May 2003 Volume XXVI Number 2 The Florida Pediatrician The Newsletter of the Florida Pediatric Society/ Florida Chapter American Academy of Pediatrics In this issue............ WHO’S WHO Page 2 THE PRESIDENT’S PAGE Page 3 THE EDITORIAL PAGE Page 5 THE GRASS ROOTS Page 6 FROM THE DEPARTMENT CHAIRMEN Page 7 PROS REPORT Page 8 REACH OUT AND READ Page 8 THE SCIENTIFIC PAGE Page 9 SPECIAL ARTICLE SARS Page 11 COMMITTEE REPORT WOMEN’S SECTION Page 13 FROM THE RESIDENTS’ SECTION Page 14 MANAGED CARE Page 15 SPECIAL REPORT NEW RESIDENCY Page 16 RISK MANAGEMENT Page 17 FROM THE AAP Page 18 FROM THE FCAAP Page 20 THE HISTORY CORNER Page 21 C.A.T.C.H. Page 23 Add-a - ‘Pearl’ Page 25 ANNUAL MEETING Page 30 UPCOMING CME Page 32
Transcript
May 2003
Volume XXVI Number 2
The FloridaPediatrician
The Newsletter of the Florida Pediatric Society/ Florida Chapter American Academy of Pediatrics
In this issue............
WHO’S WHO
Page 2
THE PRESIDENT’S PAGE
Page 3
THE EDITORIAL PAGE
Page 5
THE GRASS ROOTS
Page 6
FROM THE DEPARTMENT CHAIRMEN
Page 7
PROS REPORT
Page 8
REACH OUT AND READ
Page 8
THE SCIENTIFIC PAGE
Page 9
SPECIAL ARTICLE SARS
Page 11
COMMITTEE REPORTWOMEN’S SECTION
Page 13
FROM THE RESIDENTS’ SECTION
Page 14
MANAGED CARE
Page 15
SPECIAL REPORTNEW RESIDENCY
Page 16
RISK MANAGEMENT
Page 17
FROM THE AAP
Page 18
FROM THE FCAAP
Page 20
THE HISTORYCORNER
Page 21
C.A.T.C.H.
Page 23
Add-a-‘Pearl’
Page 25
ANNUAL MEETING
Page 30
UPCOMING CME
Page 32
WHO’S WHO in the Florida Pediatric Society/Florida Chapter American Academy of Pediatrics
It is hard to believe that this will be the last time that I write to you as yourPresident. The past two years have certainly flown by rapidly. The opportunity that yougave me to serve as President is one I will not forget.
As President, I was able to appreciate more completely the challenges facingPediatricians throughout our state. As you know I have been in academic medicine for
my entire career, and although I often practice neonatology in community settings, I have been somewhat insulatedfrom many of the pressures and complexities of practice. This opportunity has taught me more about the practiceof pediatrics in the State of Florida than I ever could have imagined. Learning and understanding the issues you arefacing in your in daily practice has helped me represent you better in Florida and also at the national level as Chairof the AAP Committee on Federal Governmental Affairs and now the Subcommittee on Access to Care. Withouta doubt, I will continue to seek your help and input as I continue to work on the issues of access to quality pediatriccare for the AAP.
* * * * *
“..I was able to appreciate more completely the
challenges facing Pediatricians throughout our state.”* * * * *
I know that I was very fortunate to follow two individuals who I think were outstanding chapter presidents,Dr. Edward “Bill” Williams and Dr. Ed Zissman. In addition, I have had the pleasure to work very closely with myformer Chief Resident, Dr. Louis St. Petery, Executive Vice President of the Chapter. Unless you become an officerin this organization, you can never fully appreciate what Louis does for us. Louis provides the valuable institutionalmemory and stability to the Chapter without which we would be lost and terribly ineffective. His dedication andthe hours he commits to our mission far exceeds his compensation. He does it because he is truly an advocate forpediatricians and the families we serve and because he wants to do what is right! All of us benefit from his
commitment to the Chapter.
This legacy of past leadership and our sound foundation will continue to serve us well as we look to thefuture. And the future Chapter leadership will be even better! President-Elect, Deborah Mulligan-Smith, is a verycapable individual with a keen sense of policy and politics. Without a doubt, David Marcus and Pat Blanco will,in their turn, also provide visionary leadership for our Chapter. Don’t forget, David Marcus was responsible forsuccessfully engineering FMA support for our 0-21 Medicaid fee increase after all other efforts failed.
Now, I would be less than honest if I did not admit that I am a little disappointed on what we were able toachieve these last two years. I had higher expectations for us; however, I do recognize that we were in the mostdifficult fiscal times the state has faced in over fifty years! For the last two regular sessions and three specialsessions, we were relegated to playing defense and I think we did it pretty well. There are so many more things thatwe could have done for Pediatricians and families, if the budget and the political will of many of our legislators werebetter. But we had to play the hand we were dealt. (See President, page 26 <)
Page 3
FPIC ad
“...in harm’s way...”
“Florida has...sizeable deficit...”
EDITORIAL OFFICE
Herbert H. Pomerance, M.D., Editor
Carol Lilly, M.D., Associate Editor
Department of Pediatrics
University of South Florida College of Medicine MDC
Y es, it is a difficult time. I sit here writing this piece in mid-April. There are two trouble zones: abig international one, and a smaller one here in Florida.
The international problem is of course the larger one, with hundreds of thousands of ouryoung men and women still “in harm’s way”. Two big questions arise: should we be doing thisand can we afford it.? Should we do it? You the readers are divided mainly into two groups:those who oppose war, and correctly so. And those who feel that Saddam is indeed a threat tothe security of the American people and should be removed, also correctly so! Yes, both groupsare right, each in its own argument. Yet, there is a third group, one with whiter hair and longer memories, whichremembers back before we fought World War II. We remember the “great appeaser”. We remember NevilleChamberlain and his umbrella, mouthing over and over “peace in our time”, to be obtained by giving Hitler that firstexpansion he wanted, since “that will satisfy him” and peace will prevail.. I don’t think one has to be a veteran ofWWII to understand this, although many of our younger people do not even recognize the name. The older grouplives in fear of a reprise of pre-WWII thinking, while hating the idea of war, thus really occupying a middle ground.Sad also is the fact that we apparently were unable to prevent the loss of much of the history of human-kind tolooters and thieves. And we still need to prove we can win the peace!
Can we afford it? We are faced with a battle the timing or the result of which we cannot begin to fathom,although we know that the costs will be high. And these are costs coming at a time when our economy is soft.Many folks do not buy the idea that reducing taxes increases the money coming into the federal coffers. Some crythat the benefit goes mostly to the upper earners of the country. Does this sound a little like the almost completelydiscredited concept of “trickle down economy”? In any event, the next few years will find the federal budget cuttingback more and more on programs which would improve the health of Americans, and for us, of children.
To put it succinctly, the federal government (that’s us) will turn around and say that some programs belongreally to the states (that’s also us). We may pay end up paying less tax to the federal government, but be forced topay more at state level. Does that hurt any less?
And so to problem number two. As I write, the Florida Legislature is in session. Florida shares, with theother states, the problems thrust upon us by the feds. Florida has its own financial problems,with a sizeable deficit from last year. The only way to try to create some balance is to cut backon programs, and the ones must susceptible are child health and education. I would be preaching
to the choir if I pointed out that basically,these are the most important facets ofcivilization! Bear in mind that we haveno state income tax, and no real chanceof having one.
Is it any wonder, then, that this editorial has a kind ofsomber tone? Of course, we can add that our country willprevail, and our children will prevail, and things aren’t halfas bad as theylook! It’s just hard to say it and smile at thesame time. -The EditorG
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REGISTRATION
Have you registered yet for the Annual Meeting
in Orlando, June 20-22, 2003?Important Business CME Credit
The Grass RootsTHE REGIONAL REPRESENTATIVES REPORT
(Each month, we provide reports from two of our eight regions)
Region III reports:
Along with Drs. Cartwright, de Miranda, Montgomery,
Payne and Zanga, I traveled to Chicago for the AAP Chapter Forum
to put forth the proposition that the Same Sex Co-Parenting Adoption
Policy is flawed and should be rescinded. This was in response to my
personal conviction as well as to represent others who share this view.
Request denied. Instead, the following resolution was
passed: “The Chapter Forum of the Academy (representing the
grassroots leadership), add(s) its support to the AAP policy, ‘Co-
parent or Second-Parent Adoption by Same-Sex Parents’. The
Chapter Forum commends the National AAP for remaining true to its
mission of acting in the best interest of children wherever they are.”
There are still a few of us blades of grass who don’t agree with this.
Ok, we lost that one. How about: “The Academy suspend
any support for homosexual or same-sex “co-parent” adoption until
longitudinal, well designed, case-controlled studies of statistically
adequate sample size exist which can confirm that such arrangements
are truly in the best interest of the children involved.”
Request denied. The prevailing opinion is that there is not
good scientific data to support this policy (I sat next to Lou Cooper
who says this. It was repeated throughout the meeting). It just doesn’t
matter, I guess. Ironically, the statement was printed in Pediatrics, the
peer-reviewed scientific journal of the American Academy of
Pediatrics (AAP).
Ouch! In fact, at the Chapter Forum, they rejected this
resolution: “That the Academy rescind family policies that fail to meet
reasonable scientific research and epidemiological standards.” They
also rejected this: “That the Academy acknowledge and promote the
value of the marriage of supportive mothers and fathers to the well-
being of children.”
In an effort to appease the supporters of the 17 resolutions
opposing the policy and perhaps hoping that over time the policy
would garner wider support, the Chapter Forum voted to: “Pursue a
course of providing a full range of available scientific literature on
parenting, including same-sex parenting, plus providing educational
opportunities where the issues can be discussed in the AAP tradition
of unbiased scientific inquiry, respect for colleagues, and concern for
children.” This causes me to ask: where is that report from the Task
Force on the Family – its release delayed because the report defends
the scientific benefits of the traditional family unit? (I’m not ready to
accept the policy at this time)
If you, like me, are having difficulty accepting this policy,
I want to hear from you – how many of us feel as I do about this
action on the part of the AAP? Please contact me at
[Disclaimer: Dr. Benton writes this report in a very personal vein.
