The New York Pediatrician

The official publication of the District is the New York Pediatrician, edited by Dr. Roger Forden and published bi-annually.

The files below are in Portable Document Format, (.PDF). These files are viewable only with the Adobe^(TM) Acrobat^(TM) Reader*. If you do not have the Adobe^(TM) Acrobat^(TM) Reader*, you may click on the icon to download it.

From the newest issue, additional updates on legislation affecting children and families

If you have a noteworthy event that you would like to share with your AAP colleagues, please send it to the Downstate District II Office via e-mail: jgeslani@aap.org or fax: 516-326-0316.

All issues are in PDF format.
We strive to have all of the material viewable online as soon as possible after publication.

September 2006 AAP District II Report
Danielle Laraque, MD, FAAP

The activities of District II continue to be move forward. In the past year, at the national level, I have represented the District on the Committee Forum Management Committee (CoFMC) and the Advisory Committee to the Board on Strategic Planning (ACBOSP). Among the functions of the CoFMC is to support the work of committees, enhance synergies among committees, sections and councils, and to serve in advisory capacity to the Board of Directors. The ACBOSP this year reaffirmed the mission, vision and values of the Academy to work on behalf of all children and advised the board of directors on the key priorities for the year. The new priorities include foster care, oral health and disaster preparedness. The Academy will continue to support previous priorities including mental health, obesity and immunizations.

At the district level the priorities of the Campaign for Health Children, led by District II in collaboration with 40 other organizations include access for all children, immunizations, mental health and children’s environmental health.

I’d like to highlight some of the work that the District and Chapters have supported in the arena of children’s mental health. Following the 9/11 survey (in part supported by the District) showing that pediatricians identified knowledge and skills gaps in identifying children with emotional distress, the District cooperated in the distribution of the Feelings Need Check Ups Too CD-ROM, participated in the Consensus Conference which helped develop the Guidelines for Adolescent Depression in Primary Care (GLAD-PC) , collaborated in the Reaching Children Initiative Training (2005-2006) and is collaborating with NY Chapter 3 in the Healthy People 2010 Web-based Child Psychiatry Access Project (Web-CPAP). The RCI training and piloting of a back-up system from child psychiatry for pediatricians is meant to increase the capacity of the primary care setting to identify, diagnose, treat and/or refer children with a myriad of mental health problems including depression, anxiety and post-traumatic stress. In addition, post 9/11, bereavement-related issues have been a focus of our efforts. NY Chapter 3 sponsored three pediatricians from the Katrina area to come for the RCI training in February: Susan Berry, MD (New Orleans, LA), Molly Droge, MD (Plano, Texas), William Payne, MD (Ridgeland, MS). It was a privilege to meet with our colleagues from the south and to share strategies for recovery and support of children and families.

Along with the focus on children’s mental health, the District supported the formation of a Task Force on Learning Differences. At our recent District II meeting in Cape Cod (May 4-7), the District endorsed the idea of bringing together the efforts of individual projects on children’s mental health and the efforts of the task force. It’s clear that the overlap in these two areas is enormous and that our efforts will be synergistic in addressing the whole child. Advocacy efforts of the District have also included support for Timothy’s Law calling for mental health parity, and if the Web-CPAP pilot is successful, the District plans to explore the statewide dissemination of the consultation model.

AAP members who would like to get involved in any of the efforts described are urged to visit the District and Chapter websites or to call us directly.

New Database System Paves Way for Due Invoice Improvements

The American Academy of Pediatrics will be implementing a new database system in January 2006. This web-based system will bring greatly enhanced data, reporting and web connectivity capabilities. In addition, the new system will allow for the implementation of anniversary-year membership cycles. What does this mean to our members?

