California's New Statewide Poison Control System Begins Operation
California’s New Statewide Poison Control System Begins Operation
by Kent Olson, M.D.,
Medical Director of the California Poison Control System; Clinical Professor of Medicine, Pediatrics and Pharmacy at the University of California at San Francisco
These cases represent common calls to poison control centers and to pediatrician’' offices and clinics. In each case, a careful evaluation is needed regarding the exact substance and formulation involved, the circumstances of the exposure and potential dose.
Beginning January 1, 1997 health professionals and the public in California will have access to a new, centralized statewide poison information service, the California Poison Control System (CPCS). Operated by the University of California, San Francisco School of Pharmacy, the CPCS will provide immediate access 24 hours a day to emergency information about poisonings in the home, hospital, or the environment. Up to now, poison information services have been provided by a loosely associated network of six independently-operated regional poison control centers (PCCs). These centers manage a total of over 250,000 poisoning cases every year in California. However, the absence of central coordination of the PCCs has resulted in inefficiency (redundant coverage at night, for example) and inconsistent treatment recommendations, as well as difficulty in obtaining secure and stable funding. Last year, the State Emergency Medical Services Authority released a Request for Proposals to develop a consolidated statewide poison information system, and the UCSF proposal was selected. Funding has been secured for the first two years of operation of the CPCS, which began consolidating its services on January 1 and will serve the entire State by mid-February. (The Los Angeles Regional PCC, which formerly served 8 counties in the Southern California region, has agreed to continue serving LA County during a 6-week transition period.)
The California Poison Control System will utilize a single statewide toll-free hotline for the public (1-800-8-POISON, or 1-800-876-4766) and a separate toll-free number for health professionals (1-800-411-8080). These new numbers will become effective on February 12. However, calling any existing regional California PCC toll-free number will result in automatic electronic forwarding to the new service, so use of these new numbers is not required yet. Telephone consultation will be provided by a team of poison information providers and certified specialists in poison information, including specially trained nurses and clinical pharmacists. Medical back-up will be provided by a panel of the State’s physicians who specialize in medical toxicology.
We are excited about this new service, and encourage you to call the CPCS when you have any questions about a poisoning or drug overdose.
Lucy S. Crain, M.D.
With a half year left until the end of my term as president of Chapter 1, I’ve an increasing sense of urgency about things intended and yet undone.
While our Chapter’s efforts on issues of tobacco and youth, violence, child advocacy, legislation, and managed care have been significant, the problems are ongoing and will not be resolved within the foreseeable future. Having been instructed from an early age to see tasks through to their completion, foundation building for ongoing projects which may never be truly completed is the antithesis of my upbringing. Nonetheless, much of what we do in our work and in our lives as pediatricians, as parents, as individuals, is necessarily time limited, and with few exceptions, time seems to fly faster each year (whether having fun or not).
Opportunity is crucial in presenting tasks and, hopefully, completing at least some of them. Having had the honor and, at times, the challenge, of being chapter president for 18 months has afforded me the opportunity to work closely with a superb Board of Directors, an outstanding Executive Director, and to become better acquainted with many of our members and with most of our committees. I’m now in a better position to see our Chapter’s strengths, as well as many of its shortcomings. While our AAP Chapter has just over 2000 members, and is one of the largest in the U.S., the real work of our Chapter is done consistently by about 50 people – the members of our Board, including the Members at Large (the liaisons to the “grass roots” comprised by the 11 regions within our chapter), the officers and administrator, and a handful of remarkable committee members and chairs. I had hoped that more of our members and our committees would take advantage of our Chapter achieving “on line” status last year, but the advent of electronic conferencing in lieu of actual committee meetings has not yet been realized to full advantage. On the other hand, certain committees stand out as exemplary models of working to full advantage. That was demonstrated at our annual winter meeting: an extraordinary demonstration of the tremendous thought, planning, and effort on the parts of our Medical Education Committee, our chapter Executive Director, and the topnotch speakers we were privileged to hear. Those included Dr. Richard Jackson, former chair of Chapter 1’s Committee on Environmental Health and now director, National Center for Environmental Health of the CDC. We also had opportunities to hear Dr. Susan Cummins, Acting Chief of the State Lead Poisoning Prevention Branch, former chair of our Environmental Pediatrics Committee and chapter treasurer; Dr. Cathy McDonald, chair of our Chapter’s Task Force on Tobacco and Youth; and a group of equally outstanding speakers bringing us up to date on environmental health issues. We had 100 in attendance, a mere third of our record attendance for the annual winter meeting, but not too bad for a CME meeting on a lovely early December Saturday ...not too good for a meeting of this caliber, either.