His opinion is not the opinion of all of the members in his region nor
of the chapter. With the consent of the writer, and at the behest of the
Editorial Board of the newsletter, it is stated that the above is
recognized as a personal statement by Dr. Benton.-Ed]GPage 6
Region VII reports:
The Broward County Pediatric Society was honored to
have the President Elect of the Academy of Pediatrics, Dr. Carden
Johnston, speak at our last meeting on February 27th in Fort
Lauderdale. He gave an overview of the Academy’s positions and
strategies for action in the coming year. A network is being
developed to find Doctors who have connections and access to
important po litical figures. Two were identified at our meeting!
The Joe DiMaggio Children’s Hospital 14th annual
Ped iatric Symposium was held in November in Ft. Lauderdale and
attracted a record 240 registrants who heard interesting talks by
nationally renowned speakers on a variety of Pediatric topics.
The Joe DiMaggio Children’s Hospital celebrated it’s 10 th
anniversary recently. It is presently searching for a Pediatric
Cardiac Surgeon to complement its cadre of Pediatric sub-
specialists.
Rallies were held recently both in Palm Beach and
Broward in support of implementation of Governor Bush’s task
force recommendations on medical malpractice reform.
Pediatricians and their staff participated in both rallies.
Marshall Ohring, M.D.
Region VII RepresentativeG
From the Department ChairmenThe Department of Pediatrics at the University of Miami
R. Rodney Howell, M. D.Professor and Chairman
Department of PediatricsUniversity of Miami School of Medicine
Miami, Florida
As with other training programs throughout the
nation, we have recently received the results of the “Match”
for next year’s interns at Jackson Memorial Hospital at the
University of Miami/Jackson Memorial Medical Center.
Florida continues to be a highly desirable destination for
young physicians training in Pediatrics, and again, we are
very pleased with the talented and diverse group of
incoming interns who will be joining us here in Miami.
Nationally, this year saw a significant increase in the
percentage of graduating medical students choosing
pediatrics, while Internal Medicine had a very small
increase, and Family Practice saw a significant decrease in
the students choosing this profession. The reasons behind
these changes are the subject of considerable discussion
and conjecture.
In recognition of the multi-million dollar gift from
the Holtz family, the Public Health Trust and the Miami-
Dade County Commission(the governing body of our
hospital) have approved the official naming of our
Children’s Hospital as the Holtz Children’s Hospital a the
University of Miami/Jackson Memorial Medical Center.
The Holtz family gift will not only result in a name-change
but lead to some major construction projects; the first of
these, a new state of the art 30 bed pediatric intensive care
unit is about to begin. The Holtz family is well known in
Miami for their philanthropy. Needless to say, we are very
pleased with this new name, which clarifies our situation as
a large children’s hospital, contained within the vast
Jackson Memorial Hospital.
Our institution suffered a great loss during the year
with the death of Dr. Charles (Chuck) Pegelow. Chuck
served as a leading Professor in our Hematology/Oncology
Division and was responsible for our very large Sickle-Cell
Program. Importantly, he had led our Housestaff Program
with skill and distinction. Although he had a rapid
downhill course after a malignancy was diagnosed, he
continued to work essentially full-time until his death. We
have been fortunate to have had a very active Housestaff
Education Committee for many years, which enabled our
program to continue without interruption. A leader of this
group, and an outstanding clinician and educator, Dr. Barry
Gelman, of our Critical Care faculty was appointed
Housestaff Director, and has taken charge of the program
with great vigor and skill. His appointment has been
enthusiastically received by the faculty, Housestaff, and all
the staff of the hospital. The new Housestaff regulations
from the ACGME dealing with hours and other areas begin
this summer, and will require a number of changes for us to
comply with the new rules and regulations. Our Housestaff
has been unionized for some years, so we will have many
fewer changes to make than some other institutions.
Our Batchelor Children’s Research Institute has
now been open for over a year, and much of the building is
fully occupied and productive at this time. The new NIH-
funded ambulatory Clinical Research Center, which was
designed for this purpose and is based on the second floor,
is now in operation and seeing children at this site. The
completion of the animal facilities on the 8th floor of this
147,500 square foot building will have the new analytic
MRS system in place by the summer. All of the remaining
areas of the building are either occupied, under
construction, or in final design for construction.
And perhaps most important , the Search for the
new Chair of Pediatrics at the University of Miami is
coming into the home stretch, and we hope a new person
will be in place this summer. Dean Clarkson is working
closely with finalists at the current time. I am in the
process of arranging my new responsibilities, which will
begin in the summer. After leaving the Chair, I will remain
a Professor of Pediatrics at the University of Miami but will
be assigned to the NIH and will spend the vast majority of
my time in Bethesda, Maryland as Special Assistant to the
Director of the National Institute of Child Health and
Human Development, of the National Institutes of Health.
I view this with great excitement and I will work closely
with Dr. Alexander, the Director, on issues of genetic
testing which focus on the scientific aspects of newborn
screening. I will continue to maintain contacts in Miami
for a long time.GPage 7
Collaborative Research
and PROS
Report
Representatives from throughout the nation metin chilly Chicago in early April to discuss the status ofold and current projects, review proposed studies, anddetermine the future of our AAP practice network.
Established in 1986, the practice based researchnetwork consists of about 1700 pediatric practitionersfrom almost 600 practices located in all 50 states, PuertoRico and Canada. Our mission has remained firm: toimprove the health of children by conductingcollaborative practice-based research to enhance primarycare practice. PROS practitioners and researchers worktogether to generate research questions, design studymaterials and protocols, obtain research funding, collectstudy data, analyze collected data, and publish results.This collaboration is accomplished through AAPchapter-based groups of practitioners recruited andmaintained by pediatrician chapter coordinators, who inturn meet twice a year with PROS research staff andconsultants.
Analysis of the data collected by the LANDstudy (4351 mother/baby pairs enrolled by 113 PROSpractices – 4 in Florida) reveal insights on maternalreadiness for discharge, maternal depression, andpractitioners practicing beliefs. Three LAND abstractswere accepted for presentation at the 2003 PedatricAcademic Societies meeting in Seattle, WA in May. Ifyour practice participated in the study and you areinterested in contributing further (for example, writingand / or editing a manuscript), contact us ASAP.
How is the Safety Check project coming along?Recruitment of practices has started and already 698eligible patients have been enrolled. Regretfully, many
PROS practices haveignored recruitmentmaterials and
(See PROS, page 28 <)
Page 8
Reach outand Read
New Collaboration
Between FPS Foundation and ROR
Recently, the Florida Pediatric Society (FPS)Foundation agreed to serve as the fiscal agent for thenewly formed Reach Out and Read (ROR) FloridaCoalition. This collaboration fits naturally with the FPSFoundation’s goals to nurture programs to benefit thechildren in Florida so that they may attain optimalphysical, mental, and social health and well-being.
The ROR Florida Coalition seeks to make earlychildhood literacy an integral part of pediatric primarycare throughout Florida. More than 70 pediatricpractices, family practices, and community medicalcenters throughout Florida are ROR sites – servingmore than 60,000 children per year.
Several randomized, controlled studiesdemonstrate the ROR program significantly improvesparent attitudes about books, parent-child readingactivities, and child vocabulary. The program wascreated to most benefit low-income families presentingat well-child visits for their children 6 months through5 years of age.
The Reach Out and Read model has threeparts:1. At each well-child visit, the pediatrician or
primary care provider speaks with a child’s
parents and/or caregiver regarding theimportance of reading aloud daily to theirchildren;
2. During the well-child visit, the pediatrician orprimary care provider gives the child a free,developmentally appropriate and culturallysensitive book to take home; and
3. In the waiting room, volunteers read aloud to theyoung children – modeling this behavior to
(See Reach out and Read, page 28 <)
The Scientific PagePediatrician Involvement, Florida Youth Suicide Prevention Prototype Project,
and Broward One Community Partnership.Deborah Mulligan-Smith, MD FAAP FACEP
President-elect FCAAP
Maria Elena Villar, MPH
Greta Costa, MPH
Institute for Child Health Policy at NSU
Improvements in child mental health servicesand outcomes can only be accomplished through thesystematic, coordinated efforts of agencies, fundingorganizations, service providers, families andprofessional groups. Pediatricians and family medicinepractitioners play a key role in early intervention formental health conditions, including suicide ideation andsevere emotional disturbance.
The Institute for Child Health Policy at NovaSoutheastern University (ICHP-NSU) is focusing onimprovement of child mental health screening andreferral within the continuum of service from emergencyresponse to therapeutic and rehabilitative care. Throughits involvement in the One Community Child MentalHealth Initiative and the Florida Youth SuicidePrevention Prototype Project (YSPPP), the Institute isdeveloping collaborative research initiatives that addresschild mental health.
The Florida Youth Suicide Prevention PrototypeProject (YSPPP) builds on the Florida State SuicidePrevention Task Force, Preventing Suicide in Florida:
a White Paper. The YSPPP considers the continuum ofcommunity-based youth suicide prevention,intervention, and postvention by cutting across thepublic/private sectors. Among the objectives of theYSPPP is to “increase the use of schools, primary careproviders, clergy and work places as access and referral
points for mental health, health, and substance abusetreatment centers.”
The Broward County One Community ChildMental Health Initiative seeks to develop a system ofcare that will sustain and support children with seriousemotional disturbance within this community in a leastrestrictive and clinically appropriate environment. Asingularly important objective of the One CommunityPartnership is to coordinate efforts of primary care andbehavioral health services to establish “a single point ofentry” for children with severe emotional disabilitiesand their families; the intent is to facilitate andstreamline access to services and promote the use ofassessments that focus on discovering individualstrengths and preferences.
Exploring the Link Between Child Mental Healthand Suicide
In Florida, Mental Health conditions rank thirdamong all reasons for hospital discharges. Whitechildren are more than twice as likely as Black childrento have a mental health-related primary diagnosis. Afterpsychoses, the leading mental health diagnoses amongchildren are associated with suicide risk: depressivedisorders in younger children and substance abuse ordependence among older youth. (Figure 1)
Suicide forces us to consider the interrelation
between injuries and mental health disorders. In
Broward, the majority of injuries among children withprimary diagnoses that were mental health related wereself-inflicted. (Figure 2) However, data collection andreporting has to improve to accurately capture the fullpicture. Of the 2,644 primary diagnoses for Broward15-24 year olds, only 3% contained a valid e-code(external cause of injury). Therefore, this graph likelyunder-represents the number of patients with both aninjury and a mental health diagnosis.
