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.


June 2018

Dear NYS AAP – Chapter 2 Member,
May and June are busy months for our Chapter, with lots of important news to relate. Please check the Chapter 2 website frequently, as new events, initiatives, valuable practice management information, and links to articles are regularly posted.
Steven J. Goldstein, MD, FAAP
President, NYS AAP – Chapter 2
Firearm Injury and Gun Violence Prevention Committee
On May 17th our newly formed Chapter 2 and 3 Firearm Injury and Gun Violence Prevention Committee met at Cohen Children’s Medical Center. There were over 30 attendees from both Chapters, including students, parents, residents, and attending physicians. Jeff Ostreicherfrom Chapter 2 and Nina Agrawal of Chapter 3 will co-chair this joint endeavor. Four working groups are planned: Legislative Advocacy, Research and Education, Grassroots, and Media Outreach. If you would like to help, click Jeff and Nina’s names above to email them.
Stress Reduction for Pediatricians – June 7th
On June 7th the Chapter is sponsoring an informal Wellness Event: Stress Reduction for Pediatricians, at the Douglaston Club in Little Neck. There will be a gourmet vegetarian dinner, an introduction to yoga led by Dr. Ron Marino, and a talk on stress reduction by Dr. Peter Nieman of Calgary, Alberta. I had the opportunity to hear Peter speak last year at the AAP District I & II Annual Meeting in Vermont – his advice is worth hearing. The evening is free for Chapter 2 members and Chapter 3 members can attend for a reduced fee thanks to a generous grant from MLMIC. It promises to be a great evening.
Immigrant Health
Another joint initiative for Chapters 2 and 3 will focus on Immigrant Health. We oppose separation of children from their parents at the border. We oppose losing 1,500 of those children.
We are working to create safe spaces for immigrant children to obtain quality pediatric healthcare and oppose the dehumanizing of any group. Take a look at the AAP’s stance on this issue: http://www.aappublications.org/news/2018/05/08/immigration050818
Please contact Laurie Gordon at lsg9004@nyp.org if you would like to work with the Chapters on this issue.
Families Belong Together March – June 14th
On June 14 there will be a Families Belong Together march and candlelight vigil in Huntington, Long Island to protest the separation of children from their parents at the US border. Chapter 2 is a sponsor of this event and invites all our members to attend this vigil or others planned for the metropolitan region. The Huntington location is the Northwest corner of Park Avenue and Main Street in Huntington Village at 7 pm on June 14.
AAP President Dr. Colleen Kraft’s op-ed on this subject can be found here.
Tobacco 21 Victory
Congratulations to Chapter 2 Vice President, Dr. Shetal Shah, and all who worked on and attended the May 23rd vote of the Nassau County Legislature, where a bill that we worked on for the last 10 years passed unanimously. This important bill raises the age to purchase tobacco and related products, including e-cigarettes, to 21. Nassau County will finally join Suffolk County and all of NYC in complying with Tobacco 21. This is a big win for our Chapter and the children we care for!
Vaping and E-Cigarettes Lecture – June 18th
Drs. Mary Cataletto and Robert Lee received a grant from the AAP Julius B. Richmond Center of Excellence for Dr. Karen Wilson to speak with NYU Winthrop Hospital, Chapter 2, and Nassau Pediatric Society attendees about e-cigarettes, secondhand smoke, vaping and JUULing and how to address these issues in the office.
A free dinner lecture will be held on June 18th at NYU Winthrop Hospital.
Chapter Needs Assessment Survey
You should have received a Chapter Needs Assessment Survey that will assist us in creating a new Chapter 2 Strategic Plan.  Please take a few minutes to share your thoughts, help us serve your needs, and enter our Amazon gift card giveaway.
Addressing the Opioid Crisis
If you are interested in joining a NY State multi-Chapter Committee to craft strategies to deal with the opioid crisis, help develop and make available educational materials for pediatricians, learn how to use SBIRT (Screening, Brief Intervention and Referral to Treatment), and learn about other addiction related issues, please contact our Executive Director, Jessica Geslani, at jgeslani@aap.org.
Diversity and Inclusion
I am pleased to announce that Dr. Juan Kupferman, our Membership Chair, will head our new Diversity and Inclusion initiative. Juan is already working on this issue and if you would like to learn more or assist him, email him at kupferjc@gmail.com
Help with Billing & Practice Management Issues
Please periodically check the Pediatric Council section of our website to view new advisories from the National AAP. The most recent post deals with a billing problem at Anthem-Blue Cross.
In addition, the Chapter can help you in addressing your billing and practice management issues. Outline the problem in an email to us at jgeslani@aap.org.
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 summer!
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
Sara Kopple, Treasurer sarakopple@gmail.com

May 2018

Dear NYS AAP – Chapter 2 Member,

Chapter leadership is a fulfilling role, with unlimited possibilities to aid the members and serve the children of New York State. It can be a full-time job for the officers. It is my pleasure to share some of what we are doing and plans for new initiatives.

