All SFMS members are invited to participate in the 2012 CMA Legislative Leadership Conference/Lobby Day.

Join more than 400 physicians, residents, and medical students from across California as they convene in Sacramento to lobby their legislative leaders as champions for medicine and their patients.

Tuesday, April 17, 2012

9:30 am to 5 pm

Sacramento Convention Center

 

The morning includes speeches from a number of key legislative leaders, including lunchtime keynote speaker California Governor Jerry Brown. Other exciting speakers include:

• California Attorney General Kamala Harris
• Former Assembly Speaker Fabian Nunez
• Former Senate Republican Leader Jim Brulte
• Los Angeles Times political reporter Anthony York

Click here for a flyer with more information. A tentative agenda can be viewed here.

Please note this is a member-only event, and registration fee is waived for all SFMS members. To register, please contact info@sfms.org or (415) 561-0850.

Hotel Details

CMA has secured a discounted rate of $159/night for members at the Sheraton Grand Sacramento for 2012. Online reservation instructions are available here. Reservations can also be made by calling (800) 325-3535 or (916) 447-1700 – ask for the California Medical Association corporate rate.

Aimed at reducing infectious outbreaks, Dr. Richard Pan (D-Sacramento) introduced AB 2109 to provide parents with health information that they can use to help keep their children and other members of the community safe and prevent epidemics like the 2010 pertussis outbreak that caused over 9000 infections, 800 hospitalizations, and ten deaths in California.

“Parents are on the front line when it comes to protecting the health of their children and their communities,” he said in a statement. “This bill empowers them with up-to-date, accurate information about immunizations.”

The number of unvaccinated children has grown over the last decade, partly because some parents fear there is a link between the shots and autism, a theory that has been repeatedly disproved in scientific literature. California is also one of 20 states that allow parents to sign a form that excludes their children from having to receive the immunizations.

AB 2109 would simply ensure that parents receive accurate information about immunizations from a licensed health care practitioner before they decide if they will sign the form. AB 2109 is sponsored by the California Medical Association (CMA), the American Academy of Pediatrics, and the California Immunization Coalition.

“As physicians, we want to know that our patients have all the information they need to make sound medical decisions,” said CMA President James Hay, MD. “AB 2109 will help parents learn all of the benefits and risks associated with immunization, as well as the health risks of the diseases themselves. This is sound legislation that will greatly contribute to children’s and the public health.”

Today, in a majority decision, the United States Supreme Court refused to reverse the Ninth Circuit Court of Appeals decision in Douglas v. Independent Living Center of Southern California ("Independent Living Center"). That court has previously sided with physicians and other providers, agreeing that interested parties should have the ability to sue in order to block cuts to California’s Medicaid program, Medi-Cal. 

The case will now return to the Ninth Circuit Court of Appeals. The federal Medicaid Act requires that government insured and privately insured patients have equal access to medical care. If the state and federal government continue to cut funding to these programs, physicians will be forced to stop taking new patients, meaning that access to care will be greatly impacted.

“This is a win for physicians and their patients in California,” said James T. Hay, MD, President of the California Medical Association (CMA). “The lower court has previously ruled that interested parties indeed have the right to sue the state and federal government if the federal Medicaid Act is being violated. They will have the opportunity to decide that once again.”

The Supreme Court’s decision will have huge implications for the more than 10 million patients who are currently enrolled in California’s Medicaid program.

“The state cannot continue to propose sweeping cuts to programs for California’s poorest and most vulnerable patients,” Dr. Hay added. “Our hope is that they get the message loud and clear with the U.S. Supreme Court’s decision today.”

Through Medi-Cal, physicians, dentists, pharmacists, adult day health care providers, clinics and hospitals provide health care services to low-income seniors, families, children and people with disabilities. By providing these primary and preventive care services, the state ensures these Californians have access to health care, while at the same time saving money by lowering the chances they will be forced to seek more costly health care, such as emergency rooms or hospital admissions. CMA is a party in the case.

The first CMA sponsored bill to be introduced this year was AB 1746, authored by Assemblymember Das Williams, which would ban sugary drinks from being sold on middle and high school campuses.