The pediatrician’s role, especially acute carespecialists and those that are hospital based, cannot beunderestimated in the effort to improve reporting.While primary care pediatricians struggle withprevention and early identification, tertiary care doctorsmust do their part to inform prevention planning throughaccurate reporting.
Pediatricians and Mental HealthThe role of pediatricians and family medicine
practitioners has been identified as key for earlyintervention of mental health conditions, including
(See Scientific, next page <)
Page 9
Scientific(= continued from page 9)
suicide ideation and severe emotional disturbance. In aneffort to better understand perceptions and practices ofprimary care physicians in mental health and mentalhealth services in their communities a survey tool wasdesigned and implemented. This survey gathers data onsuicide risk and other mental health screening and
referral practices, as well as primary physician’sperceptions of and experiences with the mental healthcare system in Broward and Alachua counties. We arecomplementing the quantitative survey, with keyinformant interviews with pediatricians and familymedicine practitioners, to obtain qualitative informationto support and to explain survey findings. Theinterviewer elicits open ended responses about the use ofyouth mental health referral practices, and barriers toeffective mental health referral practices, as identified byprimary care physicians.
This undertaking is of great significance becausewe understand that without insight from primary careproviders it is doubtful that we will be able to identifythe true magnitude of the mental health communityneeds for the pediatrician and their patients. Results
from these studies will provide a basis for future studiesin the interaction between medical care providers andmental health providers, an area that has beenunderstudied.
We extend our thanks to the Alachua andBroward pediatric community for their cooperation andcommitment to families as demonstrated by theirresponsiveness.G
Page 10
Figure 1.
Primary M ental Health Diagnoses
in Broward Pediatric Discharges
Figure 2:
Pediatric Injury and Mental Health Diagnoses
Special ArticleSARS Information
Robert S. Baltimore, M.D., FAAPMember, AAP Committee on Infectious Diseases
The recent outbreak of severe acute respiratorysyndrome (SARS) has prompted the Academy toevaluate what is known about the disease, particularlywith regard to children. Information about SARS isevolving rapidly, and pediatricians are encouraged toaccess the Web sites listed below for up-to-dateinformation.
Evolution of SARSOn Feb. 11, the Chinese Ministry of Health
notified the World Health Organization (WHO) that 305cases of acute respiratory syndrome of unknownetiology had occurred in six municipalities inGuangdong province in southern China from Nov. 16,2002, to Feb. 9, 2003. During late February 2003, anoutbreak of a similar respiratory illness was reported inHong Kong among workers at a hospital. On March 12,WHO issued a global alert about the outbreak andinstituted worldwide surveillance for SARS.Subsequently, there has been spread to other countries,but at this time all cases can be traced to contact withindividuals from Asian countries. However, a few ofthese cases appear to be the result of community spreadfrom an individual whose illness could be traced to Asia.
The agent of the disease appears from earlyreports to be a member of the coronavirus family, butthis is still being investigated. There is no proveneffective treatment for this virus. Although various
therapies including using intravenous ribavirin andsteroids have been administered to SARS patients, theefficacy of these therapies has not been determined. Fortreatment of suspected cases, consultation with aninfectious diseases expert should be sought.
Current case definitionOn the basis of these early reports, the following
case definition was developed: < Measured temperature 100.4° F (>38°C) and < one or more clinical findings of respiratory
illness (e.g., cough, shortness of breath,difficulty breathing, hypoxia, or radiographicfindings of either pneumonia or acute respiratorydistress syndrome) and
< travel within 10 days of onset of symptoms to anarea with documented or suspected community
transmission of SARS. or < Close contact within 10 days of onset of
symptoms with either a person with a respiratoryillness who traveled to a SARS area or a personknown to be a suspect SARS case.This case definition will be updated as new
information becomes available. (See Centers for DiseaseControl and Prevention (CDC) Web site below.)
In the first approximately 2,300 cases ofindividuals who met the case definition, the fatality ratewas about 4% and infections in children wereuncommon (approximately 2% of SARS cases in theCanadian data, 14% in early U.S. data). It is unclear, sofar, if the small number of children represents hostresistance to infection, illness too mild to come tomedical attention or lack of contact with infectedindividuals.
WHO, CDC and other public health agenciesworldwide are continuing to investigate thismulticountry outbreak. The number of SARS cases andcountries reporting such cases continue to increaseworldwide. In the absence of a complete understandingof SARS' etiology and how SARS is transmitted, effortsto limit transmission in the United States have focusedon early identification of potential cases throughsurveillance and implementation of infection-controlmeasures in health care settings and the community.
Infection-control precautions, which include standard,contact and airborne precautions, should be institutedimmediately for people who meet the case definition.Materials sent to diagnostic laboratories requirehigh-level precautions against dissemination. Specimensrequire special handling, and laboratories must becontacted in advance of sending any specimens fromsuspect cases in order to apply the appropriateprecautions.
CDC has developed interim infection-controlguidelines for use in U.S. health care and householdsettings. These recommendations are based onexperience in the United States to date and will berevised as more information becomes available.Infection-control practitioners and clinicians providingmedical care for patients with suspected SARS should
(Continued next page <)
Page 11
Sars( = continued from previous page)
consult these guidelines frequently to keep current with
recommendations.
Health care providers of patients whose illness is
consistent with the case definition for SARS should continue
diagnostic evaluation for other causes of respiratory tract
illness and, when appropriate, empiric therapy including
agents active against organisms associated with
community-acquired pneumonia of uncertain etiology,
including both typical and atypical respiratory tract
pathogens.
WHO and CDC have issued travel advisories
recommending that persons consider postponing
non-essential or elective travel to affected areas until further
notice. Persons who recently have traveled to affected areas
are urged to: monitor their health for 10 days after return;
seek medical care if they develop fever and cough or
difficulty breathing within 10 days of travel; and inform their
health care providers about recent travel to regions where
SARS cases have been reported. Ten days appears to be the
outside limit for the incubation period of SARS (two to 10
days).
To detect possible SARS cases among travelers
returning to the United States from these areas, CDC and
state and local health authorities have implemented enhanced
surveillance. Clinicians and public health officials are
requested to report suspected cases of SARS to their state
health departments. Current information on SARS, including
case definition, infection-control practices, diagnostic
valuation, treatment, reporting and travel advisories can be
found on the CDC Web site at www.cdc.gov/
ncidod/sars/exposuremanagement.htm. Updated case counts
and additional information also are available on the WHO
Web site at www.who.int.
The following points will be helpful in speaking with
parents and schools posing SARS-related questions:
< Children do not need to restrict their activities except
as related to official travel alerts. For travel
advisories, access www.travel.state.gov.
< Children who have been exposed to individuals who
are not ill but have traveled to areas where SARS is
occurring do not require isolation.
< Children who have been exposed to an ill individual
who is suspected of having SARS at the time of the
exposure or children who have traveled to an area
where SARS is occurring (e.g., Toronto, Hong
Kong, mainland China, Singapore) should be
evaluated based on the following:
• If well, parents should self - monitor thePage 12
child's condition for fever or respiratory
tract illness. At present, attendance at child
care or school is not restricted, although
this may change as new information
becomes available.
• If the child is not well, parents should
contact their pediatrician and the child be
isolated at home, according to procedures
established by public health authorities.
• If a child is not well and experiencing
hypoxia, shortness of breath or breathing
difficulty, he/she should be hospitalized and
health care workers informed before the
admission so SARS precautions can be
initiated. (See CDC Web site.)G
MEMBERSHIP ALERT! Do you know any pediatricians, Fellows of the Academy
or not, who appear to have been overlooked by the Society,
and are therefore not members? Contact the Executive Vice
President or Membership Director. There are several kinds
of membership in the Society:
Fellow: A Fellow in good standing in the American
Academy of Pediatrics - automatic membership on
request.
Member: A resident of Florida who restricts his/her
practice to pediatrics.
Associate Member: A physician with special
interest in the care of children.
Military Associate Member: An active duty
member of the Armed Forces stationed in Florida
and limiting practice to pediatrics.
Inactive Fellow or Member: Absenting self from
Florida for one year or longer.
Emeritus Fellow or Member: Having reached age
70 and having applied for such status.
Affiliate Member: A physician limiting practice to
pediatrics and in the Caribbean Basin.
Allied Member: A non-physician professional
involved with child health care may apply for allied
membership.
Honorary Member: A physician of eminence in
pediatrics, or any person who has mede distinguished
contributions or rendered distinguished service to
medicine.
Resident Member: A resident in an approved
program of residency.
Medical Student: A student with an interest in child
health advocacy.G
Committee ReportsReport from the Women’s Section,
Florida Chapter AAP
Shakra Junejo, M.D.
Section Chairman
Franklin’s Promise
Franklin’s Promise, Inc. (FPI) is a non-profitentity formed over two years go to address growingcommunity concerns surrounding quality of life issuesand to take the lead in improving efforts to identify andobtain resources that could serve the needs of FranklinCounty. Awareness of the community's needs,conceptualization and final incorporation as a non-profitorganization eligible for public funding took more thantwo years, yet once formed, the organization grewrapidly and is considered by many in the community tobe more effective than any other of its type in FranklinCounty.
FPI's purpose is to promote a better life forchildren and families in Franklin County. Through theusefulness of several action committees, a highlymotivated and committed volunteer group continues toserve the organization and works hard to distribute foodand medicine, mentor children, extend job-trainingopportunities and proactively participate in addressinghealth and social service issues within the community.
Action committees dedicated to the FranklinsPromise effort include:< Health and Nutrition< Recreation< Social Services
< Education, and < Elders
The Health and Nutrition committee has takenthe responsibility for coordinating community needs byworking with professionals from county healthdepartment management and staff personnel. In order tofocus a course of action, FPI facilitated countywideneeds assessment of health, nutrition and social servicesthat was the first ever initiated in Franklin County.Work on the yearlong assessment consisted primarily ofdata collection surveys, focus group discussions andstatistical analysis of health status indicators.Documentation that was developed, which defined theneeds and available resources to promote good standardsof health and nutrition, now forms the baseline forstrategic health planning in the County and for furtherexploration of funding options that agencies may findmost helpful in advocating for additional resources.
So far, five grant applications from FPI havebeen supported to help the Franklin Health Departmentand the Franklin County Medical Society improve healthand social services in the community. An indigent drugassistance program allows FPI volunteers to keephigh-risk individuals on maintenance drugs. Thevolunteers assist medical providers in conducting aweekly primary care clinic; and they assisted healthdepartment staff in developing a bioterorrismpreparedness program that includes small poxvaccinations.
