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Board Certified Pediatrician Adolescent Medicine Medical Expert Witness





Expert Witness No.899


CURRENT

Western Regional Medical Director for Care Management
Health Plan Medical Insurance
Responsible for CA, CO and NV Commercial Care Management Programs
Part of a major corporate effort to redesign high risk case management programs and prove effectiveness. Includes efforts to more fully integrate care management of highest risk cases including Mental Health.

MOST RECENT FORMER POSITIONS

9/06 - 7/09
Consulting Medical Director
UM and G&A Consulting - Including transplant and High Dollar Pharma and difficult Pediatric and Adolescent cases.

5/01 - 7/09
International Care Network & Personal Care Consultants
Utilization management for labor trusts, oversees insurance and foreign insurance cos.

4/02 – 7/09
Health Plan Company
MediCal & Healthy Families Managed Care (200,000 insured lives) – Pediatrics, Grievances and Appeals and Emergency Care and Ambulance Transport Reviews, substitute for CMO when he is away, appear at arbitrations and mediations.

2005 - 2008
Health Care Company
Home infusion company – consulting medical director for Managed Care Issues.

Also: UM Consulting, Medical-legal Consulting, Medical Editing & Medical Practice - Locum Tennans & Urgent Care - see those sections below
Also: Legal Private Practice (Continues)

PREVIOUS POSITION

10/02 - 12/1/02 & 4/1/06 - 8/1/06; Consulting: 12/1/02 - 4/1/06 = Full Time
Physician’s Network
Medical Director
Medical Director in charge of all aspects of medical management and developing physician based clinical and fiscal initiatives for this physician owned, Independent Practice Assn. with over 60 PCPs, 150 specialists and over 54,000 covered lives. Accomplishments: MLR reduced from 89% to < 75% in three years - profitability achieved.

Vice President & Chief Medical Officer (8/01 – 10/01) Consulting Medical Director (60% FTE) (11/00-8/01 & 10/01 – 12/01)
CMO Duties: Chair all Committees and in charge of all health service programs – report to BOD
Consultant Duties: In charge of Grievances and Appeals, Utilization Management, IPA Denial Review and Disease Management Program Development, and Pharmacy Program supervision - Chair UM Committee. MediCal & Commercial Health Plan (50-50) – 100,000 insured lives.

FORMER POSITIONS

12/99 - 4/00
Director of Clinical Research
Private Company
Duties: Senior clinical medical advisor for Health Information Website involved in all aspects of site content development and clinical content quality assurance, along with some aspects of marketing.

Accomplishments: Lead an innovative, interdisciplinary team in developing some of the most sophisticated interactive health information modules for wellness and diseases conceived to this point in the development of health related sites on the Internet.

12/97 - 8/98
Medical Director & Director of Health Services
Health Plan Company
Director of Health Services for this start-up MediCal (Medicaid) Managed Care Company. Responsible for QA, QM, UM, Credentialing, Pharmacy and Health Education Departments and involved in all other aspects of program development, contracting and community planning.

Accomplishments: In less than three months brought together a cohesive health services team, enabling GAHP to pass its first Calif. Dept. of Health Services Audit and developed processes to improve quality of care.

7/95 - 10/97
Regional Medical Director
Private Health Care Company
Regional Responsibilities:
Responsible for San Diego area, Palm Springs and parts of Inland Empire/PS area 10/95 - 3/95
Orange County and Long Beach, Inland Empire/PS and parts of LA Counties 4/96 - 8/96, San Diego and Inland Empire/ PS 9/96 - 6/97
Substitute Medical Director for Northern CA - 12/95 - 6/97

Work-flow Responsibilities

All Prior Authorization review for all of California.
Member of HEDIS Improvement Comm, Inter-regional Benefit Interpertation Comm, So Cal QM Comm, Statewide Credentialing Comm,, So. Cal Claims Appeals Bd. and Calif. Government Affairs Comm. and California and company-wide Pharmacy & Therapeutics Committees
Chair four sub-regional Health Care Advisory Committees
Chair of Technology Assessment Committee for California responsible for Technology Assessment Program
Director of Clinical Studies for California 3/96 - 5/96 and while no longer fully responsible due to reorganization, is the major medical director designer of clinical studies and preventive health guidelines.
Medical Director for California Organ Transplant Program
Medical Director for Government Affairs
Member California and National Pharmacy & Therapeutics Comm.
Responsible for Physician and IPA liaison within assigned regions, as well as QM, Risk and Case Management reviews for Commercial and Senior Medicare risk HMO products.
During tenure as substitute Medical Director in No. Cal. responsible for all PPO + POS product oversight for State as well as regional UR, some case management, physician and IPA liaison plus credentialing.

