Kaiser Permanente Santa Rosa Medical Center Get New Physician Leadership

Michael J. Shulman, MD, a Santa Rosa urologist, was named the new physician-in-chief of the Kaiser Permanente Santa Rosa Medical Center, helping guide the medical operation of the hospital and oversee physicians and medical staff.

Dr. Shulman, a Santa Rosa resident, joined the Kaiser Permanente Santa Rosa Medical Center in 2006. He served as Santa Rosa’s Chief of Urology for over nine years (including two years as assistant chief), and he replaces Kirk Pappas, MD, who served as physician-in-chief from 2011-2017.

“Our work is now compounded by the devastation of the fires,” says Dr. Shulman, who became physician-in-chief just eight days before the fire storm. “Nevertheless, I hold vast optimism for our future as I witness tremendous dedication and caring by our medical physicians and staff toward the work of healing and building a better medical center. For me, it is truly an overwhelming honor and privilege to serve as physician-in-chief for Kaiser Permanente Santa Rosa Medical Center.”

Dr. Shulman was born and raised in central coastal California. He graduated from Occidental College, Magna Cum Laude, with a degree in Chemistry. He received his Masters degree in Chemistry from Harvard University and from the Swiss Federal Institute of Technology in Zurich, Switzerland. He then moved to Honolulu, Hawaii where he taught high school chemistry at Iolani and Punahou Schools. He also worked as an environmental consultant for both private industry and the Hawaii State Department of Health.

To pursue his interest in medicine and service to patients, Dr. Shulman received his Medical Degree from the University of Michigan, in Ann Arbor, where he graduated Cum Laude with election to Alpha Omega Alpha (AOA). He then completed an Internship in General Surgery and Residency in Urology at the University of Texas Southwestern Medical Center, in Dallas, Texas.

“We’re pleased to welcome Dr. Shulman to the leadership team at the Santa Rosa Medical Center,” said Judy Coffey, RN, Sr. Vice President and Area Manager, Marin-Sonoma. “and we look forward to working together—physicians,  nurses, and staff—providing high quality care and service to our members.”


About Kaiser Permanente

Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve 11.7 million members in eight states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal Permanente Medical Group physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: kp.org/share.

The Buck Institute for Research on Aging Explores a New Therapeutic Avenue for Parkinson’s Disease

Systemic clearing of senescent astrocytes prevents Parkinson’s neuropathology and associated symptoms in a mouse model of sporadic disease, the type implicated in 95% of human cases. Publishing in Cell Reports, researchers in the Andersen lab at the Buck Institute provide a new potential therapeutic avenue for the incurable, progressive neurological disorder that affects up to one million Americans, robbing them of the ability to control movement.

Senescent cells, which stop dividing in response to stress, secrete deleterious factors that cause tissue damage and lead to chronic inflammation. In this study, senescence was triggered by exposure to the pesticide paraquat, a neurotoxin formally linked to the development of Parkinson’s disease in farmworkers in 2011.

“While senescence has been implicated in Parkinson’s and other neurodegenerative disease, we believe this is the first time that clearing the inflammatory cells prevented symptoms from developing in a live mammal,” said Julie K. Andersen, PhD, Buck professor and senior author on the paper. “We hope that the fact that we were able to do this in a sporadic, rather than genetic, model of Parkinson’s, highlights its relevance as a potential new way to tackle the most prevalent form of the disease.”

This research is unusual given that it focuses on senescence in astrocytes, so called “helper” cells that perform a variety of tasks, from axon guidance and synaptic support to control of the blood brain barrier and blood flow. Even though astrocytes are the most numerous cell type within the central nervous system, Andersen says they have been underappreciated “stepchildren” in most basic neuroscience research. She says the vast majority of Parkinson’s research has focused on toxicity that directly affects specific neurons implicated in the disease, “but no one has come up with an effective treatment based on that approach. This research suggests that senescent astrocytes may contribute to the development of the disease and we’re excited to explore this avenue.”