The California Poison Control System will utilize a single statewide toll-free hotline for the public (1-800-8-POISON, or 1-800-876-4766) and a separate toll-free number for health professionals (1-800-411-8080). These new numbers will become effective on February 12. However, calling any existing regional California PCC toll-free number will result in automatic electronic forwarding to the new service, so use of these new numbers is not required yet. Telephone consultation will be provided by a team of poison information providers and certified specialists in poison information, including specially trained nurses and clinical pharmacists. Medical back-up will be provided by a panel of the State’s physicians who specialize in medical toxicology.
We are excited about this new service, and encourage you to call the CPCS when you have any questions about a poisoning or drug overdose.
President’s Column
Lucy S. Crain, M.D.
With a half year left until the end of my term as president of Chapter 1, I’ve an increasing sense of urgency about things intended and yet undone.
While our Chapter’s efforts on issues of tobacco and youth, violence, child advocacy, legislation, and managed care have been significant, the problems are ongoing and will not be resolved within the foreseeable future. Having been instructed from an early age to see tasks through to their completion, foundation building for ongoing projects which may never be truly completed is the antithesis of my upbringing. Nonetheless, much of what we do in our work and in our lives as pediatricians, as parents, as individuals, is necessarily time limited, and with few exceptions, time seems to fly faster each year (whether having fun or not).
Opportunity is crucial in presenting tasks and, hopefully, completing at least some of them. Having had the honor and, at times, the challenge, of being chapter president for 18 months has afforded me the opportunity to work closely with a superb Board of Directors, an outstanding Executive Director, and to become better acquainted with many of our members and with most of our committees. I’m now in a better position to see our Chapter’s strengths, as well as many of its shortcomings. While our AAP Chapter has just over 2000 members, and is one of the largest in the U.S., the real work of our Chapter is done consistently by about 50 people – the members of our Board, including the Members at Large (the liaisons to the “grass roots” comprised by the 11 regions within our chapter), the officers and administrator, and a handful of remarkable committee members and chairs. I had hoped that more of our members and our committees would take advantage of our Chapter achieving “on line” status last year, but the advent of electronic conferencing in lieu of actual committee meetings has not yet been realized to full advantage. On the other hand, certain committees stand out as exemplary models of working to full advantage. That was demonstrated at our annual winter meeting: an extraordinary demonstration of the tremendous thought, planning, and effort on the parts of our Medical Education Committee, our chapter Executive Director, and the topnotch speakers we were privileged to hear. Those included Dr. Richard Jackson, former chair of Chapter 1’s Committee on Environmental Health and now director, National Center for Environmental Health of the CDC. We also had opportunities to hear Dr. Susan Cummins, Acting Chief of the State Lead Poisoning Prevention Branch, former chair of our Environmental Pediatrics Committee and chapter treasurer; Dr. Cathy McDonald, chair of our Chapter’s Task Force on Tobacco and Youth; and a group of equally outstanding speakers bringing us up to date on environmental health issues. We had 100 in attendance, a mere third of our record attendance for the annual winter meeting, but not too bad for a CME meeting on a lovely early December Saturday ...not too good for a meeting of this caliber, either.
Okay, enough! It’s not my intent to nag, but to point out that you have two opportunities per year to take advantage of the bargain rate, top notch CME programs produced by our Chapter. The next is our Memorial Day meeting May 24-26 in Monterey.
You have daily opportunity to phone Beverly Busher at 415-459-4775 and tell her which committee you wish to join (and actively participate in). One of the most important opportunities had by the chapter president is that of proposing chapter members for appointment to national AAP Committees or Councils. Those nominations must be received by National by mid-February. You have annual opportunity to tell your Member at Large or a chapter officer that you’d like to be considered for a chapter office or for a national committee nomination. Opportunities like these are few and far between for most people. This is your opportunity to become proactive and to use the clout of the Academy in effecting meaningful advocacy for pediatricians and for children.
The Chapter and the AAP need your active participation, and I can promise that you will benefit from the experience. And you just might be able to help complete some of those ongoing tasks.
Mergers and Managed Care
by Tom Long, MD
Who would ever have thought that Stanford and U.C. could merge as one? In the 25 years that I have been in California, this is one union I never would have anticipated. These two Northern California medical institutions have been such fierce competitors.
On the corporate side of medicine, the talk is of acquisitions. No one is surprised when some established hospitals close or others merge like Stanford and University of California. Some now own their own supporting medical groups.
Apart from the obvious financial gains, a doctor easily could feel like one of those professional athletes who is bought and sold, and traded again. It is hard for any doctor to know what to do when there is so many changes in the current style of practice of medicine.
