January 2019

NYS AAP – Chapter 2
President’s Message – January 2019

Dear NYS AAP – Chapter 2 Member,
     Happy New Year!
     Our best wishes for the New Year to each of our members and readers. 2018 was a successful year for the Chapter and we hope that your continued support and engagement in 2019 will help us to accomplish more to advance the health of the children in our care and support the practice of Pediatrics.
     Please see below for information about recent and upcoming events, and other updates.
Steven J. Goldstein, MD, FAAP
President, NYS AAP – Chapter 2
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December Chapter Executive Committee Meeting

On December 13th we held our quarterly Chapter business meeting at NYU Winthrop Hospital. In addition to regular business, a representative from the American Dairy Association spoke about the role of dairy in pediatric nutrition, the director of NYC Early Intervention educated us about accessing EI, and the NYS AAP Director of Policy, Advocacy & External Relations, Elie Ward, discussed the NY State Patient Centered Medical Home.  Important information about the NY State PCMH will be posted soon, so please visit our website for updates.  Value Based Payment is coming and all practices need to know about new payment paradigms and requirements.  If you would like to attend an upcoming Chapter meeting, please email our Executive Director, Jessica Geslani, at jgeslani@aap.org.
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E-Cigarettes in Suffolk County

Earlier in the day on December 13th Chapter Legislative Committee members, Dr. Eve Krief and Chapter V.P. Dr. Shetal Shah, and I had the opportunity to speak before the Suffolk County Legislature Health Committee to advocate for a ban on flavored e-cigarettes.  Flavored e-cigarettes are very appealing to young people and there is little awareness that the products contain nicotine and are addicting. There was a huge turnout from every vaping establishment in the county and the measure was tabled by the committee.  A week later the county unanimously passed a resolution to raise the fines for selling e-cigarettes to those under 21.  Work on this important issue also offered the Chapter a unique opportunity to partner with other community-minded organizations, such as the Suffolk County Principals Association and the Campaign for Tobacco Free Kids.
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Healthy People 2020 Grant Program

The topic of the 2019 Healthy People 2020 Grant Program for Chapters is School Success: Health and Safety.  Five chapters will be selected by May 31st and awarded $20,000 each, supported by the AAP Friends of Children Fund, to develop and implement innovative programs.  View the Request for Proposals and Application via the link above.  Applications are due March 29th.  If you have an idea for a Grant Program, please contact Jessica Geslani at jgeslani@aap.org.  The Chapter may only support one grant application each year.
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AAP Election Results and Changes in Bylaws

Dr. Kyle Yasuda is our new AAP President and Dr. Sally Goza is President-Elect.  Immediate Past President Dr. Colleen Kraft was a great role model for us all as she advocated with great energy and conviction for kids at the border (and everywhere else) during her tenure.  We look forward to hearing more from our new AAP leadership. (Follow them on Twitter! Kyle: @kyleyasuda and Sally: @sallygoza.)
The AAP National Bylaws were amended to change the structure of the National Board to include Members-at-Large.  More information is available on the AAP website and in Pediatric News.
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Call for Mentors!

We are pleased to announce that the NYS AAP – Chapter 2 is launching a new Mentoring Program!  If you are a pediatrician who completed training 10+ years ago and are interested in mentoring early career physicians in the Chapter 2 area, please consider signing up.
  • The time commitment is approximately 1 hour per month, (this can be in person or via phone, facetime, skype, etc.)
  • We are seeking a diverse group of individuals who want to make a difference in the careers of our early career pediatricians.
Any questions? Contact:
Dr. David Fagan, Mentoring Committee Chair, at dfagan@northwell.edu or Jessica Geslani at jgeslani@aap.org
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NYS AAP – Chapter 2 & 3 Gun Violence Prevention Committee

The NYS AAP – Chapter 2 & 3 Gun Violence Prevention (GVP) Committee, co-chaired by Drs. Jeff Oestreicher and Nina Agrawal, will focus on two goals for the first six months of 2019, their “30 & 30.” GVP Committee members will hold 30 in-district meetings with state and federal legislators to push for policies including Extreme Risk Protection Orders, Safe Storage and state and federal research funding.  During this time the committee will also host 30 educational forums across the state (noon conferences and ground rounds, for example) in order to galvanize the health care community in sounding the alarm on the need for evidence-based solutions to the epidemic of pediatric gun violence.
Join the monthly meetings (Jan 28, Feb 25, March 25, April 29, May 20, and June 24) to learn more, with locations to be announced soon!  The first half of each meeting will also include a wide variety of experts (writers, policy makers, public health professionals) who will teach and provide us with tools to become better, more effective advocates.  For more information about the committee, or to join, contact Jessica Geslani at jgeslani@aap.org.
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NYS AAP – Chapter 2 & 3 Opioid Crisis Committee

