JULY • 2019
Jumping Into July

With July comes fresh minds, ideas, and goals,
Meet our elected officials in their roles
And hear from our Committees and Members-At-Large
And our State Government Affairs Representatives with our advocacy priorities in charge.
President's Column
Raelene Walker, MD, FAAP

As I begin my term as President for California AAP Chapter 1, I would like to start by offering deep appreciation and thanks to Dr. John Takayama , who is now our Chapter Past President. Dr. Takayama embodies what is wonderful and inspiring about pediatricians. He is smart, kind, incredibly hard working, thoughtful, warm and a tireless advocate for children. He does amazing work with a thorough, quiet manner. We are so fortunate to have had Dr. Takayama’s leadership and guidance for our chapter and for pediatrics in general. John, thank you so much for all you do for children and for who you are!

I have also been thinking a lot about what I hope to help us accomplish in the next 2 years. I am excited about the possibilities, humbled by the challenges and eager to begin. I would like to share with you two of the topics that engage me and are areas about which I am most inspired to focus some of my energy and hope to help engage our chapter: immigration and pediatric palliative care. While these are seemingly very different issues, they have big overlap with other issues that pediatricians are helping lead right now, particularly how adverse childhood experiences affect the health of children over time and mental health issues. I am proud to be one of the voices of pediatricians speaking out on behalf of children and look forward to continuing to work with all of you.
Vice President Introduction
Nelson Branco, MD, FAAP

It seems like just a few years ago Dr. Raelene Walker and I were covering the wards together at Oakland Children’s Hospital. I’m pleased that we get to work together once again, this time entrusted with the care of our Chapter and supporting you in caring for the children of our communities. In my first year of practice, I was working for the Indian Health Service in rural New Mexico on the Navajo reservation. Shortly after I started, the president of the New Mexico Pediatric Society visited – he had traveled 240 miles to meet with our group of six pediatricians. I was impressed by his commitment to meet every pediatrician in the state and learn about their needs, concerns and expertise. 

In my time leading CA Chapter I, I’d like to do the same. I won’t be able to meet with each and every one of you, but I am interested in connecting to share experiences and perspectives, and in finding out how the leadership of our Chapter can serve you and support the excellent work that you do. Many years ago, I told a colleague that the AAP was “the best club I’ve ever joined.” I still feel that way and I hope that you do too. Please feel free to email, call, text, tweet, ping, snail mail, dm, find me on social media or just pull me aside to talk. Thank you for electing me to this position. I look forward to working with you on behalf of the kids.
Election Results Recap

Thank you to the California Chapter 1, AAP board members who have provided steadfast and exemplary leadership for the past two years on behalf of children everywhere: Zoey Goore , MD, MPH, FAAP, Past President, 2017-19, John Takayama , MD, MPH, FAAP, President, 2017-19, (has assumed the role of Past President on the board for the 2019-21 term), Sohil Sud , MD, FAAP, San Francisco Member-At-Large, 2017-19, and Brijesh Kadam , MD, Central Valley Alternative Member-At-Large, 2017-19.

Meet Your 2019-21 Elected Board Members:
President: Raelene Walker, MD, FAAP
Vice President: Nelson Branco, MD, FAAP
Secretary: Janice Kim, MD, MPH, FAAP
Treasurer: Nivedita More, MD, FAAP
Past President: John Takayama, MD, MPH, FAAP
Executive Director: Isra Uz-Zaman, MS
North Valley Member-At-Large: VACANT
Sacramento Valley Member-At-Large: Ravinder Khaira, MD, FAAP
Central Valley Member-At-Large: Yvonne Brouard, MD, FAAP
South Valley Member-At-Large: Jolie Limon, MD, FAAP
San Francisco Member-At-Large: Rhea Boyd, MD, MPH, FAAP
Santa Clara Member-At-Large: Meera Sankar, MD, FAAP
San Mateo Member-At-Large: Beth Grady, MD, FAAP
North Coastal Member-At-Large: VACANT
Monterey Bay Member-At-Large: Graciela Wilcox, MD, MPH, FAAP
Alameda Member-At-Large: Amanda Millstein, MD, FAAP
Contra Costa/Solano Member-At-Large: Diane Dooley, MD, FAAP

Read more about your elected board members on the new AAPCA1 website Who We Are page .
New AAPCA1 Website
We have been working on a brand new website for you. The latest happenings will be posted here. Check it out!
School Health Committee
Renee C. Wachtel, MD, FAAP

Our school health committee is actively recruiting new members who are interested in participating in the range of topics that relate to school health. Our current priorities include:
  • school sports-related concussion identification and management,
  • understanding and advocating for Special Education and related services for our patients
  • administration of prescription medication in schools
  • availability of school resources for our patients including nursing and mental health services
  • health and sex education in our schools
All of these issues are hot topics about which our committee members can both educate ourselves and our chapter members. We can also advocate individually and collectively for improvements in the school health systems, both locally and statewide. Our committee meets in the Bay Area about twice a year, but chapter members can join our discussions remotely as well. Please contact Renee if you would like to attend a meeting, join our committee, or have other relevant issues to add to our hot topics. Our next committee meeting will be in the fall.