The Recreation committee, working through theChronic Disease Intervention Program at the County
Health Department, identified funding sources enablingwalkway exercise paths to be developed within thecommunity. The leader of the Recreation committee istaking responsibility for organizing and coaching theonly high school tennis team in the county; and severalcomputers have also been brought into schools throughdonations to this organization.
When the local food bank suddenly closed itsdoors, a volunteer pastor immediately took over fooddistribution services; while the nutritionist on theHealth and Nutrition Committee reviewed foodpackages provided nutritional expertise.
The social services are streamlined by way ofregular dialogue offered through this organizationinvolving Healthy Start, Healthy Families, SchoolReadiness, Head Start, Even Start occupational servicesand other social services organizations; the countyvictim
(See Women’s, page 26 <)
Page 13
From the Resident SectionLaura P. Stadler, M.D.
Resident Chairperson for FL
USF Program Representative[In each issue, we will focus on the State’s Residency Programs and/or on issues affecting all programs. ]
Spotlight on Tampa
The Pediatric Residency Program at the University of
South Florida combines the strengths of a number of clinical
settings to provide an excellent variety of patient care exposure.
The program consists of 16 categorical pediatric residents each
year, along with 4-5 combined medicine-pediatric residents. In
addition, fellowships in neonatology and allergy/immunology are
offered. In future years, additional fellowships may become
available. The major training sites are All Children’s H ospital in St.
Petersburg and Tampa General Hospital in Tampa.
A national parenting publication has for the second year in
a row named All Children's Hospital as one of the top twenty
children's hospitals in the United States. For the cover story of its
February 2003 edition, Child magazine released results of a survey
it conducted of children 's facilities across the nation. All Children's
was tied for 16 th with Wolfson Children's Hospital in Jacksonville,
FL. That's the highest ranking of all children's facilities in the state
of Florida. The first Child magazine survey of children's hospitals,
published in February of 2001, also ranked All Children's Hospital
in the 16th spot nationwide. This honor places All Children's among
some very d istinguished company.
All Children's Hospital is a leading center for pediatric
treatment, education and research. All Children's provides
specialized care for children of all ages, from newborns through
teens. Located in Downtown St Petersburg, All Children's Hospital
is one of only 47 free-standing children's hospitals in the US, one of
two freestanding children 's hospitals in the state of Florida, and the
only one on Florida's west coast. It has one of the highest levels of
patient acuity in the country and provides care for children from
Florida, throughout the United States and the rest of the world. A
wide range of specialized services makes All Children's Hospital a
216-bed center of excellence for treatment of congenital and
chronic diseases. The Neonatal Intensive Care N urseries
accommodates 60 premature and at-risk infants. Two additional
intensive care units provide critical care staffing to acutely ill
children and patients who are recovering from complicated surgery.
Tampa General provides approximately 120 pediatric beds
including dialysis, NICU (including ECMO), and PICU. Research
occurs in outpatient clinics and includes both general pediatric and
HIV patients. The different hospitals provide residents with a
diverse experience and allows them to train in 2 unique settings.
The Department of Pediatrics, under the leadership of Dr.
Robert Christensen, has been selected for the second year in a row
by the USF medical students to receive the clinical department
teaching award. Dr. Christensen has recruited and filled eight
endowed chair positions with top national researchers in their fields
who will be making the Children Research Institute their Page 14
home. This is in accordance with the chairman's five-year vision to
bring the department to a national level at the forefront of pediatric
research.
Residents gain outpatient clinical pediatric experiences in
a wide variety of settings. They rotate through many teaching
centers, including the USF pediatric clinic, Genesis Clinic and the
ACH Clinic. Residents gain further experience in a number of local
private practice offices during their second continuity clinics during
second and third years. They spend time in a variety of advocacy
sites and schools as part of an advocacy rotation. Several residents
participate in the Rural Track at Lawton Chiles Community Health
Center in Bradenton. These residents elect to work in the rural
setting instead of the ambulatory settings in Tampa and St. Pete to
gain a unique experience.
Our Medicine-Pediatrics program is designed to prepare
physicians to function as both pediatricians and internists. This
rigorous four-year program gives enhanced flexibility in career
options, including general and subspecialty choices.
Dr Lynn Ringenberg, the program director, has been
missed since early 2003. She is serving our country as part of the
reserves. In her absence, Drs Dabrow and Gereige have assumed
the responsibilities of program directors in addition to their active
membership in the AAP. Dr. Dabrow serves as faculty advisor to
the resident section of the AAP. In addition she has been
instrumental in the Reach Out and Read initiative. Dr Gereige is
Chair of the Committee for School Health and is looking for
volunteers to participate on this committee. If interested in joining
this committee, please email him at GEREIGER@ allkids.org.
Dr Gereige and Dr BethAnn Gemunder received AAP
recognition for the “Reaching Children: Building Systems of Care
(REACH OUT)” grant for $10,000 presented from Healthy
Tomorrows, an AAP partnership with the Health Resources and
Services/Maternal and Child Health Bureau to obtain medical care
for children through the Lawton Chiles Community Health Center
in Bradenton. They will be presenting data from their pro ject this
May at the Pediatric Academic Societies Meeting in Seattle, WA.
In addition, they will present at this June’s Annual Chapter meeting.
Marisa Lejkowski, DO and Laura Stadler, MD received a
CATCH (Community Access To Child Health) grant entitled
“CATCH Us At Asthma Clinic” The focus of the project is to
increase Influenza vaccination among asthmatics in the general
pediatric clinic at All Children’s.
Laura Stadler, MD
University of South Florida Pediatrics
FL Chairperson, District X Chairperson
for Resident SectionG
(See Resident, page 27 < )
Managed CareSome Thoughts on M anaged Care
Note:
The Florida Pediatrician has had and continues to
have a policy to print an article on Managed Care in each
issue. This policy will be adhered to so long as suitab le
articles are submitted. Both sides of the issue will be
represented.
Publication of an article does not indicate any
endorsement of the opinion by The Florida Pediatrician or
by the FCAAP/FPS.G
Edward N. Zissman, M.D.
Altamonte Springs, FL
W
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d care area has been relatively quiet, there are several areas of note.
A. Renegotiating fees with third party payers.
When meeting with third party payers to renegotiate the necessity for
increased reimbursement, please consider the following:
1. The cost of employee benefits including, but not limited to,
health insurance has increased about thirty percent.
2. Employee salaries have increased greater than the cost of living.
3. The cost of professional liability insurance, where available, has
increased twenty-five to thirty percent.
4. HIPAA has added a new business expense
5. Third party auditing has increased overhead.
6. CLIA and OSHA expenses have increased.
7. Vaccine costs have increased.
8. Vaccine administration costs have increased including additional
record keeping requirements and the mandated use of "safety"
needles and syringes.
B. Both the AAP and the AMA, in concert with other physician
organizations have been advocating on our behalf.
1. HEALTH PLAN COM PLAINT FORM
In the summer of 2001, the AMA H ouse of Delegates directed
the AM A to establish an electronic information clearinghouse so
physicians could report information about administrative disputes that
they encounter with third-party payers. Consistent with this
resolution, Private Sector Advocacy (PSA) developed the "Health
Plan Complaint Form." This form serves as a tool for the collection
of information related to the administration of health plans by health
insurers and third-party payers. It gathers very sophisticated data on
the types and the severity of the administrative "hassles" that
physician office experience on a day-to-day basis in the managed care
environment. Using these data, PSA provides updates and presents
findings associated with the information collected through this form,
including the types and number of complaints and the aggregate
number of complaints or concerns by geographic and demographic
As a result of this initiative, the organizations have done as
follows:
2. CHALLENGE NON-STANDARD CODING PRACTICES
The AAP has been working with other national medical
specialty societies to challenge non-standard coding practices by
insurance carriers. Since July 2002, the Academy has signed-on to
letters to Anthem, Aetna, Cigna, United Healthcare, Blue Cross Blue
Shield of Florida, B lue Cross Blue Shield of South Carolina,
CareFirst, Coventry Healthcare, Health Net, Humana, MAMSI,
Medical Mutual, One Health Plan, Pacificare, PHCS, and Wellpoint.
Some issues of interest to pediatricians include:
"The undersigned medical associations oppose arbitrary and
unilateral code-collapsing and recoding practices that result in unfair
payment. We encourage third parties to accept physician claims that
have been accurately reported using applicable CPT codes and to
report back to physicians and patients using the same codes or
terminology, regardless of reimbursement methodology and levels.
Procedural descriptions should not be modified without appropriate
professional medical consultation. Use of inappropriately modified
data does not provide a proper basis for reimbursement, measuring
practice patterns, peer reviews or utilization reviews, or other related
uses. The AMA has as one of its priorities to encourage consistency
in the use of CPT codes, guidelines and conventions, as well as to
advocate the adoption of these standards.
The undersigned medical associations object when health plans
seek to arbitrarily and unilaterally recode or inappropriately bundle
codes and services. We feel compelled to identify specific CPT code
bundling problems and seek to educate health plans and other payers
in dealing with these problems."
Downcoding, bundling and lack of recognition of CPT modifiers by
IBC:
Modifier –25 has been denied for the purpose of bundling.
Modifier –25 is appended to indicate that on the day a procedure or
service identified by a CPT code was
performed, the patient’s condition required a significant, separately
identifiable evaluation and management (E&M) service above and
beyond the other service provided or beyond the usual preoperative
and postoperative care associated with the procedure that was
performed. (See Managed, Page 29 <)
Page 15
Special ReportA New Residency Program
Edward E. Packer, D.O
Chairman, Department of Pediatrics
Nova Southeastern College of Osteopathic Medicine
Palms West Hospital of Palm Beach County, Floridais proud to announce the opening of a new pediatricresidency developed in conjunction with NovaSoutheastern University’s College of OsteopathicMedicine in July 2003. Many graduates of NovaSoutheastern University and other institutions dedicatedto producing primary care physicians have expressed aninterest in finding a graduate program in pediatricsdevoted to the training of general pediatricians with aninterest in primary care. The new program at PalmsWest Hospital was established to help provide trainingfor new primary care pediatricians prepared to meet thechallenges presented in both a general ambulatorypediatric practice and the care of hospitalized pediatricpatients.
