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District of Columbia
District of Columbia
Constance J. Bohon, MD, section chair
The District of Columbia Annual Section Meeting is scheduled for September 19 at Georgetown University Hospital. Our featured speaker will be Gerald F. Joseph Jr, MD, ACOG vice president of practice activities and past ACOG president. He will discuss over-the-counter oral contraception and cervical cancer screening guidelines.
We are pleased to report that five medical students representing each of the medical schools in DC attended the Annual Clinical Meeting in New Orleans in May with support from the John M. Gibbons Medical Student Award. DC Section Junior Fellows were instrumental in the identification of these students. The students attended a variety of sessions, including skills workshops, lectures from residency program directors on interviewing for residency, and the President’s Program. Carey Wickham, a medical student from George Washington University, said, “All these sessions helped expand and reaffirm my interest in ob-gyn.”
The DC Department of Health reported the perinatal infection of four infants with HIV in 2012. The 2009 study “Heterosexual Relationships and HIV in Washington, DC” found that more women are living with HIV/AIDS than previously before. After evaluation of the cases of perinatal HIV infection, it was determined that some of the HIV-infected women in DC need additional support to comply with medications and medical appointments. If identified early and managed during pregnancy, delivery, and postpartum, the transmission rate from mother to child can be less than 1%. If not treated, the rate can be as high as 25%.
According to the World Health Organization, an HIV epidemic is considered generalized if the prevalence of HIV is greater than 1% in the population. In 2012, 2.7% of the population in DC had HIV/AIDS, making DC a high-incidence area. The current recommendation for screening for HIV in pregnancy for high-incidence areas, in accordance with ACOG and Centers for Disease Control and Prevention guidelines, is to test routinely in both the first and third trimesters.
On May 3, the DC City Council published an amendment to the HIV reporting regulation to include the reporting of pregnancy in HIV-infected women. The goal of this new requirement is to verify that these women are receiving care during pregnancy and to direct them to services they may need. To comply with this new reporting requirement, representatives from the HIV/AIDS, Hepatitis, STD, and TB Administration at the DC Department of Health are scheduled to educate providers and their staff. The program, “HIV and AIDS: What the Primary Care Physician Should Know about the Diagnosis and Management,” provides information on screening, management, and referrals for pregnant women with HIV in DC. This program is to be completed by providers before their renewal of a DC medical license.
The maternal mortality rate in DC is 34 per 100,000 live births, one of the highest rates in the US. Currently, there is no maternal mortality committee in DC to identify the causes of maternal death and interventions that may decrease this high incidence.
With the assistance of Jeanne Mahoney, ACOG director of providers’ partnership, the inaugural meeting of a committee to organize a maternal mortality and morbidity review committee in DC met on July 11. Representatives from each hospital in DC attended, including obstetricians, family practice physicians, and nurse midwives. The goal of this medical group is to determine criteria for review of cases, establish a review process, and identify the composition of the maternal mortality and morbidity committee. After this initial meeting, members of the DC Department of Health and advocacy groups will become involved. The final anticipated step is the introduction of a bill to the DC City Council for the establishment of this committee.
Special thanks go to the District IV sections that made reports available on the formation and functions of their maternal mortality review committees. This input has helped streamline the process of creating such a committee in DC.
The DC Section will participate in the ACOG State Legislative Roundtable September 20–21. The DC Pain-Capable Unborn Child Protection Act was introduced in the US House by Rep. Trent Franks (R-AZ). The bill was then expanded to include not only DC but also all states to ban abortion after 20 weeks. It passed the House on June 18 by a vote of 228–196. The DC Section lobbied against the bill. However, without a voting member in Congress, our efforts were futile. The non-voting representative from DC, Democrat Eleanor Holmes Norton, strongly opposes the bill.
Bills pending before the DC City Council include the Patient Protection Act, which creates mandatory nurse staffing ratios. The alternative bill is the Nurse Safe Staffing Act, which creates a flexible approach for nurse staffing ratios. DC hospitals and the American Nurses Association have strongly supported the latter bill. The DC Section has not endorsed either bill, but it has provided supportive wording from written ACOG policies that support the flexible approach to nurse staffing. There is great concern for the governmental establishment of mandatory staffing in hospitals. Other medical bills pending before the DC City Council include the Prescription Drug Monitoring Program Act and the Reporting of Hospital-Acquired Infection Act.
The DC Adolescent Health Working Group was established in 2013 to bring together community organizations, adolescent health care providers, and governmental agencies, including DC public schools, to develop a coordinated and comprehensive approach dedicated to improving adolescent health in DC. One of the group’s goals is to ensure comprehensive sexual and reproductive health services for all adolescents in DC. As a member of this working group, the DC Section has been asked to help improve the availability and accessibility of long-acting reversible contraception at student-based health centers and elsewhere for adolescents.