CMA took a policy position in support of the ban after its House of Delegates approved the resolution submitted by SFMS members Shannon Udovic-Constant, Arti Desai, and Adam Shickedanz introduced the resolution “Marketing of Unhealthy Food and Beverages to Children” at the 2011 HOD. The full CMA press release is posted below.

California Medical Association Sponsors Bill to Ban Sugary Drinks in Schools

AB 1746 will help fight childhood obesity and diabetes

Sacramento—On Friday, Assemblymember Das Williams (D-Santa Barbara) introduced AB 1746, which would ban the sale of sugary sports drinks on middle and high school campuses throughout California. They are currently prohibited on elementary school campuses. Existing education code bans the sale of sodas in schools; this legislation would expand that to include sugary drinks.

Beverages like these are among the most prominent factors contributing to our nation’s obesity epidemic. "One in three California students is overweight or obese. We know that sugar-sweetened beverages, including sports drinks, are a major contributor to the problem," said James T. Hay, MD, California Medical Association (CMA) President. "There is a common misconception that sports drinks, also known as electrolyte replacement beverages (ERBs), are healthy, yet many contain high-fructose corn syrup and/or other calorie-laden sweeteners that have been linked to the rise in childhood obesity, the primary cause of type 2 diabetes. CMA is pleased to join Assemblymember Williams and other groups committed to public health in sponsoring this bill."

Sports drinks are designed to replace fluids after intense exercise and generally contain sodium and potassium to improve fluid absorption in the body. The United States Department of Agriculture (USDA) states that ERBs may be useful when large quantities of fluids are lost through sweating on a daily basis, and/or by those who perform continuous exercise for more than 60 minutes. However, the USDA concludes that there is no need to substitute sports drinks for water as a primary form of fluid replacement.

“Sports drinks are an inappropriate option for California students. They were designed for athletes who have been sweating for an hour or more, not for children as they walk across campus or eat their lunch. Assemblymember Williams’ bill will close a loophole that has allowed the beverage industry to continue using California public schools to sell products that contribute to childhood obesity and diabetes,” said Harold Goldstein, MD, Executive Director of the California Center for Public Health Advocacy (CCPHA).

The American Academy of Pediatrics states that children should be given water before, during and after exercise, with the exception of small amounts of sports drinks for children exercising in hot, humid conditions for more than one hour. The current school day does not include the kind of rigorous activity that warrants ready access to sports drinks.

“This bill aims to set the example of making healthful choices in life,” Assemblymember Williams said. “Research shows that these sugary drinks directly relate to higher incidents of obesity and many youth—and adults—are still consuming them unnecessarily. These drinks should not be a replacement for water.” CMA joins CCPHA as a sponsor of the bill.

By Steve Heilig, MPH

Contraception exploded onto the front pages this month. That might seem strange to most people—what is controversial about contraception at this late date? One headline read “Changes to Contraceptive Coverage Rules Draw Mixed Reaction” and that one wins the ‘understatement’ award on this topic.

“Conservatives” seized on the issue as a potentially good wedge issue to attack President Obama on various fronts, and hoped that it would somehow awaken some version of the good old moral majority to political action. Yet almost all women, including Catholics, ignore their putative religious leaders on this issue, and always have—when they have a choice. And most men support that practice. In letters and online comments, the most incisive perspectives seem to come mostly from women—political leaders, doctors, nurses, social workers, and just plain folks. 

The New York Times editors noted that Catholic authorities were trying to have it both ways, claiming all the special financial privileges of a church but wanting to ignore any strings that might be attached, however compassionate those might be. Others observed that behind this debate was specter of abortion politics—even though the one proven way to reduce abortions is to make contraception as easily available as possible.

Amongst politicos, the gender split seemed to hold true as well. Three female senators wrote to the Wall Street Journal defending the contraceptive mandate. Some female politicians even felt compelled to boycott the male-dominated House hearing on the topic.

In the GOP candidate’s race, Romney sought whatever position he could sell to the most people; Santorum, consistent at least, already opposes contraception, perhaps not surprising for a guy who thinks women working is a “radical feminist” plot. Irrelevant cranks Ron Paul and Newt Gingrich made statements that were aptly ignored. 

