Connect with District VIII on Facebook
In an effort to provide you with current information regarding women’s health, District VIII has joined Facebook. We are updating our page regularly with news specifically relevant to District VIII members. You can find us at facebook.com/ACOGDistrictVIII.
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 VIII pages. Then, you’ll be able to comment on and share any updates posted. You’ll also get ACOG national and District VIII news sent directly to your Facebook news feed.
Anyone can view Facebook pages, but only Facebook members can interact with ACOG national and District VIII. 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!
From the chair
Susan M. Lemagie, MD
ACOG has been spotlighted in many public debates over the last year. As I write this, the New York Times has another front-page article featuring the ACOG recommendation that birth control pills should be available over the counter.
In April, a federal judge ruled that Plan B One-Step emergency contraception should be available over the counter without age restrictions, consistent with scientific evidence. Earlier this month, the Justice Department filed a notice to appeal this ruling. Days prior to this filing, the US Food and Drug Administration approved the availability of Plan B One-Step without a prescription to adolescent girls ages 15 and older.
Clearly, the politics of women’s reproductive control remains solidly in the public eye. If you have not seen it yet, I recommend you watch the Public Broadcasting Service special about the history of the women’s movement to better understand today’s debate. “MAKERS: Women Who Make America” is a three-part documentary covering the women’s movement from the 1950s to today.
Robotic surgery debate
ACOG Immediate Past President James T. Breeden, MD, past District VIII chair, did a super job as president this last year. He mobilized ACOG’s rapid response to hot topics in the media, from politicians’ scientific blunders to robotic surgery. As evidence is published, ACOG is sorting out the marketing hype and salesmanship from the benefits and risks of robotic surgery. Vaginal hysterectomy is still the procedure of choice.
At the 2013 Interim District VIII Advisory Council Meeting, the topic of robotic surgery engendered a spirited discussion between Fellows and Junior Fellows. Residents are concerned about losing the art of vaginal surgery, in addition to competing with attending surgeons for the robot console. Hysterectomies, in general, are decreasing as more endometrial ablations and levonorgestrel intrauterine devices are being used to manage menorrhagia. The complication rate expert surgeons report may not accurately reflect the issues faced by general practice gynecologists, who do an average of 15 to 20 hysterectomies per year.
Hereditary breast and ovarian cancer
The recent New York Times article from Angelina Jolie describing her decision for bilateral prophylactic mastectomy, nipple conservation, and breast reconstruction in light of her mother’s early death from breast cancer and her discovery of her own BRCA1 carrier status will likely catch your patients’ attention. Even in Alaska, my phone rings off the hook with this type of news item. You will want to refresh your memory about which patients warrant referral to a genetic counselor for additional evaluation.
ACOG Practice Bulletin #103 “Hereditary Breast and Ovarian Cancer Syndrome” addresses the role ob-gyns should play in identifying, managing, and counseling patients with inherited cancer risks. It recommends further genetic risk assessment for women who have more than a 20% to 25% chance of having an inherited predisposition to breast or ovarian cancer. These women include:
- Women with a personal history of both breast cancer and ovarian cancer
- Women with ovarian cancer and a close relative—defined as mother, sister, daughter, grandmother, granddaughter, aunt—with ovarian cancer, premenopausal breast cancer, or both
- Women of Ashkenazi Jewish decent with breast cancer who were diagnosed at age 40 or younger or who have ovarian cancer
- Women with breast cancer at 50 or younger and who have a close relative with ovarian cancer or male breast cancer at any age
- Women with a close relative with a known BRCA mutation
Genetic risk assessment may also be appropriate for women with a 5% to 10% chance of having hereditary risk. Refer to the Practice Bulletin for a complete discussion of risk factors in these women.
Screening for breast cancer in women with BRCA mutations should start at age 25 or sooner based on earliest age onset in the family. Screening should include semiannual clinical breast exams, as well as annual mammograms and breast magnetic resonance imaging. Screening for ovarian cancer in women with BRCA mutations should start between the ages of 30 and 35 or five to 10 years sooner than the earliest age onset in the family. Screening should include periodic screening with CA 125 and transvaginal ultrasonography.
It is important to remember that the gene mutations can come from either the mother’s or father’s side, so both sides of a woman’s family should be carefully examined. Hereditary breast and ovarian cancers are also associated with other rare hereditary cancer syndromes, such as Li-Fraumeni and Cowden syndromes and hereditary diffuse gastric cancer. Thus, the guidance of a professional genetics counselor is warranted.
Ob-gyns play a crucial role in identifying women at risk for hereditary cancer, providing them with important counseling and peer support, and educating them about strategies to manage risk, including surveillance, chemoprevention, and surgery. Prophylactic surgery receives much media attention, but it is not the only option. We need to step forward as compassionate experts who are truly women’s health care physicians.
New ACOG app available
Have you tried out the new ACOG app for iPhone and iPad yet? It features ACOG news, Committee Opinions, contact information for ob-gyns, as well as information for our patients. It will soon be released for Android as well.
Tests and procedures to question
In February, ACOG released a list of the top five tests and procedures to question in ob-gyn as part of the Choosing Wisely campaign, led by the American Board of Internal Medicine Foundation. The five tests and procedures are:
- Don’t schedule elective, non-medically indicated inductions of labor or cesarean deliveries before 39 weeks 0 days gestational age
- Don’t schedule elective, non-medically indicated inductions of labor between 39 weeks 0 days and 41 weeks 0 days unless the cervix is deemed favorable
- Don’t perform routine annual Pap tests in women 30 to 65 years of age
- Don’t treat patients who have mild dysplasia of less than two years in duration
- Don’t screen for ovarian cancer in asymptomatic women at average risk
The ACOG Congressional Leadership Conference, The President’s Conference (CLC), in Washington, DC, March 3–5, was dynamite! Many members consider this the best ACOG event of the year. The conference teaches attendees how to lobby and allows them to interact with members of Congress on behalf of their patients.
At the CLC, we celebrated the million-dollar milestone of ACOG’s federal political action committee, Ob-GynPAC, with $1 million raised from ACOG members. Currently, 7% of District VIII members support Ob-GynPAC. We need everyone’s support so we can continue to promote women’s health and support those who align with our agenda in Congress. (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.)
Because of the enthusiasm and support of our Junior Fellows, we have added a Junior Fellow legislative chair position to the District Advisory Council. The council has also recommended that each section add a Junior Fellow legislative chair position to its officers. If you have legislative concerns in your state that need to be addressed, ACOG can help. Each District VIII section has a legislative chair who can assist with coordinating efforts. More information and helpful resources are available on the State Legislative Activities website.
Congratulations to the Hawaii Section for its honorable mention for the ACOG Improvement in State Legislative Advocacy Award and to the Montana Section for its honorable mention for the ACOG Accomplishment in State Legislative Advocacy Award. The Hawaii Section worked hard to pass legislation that would require emergency contraception provision for rape victims in Hawaii. The Montana Section worked hard to pass legislation for maternal mortality review in Montana.
Register now for the 2013 Annual District Meeting at the Grand Wailea Resort, in Maui, HI, September 26–28. The joint meeting will be held with Districts V, VI, and IX. View an ADM teaser from Tod C. Aeby, MD, District VIII program chair.
The Second Annual Dancing with the Docs competition will happen on Saturday night, September 28, in the Tsunami Room, with all proceeds benefitting the Ob-GynPAC. Two groups from each district will compete for the mirror ball trophy. Join the fun! See you in Hawaii!
From the editor
Stella M. Dantas, MD, District VIII secretary
District VIII Fellows and Junior Fellows continue to impress and inspire me! We have so many talented ob-gyns in our district doing a tremendous amount of advocacy work. We are fortunate to be able to share ideas and programs with each other.
