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Connect with District IV on Facebook

District IV on FacebookIn an effort to provide you with current information regarding women’s health, District IV has joined Facebook. We are updating our page regularly with news specifically relevant to District IV members. You can find us at facebook.com/ACOGDistrictIV.

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 IV pages. Then, you’ll be able to comment on and share any updates posted. You’ll also get ACOG national and District IV news sent directly to your Facebook news feed.

Anyone can view Facebook pages, but only Facebook members can interact with ACOG national and District IV. 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!



Chair’s report

Dr. Haywood L. BrownHaywood L. Brown, MD

The 2013 Annual Clinical Meeting will be held May 4–8 in New Orleans. All ACOG members are invited to attend the Congress Advisory Council (CAC) Meeting and Research Awards Ceremony on Sunday, May 5. The ceremony begins at 2 pm, and the meeting begins at 3 pm. There will be a short break in between.

This year’s CAC meeting topic is “Leadership in the 21st Century.” ACOG President James T. Breeden, MD, and Thomas F. Arnold, MD, Council of District Chairs (CDC) chair and District VI chair, developed the meeting’s program.

District IV will be honored at the awards ceremony with a CDC Service Recognition Award for its Perinatal Data Project. Read more about the project and its recognition.

Also at the ACM, I will be speaking at the Ninth Annual Young Physicians Breakfast Forum on “Mentorship from a University Perspective.” The forum will be held Tuesday, May 7, from 7:30 to 8:30 am. All young physicians are encouraged to attend.

This year’s forum topics are mentorship and the Affordable Care Act (ACA). Laura A. Dean, MD, District VI vice chair, will be speaking on “Mentorship from a Private Practice Perspective.” Nevena Minor, ACOG director of federal affairs, will give an update on ACA. View more information on the 2013 ACM.

Women’s health
Dr. Breeden is working on two main areas related to contraception and women’s reproductive rights: maintenance of the patient-physician relationship and access to contraception, including recommendations for over-the-counter access to oral contraceptives. Close to 700 laws interfering with the patient-physician relationship and contraceptive access were proposed in 2012, and many passed.

Last summer, Dr. Breeden wrote letters to the editors of USA Today and The New York Times making it clear that politicians should not interfere with the practice of medicine or the doctor-patient relationship. His letters received positive feedback and many references in articles, blogs, and tweets.

In October, the New England Journal of Medicine published an important opinion piece, “Legislative Interference in the Patient-Physician Relationship,” authored by ACOG Executive Vice President Hal C. Lawrence III, MD, and leaders from the American College of Physicians, American Academy of Family Physicians, American Academy of Pediatrics, and American College of Surgeons.

Globally, Herbert B. Peterson, MD, has been working with leaders in several countries on projects to improve women’s health. ACOG held a meeting on global initiatives in December with representatives from the American Board of Obstetrics and Gynecology and 15 academic institutions.

ACOG’s Safety Certification in Outpatient Practice Excellence for Women’s Health Program (SCOPE) is doing well, with more than 120 participants and several applications in progress. All 10 of the program’s pilot-tested offices have achieved SCOPE certification. Several multi-office practices have also expressed interest in the program.

2013 ADM
The 2013 Annual District Meeting will be held October 11–13 in Rio Grande, Puerto Rico. It will be a joint meeting with Districts I and III. Read more about the 2013 ADM. I hope to see you there.



Junior Fellow news

Dr. Donna BrownDonna Brown, MD, District IV Junior Fellow chair

We had excellent Junior Fellow attendance at the Annual District Meeting in Charleston, SC. Task forces were coordinated among Junior Fellow district and section officers in Districts IV and V to promote medical student and Junior Fellow involvement at the ADM and to organize a larger, more comprehensive Junior Fellow program. 

Six Junior Fellows delivered oral presentations at the ADM, in addition to the many intriguing Junior Fellow poster presentations. Junior Fellows hosted a “Stump the Professors” session and an extremely popular skills lab and residency fair, which had approximately 80 participants. The skills lab included interactive skills stations on long-acting reversible contraception insertion, knot tying, cervical examinations, vaginal deliveries, and laparoscopic training. View photos from the ADM skills lab and residency fair.

District IV sections worked hard to encourage and fund medical students’ participation. Thanks to their concerted effort, 46 medical students received the John Gibbons Medical Student Award, funding their attendance. The Georgia and South Carolina sections were honored for recruiting and sponsoring the most medical students (nine each). 

Junior Fellows also held a diaper drive at the meeting and a raffle that raised $348 for a local women’s shelter.

Junior Fellow activities
Section Junior Fellows have been busy with community service projects, medical student recruitment, and educational endeavors:

  • District of Columbia Junior Fellows are supporting ob-gyn involvement in the HEALing Clinic, a volunteer clinic operated by students at George Washington University
  • Georgia Junior Fellows are encouraging medical student interaction with ob-gyn interest groups
  • Maryland Junior Fellows are promoting participation from all programs in a resident research day and gathering medical students for an ob-gyn career night
  • North Carolina Junior Fellows resurrected a medical student interest group that had been inactive for the last four years. They also continue to host a medical student ob-gyn skills fair
  • Puerto Rico Junior Fellows are working to educate patients on contraception and domestic violence. They also started an ob-gyn interest group and are trying to unite their residency programs
  • South Carolina Junior Fellows are hosting question-and-answer sessions with attendings, encouraging medical student involvement in ob-gyn, and working with a women’s shelter
  • Virginia Junior Fellows held a successful annual meeting in September and are working with a women’s shelter
  • West Indies Junior Fellows arrange a successful clinical symposium each year
  • West Virginia Junior Fellows won a diaper drive competition among the District IV sections. They also sponsor medical student orientation, with one-third of their medical students choosing ob-gyn

Upcoming events
Each section will be encouraged to develop at least one project for the Junior Fellow Initiative Toolkit Contest. These projects will be submitted to a district-wide contest, and the best projects will be submitted to the national contest. 

Junior Fellows will maintain their promotion of medical student participation in ACOG activities this year. We also plan to focus on reengaging residents with small contests among sections to get more residents involved in ACOG. Please visit the District IV Junior Fellow website for more information on opportunities and events. 



2013 ADM: Join us in Rio Grande

Rio GrandeThe 2013 Annual District Meeting will be held October 11–13 in Rio Grande, Puerto Rico, with Districts I and III. The meeting will offer a first-rate educational program, featuring faculty from all three districts.  The location is the perfect setting to reunite with old friends and meet new ones!

District IV is the host district of the ADM, and Roger B. Newman, MD, is program chair. ADM program highlights include:

  • Alfred A. Abuhamad, MD, Eastern Virginia Medical School in Norfolk, as the David A. Nagey Memorial Perinatal Outreach Lecturer
  • Peter E. Schwartz, MD, Yale University in New Haven, CT, as the A. Cullen Richardson Memorial Lecturer
  • Hope A. Ricciotti, MD, Beth Israel Deaconess Medical Center in Boston, presenting on the education of the next generation of ob-gyns
  • Anna K. Sfakiananki, MD, Yale University in New Haven, CT, presenting on capabilities of gynecologic ultrasound
  • Richard H. Beigi, MD, Magee-Women’s Hospital of the University of Pittsburgh Medical Center, presenting on new diagnosis and treatment recommendations for sexually transmitted diseases
  • Melisa M. Holmes, MD, practicing ob-gyn in Greenville, SC, and co-founder of Girlology, presenting on insights into understanding adolescent sexuality

For those interested, the ADM will be preceded by a postgraduate course on controversies in well-woman care in ob-gyn on October 10. Course presenters are Deborah A. Driscoll, MD, University of Pennsylvania Hospital in Philadelphia; William D. Schlaff, MD, Thomas Jefferson Hospital in Philadelphia; and Ashlyn H. Savage, MD, Medical University of South Carolina in Charleston.