The research, led by adjunct faculty Shankar Chinta, PhD and postdoctoral fellow Georgia Woods, PhD, showed that postmortem tissue from patients with Parkinson’s displays increased astrocytic senescence, and that cultured human astrocytes exposed to paraquat become senescent as well.

The mice used in this research were six months old, the human equivalent of about 34 years of age. Andersen’s lab hopes to study the impact of astrocytic senescence in mice at varying stages of lifespan to see if Parkinson’s can be reversed in addition to being prevented. “Chronic inflammation fueled by senescence drives many age-related diseases and it’s quite possible that Parkinson’s is among them,” says Andersen, who adds that astrocytic inflammation may play a role in other neurodegenerative diseases such as Alzheimer’s. “This model gives us a way to expand how we look at and potentially treat a range of maladies,” she says.

There is a desperate need for treatments for Parkinson’s. An estimated seven to 10 million people are living with the disease worldwide. In addition to resting tremor and difficulty with walking and balance, Parkinson’s also leads to cognitive decline and depression with symptoms becoming more severe as the disease progresses. About 5 percent of cases are caused by genetics. The remainder are believed to be caused by a combination of both genetic and environmental factors such as family history, genetic mutations, drinking well water and exposure to pesticides or metal.


Citation: Cellular senescence is induced by the environmental neurotoxin paraquat and contributes to neuropathy linked to Parkinson’s disease DOI: 10.1016/j.celrep.017.12.092

Other Buck researchers involved in the study include Shankar J. Chinta, Georgia Woods, Marco Demaria, Anand Rane, Ying Zou, Amana McQuade, Subramanian Rajagopalan, Chandani Limbad, David T. Madden and Judith Campisi.

The work was supported by grants from the National Institutes of Health grant AG009909, T32-AG000266, Michael J. Fox Foundation, the Ellison Senior Scholar in Aging award, a training grant from the California Institute for Regenerative Medicine, the American-Italian Cancer Foundation and the Buck Institute Impact Circle.

About the Buck Institute for Research on Aging

At the Buck, we aim to end the threat of age-related diseases for this and future generations. We bring together the most capable and passionate scientists from a broad range of disciplines to study mechanisms of aging and to identify therapeutics that slow down aging. Our goal is to increase human health span, or the healthy years of life. Located just north of San Francisco, we are globally recognized as the pioneer and leader in efforts to target aging, the number one risk factor for serious diseases including Alzheimer’s, Parkinson’s, cancer, macular degeneration, heart disease, and diabetes. The Buck wants to help people live better longer. Our success will ultimately change healthcare. Learn more at: https://buckinstitute.org

Kaiser Permanente Coming Together on MLK Day to Build Community

Working in partnership with Rebuilding Together Petaluma, more than 50 Marin-Sonoma volunteers gathered in Petaluma as part of Kaiser Permanente’s 14th annual MLK Day of Service.

Kaiser Permanente’s commitment to community health includes addressing the underlying social circumstances that influence it, such as homelessness. That’s why this year’s volunteer efforts focused on Petaluma People Services Center (PPSC) and the Kids First Emergency family shelter at the Committee on the Shelterless (COTS).

“As a nonprofit, we are often so focused on the work, and struggling to survive, that we neglect self-care,” said PPSC Executive Director Elece Hempel. “Projects like this one are so appreciated! It allows us to continue to do what we do, to care for the community.”

PPSC is dedicated to improving the social and economic health of the community through counseling and support services, including those aiding seniors, the unemployed, and people without a place to live. One of PPSC’s programs, Petaluma Bounty, is the current recipient of a KP Community Benefit grant.

COTS offers assistance with case management, income development, counseling, and housing searches. KP sponsors COTS’ annual breakfast fundraiser and helps fund the Petaluma Sober Circle.

“We couldn’t ask for a better, more responsive partner,” COTS CEO Mike Johnson said.

On KP’s MLK Day of Service, more than 1,500 KP physicians and employees gave back about 10,000 hours to serve communities at 22 sites across Northern California. In Petaluma, KP volunteers – including family members, retirees, and members of the Teen Advisory Council – pitched in with painting, landscaping, flooring work, and cleaning.