First, congratulations to William J. Peters, MD, past District VIII chair and past Montana Section chair, and the Montana Section on their legislative victory with the Fetal, Infant, and Child Mortality Review Amendment Bill. Montana will now have a maternal mortality review to address its increasing maternal mortality rate.
Another innovative initiative is the Colorado Cerebral Palsy Care Project’s legislation to assist children born with cerebral palsy and their families. The legislation offers an alternative way to provide resources to families affected by birth-related cerebral palsy rather than through the current medical liability process. Given that meaningful federal tort reform has not occurred, programs such as this are important to explore and study as a possible pathway to a better system.
Because one of the best roads to decreasing liability is improving quality, we need to also learn from the Washington State Perinatal Collaborative. Collaboratives are being considered across the country, and Washington state’s successful quality initiative is a wonderful example of what these groups can achieve.
However, in our widespread, largely rural district, the challenge is not just how to provide quality care but any care at all! Given all the challenges to women’s reproductive freedom in the last year, how we provide and protect access to abortion is an issue we continue to find difficult. Eve Espey, MD, MPH, covers the topic of abortion provision by advanced practice clinicians and pending legislative efforts in this issue of the Gazette.
Last but not least, please do not miss out on news from our stellar Junior Fellows. The incoming District VIII section Junior Fellow vice chairs traveled to Washington, DC, for the Section Officer Leadership Development Program, and some were able to stay for the ACOG Congressional Leadership Conference, The President’s Conference.
Many Junior Fellows have been inspired to lead advocacy efforts in their own sections. Arizona is one of several sections hosting legislative advocacy days. Read more about the First Annual Women’s Health Day in Arizona. Junior Fellows also awarded their first Central American Education Project grant to the Honduras ob-gyn residency program.
As always feel free to contact me at email@example.com if you have feedback, article suggestions, or questions on how to become more involved in the district or your section. ACOG wants your opinions and ideas on how to more effectively educate, advocate, and serve you.
I hope to see you all at the 2013 Annual District Meeting in September!
2013 ADM: Interactive learning in Maui
Tod C. Aeby, MD, District VIII program chair
What if you went to a three-day conference, got hours of CME instruction, and never once thought of falling asleep or checking your email?
A lofty goal, I know, but that is exactly what the Planning Committee would like to achieve with the 2013 Annual District Meeting in Maui, HI. The ADM will be held at the Grand Wailea Resort September 26–28, and it will be in what we’re calling a “sandwich format.” The presentations that make up the first slice of bread will follow breakfast or lunch and will feature important contemporary topics that spouses and significant others will also enjoy.
As an example, Charles Miller, PhD, assistant professor at the University of Minnesota and an explorer and expert in mobile learning, will give the keynote address on new and exciting methods for improving interaction and learning in face-to-face and distance educational environments. Dr. Miller will share his interactive learning system, “Flipgrid,” which we will be using throughout the ADM.
Flipgrid offers the potential for virtual attendance at the ADM, so members won’t have to travel to Maui to participate. (But really, who doesn’t want to travel to Maui?)
The meat of the sandwich will be the “Maintenance of Confidence: Learning You Won’t Forget” program, which will consist of several short, interactive sessions reviewing approaches to common ob-gyn conditions. These sessions will be heavily based on ACOG educational materials.
The last slice of bread will be “Controversies in Ob-Gyn.” The topics of these sessions will be selected about three months prior to the ADM based on suggestions from members.
Additional attractions include a leadership training forum organized by Junior Fellows and young physicians, though everyone is invited to attend, and social events, such as the Welcome Reception, Dancing with the Docs, and Junior Fellow Trivia Challenge.
The Planning Committee is excited to take on the challenge of keeping everyone awake and engaged. Will we pull it off? You won’t know unless you participate. Register today!
For more information, view my ADM teaser and the preliminary program.
Junior Fellow news
Stacy Tsai, MD, District VIII Junior Fellow chair
This year has been exciting and productive for District VIII Junior Fellows. I would like to highlight a few past and upcoming Junior Fellow events. Thirteen Junior Fellows attended the Section Officer Leadership Development Program on March 2 in Washington, DC. The event focused on preparing new Junior Fellow section officers and providing them with tools to help them effectively do their jobs.
Many of the Junior Fellow officers stayed in DC for the ACOG Congressional Leadership Conference, The President’s Conference, March 3–5. Junior Fellows were inspired by everything ACOG is doing to advocate for women’s health on Capitol Hill.
At the 2013 Interim District VIII Advisory Council Meeting April 13–14 in Las Vegas, Junior Fellow task forces worked on existing and new projects. The Social Media and Technology Task Force helps manage the District VIII Facebook page, posting important deadlines, conference information, and current articles and issues of interest. We have also been working to develop a database of graduating residents, so we can retain them as future Junior Fellows in practice and young physician leaders.
The Legislative Leadership Task Force has been planning a new leadership development course for the 2013 Annual District Meeting. Members of the task force are formulating strategies to establish more legislative days throughout the district and are implementing new Junior Fellow legislative chair positions at the district and section levels.
The Global Health Task Force met to discuss the District VIII Junior Fellow Central American Education Project. We are excited to announce our first grant recipient is the Honduras ob-gyn residency program. We are also looking for innovative ways to increase awareness of the project in Central America.
I’m excited to share some Junior Fellow activities occurring at the 2013 ADM:
- Leadership Development Luncheon and Course, Thursday, September 26, 1 to 4:30 pm: Whether it’s for running a team on labor and delivery, a hospital committee, or a private practice, this course will prepare young physicians to be more effective leaders. It includes a self-assessment to understand how participants are wired and how to interact with others who have different leadership styles
- Personalized Case List Review, Saturday, September 28, noon to 1 pm: Junior Fellows taking or preparing for their oral board examination (whether they have completed their case list or not) can preregister for this course. Please email me at firstname.lastname@example.org for additional instructions
- Junior Fellow Trivia Challenge, Saturday, September 28, 8 to 9 am
- Junior Fellow Prize Paper Presentations, Friday, September 27, 2 to 2:30 pm, and Saturday, September 28, 9 to 9:30 am
- Scavenger Hunt FUNraiser: Help raise money for the District VIII Junior Fellow Central American Education Project (donations are tax deductible!). Embark on a photo scavenger hunt with medical students, Junior Fellows, and Fellows. Sign up in advance with LaShawn Jordan, District VIII project manager, at email@example.com, or sign up at the ADM at the registration table. You’ll take pictures of your team’s success throughout the meeting. Entries will be due on Friday, September 27, at 6 pm
Please join us for a fun and exciting meeting!
Young physician report
Nicole E. Marshall, MD, and Sarah W. Prager, MD, District VIII young physicians
Sarah W. Prager, MD, is your new District VIII young physician. Dr. Prager is a family planning specialist at the University of Washington in Seattle and Washington Section treasurer. One of our primary goals this year is to increase the participation of young physicians in ACOG activities. We understand that the first few years in practice are filled with many competing interests, and we want ACOG to be as career- and family-friendly as possible.
We’re working to minimize time away from practice and family by streamlining meetings and making sure they are family-friendly. While we have come up with some ideas, including lactation rooms, child care activities, and cheaper child guest fees, we are open to suggestions. What would make it easier for you to attend ACOG meetings? What has kept you from being more involved in ACOG?
The Fourth Annual Young Physicians Luncheon will be held on Friday, September 27, as part of the 2013 Annual District Meeting. Ralph W. Hale, MD, past ACOG executive vice president, will lead an afternoon session on leadership training with practical tips for different leadership styles.
