2018 Resolutions to WSMA Annual Meeting

Here are the resolutions passed by the King County Medical Society Board of Delegates.  They have been submitted to the Washington State Medical Association for consideration at the 2018 WSMA annual meeting October 13-14.  The full program for the annual meeting can be found here.

 

SUBJECT: Clean Air Initiative Endorsement

Introduced by: Mark Vossler, MD/King County Medical Society

Whereas: The most vulnerable populations, the elderly, young children and the economically disadvantaged are disproportionately threatened by climate induced health risks and

Whereas: Changing Climate as a result of human activity is an accepted scientific fact (1), and

Whereas: Climate Change represents a serious threat to human health (2,3), and

Whereas: The health co-benefits of climate change mitigation from reduction in other pollutants, changes in dietary and transportation choices are clear and immediate (4,5), and

Whereas: The Washington State Medical Association has acknowledged that climate change is a critical public health issue and resolved to “support policies that both reduce pollution and address the issues of climate change and that will promote healthier, sustainable communities” (Resolution B-4 2016), and

Whereas: The AMA recently passed a resolution divesting itself from fossil fuels, and

Whereas: Other health care organizations including King County Academy of Family Physicians, The Institute of Neurotoxicology and Neurological Disorders, Planned Parenthood Northwest and Hawaii, Physicians for Social Responsibility (WA state and National chapters) have endorsed I-1631, and

Whereas: Investments in clean energy and protection of vulnerable communities would effectively support Washington State policy to mitigate climate change and adapt to its effects, and

Whereas: A price on carbon emissions would incentivize our economy to move away from fossil fuels (6), and

Whereas: The consensus among economists studying the issue of energy policy is that carbon pricing is essential to correcting the adverse externalities resulting from fossil fuel use and that a price on carbon emissions coupled with clean energy investments would lead to job creation and economic growth (6,7), and

Whereas: I-1631 contains provisions to assist low income communities who are both most vulnerable to the adverse health effects of air pollution and most sensitive to changes in energy prices, and

Whereas: Studies show that a strategy such as I-1631, if adopted nationwide, would result in prevention of 13,000 premature deaths annually (7), and

Whereas: Physicians have a moral obligation to advocate for policy changes that protect human health including the health threats from air pollution and climate change (8,9)

Be it Resolved: that the Washington State Medical Association take measures to promote clean energy, and

Be it further resolved, that the Washington State Medical Association endorses investments in clean energy via a fee on large suppliers of CO2 emitting products, and

Be it further resolved, that the Washington State Medical Association endorse Initiative Measure 1631

References:

1. IPCC. Summary for policymakers in Field CB, Barros VR, Dokken DJ, et al eds. Climate Change 2014: impacts, adaptation and vulnerability. Cambridge UK: Cambridge University Press, 2014: 1-32.

2. Watts N, Adger W, Blackstock J et al. for the Lancet Commission on Health and Climate Change Lancet 2015; 385: 1-53.

3. Patz J, Frumkin H, Holloway T, et al. Climate Change: Challenges and Opportunities for Global Health JAMA 2014; 312: 1565-1580.

4. Vossler M, Thomas M, Kitchell M, et al. The Health Co-Benefits of Climate Change Mitigation in Washington State WPSR 2018 https://www.wpsr.org/co-benefits

5. Chang K, Hess J, Balbus J, et al. Ancillary health effects of climate mitigation scenarios as drivers of policy uptake Environ Res Lett 2017 12 113001

6. Hsu, Shi-Ling The case for a carbon tax 2011 Island Press Washington DC

7. Nystrom S, and Lucklow P. The Economic, Climate, Fiscal, Power and Demographic Impact of a National Carbon Tax Regional Economic Models Incorporated. 2013 Washington DC

8. Jameton A. The Importance of Physician Climate Advocacy in the Face of Political Denial AMA Journal of Ethics 2017 12:1222-1237.