The American Osteopathic Association hasaccredited the new pediatric residency established atPalms West Hospital. The program was developed tomeet the special criteria of a “Fast-Track” trainingprogram. A “Fast-Track” program meets the uniquelicensure requirements needed for osteopathic physiciansin many states that require a physician to have completeda traditional internship prior to applying for a license topractice. Incorporated into the pediatric residency arethe core rotations of emergency medicine, internalmedicine, surgery, and obstetrics and gynecology. Aftercompletion of the three-year pediatric residency, theresident will be considered to have completed both an
internship and a pediatric residency in the three-yeartime span.
Palms West Hospital boasts a newly expandedpediatric unit with an active pediatric emergency roomstaffed by specially trained pediatric emergencyphysicians. The pediatric unit now has 24 privatepediatric beds and an eight bed pediatric intensive careunit staffed by a team of pediatric critical carespecialists. The newly designed units house the latest inpediatric equipment and are designed with rooms andcenters for research and education of the house staff.The patient environment has been enhanced by theaddition of playrooms and child life services.
Specialized services at the Palms West pediatricPage 16
residency are diverse with virtually every pediatricmedical and surgical specialist working as part of thestaff. This large array of specialists will allow theresidents to become experienced in all of the varioushealth care needs that are unique to the pediatricpopulation. Residents will work directly with thevarious specialists in daily patient care, and be providedopportunities to take elective rotations on most of thepediatric specialized services.
All of the pediatric residents at Palms West Hospitalwill maintain a small continuity of care practice in aprivate office setting on the hospital campus. Theresidents will learn to develop a pediatric practice, andthey will provide all aspects of care including phoneadvice and prenatal counseling visits. The pediatricresidency will work in conjunction with the Palm BeachCounty Health Department to care for children withspecial needs including health issues related to poverty,developmental disabilities, chronic illness, and HIVinfections. A rural program in Belle Glade, Florida willserve as a permanent site where residents will care forchildren in the rural environment.
Applications for residents are currently beingaccepted. Pediatricians in the area of Palms WestHospital who are interested in participating in thetraining program are also being recruited. All interestedindividuals should contact Edward E. Packer, D.O.,FAAP, FACOP at 954-262-1702 or by E-mail at
for all you want to know about our society, includinga summary of The Florida Pediatrician.G
Risk Management[The Florida Physicians Insurance Company (FPIC) is endorsed and sponsored by the Florida Chapter of the American Academy of Pediatrics as its exclusive
carrier of malpractice insurance for its members. In each issue, FPIC will present an article for our readers on matters pertaining to risk management]
The Keys to Documenting Phone CallsCliff Rapp, LHRM
Vice President of Risk Management, FPICThe most important phone call a physician ever
receives may be the one you or your staff forgets todocument. In today’s legal climate it has become evenmore important to document all medically relevantphone calls. All phone conversations need to bedocumented in the patient’s chart regardless of whetherthe call is received by you or your staff. Your officeshould have an established procedure for dealing withall calls. Failing to document a call is tantamount toforfeiting evidence in the event a defense becomenecessary.
When a patient calls your office with a problem,have your staff document the phone call in the patient’schart. Be sure they include important details of theconversations, including the time and date that the callwas received, who called, the person who received thecall, when the call was returned to the patient, and whatwas discussed. In addition, vital patient informationand the condition or clinical status of the patient shouldbe noted at that time.
It does not matter what your office procedurehappens to be, what matters is that the phone call getsdocumented in the patient’s chart. Withoutdocumentation, in the event of a claim, it is extremelyhard to defend details of discussions and specificinstructions. In most cases, if a phone call is notdocumented and a claim is made and goes to court, itbecomes your word against the patient’s word. Withoutdocumentation, the patient’s memory may carry morecredibility than that of you or your staff who may haveseen 20, 30, or more patients that day.
Remember to treat after-hour calls the same as anytelephone conversation. If you are on-call you maywant to consider establishing a procedure for thesephone calls to be documented in the patient’s chart aspart of the communication process. You may want toconsider designating one staff person to follow-up withthese patients and the on-call physician. Be sure yourstaff documents the salient portions of eachconversation and what treatment was rendered to each
patient. Protocols should also ensure that thecommunication loop is completed such that eachpatient receives a follow-up call.
The following are suggested elements to includewhen documenting phone calls:
· Date and time of the call
· Patient’s name
· Chief complaint or concern
· Brief history
· Assessment
· Disposition/advice
· Necessary follow-up by advice-giver
· Symptoms that develop which require the patient tocall back
· Signature or other information to determine advice-giver
· Date and time of call to the patient, if applicable
[Information in this article does not establish a standard of care, nor is it
a substitute for legal advice. The information and suggestions contained
here are generalized and may not apply to all practice situations. FPIC
recommends you obtain legal advice from a qualified attorney for a more
specific application to your practice. This information should be used as
a reference guide only.]
Note:Another summary of The Florida Pediatrician is onthe website for the AAP. The URL is:http://www.aap.org/member/chapters/florida.htmG
Page17
From the AAPCHILDREN SHOULD NOT BE GIVEN
SMALLPOX VACCINE Washington, DC---As the Bush Administration
implemented the first stage of its smallpox vaccination
plan, the American Academy of Pediatrics (AAP) testified
before Congress that given the information currently
available, the general public, particularly children, should
not receive the vaccine prior to an outbreak.
“Unfortunately, the concept of a pre-event voluntary
vaccination program for the public makes the least sense
from a scientific and public health standpoint,” said Jon S.
Abramson, M.D., chair of the AAP Committee on
Infectious Diseases, in testimony before the U.S. Senate
Health, Education, Labor and Pensions Committee. “The
concept of voluntary vaccination is a misnomer. If the
vaccine is made available to the general public, infants
and children who don't get the vaccine could be
unintentionally inoculated from a vaccinated adult. This
could have serious consequences since we know children
are particularly vulnerable to suffering complications from
the vaccine.”
Last year, the Academy announced support for the
"ring vaccination" strategy that is an effective method for
containing the disease, if it occurs, while minimizing
risks. The Academy does recognize the need for select
medical and emergency personnel to be vaccinated now in
order to carry out their responsibilities to the public if any
smallpox cases occur, but liability and compensation for
adverse events from the vaccine still needs to be
addressed.
“If I as part of the healthcare team suffer a serious
adverse event from getting the vaccine, I am covered by
my state workers' compensation program,” said Dr.
Abramson. “However, if I indirectly inoculate one of my
children at home or a patient I am caring for in the
hospital, and they develop a serious side effect, they are
not covered.”
The Academy urged Congress to enact a “no-fault”
system to compensate those injured directly or indirectly
by the smallpox vaccine. It could function in a way similar
to the National Vaccine Injury Compensation Program
established in the mid-80s.
The AAP testimony also called for Congress to ensure
that the smallpox vaccine is tested for use in children,
similar to the testing required for other childhood
vaccines.Page 18
“We don't even know if the vaccine is safe for use inchildren,” Dr. Abramson said. “If a smallpox attack didoccur are we really willing to let millions of children bepart of an emergency experiment? We need to beprepared to help children at the time of an outbreak withan effective vaccine at the right dose. Congress can seeto it that the necessary studies are done now.”G
AAP Partners with March of Dimes, ACOG, and AWHONN
The American Academy of Pediatrics (AAP) is
excited to be a partner with the American College of
Obstetricians and Gynecologists (ACOG), Association of
Women’s Health, Obstetric and Neonatal Nurses
(AWHONN) and the March of Dimes to accomplish the
goals and aims of the March of Dimes Prematurity
Campaign. The five-year Campaign has two goals: to
increase public awareness of the problems of prematurity
to 60% and to lower the rate of preterm births by 15%.
On the National level, the Academy will:
# Meet with March of Dimes chapter/division
representatives to determine the best strategies to
accomplish the Campaign goals.
# Designate speakers for the Campaign to address
prematurity issues at conferences, Grand Rounds and
train-the-trainer events (with funding available
through March of Dimes chapters), and at other
meetings.
We also encourage you to talk with your pregnant
patients (or pregnant parents of patients) about the signs
of preterm labor, especially those who are already parents
of children born prematurely and are at increased risk of
subsequent preterm delivery. The Campaign is a concerted
effort to address this major pediatric challenge in the US
and we want to be recognized as active partners in that
effort.G
FYIThe AAP will no longer print the tax deductibility disclosure
statement on the membership dues invoice. Since we are incorporated
as a 501 (c) (6) organization, we are required by the IRS to notify our
members of the amount of dues that can be deducted as a business
expense:
Dues remitted to the Florida Chapter are not deductible as a
charitable contribution but may be deducted as an ordinary necessary
business expense.
However, 30% of the dues are not deductible as a business expense
for 2002 because of the chapter’s lobbying activity.
Please consult your tax advisor for specific information.G
More from the AAP
It’s Not Too Early To Get Started on HIPAA[HIPAA went into effect on April 14, before press time for
this issue. However, it is not too late to be sure of the
details, even in review]
Implementation of the Administrative Simplification
requirements of the Health Insurance Portability and
Accountability Act of 1996 (HIPAA) may seem like it is
a long way off, but it is not too early to get started. Some
of the steps require you to contact your software vendors,
your billing clearinghouse (if you use one), and the major
health plans that you contract with. This could take time.
The American Academy of Pediatrics (AAP) has
developed manuals to help you through the process.
Beginning in June, AAP News will carry a monthly article
highlighting some aspect of HIPAA implementation. It
will include timelines and suggested tasks for that month
to keep you on track. Here are a few steps to get you
started.
Download Copies of the Manuals. The first thing to do
is to download a copy of each of the two manuals –
Electronic Transactions and Code Sets and Privacy. Go to
www.aap.org and select the Members Only Channel
(MOC) button in the upper right corner of your screen.
You’ll be asked for your member ID. Once on the MOC,
select the HIPAA link on the left side of the screen. Select
the link “AAP HIPAA Compliance Manuals and Tool
Sets.” Be sure to download the Word files that contain the
template forms you’ll be able to customize for your
practice.
Read the Overviews. Read the overview of each of the
two rules. They will give you a sense of the tasks ahead
and the purpose and goals of the rules.
Identify a Lead Person for Transactions and Tool Sets.
This person should be someone who is familiar with your
practice software. It might be you, your office manager, or
a billing staff person.