Informal gatherings are also planned for the ADM, including kid time by the pool and a happy hour for young physicians to network and build support systems. We should support one another as we are shaping our practices. As always, we welcome suggestions for additional gatherings and future meetings.
As a reminder, please check out the young physician website for additional helpful resources. We hope to see you at the ADM in September!
Legislative activities update
Tony Ogburn, MD, District VIII legislative chair
It’s been a busy and exciting spring for District VIII with regard to legislative activities. Sixty Fellows, Junior Fellows, and medical students from our district attended the ACOG Congressional Leadership Conference, The President’s Conference (CLC), in Washington, DC, March 3–5.
District VIII held a legislative meeting on Sunday morning prior to the start of the conference. Kathryn Moore, ACOG director of state legislative and regulatory affairs, reviewed a variety of topics with us, including legislative interference in the physician-patient relationship, dense breast screening legislation, and how the Affordable Care Act will affect individual states.
We also discussed maternal mortality review committees, state legislative days, pharmacist dispensation of oral contraceptives, scope of practice issues, and abortion access. The abortion access debate led to a proposal that abortion services be provided by advanced practice clinicians. Read more about advanced practice clinicians and abortion provision from Eve Espey, MD, MPH.
Thanks to the Fellows who facilitated outstanding discussions: Stella M. Dantas, MD, District VIII secretary; Dr. Espey; Mark F. Garnaas, MD; Steven C. Holt, MD, Colorado Section vice chair and legislative chair; Judith M. Kimelman, MD, Washington Section chair; Susan M. Lemagie, MD, District VIII chair; Maria Manriquez, MD, Arizona Section chair; and Sarah W. Prager, MD, District VIII young physician and Washington Section treasurer.
Action items that came out of the meeting included requests to the District VIII Advisory Council to consider writing letters to the appropriate national committees or representatives to:
- Update the ACOG position on breast cancer screening
- Support advanced practice clinicians in provision of first-trimester abortion services
- Support pharmacist dispensation of oral contraceptives as an interim measure until the US Food and Drug Administration approves over-the-counter access
The CLC was a huge success with an outstanding program put together by ACOG Immediate Past President James T. Breeden, MD, past District VIII chair.
I encourage you to consider attending the CLC next year on March 2–4 and the District VIII legislative meeting on the morning of March 2. All District VIII Fellows and Junior Fellows are welcome! It’s an honor and a pleasure to be your District VIII legislative chair. Please don’t hesitate to contact me at firstname.lastname@example.org if I can be of assistance.
District VIII lobbies Congress on women’s health issues
Jonas J. Swartz, MD, Oregon Section Junior Fellow vice chair
I had the pleasure of representing the Oregon Section at the ACOG Congressional Leadership Conference, The President’s Conference, in Washington, DC, March 3–5, with Marguerite P. Cohen, MD, Oregon Section chair; Stella M. Dantas, MD, District VIII secretary; Nicole E. Marshall, MD, District VIII young physician; Peter E. Palacio, MD, immediate past Oregon Section chair and legislative chair; and Eric F. Warshaw, MD, Oregon Section vice chair.
Together, we spoke with Oregon representatives and senators about several issues on ACOG’s national agenda. We asked members of Congress to support three bills introduced this legislative session: the Medicare Physician Payment Innovation Act, Quality Care for Moms and Babies Act, and Women’s Health Resolution.
The Medicare Physician Payment Innovation Act would repeal the Medicare sustainable growth rate (SGR) and instead support quality-based systems that reward high value care. Congress enacted SGR in 1997 as a way for the Centers for Medicare and Medicaid Services to control yearly expenditures. SGR is designed to keep yearly increases in Medicare spending tracking with growth in the gross domestic product (GDP). If Medicare expenditures increase less than the yearly increase in GDP, payments for physicians increase. If Medicare expenditures grow at a rate exceeding GDP, payments for physicians decrease.
When SGR was passed by Congress, lawmakers and health care leaders could not have anticipated the large scheduled payment reductions that would result. If allowed to trigger, for example, physicians would face a scheduled reduction of 30% in Medicare payments on January 1, 2014. Currently, Congress passes yearly fixes, which protect reimbursement for a single year. SGR repeal would allow our system to move forward with quality-based payment reform without the threat of slashing reimbursement.
The Quality Care for Moms and Babies Act would provide funding to establish and expand quality care perinatal collaboratives in each state. Many states, including Oregon with its Obstetric and Pediatric Research Collaborative, are already collecting statewide outcomes data. Some states, including Washington, Ohio, and Tennessee, have used these networks to help decrease inductions prior to 39 weeks’ gestation, neonatal intensive care unit (NICU) visits, and cesarean deliveries. They have also used them to increase human milk use in the NICU. Early results demonstrate that the collaboratives have the potential to both improve care and save money. Read more about the Washington State Perinatal Collaborative.
The Women’s Health Resolution lists legislative threats to women’s health at state and national levels, which were rampant in the last election cycle. These threats include bills proposed and passed to restrict full spectrum reproductive choice, mandate unnecessary tests such as transvaginal ultrasounds, and repeal the Affordable Care Act. Generally, the Women’s Health Resolution seeks to keep Congress out of the patient-provider relationship. However, it also draws attention to the detrimental trend toward legislative mandates based on fuzzy science.
We were appreciative that Sen. Jeff Merkley (D-OR), Rep. Greg Walden (R-OR), Rep. Suzanne Bonamici (D-OR), and staff from the offices of Sen. Ron Wyden (D-OR) and Rep. Earl Blumenauer (D-OR) took time to meet with our group and discuss these important issues.
Section Officer Leadership Development Program prepares Junior Fellows
Guillermo Guzman, MD, Idaho Section Junior Fellow chair
Earlier in my career, when I first decided to become an ob-gyn, I envisioned myself helping patients in office and hospital settings. When I first became a Junior Fellow officer in 2012, I was excited at the prospect of being able to help my patients outside of these settings and become an advocate for women in general. But as soon as I had this thought, my next question was: “How exactly am I going to accomplish this?” Then, I learned about the Section Officer Leadership Development (SOLD) Program.
The SOLD Program is a one-day event designed for incoming Junior Fellow vice chairs. The purpose of the program is to help Junior Fellows better understand their roles and responsibilities as section officers. The SOLD Program is held the day before the ACOG Congressional Leadership Conference, The President’s Conference, in Washington, DC. This year, it was held on March 2.
The program had a nice balance between lectures and other organized activities that helped attendees develop leadership skills. Guest speakers included many active and past Junior Fellow officers who shared their experiences.
I enjoyed the opportunity to get to know other Junior Fellow officers from across the US and Canada, as well as Junior Fellows from my own district. By talking to people who have been involved in ACOG leadership for some time, I was able to gain a better understanding of the needs of my section and the resources available to meet them.
At the end of the program, I felt better prepared in my role as a Junior Fellow section officer. I am certain that I now have the proper tools to help women in my community.
Advanced practice clinicians and abortion provision
Eve Espey, MD, MPH
District VIII was well represented at the ACOG Congressional Leadership Conference, The President’s Conference (CLC), in Washington, DC, this year. Immediately prior to the CLC, District VIII attendees held a legislative meeting where several controversial issues were discussed, including the topic of abortion provision by advanced practice clinicians (APCs).
Current legislation pending in the states of California and New York looks to expand APC practice to include provision of medical and/or aspiration abortion. Statutory restrictions deviate from the standard way in which scope of practice is regulated. Typically, state licensing boards, not legislation, delineate the training, supervision, and competency requirements for differing types of health care providers. Most states restrict the provision of abortion to physicians, although APCs in two states, Vermont and Oregon, have provided abortions since 1973.