From early on in my solo practice, I remember a favorite book called “In Search of Excellence.” One chapter called “Stick to the Knitting,” encourages individuals to do those things they know and do well. Many outstanding corporations like Walmart , or successful individuals like Peter Ueberroth and former Surgeon General C. Everett Koop, M.D. understand this principle too. In these times of change, I would encourage you to stay focused on the very thing pediatricians do so well – take the best care of children.
Some among us would say, “That’s obvious.”; others might say, “How self serving.” Yet pediatricians add value to any managed care system.
Some of you may have seen a waiting room brochure from the American Board of Diplomats. It recounted well the qualities assured by the term Fellowship, certified by the American Board of Pediatrics. In particular, it is the verification of the successful completion of a comprehensive examination following very specific and intensive training. It evidences clinical competence and is a testimony to professional and ethical behavior.
Right on target too is the following excerpt from Sam Levenson’s “Ethical Will and Testament to his Grandchildren and Children Everywhere,” I found it in the recent “Issues in Ethics.” It reads, “I leave you not everything I never had, but everything I had in my lifetime: a good family, respect for learning, compassion for my fellow man, and some four-letter words for all occasions: words like help, give, care, feel and love.” These are qualities that I see every day in the action and service of my pediatric colleagues as they tend to the needs of their patients and their families.
Although some of our intensive hospital-based training can conflict with today’s ambulatory style of practice, most pediatric programs provide an ample well-child experience. Pediatricians have long fit into the style of HMOs and managed care and their advocacy for preventive health care.
Some pediatricians find their role better suited to administrative and management duties while their colleagues concentrate on patient contact and care. Managed care often forces combining solo practices and a more complex management environment.
Today some things are better. We hospitalize fewer patients. We discharge patients sooner and usually with better home care. There is still much room for improvement.
Once again I will say, we pediatricians are the most highly trained and effective advocates for children. In this managed care world there is more than ever a need for anticipatory guidance, preventive health care crisis intervention.
With one strong conscientious voice, a voice for quality, we must speak up for children. We are guided by those four-letter words which Sam Levenson bequeathed to his children.
Our Board gives us credibility. No physician group is so well prepared to affect pediatric care. Stick to do what you do well. Although we still live with the uncertainty of mergers and acquisitions, there is still a need for your pediatric services. Managed care needs the quality found in the ideals promoted by the Fellows of the American Academy of Pediatrics.
Tobacco advocacy continues to be very important in 1997. Many pediatricians have written letters to the Governor asking him to protect Proposition 99 funds and to ask the health department to immediately implement a hard-hitting media campaign that will help youth and adults to say no to tobacco.
Actions to Take
At the State level
“Nicotine Soundbites” is not being aired. (This is a wonderful TV spot that shows tobacco industry executives testifying in Congress that they don’t think tobacco is addictive. It ends with, “Do they think we’re stupid?”) The campaign this year is focused on youth. This type of media is just the type of hard hitting message that will help to shift adolescent rebellion against the industry rather than adults and will also reach adults – the perfect combination.
At the County level
If you want to become active with tobacco in your community contact your County Tobacco Control Division. Ask them to put you on their mailing list and you will be informed of new tobacco initiatives. Ask them to let you know what activities they will be having for World No Tobacco Day, May 31, 1997.
At the Federal level
Write to your senators and representatives asking them to make a firm commitment to the new FDA tobacco regulations to protect our kids from the most insidious drug in the country. Tobacco is still viewed by many as safe yet it kills 2.5 times as many people every year as alcohol and all other drugs combined. The tobacco industry, despite its claims to the contrary, actively develops strategies to recruit our kids. There will be efforts by the tobacco industry to undercut these regulations through federal legislation.
Pediatric Practice on the World Wide Web
by Mark M. Simonian, MD
The World Wide Web and the Internet are reaching into our lives. Pediatricians can now expect their practice styles to be challenged.
The Internet has long been recognized as a route for communications between the educational and medical communities. Now growing numbers of the general population can gain access. We should expect an increasing interest in using this media to spread information about pediatrics, general health and preventative topics, data about practice populations, and research questions.
There is also another area where physicians and health professionals are experimenting – extended office practices. Web sites are being used to present an extension of a doctor’s practice by soliciting patients or treating patients.
With modern technology doctors can receive a form or e-mail that registers a patient, collects history, and completes financial information. Symptoms are described at one end, and the health provider submits his or her thoughts about the possible problem and dispenses advice regarding treatment. There is no opportunity for inspection, palpation, auscultation, or manipulation. At the end of the interchange, a fee will be collected through another newly devised electronic mechanism.
