AAP-CA State Government Affairs Committee Update- July 2012
"It was the best of times, it was the worst of times".
Truly historic developments on the heath care scene have emerged in the last few weeks. First, the Supreme Court upheld the Affordable Care Act, holding that the individual mandate is constitutional, and that the charge or tax associated with the law does not need to take effect before being challenged in court.
AAP President Robert W. Block, MD, FAAP said, "Today, the Supreme Court upheld a law that invests in children's health from the ground up. The Academy endorsed the Affordable Care Act because it addresses the same 'A-B-C' goals that are entrenched in our mission and in our 82 years of child health advocacy: providing all children in this country with Access to health care services, age-appropriate Benefits to meet their unique needs, and high-quality, affordable health care Coverage." The Academy will work with the Administration to ensure that the law's ongoing implementation continues to benefit children and pediatricians.
Almost simultaneously, Governor Jerry Brown 's 2012-2013 budget plan was introduced and passed by the Legislature. The budget proposes to shift 900,000 children from the Healthy Family rolls to Medi-Cal. District IX opposed this plan because of concerns that Medi-Cal would not be able to absorb the influx of patients all at one time, that access for children might be reduced because of inadequate numbers of pediatricians accepting Medi-Cal, and that quality of care for children involved in the shift might suffer. We advocated instead for a phased approach to that shift accompanied by deliberate monitoring of access to care; care quality; and the safety of care received by patients involved in the transition. The budget proposal passed by the narrowest of margins (one vote). Our next steps now focus on ensuring that appropriate evaluation and monitoring of the transition take place, and that long-needed improvements in Medi-Cal's processes and structure in service to children be undertaken. (There may also still be opportunities to go back to a phased approach for the Healthy Families transition linked to upcoming tax votes--more on that if it happens.) Efforts are ongoing behind the scenes.
On a happier note, AB 2109, the bill introduced by Assembly Representative Hernandez aimed at requiring parents who wish to opt out of required immunization for school attendance to file a document or affidavit with the school governing authority that immunization is contrary to their beliefs (personal belief exemption or PBE), passed out of both houses of the legislature. The required document affirms that the family has received appropriate education on the benefits and risks of vaccination as well as the consequences to both individuals and the community should illness occur because of the failure to vaccinate. The document would have to be signed by both a health care provider and a parent or legal guardian. It is hoped that the requirement will reduce the number of PBEs obtained because of convenience or lack of knowledge regarding vaccines. The number of children admitted to school with PBEs is very low in most school districts, only 2-3% in most, so the number of parents seeking these will be minimal for the vast majority of pediatric practices. The bill is currently being considered by the Senate Appropriations Committee.
You can follow this link to the District's website to see the latest information.
AAP-CA Priority Issues
CALENDAR OF EVENTS
Physicians for Social Responsibility - Los Angeles Healthcare Voices for Clean Air
July 31, 2012
10 am - 11:45 am
CHLA Page Conference Rm.
Email/call Ariana Milman at 213-689-9170 or firstname.lastname@example.org to RSVP
CME -Mini Fellowship in Primary Pediatric Psychopharmacology
San Diego, CA
Contact Marty Stein
Visit our events page for more information
The Shot Felt "Round the World"
September 9, 2012
2 - 5 pm
1151 Oxford Road
San Marino, CA 91108
Contact Terell Carter at email@example.com for more info
Ventura Town Hall
6:30 - 9 PM
St Johns Hospital
RSVP to firstname.lastname@example.org
Visit our events page for flyer and more information
Webinar slides from AAP-CA Vaccine presentation
can be found Here
Check out our new website on Wild Apricot!
AAP-CA2 wants YOU to help us test out our new and improved website with added features. It is still under construction, but please click through the site and give us your feedback!
A Members-Only section will be added, exclusively for Chapter Members.
Fit to Play & Learn launched in LAUSD!