What’s new is a study just published in the American Journal of Public Health comparing outcomes of more than 12,000 first-trimester aspiration abortions performed by APCs trained to competency and by experienced physicians. In this study, complication rates were low and did not differ by type of provider. The study adds to the literature on this issue, which now includes almost 20,000 women, and concludes that first-trimester medical and surgical abortion in the hands of APCs is safe.
Particularly in District VIII, with our large but sparsely populated rural states, abortion access is a major problem that could be improved with an increased number of appropriately trained providers. In 2011, the American Public Health Association endorsed the expansion of abortion provision to APCs. The Society of Family Planning made a similar endorsement in 2013.
Our discussion reviewed a number of issues including scope of practice, abortion access needs, and review of the evidence relative to patient safety in first-trimester abortion. In these difficult times for abortion restrictions across the country, we look to ACOG national for guidance.
First Annual Women’s Health Day in Arizona
Heather Spellman Lesmes, MD, District VIII Junior Fellow secretary-treasurer
The Arizona Section held its First Annual Women’s Health Day at the Arizona State Capitol on February 4. The day started with a “Lobbying 101” session to teach Fellows, Junior Fellows, and medical students how to get involved in advocacy and how to lobby legislators. Speakers shared information on important legislative issues relevant to women’s health.
Arizona Section Annual Women’s Health Day participants
We were introduced as a group to the Arizona House and Senate. In the afternoon, we met with individual legislators in smaller groups. Issues discussed included:
- Expansion of Medicaid
- Authorization of the use of misoprostol for non-US Food and Drug Administration indications and/or regimens
- Decriminalization of physician actions related to restrictions on abortion
- Licensed midwife scope of practice
The Women’s Health Day was modeled after the ACOG Congressional Leadership Conference, The President’s Conference, and successful advocacy days held by the Washington and New Mexico sections. The event offered an outlet for the Arizona Section to be a strong voice for women’s health in our state. We are excited to take on a more active role in advocating for women.
Colorado Cerebral Palsy Care Project drafts plan to assist children and families
Steven C. Holt, MD, Colorado Section vice chair and legislative chair
An initiative to better assist children born with cerebral palsy and their families is underway in Colorado. The Cerebral Palsy Care Project has drafted legislation that, if enacted, would create a five-year demonstration project with the following purposes:
To provide care, resource coordination, and resources frequently not available to families affected by birth-related cerebral palsy
To demonstrate that such programs are more effective, financially efficient, and conducive to improving medical care and systems than the current fault-based medical liability process
Term, birth-related cerebral palsy neonates with a birth weight of at least 2,500 grams who survive 90 days after birth and exhibit all the essential criteria of neonatal encephalopathy within the first seven days of life would qualify for the project and its afforded benefits. All benefits would be second to existing public and private insurance and entitlements. A care coordinator would be assigned to assist the family to obtain benefits and help determine needs. Respite care, home and van modifications, and educational support services would be potential benefits. Benefits would be available for life.
The project’s board of directors would be comprised of stakeholders and cerebral palsy experts. The board would determine additional eligibility for inclusion if there are irregularities attendant in the child’s birth. These irregularities could include neonates with inadequate delivery information to establish criteria or out-of-hospital births.
The project’s Program Benefits Committee members would be appointed by the board and include, among other stakeholders and providers, a family law attorney, a physical therapist, and an insurance benefits expert. This committee would determine benefits, and disputes would be resolved by a defined arbitration process.
The Medical Review Board for each case would include providers from involved specialties, a cerebral palsy family representative, a patient safety representative, and representatives from the hospital where the birth occurred. Providers and other personnel present at the birth would be included as requested, and all necessary records for review would be provided and protected.
The review board would be afforded peer-review protections and have no disciplinary authority unless it finds an immediate threat to public safety. In that case, a report would be made to the appropriate regulatory board. Aggregated and de-identified information of use to the health care community would be published as the review board deems appropriate, and a privileged report would be submitted to the birth hospital. These actions would not preclude institutional peer review. Medical review would be conducted as a learning opportunity, not as a forum for finding fault.
Funding would come from insurers and self-insurance funds currently providing liability coverage. Contributions would be based on prior expense experience in settling and defending term cerebral palsy cases. There will be an annual expense and overall program report submitted to the commissioner of insurance and the Colorado Legislature. Should the program become actuarially unsound, it would be terminated and liability action might be filed.
The project will not likely be introduced this year. Members of the Colorado Section plan to meet with sponsors and other stakeholders after the current legislative session ends.
Honduras ob-gyn residency program receives Junior Fellow project grant
Norman G. Morales Alvarado, MD
The first District VIII Junior Fellow Central American Education Project grant was awarded to the Honduras ob-gyn residency program. The program is a three-year program with 52 residents (22 first-year residents, 16 second-year residents, and 14 third-year residents). The residents and medical students rotating through the program will directly benefit from the project’s grant.
The Honduras ob-gyn residency program already has a well-suited classroom that can hold 50 people. It will use the grant to purchase technology resources for providing education.
On the labor ward, approximately 2,000 vaginal births and 800 cesarean deliveries occur each month. Between 40 and 50 gynecologic surgeries, including vaginal and abdominal hysterectomies, anterior and posterior colporrhaphies, tumor debulkings, cyst removals, and laparotomies for ectopic pregnancies, are performed each month. The gynecology department has septic, gynecologic, pathologic, postpartum, and labor and delivery wards, in addition to an outpatient management area and ob-gyn emergency room.
The grant will be used to purchase technology resources for providing education. These resources will give residents and medical students access to new information on general ob-gyn, as well as gynecologic oncology, urogynecology, maternal-fetal medicine, and reproductive endocrinology. Many of the program’s residents are not members of ACOG due to financial challenges. Better access to educational materials will allow them to receive up-to-date ob-gyn information.
The department of gynecology already has a well-suited classroom that can hold 50 people. The materials needed to provide these innovative educational opportunities are a laptop, camera, and sound system. Access to these new resources will be available soon.
Maternal mortality review legislation succeeds in Montana
William J. Peters, MD, past District VIII chair and past Montana Section chair
On March 18, Montana Gov. Steve Bullock signed the Fetal, Infant, and Child Mortality Review Amendment Bill into law. The legislation, sponsored by State Rep. Liz Bangerter (R-Helena), passed the Montana House and Senate, allowing maternal mortality review to be provided in the state once again.
Mark F. Garnaas, MD; Kathleen G. Nelson, MD, Montana Section chair; and William J. Peters, MD, past District VIII chair and past Montana Section chair, at the Montana State Capitol
This legislative success was the result of a Montana Section initiative to address the increasing rate of maternal mortality in the state and the lack of a maternal mortality review providing clinical correlation of Montana Department of Public Health and Human Services (DPHHS) maternal death data. The bill amends the already established Fetal, Infant, and Child Mortality Review (FICMR) Prevention Act (established in 1997), which had existing infrastructure (28 statewide review teams) and enabling legislation. The amendment bill was budget neutral and had the support of an overwhelmingly persistent ad hoc coalition.
The ad hoc coalition began with my position as regional chair of ob-gyn at the Billings Clinic. The amendment bill was supported by the clinic; addressed and supported by Kathleen G. Nelson, MD, Montana Section chair, and Tyler J. Bradford, MD, Montana Section vice chair; and followed by Susan M. Lemagie, MD, District VIII chair. It also had the approval of the District VIII Advisory Council.
Montana Gov. Steve Bullock signs the Fetal, Infant, and Child Mortality Review Amendment Bill into law, surrounded by members of the ad hoc coalition that supported its progress.
