District IV Forum August 2018: News
District IV Legislative Update: What You Need to Know
District IV Legislative Cochairs Dr. Connie Bohon, FACOG, and Dr. Holly Puritz, FACOG
Major concerns for women’s health are currently focused at the national level.
HHS has proposed a change in the regulations for Title X funding. Contraceptives would no longer be required to be scientifically proven to be effective — a change that would allow places such as crisis pregnancy centers to receive federal funding for abstinence-only contraception counseling. The proposed regulations would also ban health care providers that receive Title X funding from giving women comprehensive information about their health care options, specifically information on where and how to access safe and legal abortions. Provider organizations such as the AMA, ANA, and ACOG and advocacy organizations such as Planned Parenthood and the National Partnership for Women and Families all oppose these and other proposed changes in Title X regulations.
ACOG has provided a flier to inform our patients, staff, friends, and colleagues how to join in opposition to these proposed changes. We have also provided information to membership on how to submit comments to HHS before the July 31 deadline and guidelines on how to engage on the topic on social media.
The ACOG State Government Affairs team has begun discussing options for state strategies to protect access to abortion, which has reached a crisis point because of the vacancy on the Supreme Court.
The Preventing Maternal Deaths Act/Maternal Health Accountability Act have not yet been reported out of committee, and the Ending Maternal Mortality Act, which would require the Department of Health and Human Services to establish a plan to address maternal mortality and severe maternal morbidity in the United States, has been introduced in the House. Recently Dr. Connie Bohon represented ACOG at a briefing on the Hill to discuss this legislation.
ACOG Virginia Section Update
Virginia Section Chair Dr. Chris Chisholm, FACOG
Greetings from the Virginia Section officers!
After an unexpected shift in seats in the House of Delegates in the 2017 election and the election of Dr. Ralph Northam as governor, the passage of Medicaid expansion in Virginia became a reality. Much work remains to be done to assure that the many newly eligible Virginians benefit from the health care now available to them.
A long-acting reversible contraceptive (LARC) pilot program administered by the Virginia Department of Health was included in the new budget. This program allocates $6 million from surplus federal funding to expand access to LARC methods to women in Virginia up to 250 percent of the federal poverty level. All interested parties are encouraged to view the attached program announcement and submit a response to the RFA by August 17.
The Virginia Neonatal Perinatal Collaborative recently reached its first anniversary! ACOG members and Virginia legislators Dr. Siobhan Dunnavant and Dr. Christopher Stolle were instrumental in securing funding for this group, which is actively addressing problems such as obstetric hemorrhage, maternal opioid use disorders, and neonatal abstinence syndrome. We encourage everyone to learn more about the collaborative and get involved!
Network with fellow ACOG members by joining us at the Annual District Meeting and in Richmond for the Annual Section meeting on Friday, October 12. You might find your next hire there!
At the end of October, I will complete a nine-year cycle as a section leader. Our Section is in excellent hands with your new elected leaders, Section Chair Dr. Aaron Goldberg, Vice Chair Dr. Ami Keatts, and Secretary-Treasurer Dr. Michael Moxley. It has been an honor to serve ACOG at the state level and I appreciate the support of our members.
South Carolina Data Included in CDC Maternal Mortality Report
South Carolina Section Chair Dr. Judy Burgis, FACOG
The South Carolina Maternal Mortality and Morbidity Review Committee submitted local data to the Maternal Mortality Review Information App (MMRIA), a new national system that allows South Carolina to be an active national participant in maternal death data collection process. South Carolina represented one of the states whose data was included in the CDC’s maternal mortality report from nine states that was published earlier this year.
Combining data from several states allows for more robust data and stronger recommendations. This report found that 63.5 percent of pregnancy-related deaths were thought to be preventable. The MMRIA also allows committees to begin to evaluate emerging issues in maternal death, such as intimate partner violence, substance abuse, and mental health problems, and helps estimate the potential impact of changes made to improve mothers’ health.
Our committee made a report of their findings, along with a summary of the nine-state report, to the Birth Outcome Initiative in April. We are hopeful that we will receive permanent funding and legislative authority to use South Carolina vital records to match death certificates with fetal death and live birth certificates in the 2019 session of the General Assembly. We would also like to thank the South Carolina Section for sponsoring lunch for the committee this year.
ACOG strongly supports S. 1112 and HR 1318, which authorized the CDC to fund state maternal mortality committees and would dedicate funding to our committee. Please consider contacting your elected officials to ask for their support!