Accomplishments:
Kept California region afloat despite massive reorganization and personnel losses. For five months - only two medical directors for 920,000 members!
Helped revamp & streamline credentialing process
Revised & reinstituted tech assessment program
Helped to develop and assure passage of CA tech assessment legislation

3/94 - 4/94 Consulting
5/94 - 7/95 Full Time
Associate Medical Director, So. CA Market
A Health Care Provider Company

Responsibilities:
Utilization and Quality Management chart reviews for HMO, POS, and PPO health insurance products.
Chair: Quality Management and Pharmacy Comms. Member of Credentialing Comm. - 9000 MDs/yr. reviewed.
Develop health education & community involvement programs for health plan members and employees.
Management liaison with Employee Activities Committee.
Assist Medical Director in full range of administrative and clinical duties; substituted for Medical Director when she was not available, including National P&T Committee.

Accomplishments:
Developed several epidemiological, evaluative and interventional studies to improve managed care performance.
Developed liaison with mental health provider including clinical studies.
Assisted national office in review of technology assessments and preventive health guidelines and programs.
Substituted for Medical Director on national Pharm & Therapeutics Comm.
Developed processes to streamline physician credentialing
Extensive experience preparing for NCQA review.
Able to rapidly learn processes and contribute fully to management in large, advanced market, despite no previous full-time management experience.

FORMER FULL-TIME ACADEMIC POSITIONS

Associate Professor of Pediatrics, Internal Medicine, Surgery & Preventive Medicine
University of Texas Medical Branch
Director of Adolescent Medicine 10/1/91 - 2/28/94
Pediatric & Adult Emergency Room Faculty Part-time: 1/2/92 - 2/28/94; Full-time: 3/1/94 - 5/15/94 Departments of Pediatrics & Emergency Services
Assoc. Prof. in Pediatrics, Preventive Med, Medicine and Surgery Depts.
University–wide ER Supervisory Comm, Computer/IS Comm., P&T Comm.
Re-established Adolescent Medicine teaching and service component including Juvenile Justice and College health programs, enhanced community programs
Responsible for Pediatric ER program and Child Abuse Program oversight

Assistant Professor of Pediatrics, Adolescent and Preventive Medicine
New York Medical College, Valhalla, NY, 7/83 - 6/85
Research Director, Division of Adolescent Medicine.
Author of one of the earliest Robert Woods Johnson School-based Health Clinic grants for a high school in the poorest US Congressional District – Bronx, NY

EDUCATION

1965 - 1969
Hopkins School, New Haven, CT

1969 - 1973
B.S.: Georgetown University, Washington, D.C.
Majors: Psychology, Political Science, Pre-Med, Honors: Degree Cum Laude, 1973
GTU Honorary Scholarship (Merrit Finalists), 1969
Psi Chi (National Psychology Honor Society), 1973
Phi Sigma Alpha (Nat. PolySci Honor Soc), 1973
Mahoney Medal, Best Pre-Med in the Humanities, 1973

1973 - 1977
M.D.; Georgetown Univ. School of Medicine, Washington, D.C.

1977 - 1978
Pediatrics PL-1: University of California, Irvine, Orange and Long Beach, CA

1978 - 1980
Pediatrics PL-2,3: Children’s Hospital of Northern California, Oakland, CA. (Affil. Program: Univ. Calif. S.F.)

1980 - 1981
M.P.H.: Univ. California, Berkeley, Berkeley, CA.
Major: Maternal and Child Health

1981 - 1983
Adolescent Medicine Fellowship: LA Children’s Hosp. (Affiliate Program: Univ. So. Calif.) Los Angeles, CA.

2006
JD - Concord Law School, LA, CA - Passed CA Bar Exam - 7/06

ACADEMIC TEACHING EXPERIENCE

Academic Pediatrics

1983 - 1985
Taught Pediatric and FP Residents from USC and UCLA affiliated programs on elective rotations in Adolescent Health Care, Loyola Marymount University Student Health Service.

1985 - 1987
Assistant Professor of Pediatrics, Adolescent and Preventive Medicine: New York Medical College, Valhalla, NY, Research Director, Division of Adolescent Medicine.

1988 - 1989
Assistant Clinical Professor Pediatrics & Adolescent Medicine - UCLA - taught in Adolescent Clinic, Cedars Sinai Hospital and Pediatric Wards, Clinics - Ventura County Medical Center.