Rebuilding Together, which organized the Petaluma volunteer effort, repairs about 60 homes and the facilities of several nonprofits each year.

Executive Director Jane Hamilton sees such projects as a win-win for everyone involved. “For the companies that participate, volunteering allows colleagues to work together for the first time or in a new way,” she said. “For the nonprofits, it shows the organizations how much they’re appreciated by the whole community.”

Kaiser Permanente Contributing Funds to Support Community Health

Kaiser Permanente understands that total health extends beyond the doctor’s office or hospital, to the places where people live, work, and play. We also understand that building healthy communities requires financial backing for supportive resources and services.

Last year, Kaiser Permanente Northern California provided more than $40 million in grants and donations to nonprofit, community based organizations and agencies. In the fourth quarter of 2017 alone, Kaiser Permanente Community Benefit funded more than 50 substantial grants to support diverse community health needs.

In addition to state and regional grants, local CB contributions include:

Family Justice Center Sonoma County (FJCSC), Ensuring Comprehensive Services for Victims of Family Violence: Funding allows FJCSC to remain fully staffed with two full-time navigators, three full-time victim advocates, a full-time attorney, and a full-time bilingual legal assistant to support family violence victims. The goal is to enable clients and their children to live stable, well-adjusted lives ($95,000 grant for 1 year).

Partnership for Children and Youth (PCY), HousED Northern California Learning Community and Action Network: Funding allows PCY to support Marin and 12 other Northern California housing providers with training, coaching, quality assessment, and communications support. Goal is to expand and increase the quality of housing-based learning programs, reaching low-income children in at least 120 affordable and public housing developments ($300,000 in funding over 2 years).

SF-Marin Food Bank and Redwood Community Health Coalition, Building Local Outreach Capacity (BLOC): Aims to increase CalFresh (California’s Supplemental Nutrition Assistance Program or SNAP) so participating organizations can enhance service and delivery capacity to provide high-quality outreach and effective application assistance for eligible individuals and families (year-long grant totaling $1,194,000 supports 15 regional grantees).

Redwood Community Health Coalition (RCHC), Regional Clinic Consortia: One of six CB Northern California consortia grants that support community health centers to grow and successfully: meet patient choice demands; accommodate patient expansion under the Affordable Care Act; advocate for access to health coverage for low-income Californians; implement payment reform focused on value-based care; and address health needs of the uninsured ($250,000 in funding per consortium over 2 years).

Sonoma County Regional Parks Foundation, Park Accessibility for Resilient Communities (PARC): Aims to increase accessibility in communities facing inequitable access to safe parks and open spaces, and significant usage disparities by ethnicity, age, and gender (particularly in low-income and underserved communities). Developed with community input, incorporates sustainable programming and maintenance (year-long grant totaling $750,000 to support 10 regional grantees).

In response to the North Bay fires and a growing homelessness crisis, Community Benefit also fast-tracked the following grants and donations:

Mental Health Groups for Patients Affected by North Bay Fires, Santa Rosa Community Health Centers (SRCHC): Support for up to six months of weekly and monthly mental health groups for patients impacted by the Sonoma County fires. Includes administrative and outreach support, and bilingual trauma and depression groups, therapy for adults and families, and access to evaluations by licensed psychiatrists for high-risk patients ($200,000 cash donation for 6 months).

UndocuFund for Fire Relief in Sonoma County, Grant Makers Concerned with Immigrants & Refugees (GCIR): UndocuFund was established to assist undocumented residents who were displaced, lost wages and jobs, and suffered other losses due to the North Bay fires—including many undocumented wine and hospitality workers. GCIR is the fiscal sponsor of a $250,000 cash donation for 6 months.

Vista Clinic Fire Recovery, Santa Rosa Community Health Centers (SRCHC): Funding to assist 24,000 patients and 180 employees of Vista Clinic (SRCHC’s largest site), which was severely damaged by fire. Assistance to include providing patient transportation to other sites, covering the loss of payments, and providing post‐trauma support ($50,000 cash donation to help meet immediate needs).

