In March, We Watch
In March, we watch our families grow,
Investing in advocacy work and resolution writing so,
That we can extend grace and love to our diverse groups of patients,
We await the Spring CME Conference in May with patience.
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President's Column
Nelson Branco, MD, FAAP
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Have you ever thought “The AAP should…?” Well, you’re in luck! Any AAP member can put together a resolution for the Annual Leadership Conference (ALC), which is how the members of the AAP let the leadership know what they want our organization to focus on. |
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All resolutions submitted for the ALC are discussed and voted on by AAP leaders, and the top 10 are forwarded to the board for implementation. There have been many great and important resolutions authored by Chapter 1 members, including several that have made the top 10. Dr. John Takayama is our District IX Chapter Forum Management Committee representative, and he will be presenting a chapter chat on Wednesday, March 15 at 7 pm on Resolution Writing for the Annual Leadership Conference. If you have an idea, a suggestion or just something that you are passionate about, please reach out - we would love to help you put together a great resolution.
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As I write this column, I have just learned about the death of Dr. Barbara Staggers, an adolescent medicine physician (and so much more) at Children's Hospital Oakland (CHO). Dr. Staggers achieved so much in her long career at CHO, not only as a clinician but as a mentor, educator, administrator and passionate advocate for her patients and colleagues. Dr. Staggers was a mentor to me personally when I was a resident at Childrens many years ago. She taught so many of us to care for adolescents with compassion, understanding and an appreciation for their unique strengths and the challenges they face. She has influenced the way I provide care for all of my patients, especially teens, and I will never forget the lessons I learned from her. Thank you Dr. Staggers - your memory is a blessing and your work and passion has blessed us all.
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In Memoriam - Dr. Barbara Staggers
Brad D. Berman, MD, FAAP
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We mourn the recent passing of Barbara Staggers, MD, MPH, FAAP. Dr. Staggers was a well-regarded and award-winning Adolescent Health specialist for more than 30 years at Children’s Hospital, Oakland (CHO). During her tenure, Barbara established several novel programs that have set the standards of care for adolescent high-risk urban and minority due to chronic experiences of racism, socioeconomic inequity, and community-based violence. These programs include the Teen Clinic at CHO, which was a highly-regarded popular pediatric residency educational rotation. Dr. Staggers developed some of the first successful high school-based health centers for at-risk adolescent care in Oakland and Alameda County.
Barbara was a staunch advocate for equitable health care for all children of color and those living in communities exposed to deleterious social determinants of health and inadequate socioeconomic resources. She was described as a “trailblazing adolescent health expert”, for whom the word “no” simply did not exist in her vocabulary. Barbara was involved in several initiatives with the AAP Northern California Chapter 1. While serving as the Director of Adolescent Medicine at CHO, she co-created CHAMPS; an award-winning program for college-bound 10-12th high-schoolers, aimed at increasing the diversity of professionals in the healthcare field through individual mentoring with both clinical and research staff at CHO.
Her vociferous ‘take-charge’ and caring demeanor served her well in her roles as Children’s Hospital, Oakland Medical Staff President, the Director of Multicultural Affairs, and the well-deserved recipient of the Bronze Bambino, the highest honor afforded to a member of the CHO medical staff. Busy as ever, Dr. Staggers was frequently sought out for her expertise and sat on several organizational boards including The California Wellness Foundation and the California Children’s Trust.
Barbara lived with her husband of many years and raised 3, now adult children. Perhaps less well known was her passion for dance, music, poetry, gardening, and Star Trek. Dr. Staggers had such a positive impact in the lives of her adolescent patients and colleagues. Barbara was a truly gifted physician, advocate, and friend. She was loved by so many and her presence shall be greatly missed.
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Developing Concerns: My Patients Need Their ADHD Medication!
Renee Wachtel, MD, FAAP
Committee on Developmental and Behavioral Pediatrics Chair
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As you may be aware, there is currently a shortage of many ADHD medications, especially some of the most frequently prescribed ones. This is a serious problem for all pediatricians and their patients, since ADHD is one of the most commonly diagnosed mental health disorders in pediatrics, and medication is often part of the comprehensive treatment program. ADHD affects approximately 10% of children, and 4% of adults. Unfortunately, this medication shortage is not a minor glitch in the supply chain, as happened during the pandemic for many needed medical supplies. What is going on, and what can we do about it?