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

NYS AAP Annual Advocacy Day

On March 6th, Chapter members attended our Annual Advocacy Day in Albany.  125 pediatricians from across the state were in attendance and heard from the Chairs of the Senate and Assembly Health Committees and Medicaid.  Members met with their State Senators and Assemblymen to promote the AAP Agenda for Children in New York State.View our 2018 NYS AAP advocacy materials below:·     Priority Pediatric Policy, Budget and Practice Issues·     Legislative Priorities

NY Chapters 1, 2 and 3, and New York State AAP

March Executive Meeting: Focus on Gun Violence Prevention

Our last quarterly Chapter Executive Committee Meeting was held on March 8th at Winthrop University Hospital.

In response to the tragic events at Parkland, the majority of the meeting was devoted to the issue of gun violence prevention (GVP). The speakers included Young Nelson of Everytown for Gun Safety, long time GVP advocate Dr. Nina Agrawal from Chapter 3, and Dr. Jeff Ostreicher from Chapter 2, a Peds ED physician with a research interest in gun violence. Jeff will Chair Chapter 2’s new GVP Committee and will work with Nina. Parents, educators, and activists attended the meeting as well. Contact our Executive Director, Jessica Geslani, at jgeslani@aap.org if you would like to work on this issue. The first joint GVP Committee meeting will be scheduled for sometime in May.

Annual Leadership Forum

From March 15 -18th, Chapter leadership from around the state attended the AAP Annual Leadership Forum. There were educational sessions and the leadership voted on resolutions submitted by the AAP membership. All passed resolutions are addressed, and the Top Ten are given priority by the AAP Board of Directors. The resolutions can be viewed here: http://bit.ly/2GNfYIV (AAP login required).

At the ALF, I had the opportunity to defend our nomination for the 2018 Outstanding Large Chapter Award. Although we did not win, it was an honor to be nominated, and we will instead receive a Chapter of Excellence Award. The winning Large Chapter, the Minnesota Chapter, helped stop a measles epidemic within their local Muslim community. I agree that this initiative deserved special recognition.

March for Our Lives – Long Island

On March 24th, I had the privilege of speaking at the March For Our Lives-LI in Huntington, along with family members of those killed in Parkland, clergy, former Congressman Steve Israel, students, and a representative from the local NAACP.

There were about 3,000 people in attendance, including a good number of Chapter 2 members.  Pictures and my speech can be found on the Chapter website here:

http://ny2aap.org/march-for-our-lives-2018/

I was asked by the AAP to write a blog for AAP Voices on my experience with the students, and our new joint Chapter initiative to address gun safety and GVP. It can be found here: https://www.aap.org/en-us/aap-voices/Pages/Pediatricians-Advocating-for-Gun-Safety-Should-Be-No-Surprise.aspx

AAP Legislative Conference & Leadership Fly-In

On April 9th and 10th, Chapter leaders from around the country met in Washington at the AAP Legislative Conference where we improved our advocacy skills and learned a great deal about issues of concern to our profession, including healthcare, the environment/climate change, immigrant health, gun violence prevention, and many others.

On April 10th, the 350 pediatricians in attendance met with their Senators and Congressional representatives to discuss the gun safety and GVP issue. The 20 or so pediatricians from New York State were very well received by the offices visited and much information was shared. You should all know that the AAP committed $500,000 to a Gun Research Initiative to aid in bringing science into the discussion of how to address this problem.

Congressman Tom Suozzi (center) with Drs. Steven Goldstein (left) and Shetal Shah (right)

Rome CATCH Visiting Professorship: Immigrant Health

On April 11th, NY Presbyterian-Queens hosted Visiting Professor Julie M. Linton for a symposium on immigrant health issues. The program was supported by a grant from the AAP obtained by Drs. Laurie Gordon and Sara Kopple. Dr. Alan Shapiro of Terra Firma spoke about his experiences in the Bronx, along with Dr. Linton. Their presentations were followed by a panel discussion. If you are interested in working with the AAP on immigrant health issues, please email our Executive Director, Jessica Geslani, at jgeslani@aap.org.