The NYS AAP – Chapter 2 & 3 Opioid Crisis Committee is devoted to finding solutions and implementing standardized measures to help pediatricians navigate this crisis.  It is essential to identify substance abuse in adolescents early and to implement prevention strategies immediately.  The Substance Abuse and Mental Health Services Administration (SAMHSA) recommends using the Universal Screening for Substance Use, Brief Intervention, and/or Referral to Treatment (SBIRT) as a part of routine health care.  The AAP recommends screening all adolescents for tobacco, alcohol and other substance use using a validated tool such as the CRAFFT.
Opioids should only be prescribed when the benefit is seriously considered and outweighs the risks. If there is no alternative, short acting opioids, rather than long acting or extended release opioids, should be used for treating acute pain in opioid naïve patients.  Patients and families must be educated about opioid use, adverse effects, and disposal.
The Joint Commission, the CDC, and the FDA have recommended/mandated that non-pharmacologic modalities be offered to patients for pain.  We need to dramatically rethink opioid use in the world of Pediatrics.  If you would like to be part of this mission, please contact Dr. Richard Ancona at 1084e5@optonline.nett or Dr. Mirna Giordano at mg2267@columbia.edu.
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NYS AAP Policy Statement on Marijuana

The mid-term elections changed the balance of political power not only nationally, but in New York State as well.  With a new legislature, many new initiatives will be considered by Albany.  In anticipation of the possibility of new marijuana laws in NY, a state-wide committee (NYS AAP – Chapters 1, 2, and 3) created a position paper that may be found here:
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National AAP Committee Members – Call for Nominations

The AAP Board of Directors is soliciting nominations to fill the following vacancies for Member positions on AAP National Committees for terms beginning July 1, 2019:
  • Committee on Adolescence (COA): 1 position
  • Committee on Child Health Financing: 2 positions
  • Committee on Coding and Nomenclature (COCN): 1 position
  • Committee on Drugs: 1 position
  • Committee on Fetus and Newborn (COFN): 2 positions
  • Committee on Medical Liability and Risk Management: 2 positions
  • Committee on Native American Child Health: 2 positions
  • Committee on Pediatric AIDS (COPA): 3 positions
  • Committee on Pediatric Research: 2 positions
  • Committee on Practice & Ambulatory Medicine (COPAM): 3 positions
  • Committee on Psychosocial Aspects of Child and Family Health (COPACFH): 2 positions
You can find the requirements, the statements of needs for each position, and the application materials on AAP.org. To be considered complete, an application must include the following: (1) factsheet, (2) biographical summary, (3) letter of nomination, and (4) letter of support.  Upon receipt, a request for Conflict of Interest Disclosure will be sent to the candidate which will finalize the application process.
The deadline for nominations is Friday, February 22, 2019.  Nominees must submit the completed application materials to their Chapter President and the AAP Nominations Team (nominations@aap.org). If you are interested in obtaining a letter of support from the NYS AAP – Chapter 2 President, please email Jessica Geslani at jgeslani@aap.org as soon as possible. We can support one applicant per committee.
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NYS AAP Annual Advocacy Day – March 19th

Mark your calendars because our Annual Advocacy Day in Albany is scheduled for Tuesday, March 19th at The University Club. This day highlights our pediatric advocacy agenda with a full day in Albany hearing from legislators, government officials, and NYS AAP leaders, and is followed by visits to the offices of members of the State Assembly and Senate. More details will be available soon. We look forward to welcoming all Chapter members, including medical students and pediatric trainees, to this event.
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     The Officers of Chapter 2 welcome your feedback, thoughts, suggestions, and constructive criticism.  Please see our email addresses below to contact us.
Follow us on Twitter: @NYSAAPCh2
Follow Steve Goldstein on Twitter: @SteveGoldstei10
     With our best wishes for a healthy and productive autumn!
My best,
Steve Goldstein, Chapter President SJG34@Cornell.edu | Twitter: @SteveGoldstei10
and the Officers:
Shetal Shah, Vice President shetaldoc@hotmail.com | Twitter @NICUBatman
Robert Lee, Secretary rlee@aap.net
Sanjivan Patel, Treasurer sapatel@wyckoffhospital.org

Limitations on E-Cigs, Liquid Nicotine In Suffolk

Eve Meltzer-Krief MD, FAAP

Eve Meltzer-Krief MD, FAAP

(Dr. Eve Meltzer-Krief MD, FAAP is a pediatrician in Huntington and member of the NYS AAP Chapter 2 Legislative Committee and Suffolk Pediatric Society.)

I am a pediatrician and I work, reside and am a parent in Suffolk County.  On behalf of my patients and my children, I urge the Suffolk County Legislature to pass the proposed bill that will ban the sale of most flavored e-cigs and flavored nicotine in our county.

E-cigarette use is one of the leading public health issues affecting teens today with a 75% increase in use among teens in the last year alone.  E-cigarette and liquid nicotine use is rampant here in Suffolk County.Kids are vaping in school hallways, classrooms and bathrooms and are sharing devices with friends.  It is odorless and smokeless and and the vaping devices resemble pens, usb drives and battery chargers making their use easily concealed.

This issue is of huge concern to parents who are worried about their children.  Most of the teens simply do not know the potential harm they are causing themselves and the potential addiction they are putting themselves at risk for.65% of teens who vape are not even aware that the products contain nicotine.  Therefore, it is our responsibility to protect them.

Clearly the fruity and dessert flavored products with colorful packaging are meant to target youth and we know that kids who start vaping are more likely to try cigarettes.  We know that the nicotine in all these products is not safe, is addictive, can harm the developing brain and is associated with addiction to other drugs.  In addition the chemicals in the vapor can cause irreversible lung damage and contains potential carcinogens and heavy metals.

