2019 - August Edition
Alice Kuo, MD, PhD, MBA, FAAP   President, AAP - CA2    2018 - 2020 
President's Message
Coming back from our Joint District meeting at AAP headquarters in Itasca, Illinois, Raj, Tomas and I are energized for the upcoming year, continuing our efforts to extend the work of national AAP to improve children's health in our communities. Held from July 25-28, AAP leaders from California and New York received updates on the following priorities for children's health by National AAP.
AAP District IX leadership representing the four California Chapters at the American Academy of Pediatrics headquarters in Itasca, Illinois for the District II (NY) and District IX (CA) Joint District Meeting (July 25-28, 2019) 
At the national level, the AAP has been combatting "fake news" propagated by anti-vaxxers  and had conversations with Facebook and Pinterest executives. As a result of this national advocacy, if you now search "vaccines" on Facebook, the first entries that pop up are the Centers for Disease Control and Prevention (CDC), World Health Organization (WHO) and AAP. You have probably heard through the media that Facebook is taking down pages promoting anti-vax sentiments because they are not based on science. This is the direct result of conversations between AAP President Kyle Yasuda and Executive Director Mark del Monte and executives from Facebook. A search for "vaccines" on Pinterest displays the disclaimer shown on the right. 
Some of you may have noticed that vaccine payment through CPT code 90460 and its related codes has been declining. This is due to an inadvertent move by CMS to streamline these codes for adults, without realizing the impact on pediatricians. The national AAP is on top of this and has reached out to CMS and HHS to make them aware of the issue. We are confident that we will eventually undo this mistake, and it is a high priority for national AAP to fix this problem.
School Safety/Gun Violence Prevention
For the last four years, there has been a school shooting every 77 days in the U.S. Since Sandy Hook and Parkland, national AAP has been extremely concerned about the impact of gun violence broadly on children. National AAP is currently working to secure $50 million in funding from Congress for research on gun violence prevention. This would be split $25 million to the CDC and $25 million to NIH. This would be the first time in a long while that federal funds would be used for research on gun violence.
In addition, many schools have implemented active shooter drills for grades K-12. Here in California, AB 1722 (R-Kiley) is likely to pass, and this bill requires schools to implement active shooter protocols as part of the school's safety plan. AAP-California has been asked to provide guidance on how to make these protocols developmentally appropriate, and we have asked national AAP to help us with this.
Immigration/Detention Centers
National AAP is clearly the most vocal and active organization advocating for the humanitarian rights of children who are in detention centers at our borders and who have been separated from their parents. AAP leaders, including Past President Colleen Kraft and President Kyle Yasuda and many others, have been vocal and active with newspaper articles, interviews, opinion pieces and social media raising awareness about the issues.
Some of you may have heard that HR 3239 (Humanitarian Standards for Individuals in Customs and Border Protection Custody Act) passed the House last week. HR 3239 takes important steps toward ensuring that appropriate medical screening of children in CBP custody happens. It is important that children in CBP custody have timely access to appropriate screening and necessary care. Further, the legislation provides for basic minimum humanitarian standards for children such as adequate hygiene, nutrition, clean water, and sanitation while in CBP custody. View the letter in support of HR 3239 here
National AAP has been busy addressing the epidemic of teenage vaping at the federal level. We recently won a lawsuit against the FDA for not implementing graphic warning labels on cigarette products when this had been passed in 2009 (10 years is long enough!). We won a second lawsuit against the FDA this month to force the FDA to begin regulating e-cigarette products within the next 10 months. 
National AAP has an extensive strategy and has developed a strong coalition with other professional organizations to combat the efforts of Juul and other tobacco-related companies to addict youth on nicotine.  
Testifying before a House oversight subcommittee on July 24, Jonathan Winickoff, MD, MPH, FAAP, (pictured first on left at microphone) urged that JUUL be removed from the market as soon as possible to protect child health. Dr. Winickoff's testimony detailed the numerous health concerns posed by adolescent use of JUUL, including the harmful impact of nicotine on the developing brain and concerns about lung damage from exposure to JUUL aerosol.
Injury Prevention
In last month's newsletter, I mentioned the AAP's efforts to raise awareness about drowning prevention, particularly among young children. This past spring, the AAP released a policy statement (here) about the importance of addressing drowning prevention during well-child visits. The public outreach from the AAP on this issue has ramped up during these summer months, so please keep this in mind as you see your patients and talk with parents.
