Update June 2012

ACOG District II Update
Update, June 2012                                        Vol. 27, No. 6
IN THIS ISSUE:                                                      FOLLOW US:
Eva Chalas, Chair's Report  Facebook   YouTube
Exec. On the Road Again
Final Countdown: Leg to Go Home
And Justice for All?  
WebMD is Your Patients' Favorite  
FREE Audio Conference
Members in the News
Junior Fellows/Young Physicians Speak

Eva Chalas, MD, FACOG, FACS

DII Takes on Obesity
The obesity epidemic continues to be one of the most serious health issues facing America today – impacting millions of people and their loved ones. According to 2007 estimates from the National Center for Health Statistics of the Center for Disease Control and Prevention, over 60 percent of U.S. adult women are overweight – and just over one-third of overweight adult women are obese. (Those with a Body Mass Index (BMI) of 25 to 29.9 are considered overweight. People with a BMI of 30 or more are considered obese).

I am happy to report that District II is about to embark on a new initiative that addresses obesity and women. Over the next several months, we will be working closely with our colleagues in New York State and beyond to provide ACOG members with educational and clinical information on the impact of obesity in our field and tools to share with your patients to help address this national epidemic.

The health risks of obesity are staggering. Obesity-related conditions range from heart disease, stroke and type 2 diabetes to certain types of cancer. From an ob-gyn perspective, the impact of obesity on patients is just as far reaching and can be devastating. On the obstetric side, adverse outcomes are more common in obese women, and recent research suggests increase risk of autism for the baby. In gynecology, obese women are at a far greater risk for numerous types of cancer including: 

  • Esophageal
  • Pancreatic
  • Colorectal
  • Postmenopausal breast
  • Endometrial
  • Ovarian
  • Renal 

Obesity is also a strong risk factor for urinary incontinence in adults and is strongly associated with pelvic organ prolapse.

Obstetricians and gynecologists have long recognized the need for intervention, but many of us have experienced frustration due to lack of interest and commitment by some patients. As the body of evidence of the public health hazards of obesity becomes more robust, and the costs of treatment of these secondary conditions becomes prohibitive, the timing for intervention seems perfect. Women rely on us for guidance, and the obstetrician-gynecologist is in an ideal position to help educate and direct women toward a healthier lifestyle. The impact of such intervention could be quite impressive, as our nation faces the highest rate of childhood obesity ever. Women, to a great extent, continue to make choices for the entire family, and thus changes in their lifestyle are reflected in those of their family members.


On the Road Again
There is nothing like warmer weather in the Great Northeast! Imagine how pleased I was to find myself taking a beautiful springtime trip to Buffalo last week accompanied by our Director of Communications and Outreach Sue Nigra. We visited the office of George Danakas, MD, FACOG to shoot a patient education video on smoking cessation. (Stay tuned for the piece – coming soon…) This was the third time in the past 6 months we’d been to Buffalo visiting our members – including Kevin Fitzpatrick, MD, FACOG, who leads a pilot site for our Women & Alcohol initiative.

Indeed our District II office has been very busy over the past 6 months, with staff members traveling across New York State to meet with ob-gyns and their staff. In April, our coding workshops took our administrative staff from Syracuse to Queens – where about 200 people took advantage of the course. The course was so popular, that we have already set the dates for 2013. Our Medical Education Department really hit the road this spring and visited five Level 1 and 2 hospitals in Norwich, Bronxville, Niagara Falls, Oswego and Warwick. The hospitals in these regions are taking part in our NMID initiative (Elimination of Non-Medically Indicated Deliveries Prior to 39 Weeks).

I’ve always felt great joy when we venture outside the Albany ACOG office to meet ob-gyns that we work for every day. Along the way, we learn so many things about their practices, their lives and why they love this great specialty. I look forward to many more trips across District II in the coming months.

Saint Augustine once said, "The World is a book, and those who do not travel read only a page." That is certainly the case, even when you travel around the Empire State. Venturing into the summer, I wish you and your family safe and happy travels!


End of Session Final Countdown
The NYS Legislature is preparing to wrap up in the next week; District II is pounding the pavement at the Capitol in Albany. With few remaining committee meetings scheduled, there is a rush of bills heading to the floor for votes. Lawmakers are anxious to get out of Albany and head home to campaign during the summer. We will continue to fight for legislation that is crucial to women and to your practice:

Dense Breast Notification (ACOG DII opposes) The Assembly bill has been revised to eliminate the insurance mandate for additional screenings. While the legislation passed the Assembly Health Committee, it no longer has a Senate sponsor.