This interaction between patient and physician through the Internet is different than the same sequence completed through a telephone when on call or during office hours. On the telephone, general information is expected from the covering physician, nurse, receptionist, or primary physician. Care providers give advice about a range of complaints voiced.
For most situations the actions are holding in nature only. Directions are to followed-up in the office at a certain time, perform some simple task at home, or clarify an already diagnosed condition or prescribed medication.
For the Internet client, the options of a follow-up examination are not physically possible and sometimes not desired by the patient or doctor.
Doctors can provide quick answers and receive fast funds from a Mastercard or Visa account. Some might describe this as modern American capitalism at its best or medicine at its worst.
Currently there is no legal precedent for this new venture into medicine. The California Medical Association has no guidelines or recommendations at the time of this writing.
The California Medical Board legal counsel says that these are issues they are looking at with some consideration at legislative initiatives to bolster current standards and laws. (See the section on legislative changes in 1996 later in this issue.)
The American Academy of Pediatrics has not issued any guidelines or policies to its members.
Norcal Mutual provides malpractice coverage for most physicians in Northern California. They do not provide malpractice coverage for any physician who does not give good faith physical examinations for patients that receive ongoing care or treatment. Specifically, they will not cover most physicians who conduct their practice by the way of the Internet except that they may advertise their services or give general health information.
This now leaves physicians without very many specific guidelines for their use of the Internet to conduct business. Although all the agencies contacted recognize that “Telemedicine” is an increasingly considered area for the consultant and tertiary care center referral, there is little support by the licensing bodies and malpractice carriers for this activity.
For those physicians interested in conducting their pediatric practice by means of the Internet, they should be wary and go slow. Pediatricians might be on the leading edge of technology, but there are not many legal or medical policies to guide them. I hope that the Section on Computers and Other Technologies or other appropriate Section will show interest in developing some policies on “Telemedicine” and describe what complications might exist with licensing bodies, malpractice issues, and practice standards.
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Board Certified pediatrician with excellent credentials, available to do locum tenens. Speaks French, Spanish, and will travel. Ann Troy, M.D. 707-253-2915.
Green Journal Now On-line
Beginning this year, PEDIATRICS will publish 6-10 new peer-reviewed articles on-line. The articles, which can be read in full only via the Internet, will be abstracted in each hard copy issue of the journal (printed on special green pages).
Eventually, PEDIATRICS electronic pages will incorporate special features such as powerful search capabilities, on-line classified, special previews of upcoming issues, and hyperlinks for extended navigation.
To access the pages you need an Internet connection and a World Wide Web browser. The site is located at http://www.pediatrics.org.
Articles this month include:
[Remember that our Chapter was the first in the nation to have its own Internet site. We also have our newsletter on-line with up to date information on our Chapter members and activities with links to many of the sites mentioned in these articles.]
New AAP Growth Hormone Guideline
Growth hormone (GH) is ethically acceptable for children who meet specific criteria, according to a new statement in the January issue of Pediatrics. These include children with classic GH deficiency, girls with Turner’s syndrome, children with chronic renal insufficiency awaiting renal transplants, or children whose extreme short stature interferes with activities of daily living. The AAP warns there could be unknown long-term risks concerning GH use, and treatment could result in no or insignificant increase in final height. Also, there are commercial efforts targeting parents which present GH as an avenue to improved athletic ability and other forms of social “success” for their children. The therapy can cost up to $50,000 a year and last up to five years. The statement calls on pediatricians to fulfill their traditional role of protecting their patients from harm, including refusing to administer burdensome and nonbeneficial treatment. It concludes: “It would be better to eradicate the bias against short individuals than to attempt to eradicate the condition of being short.”
"Fruit juice makes you short and fat"
Children who drink at least 12 ounces of fruit juice a day are more likely to be obese and short, according to researchers at Mary Imogene Bassett Research Institute and Columbia University (January Pediatrics). Of children studied who drank at least 12 ounces of fruit juice per day, 8 of 19 (42%) were short and 10 (53%) were in the 75th percentile for body mass index (weight divided by height squared). Of those who drank less than 12 ounces, 21 (14%) were short and 47 (32%) were in the 75th percentile for BMI. There were no other significant dietary differences between those children who were overweight to those who were not.
AAP Responds To TV Industry Ratings System
The AAP says that content-based systems, such as those developed by the Recreational Software Advisory Council (RSAC) and the cable system, are effective in helping parents make informed decisions about program selections. The RSAC guidelines address sex, violence and language by utilizing a symbol for each category.