Pamela G. Gaudry, MD, section chair
Greetings from the great state of Georgia! The Georgia Section and Georgia Obstetrical and Gynecological Society (GOGS) have been working diligently for Georgia ob-gyns. I am honored to give you the following updates.
We are starting the third year of our grant with the Georgia Department of Public Health. The grant partnership allows us to complete a number of activities that benefit women and ob-gyns in the state. We have started a maternal mortality review headquartered at the GOGS office. Because Georgia consistently ranks as one of the states with the highest maternal mortality rate, the review initiative is crucial to improve care in the state.
Georgia has 40 counties without obstetric care, and labor and delivery units continue to close. With the Department of Public Health grant and a supplemental grant from the March of Dimes, we are conducting a study to better understand the physician workforce shortage and look for real solutions. A formal report will be published for physicians as soon as the information is available.
We also completed a survey of residents in the five ob-gyn residency programs as part of the study. The survey was conducted by 23 ob-gyn residents, medical students, and master of public health students from the Emory University Rollins School of Public Health. They hope to present some preliminary results at the annual section meeting as part of the resident poster session.
Anne Patterson, MD, a maternal-fetal specialist from Atlanta, recently implemented high-risk telemedicine consults for several rural areas of the state in partnership with local health departments. We are watching closely to see if this initiative will have a positive impact on care in areas that have few obstetricians and maternal-fetal medicine resources for prenatal care.
In a time of so much upheaval in the health care system, Georgia recently changed Medicaid directors again. The state continues to oppose Medicaid expansion and is planning to let the federal government run its exchange. In October, Medicaid will implement a rule of no payments for elective deliveries prior to 39 weeks’ gestation. We have been working on eliminating these deliveries for several years in Georgia and hope that our work will pay off with minimal disruption to practices.
The state’s fetal pain bill, restricting abortions beyond 20 weeks’ gestation, is still under injunction. There is no news at this point as to when we can expect the bill to be reviewed. Unfortunately, we expect several bills restricting abortion to be introduced during the next session.
The section hopes to pass legislation, introduced by Republican State Sen. Dean Burke, MD, an ob-gyn from Bainbridge, to enhance the work already being done on maternal mortality review. Additionally, an interesting bill that would do away with the current medical liability system and develop a government run adjudication system has been introduced.
The Georgia Section Annual Meeting was held earlier this month, with more than 125 ob-gyns in attendance. The meeting offered a hands-on simulation lab and lectures from Brenda Fitzgerald, MD, commissioner of the Georgia Department of Public Health, and Barbara S. Levy, MD, ACOG vice president of health policy.
In May, GOGS sponsored a CPT coding seminar for South Georgia. We hold two of these seminars per year, one in the north half and one in the south half of the state.
In February, the section held a one-day educational meeting with the American Academy of Pediatrics Georgia Section. The meeting focused on topics of interest to members of both organizations. We plan to continue this joint meeting every other year. The GOGS annual golf tournament in May drew approximately 100 participants and raised $1,500 for the Georgia Regents University Global Gynecology and Cervical Health Program in Peru. Basic supplies will be purchased with the funds and taken to Peru by residents for use in the clinic there.
Mark S. Seigel, MD, section chair
Scope of practice issues surrounding lay midwifery and home birth are likely to become major focuses of the physician community in Maryland. There is strong and growing demand for home births by a small but well-educated and vocal group of Maryland women and their families. The demand for accessible home birth options is further exacerbated by Maryland’s large Amish population, which relies on home birth. In 2011, legislation resulted in a Department of Health and Mental Hygiene work group that met extensively. The Maryland Section was included in the work group. As previously reported, it did not reach consensus on a single issue, resulting in a report that was essentially an outline of options.
Without policy direction from the work group, several bills related to certified nurse-midwives and lay midwives were introduced this year. The proposals were ultimately withdrawn by their sponsors at the request of the Senate and House committee leaders. However, there will be two separate interim studies this year to address issues raised in the legislation. The House Health and Government Operations Committee has requested the Maryland Board of Nursing and other relevant stakeholders review the current regulatory structure for certified nurse-midwives and recommend regulatory changes that will facilitate the practice of nurse midwifery. In many regards, this effort will be a defense against the increasing pressure to license certified professional midwives. A second work group, also potentially spearheaded by the Board of Nursing, will look at issues relevant to the regulation of lay midwives. Certified professional midwife licensure and home birth options will definitely be on the legislative agenda in 2014.