According to the American Academy of Pediatrics, the flavors, design and marketing of the nicotine products appeal to youth and normalize and glamorize nicotine product use.  E-cigs and liquid nicotine are addicting a new generation of youth to nicotine and are reversing more than fifty years of progress in tobacco control.

As far as I’m concerned, with youth being the primary target of these flavored products, their sale should be completely banned from the market.  We have the ability to do that here in Suffolk County with the proposed legislation.  We have a responsibility to do everything in our power to make it as difficult as possible for youth to get their hands on these products.

I can say with absolute certainty that pediatricians and parents throughout Suffolk County would welcome and be extremely grateful if this bill was passed and I urge the legislature to do so.


This is Our Lane

Eve Meltzer-Krief MD, FAAP

Eve Meltzer-Krief MD, FAAP

(Dr. Eve Meltzer-Krief MD, FAAP is a pediatrician in Huntington and member of the NYS AAP Chapter 2 Legislative Committee and Suffolk Pediatric Society.)

Last week the NRA quite arrogantly called doctors ‘self-important’ and advised them to “stay in their lane” with respect to gun violence.  They were responding to a recent policy paper by the American College of Physicians that called firearm violence a public health crisis and outlined policies that would reduce injuries and death.

As a pediatrician, I can confidently say that this is, in fact, our lane.  Pediatric Emergency Physicians and trauma surgeons try to save the lives of the nearly 1300 children under 18 that die from gunshot wounds every year and they care for the 5,790 children who are injured yearly.  Firearm related death is one of the top three causes of death among American youth, a rate much higher than any other high-income country.  Gun violence is a public health crisis and should be treated as such.  Just as car seats and seat belts have reduced death and injury from motor vehicle accidents, the implementation of evidence-based gun safety legislation could reduce death and injury from gun violence.

A recent study showed that stricter gun laws at the state level cut the number of deaths in children due to gun injuries in half. The study also found that states with no child access prevention laws had four times as many childhood suicides by guns as compared to states with safe storage or gun lock laws.  Furthermore, states with background checks for guns and ammunition also had dramatically fewer numbers of children dying from gun violence.

Such research supports the idea that gun violence must be treated like the public health crisis it is.  More CDC supported research that is currently discouraged by the Dickey amendment must be allowed to take place to prevent the tragic, senseless and preventable loss of life physicians see every day.

October 2018

NYS AAP – Chapter 2
President’s Message – October 2018

Dear NYS AAP – Chapter 2 Member,

Please see below for information about recent and upcoming events, and other updates.  Also, don’t forget to vote for AAP President Elect! Voting begins Nov. 2nd and ends Dec. 2nd! The candidates are Sara “Sally” H. Goza, MD, FAAP from Fayetteville, GA, and George C. Phillips, MD, MBA, FAAP from Overland Park, Kansas.

Vote online and get more information at: www.aap.org/vote.

Steven J. Goldstein, MD, FAAP
President, NYS AAP – Chapter 2
SJG34@Cornell.edu

Vote Kids on Nov. 6th!

Kids can’t vote, but their parents and pediatricians can. We can speak up for children and educate families about supporting candidates that work for the benefit of the next generation. Download materials from the AAP’s VoteKids Toolkit, including a Prescription to Vote that you can print and give to your patients’ parents as you speak about the importance of voting.

NY State Senate Candidate Forum

The League of Women Voters and Chapter 2 sponsored a Voter’s Forum in South Huntington on October 15th. Incumbent Carl Marcellino and challenger Jim Gaughran, candidates for the NY State Senate in District 5, answered questions about issues that affect children and families. We are hoping that this event will become a model for future elections and help us all to consider children when we make our choices at the polls. Thanks to Drs. Eve Krief and Jeff Oestreicher for their tireless work to make this happen. A video of the entire evening can be found here: https://www.youtube.com/watch?v=yKqq35J8G44

Inadmissibility on Public Charge Grounds
Why This Should Concern YOU

Someone is currently considered a “public charge” for immigration purposes when they are primarily dependent on the government for subsistence. Earlier this month the Trump Administration published intended changes to the “Public Charge” rule that would affect the health and well-being of millions of children and families in the United States by factoring in use of federal programs when applying for “green cards” or permanent status. Under the proposed rules, an immigrant family that participates in Medicaid, the SNAP program, federal housing assistance programs, or Medicare Part D would be considered a “public charge,” making it more difficult to achieve permanent status. In anticipation of these rules, even though the new regulations are not yet in effect, immigrant families are not seeking healthcare and other forms of assistance so as not to prejudice their applications. Children are not receiving needed healthcare, medication, and food and housing assistance.