The AAP has long recommended parental monitoring of TV watching in policy statements Media Violence; Sexuality, Contraception and the Media; and Children, Adolescents and Television. The Academy cites the following statistics:
For a single free copy of a brochure on television, send a self-addressed stamped business-size envelope to: AAP, Dept. C: Television & the Family, PO Box 927, Elk Grove Village, IL 60009-0927.
Notice
The Media Resource Team of the AAP Committee on Communications has been funded by California Chapter 2 to make occasional awards to the makers of television programs and films which address themes and policies of importance to the pediatric community. Television programs to be recognized may be national or local. They may be dramatic programs, feature news or feature films. If you would like to nominate a program please record the time, date and full name of the program, the producer if possible, and the channel on which it was broadcast. If you can supply a tape of the show it will be most helpful. Send nominations and tapes to:
David N. Lyon-Buchanan
Executive Liaison, Media Resource Team
Committee on Communications
American Academy of Pediatrics
30 North Raymond, Suite 414
Pasadena, CA 91103
For questions, call
818-440-9954,
FAX 818-796-0243.
e-mail: dlbautore@aol.com
Other Announcements:
Lane Tanner and Eugene Sharkin are continuing their Collaborative Office Rounds in behavioral and developmental pediatrics for community practitioners. Beginning in January, this program, now funded by a grant from the federal Maternal and Child Health Bureau, will meet every 3 weeks, in the evening, for review of behavior/development topics and cases. The group is expected to remain stable throughout the year. For information, contact Dr. Tanner.
Friends of Children Fund
Friends of the Children Fund would like to recognize the Chapter and District members who have joined the Academy's Della Robbia Club. The Della Robbia Club is for those people who contribute $250 or more to the Friends of the Children Fund. The list provided includes those members for 1997 to date:
Gold Members:
Christopher Lind-White, MD
Melvin H. Schwartz, MD and Josephine R. Schwartz
Bronze Members:
Myles Abbott, MD and Ida Abbott
Kathryn Bolton, MD
Marta Fajardo, MD
Bruce Gach, MD
B/D Harvey Charitable Gift Fund and Dr. and Mrs. Birt Harvey
Tada Sato, MD
Susan Strahosky, MD
Ritalin Prescription Doubles
Between 1990 and 1995 there was a 2.5-fold increase in the use of methylphenidate (Ritalin) to treat attention deficit hyperactivity disorder (ADHD) in the U.S. (December, Pediatrics). Media reports of a six fold increase in the medication were exaggerated. “The Drug Enforcement Administration production quotas for methylphenidate that show a six fold trend are misleading because these quotas are not based on actual patient usage,” according to researchers from Johns Hopkins University School of Medicine in Baltimore, Baltimore County Health Department and the University of Maryland at Baltimore. They examined regional and national databases to determine the prevalence of methylphenidate treatment. Approximately 1.5 million 5 to 18 year-olds were receiving methylphenidate treatment for ADHD in mid-1995. The researchers report this increase is due to three factors: an increase in duration of treatment; more girls, adolescents and inattentive youths being treated; and, an improvement in the public image of the medication.
Academy Calls For Music Labeling System On Offensive Lyrics
The music industry should develop a system of music content-labeling regarding violence, sex, drugs or offensive lyrics, if not voluntarily then by mandatory regulation, according to the AAP revised policy statement, Impact of Music Lyrics and Music Videos on Children and Youth. “The AAP strongly opposes censorship,” the statement says, “at the same time, the AAP is greatly concerned that negative behavioral messages” are promoted in music. Teens watch a half hour to two hours of videos daily. Seventy-five percent of concept music videos (as opposed to concert videos) contain sexually suggestive material. More than half contain violence, including acts committed against women. And many videos glamorize alcohol and tobacco use. “As with other media,” the statement says, “television exposure to content involving sex, violence, or drug use should be regulated by parents in accordance with the age and maturity of their children.”
10 New Year's Resolutions from the American Academy of Pediatrics
1. Help reduce tobacco use among children, adolescents and young adults. If you smoke, quit. If you can’t quit, smoke outdoors to protect your child against secondhand smoke.
2. Support the Food and Drug Administration’s regulation to limit tobacco access and use by teenagers. Spread the word to U.S. senators and representatives.
3. Good nutrition makes for a healthy child. Be sure that your child eats regularly and has a variety of nourishing foods.
4. Everyone should buckle up in the car. Help avoid the leading cause of disabilities and death of children before you turn on the engine.
5. Lower the risk of Sudden Infant Death Syndrome (SIDS) in newborns. When infants are put down to sleep, they should be placed on their back.
