Nationally-Recognized Experts to Speak at CHOC’s End of Life Care Conference

Three highly regarded experts in palliative care and pain management, Dr. Betty Ferrell, Dr. Glen Komatsu and Gay Walker, RN, will headline a two-day end of life care conference, presented by CHOC Children’s on Oct. 27-28, 2016 at Saddleback Anaheim.  The three keynote speakers will be joined by others in the field, including members of CHOC’s Pediatric Advanced Care Team (PACT), to present ELNEC-Pediatric Care curriculum, providing medical professionals with the knowledge and skills required to deliver specialized, compassionate care to patients and their families who are facing serious illnesses or end of life.

Meg Mohr, FNP-BC, ACHPN, conference organizer and coordinator of CHOC’s PACT and supportive care program, is committed to working alongside patients and their families during what is often the most challenging time in their lives.  “My goal is to support patients and families in finding a way to embrace healing in the midst of a difficult and scary journey,” she says.  Meg encourages her colleagues in medicine, from critical care specialists and primary care pediatricians to residents and registered nurses, to attend the conference to learn how they can positively impact patients and families who are nearing end of life.

The conference’s 10 modules are designed to review the need to improve focus and the provider’s role in delivering quality care to children at the end of life; cultural impacts on pediatric palliative care; and pain and symptom management.  Specific topics include:

Day One

  • Introduction to Pediatric Palliative Care
  • Cultural and Spiritual Considerations
  • General Pain Management
  • Communication
  • General Symptom Management
  • Ethical/Legal Considerations
  • Perinatal and Neonatal Palliative Care

Day Two

  • Pain and Symptom Management when Death is Imminent
  • Care at The Time of Death
  • Loss, Grief and Bereavement

“There is an increasing number of providers wanting to establish or expand palliative care programs to better serve their patients and families,” explains Mohr. “In using the ELNEC-Pediatric Palliative Care curriculum, the conference will provide a wonderful foundation for caregivers, as well as offer invaluable networking opportunities.  Our goal is to empower attendees to employ tools and techniques for providing high quality end of life care that are appropriate across different communities, cultures and beliefs.”

For more information or to register, visit

New recommendations for transitioning neurology patients

The transition for an adolescent or young adult with a neurologic disorder into adult care can be challenging, but steps outlined in a leading medical journal can help pediatric neurologists and pediatricians to ensure a smooth progression.

Dr. Mary Zupanc, division chief of pediatric neurology at CHOC Children’s, is among the 14 authors of the consensus statement published in Neurology, the journal of the American Academy of Neurology.

CHOC Children's

After reviewing studies published in the last decade on transition of neurologic disorders, the authors outlined eight best practices to ensure a smooth transition:

  1. Discuss with the patient and family the expectation of future transition into adult care before age 13.
  1. Assess self-management skills at age 12 and yearly thereafter.
  1. Annual transition planning sessions should also address current medications and potential side effects; signs and symptoms of concern; genetic counseling and reproductive implications of the condition; issues of puberty and sexuality; driving, alcohol, substance use and other risks; and emotional or psychological concerns and wellness.
  1. Discussions with caregivers about the patient’s expected legal competency (e.g. whether a need for legal guardianship and powers of attorney exists) should begin by age 14. If unclear, legal competency assessment should occur annually.
  1. For pediatricians, develop a comprehensive transition plan that considers health, finances and legal care by age 14. Collaborate with the patient, caregivers, other health care providers, school personnel, vocational professionals, community services providers and legal services.
  1. The child’s neurology team should develop the neurologic component of the transition plan and update it annually.
  1. Collaborate with the patient and caregivers to identify adult providers before the anticipated transfer time. A medical transfer packet prepared for the adult provider and provided to the youth should include the transition plan and medical summary with pertinent history, diagnostic evaluations, previous drug trials, current medications and protocol for emergency care.
  1. The patient’s neurology team should communicate directly with the new adult provider to ensure a smooth transition, which is finalized after the first appointment. Neurologists should remain available both to the youth and the adult provider for continuity and support.

The statement has been endorsed by the Child Neurology Society, American Academy of Neurology and the American Academy of Pediatrics.

Read the paper in its entirety in Neurology.


Dr. Sudeep Kukreja Recognized by California Medical Association for Increasing Local Members

Dr. Sudeep Kukreja, associate medical director of the neonatal intensive care unit at CHOC Children’s Hospital and medical director of the hospital’s newborn hearing screening program, has received the Dev. A. GnanaDev Membership Award from the California Medical Association (CMA). The award is given to the CMA physician member residing and practicing in California who during the past year significantly increased members in his area.

