Children's Hospital Central California

CENTRAL CALIFORNIAPEDIATRICSSPECIALTY INFORMATIONFOR PHYSICIANSWHO TREAT CHILDREN AND EXPECTANT MOTHERSSUMMER 2008Regional Services Improve AccessChildren’s Medical Staff puts pediatric subspecialists wherethey are most needed.Children’s Hospital Central California isthe second largest pediatric hospital in thestate (measured by inpatient admissions)and covers the most extensive geographicalservice area, the 45,000-plus square miles atthe heart of California. Draw this region ona map and you’ll make a rectangle that runsfrom Stockton to Bakersfield, the Sierra NevadaMountains to the Coast. It’s commonknowledge that kids who live in this regionand need a pediatric hospital usually come tous. What many physicians don’t know is thatwe have services and facilities strategicallyplaced throughout the area to improve accessand bring Children’s care closer to home.IN THIS ISSUE« New Team Members | 2« Pediatric Intensive Care | 3« Plastic Surgery | 4« Dr. Irene McAleer | 5« Evidence-Based Design | 5« Prenatal Diagnostic Center | 6« How to Refer a Patient | 6« Modesto Gives Back | 7« Modesto Pediatric Symposium | 8The reason for reaching out is simple. Providingtertiary care to children throughoutthe region requires giving easy access topediatric subspecialists and working closelywith other medical institutions.For example, Children’s Hospital is a90-minute drive from Modesto. That’s closerthan other pediatric hospitals when youThe expanded Modesto PediatricSubspecialty Center has allowedChildren’s to increase the varietyof subspecialties offered inand around Stanislaus County.account for traffic and congestion. But parents receive a lot of added value if theycan avoid that travel and have their child seen by a pediatric subspecialist locally.Due to the number of patients referred from the Modesto and Stockton areas,Children’s medical staff made the decision in 2003 to see these patients in theirown area whenever possible. That year they opened The Modesto PediatricSubspecialty Center.Operated by physicians from our Specialty Medical Group (SMG) and staffedby Children’s employees, the center’s visits grew progressively in its first five years.It outgrew its original location and moved to a new 5,000 square-foot block in thewell known Fifteen 24 Professional Center on McHenry Avenue in 2007. Thesecustom-designed facilities offer nine examination rooms, child friendly surroundingsand adjacent radiology and laboratory services. This has also provided theopportunity to increase the range of subspecialties at the facility. Current subspecialtiesinclude cardiology, endocrinology, gastroenterology, neurology, orthopaedicsurgery, pediatric surgery and urology, with plans to add ENT, pulmonology, genetics,and plastic surgery in the near future.CONTINUED ON PAGE 2 >>

Our New Team Members >> Regional Services continued from page 1Children’s shows the same commitment to supporting primary care physiciansand patients in Merced through its Multispecialty Center at 1190Olivewood Drive. Subspecialty services available at the Merced locationinclude: cardiology, gastroenterology, neurology, orthopaedics, pediatricsurgery, urology and NICU.Radiology: Fred Laningham, MDDr. Fred Laningham has returned to theCentral Valley to join Wishon RadiologyMedical Group and Children’s HospitalCentral California. Born and raised inBakersfi eld, Dr. Laningham’s expertise isin Neuro-imaging and MRI. Most recentlyserving at St. Jude Children’s ResearchHospital, Dr. Laningham brings seventeenyears of experience to our organization.Dr. Laningham played baseball while earninghis B.S. at Stanford University before receivinghis Medical Degree from the University ofArkansas for Medical Sciences and beingelected into the Alpha Omega Alpha HonorMedical Society. He went on to the Universityof Tennessee to complete his Residency inRadiology. Dr. Laningham then pursued aFellowship in Pediatric Radiology at HarvardMedical School, Boston Children’s Hospital.Otolaryngology: Jairo Torres, MD(not pictured)Dr. Torres will be joining Dr. Michael Dunhamand Children’s Hospital Central California inSeptember 2008. Dr. Torres earned his MedicalDegree from Universidad del Valle Facultadde Medicina in Cali, Columbia. He