6. Make sure that every child is immunized on time. It’s the best defense against many dangerous childhood diseases.
7. Urge state officials to safeguard Medicaid benefits for children. This important health care safety net covers 1 in 4 children.
8. Give your home a safety check. Install smoke detectors, store poisonous substances out of your child’s reach and know how to access emergency services.
9. Help ensure that children are “media literate.” Parents and teachers should teach children how the media work, especially in commercials and TV programming.
10. Prevent violence by setting a good example for your children. Remember that words can hurt. Give your kids plenty of love and attention.
New Pamphlets Available from the American Academy of Pediatrics
Toy Safety
The Teen Driver
Annual Chapter Forum 1997
Be an Advocate for Kids
From Lucy Crain, MD
Once again the Academy will hold its annual Forum to consider resolutions by the membership for action by the AAP Board of Directors. The Forum provides an opportunity for all pediatricians to voice their concerns, recommendations, and insight on issues affecting children and pediatric health care. This often results in significant AAP policy direction. At the Forum, which will be held on September 12-14, 1997, Presidents and Vice Presidents of all chapters will vote on all written resolutions submitted by June 1, 1997. Those resolutions which are adopted will be forwarded to the AAP Board of Directors, who will devise an action plan for each. We urge you to send in your ideas. This is the time to make your voice heard.
I will look forward to assisting you in composing individual resolutions. Just call me at (415) 476-4382. Written resolutions should be forwarded to me at the Chapter office at 900 Fifth Avenue, #204, San Rafael, CA 94901-2928 or faxed to (415) 459-0617. The deadline for submission of this year’s resolutions is June 1, 1997.
Format for the Resolutions is:
Title: _____________________
Submitted by: ______________
Date: _____________________
Disposition: ________________
Whereas, __________________
Whereas, __________________
Resolved: __________________
Resolved: __________________
Refer to: Annual Chapter Forum
Author: ____________________
Telephone number: ___________
From The Behavioral/Developmental Pediatrics Committee
by Brad Berman, M.D.
Issues discussed included:
Advocacy: Specific issues such as the growing use of Ritalin, and more global aspects of child health and welfare were discussed. Dr. Cummins noted that 50 to 60% of new births in California are currently Medi-Cal eligible. Drs. Cummins and Tanner briefly described the legislative workshop in Sacramento in September (Ed.: see last Chapter Newsletter).
Coalition Building: Drs. Berman and Tanner will contact the chairs of the Disabilities, School Health, and Adolescent Medicine committees within the next few months to sound them out regarding mutual interests and activities and perhaps convening joint meetings.
Special Needs: A specific project proposed is an informational exchange between pediatricians and school personnel regarding children with “special needs.” The focus of such a program will be to discover natural commonalties of interest and concern, places where we may be working at cross purposes, areas of true differences, and potential areas of advocacy and collaboration to develop.
This idea was stimulated by the concern about teachers’ attitudes regarding children with special needs. The pressures to understand each child individually, the diversion of funds to special education, the need for classroom accommodations, and the outside opinions of professionals were discussed as possible obstacles to the appreciation and support of children with learning disabilities, attentional disorders, and other “handicapping” conditions. From this, an idea emerged about inviting a variety of spokespersons from the schools – to include teachers, resource specialists, school psychologists, principals, and perhaps SELPA director to a future committee meeting, in the late Spring 1997. It is hoped that this might be shared by the Committees of Behavior/Development, Children with Disabilities, and School Health.
Child Health and Finance Committee
By Alan Burckin, MD Chairman
The guest speaker was Ruben Gonzalez, Medi-Cal Branch manager in charge of the managed care initiative for many of the Northern California counties.
Mr. Gonzalez gave us an overview of what is taking place in the various counties in the state. The information was provided on a county-by-county basis with an estimate of the number of patients enrolled in the different plans. We learned that it has not been a smooth transition, but some counties have been more successful than others. Most importantly, we were given suggestions of whom to contact and how to go about the job of getting our input to the correct people and places necessary to effect changes. A county-by-county review was given by Mr. Gonzalez with statistics available as of November 14, 1996:
Alameda County has:
Contra Costa County has:
Two prior contracts in place; 15,500 members enrolled (enrollments exclude Special Projects and dental-only contracts)
El Dorado County has:
Fresno County has:
One prior contract in place with 7,000 members enrolled
Marin County has:
Sacramento County has:
San Francisco County has:
San Joaquin County has:
San Mateo County has:
Santa Clara County has:
Santa Cruz County has:
Solano County has:
Sonoma County has:
Stanislaus County has:
Yolo County has:
Julian Davis, Dave Kittams, Bud Shenkin, and Steve Yedlin all had comments and questions involving Alameda and Contra Costa counties since each has important involvement in one or both of these counties. Mr. Gonzalez took the comments under advisement and offered some specific suggestions and contacts to influence the process.