The course program will focus on prenatal genetic testing, familial cancer screening, infertility evaluation, diagnosis and management of polycystic ovary syndrome, adopting new cervical cancer screening guidelines, and the role of annual pelvic exams in the 21st century.

Rio Grande offers lush tropical beauty, unspoiled natural wonders, and an endless choice of recreational activities for the whole family. The meeting’s hotel—Rio Mar Beach Resort and Spa—is located between the Atlantic Ocean and the El Yunque Caribbean National Forest. There is no passport requirement for US citizens to travel to the meeting location. 

The ADMs are always enlightening and entertaining. Please save the dates! More information will be available soon on the District IV website.



Junior Fellow advisor’s report

Dr. Scott A. Sullivan

Scott A. Sullivan, MD, South Carolina Section vice chair

I am pleased to present my first report as District IV Junior Fellow advisor. I am particularly honored to serve in this capacity, having been active in Junior Fellow activities many years ago as a resident and young physician.

I was always grateful to have strong advocacy from leaders such as Stanley A. Gall, MD, past District V chair; John R. Musich, MD, past District V chair and past Junior Fellow Congress Advisory Council (JFCAC) advisor; and Paul G. Tomich, MD, District VI Junior Fellow advisor, past District VI chair, and past JFCAC advisor. Serving as District IV Junior Fellow advisor is an opportunity for me to continue their example for a new generation of young leaders. 

I have a tough act to follow, as Shelly W. Holmstrom, MD, did a fabulous job in this role. She has been kind enough to show me the ropes from her new post as District XII secretary. I thank her for her generosity and her example.

While I have not yet attended a Junior Fellow advisory council meeting this year, I have been in contact with Donna Brown, MD, District IV Junior Fellow chair, and Rachel K. Casey, MD, District IV Junior Fellow vice chair. They reported a strong positive response to their program at the Annual District Meeting in Charleston, SC. Therefore, they’ve requested time and space at the 2013 ADM in Rio Grande, Puerto Rico, with Districts I and III for another program.

Junior Fellows also submitted plans for another “Stump the Professors” session, which calls for Junior Fellow presenters from each district participating in the meeting. Last year’s session was a resounding success and a win for the Junior Fellows, as they reminded me.

We are in the midst of the Junior Fellow district election cycle for 2013–14. Calls for nominations have gone out. More information can be found on the Junior Fellow website. A committee has been formed and will be meeting this year to finalize a list of candidates. If you know of any interested leaders, please let me know as soon as possible. You can email me at sullivas@musc.edu.

I was fortunate to attend a recent seminar on “ACOG Leadership in the 21st Century,” sponsored by ACOG President James T. Breeden, MD, and ACOG Executive Vice President Hal C. Lawrence III, MD. It was refreshing to see the progress ACOG has made in recruiting and retaining young leaders. There have been challenges in light of economic realities and generational differences, but I came away optimistic as ever about ACOG’s future. Working with the bright young leaders of District IV only reinforces that optimism.



Continuing Medical Education Committee

Dr. Frank N. Harrison

Frank N. Harrison, MD, committee chair

Greetings from a first-year, raw recruit in continuing medical education (CME). My role as District IV CME Committee chair officially began in October, and I am learning every day about the intricacies of CME. Having been introduced to CME from the provider side (ie, hosting CME-sponsored meetings), being involved with CME as a representative of the process has opened my eyes to the true value of continued education in our careers.

I began preparations for my term as chair with the accreditation workshop “2012 CME as a Bridge to Quality,” which was sponsored by the Accreditation Council for CME in August. This two-day workshop helped put in perspective the role that CME plays in our professional careers. Its overview of the educational process allowed me to understand the relationship of undergraduate, graduate, and CME. I was also introduced to the concept of maintenance of licensures.

The workshop was followed by a conference call with the ACOG CME Committee in September. As a result of the call, I was familiarized with expectations of the district committee chairs and the timeline for our responsibilities this year. I also learned about future CME occurrences, such as PROLOG eModules and Risk Evaluation and Mitigation Strategies.

Since taking over as chair of the District IV CME Committee, I have already been involved in CME issues with three of our sections: Virginia, Georgia, and South Carolina. I look forward to the next three years of being active on the CME Committee. Its activity is essential for our physicians’ professional development.

Please contact me at fharrison@carolinas.org or 704-355-3153 for any CME needs you may have.



Committee on Maternal Mortality

Dr. Arsenio C. ComasArsenio C. Comas, MD, committee chair

The District IV Committee on Maternal Mortality met with members of the District V Committee on Maternal Mortality during our joint Annual District Meeting in Charleston, SC. All members of the committees were either present or sent a written report. Donald K. Bryan, MD, District V chair, attended the meeting and was impressed. He congratulated us on our efforts.

The interchange of information was illustrative. Both committees learned from each other. The Canadians found it particularly interesting hearing about our efforts in the US as data collection in their country is more comprehensive. Committee members are looking forward to meeting again at the 2013 ADM in Rio Grande, Puerto Rico, potentially with representatives from Districts I and III. I will be contacting all our section representatives in the near future to request data.



Patient Safety and Quality Improvement Committee

Dr. Holly S. Puritz

Dear colleagues,

The District IV Patient Safety and Quality Improvement Committee is happy to share its second newsletter with you. The goal of the District IV Patient Safety and Quality Improvement Committee is to promote patient safety in hospital and office settings and to provide a forum in which members can share safety projects in the district.

We hope you find the following information helpful and applicable in your own practices. We welcome contributions from any District IV member. Please feel free to contact any one of us on the Patient Safety and Quality Improvement Committee. A list of committee members can be found at the end of the following reports. Thank you for your interest in promoting patient safety in District IV.

On behalf of my fellow committee members,

Holly S. Puritz, MD, Virginia Section chair
h.puritz@tgfw.com

 

Dr. Raymond L. CoxMessage from the committee chair: Redefining ‘term’
Raymond L. Cox Jr, MD, MBA

Ob-gyns’ current definition of “term” is remarkably similar to definitions used by many cultures as early as the fifth century. Old English law codified a broad timespan for estimated date of confinement to prevent women from being persecuted for adultery while their husbands were off fighting in the Crusades and other wars. While there have been no challenges to the notion that human gestation lasts around 280 days, we now have tools that allow us to more accurately calculate gestational age. Recent research has made a strong case for a narrow window for optimum gestation, lasting approximately two weeks.

In August 2012, ACOG sponsored the reVITALize Obstetric Data Definitions Conference. The conference brought together more than 80 leaders in women’s health, public health, and vital statistics. The purpose of the meeting was to review and update many of the metrics and definitions that inform our specialty. Consensus was reached on 70% of the topics reviewed, including a more accurate definition of “term” that more clearly reflects our current knowledge base.