What is going on?
There are numerous components to the problem, but stated simply:
- Starting last fall, Adderall became in short supply. It has been suggested that the increase in prescriptions for Adderall and its generic versions from 35.5 million in 2019 to 41.2 million in 2021 was related to the growth of telehealth and digital health platforms. VoX reports that healthcare analytic firm Trilliant Health found that prescriptions for Adderall increased by 25% for the 22-44 age group between 2020 and 2021. October 2022 the FDA declared that Adderall was in shortage. TEVA, one of the largest manufacturers of Adderall and its generics, blamed labor and manufacturing issues and increased demand. Subsequently, prescriptions for methylphenidate products started going up as providers started switching to other stimulants.
- Added to this, Janssen quietly ended its authorized generic version of Concerta (through its Patriot subsidiary) in January 2023. While it is still making brand-name Concerta, that may not continue and many patient’s health insurance only covers generics.
- For the methylphenidate products, we all know that even if the active ingredient is the same, that does not mean that all methylphenidate products are equal. In fact, the FDA has ruled some generics are NOT bioequivalent.
- Some pharmacies have even started restricting their limited supply of stimulants to their existing customers and filling less pills than the prescription calls for.
- The controlled substances rules also make filling prescriptions more difficult for patients and providers. If the pharmacy only supplies a smaller number of pills, the patient will require another prescription and have to find another pharmacy to fill it, as there are no refills allowed. They also risk getting flagged as a drug seeker.
- It is possible that the situation may even get worse over the next few months. Many drug manufacturers are unable to say when they will be able to supply more drugs to meet the demand.
- The DEA sets a quota for the maximum amounts of controlled substances that can be made in a year. It denies that that is the cause of the shortage, but……
What can we do about it?
- Be proactive with your patients, alerting them to the issue and having back up plans in place if they cannot get what they need.
- Consider switching to medications that are currently not in short supply, including Aptensio XR, Concerta, Quillichew, Ritalin LA, Jornay (check ASHP’s drug shortage database).
- Monitor the effects of medication changes on your patients.
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Become an advocate, both through the AAP and our legislators. Send letters to your legislator and local newspapers. Rep. Abigail Spanberger (D-VA), according to VoX, wrote to the FDA and DEA regarding the Adderall shortage in December. Join our AAP CAC1 Committee on Development and Behavior to advocate for this and other issues for your patients.
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The View from the Other Side: My Experience in the Hospital as a Pediatrician and Parent
Lena van der List, DO, FAAP
Sacramento Valley Member-At-Large & SOPT District IX Alternative Representative
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When my 15-month-old daughter woke up with deep retractions as a result of what seemed to be her 100th respiratory virus of this apocalyptic winter cold season, I knew it was time to go to the emergency room. When we walked in, we were greeted by my friends and colleagues. This was the same ER where I did my pediatric training, the same institution I now work as a general pediatrician. But this time was different. This time I was the worried parent, at the mercy of the medical system I have spent my entire career in.
Over the course of our 4-day admission I reflected a lot on what it meant to be a parent in medicine, while a multitude of emotions coursed through me.
I was afraid. Even in the setting of this “bread-and-butter” respiratory virus. What if my kid is the one that ends up in the ICU in respiratory failure? My cumulative trauma from training resurfaced. I lay awake next to her on a fold-out chair-bed watching her oxygen saturation, her work of breathing, listening to the beeps of the monitors. Trying to turn off my brain and lean into mothering.
I was protective. The things I rolled my eyes at as a busy resident, I now found myself doing. I asked the team if they could come back to look in her ears after she woke up. I called the respiratory therapist constantly to help me adjust her high flow nasal prongs. I breastfed during her vitals assessments and to help her fall asleep, even though our original plan had been to wean-off completely this month.
I was grateful. To our nurses and child life specialists who ensured my active toddler was kept busy in a shared room tethered to an oxygen tank. Grateful to our pediatricians, residents and medical students, who were full of empathy and explained everything to my husband as if there wasn’t another doctor in the room.