Dave Perin was able to give us a little perspective on the bureaucratic process since he has been employed by the Medi-Cal program for some years. With input from Lucy Crain and others, we imparted a message to Ruben Gonzalez that the Academy wanted to make this a successful program, but that it was important that the pediatricians and participating physicians be fairly compensated so they could afford to participate. He very much agreed with these concepts and offered his services to help pediatricians improve the process.
Please contact Lane Tanner, M.D. (415) 353-7772 or Brad Berman, M.D. (510) 204-8939 for further interest and ideas.
In Praise of Dr. Auerback
Not every success story is built on long-held dreams or thoughtfully laid plans. Many begin in casual, somewhat accidental ways. Such was the case with the 40 year career of Marvin L. A. Auerback. It was 1953 and heart disease, particularly pediatric heart disease, was an unknown quantity. Realizing the pressing need in this field, Dr. Auerback was a Fellow in Pediatric Cardiology at University of California, San Francisco, 1955-1957, and began his pediatrics practice four years before Boards for his subspecialty were established. He passed the Sub-Board of Pediatric Cardiology in 1962, becoming No. 66 to do so.
“Being a pediatric cardiologist is a little like playing Sherlock Holmes,” Dr. Auerback confided. “Young children can’t describe a pain. You must learn to communicate without words and then interpret your findings for their families.” As chief of the Pediatric Cardiac clinics at San Mateo County General since 1957 and San Francisco General since 1961, as well as through his full-time practice in Foster City, Dr. Auerback has treated children whose families spoke 14 different languages. He has developed information sheets covering the eight most commonly diagnosed heart conditions, including a healthy heart, in all 14 languages. In the near future Dr. Auerback plans to develop a section on the UCSF home page on the World Wide Web to give access to this information to pediatric cardiologists around the world.
Dr. Auerback also led the way by being one of the first to automate his retired patient files. Returning from a vacation to find his consultation room stacked with boxes of a thousand files from just one year, he made the leap to CD-ROM. Now files from previous years can be immediately accessed by computer and take up just a few inches on the shelf.
Another avenue of communication Dr. Auerback fostered is the California Pediatrician. He took over the bimonthly specialty publication in 1988, nurturing it and serving as its editor-in-chief until 1994. He continues as its editor emeritus.
After working with his young heart patients and their families for several years, Dr. Auerback recognized the need for a family support group. “Every family with a child who suffers from heart disease feels it is the only one in the world with this concern and anguish,” he said. “We formed a group for the parents and named it Parents for Heart. The families come together and share ideas and discuss expectations for the future.”
Soon a Christmas party for the children seemed in order. The first party was 26 years ago with just a few children and parents and four volunteer doctor musicians, named the Uncalled Four, who entertained. As the Parents for Heart leader and never shy about theatrics, Dr. Auerback jumped at the chance to play Santa Claus. The annual event, scheduled early in December at Peninsula Hospital, has grown to about 250 children and their parents and 25 or so musicians, and each of the heart patients still receives a gift from Santa Auerback. “Since the party keeps getting bigger every year,” Dr. Auerback joked, “that proves I’m saving many of my kids.”
Long known as a tireless worker with boundless energy, Dr. Auerback has no thoughts of retirement. But he does express concern about the future. “Unfortunately,” he said, “I see no one coming along to take my place and keep this kind of private practice going.” In a few words of wisdom to young physicians, Dr. Auerback advised, “With more managed care ahead, times will be difficult, so make your choices according to what interests you, not for other reasons.”
Letters to the Editor
Congratulations! Chapter 1 has chosen two excellent new editors for our chapter newsletter. I liked your first edition and will share with you my thoughts and ideas for future issues.
I look forward to Lucy’s (Crain) Column each issue. She has the unique ability to keep my attention focused, cover many topics on multiple levels. I often re-read it to make sure I haven’t missed any inspirational and motivational messages.
Please be informed that the October chapter newsletter arrived in my office on November 15. Most of my National AAP bulk mailings arrive late, including my 1997 Fellowship Directory Address Verification form, which arrived on the same day is was due, November 15!
Please continue to provide information for electronic access to AAP, Chapter and general pediatric information including e-mail addresses, WWW sites and AAP electronic information, including POL.