Physicians, hospitals, and states that have aggressively pursued reduction in elective induction prior to 39 weeks’ gestation have seen remarkable improvements in many perinatal outcomes. The Joint Commission has made this metric its first required perinatal core measure.

Over the next few months, the District IV Patient Safety and Quality Improvement Committee will survey all hospitals in District IV to determine the level of implementation of standards to prevent elective induction prior to 39 weeks. We hope to share the results of our findings at the 2013 Annual District Meeting in October. We believe our district membership has an important leadership role to play in ensuring the widespread prudent use of elective delivery to promote improved perinatal outcomes and patient safety.

 

Dr. Victoria L. GreenInformed consent and shared decision-making
Victoria L. Green, MD, JD, MBA, Georgia Section vice chair

The quest to provide the highest standards of quality care in clinical practice is the goal of all medical providers. Thus, the zeal to consistently and continuously improve the quality of care persists unabated. The issue of quality was propelled to the forefront of the consciousness of mainstream America with the release of the Institute of Medicine report To Err is Human: Building a Safer Health System in 1999 and its companion piece, Crossing the Quality Chasm: A New Health System for the 21st Century, in 2001.

In addition to a focus on the system failures that may result in errors, these writings elaborate on the importance of patient-centered care that is respectful and responsive to individual patient preferences, needs, and values. The importance of communication and informed consent is evident as a critical component in providing safe, quality care.

Informed consent is an ethical concept that is integral to contemporary medical practice. Effective communication increases patient satisfaction, physician satisfaction, adherence to treatment plans, and appropriate medical decisions, which may result in better health outcomes. It is a process of communication whereby a patient is enabled to make an informed and voluntary choice about accepting or declining medical care.

The emerging science of patient-centered decision-making promotes an awareness of the importance of the patient’s role in managing her own care. As health and health care are becoming increasingly complex, the need for the concept of shared decision-making in health choices that affect the quality, and often the length of an individual’s life, is growing exponentially.

Despite detailed forms, graphics, and our best efforts to relate the reasons for a particular course of treatment, the risks and benefits of treatment, and the alternatives, the patient often lacks the required information to make an informed choice. Important reasons why we may be unsuccessful in providing truly informed consent include:

  • Lack of unbiased information on the true risks and benefits of a procedure
  • Inattention to the goals and concerns of the individual patient
  • Failure to encourage and empower the patient to participate in her health care decisions by asking the needed questions to ensure adequate assessment of health care concerns

Consequently, shared decision-making is the process of providing personalized information about the options, outcomes, probabilities, and scientific uncertainties of treatment options, while allowing the patient to communicate her values and the relative importance she places on the risks and benefits discussed. Through shared decision-making, the patient should be able to easily understand the information evaluated, the alternatives considered, and the reasoning and rationale for arriving at the suspected diagnosis and to choose the recommended course of action.

During this process of sharing information about options, outcomes, and preferences, steps are taken to work toward a consensus, and ultimately an agreement is reached that reflects the values and ideology of both the patient and the health care provider. This shared decision-making safeguards the patient against unwanted medical treatment and makes possible the patient’s active involvement in her medical planning and care. 

Logically, shared decision-making meets the goals of all stakeholders in the decision-making process. However, its efficacy is also supported by randomized controlled trials that demonstrate increased patient knowledge, enhanced patient satisfaction, improved adherence to recommendations, better alignment between values and choices, and more satisfaction with decisions. In addition, providers gain increased insight into patient preferences and efficiency of care is improved.

Despite its obvious benefits, shared decision-making may be hampered by:

  • Lack of time
  • Inadequate objective data on treatment risks and complications
  • Unexplored patient values, interests, and assumptions that may influence health care choices
  • Unclear alternatives as technology advances rapidly
  • Patient access to incorrect information
  • Lack of insurance coverage for the options the patient desires
  • Detrimental influence of friends and family (although family influence may have a positive effect on information exchange)
  • Unclear roles and relationships with uncertainty as to how much information should be provided

There is significant support for widespread adoption of shared decision-making policies. The Affordable Care Act supports programs to facilitate shared decision-making and development of patient decision aids. The Washington State Legislature had bipartisan support for a coordinated demonstration project on use and evaluation of shared decision-making and decision aids, aligning shared decision-making goals and strategies with state leadership.

Health providers should ascribe to the principles of shared decision-making by engaging patients in discussion and eliciting patient preferences in health care choices. This behavior reflects respect for the dignity and autonomy of individual patients and a commitment to help them participate fully and meaningfully in the decisions that affect their bodies and their lives.

More information on informed consent and shared decision-making:

 

Dr. Tamika C. AugusteHospital safety measures across DC
Tamika C. Auguste, MD, District of Columbia Section vice chair

The District of Columbia is a city of 68 square miles with a diverse population of 601,723 and a metro population of approximately 5.3 million. DC has a total of 16 hospitals, and seven provide ob-gyn services.

Constance J. Bohon, MD, DC Section chair, and I have been investigating what safety measures these hospitals have invested in to make the city a safer place for women to have babies. Safety contacts for the DC Section have been established at these hospitals and were asked to share measures that have been implemented at their institutions to improve the care of women in the perinatal area. The responses were interesting and surprisingly similar.

The majority of hospitals are practicing simulation drills and/or activities that are both individual and multi-disciplinary. The simulation drills focus on individual tasks and teamwork. Some are quite extensive, involving high-fidelity simulators and in-situ drills with teams of people on labor and delivery. Other simulations involve low-fidelity modalities and focus on specific tasks like laceration repair. Most hospitals are focusing on simulation activities designed for improved patient care and safety.

Another major effort across the hospitals involves communication. All hospitals have implemented modalities to improve communication. They have recognized that miscommunication accounts for the majority of perinatal sentinel events and are making efforts to improve communication overall. Many of the hospitals are focusing on communication surrounding electronic fetal monitoring (EFM). They now require staff to have annual certification in EFM and education in using SBAR (Situation, Background, Assessment, Recommendation).

In efforts to improve communication across the labor and delivery team, many hospitals have also implemented team huddles. Huddles are when the labor and delivery team gathers to discuss each woman on the labor unit. Topics discussed include specific medical issues, known issues with the fetus, EFM categories, pain management, and treatment course. These huddles ensure that everyone taking care of the patient is on the same page. Any potential issues or concerns are brought up and discussed. The huddles are happening anywhere from twice a day to every three hours at some hospitals.

Other safety measures occurring across DC include infant abduction drills, increased maternal-fetal medicine involvement on the labor and delivery unit, and compliance with no elective inductions prior to 39 weeks’ gestation.

These safety measures can be implemented by any institution. Some are more extensive than others, but their use is definitely feasible. It’s important to think about new and innovative safety measures that your institution can implement to improve the care of your patients. When it comes to safety, we want to share what we are doing. We all have the same common goal of improved safety.

DC Section leadership wanted to find out what its hospitals are doing to encourage collaboration. We wanted to share some of the more successful initiatives across DC. We hope to make DC a safer and desired place for women to have their babies.

 

Dr. William E. BrownPolicy standardization in North Carolina
William E. Brown, MD, North Carolina Section vice chair

Vidant Medical Center (VMC) is a private, not-for-profit academic medical center located in eastern North Carolina. VMC is part of Vidant Health, a private, not-for-profit health system organized in 1997 through mergers and the acquisition of 10 not-for-profit entities in eastern North Carolina. VMC is the flagship hospital for Vidant Health and serves as the teaching hospital for the Brody School of Medicine at East Carolina University. VMC has 861 licensed beds and employs more than 6,500 employees.

