In an effort to provide you with current information regarding women’s health, District III has joined Facebook. We are updating our page regularly with news specifically relevant to District III members. You can find us at facebook.com/ACOGDistrictIII.
ACOG national is also on Facebook at facebook.com/ACOGNational. If you’re a Facebook member, log in and click on the “Like” button on the ACOG national and District III pages. Then, you’ll be able to comment on and share any updates posted. You’ll also get ACOG national and District III news sent directly to your Facebook news feed.
Anyone can view Facebook pages, but only Facebook members can interact with ACOG national and District III. To become a Facebook member, sign up at facebook.com.
ACOG national is also on Twitter at twitter.com/acognews. To follow its feed, go to twitter.com and sign up as a member. You’ll be the first to hear ACOG news!
Joseph Apuzzio, MD
Welcome to the District III Reporter. I am honored to be the new District III chair. Installation of new officers for District III took place at the Annual District Meeting in Puerto Rico, October 11–13, which was a combined meeting with Districts I and IV. The scientific program was excellent, and the meeting was successful.
Your other new district officers are Ann L. Honebrink, MD, vice chair; Anthony C. Sciscione, DO, secretary; Gregory W. DeMeo, DO, treasurer; and Francine E. Sinofsky, MD, assistant secretary. All district and section officers are available for your input and suggestions.
Please mark your calendar for the next Annual District Meeting with Districts I and IV. It will take place October 10–12, 2014, at the Hyatt Regency Baltimore. Districts I, III, and IV cover most of the East Coast (New York and Florida excluded). The meeting offers the perfect chance to connect with old friends, exchange ideas with colleagues, and get updates with CME-approved lectures and sessions.
One of my initiatives as District III chair is to continue efforts on ACOG’s MOMS Initiative (Making Obstetrics and Maternity Safer). I am a long-time member and current chair of the New Jersey Maternal Mortality Review Team. This multidisciplinary team meets five times per year, reviews all maternal mortalities in New Jersey, and makes recommendations for improvement of care.
The review team was started in the 1970s by James P. Thompson, MD, the first board-certified maternal-fetal medicine subspecialist in the state. Dr. Thompson passed away several years ago and handed the chair position of the committee over to me, which I gladly accepted. If anyone would like to know more about the process of formulating a maternal mortality review team, you may contact me directly at firstname.lastname@example.org.
In the US, many states do not have a statewide maternal mortality review team. Some states are in the process of assembling a review team and other states have a partial review of cases. Therefore, information reported nationally about maternal mortality has probably underestimated the actual rate. As more states review and report their cases, the maternal mortality rate is likely to increase in the near future with improved data collection and use of ICD-10 codes. More to come on maternal morbidity and mortality topics in future issues of the newsletter.
Immediate past chair’s report: Closing thoughts
Richard W. Henderson, MD
It has been a distinct honor and privilege to serve as District III chair for the past three years. It is difficult to find words to adequately describe what it has meant to represent District III on the ACOG Executive Board and Council of District Chairs (CDC).
From the district level, I am happy to report District III remains financially sound. Your District Advisory Council has embraced its fiduciary responsibilities and continued to work hard to be good stewards of your district dues. I’m confident this will not change with the incoming district leaders. They are all wonderful individuals with outstanding records of service at the district and section levels and great leadership qualities. It has been a pleasure to work with them over the years, and the district remains in good hands.
During my term as district chair, I have remained energized by the continued commitment and dedication of the leadership of each of our sections. Over the past three years, it has been my absolute pleasure to repeatedly report to the Executive Board and CDC on the outstanding achievements and activities of our sections. I look forward to Dr. Apuzzio having the same experience.
Clearly, the future of our specialty is our Junior Fellows! Over the past six years, our district and section Junior Fellow leadership has been truly amazing. Our District III Junior Fellow Day, which has been planned and executed by the Junior Fellow leadership, has grown in attendance each year. As a result, it has been recognized as one of the largest and most successful gatherings of Junior Fellows across ACOG. It has also become a model for Junior Fellow activities in other districts. We should be proud of our Junior Fellows and continue to support this important activity moving forward.
In closing, I would like to focus on one of the most important conversations in medicine today—women’s health care. This is a conversation that began when ACOG was established in 1951 and has focused on improving the health care of women; protecting reproductive rights and the advancement of our specialty through education; conducting vigorous scientific research; and advancing clinical practice. As this conversation continues into the 21st century, I believe it will be expanded to include four other important issues.
The first is the reality that medicine and the delivery of health care will continue to change at a rapid pace. The recent implementation of the Affordable Care Act is an example of that change, and it’s likely just the tip of the iceberg. ACOG must continue its work to be recognized as a valued and trusted source of information for women and as a resource for our membership as we work to understand and navigate the pace of change.