AAP-CA2 has partnered with the Los Angeles Unified School District (LAUSD) School Nurses Act to Prevent Obesity (SNAPO) to champion a childhood obesity prevention program,
Fit to Play & Learn. The brand new program is teaching low-income 4th and 5th graders and their parents ways to integrate healthy food, healthy drinks choices, and physical activities into their daily lives.
We are currently taking donations to fund this program. Thank you for your support!
American Academy of Pediatrics, California - Chapter 2
July 2012 E-Newsletter
Dear Dr. ,
This month's edition if the AAP California Chapter 2 newsletter includes several articles related to child health and wellbeing during these warm summer months. The first addresses vaccine recommendations for international travel vaccine for those children travelling to other countries with their parents. The second reminds all of us to discuss water safety with parents and children.
In addition, we have included a brief description of a rare disorder, Wolman's disease common in an ethnic population seen in many of our practices.
Finally, I would like to take the opportunity to recognize two exceptional California AAP Chapter 2 members for their contributions to our Chapter. Dr. Elisa Nicholas has served as the Chapter CATCH Facilitator for longer than I can remember, assisting Chapter members with the preparations of proposals for funds to improve children's access to health in community settings. Heide Woo, of UCLA West LA Pediatrics, serves as the Chapter Coordinator and Chair of the Steering Committee for the Pediatric Research in Office Settings (PROS Network). Both women were recognized at the June meeting of AAP District IX (California) with Special Achievement Awards. These awards will be formally presented to them at the September Chapter Board Meeting.
Helen DuPlessis, MD, MPH, FAAP
AAP - California, Chapter 2
Find the form and more information Here
New screening guidelines for TB in children went into effect in January, 2012. Health care providers will assess children for risk of exposure to TB at each annual physical examination (see Pediatric TB Risk Assessment Questionnaire). Providers will only administer TB skin testing for children at increased risk of acquiring TB infection, which is indicated in the "Health Care Provider Follow-up" section of the questionnaire. Providers will continue to complete and sign the "Report of Health Examination for School Entry" (PM 171 A), and schools will continue to require this documentation of the physical exam prior to a child's enrollment in school.
Pediatricians urged to review child's vaccination status with parents prior to travel.
With summer vacation travel in full swing, consider asking about international travel plans during children's visits as part of a review of immunization status. Many countries are experiencing outbreaks of vaccine-preventable diseases, particularly measles. Infants as young as 6 months should get the MMR vaccine prior to any international travel, and the new MMR vaccine information sheet reflects this recommendation. Visit the CDC website for more information regarding International Travel and Recommended Immunizations. For more information regarding measles vaccination prior to international travel visit the AAP and CDC websites and additional parent information on healthychildren.org
Kaiser Permanente Child Health Plan has temporarily reopened to new enrollment in Los Angeles County
Find details Here
As the summer months are upon us, and we all seek warm-weather forms of recreation, it's important to counsel children and families about water safety. Water-related activities can provide relief from the heat and a great deal of fun, but failure to provide supervision and enforce strict safety rules can result in death or devastating injuries. Unintentional drowning is the leading cause of death for children 1-4, and the fifth leading cause of death overall. While water injuries among young children occur most often in swimming pools, other water sources such as buckets and bath tubs also contribute to these injuries. Alcohol use is involved in over 70% of water-related deaths among teens. African American children are three times more likely to drown than White Children. Parents and children can prevent water-related accidents by following a few simple rules:
- Install self-locking four-sided fences around home swimming pools, regardless of whether the children and youth in the home can swim. Evidence indicates this reduces water-related deaths by 83%.
- Practice "touch safety" in and around pools and other bodies of water. Adults should be within arm's reach of young children in the water at all times.
- Learn CPR - second count in water related accidents.
- Eliminate the use of floaties, water wings and other air-filled or foam toys as safety devices. Life jackets, worn properly, are the only reliable water safety devices (the other should probably be removed from pool areas where there are young children).
- Learn how to swim. Although older AAP statements discourage swim lessons in children younger than 4 years of age, recent evidence indicates that swim lessons in children as young as 1 can be helpful.