Leaders at VMC actively engage staff in performance improvement and building highly reliable processes to ensure safe and quality care reaches patients every time. Standardization is an essential process to reduce variability and improve patient care. Three examples of policies that guide staff when caring for patients at VMC are at:

Discharge of newborns
Prevention of kidnapping
Universal protocol for preventing wrong site, wrong procedure, and/or wrong person surgery, or other invasive procedure

 

District IV Patient Safety and Quality Improvement Committee members

Raymond L. Cox Jr, MD, MBA, District IV Patient Safety and Quality Improvement Committee chair
rlc127@msn.com

Michael D. Moxley, MD, District IV Patient Safety and Quality Improvement Committee chair elect
mdmoxleymd@gmail.com

Thomas W. Hepfer, MD, District IV vice chair
twhepfer@yahoo.com

Rachel K. Casey, MD, District IV Junior Fellow vice chair
rkcasey@gmail.com

Jennifer M. Keller, MD, District IV young physician
jennymk2003@gmail.com

Tamika C. Auguste, MD, District of Columbia Section vice chair
tamika.c.auguste@medstar.net

Victoria L. Green, MD, JD, MBA, Georgia Section vice chair
vgree01@emory.edu

Jessica L. Bienstock, MD, Maryland Section vice chair
jbienst@jhmi.edu

William E. Brown, MD, North Carolina Section vice chair
wbrown@physicianseast.com

Nabal J. Bracero, MD, Puerto Rico Section vice chair
njbracero@genesfertility.com

Scott A. Sullivan, MD, South Carolina Section vice chair
sullivas@musc.edu

Holly S. Puritz, MD, Virginia Section chair
h.puritz@tgfw.com

Christian A. Chisholm, MD, Virginia Section vice chair
cchisholm@virginia.edu

Orville P.C.M. Morgan, MD, West Indies Section vice chair
ocarlm@yahoo.com

Stephen H. Bush, MD, West Virginia Section vice chair
sbush@hsc.wvu.edu



Section reports

Dr. Constance J. Bohon

District of Columbia
Constance J. Bohon, MD, section chair

District of Columbia Junior Fellows continue to be active in our community. They will begin to participate in a student-run clinic, Bread for the City, in April. The clinic is held every Tuesday evening for indigent people in the city who have no insurance. Each week, a different specialty runs the clinic, and now there will be an ob-gyn night. Medical students interested in ob-gyn will also volunteer at the clinic. If all goes well, Junior Fellows will perform routine exams as well as procedures such as colposcopy.

Four Junior Fellows attended the ACOG Congressional Leadership Conference, The President’s Conference, March 3–5. Lauren E. Finley, MD, will attend the 2013 Annual Clinical Meeting in New Orleans in May as an Ob-Gyn Reporter.

The DC Breastfeeding Coalition held its second summit on October 26. The group includes ob-gyns, pediatricians, nurse practitioners, midwives, lactation consultants, and representatives from DC hospitals, advocacy groups, and the DC Section. The goal of the group is to increase breastfeeding in DC. Currently, 14.8% of mothers are exclusively breastfeeding at six months. The group is initiating steps to support and promote breastfeeding in DC.

The section is working with Anitra Denson, MD, MPH, perinatal coordinator for the HIV/AIDS, Hepatitis, STD, and TB Administration at the DC Department of Health, on reducing HIV infection in DC. Currently, 2.7% of the DC population is HIV positive, placing the number at an epidemic level. Heterosexual transmission is now the leading method of transmission in DC, accounting for the majority of cases among women.

With funding and sponsorship from the Alosa Foundation and Harvard Medical School, the CME program “HIV Infection and AIDS: What the Primary Care Physician Should Know about the Diagnosis and Management” was created. The program uses one-on-one education sessions in physician offices to help practitioners assess screenings, diagnostic procedures, treatments, and referral centers for HIV/AIDS. This program is pending CME approval from ACOG. We plan to promote it in DC.

The DC Section has a representative on the recently formed Adolescent Health Workgroup. Included in this group are representatives from the American Academy of Pediatrics, local advocacy groups, the DC Department of Health, and DC public schools. The group plans to assess and improve reproductive health services for adolescents in DC.

The DC Section is also working with representatives from Physicians for Reproductive Health, the DC Campaign to Prevent Teen Pregnancy, and Advocates for Youth to provide training and education to providers for intrauterine device use in adolescents. 

Finally, we are also working on assessing the adequacy of the DC death certificate. There is talk of forming a maternal mortality committee in the district.

The current legislative session began in January. The only bill of interest so far is the “Patient Protection Act of 2013.” The bill would establish minimum nurse staffing ratios. It also includes whistleblower and patient protection clauses, limits mandatory overtime, establishes hospital committees, and provides funding for nursing education programs in DC. This bill is predicted to be contentious. A DC council member has introduced an alternative bill, “Nurses Safe Staffing Act.” This bill does not specify staffing ratios and is supported by the American Nurses Association, the DC Hospital Association, and some physicians.

  

Dr. Pamela G. GaudryGeorgia
Pamela G. Gaudry, MD, section chair

The Georgia Section works closely with the Georgia Obstetrical and Gynecological Society (GOGS) in strategic planning, outreach, legislative efforts, education, and funding events. Ruth M. Cline, MD, is president of the society and is working hard to achieve strategic goals for both our organizations.

The Georgia State Legislature passed a bill restricting abortions beyond 20 weeks’ gestation in 2012. The law provides that we must do everything to prevent fetal pain and suffering after this gestational age. If ob-gyns do not adhere to this provision, it may result in criminal prosecution and up to 10 years in jail.

GOGS held a special symposium in Atlanta to discuss this bill’s legal aspects and how ob-gyns may change their practice patterns to comply with the parameters of the law. The law was to be implemented on January 1; however, the Fulton County Superior Court granted an injunction preventing it from taking effect. The injunction is only temporary until the case can be reviewed. 

We contacted the legal department at ACOG, and staff members are watching the situation closely with us. They will be there to help when needed. A similar law passed in Arizona a few years ago, and it has been on hold for more than a year.

We have a significant shortage of obstetricians in Georgia. After doing some work initially in partnership with Georgia Public Health to study the problem, we obtained a grant from the March of Dimes to evaluate the shortage. The grant, which will be carried out by the Georgia Maternal and Infant Health Research Group, is run by 13 master’s candidates from Georgia medical schools, nursing schools, and public health programs. 

The candidates have determined that of the 82 primary care service areas outside the metro Atlanta area, 36% have no obstetrician and 16% have a severe shortage. Georgia has 10.9 ob-gyns per 100,000 residents, which falls short of the national average of 14.1 per 100,000. Population growth and provider exodus continue to exacerbate this shortage.

As expected, this problem disproportionately affects rural areas. The March of Dimes gave Georgia an “F” rating for preterm deliveries in 2010, a “D” in 2011, and another “D” in 2012. The organization informed us that we have the 10th highest infant mortality rate in the United States (8.1 deaths per 1,000 live births). Additionally, we just got news that the Burke Medical Center in rural Waynesboro is losing its only pediatrician to retirement, requiring the center to close its labor and delivery unit. This will make the county the 40th in the state without obstetric services. 