Redwood Credit Union Receives Heart of Marin Corporate Community Service Award

Redwood Credit Union (RCU) received the Corporate Community Service award at the 25th annual Heart of Marin awards held January 11, 2018 at the Marin Center, hosted by the Center for Volunteer and Nonprofit Leadership (CVNL). The Corporate Community Service award recognizes a local company that has fostered and encouraged volunteerism and philanthropy among its employees.

In 2017, RCU’s staff provided over 2,000 hours of volunteer support at 115 events supporting local nonprofits and community organizations in Marin, including the Marin/San Francisco Food Bank, Novato Human Needs Center, Marin YMCA, Conservation Corps of the North Bay, and many others. RCU regularly hosts “Bite of Reality” financial events at local high schools to help teens learn important real-world money management skills—more than 3,000 Marin students benefited from these programs. In addition, RCU supports SchoolsRule—a coalition that provides literacy, technology, arts and health education to all Marin public school students—through a unique program that generates a donation for every RCU credit or debit card transaction made by a Marin County Member, providing more than $30,000 to support SchoolsRule programs annually. In 2017, RCU also raised more than $31 million dollars through the North Bay Fire Relief Fund to assist people who were impacted by the devastating fires last October.

“RCU is extremely honored and humbled to receive this award,” said Matt Martin, Vice President of Community and Government Relations for RCU, who accepted the award at the event. “Giving back and supporting the well-being of our local communities is an integral part of who we are as an organization, and we are continually inspired by the amazing spirit this community has for giving and helping people in need.”

RCU also sponsored the Heart of Marin Volunteer of the Year award, which was presented to Kim Lambert of Canal Alliance by RCU’s Executive Vice President and Chief Lending Officer Ron Felder at the event.

Redwood Credit Union has 17 branch locations throughout the North Bay and San Francisco, including 3 Marin branches in San Rafael, Mill Valley, and Novato.

About Redwood Credit Union

Founded in 1950, Redwood Credit Union is a full-service financial institution providing personal and business banking to consumers and businesses in the North Bay and San Francisco. RCU offers complete financial services including checking and savings accounts, auto and home loans, credit cards, online and mobile banking, business services, commercial and SBA lending, wealth management and investment services, and more. The Credit Union also offers insurance and discount auto sales through their wholly-owned subsidiary. RCU has over $4 billion in assets and serves more than 300,000 Members with full-service branches from San Francisco to Ukiah, more than 30,000 fee-free network ATMs nationwide, and convenient, free online and mobile banking. For news and updates, follow RCU on Facebook at facebook.com/redwoodcu and on Twitter at @redwoodcu. For more information, please call 1 (800) 479-7928 or visit www.redwoodcu.org.

Dominican University and the City of Novato Team Up on Youth Civic Engagement

Novato students studying at Dominican University in San Rafael this fall will be able to pursue civic engagement through public service — and be eligible for a $100,000 scholarship.

In a unique partnership between the city of Novato and Dominican, 10 students a year can participate in “Reimagining Citizenship” — a program enabling students to earn a bachelor’s degree while working as interns at Novato City Hall. Students can receive up to $100,000 in scholarship funds over four years and a $10,000 stipend for two summers of work with the city.

“It’s a win-win because it gives young people the opportunity to gain valuable experience and skills,” said Novato Mayor Josh Fryday, who last month pitched the project to the city for further discussion. “It’s a huge benefit to the community for the services and projects the young people will be working on, and it helps create and shape civically-minded and civically-engaged citizens.”

The Novato City Council on Tuesday unanimously agreed to support the public-private arrangement, expected to launch with students working in various city departments this summer. The city will set aside $50,000 for stipends from next year’s budget.

“I think this all sounds phenomenal,” Councilman Eric Lucan said Tuesday. “I remember my summer after my high school year and it looked nothing like what we’re talking about tonight. It really provides some great opportunities.”

