according to the published Standards of Practice of the American Society of Interventional and Therapeutic Neuroradiology (ASITN). or: Membership: Active member of American Society of Interventional and Therapeutic Neuroradiology qualifies for privileges.

Maintenance of Privileges

Maintenance of privileges is contingent of full participation in an institutional multidisciplinary QI process by which procedural performance and interpretation, indications, technical and clinical outcomes, and complications are periodically reviewed.

Adherence to the Standards of Practice of the American Society of Interventional and Therapeutic Neuroradiology (ASITN), or institutionally developed standards of performance and interpretation where otherwise applicable, will be required.

Maintenance of privileges in endovascular surgical Neuroradiology is also contingent upon maintenance of skills that would be lost if not used, and continued renewal of familiarity with devices and drugs related to cerebrovascular intervention. Therefore, a physician must perform the following number of applicable procedures at a Health Alliance Hospital yearly: 1. Fifteen diagnostic cerebral angiograms for continued competence in cerebrovascular intervention, in addition to and not including: 2. Fifteen endovascular surgical\ neuroradiologic procedures.

88 Department of Radiology – Request for Clinical Privileges Page 8

Acute Stroke Therapy

Cognitive:

1. Six months ACGME formal neuroscience training including: neuroanatomy, neuropathology, neurovascular imaging, and cerebrovascular hemodynamics. This training is included in Neurology, Neurosurgery, and Radiology Residency programs. Other training programs would require six months of additional neuroscience training with documentation of completion.

AND

Brain Imaging

Successful completion of a Diagnostic Radiology Residency, a Neuroradiology Fellowship or a Neurointerventional Fellowship training program that included at least six months of brain imaging in at least one year of interventional training. All other specialties are required to document primary interpretation of the following:

1 Interpretation of 200 Head CT and 50 Head CT angiograms 2. Interpretation of 200 MR images and 50 MR angiograms of the head 3. Interpretation of 15 CT or MR perfusion studies of the brain 4. Interpretation of 100 cerebral arteriograms

AND

Technical (experiential, can be performed as part of a formal training program or may have been obtained in practice after training)

1. Performance of 100 cerebral (bilateral selective internal carotid and at least single-vessel vertebrobasilar injections) or 50 25 cerebral and 150 noncerebral angiograms (at least 50% of each as a primary operator.) 2. Performance of 30 selective (2nd or 3rd order branch) microcatheter procedures including 10 Internal Carotid Artery/External Carotid Artery catheterizations using 3 French or smaller microcatheters (all as a primary operator.)

AND

Stroke Treatment

1. Performance of a total of 10 endovascular stroke cases with acceptable outcomes. 2. Monitoring of the first 5 cases of endovascular stroke treatment, by someone with unrestricted privileges in Acute Stroke Therapy.

Maintenance of Privileges

1. Performance of at least 2 endovascular stroke treatments performed over a 24 month period, or if 2 cases not performed, an additional 2 monitored cases are required.

89 Department of Radiology – Request for Clinical Privileges Page 9

Palomar Medical Center Criteria Percutaneous Vertebroplasty and/or Balloon Assisted Vertebroplasty (Kyphoplasty)

1. In general, the requirements for the performance of percutaneous vertebroplasty and/or kyphoplasty may be met by adhering to the recommendations listed below: a. Certification in Radiology or Diagnostic Radiology by the American Board of Radiology, the American Osteopathic boards of Radiology, or the Royal College of Physicians and Surgeons of Canada. And b. Completion of an Accreditation Council for Graduate Medical Education (ACGME) accredited residency or fellowship program that included performance (under the supervision of a qualified physician) of at least 10 percutaneous vertebroplasties and/or kyphoplasties with acceptable success and complication rates documented by a log of cases performed as described in this document (see Section 4 below.)

Physicians whose residency or fellowship training did not include the above-described experience with percutaneous vertebroplasty and/or kyphoplasty may be considered as satisfying the qualifications for this procedure if they meet all other requirements and have performed at least 10 percutaneous vertebroplasties and/or kyphoplasties with acceptable success and complication rates documented by a log of cases performed as described in this document (see Section 4 below.)

Monitoring requirements include performance and completion of at least 2 successful and uncomplicated percutaneous vertebroplasty and/or kyphoplasty procedures as principal operator under the supervision of an on-site, qualified physician who currently holds unrestricted vertebroplasty and/or kyphoplasty privileges.