You may have been aware of the Fisher-Price recal l of the "Rock 'n' Play Sleepers" due to  concerns of suffocation and unsafe sleep practices with this product. This was completely due to media advocacy by the AAP to raise awareness of the unsafe product and to pressure Fisher-Price to take this product off the market. National AAP is following up with other manufacturers of similar sleepers and is working to take all of them off of the market.
Climate Change
National AAP is supporting the "Juliana 21" lawsuit against the Trump administration. Juliana 21 is a group of young adults who have been moving a constitutional climate lawsuit through the system since 2015. When the lawsuit first began hardly anyone took it seriously, including the government's lawyers, who have since watched the U.S. Supreme Court reject two of their motions to delay or dismiss the case. Four years in, it is still very much alive, in part because the plaintiffs have amassed a body of evidence that will surprise even the skeptics and have forced the government to admit that the crisis is real. National AAP has signed on to an amicus brief (one of nearly 20) from public health experts presenting scientific evidence of climate change and its impact on the health of individuals, including children.
Reducing Sugar Consumption
Across the country, states are introducing bills to add taxes on sugar-sweetened beverages in order to reduce children's sugar consumption. National AAP is supporting numerous states on these efforts, including in California where we have several priority bills related to reducing soda consumption.
Emerging Challenges
  • National AAP is tracking a number of efforts across the country that are contributing to rising rates of uninsurance among children.
  • Although the Supreme Court ruled that the 2020 Census cannot have a question on documentation status, national AAP fears that the damage has been done and people will be afraid to answer Census questions when someone comes to their door. Pediatricians will be asked next year to assure parents that answering Census questions is safe and encouraging them to do so because the Census count is crucial to get federal funds for Medicaid and other important health-related funds.
  • National AAP is monitoring the ongoing challenges to reproductive healthcare access, particularly for adolescent females, and advocating in states as these issues come up. The latest is that the Title X regulations have been amended to make access to reproductive services more difficult, and states have to determine how they will comply with these new regulations.
  • Physician wellness is increasingly recognized as a significant and serious problem. One  contributor is the heavy administrative burdens related to the care of patients (i.e., from electronic medical records). National AAP is partnering with the American Medical Association (AMA) to address the need of Prior Authorization Requests and other hurdles that add to a physician's administrative burden. Additionally, national AAP is looking to partner with the Accreditation Council of Graduate Medical Education (ACGME) to address mental health issues and suicidality among medical students and residents (please check out  https://www.newsy.com/series/unspoken/ for more information). Finally, states are examining the appropriateness of asking physicians about their mental health history as part of the medical licensing process for physicians.
As you can see, our chapter is very active addressing child health issues and supporting all of our work as pediatricians. Now is a good time to reach out to your pediatric colleagues who have not yet joined the chapter or paid their chapter dues. If there are pediatricians you know who would be willing to join the chapter, please direct them to our membership site (here). Also, it is possible to join our chapter to support local child health efforts without joining national AAP if there are cost prohibitions. Please contact Tomás for more information.
Please check out the rest of our newsletter for information on our Town Hall meetings and other CME opportunities, ways to get Maintenance of Certification (MOC) points with Quality Improvement (QI) projects, and statewide advocacy priorities that the AAP is working on behalf of children.
Thanks for all that you do on behalf of children in our communities!
Alice Kuo, MD, PhD, MBA, FAAP
Chapter President
Leadership from AAP District II (New York) and District IX (California) for the 2019 Joint District Meeting at AAP headquarters in Itasca, Illinois. 
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New Chair of Pediatrics
Santa Barbara - August 1   
Brian Santacrose, MD, FAAP
We would like to congratulate Brian Santacrose, MD, FAAP - AAP-CA2 Area Representative in Santa Barbara County - for his recent appointment as Chair of Pediatrics at Santa Barbara Cottage Hospital (SBCH). Dr. Santacrose joined staff at SBCH in 2015, and has diligently served as AAP-CA2 Area Representative since 2014.
Dr. Santacrose grew up in upstate New York, studied Human Development at Cornell University and then went on to medical school at SUNY Upstate Medical University in Syracuse, New York. In medical school, Dr. Santacrose was inducted into Alpha Omega Alpha and Gold Humanism Honor Societies. He completed his Pediatric Residency training at Children's Hospital Los Angeles (CHLA).  
Dr. Santacrose is a partner of Children's Medical Clinic of Santa Barbara and lives in Santa Barbara with his wife, Diana.  In his spare time, he enjoys playing beach volleyball, golf and tennis.
ACEs - Volume 1