No more confusion for new members as to when their membership starts and when it ends. Beginning with the implementation of netFORUM, all new members or previously lapsed members rejoining the AAP will pay 1-year dues and begin their 12-month membership on the date of payment. No more payments covering months gone by.
Chapter and Section memberships will be set to the same expiration date as the existing National membership to enable single-invoice renewals. National members joining Chapter and/or Section will pay pro-rated Chapter/Section dues for the months remaining on their existing National membership.
Benefits begin immediately. No more month-long delays in benefits or active status.
The elimination of initiation fees for new Fellows, and reactivation fees for returning members.
Membership renewal invoices will be mailed 4 months prior to the expiration of the current membership. This will allow plenty of time for members to process their invoices and return payments prior to the membership expiration date.
On the date of netFORUM implementation, all AAP members in good standing will retain their July 1, 2005 through June 30, 2006 membership year. Their membership period is printed on their membership cards.
All members* in good standing on the date of netFORUM implementation will be mailed renewal invoices the first week of March 2006. The membership renewal will be for the upcoming membership year July 1, 2006 through June 30, 2007.
*Resident Fellows will continue to be billed separately to accommodate the consolidated invoices sent to dues sponsors. Resident Fellow renewal notices will be sent in May 2006 for the upcoming academic/membership year July 1, 2006-June 30, 2007.
The AAP will continue to offer a 2-month grace period for late payments. This grace period will be the first 60 days of the new membership year; July 1, 2006 through August 31, 2006. Unpaid memberships will expire effective September 1st, 2006. Benefits will lapse as well.
Members who rejoin the AAP after the grace period will start a new membership year effective with the date their 1-year dues payments is processed. Members do not have to fill out new applications to rejoin the Academy.

Example: Dr. Smith’s membership record transfers to the new netForum database on January 3, 2006 with a membership that expires on June 30, 2006. She received her renewal dues invoice in March 2006 for membership year July 1, 2006-June 30, 2007. She doesn’t send a payment. In May, Dr. Smith receives a dues reminder invoice. On June 30, 2006 her existing membership expires and the new membership begins July 1, 2006. She is now in the 60-day grace period of the new membership. She still doesn’t send a payment. On Sept. 1st, her July 1, 2006-June 30, 2007 membership expires. The expiration date of June 30, 2007 changes to Aug 31, 2006. October 10th Dr. Smith realizes she is no longer receiving benefits so she calls to rejoin. The customer service rep takes Dr. Smith’s credit card number over the phone and ‘sells’ her a new membership beginning on Oct. 10, 2006, expiring on Oct. 9, 2007. In June 2007 Dr. Smith will receive her renewal notice for her next year of membership beginning Oct. 10, 2007.

Members who receive renewal notices in March 2006 for membership period July 1, 2006-June 30, 2007 and who pay prior to the end of the grace period of August 31, 2006 will see no interruption in benefits, nor will their membership period change from the July to June period they have always had.

Resident Fellow & Medical Student Dues Invoices
FY 2005-2006: Resident Fellow and Medical Student dues invoices for will be generated and mailed the first week of November 2005. These invoices are for the membership period July 1, 2005-June 30, 2006. Resident Fellows and Medical Students have always been invoiced mid-academic year/mid-AAP fiscal year. Resident Fellows sponsored by their programs or local AAP Chapters will be included on the sponsors’ consolidated invoices. Non-sponsored Resident Fellows and all Medical Students will be invoiced individually. Dues payments are due by February 28, 2006.
FY 2006-2007: The academic year 2006-2007 will usher in a new process for Resident Fellows. Consolidated renewal invoices will be sent to all Pediatric Residency Training Program and AAP Chapter sponsors for their Resident Fellows the first week of May 2006. These payments will be due June 30, 2006. The 2-month grace period applies; benefits will lapse on August 31st for all unpaid Resident Fellows. AAP Division of Member Services will be working closely with the residency programs to ensure a smooth transition to the new timetable.

Politicians and diapers have one thing in common, they should both be changed regularly and for the same reason

– Author unknown

It’s springtime in Albany. Of course that means not only another fiscal fight, but a predictably delayed budget. The three principles of this never-ending plague are again Governor Pataki, Senate Majority Leader Bruno, and House Majority Leader Silver. New York State has a projected budget deficit of no less than eight billion dollars and as high as twelve billion dollars out of an eighty-five billion dollar budget.