South Carolina Legislative Update
Our two-year legislative session ended in May and featured an unprecedented amount of energy around women’s health care. Thank you to all of the society members who have personally reached out to their representatives for making a tremendous difference — especially the residents at all three programs who made a enormous effort to represent our specialty to our legislators.
In addition to the legislation moving through the statehouse, the McMaster administration has proposed some significant changes to the South Carolina Medicaid program and the Trump administration has proposed some significant changes to the Title X program. Our national partners at ACOG have helped us respond during the initial comment periods, and there will be additional comment periods coming later in the fall.
South Carolina Legislative Summary
The South Carolina Pregnancy Accommodations Act
This bill supports pregnant, postpartum, and lactating women by requiring that employers with more than 15 employees provide “reasonable workplace accommodations.” Examples include:
- Providing a private place other than a bathroom stall for the purpose of expressing milk
- Providing more frequent or longer break periods including bathroom breaks
- Providing job restructuring or light-duty work, if available
Advanced Practice Registered Nurses, Scope and Standards of Practice
This law changes several things about the relationship between physicians and advance practice registered nurses (APRN), including certified nurse midwives (CNM) and certified registered nurse anesthetists.
APRN are required to have a practice agreement with a physician actively practicing in South Carolina who agrees to work with and to support the APRN. The South Carolina Medical Association has an APRN practice agreement template available on their website, along with a brief explanatory memo for practices that need to revise or develop practice agreements.
The legislation removes the geographic requirements for the physician contracting with the CNM for the practice agreement (previously 45 miles). It also allows for consultation to be provided by telecommunication, instead of in person.
This legislation also allows APRN to prescribe Schedule II narcotics, although this must specifically be within the scope of the practice agreement
DID NOT PASS
In the last week of May, abortion legislation took center stage in the South Carolina Senate.
Legislators opposed to the proposed Unborn Child Protection and Dismemberment Abortion Act prepared for a lengthy debate with planned filibusters, and many South Carolina ob-gyns helped provide background information. Late into the night of the second day of debate, Sen. Brad Hutto (D-SC) offered an amendment to expand the bill’s reach to ban all abortions at all gestational ages instead of just the dilatation and evacuation procedure. The amendment passed 24 to 1, but was defeated just after midnight on Saturday and sent back to the Medical Affairs Committee.
This bill would grant full legal rights of personhood to a fertilized egg at the moment of conception. It was introduced specifically to outlaw all abortion, and is meant to be a direct challenge to Roe vs. Wade. It would also effectively ban the intrauterine device and the morning-after pill as contraceptive methods that potentially act after fertilization. Physicians harming a fertilized egg or embryo could be charged with murder or manslaughter.
Dismemberment Abortion Act (“Methods Ban”)
This law would introduce the term “dismemberment abortion,” which is defined similarly to a dilatation and evacuation procedure, requiring the use of grasping forceps, and which would be illegal if the fetus was living at the time of the procedure. Exceptions are made to allow the procedure in order to protect the life and health of the mother. Physicians violating this statue would be fined $10,000, imprisoned for two years, or both.
Abortion (“Reasons Ban”)
This bill would make it a criminal act to terminate a pregnancy if the sole reason is the presence of a fetal anomaly. Physicians would be responsible for determining a patient’s motivation for seeking pregnancy termination.
Ob-gyns are experts in women’s health care, and it is important that we are engaged in the legislative process, particularly when it impacts so many of our patients. Please contact the executive board with questions or comments.
COMBINED MEETING WITH ACOG
We are pleased to report that we will be meeting along with ACOG Districts IV and VI in Savannah, Georgia, from September 26 to 28 at the Hyatt Regency. Registration is available online through ACOG. The meeting will feature an outstanding educational program that will be helpful to your practice. On Friday, September 28, we will meet from 1:15 p.m. to 2:15 p.m. to discuss society business and upcoming meetings.
In addition to the business meeting, we will conduct a session on physician burnout. In this session we will define burnout, discuss the scope of the problem, and introduce specific strategies to build resilience and prevent burnout.
News from Around the State
Congratulations to Chris Robinson of Charleston, who was elected to the Society for Maternal-Fetal Medicine Board of Directors.
Congratulations to Paul Underwood, who, after retiring as the chair of the department of obstetrics and gynecology at the University of Virginia in 1999 and then going on to serve at the Medical University of South Carolina as the dean of admissions and in the department of obstetrics and gynecology, is retiring. He has educated countless people and touched countless lives, and we wish him well.
In February, the maternal-fetal medicine (MFM) division of the Greenville Health System established South Carolina’s second ACGME-approved MFM fellowship program. Their first fellow started in July, and interviews for the second fellow begin later this month. Dr. Amy Crockett is the fellowship director.