Adverse Childhood Experiences: What California Pediatricians & Health Professionals Need to Know

Adam Schickedanz, MD, PhD
Adam Schickedanz, MD PhD
Chair of the AAP-CA2 Adverse Childhood Experiences Committee
Assistant Professor of Pediatrics in the Department of Pediatrics at the David Geffen School of Medicine at UCLA | Health Services Researcher with the UCLA Children's Discovery and Innovation Institute.
Dr. Schickedanz practices clinically at Olive View-UCLA Medical Center.

If there were a risk factor that markedly increased your patient's chance of heart disease, diabetes, lung disease, mental illness, and early mortality, would you want to know about it? If that risk factor was found in well over half the population, would you call it a health epidemic? If it was a theme running through the biggest news stories of the day, from family separation at the border to gun violence to the opiate epidemic, would you expect us to be talking about it more? As it happens, such a health risk factor is all too real. Adverse childhood experiences (ACEs) pose exactly this highly common and hazardous risk to children and the adults they will become. READ MORE ...
This article is the first in a series from the Chapter's newly-formed Adverse Childhood Experiences Committee to keep members up to speed in this rapidly evolving area. Please visit http://aapca2.org/aces for more details.
AAP Federal Affairs Update

Three Important Child Health Bills Head to the Senate

There were several victories for child health before members of the House left Washington for August recess. On July 24, the House passed three AAP-championed child health bills, sending them on to the Senate for consideration.
  • The Emergency Medical Services for Children (EMSC) Program Reauthorization Act would reauthorize the EMSC program for five years - which is the only federal program dedicated to improving emergency care for children.  
  • The Autism Collaboration, Accountability, Research, Education and Support (CARES) Act reauthorizes critical programs that are designed to enhance understanding of Autism Spectrum Disorder.
  • The Newborn Screening Saves Lives Reauthorization Act would renew funding for programs that help states improve and expand their newborn screening programs.


AAP Recommendations to Prevent Drowning in Children

On March 15, the AAP updated its recommendations to prevent drowning in children.
Drowning can happen to any family. It's quick, and it's silent. Drowning is the No. 1 cause of death among children aged 1-4, and is a leading cause of death among teens. We can lower these rates if pediatricians, parents and policy-makers work together to implement the types of solutions we know will keep children safe.  
This Toolkit contains recommendations for pool supervision, drowning prevention PSAs, infographics, social media graphics, information for parents, advocacy resources and links to AAP policy. Please share these resources with parents and caregivers.   
Upcoming - Events
October 2, 2019 in Woodland Hills -
Kenneth Saul, MD, FAAP 
Town Hall / Dinner  
Join AAP-CA2 Member-At-Large Ken Saul, MD, FAAP for a Town Hall at Maggiano's, in Woodland Hills on October 2, 2019. Please save the date! 
TOPIC: Advances in ADD Management
Date: 10/2/2019
Time: 6:30 PM
Location: Maggiano Woodland Hills
6100 Topanga Canyon Blvd, Woodland Hills, CA 91367 
RSVP directly to Dr. Ken Saul: docksaul@aol.com 