9. Chivan E, Why doctors and their organizations must help tackle climate change BMJ 2014; 348: g2407.


SUBJECT: Identifying, Treating, and Eliminating Childhood Lead Poisoning in Washington State

Introduced by: Amish J. Dave, MD, MPH/King County Medical Society

WHEREAS, physicians aim to diagnose and treat disease, while simultaneously eliminating their root causes; and

WHEREAS, lead is a toxic metal that can have severe physical and mental impacts in children including learning disabilities, decreased cognitive and behavioral function, decreased attention span, decreased school performance, decreased physical growth, and increased mortality; and

WHEREAS, even low levels of blood lead (<5 µg/dl) can lead to short-term and long-term health issues; and

WHEREAS, scientists have established that there is no safe level of lead exposure; and

WHEREAS, many children with lead poisoning are asymptomatic even at high blood lead levels making it difficult for parents and healthcare providers to identify lead poisoning; and

WHEREAS, lead poisoning can occur in many ways, including from living in older housing with lead-based paint; drinking water contaminated with lead from old pipes, solder and fixtures; certain occupational exposures including take-home lead from adult occupational exposures; and household items brought in or imported from other countries (e.g., spices, ceramics, jewelry, cultural items, and Ayurvedic medicines).

WHEREAS, historically Washington State has only tested 1 to 4 % of children for lead exposure each year, one of the five lowest rates in the nation; and

WHEREAS, 2014 data suggests that more than eight thousand children in King County alone may have elevated blood lead levels; and

WHEREAS, federal law mandates that all Medicaid-eligible children be tested by lead blood testing at ages twelve and twenty-four months and provides clear guidelines on initial and confirmatory blood testing; and

WHEREAS, the Washington State Board of Health and Washington State Department of Health recommends healthcare providers assess all children for risk factors for lead poisoning at 12 and 24 months of age to guide blood lead testing) and

WHEREAS, the current occupational standards for lead in state and federal law are based on scientific knowledge from the 1970s and do not reflect more recent research on lead’s adverse health effects; and

WHEREAS, the American Academy of Pediatrics already recommends anemia testing for all children between 9-15 months (with lead being a common cause of anemia in low income children); and

WHEREAS, there is a critical shortage of funds and staff persons in state and local public health offices to identify, test, and treat children at high-risk for lead poisoning and to remediate the underlying lead exposure source; and

WHEREAS, there is a lack of standardization in reporting of lead risk assessment questionnaire results and poisonings that impedes the ability of public health staff in Washington State from understanding the prevalence and sources of elevated blood lead in children; be it

RESOLVED: that the Washington State Medical Association advocates for measures by physicians and public health authorities to identify, treat, and eliminate sources of childhood lead poisoning in Washington State, including (1) adopting the federal and Washington State Department of Health reference level of >5 µg/dL as an unacceptable level of lead in children at twelve and twenty-four months, (2) increasing funding for lead blood testing in physicians’ offices and medical centers caring for pediatric patients, (3) standardizing reporting of lead test results to the Washington State Department of Health through a secure, electronic reporting system, (4) standardizing reporting and data collection and follow-up of lead testing results through state and local public health offices, (5) working with the health care authority to ensure all healthcare providers fulfill the federal obligation to test all Medicaid-eligible children at 12 and 24 months of age, (6) supporting a mandate that all pre-1978 rental housing units statewide be lead safe as per the existing Washington State Department of Ecology’s chemical action plan, (7) increasing local and state funding for treatment and case management of children with lead poisoning, (8) educating healthcare providers and the public about the importance of primary prevention of lead poisoning (removing sources) and secondary prevention (risk assessment questions and testing for blood lead as indicated per risk assessment).

This resolution has been endorsed by:
-Washington Chapter of the American Academy of Pediatrics
-Northwest Pediatric Environmental Health Specialty Unit
-Washington State Department of Health
-Public Health Department of Seattle and King County
-Washington Poison Center

DOH lead risk assessment recommendations:

https://www.doh.wa.gov/Portals/1/Documents/Pubs/334-394.pdf

Washington Chemical Action Plan:

https://fortress.wa.gov/ecy/publications/SummaryPages/0907008.html

WA Department of Ecology helpful link: https://ecology.wa.gov/Waste-Toxics/Reducing-toxic-chemicals/Addressing-priority-toxic-chemicals/Lead


SUBJECT: Preventing Gun Violence in Washington State

Introduced by: Amish J. Dave, MD, MPH/King County Medical Society

WHEREAS, all physicians have a responsibility to advocate for public health interventions that protect human life, and