The second issue will be recognition of the impact the projected changes in our workforce will have on our practices and the models of care in which we practice. As the premier organization of physicians committed to women’s health care, this is a conversation that ACOG must continue to lead while collaborating with those who share our concerns and interests in women’s health care.
The third issue will be our ongoing efforts to maintain a balance between our increasing global outreach activities to improve the health care of women in other countries and the work that remains to be done here in the US. Significant disparities in health care outcomes persist for women of color as well as for those who are either uninsured or underinsured. ACOG’s advocacy role on behalf of these women must remain strong.
The fourth issue will be our need for increasing political and legislative advocacy as physicians. We must remain vigilant and proactive in addressing the increasing intrusion of legislators and politics into the fabric of medicine as a whole and women’s health care specifically. It will be imperative that we keep legislators out of our exam rooms. I hope more District III members will join and support ACOG’s federal political action committee, Ob-GynPAC, and its advocacy role on our behalf to make this a reality. (You will not be favored or disadvantaged by reason of the amount of your contribution or a decision not to contribute. Contributions from foreign nationals are not permitted.)
Junior Fellow news
Holly W. Cummings, MD, MPH, immediate past District III Junior Fellow chair
On October 25, more than 165 Junior Fellows and medical students attended the Sixth Annual District III Junior Fellow Day, held at the Penn Medicine Clinical Simulation Center in Philadelphia. Participants listened to presentations about ACOG and its Ob-GynPAC, as well as research paper presentations from Junior Fellows. Medical students and residents participated in career planning breakout sessions and practiced clinical simulation skills.
Attendees trained with a number of clinical simulations, including vaginal breech delivery; hysteroscopy; hysteroscopic tubal sterilization; endometrial ablation; laparoscopic and hysteroscopic morcellation; laparoscopic salpingostomy; virtual reality laparoscopic hysterectomy; episiotomy repair; estimation of blood loss; Bartholin abscess drainage and Word catheter placement; intrauterine device placement; and manual vacuum aspiration. The highlight was a surgical robot with which all participants were able to practice.
We encouraged attendees to donate to the Ob-GynPAC and held a letter writing campaign to notify our local and federal representatives about important legislative issues, such as preserving graduate medical education funding. We are proud that this event continues to grow each year. As far as we know, it is the largest gathering of Junior Fellows across ACOG! Everyone had a great time, and we look forward to next year’s event.
Junior Fellows in our district are participating in and planning great events, from local legislative advocacy days to community service projects. Keep an eye out for announcements about upcoming events on the District III Facebook page. If you have any updates or announcements you’d like posted on Facebook, contact any of our district leaders with information.
Delaware Section report
Kirsten M. Smith, MD, section chair
The Delaware Section held its Third Annual Legislative Day in Dover on June 6. Sixteen physicians participated in the meetings at Legislative Hall. We spoke with Gov. Jack Markell, Lt. Gov. Matt Denn, State Sen. Patricia Blevins (D-Elsmere), State Sen. Bethany Hall-Long (D-Middletown), State Rep. Michael Barbieri (D-Newark), State Rep. Ruth Briggs King (R-Georgetown), State Rep. Joseph E. Miro (R-Pike Creek Valley), and State Rep. Melanie George Smith (D-Bear). During our meetings, we touched on a variety of topics, including state-funded programs for obesity, concerns about lay midwives practicing in Delaware, access to affordable contraception, Delaware’s high unintended pregnancy rate, abortion access, and the need for an easily accessible comprehensive site that details state resources and programs.
We are working on follow-up meetings with Lt. Gov. Denn and State Rep. Smith to better understand the disproportionate use and access to intrauterine device contraception in Delaware; State Sen. Hall-Long and State Rep. Barbieri to discuss strategies for decreasing the teen pregnancy rate in Delaware; and State Sen. Blevins to discuss efforts to better market the state’s programs.
The section held an educational event in Dover that same evening titled “Obesity and its Effects on Women and Children.” The event attracted health care providers from the northern and southern parts of Delaware, including physicians, nurses, nurse managers, and clinical care coordinators. We had a great panel of speakers, with Sherry L. Blumenthal, MD, Pennsylvania Section chair, presenting on “The OBesity Project;” David Paul, MD, speaking about obesity’s effects on infant mortality; and Leah Woodall, MPA, addressing Delaware’s role in tackling obesity. In addition to the formal presentations, we provided information about the resources and programs available in the state for health care needs to attendees.
Two bills that passed last year grant the State of Delaware power to regulate medical practice. One bill provides the Delaware Department of Health and Social Services (DHSS) with explicit authority to investigate and inspect unsanitary or unsafe conditions in facilities where invasive medical procedures are performed. It also gives DHSS the power to adopt regulations to strengthen oversight of facilities.
