Wednesday, December 17, 2014

San Francisco Medical Society Blog


Providing news to the San Francisco Medical Community.

Vaccination Rates Up in California Schools

For the first time in a decade, the number of parents who filed personal belief exemption forms to exempt their kindergarteners from vaccinations has declined in California. According to new data from the California Department of Public Health, the personal belief exemption rate decreased by 20% from 2013 to 2014, with 2.5% of kindergarten children opting out this school year, down from 3.1% in 2013.

The decline coincides with the implementation of a new state law, sponsored by the San Francisco Medical Society and the California Medical Association, which requires a parent or guardian seeking a personal belief exemption from school immunization to first obtain a document signed by a licensed health care practitioner. In the form, the practitioner is asked to attest that the parent or guardian has been informed of the benefits and risks of the immunization, as well as the health risks of the diseases that a child could contract if left unvaccinated.

AB 2109, authored by Sacramento pediatrician and Senator Richard Pan, was borne out of a rising concern over the continued increase in personal belief exemptions in California and recent outbreaks of diseases such as measles, mumps, and pertussis. Exposure to these preventable diseases places the individual child at risk, as well as the entire community, including infants too young to be fully immunized and individuals with compromised immune systems.

In California, parents could previously exempt their child from all immunizations by simply signing a two-sentence standard exemption statement on the back of the California School Immunization Record or provide a separate written statement that proclaims they are exempting their child. No other information or explanation of reason was required. The law still allows the form to be signed, but after a parent has gained full understanding of the risks and benefits of vaccination from a licensed health care professional.

Covered California Extends Deadline for January 1 Coverage

Covered California has extended the deadline for consumers to enroll in health coverage that begins on January 1, 2015. Consumers now have until December 21 to sign up for coverage.

The Los Angeles Times reports that the deadline extension signals high consumer interest. However, the extension also could be the result of problems with the exchange’s website and call centers. Wait times last week for the call center averaged 18 minutes, while 32% of callers dropped their call.

Source: California Healthline, December 16, 2015.

Significant New California Laws of Interest to Physicians for 2015

The California Legislature had an active year, passing many new laws affecting health care. In particular, there was a strong focus on scope of practice for allied health professionals, prescription drug abuse, public health issues and health care coverage. A summary of the most significant new health laws of interest to physicians are listed below. For an extensive listing, click here


CMA Position: Sponsored
Revises provisions of law requiring licensed health facilities to prevent disclosure of patients' medical information by extending the deadline for health facilities to report unauthorized disclosures from five to 15 business days after unlawful or unauthorized access, use, or disclosure has been detected. This bill also authorizes the report made to the patient or the patient's representative to be made by alternative means, including email, as specified by the patient. This bill also extends the deadline when reporting is delayed for law enforcement purposes, as specified, from five to 15 days business days after the end of the delay. This bill gives the Department of Public Health full discretion to consider all factors when determining whether to conduct investigations under these provisions.

(Health & Safety Code §1280.15)


CMA Position: Support
Deletes the limit on the number of syringes a pharmacist has the discretion to sell to an adult without a prescription and extends, until January 1, 2021, the statewide authorization for pharmacists to sell syringes without a prescription, as specified. Exempts the possession of a specified amount of hypodermic needles and syringes that are acquired from an authorized source.

(Business & Professions Code §§4144.5, 4145.5, 4148.5, 4144, 4145 and 4148; Health & Safety Code §§4149.5 and 11364.)

SB 964 (Hernandez E.) - HEALTH CARE COVERAGE

CMA Position: Support
Increases oversight of health care service plans with respect to compliance with timely access and provider network adequacy standards. Authorizes a health plan to include in its contracts with providers, provisions requiring compliance with timely access and network adequacy data reporting requirements. Requires DMHC to annually review health plan compliance with timely access standards and to post its final findings from the review, and any waivers or alternative standards approved by DMHC, on its Web site. Authorizes DMHC to develop, and requires health plans to use, standardized methodologies for timely access reporting, and exempts the development and adoption of the standardized reporting methodologies from the Administrative Procedures Act, the body of law governing state regulations, until January 1, 2020.

(Health & Safety Code §§1367.03, 1367.035, and 1380.3; Welfare & Institutions Code §§14456 and 14456.3)


CMA Position: Support
Requires, effective January 1, 2016, most health plans and insurers to cover a variety of Food and Drug Administration-approved contraceptive drugs, devices, and products for women, as well as related counseling and follow-up services and voluntary sterilization procedures. Prohibits cost-sharing, restrictions, or delays in the provision of covered services, but allows cost-sharing and utilization management procedures if a therapeutic equivalent drug or device is offered by the plan with no cost-sharing.