ACOG staff, particularly Kathryn Moore, director of state legislative and regulatory affairs, and Jeanne Mahoney, director of providers’ partnership, provided information and continued direction. The Billings Clinic, Bozeman Deaconess Hospital, and the Montana Medical Association (MMA) provided lobbyist support. Shaun Gillis, MD, incoming Montana Section vice chair and current MMA president, facilitated extra MMA legislative muscle to the coalition.
Letters of support for the legislation came from the Montana Academy of Family Physicians, Montana Academy of Pediatrics, Montana Nurse Midwives, and Montana Medical Association. Montana DPHHS was present from the beginning with documentation of maternal death certificates and a statewide survey that demonstrated accurate reporting documentation of Montana maternal deaths.
Montana DPHHS has requested the Montana Section coordinate implementation of the FICMR Prevention Act amendment. One special review request is to provide a Montana Section ob-gyn if the occasional Montana FICMR team doesn’t have access to a local ob-gyn in rural Montana.
For more background on this bill and its process, read “Saving moms in Montana: A maternal mortality review initiative” in the December 2012 issue of the Gazette.
Nevada Section nominated for Service Recognition Award
Each year, ACOG districts and sections submit projects to be considered for the Council of District Chairs (CDC) Service Recognition Award. The award is given in recognition of outstanding activities contributed to the field of ob-gyn. The Nevada Section was nominated for the award this year for its project to help reduce the incidence of fetal alcohol spectrum disorders in its state.
The project began with Ira Chasnoff, MD, pediatrician and founder of Children’s Research Triangle in Chicago. Dr. Chasnoff developed a screening tool for alcohol and substance use and obtained federal funding for projects in several states, including Nevada in 2008.
Under his initial guidance, a leadership team with community members and representatives from the Nevada State Health Division, Renown Hospital Pregnancy Center, and Health Access Washoe County Clinic was formed. The team created the following mission statement: “To develop and conduct community-wide strategic efforts to assess, treat, and educate women so all babies in Nevada can be born drug-free.”
Members of the team developed a plan to ultimately screen all pregnant women in Nevada. Since May 2008, more than 15,000 women have been screened at a growing number of sites throughout the state. The screening tool developed by Dr. Chasnoff takes about one minute to administer and can be used by any provider or medical assistant. The tool screens for domestic abuse in addition to alcohol and substance use.
The screening process in Nevada has not only identified pregnant women whose alcohol and substance use is at a high enough level to impair daily function, but has provided an opportunity for early intervention for the much larger group of women whose pregnancies are at risk from relatively small amounts of alcohol and substance use.
ACOG recognizes the hard work and determination of all the districts and sections nominated for the CDC Service Recognition Award:
- District I: Massachusetts Section, Perinatal Quality Collaborative
- District II: Rochester Gynecology Clinic for Women with Special Needs
- District III: The OBesity Project (CDC Service Recognition Award winner)
- District IV: Reviewing and Reporting on District Perinatal Mortality Data Project (CDC Service Recognition Award winner)
- District V: Kentucky Section, Healthy Babies Are Worth the Wait
- District VI: Mentorship Program
- 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. If your section has a project you'd like to submit for the award, contact Stephanie Williams at 202-863-2588 or email@example.com for more information. The deadline for submissions this year is November 30.
Washington State Perinatal Collaborative improves quality of care
Judith M. Kimelman, MD, Washington Section chair, and Roger B. Rowles, MD
The formation of perinatal collaboratives, where states can work on quality initiatives with collaborative committees, was one of the priorities at the ACOG Congressional Leadership Conference, The President’s Conference, this year. Washington state has a perinatal collaborative, which has helped significantly decrease elective deliveries prior to 39 weeks’ gestation. This successful quality initiative is a testament to the need for collaboratives across the country and to the importance of funding them.
The Washington State Perinatal Collaborative (WSPC) was formed in 2008 as a subcommittee of the state Perinatal Advisory Committee, a group that was formed in 1985 and functions under the auspices of the Washington State Department of Health. The impetus for the formation of the collaborative was a shift in the focus of the Perinatal Advisory Committee from perinatal education and regionalization of health care resources to the development of initiatives to improve the quality of perinatal care in the state.
The collaborative includes stakeholders in the Perinatal Advisory Committee, including the March of Dimes, Washington State Hospital Association, Washington State Department of Health, Midwives’ Association of Washington State, ACOG, and many others. It also partners with representatives of organizations throughout the state, such as businesses, insurance carriers, and consumer groups, as well as most of the obstetric hospitals in Washington.
Increasing national attention to the rising cesarean delivery rate and concerns about elective deliveries prior to 39 weeks framed the initial discussions of the collaborative and gave rise to its first initiative in 2011. Hospital surveys at that time showed wide unexplained variations in the percentage of elective deliveries prior to 39 weeks. Reducing the statewide percentage to less than 7% became the first quality initiative of the collaborative.
By utilizing webinars, in-person conferences, personal visits to struggling hospitals, and a publicity blitz facilitated by the March of Dimes and the Washington State Hospital Association, the statewide percentage of elective deliveries prior to 39 weeks dropped from 15% to less than 5% over the first 12 months of the initiative, and it continues to drop.
Other quality initiatives of the collaborative include Smooth Transitions, a project to enhance the safety of planned out-of-hospital birth transports; an evidence-based breastfeeding hospital support program; and an ongoing project to optimize episiotomy rates in the state. Most recently, the collaborative has queried all the obstetric hospitals in the state regarding practices that may influence the cesarean delivery rate. It is now working closely with the Washington State Hospital Association to develop evidence-based guidelines that may favorably affect the overall cesarean delivery rate and reduce maternal and neonatal morbidity.
The stated objectives of WSPC are to produce better outcomes for babies and mothers, to provide better experiences for families when babies are born sick or premature, and to provide better value for each health care dollar. These quality initiatives are the beginning of a long and sustainable mission.
Thanks to the success of WSPC and another committee appointed by the governor to decrease cesarean delivery rates, a similar collaborative group has emerged with funding through the Centers for Medicare and Medicaid Services Partnership for Patients. This group includes the Washington State Hospital Association, ACOG, WSPC, and physician leaders. Hospital surveys have revealed large variation in hospitals’ approaches to induction and labor management. This collaborative will help hospitals across the state adopt better strategies for scheduling elective inductions, delaying admission in labor until a patient is in active labor, and redefining labor curves. The group will measure its impact on cesarean delivery rates and maternal and neonatal complications.
Kathryn M. Ostrom, MD, section chair
Legislatively, Alaska faces two challenges to reproductive rights. There is a bill in committee that would limit Medicaid coverage of abortions that are “harmful to the woman’s physical or psychological health.” It may not have a final vote this session. The second challenge is a statute requiring parental notification prior to a minor’s abortion. The current law was passed in 2010 after a previous version was struck down in 2007. ACOG filed an amicus brief with the Alaska Supreme Court in the case of Planned Parenthood vs. Alaska to appeal this statute.
The Alaska Section has been working with the March of Dimes to eliminate elective deliveries prior to 39 weeks’ gestation. Many hospitals in the state have instituted hard-stop policies. At Providence Hospital in Anchorage, non-medically indicated deliveries are linked to the peer-review process, which highly discourages these inductions.
The number of Alaskan Junior Fellows will increase from five to 15 this year. We hope to encourage participation in the section. We are also working on a project to institute a statewide grand rounds series via video conferencing, which would be available to Fellows and Junior Fellows throughout the state.