The other bill gives DHSS the authority to require accreditation for medical facilities that perform invasive medical procedures. It also allows DHSS to promulgate regulations for accreditation. The bill requires that DHSS work with stakeholders in the development of these regulations and outlines who those stakeholders should be.
Draft regulations have been developed in response to these bills. As the Delaware Section representative in the stakeholders’ group, I reviewed these drafts and provided comments.
The most recent stakeholders’ group meeting occurred on July 23. One of the most contentious issues has been how to define “invasive medical procedures.” The current definition is “any medical procedure, including dental and podiatric procedures, in which the accepted standard of care requires anesthesia, major conduction anesthesia, or sedation.” Essentially, offices that perform procedures under local anesthetics (but not major conduction anesthesia or sedation) will not be affected.
The issue of lay midwives practicing in the state has presented itself again, unfortunately with poor maternal and neonatal outcomes. Because lay midwives are not licensed, they do not fall under the purview of the Board of Medical Licensure. In the spring, two individuals were reviewed by DHSS, given an order to cease and desist, and assessed a penalty of $1,000. Legislation passed in July aligns the penalty for non-compliance with the non-nurse midwives law and regulations with the penalty for practicing medicine without a license. It imposes civil and/or criminal penalties for violations of existing law.
On July 29, a meeting was held at the Medical Society of Delaware to discuss ways to address current and future concerns related to lay midwives practicing in Delaware. The primary goal for all who participated was to optimize patient care and safety to decrease morbidity and mortality for mothers and infants. Many issues were discussed, but none were resolved. The meeting preceded another meeting with DHSS staff, direct-entry and lay midwives, and interested legislators. The Delaware Section will continue to work for safe and collaborative care for women and their infants.
The Delaware Child Death, Near Death, and Stillbirth Commission reviews individual cases of child deaths and maternal deaths within one year of pregnancy. Fetal and infant mortality review and maternal mortality review fall under this commission. It provides recommendations to alleviate practices or conditions that impact the mortality of children and pregnant women. The Delaware Section has been asked to review several current recommendations formulated by the commission. These recommendations were discussed at the Delaware Section Advisory Council Meeting on September 16, and a formal response will be submitted to the commission.
Dominican Republic Section report
Ann L. Honebrink, MD, District III vice chair
On October 8, the Dominican Republic Section held its first educational symposium in Santo Domingo. More than 160 people attended this daylong event! Milciades Albert-Fiorinelli, MD, section chair, organized the successful program with Alejandro A. Paradas-Caba, MD, section vice chair.
Five speakers presented on 10 different topics. The speakers were Thomas Westover, MD, New Jersey Section secretary-treasurer; Audrey A. Merriam, MD, District III Junior Fellow chair; Vivian Brache, MS, and Raul Sanchez, MD, from the Dominican Republic; and me. We hope this will be the first of many Dominican Republic Section-sponsored events hosted in the Dominican Republic.
New Jersey Section report
Sharon B. Mass, MD, section chair
The New Jersey Section has been busy the last several months with activity in each of our three focal areas: communication, advocacy, and leadership development.
The New Jersey Section website launched, featuring accurate listings of Section Advisory Council members, ob-gyn departments and their chairs, and residency programs and their directors. Furthermore, we are in the process of developing town hall-style meetings, which will occur regionally, allowing more members to network with each other and with section leadership. Finally, we are partnering with the District III ROUNDS project and are happy to report that New Jersey has the most requests of the sections in our district for educational presentations. Talks by Thomas Westover, MD, section secretary-treasurer, and me were highly requested.
New Jersey Section members were active in the development of legislation regarding dense breast tissue notification. In July, Jessica Frasco, ACOG lobbyist, and I attended a roundtable hosted by Assemblyman Troy Singleton (D-Burlington), sponsor of the legislation. Bills were introduced in the House and Senate on September 9. The final language:
- Mandates health insurance coverage of any screening and/or testing deemed medically necessary by providers
- Recommends a baseline mammogram at age 40 followed by yearly screening
- Includes a lay letter to be sent to all patients along with their mammography report
- Requires creation of a breast cancer task force that will assess and recommend strategies to improve patient awareness
The New Jersey Section also committed to developing educational materials regarding dense breast tissue. In preparation for this effort, I’ve created a survey regarding dense breasts, as well as new screening modalities, which will evaluate the current state of a patient’s knowledge.
The New Jersey Women’s Health Coalition held a meeting on May 23 with Assemblywoman Mary Pat Angelini (R-Monmouth). On August 26, I attended a dinner where several key Republican leaders in New Jersey met with physicians from six specialties to discuss issues in health care. Gov. Chris Christie attended and shared his thoughts. Donald M. Chervenak, MD, section vice chair, attended the ACOG State Legislative Roundtable in September.