I was aware. Acutely aware parents don’t always get to walk out of the hospital with a healthy child. That it is an all-too-common occurrence for families to enter these four walls and leave with their lives forever changed. As I complained about my back from sleeping on those chair-beds, I thought of the families who sleep on them night after night for months while their child undergoes chemotherapy. I thought of our roommates, a Spanish-speaking family, and the look of fear in their eyes as the team explained to them through a video interpreter, that their son needed to be upgraded to the PICU for worsening hypoxemia. Realizing how easy it is to take something as simple as communication for granted.
I walked out of the hospital, clutching my daughter on my hip, with a renewed commitment. A commitment to mothering: to be present, to make time for joy and play daily, to never take our health or home for granted. A commitment to pediatrics: to never lose my curiosity, to be a source of comfort for families in those hard moments, to continue to advocate for an equitable health care system for all kids. And a commitment to myself. To treat myself with kindness and compassion. The work that we do, at home and at work, is exceedingly challenging but so rewarding.
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National and Statewide Progress for Health Data Exchange
Seth Bokser, MD, MPH, FAAP
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All California pediatricians will soon have a powerful tool available to us to access critically important health and social service information on our patients. The California Data Exchange Framework (DxF), which will begin functioning in January 2024 will make it possible for us to access information on our patients wherever they are seen in California. Equally important is that statewide health and social service systems will have access to our records with the consent of our patients. This is no small feat and requires our health systems to connect our EHRs to an intermediary Qualified Health Information Network (QHIN) that will exchange information to and from all types and brands of EHR systems.
On February 13, the Office of the National Coordinator for Health Information Technology (ONC) took a significant leap forward toward comprehensive nationwide Health Data Exchange when it announced the first set of Qualified Health Information Networks (QHINS). The first six QHINs announced by Secretary for Health and Human Services Xavier Becerra are the following:
- CommonWell Health Alliance (allied with Oracle-Cerner)
- eHealth Exchange
- Epic Systems
- HealthGorilla
- Kno2
- KonzaHIE
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Committee on Native American Child Health (CONACH) Updates
Marah Gotcsik, MD
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I am a pediatrician at Southcentral Foundation/Alaska Native Medical Center in Anchorage, Alaska, and a member of the AAP Committee on Native American Child Health (CONACH). I am the liaison for the California area and am eager to build connections and help spread information about the great work that CONACH is doing.
CONACH includes six appointed AAP members as well as liaisons from the American College of Obstetricians and Gynecologists, Association of American Indian Physicians, American Psychological Association, and American Academy of Child and Adolescent Psychiatrists. CONACH members work to develop policies (such as the 2021 policy statement Caring for American Indian and Alaska Native Children and Adolescents) and programs to improve the health of Native American and Alaska Native (AI/AN) children. We work closely with the AAP federal advocacy team to elevate legislation that supports tribal health. Through a contract with the Indian Health Service (IHS), CONACH also conducts pediatric consultative site visits to IHS, urban, and tribal health facilities and works to strengthen ties with tribes throughout the United States.
Building connections among pediatricians and other health care professionals serving AI/AN children is a key part of our mission. With this goal, the committee supports the AAP Indigenous Health Special Interest Group listserv which is a forum to share successes, strategies, and resources as well as to receive updates on CONACH’s work. We also partner with the Canadian Pediatric Society to present the biennial International Meeting on Indigenous Child Health which is happening March 24-26 in Tulsa, Oklahoma. We welcome you to join us! We are continuing to develop and add more information to the Native American Child Health Patient Care page on the AAP website.
One critically important issue in Native American child health right now is the current United States Supreme Court case Halland vs. Brackeen which is challenging the constitutionality of the Indian Child Welfare Act (ICWA). ICWA was passed in 1978 in response to high numbers of indigenous children being removed from their families and communities by state child welfare agencies and private adoption agencies. ICWA developed standards for child custody proceedings involving children from federally recognized tribes and has since become the gold standard for many child welfare programs with its focus on kinship and community care. The loss of ICWA protections would have a significant, far reaching, impact on indigenous child health and wellbeing. The AAP submitted an amicus brief to the Supreme Court in support of ICWA (see page 13). CONACH Chair and Confederated Tribes of Grand Ronde citizen, Dr. Allison Empey, wrote a powerful Op Ed supporting ICWA which is a good place to learn more about this high stakes issue that has the potential to significantly impact children in your practice.