(Health & Safety Code §1367.25; Insurance Code §10123.196; Welfare & Institutions Code §14132)

Gordon Fung, MD, PhD Wins 2014 CMA Foundation Access to Health Care and Disparities Award

UCSF Cardiologist Recognized for Commitment to Improving Health Care Access for San Francisco’s Asian Community

Gordon Fung, MD, PhD, a cardiologist and current Editor of San Francisco Medicine, was selected as the recipient of the 2014 Adarsh S. Mahal, MD Access to Health Care and Disparities Award from the California Medical Association Foundation. Dr. Fung was recognized for his role in establishing the first Asian heart and vascular center in the nation and his ongoing commitment to improve health care access for the Asian community.

The Mahal Award acknowledges “an individual or organization that has demonstrated extraordinary interest and efforts toward improving access to health care or reducing health care disparities in California.”

Dr. Fung has dedicated more than 25 years of his cardiology career to addressing disparities in health care. He co-founded the Asian Heart and Vascular Center (AHVC) at the University of California – San Francisco in 2006, after noting Asian patients often do not seek care or delay care for heart attacks and strokes—the two leading causes of death for Asian Americans—due to language barrier and cultural differences. AHVC was the first center in the county to serve the specific cardiovascular care needs of Asian Pacific Islanders.

Under his guidance, the center developed prevention and treatment programs that cater to Asians culturally, linguistically, and medically. It enabled Asian patients to learn in their own language and culture about disease processes, treatment options, and symptom recognition of cardiovascular diseases. Additionally, the center was seen as the leading institution to coordinate clinical research efforts and support program activities with community partners to decrease health disparities in the Asian community.         

Recognizing the importance of community education, Dr. Fung spearheaded AHVC’s educational outreach efforts to the public with monthly outreach community meetings and seminars. He also volunteered with the American Heart Association as well as the Chinese Community Health Care Association to engage San Francisco’s Chinese community in heart disease prevention and treatment. Awareness about heart disease risk factors and prevention tips significantly increased from 10% to 80% in the Chinese community in a five year span as a direct result of Dr. Fung’s community talks and AHVC seminars.

In addition to an active clinical practice in consultative general clinical cardiology, Dr. Fung serves as a clinical professor at the UCSF School of Medicine, and represents the San Francisco Medical Society on the Healthy San Francisco Advisory Oversight Committee, a program to provide universal health care access for all San Franciscans. He is a founding board member of the National Council of Asian Pacific Islander Physicians, and Asian American Research Center on Health, a leading organization in Asian American health research to promote health and health equity. Dr. Fung was appointed by Mayor Gavin Newsom as a member of the Healthy San Francisco Advisory Oversight Committee to represent the San Francisco Medical Society and physicians in implementing Healthy San Francisco, a program designed to provide universal health care access for citizens of San Francisco. He was also appointed by Governor Arnold Schwarzenegger as Chairman of the Council of Multicultural Health, which was designed to develop programs and monitor statewide health activities to decrease ethnic disparities.

SFDPH Health Update: Influenza 2014-15

Influenza A (H3N2) virus strains are likely to predominate during the 2014-15 influenza season and a “drifted” H3N2 strain (antigenically different from the H3N2 vaccine strain) may be common. CDC advises that vaccination has been found to provide some cross-protection against “drifted” viruses and will also offer protection against the other vaccine viruses such as influenza A (H1N1) and influenza B viruses. In addition, CDC emphasizes the importance of using Oseltamivir and Zanamivir when indicated for treatment and prevention of influenza.

Actions Requested of all Clinicians by the SFDPH:

  1. REPORT the following cases to SFDPH Disease Control at (415) 554-2830:
    outbreaks of influenza or undiagnosed influenza-like illness (ILI2) in residents of large group or institutional settings

    (b) individual lab-confirmed cases of seasonal or novel influenza meeting criteria below under Surveillance and Reporting

  2. PRESCRIBE ANTIVIRALS for patients with suspected or confirmed influenza who are hospitalized for severe illness or who are at higher risk for influenza-related complications. Use Oseltamivir or Zanamivir. Treat early and empirically, without relying on lab test results. 
  3. ENCOURAGE AND FACILITATE influenza vaccination for all persons 6 months of age and older and pneumococcal vaccination for those at increased risk of pneumococcal disease. 
  4. IMPLEMENT INFECTION CONTROL PRECAUTIONS as described on page 3 of the full SFDPH Health Update. Note: 
    • ALL PERSONS with fever & cough should wear a face mask in all health care settings. 
    • ALL PERSONS with ILI 2 should be instructed to stay at home until 24 hours after fever resolves, except patients who require medical evaluation and care.

Click here to view the SFDPH Health Update issued on December 3, 2014.

Health Care Workers: September 9, 2014, health order mandates all hospitals, skilled nursing, and other long term care facilities in the City and County of San Francisco to require their health care workers to receive an annual flu vaccination, of if they decline, wear a mask in patient areas during the influenza season. In addition, California law (Health & Safety Code §1288.7/Cal OSHA §5199) requires either flu vaccination or the signing of a declination form for all acute care hospital workers and most health care personnel including clinic and office-based staff.

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