WHEREAS, firearm-related injury and death is a preventable public health problem, and

WHEREAS, more than 36,000 people in the United States are killed by gun violence each year, of which 61% were suicides and 36% were homicides, and

WHEREAS, more than 682 residents of Washington State died from a firearm injury in 2016, of which 75% were suicides, approximately half of all suicides in Washington State, and

WHEREAS, over 60% of all homicides in Washington State were committed with firearms, and

WHEREAS, in Washington State in 2015, 39 children (age 17 or younger) died as a result of firearms (an equivalent of one child or teen killed by gunfire every 9 days) with an additional 30 children hospitalized statewide, and

WHEREAS, during the 2015-2016 school year, the Washington State Superintendent of Public Instruction reported 130 incidents involving a firearm on school premises, transportation systems, or school facilities, and

WHEREAS, according to the Washington Association of Sheriffs and Police Chiefs, the total value of firearms reported stolen in Washington State was $3,312,794, and

WHEREAS, approximately 21% of King County adults (340,000 people) reported firearms present in or around their homes while 15% (51,000) of firearm owners reported storing them loaded and unlocked, and

WHEREAS, the American Academy of Family Physicians, American Academy of Pediatrics, American College of Emergency Physicians, American Congress of Obstetricians and Gynecologists, American College of Physicians, American College of Surgeons, and American Psychiatric Association have collectively called for commonsense measures to reduce gun violence, including universal background checks, elimination of laws intruding on physicians’ and patients’ rights to discuss issues related to health and safety, including guns, and restricting the manufacture and civilian sale of military-style weapons and high-capacity magazines, and

WHEREAS, the American Health Association and American Bar Association have reviewed these organizations’ collective recommendations and affirmed that they do not conflict with Second Amendment rights or U.S. Supreme Court rulings, and

WHEREAS, current federal law has the potential to drastically limit the ability of the Centers for Disease Control and other federal agencies to conduct research on gun violence without fear of retaliation, and

WHEREAS, a recent systematic review found that there were zero published research studies between 2004-2015 on the association between access to guns and firearm-associated homicide and suicide, and

WHEREAS, in 2013, the Washington State Medical Association supported criminal background checks for all firearm sales and transfers of ownership, with permissible exceptions, (e.g. gifts between immediate family members, antiques, and loans for lawful hunting or sporting activities.), and

WHEREAS, in 2014, the Washington State Medical Association supported efforts by the state of Washington to require universal background checks by licensed dealers for all firearm sales and transfers, including gun show and online sales, and

WHEREAS, in 2014, the Washington State Medical Association encouraged incorporating questions about firearms in and outside the home when documenting social history in the medical record, as well as resolved that educational materials regarding gun safety and storage be available online to patients, and

WHEREAS, in 2016, the Washington State Medical Association supported the concept of Extreme Risk Protection Orders, which allow families and law enforcement to petition a court to temporarily suspend a person’s access to firearms if there is documented evidence that an individual is threatening harm to themselves or others because of dangerous mental illness or at high risk of violent behavior;

NOW, THEREFORE, BE IT RESOLVED: that the Washington State Medical Association advocate for measures to reduce gun violence, including (1) elimination of state and federal laws intruding on physicians’ and patients’ rights to discuss gun violence, (2) supporting the concomitant sale of safe storage lockers and lockboxes with purchase of all guns in Washington State with state-level verification, (3) restricting the manufacture and civilian sale of military-style weapons – including assault weapons – and high-capacity magazines, (4) increasing state and federal funding on research related to gun violence as a public health issue, (5) encouraging physicians and healthcare workers to discuss safe storage of guns and the association of guns with risk of homicide, accidental shooting, and suicide, and counsel about risk, (6) closing loopholes in gun purchases online and at unregulated gun shows, (7) allowing researchers and the public access to local and state prosecutor data on gun violence, and (8) establishing an Office of Washington State Gun Violence Czar within the Washington State Department of Health with a budget allowing for better understanding of the causes of gun violence within our state and best practices to stop gun violence.

References

Centers for Disease Control and Prevention.  About compressed mortality, 1999-2014. https://wonder.cdc.gov/cmf-icd10.html. Accessed June 15, 2016.

