Document Decision Making Capacity (DMC)

by Frank Randolph, MD

Many nursing home admission forms ask physicians to address patient decisional capacity. I am unsure how this came to be a part of the admissions forms. I could not find references to it in California’s Title 22 regulations. Title 22 (§ 72303) states that physician services shall include but are not limited to: “Patient evaluation including a written report of a physical examination within 5 days prior to admission or within 72 hours following admission; an evaluation of the patient and review of orders for care and treatment on change of attending physicians; patient diagnoses; advice, treatment and determination of appropriate level of care needed for each patient; written and signed orders for diet, care, diagnostic tests and treatment of patients by others; health record progress notes and other appropriate entries in the patient's health records; provision for alternate physician coverage in the event the attending physician is not available.”  Also, federal regulations (§483.40 Physician Services) make no mention of capacity assessment.

Is Gratitude a Part of Your Healthcare?

by Timothy Gieseke, MD

In Sonoma County, signs saying “Thank you, First Responders” abound in recognition of the vital help they provided during those early days of the Sonoma County wildfires.  As a first responder for healthcare in my remaining facilities, I was very grateful for employees who came to work despite losing their homes.  A wise rabbi in a sheltering facility told one of my good friends that he had not lost his “home,” but only his “house”.  This was a surprisingly helpful truth, for him to process.

At this time of year, I have been challenged by several theologians to focus more on living in gratitude as a measure of wellness.  As I think about the fires, I am grateful that my home was spared, but I also am moved to action to provide tangible help to those who have lost so much and are now under-resourced.

Santa Rosa Apocalypse

by Timothy Gieseke, MD, CMD

On the evening of October 8, the expected “El Diablo” winds arrived in Sonoma and Napa Counties with peaks winds of 80 mph.  Unfortunately, wildfires began that evening.  Late that night, the Tubbs Fire that started in the Calistoga area became a blowtorch that moved within 4 hours through a broad swath of Northern Santa Rosa, consuming a broad swath of our city.  We were shocked that it jumped a 6-lane freeway continuing a path of destruction through another 2 miles of North West Santa Rosa.  During that short time, emergency evacuations of residents at 2 of our 3 acute hospitals occurred (Sutter & Kaiser).  The rest of Santa Rosa awoke to explosions, dark smoke, and glowing surrounding skies.  Within hours, 5 of our 8 SNFs (1 CCRC) were evacuated to shelters and then on to other out-of-area facilities.  Communication by phone, cell, and internet was difficult with wide power outages and 80 cell towers down.  Battery-operated transistor radios allowed for local on-the-ground, real-time news (KSRO) about the surrounding uncontrolled wildfires.  When the internet returned, many of us used the EMS emergency text message system (Nixle), which sent out updates on impending fire threats based on zip code of end user.  (If you want Nixle updates, simply text your zipcode to 888-777; please note text messaging rates from your phone carrier apply - visit for full details.)

Pain Management: First, Do No Harm


We are so excited about our upcoming event that we are giving you a sneak peek of the first talk of the day by Rebecca Ferrini, MD, CMD entitled “Pain Management: First, Do No Harm”.  Dr. Ferrini has prepared a comprehensive handout to complement her presentation and with her permission, we are sharing it with our readers.  Some of Dr. Ferrini’s pearls of wisdom are provided below, and the complete handout is available for download.

Dr. Ferrini’s Pearls:

  • You must do something, but you will likely NEVER alleviate all pain.  The best treatment: “I believe you”—compassion and empathy, be present and trying, hope/optimism and explanations –far exceeds the prescription.  Get the conversation off asking for opioids and back to treating pain.

Wi-Fi calling in your Facility?

by Tim Gieseke MD, CMD

I have been the Medical Director of a large CCRC since 1986, which was before we had cell phones.  Over the years, this technology has dramatically improved, but at this particular facility, I barely receive text messages and still can’t receive cell phone calls.  The big issue is the 1000-foot elevation Annadel State Park immediately next door, which blocks much of the signal of my carrier.  There is another carrier with a better signal, but even that signal is weak.  Some years ago, I tried a signal amplifier unit, but that proved ineffectual.

My new associate, Dr. David Greene, has the other carrier, but found it inadequate and did activate a better option.  Newer phones available over the past 3+ years have an option to make and receive calls by tying into the facility w-ifi system.  I went to my carrier and they set up this wifi option without charge.  I am pleased to report that I now call and receive calls with an excellent landline-like clarity.

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