Here is a link to the Federal Register that details the new proposal:

https://www.federalregister.gov/documents/2018/10/10/2018-21106/inadmissibility-on-public-charge-grounds utm_campaign=subscription%20mailing%20list&utm_source=federalregister.gov&utm_medium=email

It is estimated that the new public charge rule, should it go into effect, will affect 24 million people including 9 million children nationwide. What this means for New York State, should this happen, can be found here:

http://fiscalpolicy.org/wp-content/uploads/2018/10/NY-Impact-of-Public-Charge.pdf

Both the National AAP and the Chapter request that members post comments opposing the rule to the Federal Register by December 10th. The AAP is asking for 100,000 comments opposing the rule. Instructions for submitting your comment, guidelines and further information can be found here:

https://downloads.aap.org/DOFA/PublicChargeToolkit2018.pdf

Dinner Lecture: Novel Adventure in Human Milk Feeding – Nov. 8th

Event: Novel Adventure in Human Milk Feeding
Presented by: Committee on Fetus & Newborn, NYS AAP – Chapter 2
Date: Thursday, Nov. 8th from 5:45 – 9:00pm
Location: Akbar Restaurant, 2 South Street, Garden City, NY 11530
Tuition: No charge for Chapter members
Supported by: A generous grant from Prolacta Bioscience

TO REGISTER, CONTACT: 

Doreen Hunter 516-663-3853, Fax: 516-663-8955, doreen.hunter@nyulangone.org
Jessica Geslani, Exec. Director, NYS AAP – Chapter 2, 516-326-0310, jgeslani@aap.org 

Objectives:

  1. Importance of preterm nutrition for neonatal and long term “programmed” health outcomes
  2. Optimizing neuro-development through neonatal nutrition and lacto-engineering of EHM diet
  3. Research on EHM diet based on randomized control on short and long term outcomes trials
  4. Mechanistic aspects of EHM feeding and the adverse effects of cow’s milk
  5. Health Economics
  6. Future of preterm nutrition

Speaker:

Alan Lucas, MB, BChir., MA, MD, MRCP, FRCPCH, FMedSci
Medical Research Council Clinical Professor
Founder and Professor of Paediatric Nutrition,
Childhood Nutrition Research Centre
UCL Institute of Child Health, London

Social Event: Hops, Grapes & Pediatricians – Nov. 15th

Event: Hops, Grapes & Pediatricians
Presented by: Chapters 2 & 3 of the New York State American Academy of Pediatrics (NYS AAP)
Date: Thursday, November 15th from 7:00 – 9:00pm
Location: Black Door, 127 W. 26th Street, New York, NY 10001

REGISTER ONLINE

This social networking event is for current (and future!) Chapter 2 & 3 members. A light dinner and drinks will be served. We will be joined by special guest speaker, Honor Jones, Opinion Health Editor for the New York Times! Honor will give a brief talk about writing op eds.

In addition to hearing from Honor Jones, this event is a terrific opportunity to:

  • connect with fellow pediatricians
  • meet AAP leaders – hear about their careers in pediatrics, how they got involved with the AAP, and how being a part of the AAP has enriched their lives
  • learn about your local AAP Chapter and how you can get involved – advocacy, grant funding, committees, educational programs, etc.
  • share your thoughts, comments and concerns with the leadership

There is a $10 refundable deposit for Chapter members which will be refunded to you after you attend the event. The fee for non-members is $25 (which can be applied to membership dues if you decide to join).

Space is limited, so register today! We look forward to seeing you there!  For more information, contact Jessica Geslani at jgeslani@aap.org.

Resilience and Adverse Childhood Experiences

The Chapter, along with Docs For Tots, The Child Care Council of Nassau, and a host of other organizations sponsored a viewing of the movie “Resilience” at the Nassau County Legislative Offices on October 9th. Readers that would like access to the movie for their organizations at no cost should contact our Executive Director, Jessica Geslani, at jgeslani@aap.org. Here is an excellent short TED Talk by Dr. Nadine Burke-Harris that distills the main points of the movie: https://youtu.be/95ovIJ3dsNk

Environmental Health

Many of you are aware that Dr. Ruth Etzel, head of the EPA’s Office of Child Health Protection and co-editor of The AAP’s Green Book on Environmental Health, has been placed on administrative leave. This move prompted protests from the AAP and environmental organizations.

Read about this issue here.

See an interview with Dr. Etzel on CBS News here.

Committee Vacancies

Multiple Chapter Committees, including the committees on Opioid Crisis, Membership, Gun Violence Prevention and Parents are recruiting interested members to aid in their work. If you wish to help or if there is an issue you are passionate about and would like to get involved, please contact Jessica Geslani at jgeslani@aap.org. If you are interested in Mentorship (either as a mentor or mentee), there is a committee in formation.

Pediatric Council

Please periodically check the Pediatric Council section of our website to view new advisories from the National AAP. In addition, the Chapter can help you to address billing and practice management issues if you outline the problem in our Insurance Grievance Form.

Value Based Payment is coming. View a webinar on Value Based Payment from UnitedHealthCare.

For those of you going to the NCE in Orlando, there is a Pediatric Council Forum on Saturday, November 3rd, from 2:00-4:00 pm. If anyone is interested in attending, let us know by emailing Jessica Geslani at jgeslani@aap.org.

Strategic Planning

Chapter 2 is moving along in its strategic planning process. Members were asked to complete a Member Needs Assessment Survey over the summer, and were invited to a strategic planning brainstorming meeting on Sept. 13th at NYU Winthrop Hospital in Mineola, NY. Next, we will convene a small strategic plan work group to review the data and work out the details. We look forward to having a finished product by early 2019 that will reflect our Chapter’s priorities and our members’ needs.