Councilwoman Pam Drew said she can support the program if it helps low-income students, but said she wanted more information.

“I support public-private partnerships if it can be shown to aid Novato high school graduates to have access to college,” she said. “But I want to see the parameters, the basics, of the program.”

High school seniors living in Novato who plan to study any major at Dominican this fall can join the program. Fryday said the opportunities at City Hall this summer are still being fleshed out, but he envisions students working in unique ways.

“(I see) everything from working in the parks and recreation department to put on programs for all citizens, to helping our engineering teams, assisting the police department with their work to keep the community safe,” he said. “The idea is there are a variety of opportunities to work on different kinds of meaningful projects for the community.”


Dominican President Mary Marcy said students, who will progress through the program as a cohort, will engage in work that helps their education and the city.

“We plan to sit down with the team at the city and have them go through the list of greatest need, and to talk about aligning students’ capabilities,” she said. “The ideal position is where they can make genuine contributions right away but where they’re exposed to the way city government works — how it can make a difference.”

Over four years, students will take a series of courses that will earn them credits toward the university’s minor in community action and social change, which provides an understanding of issues affecting communities and the nation. The minor requires the completion of four courses, but more classes would be required.

Marcy said young people have become more civically engaged over the past two years, but they need the tools to learn how they can become even more involved.

“I know our students are very interested in politics, whether it’s local or national,” she said. “I think they need avenues for using that interest to actually make a difference. They’re interested in more than just protesting or voting. They want to make a difference in the community. We’re providing an opportunity for them to do that.”


At Dominican University, students are encouraged to become involved in community engagement — one of four pillars making up what is called the “Dominican experience.” The school in 2016 held a two-day workshop, dubbed “College Debate 2016,” focused on encouraging young people to vote. The school invited 138 college students from 47 states to the event. The campus has sponsored forums on issues, hosted speakers and opened its doors to allow young voters to watch the presidential debates.

The “Reimagining Citizenship” program was pitched by Fryday after meeting with Marcy about providing a platform that encourages young adults to get involved.

Fryday and Marcy said the program model can be expanded not only to other schools across Marin and the Bay Area, but statewide.

Rep. Jared Huffman, D-San Rafael, said in a written statement said he applauds Marcy and Fryday for their investment in the effort.

“This unique program — a potential model for other communities — is about investing in the future of America,” he said. “It should serve as a national model for public/private sector partnerships focused on creating more engaged citizens and education opportunities.”

Interested students can contact Maria Upmeyer in Dominican’s admissions office at 415-257-1307, or maria.upmeyer@dominican.edu.

“There are a lot more details to come and lots for the community to learn about this program and the service opportunities,” Fryday said. “All of us have work to do now to get the word out to make sure every student in Novato knows this opportunity is available to them.”

College Of Marin To Present Private Art Collections From Locals

The Art Department at College of Marin (COM) had its beginnings in the Butler Barn in 1931 under the direction of William F. Rauschnabel. Since then, students have received instruction from award-winning artists such as Harry Crotty and world-renown sculptor Robert Ellison.

Over the years, a number of donors have contributed important works of art to COM’s permanent collection as well as a variety of pieces currently on loan. Two sculptures by Robert Ellison are installed at the Kentfield Campus. COM is also home to six original William Keith paintings depicting Mt. Tamalpais, the Sierra Nevada Mountains, and other local vistas.

The availability to view art created by emerging and established artists is a critical component of the Art Department’s curriculum. This engagement, whether active or passive, provides opportunities for students and the community to study and experience art.

Reviewing potential artwork to be installed on District property now falls under the purview of an advisory group. This process was formalized in a new administrative procedure approved by members of the board of trustees in May 2017. Formed by the Fine Arts Department chair, the group includes Art Department faculty and staff and a representative from the Advancement Office. After reviewing requests for installations on campus, the group’s recommendations are considered by the Office of the Superintendent/President for a final decision.