Our grant work is now focusing on potential solutions to the problem. In the meantime, information cards have been sent to 178 Georgia representatives and 56 Georgia senators, displaying data specific to each legislator’s district. We have included the number of births and deliveries, information about providers, and the average annual deliveries per provider.

Gov. Nathan Deal reported to US Department of Health and Human Services Secretary Kathleen Sebelius that he will not create a health care insurance exchange program for Georgia. Consequently, beginning in 2014, Georgians will have an insurance exchange program run by the federal government as part of the Affordable Care Act. Additionally, at this time, the state does not plan to expand its Medicaid program. The ob-gyn community, along with our primary care colleagues, is campaigning for an expansion. Approximately one-fourth of women of childbearing age in Georgia are uninsured.

In February, Gov. Deal signed a bill requiring hospitals to pay 1.45% of their net patient revenue. The state will use that money to draw roughly $450 million in federal matching dollars. Without the fee, it’s likely that hospitals would have faced Medicaid reimbursement cuts of 20% or more. However, even with the fee, the program is facing a nearly $390-million budget hole.

One of the Georgia Section’s top priorities this legislative session will be to stop Medicaid budget cuts that would hurt ob-gyns and low-income women. The governor’s budget includes a 0.74% cut to ob-gyn and other non-primary care provider Medicaid fees. Continuing the already inadequate payments to ob-gyns will contribute to the decreasing number of practicing obstetricians in Georgia.

The governor’s budget also calls for savings by no longer paying for elective deliveries prior to 39 weeks. The state expects to save money by eliminating payments for these early deliveries and the high neonatal intensive care unit costs for babies born too early. However, GOGS members, ACOG Fellows, and hospitals across the state have already implemented 39-week rules and most have already met their goal. Therefore, we do not think the governor will see the savings he expects.

Georgia has one physician in its House of Representatives, Ben Watson, MD (R), an internist from Savannah. It also now has one physician in its Senate. Dean Burke, MD (R), an ob-gyn from Bainbridge, won a runoff election on February 5 for District 11 state senator.

Sandra B. Reed, MD, recently completed her tenure as president of the Medical Association of Georgia (MAG). We are proud that she has now taken the position of District IV treasurer. The MAG House of Delegates meeting was held in Savannah in October. GOGS supported resolutions to promote measures to decrease obesity and to enhance breastfeeding through licensure of lactation consultants. Additionally, MAG passed a resolution to support ob-gyns should birth control, infertility treatments, and other women’s services be threatened by future legislation.

A fully functioning maternal mortality committee for the state has been a goal of GOGS for many years. We are pleased to say, in partnership with Georgia Public Health and support from the Centers for Disease Control and Prevention, a committee has been established and training has been completed. The committee will start evaluating its first cases this month.

GOGS will sponsor a CPT coding seminar on May 3 in Macon. The GOGS annual golf tournament is scheduled for May 15 in Suwanee. Visit the GOGS website for more information on these events.

Plans for the Annual Georgia Section and GOGS Meeting in August are under way. Faculty and topics have been chosen, and we are waiting for approval of CME credits from ACOG. The meeting will be held at the Ritz-Carlton Lodge in Lake Oconee.

Georgia Junior Fellows had strong attendance at the Annual District Meeting in Charleston, SC. The section also had nine medical students attend as recipients of the John Gibbons Medical Student Award, which funded their attendance. Georgia Junior Fellows are working to make the Susan G. Komen Race for the Cure in Savannah an annual fundraiser for breast cancer research.

 

Dr. Mark S. SeigelMaryland
Mark S. Seigel, MD, section chair

The Maryland General Assembly convened on January 9. It is anticipated that transportation funding and gun control legislation will be the most hotly debated issues, but much of the agenda has yet to be determined.

During the last legislative session, a bill was introduced that would have allowed certified professional midwives to attend home births without insurance, backup, or any formal training beyond a high school diploma or equivalent. The legislation also requested approval to provide care for newborn infants for the first six weeks of life. The proponents of the legislation shifted their focus to a forum on the rights of women to have home births and the relative unavailability of that service in Maryland.

Despite a vigorous attempt by proponents to pass this legislation, it only resulted in a summer study focus group by stakeholders, which led to a report with no agreed-upon recommendations. There has not yet been legislation relative to midwives introduced this session, but it’s likely there will be.

Bills that outline reporting requirements for child abuse and neglect and substance-exposed infants at the time of delivery have been introduced. Additionally, a bill to mandate hepatitis B testing has been reintroduced.

With respect to federal health care implementation, Maryland has implemented a structure that will continue to ensure a broad set of benefits, including comprehensive maternal and child health coverage.

The section held its Annual Emil Novak Conference in November in Baltimore. The meeting’s lectures focused on medical liability, emotional intelligence, work-life balance, and assessing cost-effectiveness in ob-gyn.

We are currently planning for the Annual David A. Nagey Resident Research Day, which will be held on April 12. This popular conference gives residents a chance to create research projects and present them in a public forum attended by other residents, attendings, and program chairs. Awards are given for the best papers.

The Maryland Section recently sponsored a “Be an Ob-Gyn Night” at Johns Hopkins Hospital in Baltimore. Area medical students were invited to a simulator event where different stations gave an introduction to the variety of endeavors that ob-gyns perform. There were many stations illustrating labor and delivery, ultrasound assessment, and gynecologic surgery. I was happy to teach at the knot-tying station. The enthusiasm of the medical students was impressive!

Maryland Section Junior Fellows have established three primary goals:

  • To educate medical students about what ob-gyn has to offer and encourage resident research and national conference attendance


  • To keep Junior Fellows informed of legislative issues pertinent to the ob-gyn field and to promote resident advocacy and understanding of the politics of medicine 


  • To organize a women’s health-related service activity targeting Baltimore youth

Additionally, they hope to hold regular social events to promote inter-residency relationships and to build an even stronger cohort of Maryland residents and Junior Fellows.

 

Dr. Brenda S. PeacockNorth Carolina
Brenda S. Peacock, MD, section chair

There is no new legislative activity to report with North Carolina’s new governor and legislators just starting to lay out their agendas. We have a Republican governor for the first time in more than 20 years, former Charlotte mayor Pat McCrory. The General Assembly is two-thirds Republican. It is our state’s first Republican majority in the executive branch and the General Assembly since 1870.

Thanks to the legal department at ACOG, the North Carolina Section and the North Carolina Obstetrical and Gynecological Society (NCOGS) now have a contract. The society has been acting on behalf and in the interest of the section, including hosting an annual meeting and organizing lobbying efforts. The contract was implemented January 1.

Section and society leaders held an interim meeting in late October, in conjunction with the North Carolina Medical Society Annual Meeting. We look forward to the 2013 Annual North Carolina Section Meeting, which will be held at the Grove Park Inn in Asheville in April. We anticipate more than 100 registrants. John M. Thorp Jr, MD, remains program chair. We have an excellent scientific program in place, with resident papers for competition from all but two of the state’s teaching hospitals.

Haywood L. Brown, MD, District IV chair, is also now NCOGS president. We continue to work on increasing section member involvement in the society for those who are not members of both organizations.

The North Carolina Medicaid pregnancy medical home program received a grant for an additional data analyst. At last report, more than 85% of practicing ob-gyns in the state were participating in the program. Kathryn Menard, MD, MPH, will report on the program’s progress at our section meeting in April.