completedhis Otolaryngology training at the UniversityHospital of Cleveland. Dr. Torres is fl uent inEnglish and Spanish.Other Medical Staff ChangesDr. Donald Fields has moved from his role in Child Advocacyto pediatric care and Dr. John Kinnison has increasedhis focus on Child Advocacy.Dr. Cherie Ginwalla, currently practicing in the CharlieMitchell Clinic is moving to UC Davis in Sacramento.Dr. Mathew Halsey, Orthopaedic Surgeon is moving hispractice to Portland, Oregon.Dr. William Hennrikus, Orthopaedic Surgeon is moving hispractice to Pennsylvania.By spreading “the Children’s net” with these centers, we now see over 150,000outpatient visits at locations in Fresno, Modesto, Merced, and Visalia.Children’s uses a partnering approach with SMG in these endeavors, andthat method works just as well in the inpatient setting, where SMG’spediatric hospitalists serve the children at Turlock’s Emmanuel MedicalCenter. The SMG hospitalist program began in the 1990’s at Children’swhere hospitalists fill key roles in providing around-the-clock inpatient careincluding admitting and discharge. Their presence improves and standardizesquality of care hospital-wide and has greatly improved patient throughput.At Emmanuel, one of the hospitalist’s most important roles is their communicationwith referring physicians, regularly updating primary care providerson the condition of their patients.Children’s Hospital and its medical staff look forward to being able to useadvances in telemedicine to work with other facilities in Central California toenhance the level of pediatric care throughout the region. Already Children’spediatric neurologists read electroencephalograms remotely for patients in theNICU at Doctors Hospital Modesto and pediatric cardiologists have arrangementsto consult on and read ECHOS from Emmanuel Hospital in Turlockand Sierra Vista Hospital in San Luis Obispo.Pediatric subspecialists from Children’s Hospital are often engaged in providingclinical education throughout the Valley from on-site grand roundslectures to hospital and community based CME events. One such educationalevent is the Modesto Clinical Pediatric Symposium, now in its fourth year.The next Modesto Symposium will take place on Saturday, September 27,2008 at the Double Tree Hotel. If your schedule allows, join us for thisexciting Modesto-based CME course designed with a particular emphasis onproviding state-of-the-art information pertinent to the recognition, diagnosisand treatment of the most prevalent conditions encountered in a pediatricpractice. These will include: urology, pediatric surgery, plastic surgery, andblood disorders (Please see CME details on page 8 for registration details).Children’s provides specialized training for nurses throughout the region bymeans of preceptorships, outreach education and training partnerships withother hospitals. Other regional services include neonatal satellites in placeslike Hanford, Fresno and Merced and transport agreements with over 50hospitals throughout California.2 | Children’s Hospital Central California >>

PICU MeasurementUnit benchmarked in the nation’s top 10%.Our New Team MembersThe Pediatric Intensive Care Unit(PICU) at Children’s Hospital CentralCalifornia is one of the largest PICUsin the country based on bed capacity,but it’s another ranking that mattersmost. In the field of intensive care,severity adjusted mortality rate is a keybaseline benchmark, and in this arenaChildren’s PICU is ranked in the best10% in the country.The PICU is licensed for 34 beds and isa combined medical/surgical unit. Themost recent expansion of six additionalbeds was completed in the fall of 2007.Twelve of the ICU rooms are equippedto convert to surgical suites if anemergent event presents itself.The mortality rates are collated froma validated data set which consistentlyranks Children’s in the top 1-2 PICU’sout of 33 benchmarked units for thepast decade. Great teamwork betweenthe PICU staff, transport team (bothground and air), and a board certifiedpediatric intensivist group, on dutyaround-the-clock, contribute not onlyto the PICU’s great outcome databut also to the Unit’s high patient satisfactionscores. The intensivists’ presencemeans that attending physiciansare always in the Unit, and