The Officers of Chapter 2 welcome your feedback, thoughts, suggestions, and constructive criticism.  Please see our email addresses below to contact us.

Follow us on Twitter: @NYSAAPCh2
Follow Steve Goldstein on Twitter: @SteveGoldstei10

With our best wishes for a healthy and productive autumn!

My best,

Steve Goldstein, Chapter President SJG34@Cornell.edu

and the Officers:

Shetal Shah, Vice President shetaldoc@hotmail.com
Robert Lee, Secretary rlee@aap.net
Sanjivan Patel, Treasurer sapatel@wyckoffhospital.org

New York State American Academy of Pediatrics (NYS AAP) – Chapter 2
516-326-0310 | Follow us on Twitter |  www.ny2aap.org


 

Your Vote Impacts the Health of NY Kids

Shetal Shah, MD, FAAP

Shetal Shah, MD, FAAP

Eve Meltzer-Krief MD, FAAP

Eve Meltzer-Krief MD, FAAP

(Dr. Shetal Shah, MD, FAAP is a neonatologist at Maria Fareri Children’s Hospital.  He is NYS AAP Chapter 2 Vice President and Chair of the Legislative Committee.  Dr. Eve Meltzer-Krief MD, FAAP is a pediatrician in Huntington and member of the NYS AAP Chapter 2 Legislative Committee and Suffolk Pediatric Society.)

While national events consume the news prior to the upcoming midterm elections, it is important to remember that there is a lot at stake for children in this election.  Voting outcomes at the state and county levels of government can impact the health and well-being of children in our communities.

As pediatricians and volunteers with the local chapter of the American Academy of Pediatrics, we frequently meet with policy makers on behalf of our region’s children.  As we prepare to enter polling stations next month, we must remember that our votes are the only voice that our kids have.

Pediatricians immunize children every day against common and deadly diseases.  However each year, illnesses once forgotten are returning.  Earlier this month, New York saw several cases of measles.  Vaccine preventable diseases like whooping cough and influenza are now commonplace.  Last season was the worst flu epidemic in a decade, with 128,000 cases in New York.

Six children died.

Yet last year the New York State Legislature strongly entertained relaxing immunization requirements for children in public schools, where these infections are easily spread.  Only vigorous protest by the medical community and parent groups helped defeat the bill (but just barely).  State legislators also did not pass a bill which would strengthen day care influenza vaccination requirements, despite evidence that this measure protects young children and their adult parents from being hospitalized with influenza.  Data from New Jersey and Connecticut, which have enacted the same law, show that  these policies improve the health of our toddlers and boost vaccination rates in a population of children highly vulnerable to flu.

Use of electronic cigarettes is another epidemic – mostly targeting teenagers.  Roughly 10% of 8th graders have vaped in the past month, and among 12th graders, the rate is 16%.  Though New York City, Long Island and several suburban counties have raised the age to purchase tobacco to 21 years, there is no state legislation protecting our teens.

Raising the age of tobacco purchasing to 21 years has been shown to reduce teen vaping and smoking by 50%, and already exists in California, Hawaii, New Jersey, Massachusetts, Oregon and Maine.  However our state has been inactive on this issue for at least a decade.

Appealing liquid flavors in nicotine, like bubble gum, cotton candy and banana split, are clearly marketed to children and facilitate addiction.  A recent survey found these flavors perpetuate vaping in almost half of all kids who use these products.  To remove this “on-ramp” to childhood nicotine addiction, large cities like San Francisco have banned the sale of flavored e-cigarette liquids.  But locally, no major municipality or county has taken similar actions, despite the existing public health data.  Teen e-cigarette use is linked to subsequent marijuana use, and as New York State is poised to legalize marijuana next year, these protections will only become more important.

Seven children die from gun violence every single day.  Since the tragedy in Parkland, Florida, there have been over 100 mass shootings.  While these tragic events dominate headlines, people forget that 89% of accidental shooting deaths in children occur at home.

In the wake of the Sandy Hook Elementary School shooting, New York State enacted several common-sense measures to prevent gun violence.  But our state does not mandate that guns at home be stored safely and away from children.  This “safe-storage” proposal has the strongest public health evidence supporting its ability to keep children safe from firearms in the home.  The federal government estimates roughly one-third of accidental deaths by guns could be prevented with this one simple law.  Though this bill has been introduced annually for several years, it has been opposed by “gun-rights” advocates who claim that a requirement to purchase a container to safely store the firearm constitutes a “tax” on gun ownership.

Three years after the mass public health disaster in Flint, Mich., which exposed thousands of children to toxic levels of lead, New York State laws on childhood lead poisoning remain outdated.  Your vote could determine if lead-exposed children have access to critical health services.  Currently the threshold lead level to test a child’s home and water in New York State is double the level recommended by the Centers for Disease Control.

Though the American Academy of Pediatrics notes that there is no safe level of lead, a bill will be introduced next year to make our state regulations current with the latest science on toxicity.  Such measures are the only way to make sure what happened in Flint does not happen here.