For many years, the North Carolina Medical Society has sponsored “White Coat Wednesdays” for physicians to meet with state legislators in Raleigh on issues pertinent to their specialty and others. May 1 has been designated “Ob-Gyn White Coat Wednesday.” On this day, we will meet at the North Carolina Medical Society office for a briefing, speak with state legislators, and attend legislative committee meetings and sessions. Please save this date.

Two North Carolina Fellows and one Junior Fellow attended the ACOG Congressional Leadership Conference, The President’s Conference, March 3–5. The lobbyist for NCOGS has resigned because of another opportunity. There is a search committee in place, working with a number of criteria outlined for a replacement.

Certified professional midwives have garnered quite a bit of support in the General Assembly over the last few years. The House and Senate have been made aware of the difference between international training and training in North Carolina for certified professional midwives. There was no vote taken on licensure of certified professional midwives last year, but some representatives are now arguing for it.  

The General Assembly has a number of members opposing abortion who are stating that they will pursue proposals to exclude abortion coverage from any federal health insurance exchange. They also have mentioned a plan to outlaw any abortion based on gender preference. North Carolina has not yet established any federal exchanges as required by the Affordable Care Act. Gov. McCrory, who is considered to be a moderate Republican, has stated that he has no plans to sign additional abortion restrictions into law. We hope to have influence in this debate.

 

Dr. Eduardo J. Muniz-VelezPuerto Rico
Eduardo J. Muniz-Velez, MD, section chair

The Puerto Rico Section is looking forward to the 2013 Annual District Meeting, which will be held with Districts I and III at the Rio Mar Beach Resort and Spa in Rio Grande.

The Annual Puerto Rico Section Meeting was held during the 31st Sunshine Seminar August 2–5 at the Gran Melia Resort in Rio Grande. The meeting had 320 ob-gyns in attendance. Approximately 70% of attendees were ACOG Fellows and Junior Fellows. Two Fellows from Puerto Rico attended the ACOG Congressional Leadership Conference, The President’s Conference, in Washington, DC, March 3–5.

Puerto Rico Junior Fellows participated in grand rounds at the University of Puerto Rico. Topics discussed were incidence and epidemiology of the cesarean delivery rate in Puerto Rico, cervical cancer screening, and human papillomavirus vaccination. Puerto Rico Junior Fellow Section officers and a few of our medical students will attend the 2013 Annual Clinical Meeting in New Orleans in May.

The Puerto Rico Section is collaborating on projects with Puerto Rico Obstetrics and Gynecology (PROGyn). In November, PROGyn organized a seminar on excellence in endometriosis. The keynote speaker was Mauricio Abrao, MD, president of the 12th World Congress on Endometriosis. Most interdisciplinary topics regarding endometriosis were covered, including patient group advocates.

Puerto Rico has a new Democratic governor in office, Alejandro Garcia-Padilla. New state legislators started in mid-January. Bills to aid in implementation of the Affordable Care Act are expected in this legislative cycle. Tort reform will be discussed locally.

The Puerto Rico Section and the March of Dimes sponsored a summit of all ob-gyn department chairs in Puerto Rico in November. It was the second summit of its kind. The keynote speaker was Robert W. Yelverton, MD, District XII chair, who presented a lecture on the “Avoidance of Prematurity in the 21st Century: The 39-Week Goal.” 

 

Dr. William T. CreasmanSouth Carolina
William T. Creasman, MD, section chair

The South Carolina Section sent three officers to the ACOG Congressional Leadership Conference, The President’s Conference, March 3–5, along with our new section Junior Fellow vice chair, Jill B. McLeod, MD.     

The Birth Outcomes Initiative (BOI), a partnership between our section, the South Carolina Department of Medicaid, the South Carolina Hospital Association, and several insurers, continues to grow and attract the attention of policymakers. A press conference was held in the State Capitol on December 12 to review the progress made thus far. The conference was attended by Gov. Nikki Haley, South Carolina Medicaid director Anthony Keck, and various stakeholders. Gov. Haley announced that since the start of BOI, elective deliveries prior to 39 weeks’ gestation have fallen by 60%. Every hospital in the state has signed on to the BOI pledge to eliminate all medically unnecessary preterm deliveries.

          Press Conference
 

 Gov. Nikki Haley speaks on the progress of the Birth
 Outcomes Initiative at a press conference in the
 State Capitol

 

Current initiatives of BOI include improving the number of women in South Carolina who breastfeed and encouraging the use of group prenatal care. South Carolina Medicaid has authorized increased delivery payments to hospitals and providers that meet certain breastfeeding goals and benchmarks.

Pilot data demonstrating the efficacy and cost-effectiveness for group prenatal care for the prevention of preterm labor has also led to a statewide program encouraging providers to become involved. Through BOI, groups or providers who participate will receive training for their staff, educational materials, and a significant increase in the delivery fee for each participant. 

Future plans of BOI include trying to reduce South Carolina’s infant and neonatal mortality rate, which ranks among the highest in the US. The South Carolina Section is proud to have been a founding member of this public-private partnership, and we look forward to continuing to improve the health of South Carolina mothers and babies.

South Carolina Junior Fellows are having great success with their medical student interest group meetings and enjoyed welcoming local third-years back in the fall for their sub-internships. The interest group meetings have become quite large at the University of South Carolina and the Medical University of South Carolina, with residents and faculty members participating together. In addition to meetings, open forums are being held for medical students to ask residents and attendings candid questions.

Junior Fellow section leaders are working to increase awareness of ACOG member benefits and to encourage residents throughout South Carolina to participate in ACOG activities. They plan to host a diaper drive in the near future, as well as a fundraiser for a local domestic abuse shelter. They hope to engage statewide interest in community service and get medical students involved with these events.

As noted in my last report, a bill passed by the Legislature on making information concerning the human papillomavirus (HPV) vaccine more available was vetoed by the governor. Even though it passed by large margins, the Legislature did not override the veto. In January, Rep. Bakari Sellers (D-Bamberg) introduced a bill in the House that, beginning with the 2013–14 school year, would:

  • Offer HPV vaccination to adolescent students enrolling in the seventh grade of any public or private school in South Carolina
  • Provide an information brochure related to the vaccine with specific content requirements
  • Define “cervical cancer vaccination series”

Implementation of this act would be contingent upon receipt of full state and federal funding. No student would be required to have the vaccine before enrolling in or attending school. The success of this bill is debatable at this point in time.

Other bills of note that have been introduced this session include:

  • Senate Bill 87 and House Bill 3323: Establish that the right to life for each born and preborn human being begins at fertilization
  • Senate Bill 117 and House Bill 3366: Require physicians to ask patients what family members may be involved in health care decision-making
  • Senate Bill 182: Declares March Endometriosis Awareness Month
  • Senate Bill 204: Requires abortions outside of hospitals to be performed by board-certified ob-gyns with hospital privileges
  • Senate Bill 278: Requires South Carolina Medical Association membership as a condition of physician licensure
  • Senate Bill 3324: Creates the South Carolina Unborn Children’s Monument Commission to erect a monument on the House grounds as a memorial to children whose lives ended before birth
  • Senate Bill 3416: Prohibits physicians or nurses from asking patients about firearms ownership

Regulations related to certification requirements of midwives have also been submitted to the Legislature. They do not include expansions on scope of practice.

