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.

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.

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 53^rd 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.

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

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.

• NYS AAP Letter to Governor Cuomo
• NYS AAP Letter to Mayor de Blasio

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.

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

Heather Brumberg, MD, MPH, FAAP

Shetal Shah, MD, FAAP

This blog post was originally published as an Opinion-Editorial piece in www.lowhud.com.

(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. Heather Brumberg, MD, MPH, FAAP is Director of Regional Neonatal Public Health Programs and Medical Director of the Lower Hudson Valley Perinatal Network.  She is NYS AAP Chapter 3 President.)

Influenza has a public relations problem.  Though often perceived as a mild inconvenience, this past influenza season, commonly known as “flu,” demonstrated how serious the virus can be, infecting an estimated 34 million people nationwide and killing almost 4,000 this year.

As pediatricians in the neonatal intensive care unit, we cared for several babies whose influenza was so severe they required mechanical ventilators to help them breathe and intravenous medication to help their hearts beat stronger.  Our patients survived, but about 150 other children weren’t so fortunate.

With the increased attention this year’s flu season has received, the New York State Legislature is considering a bill (A1230a/S6346) to increase flu vaccination rates in preschoolers – the pediatric population most likely to harbor, and get seriously ill from influenza.  The bill would require infants, toddlers and young children who attend certain daycares to obtain an annual flu shot.  The measure being considered in Albany, which is similar to existing legislation in New Jersey and Connecticut, is highly effective at protecting kids from flu’s most severe complications.  In Connecticut, the regulation reduced flu-associated hospitalization in young children, and in New Jersey, preschool rates of flu immunization increased to 88 percent in the law’s first year.

The numbers from this past flu season define a public health epidemic.  In New York State, there were about 120,000 cases of influenza this past season, which doesn’t include additional undiagnosed illness.  Almost 12,000 people have been hospitalized and roughly 8,300 children under 5 years old were infected.  Eight children in our state died.  Fortunately, immunization against flu is an effective and safe means of protecting children from influenza.  Even in years when the vaccine doesn’t confer as much protection as it could — this year’s vaccine was about 30 percent effective – it still minimizes the risk of the most severe complications from influenza, including hospitalization and death.

The Centers for Disease Control recommend an annual flu shot for all children and adults with rare exceptions.  Immunizing young children is paramount, because their immune systems are inexperienced, not having encountered many flu strains before.  These children are therefore more likely to get critically ill from influenza.  Children in the close confines of daycare also serve as reservoirs of disease – passing the virus to other young children, siblings, their parents and grandparents.

While preschoolers are roughly one quarter of the child population, they represented almost 40 percent of all pediatric deaths from influenza from 2004-2012.  Unfortunately, flu vaccination rates in children are shockingly low compared to other recommended vaccines.  In 2014-15, only two thirds of New York’s children received a flu shot, while greater than 90 percent were immunized against Hepatitis B.

Unfortunately, there are opponents who object to any new regulations, seeing scientific-based policies as an infringement of personal choice, combating scientific fact with passion and volume.  These arguments were made when sates introduced seat belt laws, which the National Highway Transportation Safety Administration estimates save 10,000 lives annually.  They were made when infant car seat rules were introduced, which save 250 babies per year.  Bike helmet laws, which reduce head injuries by 40 percent, prohibitions on smoking in airplanes and other vaccination rules have always been initially met with dissent, despite having roots in public health data.

Reinforcing our protection against influenza for children in daycare does not mandate flu vaccination.  Parents who choose not to immunize their child have a right to do so.  However, this right should not allow them to be in areas where disease can be easily transmitted.  This is especially true for a highly infectious disease like flu, which can infect children even before the initial child is sick.  It would also prevent passage of disease to children in same daycare who are too young to get vaccinated, like newborns.  Parents who disagree with school vaccination requirements have for years chosen to home school there children.  Similarly, parents who disagree with these medically-supported proposals can seek alternative child-care arrangements.

Immunization remains one of our country’s greatest public health success stories.  Failing to take practical steps to protect toddlers and young children from a highly infectious, potentially serious disease would represent a missed opportunity for New York State.

This blog post was originally published as an Opinion-Editorial piece in the Huntington Patch.

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

Cuts To Farm Bill Will Affect Hungry Children On LI, Doctor Says

Dear Editor,

As a pediatrician I feel compelled to speak out against the proposed cuts to SNAP in the Farm Bill, H.R.2, which is currently up for a vote in the House.

SNAP is the Supplemental Nutrition Assistance Program.  It is the most effective domestic U.S. hunger safety net program and nearly half of its recipients are children.  Over one million children in New York State receive benefits from SNAP.  Cuts to SNAP will adversely affect children in the nearly 22,000 households with children that participate in SNAP right here on Long Island.

SNAP delivers critical support to vulnerable families to ensure that they can put food on the table.  Children who live in households that are food insecure are likely to be sick more often, recover from illness more slowly and be hospitalized more frequently.  Lack of adequate healthy food can impair a child’s ability to perform well in school and can lead to higher levels of behavioral and emotional problems from preschool to adolescence.

SNAP is reauthorized under the Farm Bill, legislation that renews federal agriculture, trade and nutrition programs.  At present, SNAP benefits are not enough to provide funding with the resources to obtain an adequate healthy diet, and they should not be cut further.

No child should have to struggle with hunger and food insecurity in our country.  SNAP serves as a critical support for the health and well being of children and it’s funding should not be cut in the Farm bill.