Jagger J, Dietz PE.  Death and injury by firearms: who cares?  JAMA. 1986;255(22):3143-3144.

Kellermann AL, Rivara FP.  Silencing the science on gun research.  JAMA. 2013;309(6):549-550.

Ladapo JA, Rodwin BA, Ryan AM, Trasande L, Blustein J.  Scientific publications on firearms in youth before and after Congressional action prohibiting federal research funding.  JAMA. 2013;310(5):532-534.

National Institutes of Health.  FY 2004-2015 Federal RePORTER project data. https://federalreporter.nih.gov/FileDownload. Accessed June 15, 2016.

Rubin R.  Tale of 2 agencies: CDC avoids gun violence research but NIH funds it.  JAMA. 2016;315(16):1689-1691.

Washington Hospital Discharge Data, Comprehensive Hospitalization Abstract Reporting System (CHARS) 1987-2015.

Washington State Department of Health, Center for Health Statistics, Community Health Assessment Tool (CHAT), August 2016.

Washington State Department of Health, Center for Health Statistics, Death Certificate Data, 1990-2016, Community Health Assessment Tool (CHAT), October 2017.


 

SUBJECT: Specialist Approval for Hospital Emergency Room Transfers within a Hospital System

Introduced by: David C. Green M.D. / King County Medical Society

WHEREAS, hospital system administrators are advancing policy to allow for ER transfers of patients requiring specialty care, within a single hospital system, using approval of either a Nurse Administrator or ER Physician alone, without prior specialist approval, and

WHEREAS, the above policy would compromise patient safety by risking an inappropriate transfer to a hospital with inadequate medical or surgical specialty services, and

WHEREAS, the above policy would also potentially overextend the coverage of one specialist at a small community hospital to several hospitals across the state, and

WHEREAS, many specialists are now employed by these hospital systems and either feel powerless to prevent hospital administrative staff from advancing the above policy, or have contractually agreed to the above policy, be it

RESOLVED, The WSMA support EMTALA policy that requires approval of the accepting specialist, arranged through the Hospital ER Transfer Center, before allowing an ER to ER transfer to occur for patients requiring medical or surgical specialty care, even within the same hospital system, and be it further

RESOLVED, The WSMA should support EMTALA policy that views ER transfers for specialty care, without the approval of the receiving specialist, as an EMTALA violation.


SUBJECT: Pharmacy Vaccination Records

Introduced by: Richard Kaner, MD/King County Medical Society

WHEREAS, it is widely accepted that vaccination is an important part of a person’s healthcare, and

WHEREAS, proper charting is an important part of proper patient care, and

WHEREAS, a person’s primary care provider is expected to keep proper records of a patient’s vaccination history, and

WHEREAS, pharmacies now advertise and give a wide variety of vaccines to patients without consultation with the patient’s provider

NOW, THEREFORE, BE IT RESOLVED: that any pharmacy giving a vaccine to a patient be obligated to provide written notification to that patient’s primary care provider if primary provider information is available.


SUBJECT:  Health Care Workers State Vaccine Database

Introduced by: Mark Vossler, MD; Ed Leonard, MD; Emily Darby, MD/King County Medical Society

WHEREAS, standard immunizations required for all licensed Health Care Workers (HCW) for both patient safety and provider/staff safety include: Hep B, varicella, Tdap, MMR, annual flu vaccine, and meningococcal vaccines for all microbiology workers, and

WHEREAS, preemployment and credentialing to collect these vaccine data involves an enormous “paper chase” that often results in reimmunization if records can’t be found, and

WHEREAS, only collecting the data for annual flu vaccines takes hundreds of hours as HCW receive vaccines at clinics, pharmacies, hospitals, etc., then try to share the data with other hospitals or health groups, and

WHEREAS, HCW are increasingly mobile and sometimes credentialed at multiple institutions leading, once again, to an enormous outlay of time to collect and obtain data, and

WHEREAS, these data exist but are sequestered in individual silos of health care systems, hospitals and clinics, and

WHEREAS, a central repository like the Washington State Immunization Information System is the logical repository of these data,

NOW, THEREFORE, BE IT RESOLVED that the WSMA suggest that (1) all hospitals contribute by uploading their immunization data to a data bank similar to the Washington State Immunization Information System, and (2) the Department of Health, in conjunction with individual hospitals or health care systems, create the appropriate computer links to facilitate these downloads, and (3) the state provide funds to the Department of Health for this purpose.