I noted in the October AAP News on page 3, Chapter Forum Resolution # 74 “Electronic Publication of AAP Policy Manual” submitted by Jerold Aronson, was withdrawn. As we have spoken before, I have supported an easy access to current AAP policy, and posting somewhere on the Internet makes the most sense. If AAP leaders do not want it accessible to the general public, it could be posted on POL.
This would help the chapter Public Relations Committee goal of information dissemination to key chapter members. If a newspaper or TV or radio station wants an opinion about a child topic, we want to know the latest AAP policy on that topic before giving a statement or opinion. Calling the AAP office and having them fax the information is time consuming and unnecessarily labor intensive.
Steve Buchner, MD
Previous Member-at-Large, San Mateo County
These are some of the latest legislative changes that are important for your review.
Dr Robert L. Black is our region’s legislative representative who does the hard work of keeping up to date on the most pressing issues for our members and children in California.
Other resources from the following groups are available through our Web Page for the Chapter (http://www.cybergate.com/~simonian/aap1.html) including information from:
American Academy of Pediatrics
American Medical Association
California Medical Association
California State Government
1996 CMA Sponsored Legislation
Bill AB 3013
Author Barbara Alby (R-Fair Oaks) and Byron Sher (D-Palo Alto)
Description
Would prohibit health plans from including gag clauses in their contracts with physicians which limit the ethical and legal responsibility of physicians to fully inform patients about treatment options, alternative coverage arrangements, or other issues which affect patient’s health. Signed into law
Bill AB 2649
Author Bruce Thompson (R-Fallbrook), Liz Figueroa (D-Fremont) Mike Sweeney (D-Hayword)
Description Requires health plans to disclose types of physician reimbursement to enrollees and prohibits certain physician incentive plans. Signed into law
Bill AB 8 SB 371
Author Barbara Friedman, Herschel Rosenthal D-No. Hollywood)
Description
Expands Calif. small employer health insurance purchasing pool (HIPC) to employers with 2 employees. The HIPC is currently limited to businesses with from 3-50 employees. Signed into law
Bill AB 1663
Author
Barbara Friedman D-No. Hoolywood, David Knowles
(R-Placerville)
Description
Would give patients the right to an independent medical review outside of their health plan when their plan intends to deny coverage for treatment on the basis that it is experimental or investigational. Signed into law
Bill SB 1478
Author Hilda Solis (D-El Monte)
Description
Requires medical groups and IPAs to pay physician claims no later than 30 working days after receiving a claim. Signed into law
Bill SB 1986
Author Mike Thompson (D-Napa Valley)
Description
Re-authorizes funding for medical programs funded by proposition 99 tabacco tax revenues. Allows General Fund allocations for the health programs challenged in pending prop 99 litigation, thereby restoring funding for anti-smoking education, research, and indigent health care and ending the ongoing dispute over prop. 99 funds. Signed into law
Bill SB 2003
Author Jim Costa (D-Fresno)
Description
Gives non-designated facility emergency departments the authority to place a new interim hold on mentally disordered individuals until they can be transferred safety to a designated facility. It also gives liability immunity protections to emergency physicians. Signed into law
Author Bill Morrow (R-Oceanside)
Description
Provides relief from civil and criminal penalties to physicians who charge patients less for clinical lab tests than patients would pay if they were billed directly by the clinical lab. This would end unjust prosecutions of physicians who save patients significant money on the costs of lab tests. Signed into law
Bill AB 1758
Author David Knowles (R-Placerville)
Description
Establish state tax deductions for Medical Savings Accounts. Language of bill amended into the comprehensive Federal tax conformity legislation. Signed into law
Bill SB 1665
Author Thompson, Chapter 864
Description
Allows physician to physician consultation via telecommunication technology over state lines without requiring a California license, and makes clear that consultants are not to be responsible for patient care. It imposes several requirements for governing the delivery of health care services, through telemedicine, and prevents payors from refusing to pay for the services simply because they were rendered through telemedicine and there was no face-to-face contact with a patient. Signed into law
Bill SB 2098
Author Kopp, Chapter 902
Description
Authorizes the Medical Board to develop a telemedicine registration program for physicians not licensed by California but who wish to perform interstate practice via telecommunication technology. Any program developed must be placed in statute by future legislation before it may be implemented. Signed into law. Created December 5 1996 Last updated 1/22/97
Flood effected Chapter 1 Pediatricians
From Tom Long, MD, Vice President
Pediatricians who may have lost equipment, supplies, or offices in the recent floods please share this information and your specific needs with our Chapter via the Executive Office. I also suggest that any pediatrician who has equipment or supplies which they might be able to donate to those who experienced flood damage, make that known to Beverly Busher at our Chapter office.
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