Committee on Developmental and Behavioral Pediatrics: Accessing Early Intervention Services for Your Patients
Renee C. Wachtel, MD, FAAP

Pediatricians know how important early intervention services (EIS) are to young children showing developmental delays and their families. In California, EIS services are provided through the Regional Center system in the program called Early Start. This program (part of the Individuals with Disabilities Education Act or IDEA) provides services, in coordination with health insurance, for children birth to 36 months with developmental delay. The standards to determine eligibility are based upon an evaluation conducted by the Regional Center staff, so pediatricians only need to refer families to their local Regional Center if they SUSPECT a developmental delay, or the child has a medical condition or risk factors that increase their probability of delay. The family can call the Regional Center themselves, and the Regional Center has 45 calendar days to complete a FREE evaluation to determine if the child is eligible. The specific categories of eligibility are:
  1. Child has established risk condition having a high probability of resulting in developmental disability. The condition shall be diagnosed by qualified personnel who are recognized by or part of the multidisciplinary team.
  2. Child demonstrates significant difference between the expected level of development for their age and their current level of functioning. A significant difference is defined as a 33-percent delay in one or more developmental areas.
  3. Child is under 3 years of age and is at high risk of becoming developmentally disabled. High risk for developmental disability exists when a multidisciplinary team determines that an infant or toddler has a combination of two or more of factors that require early intervention services or that the parent is a person with a developmental disability
When a child is found to be eligible for EIS, a case manager will help the family access the needed intervention services, which can include speech language therapy, physical therapy, Special Education services as provided by a developmental specialist, or other relevant interventions. The case managers can also help the family access community based programs, such as developmental play groups, Early Head Start, and library story time. When the child is close to three years old, a FREE re-evaluation will occur to determine:
  • Whether the child qualifies to continue in the Regional Center program
  • Whether the child would qualify for Special Education Services in the local school district with an Individualized Education Plan (IEP)-a transition meeting is scheduled
  • What additional supports or resources the child and family continue to need
Our committee addresses issues involving topics such as Early Intervention, Special Education, Autism Spectrum Disorders, other Developmental Disabilities, and Behavioral/Mental Health. These are priorities about which our committee members can both educate ourselves and our chapter members. Our committee meets in the Bay Area about twice a year, but chapter members can join our discussions remotely as well. Please contact Renee if you would like to attend a meeting, join our committee, or have other relevant issues to add to our hot topics. Our next committee meeting will be in the fall.

Central Valley Member-At-Large Report
Connected Cases: The Many Faces of One Disease
Yvonne Brouard, MD, FAAP

Case 1. A seven-year-old obese African-American girl presents in March with leg pains at rest for several months. She appears healthy but overweight, sleeps well but gets fatigued more easily than before.
Case 2. A fourteen-year-old boy presents in November, complaining of a month of severe daily migraine type headaches, with nausea and visual changes. He home schools and is working on his black belt in Karate. He has never had headaches like this before. General and neurological exam is normal.
Case 3. A sixteen-year-old girl presents in July with severe dysmenorrhea, irregular and very painful periods that make her miss school. She started her periods at age 13 and initially they were normal, regular, and not painful. General exam is normal apart from slight pallor.
Case 4. A four-year-old boy presents in February with increasing severe separation anxiety, in spite of no changes at school or at home that the parents can tell. General exam is normal, and parent child interactions appear appropriate in the office.
Case 5. A four-month-old girl is referred to the office by the lactation consultant in August with concerns of ongoing severe fussiness, crying to the point of sweating, in spite of apparently latching well, breastfeeding well, and being 60th percentile for head and height, and 98th percentile for weight. She appears normal except for chronic fussiness atypical for a 4-month infant. She does have mild frontal bossing of the forehead.