 

Dr. Holly S. PuritzVirginia
Holly S. Puritz, MD, section chair

The Second Annual Virginia Section Meeting will be held September 20 at the Richmond Marriott. We hope to build on the momentum of our successful first meeting. Continuing medical education will be offered, and a Fellow and Junior Fellow business luncheon will be held during the meeting. Residents from each of our five residency programs will present their research in the morning. Afternoon lectures will focus on a broad range of subjects of interest to the practicing ob-gyn. The meeting’s keynote speaker will be Steven L. Warsof, MD, from Eastern Virginia Medical School in Norfolk, who will discuss non-invasive prenatal testing and new genetic screening tests.

A conference on mental health during and after pregnancy will be held in Hampton in May. Section members helped identify speakers for the program, which is being led by pediatricians. Additionally, the Virginia Health Commissioner’s Immunization Task Force and Task Force on Infant Mortality are working with section members to promote shared goals.

The Virginia Section sent six members to the ACOG Congressional Leadership Conference, The President’s Conference (CLC), March 3–5. There was strong statewide interest in the conference this year. Additionally, I served on a panel at the CLC, discussing ACOG’s involvement in state-level legislative issues.  

The Virginia Section has started a new program, inviting Fellows and Junior Fellows to spend a day with section lobbyist Melanie Gerheart in Richmond. Testimony is often needed for committee hearings, and it’s difficult to find a physician to testify at the last minute. Committee meetings are held every Tuesday and Thursday. Therefore, physicians are scheduled to attend every Tuesday and Thursday of the two-month legislative session so there will always be someone to speak on behalf of ob-gyns. The program has been very successful to date. Members who receive sponsorship to the CLC are required to commit to this project. All ACOG members are invited to participate.

The Medical Society of Virginia (MSV) has decided to start supporting state society issues as they affect physician-patient relationships. MSV’s lobbying committee has been asking for ACOG’s input on many bills and is lending its support to many of our issues. Several items that were addressed last year are being revisited this year in committee.

The 2013 General Assembly session will last for only 45 days. Despite this short session, Virginia House and Senate members have introduced more than 2,000 bills, making it difficult to track legislation. Thus far, no items have made it out of the committees, including the following bills relevant to our members:

  • Senate Bill 826: Repeals the Board of Health’s authorization to fund abortions for women who meet the financial eligibility criteria of the State Plan for Medical Assistance in cases in which a physician certifies that he or she believes that the fetus would be born with a gross and totally incapacitating physical deformity or mental deficiency
  • Senate Bill 1082: Removes the requirement that a woman undergo a transabdominal ultrasound prior to an abortion
  • Senate Bill 1080: Provides that no law, regulation, or administrative action of an agent of Virginia should require that a person receive ultrasound imaging for non-medical reasons or ultrasound imaging that is not medically indicated as a condition of receiving a medical procedure
  • Senate Bill 1115: Eliminates language classifying facilities in which five or more first-trimester abortions per month are performed as hospitals for the purpose of compliance with regulations of the Board of Health related to construction, maintenance, operation, staffing, and equipping of hospitals
  • Senate Bill 1116: Provides that regulations of the Board of Health for the construction, maintenance, operation, staffing, and equipping of hospitals shall apply to facilities in which five or more first-trimester abortions per month are performed only when the design or construction of such facility is initiated after July 1, 2013. This bill includes an emergency clause
  • Senate Bill 783: Defines “birth control” as contraceptive methods that are approved by the US Food and Drug Administration. Birth control should not be considered abortion

The Virginia Hospital and Healthcare Association (VHHA) and the March of Dimes started a committee to stop early elective deliveries in our state. MSV is also involved, and I was asked to be on the committee. VHHA has approved a plan to ask all hospitals to work together to determine the baseline early elective delivery rate and to assist hospitals in reducing that rate. VHHA is asking for a commitment from the hospitals to submit data and pledge to have policies in place to reduce the rate.

A webinar was presented to all maternity hospitals in February. I spoke on ACOG’s recommendation that deliveries prior to 39 weeks’ gestation should not be done without maternal or fetal indication. Many of the academic and large hospital systems have a 39-week rule in place. The committee hopes to reach the smaller hospitals in Virginia and offer help and advice on getting a similar policy in place. One of the major problems facing smaller hospitals is verification of a medical delivery prior to 39 weeks. The need for chart review and follow-up can be onerous.

The Junior Fellow Annual Section Meeting was held in September. Contacts were established at each residency program in Virginia. These contacts will relay information to residents from the section.

In an attempt to involve and recruit medical students into the field of ob-gyn, a simulation event was set up at the Carilion Clinic in Roanoke. First- and second-year medical students from local medical schools were invited. For the first hour, students practiced their laparoscopic techniques at multiple simulations stations. In the second hour, students competed against each other to achieve faster laparoscopic techniques. The winning group was given the privilege of shadowing residents on labor and delivery.

 

Dr. Owen D. WalcottWest Indies
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 demographics. Thankfully, I am pleased to report that some encouraging trends have been developing, which I hope will result in improvements in our poor health indices.

In Jamaica, the government has decided to abandon its experiment with free health care in the public sector. This experiment produced a watered-down system characterized by grossly inadequate resources and overwhelming demand. There is now a proposal to return to user fees with means testing to ensure that the very poor continue to access medical care. Hospitals and clinics will also be authorized to file health insurance claims on insured patients who use public facilities.

Over the past few months, there has been a spate of medical catastrophes among health professionals. Several of our colleagues have suffered strokes and heart attacks, and these occurrences culminated tragically in the untimely death of Wilmot H. Hedrington, MD, one of our most popular and esteemed members. Dr. Hedrington died on January 13. This series of events has prompted us to reexamine the culture of our medical practice and to choose the theme “Heal Thyself—Physician Wellness” for our annual meeting.

The Annual West Indies Section Meeting will be held on April 13. We will look at issues affecting the general health of physicians, including diet and weight control, screening protocols, and stress in the work environment, as well as financial wellness and retirement planning. We hope these topics will encourage some introspection and encourage physicians to adopt healthier, more balanced lifestyles.

Cathy A. Maddan, MD, has completed a successful term as section Junior Fellow chair. Jody-Ann S. Jarrett, MD, is our new section Junior Fellow chair. Junior Fellows continue their outreach and community work, primarily focusing on breastfeeding and adolescent sexuality initiatives. Their annual meeting was held on September 30 and focused on the theme of infertility. Junior Fellows are extremely active, and their energy and enthusiasm is a source of inspiration to all of us.

A recurring theme in West Indies Section reports has been the great need we have for specialist training, especially in the areas of gynecologic oncology and maternal-fetal medicine. We have been able to secure fellowships in Canada, and over the last two years we have seen the return of a gynecologic oncologist and maternal-fetal medicine physician. Currently, two residents are pursuing fellowships in maternal-fetal medicine. We hope this will result in steady improvement in the quality of care offered in our section. We remain open to opportunities for specialist training within District IV.

On another positive note, a state-of-the-art endoscopic unit has been commissioned into service at the University Hospital in Jamaica. Robotic services are not yet available, but the facility has already had a tremendous impact on the level of training and service we are able to provide.

 

Dr. Brenda L. DawleyWest Virginia
Brenda L. Dawley, MD, section chair

Drug overdose was the leading cause of maternal deaths in West Virginia last year, with the majority occurring two to three months postpartum. A bill designed to reduce drug diversion and narcotic shopping passed. It increases regulations associated with pain clinics and their dispensing of controlled substances. Neonatal withdrawal is an escalating problem.

