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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.