A small group of private obstetricians in Anchorage has begun the initial phase of developing a laborist program through Providence Hospital. Deliveries at this hospital, the state’s largest hospital, have reached record numbers. The program would protect the practice needs of private obstetricians while increasing patient safety.
Our members continue to be actively involved in educating WWAMI (a partnership between the University of Washington School of Medicine and the states of Wyoming, Alaska, Montana, and Idaho) medical students and working with Providence Family Medicine residents.
Karen J. Bailey, MD, section chair
Alberta physicians have been working without a contract since March 2011. Negotiations with the government have not been productive. The Alberta Medical Association agreed to proceed to arbitration, but the government proposed a settlement with significant cost-cutting that would reduce physicians’ gross income by about 20%. Several previously paid benefits would also have been lost, including retention benefits and support for electronic medical record computer systems.
Despite these developments, physicians have remained calm, with no work action threatened or undertaken. There is now a memorandum of agreement that needs to be ratified. It will preserve the previous benefits and offer small fee increases over the next few years.
The Alberta Society of Obstetricians and Gynaecologists met in Banff on March 22, in conjunction with the Society of Obstetricians and Gynaecologists of Canada (SOGC) West/Central CME Update. The main topic of conversation was negotiations between the government and the Alberta Medical Association. The 69th SOGC Annual Clinical Meeting will be held June 11–14 in Calgary.
Martine N. Roy, MD, has filled the vacant section vice chair position.
Maria Manriquez, MD, section chair
The 2013 Interim District VIII Advisory Committee Meeting was well attended with great issues discussed, including the resurgence of home delivery and the appropriateness of increasing the scope of practice for licensed, or direct-entry, midwives. During Arizona’s last legislative session, the Arizona Department of Health Services was charged with considering increasing the scope of licensed midwife practice to include breech, twin, and vaginal birth after cesarean deliveries. I was selected to sit on the committee considering this issue, which has met five times to date. No change in scope of practice has been determined at this time, but the committee continues until June.
Many sections, like ours, have started to become more legislatively active on the local level. This year, the Arizona Section held its First Annual Women’s Health Day at the Arizona State Capitol. We also sent five section members—two Fellows and three Junior Fellows—to the ACOG Congressional Leadership Conference, The President’s Conference, in Washington, DC. We met with Rep. Kyrsten Sinema (D-AZ) and staff from the offices of our other representatives and senators.
Medical education is growing in Arizona with the accreditation of the University of Arizona College of Medicine-Phoenix and the announced plans of a partnership between Arizona State University and the Mayo Clinic in Rochester, MN. We continue to advocate for graduate medical education in our state and engage in recruitment activities for future ob-gyns.
Petra A. Selke, MD, section chair
British Columbia just completed a 10-year review of maternal deaths in the province. An unexpected finding was that epileptic seizures were the second most common medical cause of death after suicide (5.6% of total deaths; 0.72 per 100,000 maternities). This finding, though surprising, was consistent with the 2006 to 2008 Centre for Maternal and Child Enquiries report of a significant increase in maternal deaths due to epilepsy (9.0% of total deaths; 0.61 per 100,000 maternities).
In British Columbia, half of the deaths occurred during pregnancy and the immediate postpartum period, and the remainder occurred six weeks or more after the end of pregnancy. All the deaths were of patients with an established diagnosis of epilepsy, and all had been seizure free for a number of years. Only one patient was on treatment with therapeutic levels of medication (carbamazepine) at the time of death, and the others were untreated.
Inadequate pre-pregnancy counseling and inadequate treatment and monitoring during and after pregnancy appear to be issues requiring attention. In the United Kingdom, the use of lamotrigine, with its changing dose requirements during and after pregnancy, has been cited as a particular concern. Perinatal Services British Columbia, the provincial authority advising obstetric health care policy, is beginning work on a program to increase awareness of the significance of epilepsy in pregnancy and the postpartum period among health care providers and patients.
Luis A. Villatoro, MD, section chair
It is my pleasure to report that the Honduras ob-gyn residency program was awarded the first District VIII Junior Fellow Central American Education Project grant. On behalf of the Fellows and Junior Fellows of Central America, I’d like to thank all the district and section Junior Fellow officers for their help. Special thanks to Stacy Tsai, MD, District VIII Junior Fellow chair, and Laura T. Mercer, MD, District VIII Junior Fellow vice chair.
The following officers have been elected to serve the Central America Section from 2014 to 2016:
- Chair: Eduardo Cordova, MD, El Salvador, current section vice chair
- Vice chair: Floridalma Rivas Bustamante, MD, Nicaragua, current section treasurer
- Treasurer: Cesar Augusto Reyes, MD, Guatemala, current section secretary
- Secretary: Flory Morera Gonzalez, MD, Costa Rica
- Vocal one: Tomas G. Arias, MD, Panama
- Vocal two: Ruben Dario Fernandez, MD, Honduras
Kimberly D. Warner, MD, section chair
More than 600 bills have been introduced this legislative session, which calculates to about five per day. State Sen. Irene Aguilar, MD (D-Denver), has withdrawn her proposed referred constitutional amendment to create a single-payer health care system in Colorado. There was no chance the measure could have secured the required two-thirds vote in either the House or Senate. However, two citizen initiatives on health care reform have been filed and are beginning the ballot preparation review process. Sen. Aguilar also has a resolution requesting an interim study committee on single-payer systems.
We have no abortion or personhood bills active in the Colorado Legislature. Gov. John Hickenlooper signed a civil unions bill into law in March. The bill gives same-sex couples many (but not all) of the rights and responsibilities of marriage. The Cerebral Palsy Care Project has drafted legislation to assist children born with cerebral palsy and their families, but it is not likely to be introduced this year.
The governor also signed a bill that increases the amounts for which the state can be sued. The governmental immunity amounts in Colorado had not been changed since the 1980s. The individual claim cap increased from $150,000 to $350,000 (the original ask was for $485,000), and the aggregate cap (including all plaintiffs) increased from $600,000 to $990,000. These caps can be adjusted every four to five years. The increases might have serious implications on our liability climate in Colorado.
The 10th Annual Mountains, Music, and Hot Topics in Ob-Gyn Meeting will be held June 21–22 in Aspen. This meeting serves as our annual section meeting. Please save the dates, and join us!
Lori E. Kamemoto, MD, MPH, section chair
Welcome to Greigh I. Hirata, MD, section vice chair, and John Chong Hoon Lee, MD, section secretary-treasurer. They have been section officers for only a few months and already have contributed a great deal to the section.
Guam became part of the Hawaii Section in January. Thomas Shieh, MD, is our Guam representative and will attend meetings whenever he can. Dr. Shieh is Guam Medical Association president and does a lot of good work in Guam, including community volunteer work and CME conference planning. The governor of Guam released a proclamation urging the use of the human papillomavirus vaccine in January.
Gov. Neil Abercrombie and Lori E. Kamemoto, MD, MPH, section chair, at the signing of a bill requiring hospitals to offer emergency contraception to all rape victims in Hawaii
The 26th Hawaii Section Annual Ob-Gyn Update Meeting will be held at the beautiful Hapuna Beach Prince Hotel on the Kohala Coast of the Big Island of Hawaii over Veterans Day weekend, November 9–11. Save the dates! All are welcome.
The 2013 legislative session began on January 8. Bills for the establishment of a maternal mortality review panel and expedited partner therapy for sexually transmitted diseases were introduced on behalf of the section. Outcomes will be included in the next issue of the Gazette.
In April, Gov. Neil Abercrombie signed a bill requiring hospitals to offer emergency contraception (EC) to all rape victims in Hawaii and to have EC readily available on site. I was fortunate to attend the signing, in addition to many others who supported the bill during the 17 years it took for it to finally become law. Gov. Abercrombie gave a moving speech and said he thought this was the most important law he has signed thus far.