As pediatricians, we ask that children be at the top of your agenda when you vote.  We urge parents and state leaders to invest in programs and policies that keep children, families and communities safe and healthy.  Voting for kids is a small act that can have a profound influence on the health of our state’s children.  Pediatricians across the country have been distributing ‘Prescriptions to Vote’ like the one pictured, urging parents to ‘Vote Kids.’  We owe it to our children to vote with their interests in mind.


Public Charge

Eve Meltzer-Krief MD, FAAP

Eve Meltzer-Krief MD, FAAP

Dr. Eve Meltzer-Krief MD, FAAP is a pediatrician in Huntington and member of the NYS AAP Chapter 2 Legislative Committee and Suffolk Pediatric Society.  She is the founder of the organization called Long Island Inclusive Communities Against Hate.

Currently, when immigrants who are in this country legally are seeking permanent residency, they can be denied this status and labeled as a “public charge” if more than half of their income is determined to be derived from government funded cash assistance.

The Trump administration is seeking to dramatically change these guidelines wherein someone would be deemed a public charge and denied permanent residence or legal entry into the country if they OR their dependents who may be US citizens are receiving any amount of government funded benefit via Medicaid, Children’s Health Insurance Program (CHIP), and subsidized health insurance through ACA Medicaid expansion.  In addition to cash subsidies, they would be considered public charges if they or their dependents receive non-cash subsidies including nutritional help from Supplemental Nutrition Assistance Program (SNAP) and Women, Infants and Children (WIC).

This change would have far reaching negative effects on the health and well-being of children and is of concern to pediatricians across the country. It is estimated that 10.4 million citizen children with at least one non-citizen parent would be affected.It would result in lower rates of healthcare coverage and would reduce enrollment in other essential benefits affecting health including SNAP and WIC with more than one million people becoming food insecure.  It would lead to poorer health among immigrants and their dependents, reduced prenatal care and increased infant mortality as well as much lower rates of routine well care and immunization rates.  This will all lead to higher health center and hospital costs for uncompensated care.

This change in who is considered a public charge will basically force parents to face deportation unless they give up the healthcare needs of their children.  It will adversely affect the health of millions of people, particularly U.S. citizen children.  If this change in policy is proposed we ask that our leaders in Congress speak out against it because of the devastating effects it would have on healthcare in our country.


Separated Children

Eve Meltzer-Krief MD, FAAP

Eve Meltzer-Krief MD, FAAP

(Dr. Eve Meltzer-Krief MD, FAAP is a pediatrician in Huntington and member of the NYS AAP Chapter 2 Legislative Committee and Suffolk Pediatric Society.  She is the founder of the organization called Long Island Inclusive Communities Against Hate.)

It was so incredibly heartening to see so many people come out for our third protest in 6 weeks on Long Island, of what continues to be a humanitarian crisis of this administration’s own creation.

Hundreds of children still remain separated from their parents, many of whom have already been deported. Many of those deported parents were unaware they would never see their children again when agreeing to deportation. Some of these parents were forced to choose between never seeing their children again or bringing them back to a country where their lives would be in danger.

Some of the families that have been reunited are being held in detention centers in conditions which are inappropriate for children. We know that even short periods of time in detention can have harmful long term consequences for the physical and emotional health of these already traumatized children. The reunited families should not be held in detention. They need legal counsel to make their plea for asylum. In the past, immigrants who are set free all return for their hearings and do not need to be detained.

The children who remain separated as well as those reunited need trauma counseling. There needs to be medical oversight of their physical and mental health as we have heard of many instances of abusive and negligent care in the facilities where children have been detained. There needs to be congressional oversight of the reunification process to ensure transparency.Our country needs to remain a beacon of hope and we once again need to welcome those fleeing for their lives from gang violence and domestic abuse.

Everything about this country’s immigration policies are morally reprehensible at this point in time and based in xenophobia. From the separation of these poor children, to TPS holders being forced to return to their home country without their US born children after having lived here for decades, to the threats to our DACA community with their lives in the balance, to the criminalization of undocumented individuals, and to the closed door refugee policy where during the worst world refugee crisis since WW2, this country has seen fit to take in the fewest number of refugees in decades.

We have much to fight for. I would disagree with the judge that said the “government should be proud” of reunifying 1500 of these children. They should be ashamed that they could conceive of the cruel and heartless policy that led to this disaster in the first place. Furthermore there must be accountability from this administration. They are responsible for reunifying children with the parents they deported. Not NGOs like the ACLU. We will continue to fight for immigrant justice as long as it takes.


Threats to Healthcare

Eve Meltzer-Krief MD, FAAP

Eve Meltzer-Krief MD, FAAP

(Dr. Eve Meltzer-Krief MD, FAAP is a pediatrician in Huntington and member of the NYS AAP Chapter 2 Legislative Committee and Suffolk Pediatric Society.  She is the founder of organization called Long Island Inclusive Communities Against Hate.)

This week marked the 53rd birthday of Medicaid and Medicare.  This is a moment when we should celebrate these two programs that together provide quality, affordable health coverage to over one hundred million Americans.  They include the elderly, children, disabled and low-income households.