Consistent with legislative efforts across the country, legislation regarding the inclusion of specific information on mammography reports of patients who are found to have dense breast tissue was introduced early in the session. However, the sponsor was open to amending the bill to address our concerns. The end result is legislation that requires notification that is not patient specific and is included in all women’s mammography reports. The legislation also includes a provision enabling the Department of Health and Mental Hygiene to change the language of the disclosure if it is inconsistent with science.
The Maryland Health Progress Act of 2013, the third and final legislative step in implementing the Affordable Care Act, was passed by the General Assembly. It provides multiple details relating to the new exchange (the Maryland Health Connection), which will be the marketplace for uninsured individuals to obtain coverage. Of particular interest in this legislation were the continuity of care provisions. These provisions provide patients shifting from one insurance to another with coverage for up to 90 days, with the new insurance company responsible for compensation even if the providers are not part of the new carrier’s panel. An amendment was added to the legislation specifying that Maryland’s Assignment of Benefits law would apply even after the 90 days, meaning that, in certain circumstances, patients could continue with their traditional doctors by assigning the new insurance benefits. This issue was of particular importance as it relates to pregnancy coverage. The law provides for continuity of care for the full term of the pregnancy and the postpartum visit. It will remain critical that implementation of the ACA continues to be monitored to ensure these provisions are appropriately operationalized.
Katherine I. Stewart, MD, MBA, District IV Junior
Fellow secretary-treasurer; Clark T. Johnson, MD,
Maryland Section Junior Fellow vice chair; and
Tiffany S. McNair, MD, Maryland Section Junior
Fellow chair, at the 2013 ACOG Congressional
Leadership Conference, The President’s
Conference, in March
Maryland Section Junior Fellows have been doing well in their three-pronged effort to educate, advocate, and serve. Many thanks to Katrina S. Mark, MD, for her service as section Junior Fellow chair. Tiffany S. McNair, MD, is now section Junior Fellow chair, and Clark T. Johnson, MD, is section Junior Fellow vice chair. Both officers have stepped into their roles with passion and excitement. Also, congratulations to Katherine I. Stewart, MD, MBA, for her election to the District IV Junior Fellow secretary-treasurer position.
Dr. McNair will soon take over as section legislative chair, helping to coordinate all section legislative efforts in the state. During the 2013–14 term, the section will be pursuing the legalization of expedited partner therapy in Maryland. This public health strategy would make it easier to provide partner therapy for our patients with sexually transmitted diseases across the state.
The Annual David A. Nagey Resident Research Day was held on April 12. Residents from all programs were encouraged to submit their original research. Eleven residents were selected to give formal presentations of their research, with faculty, residents, and medical students from all programs in attendance. A committee evaluated the research, and prizes were awarded to the best papers.
We are currently planning for the Annual Emil Novak Conference to be held on October 25. This conference features guest lecturers and is a popular meeting for attending physicians and residents. Last year’s conference was well attended and had a nice selection of speakers.
The Maryland Section received a record number of applications for the John M. Gibbons Medical Student Award from medical students who wanted to attend the Annual Clinical Meeting. The students’ applications were impressive, with essays describing a range of interests in women’s health and strong desires to pursue a career in ob-gyn. Five students were selected to attend the ACM. We are excited and grateful for the participation of this future generation of women’s health practitioners and advocates.
The Maryland Section continues its involvement with women’s health interest groups at the University of Maryland in College Park and Johns Hopkins University in Baltimore, helping to coordinate activities that increase medical student interest in the ob-gyn field. We also provide mentoring to medical students interested in women’s health. Several medical students from these universities have been selected to give oral presentations and posters at prominent national meetings.
In May, Maryland Section Junior Fellows participated in a service event with the Baltimore-based Girls’ Empowerment Mission. Junior Fellows sat on a panel and helped facilitate breakout sessions on various women’s health issues at the organization’s spring retreat. Junior Fellows would like to establish a relationship with the Baltimore Public School System so they can further assist in educating youth on pertinent sexual and reproductive health issues.
Brenda S. Peacock, MD, section chair
North Carolina has joined states such as Wisconsin and Texas in passing laws that further restrict women’s access to abortion, failing to keep legislators out of our exam rooms. Senate Bill 132 and Senate Bill 353 were passed by the Legislature and signed by Gov. Pat McCrory in July.
Senate Bill 132 requires North Carolina schools to teach students that abortions lead to preterm birth in subsequent pregnancies. Senate Bill 353 requires all abortion clinics to meet the same requirements as ambulatory surgery centers in North Carolina, forcing many of the state’s abortion clinics to close and decreasing the number of doctors who can care for women seeking an abortion.