Once you have taken the necessary steps to get started
plan on actively preparing for HIPAA in the upcoming
months! It is important that you give yourself enough time
for completing necessary activities to become compliant.
The effective date for the Privacy Rule is April 14, 2003.
The effective date for the Transactions and Code Set
standards is October 16, 2002, but you can file an
To order Bright Futures materials please call 888/227-
1770 or log onto the Bright Futures website
(http://brightfutures.aap.org).GPage 19
From the FCAAPGov. Jeb Bush declared Wednesday, March 26, 2003,
Suicide Prevention Day and announced a goal ofreducing suicide rates by one-third by 2005. "It issomething that is clearly preventible and if we believe inthe sanctity of life, we believe all life is precious, thisshould be something we're actively involved in," Bushsaid. "Suicide is a serious problem in our country and ourstate. It is the ninth leading cause of death in Florida. Florida is ranked 11th in the nation for suicide among allage groups. In 2001 there were 2,200 suicide deaths inFlorida - that's more than double the number ofhomicides." As part of the effort, schools will be givenkits that provide information on how to assist studentswho pose a suicide risk. G
STATEMENT BY TOMMY G. THOMPSON
Secretary of Health and Human Services
Regarding New Federal Privacy Regulations
From the time of Hippocrates, privacy in medicalcare has been of prime importance to patients and to themedical profession. Today, as electronic datatransmission is becoming ingrained in our health caresystem, we have new challenges to insure that medicalprivacy is secured. While many states have enacted laws
giving differing degrees of protection, there has neverbefore been a federal standard defining and ensuringmedical privacy. Now new federal standards are cominginto force to protect the personal health information ofevery American patient.
Page 20
As of Monday, April 14, millions of healthplans, hospitals, doctors and other health careproviders around the country must comply with newfederal privacy regulations. To develop theseregulations, the Department of Health and HumanServices went through an extensive process ofconsultation and consensus that included reviewing andconsidering more than 100,000 public comments.
These new federal health privacy regulations set anational floor of privacy protections that will reassurepatients that their medical records are kept confidential.The rules will help to ensure appropriate privacysafeguards are in place as we harness informationtechnologies to improve the quality of care provided topatients. Consumers will benefit from these new limitson the way their personal medical records may be usedor disclosed by those entrusted with this sensitiveinformation.
The new rules also reflect a common-sense balancebetween protecting patients' privacy and ensuring thebest quality care for patients. They do not interfere withthe ability of doctors to treat their patients, and theyallow important public health activities, such as trackinginfectious disease outbreaks and reporting adverse drugevents, to continue. Over the past two years, we'veworked aggressively to provide doctors, hospitals andother covered entities with the information that theyneed to comply with the rule. We've held a series ofregional conferences on the privacy regulations andparticipated in hundreds of other conferences andmeetings with those affected by the regulations. We'veprovided extensive guidance and other technicalassistance materials that clarify key provisions of therule, so those affected take the right steps but don't gooverboard at the expense of the quality of their patients'
care. Many of these materials, including an extensivecollection of frequently asked questions, are on our Website at http://www.hhs.gov/ocr/hipaa/assist.html.
We will continue our efforts to encourage coveredentities to comply with the regulations' requirements.After all, this is the best way to ensure that patients getthe rights and protections that they expect. Of course, wehave all the enforcement options available to us underthe rule, including civil monetary penalties, and we willuse them as and when necessary to obtain our goal ofprotecting the confidentiality of personal medicalinformation.G
The History CornerPEDIATRICS IN FLORIDA
A TRADITION OF COMPASSIONATE CARINGDeborah Mulligan-Smith, M.D.
[A continuation of the history of FPS/FCAAP, from the previous issue) President Elect
The past causes the present, and so the future. 1970 - 1980
An important contribution to the affairs of theChapter and Pediatric Society were periodic newslettersby the Chapter Chairman and the President of the FPS.The first of which was that by Dr. Bob Grayson, datedFebruary 1965.< From a one or two page copy machine production, an
improved Newsletter of the FPS was formallyinitiated (volume 1, July 1979) under the editorshipof Dr. Louis St. Petery. A Tallahassee pediatrician, Dr. Louis St. Petery,
became Executive Secretary of the FPS and has filledthis position continually since then, with the current titleof Executive Vice President.
The terms of office of the officers of the twoorganizations were not synchronized, and because theFPS was continually active and successful in itslegislative advocacy, it became the dominantorganization in our state. During this time, however,most other states combined their Pediatric Societies andChapters not only in name, but in operating reality.
Among legislative victories were: < Change of the Florida Crippled Children's program
to the Children's Medical Service which would coverall chronic medical and surgical conditions rather
than only orthopedic problems. < The constitution was amended so that eight regional
districts were established in the State, and an electedrepresentative from each district served on theExecutive Committee. This was initiated to improvegrass roots member participation, and to inform themembership of the activities of the ExecutiveCommittee and of the National Academy.
< The AAP Chapter Forum was initiated in 1977 andhas continued to gain in importance as the method ofcommunication for the general membership and theAAP Executive Board. Our current Editor of the Florida Pediatrician was oneof the members of the five-person Task Force whichcreated the Forum. The Chapter Chair (later calledthe Chapter President) and the Alternate Chair, (VicePresident) attended the Annual Chapter OfficersForum to learn about and discuss issues concerningchild health and child well being.
1980 – 2000The 1980's dawned with a rapidly growing
membership, augmented by many Cuban and CentralAmerican pediatricians who emigrated to the UnitedStates and Miami area to escape the political changes intheir native countries. The University of Miami had beenparticularly helpful in the late 60's and 70's in preparingthese pediatricians for taking the Florida licensing
examinations through review sessions in Spanish andEnglish.< During a ten-year period, the Chapter membership
nearly tripled from 555 in 1980 to 1463 members in1990.
< A major accomplishment of the nineties, anticipatedin the constitution approved in the seventies, was theamalgamation of the FPS and the Florida Chapter in1994. By-laws, the long sought goal were achieved.
< In addition to the Regional Representatives, a strongLegislative Committee was formed under theleadership of Dr. Bob Stempfel of Miami.
< A Child Advocate, Dr. Gerold Schiebler, was madean ex-officio voting member of the ExecutiveCommittee.
< Following the “Annual Post-Graduate Course”, Dr.Altman and faculty members provide a "mini course"in three Central or South American cities.
< In 1985, the entire annual course was simulcast inEnglish and Spanish via satellite to the nations ofCentral America, South America, and the Caribbean.
< The annual attendance of pediatricians at Miami Beach numbered as many as 1,700, and estimates of15,008 physicians attended via satellite.
< Drs. Reed Bell and Donald Ian MacDonald wereappointed to positions in the Federal Alcohol, DrugAbuse and Mental Health Administration. Dr.MacDonald was Administrator of this Agency forseveral years during the Bush administration
(Continued next page)
Page 21
History( = continued from previous page)
< Drs. Reed Bell and Donald Ian MacDonald wereappointed to positions in the Federal Alcohol, DrugAbuse and Mental Health Administration. Dr.MacDonald was Administrator of this Agency forseveral years during the Bush administration.
< Pediatrician, clinician, cardiologist, educator,administrator, advocate, lobbyist, politician, andfriend of children, Dr. Gerry Schiebler, took asabbatical as University of Florida Chair to becomethe first head of the CMS to secure a firm beginning.
< Dr. Gerry Schiebler was recognized in 1993 by theAMA and AAP, jointly, with the Jacobi Award, givenfor contributions to the practice of pediatrics, for
excellence in teaching and for advocacy in behalf ofchildren.
< In 1994, the Newsletter was taken over by HerbertPomerance of USF, Tampa, who assumed the role ofeditor. The Newsletter, now entitled "The FloridaPediatrician" runs some 25 or more pages,professionally printed on glossy hard paper, andsupported by advertising of pediatric products.
< 1990s, FPS President Dr. Ken Morse and ChapterPresident Dr. David Cimino arranged for a singleslate of officers for the combined organizations.
< In the early 90's another creative insuranceinnovation was introduced by Steven Freedman,PhD, an honorary member of the FPS and AAP.Through Freedman and the Society's efforts, theHealthy Kids Corporation Act was passed. Thisprovided for health insurance through the schoolsystem, starting in Volusia County (Daytona), andnow being offered in county school systemsthroughout the state.
< 1993 – 1994, AAP Chapter Award for outstandingChapter activities is received.
< In l995 Dr. John Curran assumed the office of thecombined presidency of the joined organizations for the first time.
< On his retirement as chair of the FPS/Chapter
Legislative Committee in 1995, Bob Stempfel washonored by the Florida Legislature with a jointresolution of the House and Senate recognizing hisoutstanding contributions to child health.
< In 1997 Dick Boothby, a continuously involvedpediatrician from Jacksonville, delivered an accountof the history of the Florida Regional PerinatalProgram, of which he was the first chairman. Herecounted that in the early 1970's at which time therewere 5 neonatologists in the state, the infantmortality rate was 19 per thousand live births. Witha grant of $50,000 from the Florida RegionalMedical Program, a multi-disciplined steeringcommittee was formed to improve the care of highrisk newborns. The five neonatologists in the initialcommittee were Drs. Eduardo Bancalari, Miami,John Curran, Tampa, Don Eitzman, Gainesville, DonGarrison, Jacksonville, and Ed Westmark, Pensacola.At the time of Dick Boothby's report (1997), therewere over 100 neonatologists (perinatologists), andan infant mortality rate of 7.5 in 1995.
< 1998, the new Title XXI program, the State
REGISTRATION
Have you registered yet for the Annual Meeting
in Orlando, June 20-22, 2003?Important Business CME Credit
C.A.T.C.H.
Children's Health Insurance Program (SCHIP) isimplemented. Florida was one of the first to have itsplan of implementation approved by the FederalGovernment.G
[To be continued in next issue]
Note:If you are a Fellow of the American Academy ofPediatrics, you are automatically a member of the FloridaPediatric Society/Florida Chapter of the AmericanAcademy of Pediatrics, and you automatically receiveThe Florida Pediatrician. If you have not already doneso, please pay your annual Florida dues, billed throughthe Academy Office. G
The CATCH CornerDavid L. Wood, M.D.
North Florida Regional CATCH Facilitator
University of Florida/Jacksonville
It is with great pleasure that,
as the new North Florida Regional
CATCH Coordinator, I write my
first Catch Corner for Florida
Pediatrician. Now is the time to think about a CATCH grant!!!