2. In the absence of appropriate ACGME approved residency or fellowship training (as listed in Section 1a above) or other postgraduate training that included comparable instruction and experience, physicians may meet the requirements listed in Section 1 by adhering to the following recommendations: a. Documentation of “hands-on “ training in the performance of percutaneous vertebroplasty and/or kyphoplasty. And b. Performance and completion of at least two successful and uncomplicated percutaneous vertebroplasty and/or kyphoplasty procedures as principal operator under the supervision of an on-site, qualified physician who currently holds unrestricted vertebroplasty and/or kyphoplasty privileges.

c. Substantiation in writing by the supervising physicians on an approved monitoring form that the monitored physician is familiar with all of the following: 1. Indications and contraindications for percutaneous vertebroplasty and/or kyphoplasty. 2. Preprocedural assessment and intraprocedural monitoring of the patient. 3. Appropriate use and operation of fluoroscopic and radiographic equipment, digital subtraction systems, and other electronic imaging systems. 4. Principles of radiation protection, hazards of radiation exposure to the patient and the radiologic personnel, and radiation monitoring requirements. 5. Anatomy, physiology, and pathophysiology of the spine, spinal cord, and nerve roots. 6. Pharmacology of contrast agents and of polymethl methacrylate and recognition and treatment of adverse reactions to these substances. 7. Technical aspects of performing this procedure. 8. Postprocedural patient management, particularly the recognition and initial management of procedural complications.

90 Department of Radiology – Request for Clinical Privileges Page 10

3. Maintenance of completion Maintenance of competence requires regular continuing clinical activity, including: a. Regular performance of imaging-guided percutaneous interventions, including sufficient numbers of percutaneous vertebroplasties and/or kyphoplasties to maintain success and complication rates as outlined below. A sufficient number is defined as 10 cases within the two-year reappointment period. b. Participation in a quality improvement program that monitors these rates. c. Participation in postgraduate courses that provide continuing education on diagnostic and technical advances in percutaneous vertebroplasty and/or kyphoplasty. d. The physician’s continuing education should be in accordance with the ACR Standard for Continuing Medical Education (CME).

4. Complication Rates and Thresholds (1-20) While practicing physicians should strive to achieve perfect outcomes (i.e. 100% success, 0% complications), in practice all physicians will fall short of this ideal to a variable extent. Thus, indicator thresholds may be used to assess the efficacy of ongoing quality improvement programs. For the purposes of this standard, a threshold is a specific level of an indicator (e.g. complication rate) that should prompt a review. When complication rates exceed a maximum threshold, a review should be performed to determine causes and to implement changes, if necessary.

Routine periodic review of all cases having less than perfect outcomes is strongly encouraged. Serious complications of percutaneous vertebroplasty and/or kyphoplasty are infrequent. A review is therefore recommended for all instances of death, infection, and symptomatic pulmonary embolus.

A review may be prompted when a complication rate surpasses the threshold values outlined below (suggested thresholds are listed in parentheses): 1. Clinical complications a. Death (0%) b. Permanent (duration > 30 days) neurological deficit (Other than radicular pain); 1. osteoporosis (0%) 2. neoplasm (5%) c. Transient (duration < 30 days) neurological deficit (other than radicular pain) or radicular pain syndrome (either permanent or transient): 1. osteoporosis (5%) 2. neoplasm (10%) d. Symptomatic pulmonary cement embolus (0%) e. Symptomatic epidural venous cement embolus (5%) f. Infection (0%) g. Fracture of rib or vertebra (5%) h. Significant hemorrhage or vascular injury (0%) i. Allergic or idiosyncratic reaction (1%) 2. Technical/procedural complications a. Failure to obtain proper informed consent (0%) b. Cement embolus to pulmonary vasculature without clinical sequela and estimated volume >0.25 ml (5%) c. Cement embolus to epidural veins without clinical sequela and producing >10% spinal canal compromise or estimated volume >0.25 ml (10%)

91 Department of Radiology – Request for Clinical Privileges Page 11

PALOMAR MEDICAL CENTER/POMERADO HOSPITAL PERCUTANEOUS VERTEBROPLASTY/KYPHOPLASTY MONITORING FORM DEPARTMENT OF RADIOLOGY

Name of Physician: ______

Date of Procedure: ______

Name of Monitoring Physician: ______

Medical Record #: ______

The Physician Performing the Procedure is Familiar with: Yes No 1. Indications and contraindications for percutaneous vertebroplasty.

2. Preprocedural assessment and intraprocedural monitoring of the patient.

3. Appropriate use and operation of fluoroscopic and radiographic equipment, digital subtraction systems, and other electronic imaging systems.

4. Principles of radiation protection, hazards of radiation exposure to the patient and the radiologic personnel, and radiation monitoring requirements.

5. Anatomy, physiology, and pathophysiology of the spine, spinal cord, and nerve roots.

6. Pharmacology of contrast agents and of polymethyl methacrylate and recognition and treatment of adverse reactions to these substances.