residentsare never left without the support ofan experienced specialist.Achieving this level of success is aresult of constant efforts to improvequality and performance. Children’sPICU is currently engaged in anumber of projects toward that end.For example, the PICU has initiatedan electronic insulin protocol researchstudy for non-diabetic patients inwhich well established protocols areDr. Newton Seiden, Intensivist andChildren’s Hospital Chief of Staff.applied and then adjusted based on aprescribed dataset for the individualpatient. To date this ongoing study hasproved to be simple to implement andoutcome positive. Additionally, thePICU is part of a collaborative withinNACHRI (National Association ofChildren’s Health and Related Institutions)to reduce catheter associatedblood stream infections. This researchproject is part of a national collaborativewhich has completed Phase I witha significant reduction of blood streaminfections and is now embarking onPhase II which will add additionalstudy and refinement to both insertionand care of central lines.Children’s PICU will continue to seekopportunities to improve the level ofquality and service to patients, theirfamilies and customers. An additionaleight bed PICU expansion will becompleted in approximately three years.Plastic Surgery:Mimi Chao Mills, MDDr. Chao Mills has joined Drs. Peter Wittand Angela Rodriguez in Children’s PlasticSurgery Department. Dr. Mills earned herMedical Degree from the University of IowaCollege of Medicine and was elected into theAlpha Omega Alpha Honor Medical Society.She completed her surgical internship andresidency at St. Louis University School ofMedicine, St. Louis University Hospital. Shemost recently completed a Craniofacial/PediatricPlastic Surgery Fellowship at Children’sHospital of Pittsburgh. She is fl uent in Englishand Chinese.Hematology/Oncology:Ruetima Titapiwatanakun, MDDr. Titapiwatanakun received her MedicalDegree with honors from Mahidol Universityin Bangkok, Thailand. She completed herPediatric Residency Training at Mount SinaiSchool of Medicine in Jersey City, NJ andwent on to pursue a Fellowship in PediatricHematology/Oncology at the Mayo Schoolof Graduate Medical Education in Rochester,MN. She will join Specialty Medical Groupand Children’s Hospital Central California inAugust 2008.Children’s Hospital Central California | 3>>

Pediatric Plastic SurgeryNationally recognized physicians and researchers help the Valley’s kids.You may have seen the work of Children’s plastic surgeonsin the news. The media has run several stories on highprofilecases in which surgeons completed amazingreconstructions after major trauma. But the team does farmore - everything from the management of complicateddiaphragmatic hernias to taking care of moles, frommanaging facial cuts to closing difficult meningomyelocelewounds with exposed hardware. And the division’s volumeshows that the need for this kind of specialty care hasbecome very important to the Valley.Led by Dr. Peter Witt, the division serves over 1,650children every year, with over 4,000 combined visits, daysurgeries and inpatient stays. And each year they perform500 plastic surgeries. With increased volume cameexpanded access, and Dr. Witt and Dr. Angela Rodriguezhave been joined by Dr. Mimi Chao Mills, giving thedivision three full-time, board certified/eligible surgeons.The outcomes these surgeons post are impressive. Children’splastic and reconstructive surgery length of stay (LOS) isless than 3 ½ days, which is almost a full day shorter thanthe adjusted LOS for children having plastic surgery at 40other pediatric hospitals across the nation.Faculty in the division comprises highly trained, nationallyrecognizedresearchers, who are involved in internationaloutreach, and are committed to achieving the bestclinical and aesthetic outcomes with the fewest risks.And their patient families appreciate it. Children’s PlasticSurgery services scored a 91.1% on overall patient andfamily satisfaction.The team has years of experience in diagnosing andtreating children with craniofacial anomalies, includingcraniosynostosis, cleft lip and palate, microtia, and facialasymmetry. Our qualified experts manage congenitalhand problems (webbed fingers, extra