Through Dr. Kukreja’s advocacy, Orange County Medical Association’s (OCMA) membership has grown by close to 300 members.

CHOC Children's

“I feel good that more physicians are learning about the great work that OCMA does and are becoming members,” Dr. Kukreja said. “That really means a lot to me.”

As past president of OCMA and member of CMA’s Legislative Committee, Dr. Kukreja goes to Sacramento a few times a year to provide education and seek reform on current issues affecting the medical profession and health care delivery. He is also a CMA delegate.

Among his efforts, Dr. Kukreja is lobbying in support of proposition 56, which would increase taxes on cigarettes and in turn, fund health care and dental disease prevention programs for underinsured patients, including Medi-Cal.  Funds would also support research for smoking-related diseases, among other initiatives.

Dr. Kukreja has been recognized by the CMA in the past for his extensive volunteer work. Through his nonprofit volunteer medical organization, Arpan Global Charities, Dr. Kukreja and other medical professionals have provided free health care and supplies to countless underserved areas around the world. He and his team of volunteers plan to go on their next medical mission to Colombia, in February. Locally, he participates in many charitable clinics and health fairs.

Dedicated to clinical excellence, Dr. Kukreja is the director of quality improvement in the NICU at CHOC, and is board certified in neonatal-perinatal medicine.  He served his fellowship and residency at UC Irvine Medical Center in Orange and at Thomas Jefferson University Hospital in Philadelphia, respectively. He completed his internship and medical training at King George’s Medical College in Lucknow, India.

Dr. Kukreja will be formally recognized on October 16 at the 145th CMA Annual House of Delegates in Sacramento.

CHOC Specialist Appointed to CalOptima Board

A CHOC Children’s specialist has been appointed to CalOptima’s board of directors.

Dr. Paul Yost, chair of CHOC’s anesthesiology division, was sworn in Aug. 4.

Paul Yost, M.D.

He was appointed by the Orange County Board of Supervisors as one of six new members to guide the agency that administers health insurance programs for low-income children, adults, seniors and people with disabilities in Orange County.

“I am honored to join the CalOptima Board of Directors,” Dr. Yost said. “This role presents an exciting opportunity to serve our community’s children and families in a new way.”

He attended medical school at Baylor College of Medicine in Houston. Dr. Yost performed his anesthesiology residency at UCLA and his pediatrics residency at the University of Miami.

Dr. Yost’s CalOptima seat is reserved for a physician who is affiliated with a contracted health network. His term ends in August 2020.

Olympic Medalist Turned Physical Therapist

When athletes of any caliber come to physical therapy appointments, they often struggle with emotional hurdles as big as their physical challenges. Working with an expert who understands their struggles can make it easier to cope, especially when that expert is a former Olympian.

Robin Beauregard, a physical therapist at CHOC Children’s and two-time Olympic medalist in women’s water polo, understands the physical challenges that can sometimes stand in the way of achieving athletic goals.

“Having a career in athletics helps me establish a rapport with my patients, particularly my history with sustaining and overcoming injuries,” she says. “Sincere empathy creates a stronger bond than sympathy.”

Shortly before the team was named for the Sydney Olympics in 2000, the first time women’s water polo was to be recognized as an Olympic sport, Beauregard dislocated her knee and didn’t know if a recovery was possible. Distraught but determined, she committed fully to her physical therapy plan, as well as a rigorous conditioning program, and made the team. They’d win a silver medal that year, and a bronze four years later. She was later inducted into the USA Water Polo Hall of Fame.

Beauregard’s experience with physical therapy in the midst of her Olympic career ultimately played a big role in her professional career.

“I was not the perfect patient, but it prepared me for being a physical therapist because it gave me an idea of asking only what is reasonable of my teen and young adult patients,” she says. “I really do understand their worry of not being able to get back to the top level in their sport, but also weighing the risks of not wanting to cause further or permanent injury.”

Growing up in Southern California, Beauregard loved to be outdoors and was always active. Having an older brother who was also athletic made her competitive, too. She started swimming competitively for a local club team on her fourth birthday simply because her brother swam, and she wanted to be as a good as he was. Water polo came into play just four years later, and by age 8 she joined a competitive club team.

But when she got to high school, there was no girls’ varsity team. Instead of giving up on her passion, she simply joined the boys’ team instead. Playing with the boys didn’t faze her, or them, since they’d been competing together for almost a decade by that point. When opponents made comments about playing with a girl, she channeled it into her game and used it as fuel to play even harder.

After high school, she attended UCLA to play water polo, and originally planned on becoming an orthopedic surgeon. She later changed her path to physical therapy, which would ultimately give her a different kind of interaction with patients and athletes.