“Art exhibited at College of Marin’s campuses—whether in the gallery or other locations—can provide a vehicle for dialogues to take place across disciplines,” said Superintendent/President Dr. David Wain Coon. “The upcoming exhibits broaden the conversation farther out into the community as they feature pieces with direct connections to Marin.”

In 2018, COM’s commitment to the arts takes shape in the form of new biannual exhibits. Opening in March, Marin Collects showcases significant art and design from the private collections of Marin County residents. The inaugural exhibit will feature works on loan from the Blunk Foundation, the Parker family, and the Cella family.

Marin Collects is intended to celebrate the passion that moves people to acquire art. Just as community colleges draw a diverse group of people, the exhibit seeks to bring unique pieces together in support of sharing an appreciation of the arts.

Opening in fall 2018, Made in Marin will feature works by local makers—designers and manufacturers, artists and craftspeople—based in Marin. This reoccurring exhibit highlights art from emerging makers who live and work in this community. Made in Marin lauds the county’s heritage of creative artisans. The inaugural exhibit will include art by Ido Yoshimoto and Grayson Kent.

COM’s Fine Arts Gallery hosts five to six exhibits each academic year and serves as a classroom which gives students hands-on training in the fields of exhibition installation and gallery management.

More information about gallery hours and exhibits is available online at http://www1.marin.edu/fine-arts-gallery.

About College of Marin
Established in 1926, College of Marin remains committed to educational excellence, providing equitable opportunities, and fostering success in all members of its diverse community. With campuses in Kentfield and Novato, students of all ages have affordable access to an exciting variety of credit and noncredit courses as well as community education classes for lifelong learning. College of Marin is one of 114 public community colleges in California and approximately 13,000 credit, noncredit, and community education students enroll annually.

College of Marin is accredited by the Accrediting Commission for Community and Junior Colleges, Western Association of Schools and Colleges, 10 Commercial Boulevard, Suite 204, Novato, CA 94949, (415) 506-0234, an institutional accrediting body recognized by the Council for Higher Education Accreditation and the U.S. Department of Education.

Codding family buys out Simon Property Group’s stake in Coddingtown Mall in Santa Rosa

Santa Rosa’s Coddingtown Mall has returned to fully local ownership after the Codding family business last week repurchased the 50 percent stake in the shopping center previously owned by mall giant Simon Property Group.

Simon sold its half of the mall to Codding Enterprises, which had retained the other half of the business for the last 12 years, for an unknown price in a deal completed Thursday, according to mall manager Jimmy Scales.

The family company is led by Lois and Lisa Codding, whose late grandfather Hugh, a widely known figure in Sonoma County business and politics, developed the mall 55 years ago.

“The mall itself is going to be family run; it’s not going to be run by a corporation,” Scales said Sunday of the transaction.

“It just gives them complete control of what kind of stores they want to go in, what direction they want to take it. When they want to sign a deal with a lease they can sign a deal with a lease — they don’t have to wait for five other approvals … Now it can just be done by the Coddings.”

A representative of Simon, which still owns the Santa Rosa Plaza, couldn’t be immediately reached for comment Sunday.

Scales, who was promoted from assistant mall manager and marketing director as part of the transition, indicated the deal has been a long time coming.

“The Coddings have always wanted to buy back their mall,” he said. “But I would say, probably in the last six to nine months they have been doing whatever they needed to do on their part to put them in a position where they would be able to buy out Simon.”

Scales was unfamiliar with the exact terms of the deal, including the sales price. He referred questions about the sale’s details to Lois Codding, who couldn’t be reached Sunday.

Hugh Codding developed the 60-acre mall property in 1962 and it prospered in its early years before losing economic ground when the Santa Rosa Plaza debuted downtown in the 1980s. Codding famously fought the plaza’s development in the courts for many years, delaying its opening more than a decade.

Simon acquired half of Coddingtown Mall in 2005, a deal seen at the time as bolstering the shopping center’s prospects for attracting national retailers. In the mall’s most recent history, it gave Sonoma County residents a sorely-desired shopping option in 2016 with the debut of a 31,000-square-foot Nordstrom Rack.