What do all of these cases have in common? Keep reading to find out.
Disaster Preparedness, Part 1
John I. Takayama, MD, MPH, FAAP
Past President

I was minding my business when suddenly the glass windows and metal doors began to rattle. I tried to stand up but then the floor shook so I sat back down. It was all over in less than one minute and most everyone else who were walking about did not seem to notice. When I opened the “yurekuru” app on my smartphone, I realized that I had just experienced a small earthquake, magnitude 3 on the Richter scale. It was 9 am on June 24, 2019, in Minato-ward, Tokyo. 
Disasters can happen anywhere, anytime and probably when least expected. The wild fires of last summer reminded all of us that our daily routines can suddenly change. How can we best prepare, so that we can minimize loss of lives and properties, so that we can overcome potential disruptions and continue to do what we do best, to take care of our patients? This is the first of a series of articles on disaster preparedness this summer. Continue reading… 
The SGA Side
Zarah Iqbal, MD, PL-3, MPH and Nora Pfaff, MD, FAAP
SGA California Chapter 1 Representatives

The AAPCA State Government Affairs Committee is a working group including representatives from each California AAP chapter, as well as resident and early career pediatrician representatives. We review proposed legislative bills along with some regulatory changes and make recommendations for AAPCA positions on those issues. This year we have seen a record number of bills related to child health and AAPCA priorities and have taken positions on hundreds of bills . In addition to taking positions and writing letters on bills, each year we have 2-5 priority issues that we co-sponsor and/or work on at a deeper level. This year, we have three main priorities:
  1. Vaccines (SB-276)
  2. Sugar Sweetened Beverages (multiple bills)
  3. Chlorpyrifos Ban (SB-0458) 

Passage of SB 276 (Pan) : June was an exciting month for the health of children in California! As many of you have heard by now, SB 276 (Pan) passed in the Assembly Health Committee after a very emotionally charged hearing on June 20 -- only days after undergoing some major amendments in order to win the stated support of Governor Gavin Newsom. SB 276 (Pan) still needs to pass in the Assembly and be signed by the Governor in order to become law, but this was seen as passing a major hurdle. 

Read more about the SB 276 (Pan), Sugar Sweetened Beverages bills, and the Chlorpyrifos Ban HERE .
Upcoming CME Conferences
All upcoming events can be viewed at on our website events page: https://aapca1.org/events/
Obituary: Robert L. Black, MD, FAAP
August 25, 1930 - May 8, 2019
Monterey, CA

Dr. Robert L. Black, long-time AAP advocate and pediatrician to generations of Peninsula children, has died. As a partner in the practice of Bates, Branson, Black and Penn for over 50 years, Bob helped better the lives of children through his practice, his community involvement, and his influence on public policy. Bob studied at Stanford University, interned at Kings County Hospital in Brooklyn NY, and then served in the US Air Force before returning to Stanford for his pediatric residency. He began practice in Monterey in 1962. He kept lifelong ties to Stanford, returning once a week as a clinical professor, to teach pediatric cardiology at Stanford, and served on the board of the Packard Children's Hospital. Bob did extensive service in pediatric health policy, helping to write the 1979 California Health Plan for Children by the American Academy of Pediatrics, and serving on health advisory committees for the California Legislature. In recognition of these efforts, he was elected to the Institute of Medicine (now the National Academy of Medicine) in 1983. Dr. Black was also the recipient of the 1997 Martin Gershman Child Advocacy Award for his tireless dedication. Dr. Black was an active member of the American Academy of Pediatrics, having served as Alternate District Chair, Acting District Chair, Acting Chapter 1 President, Chapter 1 Vice President and as a member of the National Committee on State Government Affairs and the Nominating Committee. Thank you Dr. Black for your lifelong service to the health of children.
Upcoming Events for Your Benefit

AAP Hub & Spoke QI Opportunity
As an extension to the AAP HPV quality improvement (QI) initiative, there is an opportunity to gain additional QI knowledge and learn from each other at the upcoming AAP’s 2019 Hub and Spoke Quality Improvement Training August 23-24 in San Diego, CA: This training will have two tracks and two presenters. One track will be QI Basics 101 and the other will be QI Intermediate. If you are interested, please contact California Chapter 1 at info@aapca1.org

UCSF Benioff Children's Hospital Oakland - 49th Annual Monterey Conference
Mother Nature's Best Medicine: Rx Go Outside!
Nov. 1 - 3, 2019
Early Registration ends August 1st
More Information and Registration HERE

Recruiting CA Practices: Chlamydia Screening among Adolescents: eLearning Collaborative QI Project
Sept 2019-Mar 2020, Webinar Based
Registration closing on July 26; FREE MOC Pt 4 Available
More information HERE

October 5, 2019:  Advocating for Children Together Conference, Oakland - Register Now

October 25-29, 2019:  AAP National Conference & Exhibition, New Orleans

November 21-24, 2019: AAP California 41 st Annual Las Vegas Seminars

December 7, 2019:   Pediatric Puzzles Interactive CME Conference, San Francisco

Our mission is to promote the optimal health and development of children and
adolescents of Northern California in partnership with their families and communities, and to support the pediatricians who care for them.

President: Raelene Walker • Vice President: Nelson Branco
Secretary: Janice Kim • Treasurer : Nivedita More Past President: John Takayama
Executive Director: Isra Uz-Zaman