Social Event: Networking, Art & Pediatricians

On April 18th, about 60 pediatricians and medical students attended a joint Chapter 2 and 3 evening networking event at The Flowers Gallery in Chelsea. Attendees had the opportunity to socialize and hear from the Chapter leadership as they sipped wine and ate gourmet pizza. We plan to continue to hold events such as this one to keep our members informed and involve new pediatricians in our work. Attendees included practicing pediatricians, residents, fellows, Department Chairs, first year medical students, and retired members.

Coming Up: Watch Your Email & the Chapter Website

May 16:
Joint Chapter 2 & 3 Executive Committee Meeting
The National AAP President-Elect Candidates will join us via Skype.

Early June:
We plan to hold a Wellness Event for Pediatricians: Yoga, Stress Reduction, and Avoiding Burnout
More details to follow.

June 18 – 19:
Julius B. Richmond Visiting Lectureship Program with Dr. Karen Wilson
“How to Address the Problem of E-cigarettes and Vaping”

The Officers of Chapter 2 are happy to hear from you. Let us know about your concerns, your needs, and your suggestions. We regularly post webinars, educational opportunities, resources, handouts, and videos on our website: ny2aap.org

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

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
Sara Kopple, Treasurer sarakopple@gmail.com


Gun Violence Prevention

Nina Agrawal, MD, FAAP

Nina Agrawal, MD, FAAP

Dr. Nina Agrawal, MD, FAAP is the Medical Director of the Child Advocacy Center at Lincoln Medical Center in the South Bronx, where she practices child abuse pediatrics and runs the Center’s Community Pediatrics residency rotation.  She is member of the NYS AAP Chapter 2 and 3 Gun Violence Prevention Committee.

NYS AAP Chapter 2 and Chapter 3 members:

For the first time since the shootings at Sandy Hook elementary school, I feel hopeful.  The next generation is standing up for kids everywhere – rural, suburban, and urban.  They are standing up for the countless children traumatized every day by gun violence – directly and indirectly.

We had over 100 medical students, pediatric residents, and practicing physicians from programs all over NYC participate in the nation wide March for Our Patient’s Lives on March 24th.  Kudos to Hofstra medical students for coming out in huge numbers! (https://www.youtube.com/watch?v=eFWIXT6_IiM&feature=youtu.be)

We must continue to stand up and speak out!  As pediatricians, we are a trusted voice and can save lives.  Here’s what you can do NOW:

  1. LEARN
    1. Gun violence is a public health crisis. This is not politics.  This is about policies that keep children safe.  Gun violence is now the 2nd leading cause of death in children and is on the increase.  Every day we do nothing, 7 more children die.
    2. Gun violence is preventable. We need research and data to support effective policies.  Because of the Dickey Amendment stating that “no funds could be used by the CDC and NIH to advocate or promote gun control, we are 22 years behind in identifying evidence based solutions.  We need Congress to repeal the Dickey Amendment and appropriate $50 million to the CDC to do their job.
    3. We are promoting gun safety not gun control. This is similar to past highly successful public health campaigns such as Safe to Sleep and Motor Vehicle Safety.  Because of “Back to Sleep” and car seats, we have dramatically reduced deaths from these preventable injuries.  We need to do the same for gun violence.
  2. CONNECT
    1. We can’t do this alone. There are lots of opportunities to get involved.  Whatever you can give – a day, a week, a month – It all makes a difference.
    2. Connect with gun violence prevention advocacy groups like Moms Demand Action or the new Gun Violence Prevention Committee of NYS AAP Chapters 2 and 3.  Other groups always welcome white coats!
    3. Create dialogue with other health professionals. Offer to speak at noon conferences, grand rounds, etc.  Connect with speakers and ask them to present at your institution.
  3. ACT
    1. Raise awareness about the need for research – on a state level and on a federal level.  Most physicians don’t know about the Dickey Amendment. Repealing the Dickey Amendment has bipartisan support.  There is proposed legislation to create a NY State firearm research center.
    2. Put a face on gun violence. Tell your story about a patient or an experience.  Legislators have the stats but don’t have the front line experiences we have.
    3. June is gun violence prevention month.  June 2nd is wear orange day. Orange is the color for hunters, warning people not to shoot.  Host an event. Can be large or small.  We are happy to help you!

Stay tuned for a gun violence prevention summit in NYC on June 23rd organized by NY Docs – A coalition of advocacy groups dedicated to improving health for all.  To learn more, feel free to contact me.  We will be educating health professionals on policy advocacy and giving you the tools to take action.

Please read the attached letter from a 9 year old advocating to keep kids safe from guns.

 

In unity,

Nina Agrawal, MD
ninaagrawalmd@gmail.com