Today, Coddingtown Mall spans 822,000 square feet of retail space and more than 40 stores. The mall remains focused on a major renovation on its northwestern side that’s set to house an Ulta Beauty store and other businesses, according to Scales.

In its newly regained status as an entirely locally-owned business, the mall will continue to support community events with an eye toward providing a varied lineup of national and local retailers, Scales said.

“It’s never going to get back to the way it used to be at Coddingtown, back when it was booming,” he said. “But we’re hoping to get it close. Everything’s changing in retail, so it’s just going to be a nice mix and supporting the community. Especially being local, it’s just a different feel.”

Kaiser Permanente Stroke Patients Receive Clot-busting Medication More Than Twice as Fast as National Rates

Kaiser Permanente hospitals in Northern California are delivering clot-busting medication to new stroke patients more than twice as fast as the national average. This follows the regionwide adoption of an integrated telemedicine program, according to new research published Dec. 15 in the journal Stroke.

This is the among the first peer-reviewed, published studies to show how the successful implementation of standardized treatment protocols and telemedicine for acute ischemic stroke in a large, integrated system of hospitals can dramatically reduce the time it takes to start critical treatment.

“When a stroke happens, minutes matter,” said lead author Mai Nguyen-Huynh, MD, MAS, vascular neurologist and research scientist with the Kaiser Permanente Division of Research. “Faster treatment with intravenous r-tPA, which dissolves the stroke-causing clot and restores blood flow to the brain, is strongly associated with better functional outcomes for stroke patients.”

Intravenous r-tPA, also known as alteplase, is the only medication approved by the Food and Drug Administration to treat acute ischemic stroke.

American Heart Association and American Stroke Association guidelines recommend “door-to-needle” times of 60 minutes or less for intravenous r-tPA. Studies show that less than 30 percent of acute ischemic patients in the United States are currently being treated within this window. The new study in Stroke shows that across Kaiser Permanente’s 21 Northern California hospitals, 87 percent of stroke patients were treated in 60 minutes or less, 73 percent in 45 minutes or less, 41 percent in under 30 minutes, and the average treatment time for intravenous r-tPA was 34 minutes.

With the Stroke EXPRESS program (EXpediting the PRocess of Evaluating and Stopping Stroke), all Kaiser Permanente emergency departments in Northern California were equipped with telestroke carts, which include a video camera and access to scans and tests results, enabling the stroke specialist to conduct a patient’s neurologic physical exam even when they are many miles away.

Telemedicine was integrated into a complete reorganization of how acute strokes are managed in Northern California, said co-author Jeffrey Klingman, MD, chair of chiefs of neurology for Kaiser Permanente Northern California.

“Processes that used to happen sequentially during a stroke alert, one after another, are now happening at the same time, allowing us to quickly, safely and confidently provide evaluation and treatment with intravenous r-tPA to stroke patients who can benefit,” he added.

Each member of the stroke team is responsible for executing tasks in tandem, meticulously and quickly. Paramedics provide advance notification to the emergency department that a stroke patient is on the way. A “stroke alert” notifies a stroke neurologist, who meets the patient upon arrival, in person or via video, to coordinate the stroke alert. Pharmacists prepare clot-busting medication early so it is ready to be administered once a radiologist has read neuroimaging and confirmed that the patient is not having a hemorrhagic stroke and is thus a good candidate for intravenous r-tPA.

Stroke EXPRESS was rolled out in all Kaiser Permanente hospitals in Northern California from September 2015 to January 2016. The researchers compared Kaiser Permanente members treated with intravenous r-tPAin the nine months before implementation (337 patients) with those treated in the nine months afterward (557 patients).

All 21 Kaiser Permanente medical centers in Northern California and 15 additional hospitals across the Kaiser Permanente program have been recognized by the American Heart Association/American Stroke Association for the accomplishment in the Get With The Guidelines quality program.

About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 11.7 million members in eight states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal Permanente Medical Group physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: 

Kaiser Permanente is North Bay Strong

It was 1:15 in the morning of October 9 when Judy Coffey, RN, Marin-Sonoma senior vice president and area manager, got the call at home that smoke was bothering patients and staff in the Kaiser Permanente Santa Rosa Hospital.