digits, absentdigits), vascular anomalies (hemangiomas or vascularmalformations), in addition to pediatric trauma (facialfractures, lacerations, scars).Specialists provide consultations for soft tissue tumors,dental malocclusions, breast hypertrophy/asymmetry,and burn reconstruction. They also provide pretermMedical Director Dr. Peter Witt performs a cleft palatesurgery. Dr. Witt is a nationally recognized expert incleft lip and palate repair as well as the subsequentspeech issues.counseling, including pre-delivery nursing education, forexpectant mothers with intrauterine-diagnosed anomalies.There is no other service like this in all of Central California,and this highly-specialized team helps provide solutions tocomplex pediatric soft tissue conditions. They work closelywith referring physicians to positively improve the quality oflife of all patients.4 | Children’s Hospital Central California >>

Expansion to focus onevidence-based designChildren’s will break ground at the end of this year on its largestexpansion since the opening of the new Hospital ten years ago. Theproject will take two to three years and add 60,000 square feet, expandingpediatric intensive care, operating rooms, imaging and emergencydepartment capacity.The state-of-the-art expansion will include: Minimally invasive surgical suites equipped with advancedaudio-visual technology designed to reduce dependence on mobileequipment, increase patient flow and improve patient outcomes; Installation of a new GE Signa HDx 3.0T MRI scanner withunprecedented imaging speed, resolution, and contrast in neurovascular,cardiovascular, abdominal, orthopaedic and spectroscopic imaging; Installation of GE’s MPi radiography and fluoroscopy imaging system,which includes an interventional package as well; Installation of GE’s Definium 8000 digital radiographic system, whichoffers excellent image quality with proven dose efficiency; Two new ultrasound suites equipped with the latest technology. Two, large state-of-the-art trauma rooms. Eight major care exam rooms in the ED. An eight bed PICU addition, giving a total of 42 beds. Shell space for future growth.Further, evidence-based design principles were utilized to improvepatient safety and increase care delivery effectiveness, resulting in: Decentralized nurses stations. Enhanced noise barriers. Single patient rooms. Integrated wayfinding. Equipment standardization.Designed with sensitivity to the existing campus architecture and toaffect appropriate adjacencies to existing services, the new addition willbe a seamless modernization to the existing Hospital.Architect’sillustrationof Children’sexpansion.PhysFocusIrene M. McAleer, MD, FAAP, FACSjoined Children’s Pediatric Urology departmentin July 2007. Dr. McAleer graduated from OhioState University College of Medicine, fi nishedher Urology Residency at the National NavalMedical Center in Bethesda, Maryland andcompleted a Pediatric Urology Fellowshipat the University of California, San Diego in1990. She is board certifi ed and focuses solelyon pediatric urology. She was the Directorof Pediatric Urology at the National NavalMedical Center and Walter Reed Army MedicalCenter before becoming an attending pediatricurologist at Children’s Hospital, San Diego,Children’s Hospital, Austin, Texas and theConnecticut Children’s Medical Center.Academic appointments include AssistantProfessor of Urology and Pediatrics at UC SanDiego and The University of Connecticut, andAssociate Director of Pediatric Urology atChildren’s Hospital, San Diego. She wasrecently granted an Assistant Professorship(clinical) at UC San Francisco, Fresno. Shehas published over 60 medical publicationsin urologic journals and texts and continuesto review journal articles for several majorurological publications.Dr. McAleer is the past president of the AmericanAssociation of Pediatric Urologists andbelongs to other professional organizationsincluding the American Academy of Pediatrics,the American Urological Association, and theAmerican College of Surgeons.Dr. McAleer cares for pediatric conditionsincluding pre and post-natal care of congenitalproblems of the kidneys/bladder and genitaltract, and manages and performs surgicalprocedures for hypospadias, undescendedtestes, hernias, hydroceles, vesicoureteralrefl ux, urinary tract obstruction, urinary stonedisease, and neurogenic bladder conditionsassociated with spina bifi da disorders.Children’s Hospital Central California | 5>>