Cynthia J. Goto, MD, and I gave advocacy presentations to residents on October 26, to ob-gyn faculty on February 19, and at ob-gyn grand rounds on March 20 at the University of Hawaii.
The section is becoming increasingly involved in community meetings to improve women’s health care in Hawaii. Members have participated in meetings with the Hawaii Pregnancy Risk Assessment Monitoring System Board; Pertussis/Tdap Vaccine Committee; Collaborative Health Initiative; Medical Service Association; Sex Abuse Treatment Center; Medical Association Legislative Committee; and Women’s Coalition.
The section has also been holding meetings with ob-gyn and pediatric department chairs regarding collaboration on legislative issues. Requests for section participation in community meetings continue to increase.
Darin L. Weyhrich, MD, section chair
A federal judge overturned Idaho’s fetal pain law, which banned abortions after 20 weeks of pregnancy based on the theory that fetuses can begin feeling pain at that point. Though there are no ob-gyns in the state that provide elective termination of pregnancy beyond 18 weeks, cessation of pregnancy for lethal anomalies was illegal with the law in place.
Gov. C.L. “Butch” Otter just appointed a 19-member Health Insurance Exchange Board to design and implement Idaho’s health exchange under the Affordable Care Act. The board must establish an exchange by January 1, 2014, as required by federal law.
Kathleen G. Nelson, MD, section chair
The Montana Section Annual Meeting was held in Big Sky, January 31–February 2. Tyler J. Bradford, MD, section vice chair, organized an excellent meeting with increased participation. Next year’s meeting will be held January 30–February 1, again in Big Sky. Please attend!
House Bill 28, championed by William J. Peters, MD, past District VIII chair and past section chair, passed the House and Senate unanimously. The bill allows for the review of maternal deaths through review teams established by the Fetal, Infant, and Child Mortality Review Prevention Act. Both ACOG and the Montana Medical Association were instrumental in the success of this bill. Read more about the Fetal, Infant, and Child Mortality Review Amendment Bill from Dr. Peters.
Timothy C. McFarren, MD, section chair
Congratulations to ACOG Immediate Past President James T. Breeden, MD, past District VIII chair, for a successful year as ACOG president and for organizing and running this year’s ACOG Congressional Leadership Conference, The President’s Conference (CLC), in Washington, DC. Nine eager and enthusiastic Nevadans visited Capitol Hill to lobby for women’s health at the CLC.
Congratulations to Keith R. Brill, MD, section vice chair, who will be the next president of the Clark County Medical Society, and to Florence N. Jameson, MD, who will be the next president of the Nevada State Medical Association.
Currently, Nevada is in the midst of its biennial legislative session. Bills of interest include:
- Assembly Bill 147, which requires the notification of patients regarding breast density and supplementary mammographic screening tests
- Senate Bill 69, which allows advanced practice nurses (including certified nurse-midwives) to practice independently
- Senate Bill 75, which states that if a patient becomes addicted to narcotics from a prescribing doctor, then the prescribing doctor and pharmaceutical company are liable for civil penalties and costs of rehabilitation
The deadline for applications for Nevada Section vice chair is June 1. Application information is available on the ACOG website.
Sharon T. Phelan, MD, section chair
The New Mexico Section has had an active few months. Cynthia Lewis, MD, accepted a position in Seattle and had to resign from her position as section chair. I moved up to fill the vacancy, and Michael S. Ruma, MD, agreed to serve as section vice chair. The remainder of our leadership has stayed the same. Although we are sad to see Dr. Lewis leave, at least she will remain in District VIII.
The New Mexico Section held its Annual Women’s Health Care Symposium in March. It was our 15th year working with the University of New Mexico (UNM) ob-gyn department and the New Mexico Chapter of the American College of Nurse-Midwives on the event. Michael L. Nix, MD, gave an outstanding keynote lecture on eliminating elective deliveries prior to 39 weeks’ gestation, which is a statewide initiative in New Mexico.
The section continues to support its members to attend ACOG activities. We sent five physicians to the ACOG Congressional Leadership Conference, The President’s Conference, in Washington, DC, this year. Due to an outstanding number of applications, we decided to support three University of New Mexico medical students to attend the Annual Clinical Meeting in New Orleans. We hope to share their experiences in the next issue of the Gazette.
Though small, our section is active in a number of national and district ACOG activities:
- Tony Ogburn, MD, is District VIII legislative chair, Region 5 CREOG council representative, and McCain Fellow
- Eve Espey, MD, is chair of the Committee on Health Care for Underserved Women and the Long-Acting Reversible Contraception Work Group
- I am chair of the Appeals Panel Committee and a member of the Safety Certification in Outpatient Practice Excellence for Women’s Health Program (SCOPE) board
- William F. Rayburn, MD, MBA, chair of ob-gyn at UNM, has worked extensively with ACOG to review workforce issues in ob-gyn and has presented locally and nationally on this topic
The New Mexico Section Maternity Mortality Task Force has been reinvigorated with support from the New Mexico Department of Health. We are currently reviewing matched birth-death certificates from 2009 to 2010. With this data, we hope to identify educational opportunities for obstetric providers in the state.
We held a successful Fourth Annual Advocacy Training and Lobby Day in Santa Fe in February, focusing on issues related to reproductive health. Specifically, attendees lobbied for a bill allowing pregnant and parenting teens to miss as many as 10 days of school for birth and for prerelease authorization of Medicaid for incarcerated individuals.
Dr. Espey hosts an annual dinner event for Fellows, Junior Fellows, and medical students to discuss reproductive health issues from both legal and clinical standpoints. This year’s dinner had 40 participants.
Luis B. Curet, MD, past District VIII chair and past section chair, and Jim Harbaugh, San Francisco 49ers head coach
We remain fortunate to have the services of Linda Siegle as our lobbyist. She is giving weekly updates to members on a number of issues related to ob-gyns throughout the legislative session.
The national ACOG movement to limit elective deliveries prior to 39 weeks has been actively embraced by the New Mexico Section. Our three major hospital systems all have programs with hard-stop policies in place to prevent these deliveries. More formally, UNM Hospital has partnered with the March of Dimes and the New Mexico Section to collect data to demonstrate the process of this clinical practice change and ways to overcome barriers to success.
This program has been launched with the efforts of a number of stakeholders at UNM Hospital, including Lawrence M. Leeman, MD, and me. We hope to take this program to other hospitals that have not yet implemented policies to limit elective deliveries prior to 39 weeks. We will do this after we have a better understanding of how to overcome the barriers to this type of change.
If you were watching the Super Bowl this year and saw Luis B. Curet, MD, past District VIII chair and past section chair, on your screen, it wasn’t your imagination. Dr. Curet’s son-in-law is an orthopedic surgeon for the San Francisco 49ers, and he and members of his family were there as guests of the team. Dr. Curet got to meet the 49ers’ head coach, Jim Harbaugh, at a special practice the day before the Super Bowl and was sure to give him some advice for the big game.
Marguerite P. Cohen, MD, section chair
The 21st Oregon Section Annual Meeting was held in Sunriver, April 5–7. We held a panel discussion with practitioners who had been abroad on medical missions and a skills lab where attendees were able to try out the latest laparoscopic and hysteroscopic instrumentation. The theme was “Finding Our Place in the World: A Local View of World Medicine.” Topics included:
- Political forces in play in our health care statistics
- Early interventions in child nutrition
- Circumcision in the US and around the world
- Controversies about HIV and breastfeeding
- Long-acting reversible contraception and contraceptive access
- Obstetric fistulas in the Third World
- Mesh complications in urogynecology
- Perils and pitfalls of international research
Though the meeting program was successful, we may need to look at changing the location and timing of future events. The number of meeting attendees continues to decrease. With the American Board of Obstetrics and Gynecology requiring a minimum of 25 hours of CME each year, the need for this type of CME activity has diminished.