Smoking, obesity, hypertension, and diabetes continue to be prevalent problems in West Virginia. There have been recent statewide changes in school meals to help eliminate childhood obesity. The West Virginia Tobacco Quitline (877-966-8784) is well funded and utilized. It has helped more than 40,000 West Virginians stop smoking.

The teen pregnancy rate in West Virginia is stable, but I hope it will begin to decrease as sex education efforts in high schools, access to contraception through family planning clinics, and use of long-acting reversible contraception in adolescents increase.



2013 ACM: Join ACOG in New Orleans

2013 ACM in New OrleansThe 61st Annual Clinical Meeting will be held in New Orleans, May 4–8. Attendees can expect to participate in a wide variety of hands-on courses and educational and interactive sessions related to ob-gyn practice. Register today!

2013 ACM educational session topics include:

  • Updates in contraception
  • Noninvasive prenatal testing
  • Cervical cancer diagnosis guidelines
  • Endometrial cancer staging
  • Global health
  • Maternal mortality reduction
  • Environmental exposures to the unborn child
  • Cultural and religious perspectives on abortion

The ACM program will also feature sessions on work-life balance, family and professional relationship building, and leadership skills. The President’s Program will focus on the themes of patient safety, women’s health care advocacy, communication and technology, and practice and leadership in the 21st century. New this year will be three interactive surgical tutorials on pelvic anatomy, laparoscopic surgery, and techniques in abdominal wound closure. You won’t want to miss these outstanding presentations!

New Orleans is known for its rich history, culture, and traditions. The French Quarter (including the St. Louis Cathedral and Bourbon Street), New Orleans Botanical Garden, Audubon Zoo of New Orleans, and Audubon Aquarium of the Americas are just a few of the attractions attendees can look forward to visiting.

To find out more about what the ACM has to offer, read the ACM preliminary program and the special ACM preview issue of ACOG Today.

Save the meeting dates, and join thousands of ob-gyns and other women’s health care professionals at the ACM. It will be an experience to remember!



Council of District Chairs honors District IV with Service Recognition Award

District IV has won a Council of District Chairs Service Recognition Award for its efforts in perinatal data collection over the last seven years. The award is given to an ACOG district or section in recognition of an outstanding activity it has contributed to the field of ob-gyn.

In 2005, Ramon A. Suarez, MD, then-District IV chair, recognized a need for current, reliable perinatal statistical information to be available for the purpose of health care planning. The responsibility for developing this data was delegated to the West Virginia Section. Over the ensuing seven years, a network of health care statisticians was identified, encompassing all the District IV sections, with the exception of the West Indies Section for which there was no common geopolitical entity.

A report was generated each year thereafter. Initially, the report consisted of 14 data sets presented over 29 pages. The report now includes 20 data sets presented on 62 pages. The most recent report is available on the District IV website.

The West Virginia Section undertook this project and expanded its scope well beyond any expectations. The data collected has been used to keep Fellows apprised of current outcomes. It has also been an invaluable asset in highlighting patient safety issues and providing current reliable outcome information to health care system planners. District IV is pleased to have initiated this project and is exceptionally proud of the efforts of the West Virginia Section, particularly Robert C. Nerhood, MD, in bringing it to fruition.

District III also won a CDC Service Recognition Award this year for “The OBesity Project,” an educational collaboration with its Pennsylvania Section. ACOG recognizes the hard work and determination of all the districts and sections nominated for the award:

  • District I: Massachusetts Section, Perinatal Quality Collaborative
  • District II: Rochester Gynecology Clinic for Women with Special Needs
  • District V: Kentucky Section, Healthy Babies Are Worth the Wait
  • District VI: Mentorship Program
  • District VIII: Nevada Section, Fetal Alcohol Spectrum Disorders Project
  • District IX: Speakers Bureau Project
  • Armed Forces District: Air Force Section, Obstetric Quality Initiative

More information on all these submissions is available on the District and Section Activities website.



Free resources on drug abuse and addiction in patients

If your patient was abusing prescription or illicit drugs, would you know? In 2011, 3.1 million people 12 and older reported using an illicit drug for the first time within the past 12 months. This averages to approximately 8,500 initiates per day. Additionally, 6.1 million people 12 and older reported the non-medical use of prescription psychotherapeutic drugs in the past month.

The National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, is interested in improving clinical outcomes by providing science-based resources to clinicians about drug abuse and addiction. To help achieve that goal, NIDA has developed a portfolio of resources called NIDAMED to help clinicians better address drug abuse in their patients.

Available materials include:

  • The NIDA Drug Use Screening Tool: This interactive tool, easily accessible from mobile devices, offers a single-question quick screen to identify patients with recent substance use. If a patient is found to be at risk, the tool provides more in-depth questions about patient drug use. A substance involvement score, generated from patient responses, suggests the level of intervention needed
  • Screening for Drug Use in General Medical Settings: This guide supplements the NIDA Drug Use Screening Tool by providing more detailed instructions to clinicians about how to use the tool, discuss screening results, offer brief interventions, make necessary referrals, conduct biological specimen screening, and locate substance abuse treatment facilities
  • Screening Tool Quick Reference Guide: This pocket guide provides an abbreviated version of the NIDA Drug Use Screening Tool and instructions on its use
  • Patient Resources: These materials were developed to help clinicians provide patients with information about drug use, addiction, and treatment. Resources include one-page fact sheets about prescription drug abuse, marijuana, and substance abuse treatment options; booklets about the science of addiction, facts about drugs, and tips for finding treatment; posters to help start conversations with at-risk patients about their drug use; an online tool that highlights parenting skills to prevent the initiation and progression of drug use among youth; and a website written in simple, direct language to help readers understand drug abuse, addiction, and treatment
  • Substance Abuse-Related Continuing Education Courses: These two new MedScape courses, which offer up to three CME credits, include video vignettes modeling clinician-patient conversations about the safe and effective use of opioid pain medications. The courses were created to help clinicians understand and address the complex problem of prescription drug abuse
  • Curriculum Resources: This series includes 10 innovative drug abuse and addiction curricula, which were designed to help teach medical students and residents to identify and treat patients struggling with drug abuse and addiction. The resources were created to help fill gaps in current medical education related to both illicit and prescription drug abuse

All resources are available free of charge. If you have questions about any of the NIDAMED resources, contact nidacoeteam@jbsinternational.com.



Calendar of events

2013

April

19–21
North Carolina Annual Section Meeting
Grove Park Inn
Asheville
Contact: Nancy Lowe, 919-833-3836 or
nlowe@ncmedsoc.org

May
4–8
Annual Clinical Meeting
New Orleans
acog.org/acm

August
22–25
Georgia Annual Section Meeting
Ritz-Carlton Lodge
Lake Oconee
Contact: Georgia Obstetrical and Gynecological Society, 770-904-0719

September
20
Virginia Annual Section Meeting
Richmond Marriott
Contact: Melanie Gerheart, 804-788-8006 or
mrgerheart@aol.com 

October
11–13
Annual District Meeting (with Districts I and III)
Rio Mar Beach Resort and Spa
Rio Grande, Puerto Rico
Contact: Barbara Kallas, 202-863-2441 or
bkallas@acog.org