Kris Long, a nurse writing in the New York Times likely had it best: “As a former employee of a Catholic-run hospital, I find it appalling that the party of ‘individual rights’ would stand up for a religious bias rather than for the non-Catholic employees who are deprived of the right to choose health insurance commensurate with the private needs and beliefs. Why should I not be allowed birth control through my insurance because my boss has a problem with it?”

Strangely enough, organized medical voices have been muted in this heated debate. But the contraceptive mandated did not spring anew out of the White House health reform plan. It is an old idea, long supported among healthcare policy wonks and, last summer, given strong endorsement by perhaps the highest medical authority in the land, the Institute of Medicine (IOM) of the National Academy of Sciences. Their report “Clinical Preventive Services for Women: Closing the Gaps” focuses on preventive care for women, including but not limited to contraception. In medical circles it was hardly controversial and seemed to be greeted in the clinical trenches with an “OK, now make it happen” sentiment, as is often the case with rational, evidence-based medical recommendations.

Given that, and sensing that the IOM recommendations might be more controversial in non-scientific arenas, I thought it might be good to have a strong statement of support from the medical organizations I work with, and drafted the statement below for the San Francisco Medical Society’s policy-making body:

Contraception as a Fully-Covered Health Insurance Benefit

Whereas, the United States Institute of Medicine in July 2011 strongly recommended that “the full range of FDA-approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity” be a fully covered benefit of all health insurance plans; and

Whereas, the costs of contraception have long been identified as a barrier to many women’s optimal use of contraception, with negative impacts on their health and in terms of unwanted pregnancies, as well as discriminatory implications; and Whereas, The Federal administration has just mandated that contraception be a covered benefit, but health insurance industry representatives have voiced their opposition to this measure and might try to repeal it; now be it

RESOLVED: That the California Medical Association supports the coverage, without co-payments, of all FDA-approved contraception methods as a mandated health benefit of all health plans.

True to form, this statement was noncontroversial among the 20+ physicians of various specialties who reviewed it and three physicians signed on as co-authors—all of them women (I am omitting their names here to protect them from the scary minority), but we could have added men as well. The statement then went to the annual policy-making meeting of the California Medical Association (CMA)—a much larger and often more conservative bunch, made up of hundreds of doctors from all over the state. 

We thought there might be some opposition there, but in the open debate, the CMA physicians even strengthened the final statement to include voluntary sterilization. Thus, here is one of the nation’s largest state medical association’s concise position on this matter: RESOLVED: That the California Medical Association supports the coverage, without co-payments, of all FDA-approved contraception methods and sterilization as a mandated health benefit of all health plans. Simple, direct, and medically correct, regarding a private medical matter between women and their physicians. 

As for the rest of those pundits weighing in, mostly male and including religious figures and politicians, I can’t help but be again reminded of what pioneering lawyer and yes, feminist Florynce Kennedy once quipped, “If men could get pregnant, abortion would be a sacrament.” The importance of this mandate is highlighted in The New York Times report this week showing that Catholic control of hospitals in some areas is growing, with resultant restrictions on some services. I also can’t help but note that a recent report from the widely-respected group Save the Children confirmed what has long been known—one out of four children already here on this planet are malnourished, and many of them are starving to death around the world, at a rate of one every five minutes. Some would say these issues are related. The Catholic church does much good in the world; some of my best friends are Catholic (seriously). But on this topic, pundits have pointed out that for all the fire and brimstone directed by church leaders against the contraceptive mandate, they tend to be much less vehement when politicians propose policies that seemingly violate other teachings about war, inequality, compassion and empathy for the poor. I respectfully wonder if Catholic and political leaders opposed to contraception could meditate on that for a moment, and instead of fulminating against one of the only solutions we have for helping women live better lives—and to prevent abortions—they might devote their time and energy towards alleviating this ongoing tragedy of suffering in the world. And—a novel idea—perhaps they could listen to what doctors think as well. Once can hope so, but I will not hold my breath.

Originally published on sfgate.com/San Francisco Chronicle blog on February 21, 2012.