I want to encourage all pediatricians and pediatric residents in
Florida to consider submitting a CATCH grant this year. The
CATCH Planning Funds grant cycle l begins in mid-May. New
Applications (including on-line) will be available in May.
Submitted applications must be postmarked no later than Friday,
July 26, 2002. Award recipients will be notified by the end of
January 2003. See the following website (on the AAP website
under Community Pediatrics) for more information:
http://www.aap.org/visit/catchgrants.htm The resident grants
have two annual cycles: one that starts in May with a due date
of July 25, 2003 and a second cycle that starts in November
with a due date of the last Friday of Jan. 2004.
If you have any questions or just want to bounce ideas off
someone, talk to your local District CATCH Facilitator. The
state of Florida is divided into 8 Districts and below are the
names and contact information for each District CATCH
Coordinator along with the names of the counties they cover.
DISTRICT I (Escambia, San ta Rosa , Okaloosa, Walton, Holmes,
Jackson, Washington, Bay, Calhoun, Gulf, Gadsden, Liberty,
Improving Access to the Medical Home for Childrenwith Special Health Care Needs. There have beenmany CATCH projects that have focused on improvingaccess to a medical home for children with specialhealth care needs (CHSCN). Our own Karen Toker,MD, the prior North Florida Regional CATCHCoordinator, received a CATCH grant last year toimprove access for CHSCN in the Jacksonvillecommunity. Her proposal was to organize the childhealth community through the local Commission forChildren with Special Health Care Needs and create aplan for a system of care that would make the medicalhome more accessible for CSHCNs. Thus far Dr. Tokerhas been able to convene several community-wideorganizational meetings, which have includedcommunity pediatricians and public and privateproviders of allied and special services for CSHCN. She is fielding a survey to assess pediatrician’swillingness to provide a comprehensive medical homefor additional CSHCNs. Based on this information andother input they will write a plan and a larger grant thatwill allow funding for training and support forpediatricians to do case management, developmentalscreening and other services for CHSCN that are
components of the medical home. As exemplified by Karen’s project, CATCH grants
are planning grants. CATCH projects commonly providefunds to a pediatrician to mobilize their local communitywith the goal of improving access to health or otherservices for children. The CATCH grants alsocommonly result in a plan or proposal for a largerproject. Many have been successful at having a majorimprovement in services for children, especially poor ordisadvantaged children.
Medical Home Collaborative for CSCHN. Providingaccess for all children to comprehensive medical homesis also major emphasis of the AAP, Title V and childhealth advocates. Another Medical Home-focusedproject is also in Jacksonville (pardon my geographicbias, but as they say…’write what you know.’ Deise willget her chance in the next Florida Pediatrician!!). TheFlorida Children’s Medical Services, local CMS inJacksonville and 3 pediatric practices in Jacksonville, fora team, one of 11 State Title V agencies/pediatricpractice teams chosen to participate in a national learningPage 24
collaborative developed by the National Initiative forChildren’s Healthcare Quality (NICHQ), the Center forMedical Home Improvement (CMHI) and the UnitedStates Maternal and Child Health Bureau (USMCHB)Division of Services for Children with SpecialHealthcare Needs.
The collaborative is a tremendous opportunity tolearn and identify how we, as primary care providers forCHSCN, can support and improve on our provision ofthe comprehensive medical home. The three practicesparticipating in the collaborative are Dr. David Weiss, apediatrician in solo private practice; Dr. Olin B. “Chip”Mauldin, of the University of Florida Pediatric Center atAndrew Robinson Elementary School; and Dr. SandraMorales, of the University of Florida Pediatric Center atSan Jose. In addition to the physician/leaders, eachpractice team will consist of an office staff member anda parent of a child with special health care needs.
The teams will work together for twelve monthsduring which they will attend three two-day LearningSessions, participate in action periods between LearningSessions and maintain continuous contact with thecollaborative faculty members, each other and thecollaborative organizations. The offices will assess theirown provision of the medical home as defined by the
Center for Medical Home Improvement(www.medicalhomeimprovement.org). I encourage allof you to take the test! When I took the test with ourresidents we found outthat we have a lot to learn and doin our clinics to improve our provision care to CHSCN.As part of the process the Title V programs will seek toimprove their understanding of community-basedprimary care practice as it relates to children withspecial health care needs and how they can bettersupport pediatricians’ practices. “The LearningCollaborative … goals are consistent with the HealthyPeople 2010 objective that every child with specialhealth care needs will receive comprehensive care in aMedical Home.” according to Phyllis Sloyer, Directorof Florida’s CMS Network and Related Programs, “Thesecond purpose of the collaborative is to foster strongrelationships between Title V (CMS) programs and theprimary care communities within the state.”G
Add-a-Pearl...from Chuck Weiss
[Here are 10 questions from Chuck. Try them! Answers on Page 27 ]
Questions and Answers1. Two years ago the UK Childhood Cancer Study
found what researchers called “weak evidence ofborderline statistical significance”that breast feedingreduced childhood cancer risks. The repeat surveyof 3376 mothers with children who died ofcancer found no evidence of the claim. T F
2. In a recent report by Harris Interactive, 110 millionpeople look for health information online, and 90percent of those surveyed want to communicateonline with their physicians. T F
3. Most Florida Pediatricians have and use the OnlineDoctor-Patient Communication tool. T F
4. Throat clearing can be the first sign of pediatricasthma. T F
5. Doctors are “too aggressive” about type 2 diabetescontrol . T F
6. Increasing rates of type 2 diabetes in adolescents isparticularly worryissome. T F
7. Depression in adolescence does not influence risk ofobesity. T F
8. Some academic researchers report a high prevalenceof impaired glucose tolerance in severely obesechildren and adolescents T F
9. Soft drinks are the major source of caffeine incaffeine consumption and altered sleep patterns inteenagers. It may be reasonable to limit the caffeinecontent and restrict the type of beverages promotedto teenagers. T F
10. The administration of vaccines containing thiomersaldoes not appear to raise blood mercuryconcentrations above safe levels and
ethylmercury seems to be eliminated rapidly via the
stools. T F
OBESITY AND “TYPE 2"DIABETES CONTROLThe International Diabetes Foundation (IDF) states that primary
care physicians/pediatricians need to manage their patients blood
glucose levels much more aggressively if the global explosion in
type 2 diabetes prevalence is to be slowed.1 Many doctors are “too
complacent“ about the need for close control of glucose levels.
Unfortunately, this lack of motivation is being passed on to patients.
It is inappropriate to say to a patient you’ve just got mild diabetes
and you don’t need insulin.
Diabetes specialists try to reduce people’s blood glucose levels
to normal, according to the IDF. They must convince their
colleagues that they should do that and at the same time treat all the
heart disease risk factors just as seriously. All should be treated
aggressively.
Type 2 diabetes affects 22.5 million European adults and
accounts for 10% of the European health care budget. Professor
Alberti, IDF President* says the increasing rates of type 2 diabetes
in adolescents and children are particularly worrisome. “ . . ., unless
they’re dealt with meticulously, are going to die of heart disease of
kidney failure in their 30's . . . .now we are seeing it in fat white
children.” . . . studies show that reducing the blood glucose control
marker Hb1c by just 1% cuts the risk of MI by 14% and the risk of
eye and kidney damage by nearly 45%. Type 2 diabetes is largely
a consequence of an unhealthy lifestyle and it is preventable.
Other serious risks of adolescent obesity: Depression2
Adolescents with depression are at increased risk for the
development and persistence of obesity.2 A depressed mood present
at the first interview, based on a modified Center for Epidemiologic
Studies Depression Scale more than doubled the risk of obesity at
one-year follow-up as well as the risk of developing obesity among
those who initially were not obese. This suggests that if you treat
depression in adolescents you may stave off the onset of obesity or
prevent an obese child from becoming more obese.
These supporting data are the result of a joint study of
Banders University and the Cincinnati Children’s Hospital
Medical Center. They gathered data jointly on 9,000
adolescents who were in grades 7-12 when first interviewed
in 1995. In this cohort, the number of obese parents was the
strongest correlate of obesity at the baseline.
Clinicians should “talk to young people, not just their
parents” and “encourage parents to talk to their kids about
feelings, and to definitely not make light of them.
Self-esteem of Obese Children Below That of Peers3
A study has found a startling level of despair among
obese children, with many rating their quality of life as low
as (See Pearls, page 27 <)
Page 25
President
REGISTRATION
Have you registered yet for the Annual Meeting
in Orlando, June 20-22, 2003?Important Business CME Credit
(= continued from page 3)
Nonetheless, we did make some significant progress.The Medicaid fee increase, although modest, has movedreimbursement closer to being acceptable for someservices, but there is still more to do. We have had somesuccess with legislation aimed at making theenvironment in Florida safer for children, but there isstill more that can be done. We have begun to streamlinethe KidCare program to make it friendlier to familiesand pediatricians, but there is still more that must bedone.
To strengthen our position, we have reached out toother child and family advocates within the state to builda broad-based coalition to address these challengessuccessfully. All members of the coalition have acommon goal: access to affordable, quality pediatric carefor all of Florida’s children. Each member of thecoalition is dedicated to improving the administrativestructure of the KidCare program to make it seamless forfamilies and Pediatricians. Each member of thecoalition sees Pediatricians as the best qualified todeliver that quality care to children. And each memberof the coalition understands that full access to qualitycare will not occur in Florida until Pediatricians areadequately and appropriately reimbursed from allcomponents of the KidCare program.
In closing, I want to thank all of you for your activeparticipation in the Chapter, but most of all, I want tothank you for allowing me to be your President.
With warmest regards,
Richard L. Bucciarelli, M.D.G
The “Ticked Off” Column.
If you are really “ticked off” about something in your practice or about
medical economics in general, write about it and send it in. Any
reasonable complaint will find its way into print!GPage 26
Women’s( = continued from page 13)
advocate and violence folks have the opportunity tocommunicate with providers and improve awareness inthe community.
The organization helped recruit new mental healthservice providers in the community, collaborated withJuvenile Justice in conducting a public forum withfamilies and adolescents and obtained grants for theteenage pregnancy prevention through the libraryprogram. The library also received funds for a readingenhancement program.