Prenatal Diagnostic CenterService grows to meet the needs of referring physicians and expectant mothers.Dealing with expectant mothers of advanced maternal age,family history of genetic disease or positive Ca. Quad MarkerExpanded alpha feto protein (AFP) tests can be a timeconsuming challenge in a busy medical practice. Taking thetime to determine the appropriate testing, interpreting theresults for the patient, counseling them on their options andmaking arrangements for the follow-up care of the newbornmay take several visits to your office and to multiple locationsfor diagnostic tests for the parents.Children’s Hospital has gathered a team of experts togetherinto a “one stop shop” capable of providing the latest technologyin prenatal diagnostic testing, genetic counseling andphysician consultation. Patients can be managed through theentire prenatal diagnostic process with minimal impact onyour practice.The ARDMS credentialed sonography staff at Children’sis among the best trained in the area and able to offer firsttrimester (nuchal translucency) screening. Patients whoscreen positive are immediately scheduled for follow-upconfirmatory testing later in their pregnancy. Board certifiedpediatric radiologists offer advanced skills in performingamniocenteses and interpreting fetal ultrasounds. Genzymegenetics performs a broad array of genetic disease testswith very rapid turnaround time. Our licensed GeneticCounselors work with our board certified Geneticists toJoy Guthrie, DHSc, RDMS, RDCS, RVT, ROUB, is one of only twosonagraphers out of 52,000 in the United States who have all tenultrasound certifications.interpret the test results and provide information to theparents about options and prognosis for their unborn child.For expectant mothers who have tested positive in the State’sAlpha Feto Protein program, Children’s is a recognizedreferral site for follow-up services.For more information about Children’s Prenatal DiagnosticCenter, please call 559.353.5916.Referring a PatientFor urgent referrals, or to transfer a patient, call ourTransfer Center toll free at 866.353.KIDS (5437).Or go online to childrenscentralcal.org for a complete listof physician offi ce numbers and information.Outreach Centers:Merced Subspecialty Pediatric Center209.726.0199Modesto Subspecialty Pediatric Center209.572.3880For a copy of Children’s Quick Reference Telephone Guide, call 559.353.6621.6 | Children’s Hospital Central California >>

Modesto Gives BackTwo prominent leaders embrace Children’s.Children’s Hospital Central California has been a part of lifein Stanislaus, San Joaquin and Merced Counties for years,relationships cemented in the past decade as the Hospitaland its physician partners opened outpatient centers inMerced and Modesto. But that’s not how the Gallo namebecame associated with the Hospital.That happened when these communities adopted Children’swhole-heartedly and began raising funds for the notfor-profitHospital. Two leaders emerged in the fight tohelp Valley kids - Gallo family members Greg and JessicaColeman. Greg serves as Vice President of Grower Relationsfor Gallo Family Vineyards, and the Colemans are foundingmembers of the Hospital’s highly successful black-tiefundraiser, the Harvest Ball. They have each served as officerson one of Children’s two major boards - Jessica on theFoundation Board of Directors, and Greg on the Hospital’sBoard of Trustees. Greg is the incoming Board of TrusteesChair, the first from Stanislaus County.“People don’t realize what they have right here in their ownbackyard,” said Jessica. “There are so many talented andcaring people that work at the Hospital. The doctors aresuper knowledgeable and there are so many subspecialtiesthere that you can’t get anywhere else. We’ve always had avery pleasant experience there with our kids and there’s noother place we’d rather take them.”Living in the Modesto area means they have many choiceswhen it comes to pediatric health care, including going toSacramento or the Bay Area. The Colemans understand thebenefits of having one of America’s largest children’s hospitalsjust down the 99, though. They’d rather make the drive south,where the people are friendly, the facility rivals any inthe nation, and the quality and expertise are proven.