This occasion should also remind us of the serious threats to healthcare that we face.  The coverage for pre-existing conditions is at risk.  This month, a district court in Texas will hear a lawsuit that challenges the constitutionality of the Affordable Care Act.  The Trump Administration, instead of defending the ACA, has agreed with the lawsuit’s argument, suggesting that the Department of Justice will not defend against it.  If this lawsuit prevails, then insurance companies will be allowed to deny healthcare to millions of people on the basis of pre-existing health conditions, or make them pay much more to be covered.

Rising healthcare costs are another concern.  Heath insurance companies have submitted their requests for higher premiums for 2019.  These same companies made huge profits thanks to the tax bill that was passed in December – up to a 145 percent increase in first quarter profits from 2017 to 2018.  In New York, the average requested increase is 24 percent.  These requested premium increases are posted on the website of the New York State Department of Financial Services (DFS) which makes the decision on granting them or not.

We also face the dire threat to Medicaid from those who are trying to revive the Graham-Cassidy bill, which did not pass the Senate last year.  This is the same bill that was opposed so strongly by medical professionals and advocacy groups such as the AAP, AARP, American Diabetes Association, and American Cancer Society; and governors around the country, to name just a few.  If Graham-Cassidy is revived it would eliminate the expansion of Medicaid that has covered over 15 million Americans in the states that chose to expand it.  It would convert Medicaid into a block grant program.  This means that states would receive a fixed amount from the federal government and they would have to meet all their Medicaid requirements within that fixed amount, making them unable to respond to actual need.  Federal funding to states would be reduced by $120 billion from 2020 to 2026.

Finally, the appointment of Brett Kavanaugh as a Supreme Court Justice could put the ACA and Medicaid expansion in peril.  He argued in a 2011 dissent that the president should be able to refuse to enforce the ACA even if the Supreme Court upheld the law’s constitutionality.  His appointment could also put women’s reproductive rights at risk.  He ruled in 2015 that the Affordable Care Act’s birth control coverage mandate infringed on religious liberty.

Long Islanders along with all New Yorkers need to make their voices heard and their representatives should stand with them in the fight to prevent the dismantling of healthcare protections and coverage for all – especially those who need it most.


Recipient of the Julius B. Richmond Center of Excellence Visiting Professorship

Mary Cataletto, MD, MMM, FAAP

Mary Cataletto, MD, MMM, FAAP

(Dr. Mary Cataletto, MD, MMM, FAAP, FCCP is a pediatric pulmonologist and Associate Director of Pediatric Sleep Medicine at NYU Winthrop Hospital.  She is chair elect for Pediatric Chest Medicine NetWork of the American College of Chest Physicians and past chair of the Asthma Coalition of Long Island.  She is the Nassau Pediatric Society Representative to NYS AAP Chapter 2.)

This year’s award for the Julius B. Richmond Center of Excellence Visiting Professorship went to NYS AAP Chapter 2 serving the Pediatric Societies of Brooklyn, Queens, Nassau and Suffolk.  The award, funded through a grant from the Flight Attendant Medical Research Institute brings together tobacco control experts with pediatric organizations and training programs throughout the country. We were honored to host Dr. Karen Wilson as our visiting professor.  Dr. Wilson is the Debra and Leon Black Division Chief of General Pediatrics and Vice Chair for Clinical and Translational Research for the Department of Pediatrics at the Icahn School of Medicine at Mount Sinai.

In a series of three sessions over 200 community and academic pediatricians, fellows, residents and students had the opportunity to learn more about the impact of targeted marketing and deleterious health effects of e-cigarettes on adolescents, the impact of second and third hand smoke exposure and motivational interviewing to engage appropriate parents in smoking cessation discussions. There is clear evidence at all ages and developmental stages that exposure to tobacco is harmful.  Prenatal exposures have been associated with preterm birth, low birth weight and sudden infant death. During childhood increase rates of asthma, ear infections and pneumonia are well described.  There is no safe lower limit for tobacco smoke exposure.  Pediatricians are encouraged to advocate for smoke free environments for all children.

Tips for pediatricians to share with parents include:

  • Set a good example by not smoking
  • If you are a smoker, there are effective strategies to help you succeed in stopping
  • Keep your home and care smoke free
  • Work with your school and child care to keep play areas smoke free

While teen use of traditional cigarettes is declining, electronic cigarettes are on the rise. Targeted marketing, addition of flavors and the misconception that electronic cigarettes are a “safe alternative” contribute to changing trends.  Also known as e-cigs, e-hookahs, vapes, mods and ENDS (electronic nicotine delivery systems) these devices are not regulated and can contain nicotine, carcinogens and other toxic chemicals.  Nicotine is highly addictive and has harmful effects on adolescent brain development as well as to pregnant women and developing fetuses.  Multiple studies have shown that teens who use e-cigarettes are at higher risk for regular tobacco use in the future.

Key messages for pediatricians to share with parents and teens:

  • E-cigarettes are not a safe alternative to traditional tobacco products
  • There is no safe lower limit for exposure to nicotine in children
  • Teen users have a higher risk of nicotine addiction and higher rates of becoming long term tobacco smokers
  • Advocate for inclusion of e-cigarettes in tobacco free school legislation and prohibition of use in outdoor areas and locations where children may be present
  • Support ban on promotion and sale of e-cigarettes to children
  • Talk to your teen

Legislative Wins & Losses 2018; School Health Form

Elie Ward, MSW

Elie Ward, MSW

(Mrs. Elie Ward, MSW is the Director of Policy, Advocacy, and External Relations for NYS AAP Chapters 1, 2 &3.  She provides an update on the status of issues for which pediatricians across the state strongly advocated.) 