Before the bills were passed, the North Carolina Section and the North Carolina Obstetrical and Gynecological Society released a joint statement in firm opposition to the bills. Additionally, ACOG President Jeanne A. Conry, MD, PhD, and Haywood L. Brown, MD, District IV chair, wrote an open letter to North Carolina legislators published in the July 17 issue of The Charlotte Observer, asking them to get out of our exam rooms and reminding them that facts are important and women can make their own medical decisions without state interference.
Legislators all but admitted their concerns for patient safety were unfounded and that Senate Bill 353 will also prohibit local government and county health plans and any new health plan exchanges from covering the cost of abortion. It’s likely the law will be held up in litigation, much like the Woman’s Right to Know Act passed two years ago.
Nabal J. Bracero, MD, section vice chair
The Puerto Rico Section would like to extend a warm invitation to the members of Districts I, III, and IV to the Annual District Meeting in Rio Grande October 11–13. The meeting is an excellent opportunity to expand your scientific knowledge while enjoying the beautiful tropical surroundings of the El Yunque Caribbean National Forest. We’re looking forward to showing you our Caribbean hospitality!
On April 20, Puerto Rico Section Junior Fellows hosted a seminar on medical liability in ob-gyn at the University of Puerto Rico in San Juan. Congratulations to Sara I. Montalvo-Medina, MD, section Junior Fellow chair, and Rosa A. Martinez-Vazquez, MD, section Junior Fellow vice chair, for organizing this superb activity and helping Junior Fellows and Fellows with the legal side of our profession.
The Puerto Rico Section met recently during the Caribe-Gyn Convention in Ponce August 2–4. We discussed local legislation regarding midwifery regulation and tort reform and the impact of the Affordable Care Act on our patients and practices.
On August 18, the Puerto Rico Section cosponsored a seminar on primary care in ob-gyn with support from an educational grant from the American Board of Obstetrics and Gynecology. The section will join forces with the Puerto Rico Obstetrics and Gynecology Foundation on September 8 for a review course on chronic pelvic pain for primary care physicians.
See you all in Rio Grande!
Scott A. Sullivan, MD, section vice chair
The annual joint meeting of the South Carolina Section and the South Carolina Obstetrical and Gynecological Society was held August 8–11 at the Charleston Place Hotel. The meeting featured national and regional speakers, as well as resident research presentations from three South Carolina academic centers. Attendees enjoyed family-friendly social events and, of course, the history, charm, and food of Charleston.
The section continues to help lead the South Carolina Birth Outcomes Initiative project, which is a public-private partnership with the goal to improve obstetric and perinatal outcomes in the state. Deliveries prior to 39 weeks’ gestation have decreased by more than 60% since the project initiated a plan to drastically reduce these early deliveries. The initiative has branched out into several new areas of perinatal outcomes, including breastfeeding, neonatal abstinence syndrome, and preterm birth prevention.
In an effort to reduce substance abuse and encourage referral and treatment, major insurers, including Medicaid, have introduced the Screening, Brief Intervention, and Referral to Treatment (SBIRT) system. Ob-gyns will be paid to screen for smoking, substance abuse, alcohol use, and domestic violence. Referrals and interventions will be fast-tracked and provide additional income to the obstetric practice. The section worked closely with the South Carolina Department of Health and Human Services to roll out this project. We feel it’s a win-win situation for patients and practices. Anyone interested in learning more about this system can contact any section officer or the South Carolina Department of Health and Human Services.
The Department of Medicaid has also announced new bonus programs for increasing breastfeeding and developing centering pregnancy models around the state. Incentives of up to $100 per delivery (on top of the usual fee) are being offered for these initiatives. We encourage anyone interested in these projects to contact any section officer for further information. The programs do require preauthorization and substantial groundwork and preparation, but we are happy to assist any practice that may want to participate.
The South Carolina Section had an excellent showing at the ACOG Congressional Leadership Conference, The President’s Conference, in Washington, DC, this year. All South Carolina legislators were contacted about ACOG’s legislative priorities. If you are interested in attending next year’s conference, March 2–4, in Washington, DC, please contact any section officer for additional information. There is no limit on who can attend. In South Carolina, the section testified on a number of bills in consideration. We continue to support ACOG’s policy on legislative interference.