1989 - 1991
Attending Physician Pediatric Ward & Juvenile Hall: San Bernardino County Med. Center, paid part-time faculty position, Family Practice residency program

1990 - 1995
Clinical Assistant Professor Pediatrics & Medicine, Osteopathic College of the Pacific, Pomona, CA.

1991 - 1994
Associate Prof: Pediatrics, Internal Med.,Surgery & Preventive Med.:UTMB Galveston, Galveston, TX

1995 - 1997
Associate Clinical Professor of Pediatrics, Loma Linda Univ. Medical School, Loma Linda, CA.

1996 - 2002
Assoc. Clinical Professor of Pediatrics, UCSD Med School, San Diego, CA (Adolescent Med Clinic Attending 1996- 97)

Full-time Private Practice - Pediatrics & Adolescent Med.

7/1987 - 10/1988
Children’s Medical Group, Thousand Oaks, CA

10/1988 - 10/1991
Pediatric Medical Group, Redlands, CA

Pediatric Clinic and Hospital Coverage

1979 - 1981
Pediatric Walk-in Clinics, Kaiser Hospitals Oakland and Walnut Creek, CA

1981 - 1985
Pediatric Walk-in Clinics and Overnight

1989 - 1991
Coverage including ER, Ward and Nursery Doctor, Kaiser Hospitals: Panorama City, Harbor City, and West Los Angeles, CA.

1981 - 1983
Pediatric Walk-in Clinics, Kaiser Hospital, Sunset Blvd., Los Angeles, CA.

1984 and 1988
Pediatric Walk-in Clinics, Kaiser Hospital, Woodland Hills, CA (also brief locums).

1989 - 1991
Pediatric Walk-in Clinics, Kaiser, Riverside, CA.

1988 - 1989
Cigna Health Centers, Walk-in Clinics, Pasadena, West Covina, and Pomona, CA.

1988
Los Angeles County Pediatric, STD and TB clinics, Canoga Park and Van Nuys, CA.

1995 - 1996
Pediatric Medical Group., Redlands, CA - night clinics

1996 - 2000
Pediatric Urgent Care - San Diego Children’s Hosp.

1998 -
Pediatric Urgent Care - San Diego, CA (also locum tennens coverage at several locations)

Pediatric Emergency Room

1980-81
Children’s Hospital of Northern CA, Oakland, CA (also Nursery and Adolescent Clinics).

1980-81
St. Lukes Hospital, San Francisco, CA (Also overnight Ward and Nursery/DR Coverage)

1981-83
Orthopedic Hospital, Los Angeles, CA (Also Overnight Ward Coverage)

1981-83
Children’s Hospital, Los Angeles, CA (Emergency Medical Systems Attending Physician)

1992-94
Pediatric and Adult Emergency Room Attending, Univ TX Medical Branch, Galveston, TX

1998 – 99
Fill-in, Children’s Hospital San Diego, CA

Locum Tennans: Pediatric Private Practices

1980-81
Coverage provided to six different Pediatric Practices - Berkeley/Oakland area (list available)

1984
Kwook Huh, M.D., Porterville, CA, July.

1985
Carol Gill, M.D., Gilroy, CA, May.

1988
Moon Chung, M.D., Valencia, CA, May & Aug.

1988
Krisnan Goel, M.D., Turlock, CA, July.

1990
Herb Rhus, M.D. & Vickie Solonik, M.D. Moreno Valley, CA, Apr.-Sept.

1999
Marvin Gale, MD & Elaine Cohen, MD - Chula Vista, CA

Various Dates 4/99 – 8/99
Karen Hanten, MD - Alpine, CA 7/99
Cecelia Perez-McGraw, MD – National City, CA 8/99 & 3/01 – 5/01 (1 day/wk), 8/05 – 16/02
Shelter Island Pediatrics – San Diego, CA 12/99

2000
Sanchez Pediatrics – Chula Vista, CA 10/00 – 11/01 various dates

2002
Willie Rios, MD - Chula Vista, CA 3/01 – 3 days

2002
Sharp Rees-Steely Pediatrics – Chula Vista, CA 3/02 – 5/02 (60 – 80% time)

2002
Lassen Medical Group Pediatrics, Red Bluff, CA 4/29-5/10/02

Locum Tennans: Family Practice

1984
Victoria Sammler, M.D. Hollywood, CA, July & other dates in 1985.

1984 and 1985
Lawrence Miller, M.D., Hawthorne, CA, Dec - Jan

1991
Tim Williamson, M.D., Ojai, CA, September

2000
Clinica Consuelo, Escondido, CA – August, parts of September

Urgent Care: (Family Practice/Emergency Room/Occupational Health)