“It’s just a fabulous place,” she said. “In the Bay Area youget all the hustle and bustle and it’s just not a very pleasantexperience. Children’s Hospital is located out in the country,it’s a beautiful facility and the doctors are wonderful.”But the trip is often traveled without the kids. Throughinvolvement in their respective Boards and planning forother Hospital fundraisers, the couple are frequent flierson Highway 99. Back home in Modesto, Greg and Jessicahave also initiated a grass roots effort to raise awareness forChildren’s in their community. The campaign includes toursof Children’s to introduce Stanislaus and San Joaquin countyresidents to the facility, and Jessica has thrown herself intoGreg and Jessica Coleman.the Color the Skies Hot Air Balloon Festival that benefitsChildren’s Hospital.Jessica founded Color the Skies in 2006. The annual festivaltakes place on Labor Day Weekend in Mistlin SportsPark and features activities and performances for families,and a 5K run. The sky is filled with balloons, and allproceeds from parking, breakfast, merchandise and rafflesales benefit Children’s. As Jessica has a habit of saying, “It’sa little about balloons and a lot about Children.”“This is a great way of bonding with this community,”says Christopher Long, Children’s Executive Director ofCommunications and Advocacy. “You can’t take care of acommunity’s kids if you don’t get to know their families.With this event we prove that we all have something specialto give to each other.”“We give because we feel like Children’s is a diamond in ourcommunity,” Jessica said. “This Hospital is here for everyone,and we should all take a part in it and make sure it’s here forfuture generations. For Greg and me, there’s no other placewe’d rather give our time, money and energy than to helpkids get better.”The Colemans are leading philanthropists in the Modestoarea and contribute to many causes. Elevating goodstewardship through philanthropy is one of the family’smission statements, and a value that Jessica firmly believes in.“There’s a difference between being wealthy and prosperous,”she said. “It’s a great feeling to be able to have somethingand give it away freely. It makes your life better and it makesother’s lives better. When you give back, you get back a lotmore. That’s when you become truly prosperous.”COLOR THE SKIESLabor Day Weekend • Saturday & Sunday • Mistlin Sports Park • Ripon, CAEvent kicks off at 5 a.m. with a Pancake BreakfastFor more information you may contact: Peggy Dunlap 559.353.7108or visit www.colortheskies.com.Children’s Hospital Central California | 7>>

CME Calendar« September 4: Advancing Qualitythrough Cultural Awareness andResponsiveness. 8 a.m. to 4 p.m. atChildren’s Hospital. Increase your culturalawareness in the health care setting.« Every Tuesday & Thursday:Pediatric Consulting & SubspecialtyLectures. 12:30 to 1:30 p.m. August Series:Pediatric Emergency Care.For a complete list of monthly CME topicsvisit www.childrenscentralcal.org.Children’s Hospital is accredited by theInstitute for Medical Quality/CaliforniaMedical Association (IMQ/CMA) to providecontinuing medical education for physicians.For questions about our CME program, contactNorma Barajas, PhD at 559.353.7230or email nbarajas@childrenscentralcal.org.Modesto Pediatric Clinical SymposiumA post graduate continuing medical education (CME) symposium for thegeneral, family and pediatric practitioner.You are invited to join us in Modesto for this exciting CME course designedwith a particular emphasis on providing state-of-the-art information pertinentto the recognition, diagnosis and treatment of the most prevalent conditionsencountered in a pediatric practice.Saturday, September 27, 2008Modesto Double Tree Hotel1150 9th Street, Modesto CA8:00 a.m. to 1:30 p.m.This half-day Saturday program will focus on advances in pediatricpractice including:UrologyPediatric SurgeryPlastic SurgeryHematologyNON-PROFITORGANIZATIONUS POSTAGEPAIDFRESNO, CAPERMIT 1149300 Valley Children’s PlaceMadera, CA 93636-8762RETURN SERVICE REQUESTED