Gala - October 10   
BreastfeedLA is dedicated to improving the health and wellbeing of in fants a nd  families through education, outreach, and advocacy - by promoting and supporting breastfeeding.  
BreastfeedLA was founded 25 years ago by a group of dedicated volunteers who wanted to make a difference in the breastfeeding rates in Los Angeles County. This October (Thursday October 10th at Pickwick Gardens in Burbank, CA) BrestfeedLA is celebrating its 25th Anniversary with a Gala Masquerade and we would like to invite AAP-CA2 members to attend and sponsor their event. ALL BreastfeedLA proceeds go directly to education programs and advocacy efforts including: scholarship towards our Lactation Education Specialist Training and Lactation Consultant Education Course, continuing education seminars, conferences focused on equity and advocacy, and paid family leave advocacy efforts.

BreastfeedLA Educational Events 
What They Didn't Teach You About Breastfeeding In Your Training
MemorialCare Miller Children's & Women's Hospital Long Beach
September 6 @ 8:00 am - 4:15 pm
Speaker: Dr. Jack Newman 
The Return of Breastsleeping: Humankind's Oldest and Most Successful Sleep and Feeding Arrangement
Henry Mayo Newhall Hospital
October 11 @ 9:00 am - 4:15 pm
Speaker: Dr. James Mckenna
QI Opportunities - CME and MOC Part 4
 Dental Transformation Initiative
In a state-funded effort to improve the oral health of Los Angeles County children on Medi-Cal, UCLA's More LA Smiles Dental Transformation Initiative invites medical providers and their staff to participate in clinical trainings and quality improvement (QI) programs. Provided by UCLA faculty in collaboration with various program partners, the free education equips providers to deliver pediatric risk-based prevention and disease management services.  
Overview Training: This 1-hour training explains the Medi-Cal 2020 Dental Transformation Initiative and provides contemporary understanding of dental caries and systems-based approaches to improving children's oral health. Participating providers may earn 1 CME credit online by visiting https://morelasmiles.org/medicaloverview or can request an in-person training for their office by emailing training@morelasmiles.org.

Advanced Training: The 3-hour training includes in-depth instruction on performing caries risk assessments, applying fluoride varnish, utilizing self-management goals and contemporary approaches for prevention and management of dental caries as a chronic infectious disease. Participating providers earn 3 CME credits. We welcome the opportunity to provide an in-person training for your organization; please email training@morelasmiles.org to coordinate.
Join today!
Stay Connected!  @moreLAsmiles    
Disaster Preparedness

Southern California has recently experienced earthquakes higher than 6 in the Richter magnitude scale.  In this section you will find resources so that you may better prepare for such events. 
This publication features practical and low-cost techniques to make child care facilities safer in the event of an earthquake, whether they are based in a home or a larger facility. The publication offers tips for conducting earthquake drills and includes a checklist of supplies to keep on hand in an emergency kit. 
FEMA's E-mail Updates: Fast, Free, and Automatic
Get the FEMA Mobile App
The FEMA App is the best option to receive emergency alerts and information so that you and your loved ones know what to do before, during and after disasters. This simple and easy-to-use app provides safety notifications, emergency preparedness tips, and disaster resources. 
Install the FEMA App (Apple and Android mobile devices) 
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Please Donate
AAP-CA2 is a 501(c)(3) non-profit organization. Please consider a tax-deductible charitable donation to one of our many programs
  • The Medicine-Biological Sciences Scholarship Program, which awards scholarships to exceptional high school students each year.
  • The Committee on Service, Education, and Mentoring, which awards scholarships to pediatric residents for outstanding research projects. 
  • The S. Michael Marcy Memorial Lecture, which helps sponsor a portion of our annual Advances in Pediatrics Conference in his honor.

Please contact Tomás Torices, MD (Chapter executive director) for all Chapter 2 related matters.
Cell. (818) 422-9877
Mailing Address: 
PO Box 94127  
Pasadena, CA 91109

Please visit our website at  http://aapca2.org/