The New York State Legislature left Albany on June 20th.  Despite a chaotic and highly dysfunctional session, we were able to secure several high value victories for the children and families of New York.

NYS AAP Priority Legislation that Passed:

  • Standing Orders legislation, allows Nurses in the delivery room to admit a healthy newborn to the regular nursery without calling a pediatrician at home who has not seen the newborn. This was a high priority for our members.
  • Indoor Tanning Prohibition for all young people under the age of 18
  • Maternal Depression screening in pediatrics & primary care now covered by Commercial Insurance
  • Medically Necessary Donor Breast Milk for the tiniest, most medically fragile newborns now covered by Commercial Insurance
  • Sex Trafficking of a Child legislation was strengthened to include stronger penalties for perpetrators and stronger protections for child victims
  • CMV Testing Added to Universal Newborn Testing Under Specific Circumstances included CMV testing as part of universal newborn testing, if the newborn fails a hearing test, and requires a specific test for CMV as defined by the AAP

We and our partners were not able to move:

  • Statewide Lead Screening and Lead Action Level to 5 mg/l: The current statewide Action Level is 10mg/l which is above the CDC recommendation. But we have made progress with our coalition advocacy and as a result several key legislators who want to start working on moving the bill have reached out to start meeting as soon as early August. Memo of Support
  • Extreme Risk Protection Orders (ERPO) which allows a family member or other close friend to identify a person who is at risk and allows a judge to remove weapons from that person for a specified period of time.
  • Safe Storage of Fire Arms: Requires safe storage of all guns and stipulates exactly what safe storage means. Includes penalties. Memo of Support
  • Tobacco 21: Requires tobacco purchase age statewide to move to 21. Many counties have already moved in this direction, but a statewide approach would help protect all New York young people from being introduced to smoking too early.

IMMIGRATION ADVOCACY FOR SEPARATED CHILDREN

We are all too acutely aware of the inhumane treatment of families and children crossing our southern borders seeking safety.

The combination of Family Separation and Zero Tolerance policies have led to more than 3,000 children, including more than 150 infants and toddlers, being placed in various care situations away from their parents.  Some of the detention facilities for children are hellish and completely inappropriate, others, like some of the New York child welfare agencies that are caring for children, are more humane, but they are no substitute for family and parent caregivers.

Everything that we are doing at the NYS AAP is focused on reunification.  Only by reunifying children and parents and keeping families out of detention can we be assured that the children and families crossing our borders are being given the rights and supports they need as they work through their asylum processes.  The National AAP is doing work every day to help push the federal government to do the right thing for these children and their families. But we in New York can do even more.

Below are links to two letters your Chapter leaders wrote to both the Governor and the Mayor of NYC alerting them to our deep concern about the care of separated children in facilities in New York and demanding that all state and city efforts focus on reunification.

In addition, many of our members attended local rallies on June 30th Demanding Reunification for All Children Separated From Their Families.

But this problem is not solved. Children are still separated from their parents and there is the continuing specter of the federal government keeping these families in detention.

Here are some ACTIONS you can take to help these families:

  • Take any part of the letters we wrote (linked above) and edit them for publication in your local newspaper under your name.
  • Contact the Legal Services Offices in your area and offer your help and expertise to those attorneys who are trying to represent separated children in court. You can offer specific health, development and emotional impacts of separation.
  • Use this link to find Volunteer Opportunities in Your Area: Stand with Immigrants.
  • Call your Congress Person and your Senator and demand they focus on the reunification of separated families.
  • This is an election year. If you are attending any candidate forums, ask about the candidates’ positions on reunification and detention of families.
  • Attend more local rallies and events. Don’t stop speaking out until the children are back with their parents and the families are released into the community to await their asylum hearings.

NEW SCHOOL HEALTH FORM UPDATE

As many of you know, the State Department of Education (SED) announced a new School Health Form about 2 months ago.  No one from the NYS AAP was involved in the creation or design of the form.  We had been talking with the SED since last November asking to see a draft of the form and asking that it be electronically linked to EHR’s.  Our requests were ignored.  No one from the NYS AAP saw the form until the form was e-mailed, causing quite a stir among our members across the state.

We contacted the SED and asked for more conversations.  At this time there is a group of pediatricians who are involved in school health and experienced in practice administration who are attempting to work with the SED to make changes to the form and to get an extension on the implementation date.

At this time no one needs to use this form until the 2019-2020 School Year.  That would take implementation, unless we can get it delayed, to sometime in 2019 depending on when you see the child for the September 2019 school year.

Here is a link to the FAQ about the form:

https://www.schoolhealthny.com/cms/lib/NY01832015/Centricity/Domain/85/FAQsChangesHealthExam.pdf 

The important thing to remember is that no school district can demand the form now.

We will report back on the progress we make working with the SED to significantly change the form, the information it requests, and how it links with existing electronic health records.