Collective Bargaining (ACOG DII supports) Allows physicians to negotiate with insurance carriers for fair rates. This bill was put on the Senate health agenda earlier this week and PASSED because of your advocacy.  Click here to read more. Please help us pass this bill by contacting Senate Majority Leader Dean Skelos at 518-455-3171 / skelos@nysenate.gov and contact the Assembly Chair of the Ways and Means Committee, Denny Farrell at 518-455-5491 / Farrelh@assembly.state.ny.us.

Reproductive Health Act (ACOG DII supports) Guarantees that every woman makes her own personal, private health care decisions with her physician. Click here to read more. Last week, District II participated in a Bi-partisan Pro-Choice Women’s Caucus and a Senate Democratic Women’s Forum on health issues. District II addressed the important relationship between a woman and her ob-gyn and the ability to discuss personal and private health care decisions. New York must continue its long and proud legacy of protecting women's health and access to the full range of reproductive health care. Since 1970 when abortion became legal here, New York has led the way by ensuring a woman can make her own personal, private health care decisions. District II will continue fighting for passage of the Reproductive Health Act.

Telemedicine (Passed both houses of the Legislature) Click here to read more. The State Senate and Assembly this week passed legislation to streamline the process to credential health care practitioners providing telemedicine services to patients in New York State. The bill, introduced by the Legislative Commission on Rural Resources, allows a hospital that wishes to contract for practitioner services via telemedicine to arrange for the sharing of credentials verification paperwork used for granting hospital privileges. It also allows the hospital receiving the telemedicine services to rely on the hospital providing the service to carrying out mandated peer review and quality assurance activities.

Prescription Reporting (Passed both houses of the Legislature) Click here to read more. New York officials have announced a deal on legislation to establish tighter online oversight of prescription drugs. The goal is to curb the black market fueled by painkiller addictions and doctor shopping. The measure will make New York the first state to establish mandating that physicians consult a database of a patient’s prescription history before prescribing most controlled substances. It would also require reporting by pharmacists when such prescriptions are filled.

Streamlining Doctors Across NY Statutory changes were made in this year’s state budget to improve and streamline the Doctors Across New York (DANY) program. The application process going forward will be non-competitive, with a 30-day turnaround time for review of applications. DOH established a workgroup that included District II. The group has developed a streamlined, single application process to be used for both DANY and the physician loan repayment program. The new application will be able to be submitted electronically.

Cuomo Seeks to Reinvest $10B in Health Care Reforms Governor Cuomo has announced the state's intent to request a federal waiver related to Medicaid Redesign Team (MRT) savings, implementation of the MRT action plan, and to prepare the state for national health care reform. Click here for more. For more information on the waiver, click here.

District II will have a complete wrap up of the legislative session in the August newsletter.


Ronald Uva, MDRonald Uva, MD, FACOG
Vice Chair
Roughly four years ago our midwife (CNM) on call recognized a potential difficult delivery and called one of my partners who indeed encountered a shoulder dystocia (baby was not macrosomic) and successfully completed the delivery with the appropriate maneuvers. A very mild erb’s ensued and after the usual long delay a lawsuit was filed. After the customary depositions, etc. it went to court two weeks ago. MLMIC represented my partner and midwife. The child was in court and had such a minimal dysfunction that physical therapy alone had been the treatment modality and no request was made for lifelong disability. In court the expert witness for the defense was completely flummoxed by the plaintiff attorney and even said: “I don’t know what nuchal arms are.”

Ultimately the jury was instructed by the judge that in order to find malpractice there must be an injury, negligence, and the negligence must be a proximate cause of the injury. Upon deliberation, the jury returned and stated that they had found negligence (apparently “right” was written in the record when it should have been “left”) but they did not believe that this negligence was proximate cause.

Should be the end, right? Thank you, you did your duty, go home. Not even close.

The jury was polled and found to have voted this way 5 to 1. The plaintiff attorney was outraged and made quite a scene. The jury foreman stated that they wanted to give money to the child for future physical therapy (175K). The jury was then instructed to go back and determine that the negligence was proximate cause – which they did.