SUBJECT: Protecting Children from Adverse Childhood Events

Author: Danny Low, MD/King County Medical Society

WHEREAS, Adverse Childhood Events (ACEs) refer to categories of abuse, neglect and household/family challenges that children experience during the first 18 years of life, and

WHEREAS, experiencing ACEs has repeatedly revealed a dose-response relationship between ACEs and negative health and well-being outcomes across the life course, and

WHEREAS, experiencing an increasing number of ACEs has specifically been shown to increase the risk for autoimmune disease, alcoholism, chronic obstructive pulmonary disease, depression, early death, illicit drug use, ischemic heart disease, liver disease, poor work performance, intimate partner violence, sexually transmitted diseases, smoking, suicide attempts, and unintended pregnancies, and

WHEREAS, current immigration practices that allow for the separation of families result in children experiencing at least 3 ACEs – parental separation, emotional neglect and physical neglect from parents who are forcibly separated from their children; and

WHEREAS, studies of detained immigrant children have shown that children often subsequently suffer negative physical and emotional symptoms from detention, including anxiety, depression and posttraumatic stress disorder, and

WHEREAS, conditions in U.S. detention facilities reportedly have included forcing children to sleep on cement floors, use open toilets, and receive insufficient food and water, leading to ill and malnourished children, and

WHEREAS, such immigration practices are therefore designed in a manner that increase poor health outcomes for children; be it

RESOLVED, that the Washington State Medical Association make a formal statement publicly opposing the enforcement of immigration policy on undocumented immigrants that impose increased ACEs, and be it further

RESOLVED, that the Washington State Medical Association support policy that promote unification of families at the border, and be it further

RESOLVED, that the Washington State Medical Association oppose policy that detains immigrant children in detention facilities and oppose policy that increase ACEs for children.

[1] Adverse Childhood Experiences (ACEs). https://www.cdc.gov/violenceprevention/acestudy/ace_brfss.html
[2] Dube SR, Fairweather D, Pearson WS, Felitti VJ, Anda RF, Croft JB. Cumulative childhood stress and autoimmune disease. Psychom Med.2009;71:243–250.
[3] Anda RF, Whitfield CL, Felitti VJ, Chapman D, Edwards VJ, Dube SR, Williamson DF. Adverse childhood experiences, alcoholic parents, and later risk of alcoholism and depression. Psychiatr Serv. 2002;53(8):1001–1009.
[4] Anda RF, Brown DW, Dube SR, Bremner JD, Felitti VJ, Giles WH. Adverse childhood experiences and chronic obstructive pulmonary disease in adults. Am J Prev Med. 2008;34(5):396-403.
[5] Chapman DP, Anda RF, Felitti VJ, Dube SR, Edwards VJ, Whitfield CL. Adverse childhood experiences and the risk of depressive disorders in adulthood. JAffect Disord. 2004;82:217–225.
[6] Remigio-Baker RA, Hayes DK, Reyes-Salvail F. Adverse childhood events and current depressive symptoms among women in Hawaii: 2010 BRFSS, Hawaii. Matern Child Health J. 2014 Dec;18(10):2300-8.
[7] Brown DW, Anda RA, Tiemeier H, Felitti VJ, Edwards VJ, Croft JB, Giles WH.  Adverse childhood experiences and the risk of premature mortality.  Am J Prev Med.  2009;37(5):389-396.
[8] Dube SR, Felitti VJ, Dong M, Chapman DP, Giles WH, Anda RF. Childhood abuse, neglect and household dysfunction and the risk of illicit drug use: The Adverse Childhood Experience Study. Pediatrics. 2003;111(3):564–572.
[9] Dong M, Giles WH, Felitti VJ, Dube, SR, Williams JE, Chapman DP, Anda RF. Insights into causal pathways for ischemic heart disease: adverse childhood experiences study. Circulation. 2004;110:1761–1766.
[10] Dong M, Anda RF, Dube SR, Felitti VJ, Giles WH. Adverse childhood experiences and self-reported liver disease: new insights into a causal pathway. Arch Intern Med. 2003;163:1949–1956.
[11] Anda RF, Felitti VJ, Fleisher VI, Edwards VJ, Whitfield CL, Dube SR, Williamson DF. Childhood abuse, household dysfunction, and indicators of impaired worker performance. Perm J. 2004;8(1):30–38.