7. Technical aspects of performing this procedure.

8. Postprocedural patient management, particularly the recognition and initial management of procedural complications.

All “No” selections require further explanation: ______

______

Summary – Please state personal opinion in as concise a manner as possible:______

______

Do you feel that further monitoring is needed beyond the required number of cases? Yes ____ No ____ Signature of Monitoring Physician: ______

92 Department of Radiology – Request for Clinical Privileges Page 12

Privileging Criteria for Stereotactic Radiosurgery and Radiotherapy Intracranial and Extracranial

I. Purpose To outline the training requirements and/or clinical practice experience required for obtaining privileges to perform Stereotactic Radiosurgery and Radiotherapy at Palomar Medical Center. The Intracranial Stereotactic Radiosurgery team shall consist of a stereotactic neurosurgeon, a radiation oncologist, and a physicist. The Extracranial Radiotherapy team shall consist of a radiation oncologist, and a physicist (radiosurgery of any intracranial lesion must be performed in collaboration with a neurosurgeon.)

II. Definition

Stereotactic Radiosurgery is the treatment of well defined lesions with focused radiation in a single treatment session. When the radiation dose is fractionated over a number of treatment sessions up to a maximum of 5 fractions, it is termed stereotactic radiotherapy.

III. Training/Experience

The following minimum standards are required at Palomar Medical Center with insistence on documentation of appropriate training, demonstrated competence and maintenance of skills for all physicians to receive privileges to perform stereotactic radiosurgery and radiotherapy.

1. Board certification or active candidacy for board certification in the practitioner’s specialty.

2. Successful completion of an approved residency training program in neurological surgery or radiation oncology with specific training in stereotactic radiosurgery and radiotherapy.

The physician must have successfully completed a formal stereotactic training course at a recognized center with an established radiosurgery program providing a minimum of three days of training.

Documentation of the above requires a letter from a supervisor of the residency training program or fellowship attesting to the applicant’s experience in radiosurgery (estimating number of observed or supervised cases), or certificate of completion of the stereotactic radiosurgery training course.

IV. Procedure

Radiation Oncologist Participate in the initial treatment decision-making with the neurosurgeon. Overseeing the radiation-therapy management of the patient Locating and specifying the target volume and relevant critical normal tissue in concert with the neurosurgeon and radiologist, if necessary. Prescribing the radiation dose to the target volume. Participate in the interactive process of plan development and approving the final treatment plan. Ensuring that patient alignment on treatment unit is appropriate. Follow the patient for control of the abnormality and for monitoring potential complications.

Stereotactic Neurosurgeon (radiosurgery of any intracranial lesion must be performed in collaboration with a neurosurgeon.) Participate in initial treatment management with the radiation oncologist. Locating and specifying the target volume and relevant critical normal tissues in concert with the radiation oncologist.

93 Department of Radiology – Request for Clinical Privileges Page 13

Participate in the interactive process of plan development. Follow the patient for control abnormalities and for monitoring potential complications.

V. Peer Review and Quality Assurance Plan

All physicians practicing stereotactic radiosurgery and radiotherapy are subjected to a quality review in the specialty under which the physician is part of the hospital’s medical staff. In case of an adverse outcome that may be directly related to the use of stereotactic radiosurgery or radiotherapy, the case will be forwarded to the appropriate supervisory committee as part of the peer review process..

VI. Maintenance of Privileges

Re-privileging will be considered on a biannual review at the time of reappointment. In order to maintain privileges, the physician must demonstrate that they have maintained competency by showing evidence that they have successfully performed three (3) stereotactic radiosurgery procedures in the past twenty-four (24) months. If the designated number of cases is not met, the appropriate Supervisory Committee will review the practitioner’s activity on an individual basis and make recommendation for maintenance of privileges.

94 Department of Radiology – Request for Clinical Privileges Page 14

Privileging Criteria for High Dose Rate Gynecologic Brachytherapy

Practitioners who perform gynecologic brachytherapy should have a thorough understanding of gynecologic oncology. The following requirements should be met for privileges:

x successful completion of a radiation oncology residency program x board certification in radiation oncology or (board eligible) x documentation of experience performing gynecologic brachytherapy

--10 documented cases with acceptable complication rates within the past three years, or -- A letter of attestation from the former residency or department chief can substitute for actual case documentation.

Proctoring: x If there are not 10 previous cases within the last three years, applicants will be proctored for a minimum of their first 3 cases.

Continuing Education: Applicants will attend a minimum of one radiation oncology seminar that includes at least one Brachytherapy course every two years to maintain privileges.

Privileging Criteria for High Dose Rate Breast Brachytherapy

Practitioners wishing to perform High Dose Rate Breast Brachytherapy must first meet the criteria for High Dose Rate Gynecologic Brachytherapy.