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The SGA Side
Your Key to State Government Affairs
Nora Pfaff, MD, FAAP and Anna Kaplan, MD, FAAP
SGA Chapter Representatives
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California Chapter 1, American Academy of Pediatrics Signs On to Two Support Letters:
“As health organizations, we recognize the dangers of air and climate pollution and the benefits that will be experienced by all if the nation takes significant steps to reduce emissions and lessen the use of fossil fuels. This proposal by EPA to limit pollution from the oil and gas sector is needed to provide relief to communities that have been overburdened by dangerous pollution. We urge EPA to finalize the strongest possible rule by no later than August 2023.”
“Our organizations believe that all coverage for children must ensure access to timely, affordable, high-quality, and age-appropriate health care that meets their unique developmental needs and enables them to meet their full potential as adults. We recognize the agency’s continued commitment to promoting coverage, improving access, and eliminating health disparities, and appreciate the opportunity to submit feedback.”
For the most up-to-date information on AAP California bill positions, letters, and outcomes from the current California Legislative year, go to www.aap-ca.org/bill. For the latest organizational advocacy updates follow @AAPCADocs on Twitter. If you have questions and/or are interested in knowing more about certain legislation, reach out to our State Government Affairs Chapter Representative Nora Pfaff, MD, FAAP and Anna Kaplan MD, FAAP at info@aapca1.org.
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See All Available Pediatric Jobs on our Job Board! |
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Opportunities for Your Benefit |
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2023 Annual Spring CME Conference: Ask the Experts – May 6, 2023 |
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Our Annual Pediatric Spring CME Conference is back! Pediatricians, family practitioners, nurses, nurse practitioners, and Physicians-in-Training are invited to receive the latest updates on short stature, dysfunctional uterine bleeding, and irritable bowel syndrome in children from lectures, case studies, and breakout Q&As with our faculty. Participants are eligible for 3.5 hours of CME credits (pending approval). You will also have an opportunity to meet and greet pediatric chapter colleagues during our optional networking lunch! Hope to see you on May 6 at Partnership HealthPlan of California, 4605 Business Center Dr. Fairfield, CA 94534.
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March 15 - Resolution Writing for the Annual Leadership Conference - REGISTER HERE!
May 6 - 2023 Annual Spring CME Conference: “Ask the Experts” in Fairfield, CA - REGISTER HERE!
May 9 - Advocacy Day - SAVE THE DATE!
May 18-19 - Inflammatory Brain Disorders Conference 2023 - REGISTER HERE!
July 30 - 40th Annual Conference on Pediatric Infectious Diseases - REGISTER HERE!
December 2 - 8th Annual Pediatric Puzzles CME Conference - SAVE THE DATE!
December 8-10 - 2023 Las Vegas Seminars - SAVE THE DATE!
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Add our social media accounts to get the latest chapter updates!
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Your membership makes a difference for children in California, thank you!
The AAPCA1's ability to advocate on behalf of children is only as strong as the support we receive from our members. Encourage your colleagues to join today by visiting the AAPCA1 website.
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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.
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Executive Committee:
President: Nelson Branco • Vice President: Nicole Webb
• Secretary: Resham Kaur • Treasurer: Amita Saxena • Past President: Raelene Walker
Executive Director: Yolanda Ruiz
Board Members:
North Valley MAL: Thiyagu Ganesan • Sacramento Valley MAL: Lena van der List • Central Valley MAL: Deborah Shassetz • South Valley MAL: Vacant • San Francisco MAL: Maya Raman • Santa Clara MAL: Vacant • San Mateo MAL: Neel Patel • North Coastal MAL: Jeffrey Ribordy • Monterey Bay MAL: Graciela Wilcox • Alameda MAL: Renee Wachtel • Contra Costa/Solano MAL: Omoniyi Omotoso
Pediatric Insider News Editors:
• Mika Hiramatsu • Deborah Shassetz • Alyssa Velasco
Staff:
• Project Assistant: Sana Sayyid
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