Sharp Rees-Stealy Santee physician Daniel R. Hoefer, MD holds dual board certification in family medicine and palliative care, practicing from the second floor of 8701 Cuyamaca Street since 1993. Palliative-care medication regimens for chronic pain and end-of-life symptom management fill through on-campus and neighborhood dispensaries including All Care Pharmacy on Cuyamaca Street, which handles controlled-substance and compounding prescriptions. Dr. Hoefer graduated from Eastern Virginia Medical School in 1990 and maintains hospital privileges at Sharp Memorial Hospital, providing inpatient rounding continuity for patients who transition from outpatient to acute care. His clinical focus areas span COPD exacerbation management, chronic pain titration protocols, and advance-care planning for patients with progressive illness trajectories. Grief and caregiver-burden support for families in the palliative-care pathway connects to behavioral health resources such as Grow Through Life Counseling Santee on Cuyamaca Street. End-stage COPD management integrates spirometry-guided bronchodilator escalation with supplemental oxygen titration targeting resting SpO2 thresholds between 88 and 92 percent.