On a sad note, I’d like to mark the passing of a colleague and active section member, Susan J. Keeshan, MD, who died in Columbia on June 25. Susan was a tireless advocate for women’s health and a frequent contributor to our advocacy efforts. She was especially skilled in issues involving scope of practice and was our liaison to the South Carolina Medical Association for many years. I will certainly miss her good humor and boundless energy. The section sends our condolences to her family and her patients. Her husband and section legal counsel, Aaron Koslowski, requests that any expressions of sympathy be sent to your local animal shelter in Susan’s name.
Holly S. Puritz, MD, section chair
Melanie Gerheart, our section lobbyist for the last 25 years, has retired. She was an incredible supporter of ACOG and women’s health in Virginia and worked tirelessly on our behalf. She will be greatly missed. We are now interviewing for a lobbyist to take her place.
The Virginia Section Annual Meeting will be held in Richmond on September 20 with resident presentations and talks by faculty members from all five Virginia residency programs. The keynote speaker will discuss the new noninvasive genetic screening currently available and how to incorporate it into private practice.
Gov. Bob McDonnell supported an amendment that was passed allowing Virginia health plans under the Affordable Care Act to opt out of providing abortions. Otherwise, it was a quiet legislative session. All bills related to women’s health did not make it out of committee in this election year. Democrat State Sen. Ralph Northam, MD, a pediatrician from Norfolk, is running for lieutenant governor. He is supportive of many of ACOG’s positions.
The section continues to improve its working relationship with the Medical Society of Virginia (MSV). We presented a proposal at the MSV legislative conference to pilot an expedited partner therapy (EPT) project. It would allow practitioners to provide treatment of partners when a sexually transmitted disease is diagnosed. EPT has been successful in many other states. The MSV legislative committee received 50 proposals and will choose an unknown number to work on in the upcoming year.
ACOG is working with MSV and the Virginia Hospital Association on a project to decrease early elective deliveries at all Virginia hospitals. There is marked variance in policies among the hospitals. The section has participated in two statewide webinars to help hospitals achieve some improvement in this area.
The Virginia Maternal Mortality Review Committee is applying for the Association of Maternal and Child Health Programs grant for a new program called the Every Mother Initiative. The goal of the initiative is for all states and territories to have full capacity to support their maternal mortality surveillance systems and use data to change programs and policies at all levels to eliminate preventable maternal death. Six states will be chosen to be part of an active learning coalition to improve maternal mortality.
Owen D. Walcott, MD, section chair
The West Indies Section continues to share some of the frustrations in the delivery of health care experienced by other District IV sections. In Jamaica, the newly elected government has decided to not to modify the free public health care system instituted by the previous administration. This decision was made in spite of the system’s chronic problems with underfunding. Oversubscription of public health services has intensified with progressive devaluation of the Jamaican dollar. Plans to implement user fees, means testing, and private health insurance support where available have largely been abandoned.
A recent effort to reclassify public health workers resulted in a proposal that would give nurses in the public health system better remuneration than the doctors who supervise them. In the face of an impending strike by public sector physicians, this reclassification exercise was averted and a mutually accepted agreement was obtained.
The case of a senior obstetrician who was arrested and charged for assisting in the termination of pregnancy in a minor is still pending. We eagerly await the outcome of this landmark case.
On April 13, the West Indies Section held its annual clinical conference. The conference’s focus on physician wellness was well supported. For the first time in many years, the meeting was able to record a small profit largely due to the omission of an annual banquet that had consistently incurred losses.
West Indies Section Junior Fellows remain active under the leadership of Jody-Ann S. Jarrett, MD, section Junior Fellow chair, with an emphasis on community outreach programs. They also continue to encourage our best and brightest medical students to consider a career in ob-gyn. Their annual meeting is scheduled for September 7, during which they intend to examine the role of preventive health in our specialty.
The department of ob-gyn at the University of the West Indies has commissioned into service a new state-of-the-art endoscopy unit. This development is partly due to the vision of former section chair, Horace M. Fletcher, MD, who is now acting dean of the university’s medical school. Regrettably, the robotic surgery and teleconferencing facilities are not ready yet.
The lack of expertise in maternal-fetal medicine in the section has been alleviated somewhat by the return of one specialist based at the University of the West Indies Hospital. Two additional maternal-fetal specialists are scheduled to return within the next year, after completion of fellowships in Canada. Service in the equally vexing area of gynecologic oncology has also been boosted by the return of another Canadian-trained specialist. Once again, the West Indies Section is open to training opportunities within District IV. I hope the completion of our robotic surgery and teleconferencing facilities will enhance academic interaction between our section and the rest of District IV.
On a more personal note, Orville P.C.M. Morgan, MD, section vice chair, was recently appointed senior medical officer in charge of the Victoria Jubilee Hospital, the largest maternity hospital in the English-speaking Caribbean.