While MLMIC is not going to appeal the case, the midwife involved is so devastated that she is moving to Tennessee to a birthing center – further eroding our ability to care for the underserved. The doctor involved is licking his wounds – and is happy that the child has no injury that will affect its life. (The injury was so minor that the plaintiff attorney did not even seek pain and suffering money).

Federal lawmakers feel that tort reform will happen at the state level. Unfortunately, liberal states such as New York will probably not see reform in the near future. I think that this case is an exemplary example of the need for District II’s long sought - after neurologically impaired infant (no-fault) proposal. While the proposal has yet to become a reality – we can hope for the future – and continue fighting the fight in Albany.


Where do you think your patients get their health information on the web? WebMD is the winner of May's survey, garnering 73.9% of the response rate.


Working to Eliminate Mother-to-Child Transmission of HIV
While New York State has had a significant decline in the number of HIV-exposed births, there are still approximately 500 HIV-positive women who deliver HIV-exposed newborns each year. In 2010, the AIDS Institute assembled an advisory panel of HIV-positive women and experts with expertise in caring for HIV-positive women and their children. Their goal was to develop recommendations to further eliminate, and eventually eradicate, mother-to-child transmission of HIV in New York State.

From these recommendations, the AIDS Institute developed a New York State Strategic Plan for Elimination of Mother-to-Child Transmission of HIV, as well as a companion User Guide. Click here to read both documents – and for more information on this effort.


Please join us Wednesday, August 15, 2012 for a FREE audio conference on the MOREOB Program. MOREOB (Managing Obstetrical Risk Efficiently) is a three-year, comprehensive patient safety improvement & professional development program for providers and administrators in hospital obstetric units. To register, click here.


District II Fellows Attend the ACOG Leadership Institute
The ACOG Leadership Institute offers a series of workshops with highly recognized physicians, lawyers, journalists, and leadership experts, to give ob-gyns the tools they need to accomplish the goal of Leading Transformation in the 21st Century for Women's Healthcare. District II Fellows who participated in the Leadership Institute program this past April give their testimonials below.

Peter Bernstein, MDPeter S. Bernstein, MD, MPH, FACOG
What a great experience I had at the ACOG National Leadership Institute. I learned all sorts of important leadership skills, got to network with interesting people from around the country, and get insight into my own personality and talents. This course will allow me to be more effective at what I do every day.

Hartaj Powell, MDHartaj K. Powell, MD, MPH, FACOG
How do I handle change? Do I communicate well with others? These are just a few of the insightful questions that are addressed at ACOG's Leadership Institute where I got a unique opportunity to reflect and understand who I am, what makes me tick, and how others perceive me. The Institute arms you with this knowledge and then gives you the tools to enhance your ability to effectively interact at the workplace to promote positive change. I met inspiring colleagues and learned from an incredible cast of highly regarded teachers. It was a privilege to have attended and I am so grateful to District II for allowing me this opportunity.

John Vullo, MDJohn Vullo, DO, FACOG
The ACOG National Leadership Institute was one of the most useful and enlightening conferences I have ever attended. It provided skills, valuable information and personal experiences that allowed for self discovery to enhance our professional development. The conference was well organized, well designed, and inspirational. The faculty panel made up of professors, lawyers, and leadership mentors was diverse and outstanding. The group of participants from around the country made the experience unforgettable. The conference is an excellent example of ACOG’s commitment to its leaders and members. I recommend it highly and thank ACOG for the opportunity to participate.


Omar Duenas, MD2012 Gerald and Barbara Holzman Stump the Professors Session
This past May 5th during the Annual Clinical Meeting in San Diego, California three cases were selected from submissions received across the country and overseas to be presented at the very prestigious Gerald and Barbara Holzman Stump the Professors Session. Omar F Duenas, MD from Bronx-Lebanon Hospital was selected as one of the three semi-finalists with his case " The Phantom Beta." After multiple questions by the Professors - Dr. Nanette F. Santoro and Dr. Cynthia I. Macri - a tie was declared. Congratulations to Dr. Duenas for being selected as one of the top three submissions!

John Gibbons Medical Student Travel Award
This year District II selected four medical students to participate in the John Gibbons Medical Student Travel Award. These medical students, who have an interest in specializing in obstetrics and gynecology, received the award to help offset their cost to attend the 2012 Annual Clinical Meeting in San Diego, California. To read about their ACM experiences, click here.