- Do not drink alcohol when supervising children around water, and counsel youth and their parents about the risks of alcohol use in teen-related water deaths.
For more information, and informational hand-outs about water safety, please see the following:
(Download free materials)
| Common Symptoms in a Rare Disorder: Early onset Lysosomal Acid Lipase (LAL) Deficiency
The early onset form of Lysosomal Acid Lipase (LAL) Deficiency, also known as Wolman disease, is almost universally fatal within the first year of life. While very rare in the general population, the incidence in the Persian-Jewish community of Los Angeles was recently estimated to be as high as one in 4,200 births. 
Wolman disease is characterized by an accumulation of cholesteryl esters and triglycerides in the liver, spleen, and small intestine. Pediatricians may be the first to observe a collection of signs and symptoms including vomiting, diarrhea, hepatosplenomegaly, abdominal distension and failure to thrive. Adrenal calcification is considered a hallmark of the disease, but may not always be present.
Data from a natural history study of Early Onset LAL Deficiency presented at the 3rd International Congress of Lysosomal Diseases reveals the importance of early diagnosis. Patients in this study presented with symptoms at a median of one month of age, followed by death at median age of 3.4 months. Given the very short time between onset of symptoms and death it is important to quickly conduct testing to rule out Wolman disease so that all options can be considered.
Diagnosis can be confirmed by simple blood tests, including dried blood spots, to measure lysosomal acid lipase activity. Lab listings are available at www.genetests.org . There are currently no approved treatments for early onset LAL Deficiency; however, enzyme replacement therapy is currently under investigation by Synageva BioPharma in children with growth failure due to early onset LAL Deficiency (Wolman disease). There are two sites in the United States conducting the enzyme replacement therapy trial. If a diagnosis of early onset LAL Deficiency (Wolman disease) is suspected please contact:
Dr. Jay Gargus or Dr. Virginia Kimonis
Department of Pediatrics, Division of Genetics
University of California, Irvine
949-824-7702 or 949-824-0571
email@example.com or firstname.lastname@example.org
Study Coordinator: Marie Wencel: email@example.com or 949-824-0521
More information on the pediatric clinical study is available at: www.clinicaltrials.gov
Search term: Synageva
 Synageva BioPharma Corp
 Valles-Ayoub et al., Wolman disease (LIPA p.G87V) genotype frequency in people of Iranian-Jewish ancestry, Genet Test Mol Biomarkers 2011.
Promoting Early Brain and Child Development Through CATCH Planning
The American Academy of Pediatrics has identified Early Brain and Child Development (EBCD) as a strategic priority. If infants and young children do not have supportive, nurturing relationships, significant adversity in childhood such as poverty, abuse, or parental depression can become "toxic," altering the way their brains develop. In this way, "toxic stress" influences behavior, health, and learning not just in childhood, but for decades to come.
The mission of the CATCH program is to support pediatricians to collaborate in their communities to ensure that all children have access to all needed health services and a medical home.
The next deadline for applications for CATCH planning grants is July 31, 2012.
Feel free to contact your CATCH representatives Elisa Nicholas, MD, or Alice Kuo, MD.
Request for Proposals
The Los Angeles County Department of Public Health is issuing a Healthy Eating Active Living (HEAL) Request for Proposals (RFP) to solicit proposals for contracts with up to eight cities, non-profit organizations, and/or school districts in Los Angeles County to develop and implement one or more strategies that will create an environment where it is convenient, safe and easy for community members to eat healthfully and participate in physical activity every day. Proposers may pursue a variety of strategies including, but not limited to, active transportation plans; zoning and permitting for healthy foods; and safe routes to school plans.
Selected Proposers will receive up to $125,000 per year for approximately four years. A MandatoryIntent to Apply Form is due by July 30, 2012 by 3:30 PM (PST). Proposals are due by August 30th by 3:30 PM (PST).
This grant program is made possible by an award received by the Department of Public Health from the Centers for Disease Control and Prevention (CDC) as part of U.S. Department of Health and Human Services' Community Transformation Grants initiative.