[12] Ports KA, Ford D, Merrick MT. Adverse childhood experiences and adult sexual victimization. Child Abuse and Neglect. 2016;51, 313-322.
[13] Hillis SD, Anda RF, Felitti VJ, Nordenberg D, Marchbanks PA. Adverse childhood experiences and sexually transmitted diseases in men and women: a retrospective study. Pediatrics. 2000;106(1):E11.
[14] Anda RF, Croft JB, Felitti VJ, Nordenberg D, Giles WH, Williamson DF, Giovino GA. Adverse childhood experiences and smoking during adolescence and adulthood. JAMA. 1999;282:1652–1658.
[15] Edwards VJ, Anda RF, Gu D, Dube SR, Felitti VJ. Adverse childhood experiences and smoking persistence in adults with smoking-related symptoms and illness. Perm J. 2007;11:5–7.
[16] Dube SR, Anda RF, Felitti VJ, Chapman D, Williamson DF, Giles WH. Childhood abuse, household dysfunction and the risk of attempted suicide throughout the life span: Findings from Adverse Childhood Experiences Study. JAMA. 2001;286:3089–3096.
[17] Dietz PM, Spitz AM, Anda RF, Williamson DF, McMahon PM, Santelli JS, Nordenberg DF, Felitti VJ, Kendrick JS. Unintended pregnancy among adult women exposed to abuse or household dysfunction during their childhood. JAMA. 1999;282:1359–1364.
[18] Linton JM, Griffin M, Shapiro AJ, et al. Detention of Immigrant Children. Pediatrics. 2017. Policy Statement
[19] Manrique J and Solis D. “At the border, doctors, advocates worry medical care for immigrants is lacking.” Dallas News. June 28, 2018. < https://www.dallasnews.com/news/immigration/2018/06/28/border-doctors-advocates-worry-medical-care-immigrants-lacking>

 


SUBJECT: Resolution Supporting Legalization of Biochemical Hydrolysis in Washington state
Introduced by: Hal C. Quinn, MD/King County Medical Society

WHEREAS, many individuals prefer cremation over traditional burial, and

WHEREAS, the 2018 US cremation rate is projected to be 53.5 percent and the burial rate is projected to be 40.5 percent, and

WHEREAS, traditional (flame) cremation uses about 110 liters (28 US gal) of fuel and releases about 240 kg (540 lb) of carbon dioxide into the atmosphere, and

WHEREAS, biochemical or alkaline hydrolysis, compared to traditional cremation, eliminates emissions of carbon dioxide, nitrogen oxide, and mercury, and

WHEREAS, biochemical hydrolysis reduces carbon output by 75% (versus flame), and

WHEREAS, biochemical hydrolysis uses 1/8 the amount of energy (versus flame), and

WHEREAS, the solution remaining after biochemical hydrolysis is sterile and can be released to waste water systems as non-potable water; and is safe for lakes, rivers and streams; and

WHEREAS, there is currently a bill in the Legislature (Senate Bill 5673/House Bill 1700), sponsored by Sen. Jamie Pedersen and Rep. Joan McBride, which gives individuals a green alternative to traditional cremation; conforms biochemical hydrolysis to existing law, and complies with RCW 68.50.160 that gives each person the right to choose their own disposition, and

WHEREAS, California, Colorado, Florida, Georgia, Idaho, Illinois, Kansas, Maine, Maryland, Minnesota, Missouri, Nevada, Oregon, Vermont and Wyoming have already legalized Biochemical Hydrolysis, therefore

NOW, THEREFORE, BE IT RESOLVED that the WSMA encourage the State Legislature and Governor Inslee to legalize biochemical hydrolysis in Washington state.

(1) According to the 2018 NFDA Cremation & Burial Report

(2) Additional information from Biochemical hydrolysis Fact Sheet, published by Peoples’ Memorial Association

 

 

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