We sent six delegates to the ACOG Congressional Leadership Conference, The President’s Conference, in Washington, DC, this year. We were able to meet with one senator and three representatives to discuss several issues on ACOG’s national agenda.
Much of our state legislative agenda concerns licensure and scope of practice for direct-entry midwives. A delegation of ob-gyns, certified nurse-midwives, and public citizens traveled to Salem to testify before the House Health Care Committee concerning House Bill 2997, which requires mandatory licensing of direct-entry midwives. We presented new statistics on perinatal mortality with home births. Our goals were to eliminate the exemptions to mandatory licensure in the bill and to add the phrase “low risk” to the scope of practice.
Epidemiologist Judith Rooks, CNM, testified with data from the Oregon Vital Records Office, shown in the table below. Two years ago, we lobbied for a change in Oregon birth certificates to list intended location of delivery, which allowed data to be collected as of January 1, 2012.
Stella M. Dantas, MD, District VIII secretary and immediate past section legislative chair, was also present at the hearing, as were representatives from the American College of Nurse-Midwives who supported our concerns with the bill.
Delegation of ob-gyns, certified nurse-midwives, and public citizens that testified before the House Health Care Committee concerning mandatory licensing of direct-entry midwives
Dr. Dantas worked with the Oregon Medical Association on Senate Bill 420, which originally required providers to notify patients if their mammogram showed dense breast tissue. The bill was amended to remove a mandate for insurance coverage and to have the facilities where the mammograms are performed send the notification instead of providers.
Gov. John Kitzhaber signed Senate Bill 483 into law in March. The bill establishes a new voluntary process for health care providers and patients to discuss and resolve adverse events prior to litigation. The Oregon Medical Association supported this legislation.
In the busy and chaotic world of American medicine these days, why would anyone give his or her time to an organization like ACOG? Well, part of the answer is mentorship. From the moment I started medical school at the University of Southern California in Los Angeles, I was pretty sure I was going into the field of ob-gyn. But I had never heard about ACOG as a medical student and still didn’t know about it as a resident at Oregon Health & Science University in Portland.
When I finished residency and joined Portland Obstetrics and Gynecology Clinic, PC, in 1985, I was joining a group with a long history of participation in organized medicine. Max Parrott, MD, who recently retired, was president of the American Medical Association (AMA). Raymond S. Corwin, MD, was ACOG vice president and District VIII chair; Richard Allen, MD, was president of the Multnomah County Medical Society and an AMA delegate; and Timothy A. Dooley, MD, was chair of ob-gyn at Good Samaritan Hospital. Getting involved was just part of what everyone did. So I did as well, mostly in hospital and health system leadership. Even as my family grew, I stayed involved.
My point is that we must build leadership from the ground up. We should encourage residents and medical students to participate in ACOG activities and provide funding for them to attend our meetings at the local, regional, and national level. Keeping residents and medical students engaged throughout their careers will reap great benefits to our organization.
Alan T. Rappleye, MD, section chair
Utah was blessed with relatively few major legislative battles in its last legislative session. There were no new challenges from midwives in the state. We are grateful for the information available on direct-entry midwives from the Oregon Section, which has been working on the issue of out-of-hospital birth safety for several years. It is nice to have some hard data to give our legislative representatives when new issues arise.
The Utah Section is participating in the Utah Perinatal Quality Collaborative. We have patterned the group after a similar project in Colorado, which has been successful. Our goal this year is to reduce preterm deliveries by 8%. We have all provider groups and hospital personnel on board. The March of Dimes has also been helpful in funding this project.
W. Lawrence Warner, MD, section vice chair, spearheaded a project in Utah to reach out to all outlying hospitals, especially rural hospitals. This outreach includes sending resources to the hospitals and personally visiting with hospital staff to provide encouragement and education. Dr. Warner has been disseminating reviews on various safety issues to our members every other month. Any District VIII member is welcome to this information. The section has had positive feedback on both of these projects.
We continue to battle for women’s rights and excellence in their care and look forward to ongoing success in these areas.
Judith M. Kimelman, MD, section chair
There is growing concern around the issue of authorization for gynecologic surgeries by Regence, an insurance company serving select counties of Washington. Delays in obtaining preauthorization for gynecologic procedures have increased significantly since November 2012 when Regence adopted new policies to determine authorization.
Specifically, Regence began using the Milliman Care Guidelines to help determine authorization for hysterectomies and other gynecologic procedures. These guidelines have led to denial of procedures until additional procedures and treatments have been tried. Physicians feel they are being told to subject their patients to unnecessary additional studies before authorizing hysterectomies and ablations and to recommend inappropriate therapies. There have also been significant delays in the appeals process, and it has become harder for groups to find out if procedures are authorized.
Washington State Ob-Gyn Resident Legislative Day participants
On April 2, Roger B. Rowles, MD, and I met with State Sens. Curtis King (R-Yakima) and Randi Becker (R-Eatonville), Senate Health Care Committee chair; State Rep. Eileen Cody (D-District 34), House Health Care and Wellness Committee chair; and representatives from Regence. Issues brought up by ob-gyns from across the state were discussed. We are now working with Regence to revise the guidelines and streamline the preauthorization process.
Washington state once again introduced a reproductive parity bill to preserve abortion coverage within all insurance plans that already cover maternity services when the Affordable Care Act goes into effect. Ob-gyns testified in favor of this bill in the House and Senate, but unfortunately after clearing the House this progressive bill died in committee in the Senate.
A bill requiring parental notification for abortion was introduced and defeated. Ob-gyns testified against this bill in front of overflow rooms in the Senate Law and Justice Committee.
The Fifth Washington State Ob-Gyn Resident Legislative Day was a success with almost 40 attendees, including seven residents, 12 medical students, and new attendees from the University of Washington and the community. Participants lobbied legislators on the reproductive parity bill, Medicare expansion, and budget issues.
The Washington Section brought its biggest group yet it to the ACOG Congressional Leadership Conference, The President’s Conference (CLC), in Washington, DC, this year, with a total of 15 physicians. Participants came from eight of our 10 congressional districts, and included two Junior Fellows, three young physicians, and five newcomers. Enthusiasm from section members has forced us to limit the number of interested candidates who participate in the CLC as we strive to bring a wide geographic distribution and a mix of first-timers and experienced attendees.
Susan M. Sheridan, MD, section chair
The Wyoming Section is assisting with the development of guidelines for the new EqualityCare Medicaid policy regarding elective induction, medical necessity, and provider incentive. The current plan is to retroactively audit practitioners and reclaim any money paid as of 2012 for elective inductions that were not performed within the policy guidelines. Given our state’s geographic and demographic challenges, such as provider call coverage and patient access limitations, this initiative will likely cause challenges in the state.
Calendar of events
Colorado Section Meeting
Contact: firstname.lastname@example.org or 303-355-8848
Annual District Meeting (with Districts V, VI, and IX)
Grand Wailea Resort
Contact: Linda Minor, 202-863-2488
Hawaii Section Meeting
Hapuna Beach Prince Hotel
Contact: Lori E. Kamemoto, MD, MPH, email@example.com
Montana Section Meeting
Contact: Kathleen G. Nelson, MD, firstname.lastname@example.org or 406-752-5252
Congressional Leadership Conference, The President’s Conference
Contact: Stacie Monroe, 202-863-2505