Coffey called Tom Hanenburg, senior vice president of Hospital & Health Plan Operations. They learned the smoke was worsening, and sent out an emergency notification, or Tier 1.

Next, Coffey noticed the smoke at her home in the Fountaingrove neighborhood of Santa Rosa, and called Joshua Weil, MD, assistant physician in chief for Hospital Operations, who was on duty in the Emergency Department.

“He said, ‘I think my house just burned down,’” Coffey remembered. “At that point, we activated Tier 2: calling in everybody who could make it to help at the facility.”

By 2:30 a.m. the hospital command center was opened. A regional command center followed one hour later, and within minutes, Dr. Weil called the evacuation order. Employees and physicians loaded more than 100 patients — including women in labor and ICU patients — into ambulances, city buses, and, in some cases, their own cars to get them safely to other hospitals, including Kaiser Permanente San Rafael.

Fanned by wind and fed by parched vegetation, the multiple North Bay blazes destroyed nearly 9,000 structures and scorched around 210,000 acres. To date, there are 43 confirmed deaths and many people injured.

With the Santa Rosa Medical Center closed, Kaiser Permanente hospitals throughout Northern California pitched in.

“We received tremendous support from local physicians, nurses, and staff as well as from our Northern California leaders and medical centers,” Coffey said. “Santa Rosa Memorial Hospital and our Kaiser Permanente sister facility in San Rafael opened their doors to receive and care for our patients.”

“The disaster proved that we can count on each other in a crisis,” said Dr. Weil. “And that’s what we think of as a real high point — just knowing how much people have your back.”


Unable to go the hospital, the 28-year Kaiser Permanente employee set up shop in downtown Windsor, 9 miles north of Santa Rosa, to manage her patient care responsibilities. She has referred to employees and physicians as family — and said that their closeness is now magnified.

Reopening After Disaster

On a late October visit to the Santa Rosa Medical Center, one would barely know the Kaiser Permanente community had faced the worst disaster in the organization’s history — and the deadliest week of wildfires on record in California.

Employees and physicians moved with purpose through the facility’s halls, which smelled of scrupulous cleaning, not smoke. Members received flu vaccinations in a lobby clinic and the parking lots were full.

But a closer look showed people hugging and talking urgently. After all, the medical center had just reopened on Oct. 25. And everyone had a story to tell.

On that first night of the fires, Judy Coffey lost her own home, driving her husband, who was recuperating from knee surgery, through falling, burning trees to safety. Dr. Weil listened in anguish on the phone as his terrified wife and daughter escaped through a wall of fire.

So far, about 1,200 employees and physicians are displaced by the disaster. While supported by emergency monies, grants, and loans from the organization, including Kaiser Permanente’s donation of $250,000 to the Red Cross, it will take a long time to rebuild homes and longer still to recreate lives.

A Glimpse of Green

Camille Applin-Jones, RN, the medical group administrator, was evacuated from her Solano County home. Having served in the U.S. Army during Desert Storm, she likened the fear, uncertainty, and shock of the fires to war.

“I’ve seen a lot of pain and loss, but also a spirit of resilience like I’ve never seen before,” she said. “A nurse from Pediatrics said that our landscape is changed, but just over the hill you see a glimpse of green. That is a beautiful way to see a new day on the horizon.”

When the facility reopened, she recalled another happy sight: children skipping through the lobby on their way to the temporary daycare provided for staff left without child care.

Michael Shulman, MD, physician in chief for only 8 days when disaster struck, returned to his evacuated home after a week, and felt “so proud and appreciative of Kaiser Permanente’s response in the crisis.”

“All of the other medical centers came to our assistance; individuals, departments, and physicians reached out. It was a regionwide and even Programwide effort, in any and all ways. It was tremendous and it was inspiring.”

“I see the amazing spirit, cooperation, support, kindness, and resilience of our community,” added Coffey.