1983
Euclid Urgent Care, Fullerton, CA, Aug. - Nov.

1983 - 1985
The Health Care Center, Hawthorne, CA (included adult hospital ward night coverage)

1984
Community Urgent Care, Manhattan Beach, CA, June.

1999
Valley Immediate Care, Escondido, CA March - July

Occupational Health Clinics

1980
Overseas Medical Center, San Francisco, CA (Locum Tennans), July.

1980, 1984, and 1985
Ship’s Surgeon, USS Independence, Honolulu, Hawaii, Aug., July and June - total seven weeks

1981
Santa Rita Prison Clinic, Alameda County Prison, Santa Rita, CA.

College Health

1981
UC Berkeley Student Health Service, Per Diem.

1983 - 1985
Loyola Marymount University SHS, Los Angeles, CA, Full Time.

1990 - 1991
Univ. of Redlands SHS, Redlands, CA, MD Coordinator 1990, Per Diem.

1992 - 1994
Univ. Houston Clear Lake, weekly half-day GYN and General Medicine Clinic, Per Diem

10/2002 - 11/2002
California State University San Marcos – 50% time locum tennans

Neonatology

1980 - 1981
Oakland Children’s Hospital, NICU, per diem.

1984
San Diego Children’s Hospital, NICU, per diem.

Paid Consulting

Available Upon Request

RESEARCH GRANTS AWARDED

Available Upon Request

SERVICE GRANTS WRITTEN AND AWARDED

Available Upon Request

PROFESSIONAL SOCIETY MEMBERSHIPS

American Academy of Pediatrics
Physicians for Social Responsibility
Society for Adolescent Medicine
American Public Health Association
International Assn. for Adolescent Medicine
American College of Physician Executives
American College of Legal Medicine
Children’s Advocacy Institute, Univ. of San Diego Law School, Board of Advisors

BOARD CERTIFICATION AND PROFESSIONAL SOCIETY FELLOWSHIPS

National Medical Boards Certification
American Board of Pediatrics Certification
Board Certified - Adolescent Medicine
Board Certified - Preventive Medicine
Recertified - Adolescent Medicine
Recertified - Preventive Medicine 2009
American Ht. Assn. CPR, Neonatal Resuscitation Certification and Pediatric Advanced Life Support
American Academy of Pediatrics
Society for Adolescent Medicine
American College of Legal Medicine

LICENSURE INFORMATION

Available Upon Request

ADDITIONAL INFORMATION

International Health Experience

Pediatrician: Hardecker Children’s Clinic, Nassau, Bahamas, 4/77 - 5/77
In-Flight M.D.: Southeast Asian Refugee Transports, 9/79, 12/80
Medical Director: International Rescue Committee Medical team Sa Kao and Khao i Dang Refugee Camps, 11/79 - 12/79
Resident, Pediatric Neurology, Montreal Children’s Hospital Montreal, Canada, 3/80
Advisory Board: Operation Survival (Thailand/Somalia Refugee Relief), 1981
Medical Advisor: California Medical Teams(Thailand Refugee Relief) 1981
Medical Observer: Concern - Honduran Refugee Camps, 3/82
Pediatrician: LBJ Tropical Medical Center, American Samoa, 8/82-9/82
Pediatrician: Albert Schweitzer Hosp., Deschapelles, Haiti, 12/86
Advisory Bd. - Institute on War & Children 1988 - 1994
Advisory Bd. - Doctors for Global Health 1994
Physicisn for barrio clinics in Cabo San Lucas, Baja Cal, Mexico - Doctors of Charity - 10/96
LA Chidrens Hosp Teaching Exchange Program with Children’s Hosp, Ulan Batar, Mongolia, July, 1997

International Medical Conferences

Available Upon Request

LANGUAGES

English (Native)
French (Very Good)
Spanish (Good)
Portuguese (Fair)
American Sign Lang., Russian, German, Italian (All Beginning Level)
Latin - 2yrs

PEER REVIEW MEDICAL JOURNAL ARTICLES

Available Upon Request

NON-PEER REVIEW MEDICAL JOURNAL ARTICLES

Available Upon Request

PAPERS AND POSTERS PRESENTED AT CONFERENCES

Available Upon Request

WORKSHOPS PRESENTED AT CONFERENCES

Available Upon Request

ABSTRACTS PUBLISHED AT MEETINGS BUT NOT PRESENTED

Available Upon Request

LETTERS TO EDITOR IN MEDICAL JOURNALS

Available Upon Request


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