In NYS, over two thirds of the state budget is accounted for in Medicaid, public assistance, and education (primary through graduate). Since the NYS budget must be balanced, each of these areas is threatened, as is every other program in the state. The NYSDOH has had significant restrictions on programs, hiring, and equipment since last year.

What does all this mean for children, their families and health care providers? No matter how noble, new programs and the expansion of existing programs are highly unlikely. The goal of the AAP and its partners is to ensure that programs and services for children aren’t scaled back.

Issues that have been addressed favorably and have a good chance of implementation include:

1. Passage of a comprehensive ban on smoking in virtually all public places, the Comprehensive Clean Indoor Air Legislation. This was passed through the Assembly and Senate and signed into law by Governor Pataki.

2. Assembly member Paulin and Senator Gottfried are supportive of the physicals done within one year being acceptable for the required school physical.

3. Senator Joe Bruno is progressively spearheading the issue of TORT reform. The primary issue in NYS and at the federal level is limiting the excessive awards for pain and suffering.

4. Newborn screening

a. Although newborn hearing screening is being performed regularly in the NYS birthing hospitals, the NYSDOH does not have the resources to track the false-negative and false-positives. Oversight of the process may be delegated as a quality surveillance issue to the Regional Perinatal Centers.

b. Metabolic genetic screening for cystic fibrosis, congenital adrenal hyperplasia, and the fatty acid oxidation disorders has been fully implemented, resulting in a significant increase in sweat testing. Many premature infants screened for congenital adrenal hyperplasia have abnormal results necessitating further testing. The ranges of normal may be redefined for this population.

c. The NYS leadership of the American Academy of Ophthalmology and the AAP have prevented newborn eye screening from being enacted. (This would have included dilation of pupils and screening for retinal anomalies, especially retinoblastoma.)

5. For the 18th straight year in a row the legislature failed to pass a budget by the April 1st deadline. The budget was finally passed on May 2nd, 2003.

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The focus of the Campaign for Healthy Children, a partnership of Statewide Youth Advocacy and the American Academy of Pediatrics, District II, is to retain the funding for various children’s programs. Our attention is to continue to advocate for a medical home as well as the general safety and well being of children. The specific issues drawn from the Campaign for Healthy Children include:

1. Documentation simplification – all the necessary state requirements should be eliminated and the federal required documentation should be simplified as much as possible.

2. Universal access for both Child Health Plus A and Child Health Plus B. Adequate reimbursement and provider capacity – every child must have access to a quality medical home and New York State must work with the insurers to guarantee adequate reimbursement to the providers to cover actual cost of care.

3. State takeover of Child Health Plus A. New York State is an anomaly among the states in that it requires the local counties to pay a share of Medicaid costs. New York State should assume the county share of the children in Medicaid. This would give the state experience that would allow it to take over the responsibility of Medicaid for all other eligible populations.

4. School-based health services – providing school districts with technical assistance to set up quality health programs. New York State should work with of providers, schools, and parents to create the most efficient health care services for school age children.

5. Extension of Medicaid that govern 18-20 year olds in special categories, children in foster care, especially hard to place children, should retain their Medicaid coverage until age 21.

6. Children with special health care needs include those with chronic physical, developmental behavioral, or emotional conditions. These children will require more comprehensive health care services than the general pediatric population. Integration and coordination of these services will avoid unnecessary duplication and costs.

Mental health services for children remain a priority. Issues identified by SYA and the AAP include:

1. Building infrastructure for mental health for children.

2. Increasing investments in school-based mental health programs.

3. Developing capacity by career development of mental health providers.

4. Ending discriminating health insurance practices in treating children with mental illness.

The last major issue is the protection of children in the environment. Children are particularly at risk for environmental health threats. Chronic illnesses such as asthma are on the rise in New York State. The State Education Department with the State Health Department and legislators should address indoor air quality, toxic and hazardous chemicals as well as other environmental pollution in all locations where children are brought together including schools, child care centers, and recreational programs.

It is not clear how all this can be accomplished in times of fiscal constraint. Collectively we must be vigilant and continue to advocate for the comprehensive care of children.

There will always be death and taxes, however, death doesn’t get worse every year
– Author unknown

- David Clark, Chair, Youth Advocacy Committee