The best part was, in my opinion, the celebration ofchildren this past March. Franklin's Promise presentedthe Franklin County Board of County Commissioners'with a resolution supporting children, communityinitiatives serving children, and declaring ThursdayMarch 20th Children's Day. The Board adopted theresolution acknowledging that every dollar used to fundchildren's initiatives is a dollar well spent and asignificant investment in the future of the community,the state and the nation. On Children's Day in theplayground of Chapman Elementary School inApalachicola, about eighty-seven children attended totwo hours of fun and games. Volunteers from Franklin'sPromise manned the booths. The celebration was a greatsuccess. And I expect continuing success on the part ofthe community through the initiative of Franklin'sPromise, Inc. G
Resident( = continued from page 14)
Top Ten Reasons why you should become a member ofthe Resident Section10) To receive free journals and other resources availableto AAP members9) To use the resident section web pagewww.aap.org/sections/resident8) To learn how the AAP affects legislation through ahealth policy elective at the national AAP office7) To get INVOLVED in the community whether byservice, advocacy, or politics6) To lobby for children’s issues5) To learn about new job opportunities4) To meet life-long mentors and colleagues3) To meet and build relationships with residents fromacross the country2) To participate in the Florida Chapter AAP AnnualMeeting
** June 20-22nd in Orlando**THE TOP REASON…..1) To participate in the national conference
**This year it’s in New Orleans! October 31st-November 5th** G
Add-A Pearl from Chuck W eiss
( = questions on page 25)
Add-a-Pearl Answers from Chuck Weiss
1. True
Ref: Br J Cancer 2003; 88:000-000
2. True
Ref: Harris Interactive Poll
3. False
Ref:Harris Interactive Poll
4. True
Ref: N Engl J Med 2002; 348:1502-1503
5. False
Ref: Intl Diabetes Foundation, April News release
6 True
Ref: Intl Diabetes Foundation, April News release
7 False
Ref: Pediatrics, 2002; 109:497-504
8 True
Ref: N Engl J Med 2002; 346:802-810, 854-855
9 True
Ref: Pediatrics 2003; 111: 42-46
10 True
Ref: Lancet 2002; 360: 1737-1741 G
Pearls( = continued from page 25)
that of young cancer patients on chemotherapy. The JAM A offers
a sobering glimpse of what life is like for an obese youngster. They
are teased about their size, have trouble playing sports and suffer
physical ailments linked to their weight. An obesity researcher,
Kelly Brownell, who runs a Yale University weight disorder center,
said the increasing prevalence of obesity hasn’t made it any less
stigmatizing.
In the study, 106 children, age five to 18 were asked to rate
their well-being on physical, emotional and social measures. Obese
youths scored an average of 67 points out of 100. 16 points lower
than a group of 400 mostly normal weight children. The obese
children’s scores were similar to the quality of life self-ratings from
a previously published study of about 100 pediatric cancer patients.
Girls and boys in the study appeared to be equally adversely
affected by obesity.
On the average the typical 12-year-old youngsters were 5 -foot
= 1 and 174 pounds . Obesity related ailments were common,
including fatty liver disease, obstructive sleep apnea, diabetes and
orthopedic problems caused by excess weight. Even in the absence
of this conditions, \, children and parents reported a low quality of
life.
Reportedly parental assessments rated their childrens’ well-
being even lower than the childs’ self-ratings. The only hope for
relief today, is the experimental (un licensed) drug Sibutrime. In
studies, thus far, it has provided what might be considered useful
weight control, reductions in hunger and body mass index. (BMI)
Side effects require more safety and efficacy data before the drug
may be used outside of experimental settings.
Impaired Glucose Tolerance Common in Obese Children and
Adolescents.4
Researchers at the Yale University School of Medicine report
a high prevalence of impaired glucose tolerance in severely obese
children and adolescents. Among 55 obese children, 25% had
impaired glucose tolerance, as did 21% of the 112 obese
adolescents. In addition 4% of the adolescents were diagnosed
with silent type 2 diabetes.
“Despite all our best efforts, prevention of childhood obesity
eludes our grasp,“ comment of a University of Michigan research
physician, in a journal editorial. “Even with successful weight
loss, the rate of relapses is high. I believe that a more effective
strategy is to identify those obese children who are at high risk for
diabetes and to target them for intensive weight-loss treatment,” he
advised.
“Oral glucose-tolerance testing appears to be an excellent
method for reliably identifying obese children who are at high risk
for diabetes.”
1. Reuters 2002-05-29 9:31:23
2. Pediatrics Sept 02
3. JAMA, April 9, 2003
4. N Engl J Med 2002; 346:802-810, 854-855 GPage 27
PROS(=continued from page 8)
routine well child check up season (April – August) isupon us. We need your help now!! Are you interestedin testing some new, brief screening and counselingtools for violence prevention and reading promotion?The project involves minimal paperwork and last only 2– 4 weeks. Its results will lead to new recommendationson how we as pediatricians provide guidance on theseand other safety & developmental issues.
We are actively enrolling practices in PROS CARES(Child Abuse Recognition Experience Study).Clinicians complete a postcard size survey when seeingchildren presenting with an injury and a longer survey ifthe child has a high likelihood of abuse. Outcomes arethen monitored. By collecting this information frommany practices across the nation, we expect a pattern toemerge that will help inform our decision-making.
New projects in the pipeline include identifyingtiming of pubertal changes in boys, creating tools to helpclinicians update immunizations, and improving theeffectiveness of anticipatory guidance. Keep an eye outfor future developments.
If you are interested in working on a PROS study atany level (enrolling patients to designing projects),contact us at [email protected] or call 800-433-9016,extension 7626. Further, please contact me if you areinterested in having a 12-minute slide presentation aboutPROS at your local hospital or pediatric society meeting.
fax your CV to 813.622.7589. Visit us on the web at
http://www.afterhourspediatrics.com. EOE M /F/D/V
Reach out and Read(= continued from page 8)
parents and enticing the interest of the children.
The ROR Florida Coalition will support theactivities of individual sites in Florida throughtechnical assistance and training, legislativeadvocacy, fundraising, and expanded visibility. Youcan learn more about Reach Out and Read atwww.reachoutandread.org. The partnershipbetween the FPS Foundation and the ROR FloridaCoalition promises to promote the healthydevelopment of young children in Florida. Can thestatewide presence of the Florida Pediatric SocietyFoundation similarly help an organization you workwith?
Respectfully submitted,
Lloyd N. Werk, MD, MPH, FAAPNemours FoundationLee Sanders, MD, MPH, FAAPUniversity of Miami
Managed(= continued from page 15)
Examples include:
• CPT code 17250 - chemical cauterization of granulation
tissue (proud flesh, sinus or fistula); with E&M services;
• CPT code 53670 - catheterization, urethra; simple; with
E&M services (Please note the complaint received was
concerning CPT code 53670 that has been deleted in the 2003
CPT Book and replaced with CPT code 51701 - insertion of
SCIENTIFIC SESSIONS - Friday. Saturday. and Sunday
Please check appropriate category for registration
______FPS/FCAAP Member - $150 registration fee
______Non-Member - $250 registration fee (includes a one-year membership to FPS)
______Resident - No Charge
______Emeritus Fellow - No Charge
Enclosed is my check made payable to the Florida Pediatric Society in the amount of $______.
Please mail this form and check to: The Florida Pediatric Society
1132 Lee Avenue
Tallahassee, FL 32303
The Hilton in the Walt I)isnev World Resort is holding a block of rooms for our meeting. The
room rate is $115 plus tax (Junior Suite is $155 plus tax). Please call 1-800-782-4414 and mentionthe Florida Pediatric Society Meeting. The deadline for reservations is May 20, 2003.
Reach Out and Read - Florida Book Drive: Bring a new or gently used children’s hook (suitable for
ages 6 months to 5 years old), All books will be distributed to young indigent children to promote
reading and early child literacy. For further information, please contact us at (305) 243-3619.
Non-Profit Org.U.S. Postage
PAIDPermit No. 1632Tampa, Florida
Upcoming Continuing Medical Education Events
THE FLORIDA PEDIATRICIAN will publish Upcoming Continuing Medical Education Events planned. Please send notices to the Editor
as early as possible, in order to accommodate press times in February, May, August, and November.
Program: Practical Pediatrics
Dates: May 16-18, 2003
Place: Anchorage Marriott Downtown, Anchorage, AK
Credit: Hour for hour (up to 16.5 hours), for Category 1
for AMA Physician Recognition Award
Sponsor: American Academy of Pediatrics
Inquiries: American Academy of Pediatrics, (800) 433-
9016, ext 6796 or 7657
Program: Pediatrics Symposium: Update 2003
Dates: May 24-26, 2003
Place: Sandestin Beach Hilton Golf and Tennis Resort,
Destin, FL
Credit:: Hour for hour (up to 29 hours), for Category 1 for
AMA Physician Recognition Award
Sponsor: Medical Educational Council of Pensacola/Sacred
Heart Children’s Hospital
Inquiries: Call (850) 477-4956
Program: 27th Annual Florida Suncoast Conference
Dates: June 27-29, 2003
Place: Trade Winds Island Grand Resort, St. Pete Beach
Credit: Up to 13 hours for Category 1 for AMA Physician
Recognition Award
Sponsor: University of South Florida and All Children’s
Hospital
Inquiries: Terra Sroka, (727)892-8584
Page 32
The Florida Pediatrician
c/o USF Department of Pediatrics
12901 Bruce B. Downs Boulevard
MDC Box 15CE
Tampa, FL 33612
Program: Practical Pediatrics
Dates: August 29-31, 2003
Place: Seattle, Washington
Credit: Hour for hour (up to 16.5 hours), for Category 1
for AMA Physician Recognition Award
Sponsor: American Academy of Pediatrics
Inquiries: American Academy of Pediatrics, (800)433-9016,
ext 6796 or 7657
Program: Practical Pediatrics
Dates: October 10-12, 2003
Place: Toronto, Ontario, Canada
Credit: Hour for hour (up to 16.5 hours), for Category 1
for AMA Physician Recognition Award
Sponsor: American Academy of Pediatrics
Inquiries: American Academy of Pediatrics, (800)433-9016,
ext 6796 or 7657
Program: Practical Pediatrics
Dates: November 14-16, 2003
Place: Tempe, Arizona
Credit: Hour for hour (up to 16.5 hours), for Category 1
for AMA Physician Recognition Award
Sponsor: American Academy of Pediatrics
Inquiries: American Academy of Pediatrics, (800)433-9016,