Several young physician leaders have been invited to participate in section activities. We continue to develop our Leadership and Mentorship Program.
Pennsylvania Section report
Sherry L. Blumenthal, MD, immediate past section chair
This is my last report as Pennsylvania Section chair. To start, I would like to acknowledge the great work of our team—Kurt T. Barnhart, MD, section chair; Lynne M. Coslett-Charlton, MD, section vice chair; and Stephen J. Smith, MD, section treasurer—in making the last three years successful and rewarding. I would also like to thank Richard W. Henderson, MD, immediate past District III chair; Ann L. Honebrink, MD, District III vice chair; ACOG Fellow-at-Large Owen C. Montgomery, MD, past District III chair; and Charles A. Castle, MD, for their mentoring and lessons in political correctness. Thanks also to Christine Himes, District III manager, and Jan Reisinger, section executive director, for their valuable support.
Part I of the OBesity Project, which won the Council of District Chairs Service Recognition Award, is being presented around Pennsylvania, most recently at Reading Hospital and soon at the Hospital of the University of Pennsylvania. Part II of the project focuses on strategies for management of the obese patient in ob-gyn. It premiered at Winthrop-University Hospital in Mineola, NY, in November. I hope to add it to the list of District III ROUNDS project offerings.
Our legislative program is extremely busy now that the Legislature is back in session. We held a successful Legislative Day in Harrisburg on September 24, which included many residents and medical students from Pennsylvania. Dr. Coslett-Charlton, section legislative chair, is working closely with our lobbyists to push legislation written by the Pennsylvania Chapter of the American College of Emergency Physicians and our section to make standards for lawsuits involving emergency care adhere to a higher standard of proof.
Legislation regarding dense breast tissue notification passed the Pennsylvania Senate with no opposition from legislators. We have been educating legislators about flaws in this bill and negotiated an amendment to the wording to make it less alarming to patients. We were able to add that dense breasts affect more than 50% of women and that each woman should discuss any further management with her personal physician. We expect the bill to pass the House and be signed by Gov. Tom Corbett.
Senate Bill 379, which prevents apologies by physicians from being included as evidence in liability cases, passed the House and Senate and was approved by Gov. Corbett. There has been an overall decrease in the amount of medical liability filings and the number of non-jury and jury verdicts in Pennsylvania. Case filings are down 44.8% from 2002, when reforms were introduced.
We were unsuccessful in stopping legislation to bar health exchanges under the Affordable Care Act (ACA) from covering abortion services. Another bill, allowing companies to avoid paying for contraception due to their conscience has been introduced in committee by the same legislators, but it has not moved yet. We are readying to fight this bill as well. There have been various lawsuits around the country regarding this issue. We hope that courts continue to rule against these exceptions to the ACA contraception mandate.
Gov. Corbett, who has steadfastly refused to expand Medicaid or set up insurance exchanges in Pennsylvania, has now come up with a plan for Medicaid expansion. Details are hazy, but he would like all Medicaid recipients to pay a part of the cost for their care. We are waiting on more information.
For the next four years, I will have the honor of occupying the obstetric seat on the Pennsylvania Medical Society (PAMED) Board of Trustees, a position recently held by Dr. Castle. Our section is determined to keep women’s health care visible on the PAMED agenda. Dr. Barnhart is our representative to the PAMED Specialty Leadership Council, and John P. Gallagher, MD, one of our Section Advisory Council members, hopes to be elected as the PAMED district representative for Western Pennsylvania. Enrique Hernandez, MD, also a member of our Section Advisory Council, is the PAMED district representative for Philadelphia. I will also continue as the ACOG liaison on the Obstetrical Society of Philadelphia Advisory Council.
I have greatly enjoyed and benefitted from being part of the District III Advisory Council and hope I can continue to contribute to ACOG in the future. I will continue to pursue my passion for health care rights for our patients.
ROUNDS: Bring free educational presentations to your institution
Ann L. Honebrink, MD, District III vice chair
The District III ROUNDS (Regional Ob-Gyn Up-to-Date New Didactic Sessions) project began offering a menu of free presentations to district members recently. These didactic sessions are available to any ob-gyn department or group of ACOG members in District III. The presentations cover a variety of topics, including obstetrics, gynecology, and advocacy, with excellent speakers. If you’re interested in bringing a presentation to your institution, fill out a request form or contact me at email@example.com or Christine Himes, District III manager, at firstname.lastname@example.org.
Calendar of events
Congressional Leadership Conference
Contact: Stacie Monroe, 202-863-2505
Interim District Advisory Council Meeting
Contact: Chris Himes, 202-863-2561 or email@example.com
Annual Clinical Meeting
Annual District Meeting (with Districts I and IV)
Contact: Chris Himes, 202-863-2561 or firstname.lastname@example.org