In addition, documentation of completion of an appropriate Radiation Oncology Program (MammoSite training course) that provides training in breast brachytherapy must be submitted.

95 Palomar Medical Center Escondido – Department of Radiology Request for Clinical Privileges

Requested by: ______Print Name

Privileges Requested (Choose One): ______1) Consulting Only – May request Interpretation- Teleradiology Bundle ______2) Request privileges from the following bundles

COGNITIVE BUNDLES Requested Action

PROCEDURAL BUNDLES Requested Action

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Requested Action

Privileges Requested By: ______Date:______Signature

Recommendation by Chairman of the Department: ______Date:______Signature

Approved Board of Directors 06/12/2017

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BLANK PAGE TO SLIP CONSCIOUS SEDATION IN –

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Privileging Criteria for Cardiac CT Angiography Source: ACR Practice Guidelines Revised 10/01/2006

The radiologist who supervises and interprets cardiac CT examinations should meet the following criteria for calcium scoring:

Maintenance of competence.—All radiologists performing cardiac CT examinations should demonstrate evidence of continuing competence in the interpretation and reporting of those examinations. If competence is assured primarily on the basis of continuing experience, a minimum of 25 examinations, excluding those performed exclusively for calcium scoring, every 3 years is recommended in order to maintain the radiologist’s skills.

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Palomar Medical Center PERIPHERAL, PERCUTANEOUS TRANSULUMINAL ANGIOPLASTY AND ASSOCIATED PERIPHERAL VASCULAR INTERVENTIONS

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Privileging Criteria for Endovascular Surgical Neuroradiology

Scope of Practice

Education

MD or DO degree from an accredited institution or equivalent.

Training

Proper training includes both basic and ad advanced components.

Basic Training

Advanced Training

Experience

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And:

Maintenance of Privileges

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Acute Stroke Therapy

Cognitive:

AND

Brain Imaging

AND

Technical (experiential, can be performed as part of a formal training program or may have been obtained in practice after training)

1. Performance of 100 cerebral (bilateral selective internal carotid and at least single-vessel vertebrobasilar injections) or 25 cerebral and 150 noncerebral angiograms (at least 50% of each as a primary operator.) 2. Performance of 30 selective (2nd or 3rd order branch) microcatheter procedures including 10 Internal Carotid Artery/External Carotid Artery catheterizations using 3 French or smaller microcatheters (all as a primary operator.)

AND

Stroke Treatment

Maintenance of Privileges

1. Performance of at least 2 endovascular stroke treatments performed over a 24 month period, or if 2 cases not performed, an additional 2 monitored cases are required.

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Palomar Medical Center Criteria Percutaneous Vertebroplasty and/or Balloon Assisted Vertebroplasty (Kyphoplasty)

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PALOMAR MEDICAL CENTER/POMERADO HOSPITAL PERCUTANEOUS VERTEBROPLASTY/KYPHOPLASTY MONITORING FORM DEPARTMENT OF RADIOLOGY

Name of Physician: ______

Date of Procedure: ______

Name of Monitoring Physician: ______

Medical Record #: ______

The Physician Performing the Procedure is Familiar with: Yes No 1. Indications and contraindications for percutaneous vertebroplasty.

2. Preprocedural assessment and intraprocedural monitoring of the patient.

3. Appropriate use and operation of fluoroscopic and radiographic equipment, digital subtraction systems, and other electronic imaging systems.

4. Principles of radiation protection, hazards of radiation exposure to the patient and the radiologic personnel, and radiation monitoring requirements.

5. Anatomy, physiology, and pathophysiology of the spine, spinal cord, and nerve roots.

6. Pharmacology of contrast agents and of polymethyl methacrylate and recognition and treatment of adverse reactions to these substances.

7. Technical aspects of performing this procedure.

8. Postprocedural patient management, particularly the recognition and initial management of procedural complications.

All “No” selections require further explanation: ______

______

Summary – Please state personal opinion in as concise a manner as possible:______

______

Do you feel that further monitoring is needed beyond the required number of cases? Yes ____ No ____ Signature of Monitoring Physician: ______

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Privileging Criteria for Stereotactic Radiosurgery and Radiotherapy Intracranial and Extracranial

II. Definition

III. Training/Experience

1. Board certification or active candidacy for board certification in the practitioner’s specialty.

2. Successful completion of an approved residency training program in neurological surgery or radiation oncology with specific training in stereotactic radiosurgery and radiotherapy.

The physician must have successfully completed a formal stereotactic training course at a recognized center with an established radiosurgery program providing a minimum of three days of training.

IV. Procedure

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Participate in the interactive process of plan development. Follow the patient for control abnormalities and for monitoring potential complications.

V. Peer Review and Quality Assurance Plan

VI. Maintenance of Privileges

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