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!Welcome!Packet!and!Legislative!Information!

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Thursday!June!20th,!2013!

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Dear!Physician!Advocate,!

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We’d!like!to!personally!welcome!you!to!the!Residents!and!Fellows!Day!at!the!State!House!

(RFDASH).!It!is!an!exciting!time!for!healthcare!advocacy!as!we!face!systemMwide!change!in!the!

way!we!care!for!children.!The!world!of!pediatrics!is!an!engaging!area!in!which!to!work,!and!we!

feel!honored!to!be!able!to!bring!inspired!people!together!to!meet!in!forums!like!this,!ensuring!

our!community!of!residents!and!fellows!remain!actively!involved!in!physician!advocacy.!

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We!have!a!full!agenda!today!so!please!take!a!few!minutes!to!read!through!the!information!in!

this!packet.!It!includes!our!schedule!and!other!important!legislative,!advocacy,!and!lobbying!

information!that!will!be!useful!not!only!for!today,!but!also!in!any!future!involvement!you!wish!to!

have!with!the!American!Academy!of!Pediatrics'!legislative!advocacy!efforts.!

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Let!us!give!you!a!brief!update!on!where!we!are!today.!RFDASH!was!founded!eight!years!ago!by!

residents!in!the!Massachusetts!General!Hospital!for!Children!Pediatrics!residency!program.!Since!

then,!we!have!advocated!for!23!bills,!many!of!which!have!been!passed.!This!year,!we!will!be!

focusing!our!efforts!on!2!legislative!topics!that!address!the!needs!of!our!pediatric!patients!in!

diverse!ways:!1)!Establishing!universal!vaccination!and!an!immunization!registry!and!2)!Creating!

safer!gun!policies!in!Massachusetts.!

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We!would!like!to!thank!the!Massachusetts!Chapter!of!the!American!Academy!of!Pediatrics!

(MCAAP)!for!their!support!in!this!endeavor.!We!are!all!very!proud!of!where!RFDASH!is!today!and!

are!ever!grateful!for!the!help!and!mentorship!of!MCAPP!leaders.!Before!we!close,!we!would!like!

to!thank!you!personally!for!attending!this!lobby!day!and!bringing!your!expertise!and!passion!to!

this!important!event.!You,!as!a!physician!leader,!have!the!vision,!the!knowledge,!and!the!

experience!to!truly!make!a!difference!in!the!lives!of!our!children!and!their!families!through!

advocacy.!You!are!our!greatest!asset!and!we!could!not!effect!change!without!your!support!and!

commitment.!If!this!is!your!first!exposure!to!physician!advocacy,!we!welcome!you!and!are!

here!to!guide!and!support!you!throughout!this!exciting!day.!We!also!urge!you!to!consider!

staying!engaged!in!pediatric!advocacy!even!after!you!leave!the!State!House!this!afternoon.!As!

physician!leaders,!we!can!and!will!work!together!to!continue!to!shape!the!future!of!pediatrics.!

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With!deep!respect!and!gratitude,!

!

Rachel!Sagor,!MD!

Lily!Maltz,!MD!

Sylvia!Romm,!MD!MPH!

RFDASH!CoMLeaders!

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Welcome!Letter!

Welcome!

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PEDIATRIC!RESIDENTS!AND!FELLOWS!DAY!AT!THE!STATE!HOUSE!Thursday, June 20th 2013

Massachusetts State House – The Great Hall

8:30am REGISTRATION AND BREAKFAST

9:00am WELCOME AND INTRODUCTIONS

9:15am KEYNOTE SPEAKER

AAP Priorities: Poverty and Brain Development James Perrin, MD, FAAP

President-Elect of the American Academy of Pediatrics, Director of General Pediatrics at MassGeneral Hospital for Children

9:45am SKILLS & TRAINING

How to be an effective lobbyist Alex Calcagno, Government Relations, Massachusetts Medical Society

10:45am SHORT BREAK AND SNACK

11:00am FOCUS ON THE ISSUES

Firearms Injuries and Deaths: Legislative Opportunities to Save Children’s Lives Robert Sege, MD, PhD

Director, Division of Family and Child Advocacy, Boston Medical Center 11:20am

Massachusetts Childhood Vaccine Legislation Richard Moriarty, MD

Clinical Professor of Pediatric Immunology and Infectious Disease, UMASS Medical Center 11:40am

PEDIATRICIANS AS ADVOCATES Finding Your Voice: Pediatricians as Advocates

Anna Rosenquist, MD Pediatrician, Harvard Vanguard Burlington

12:00pm LUNCH

Ed Brennan, JD, Legal Counsel & Lobbyist, Massachusetts Chapter of the AAP Legislation & Lobbying Q&A

1:00pm LEGISLATIVE MEETINGS

3:00pm FEEDBACK & WRAP-UP

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Schedule!of!Events!

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JAMES!PERRIN,!MD!

AAP!PRESIDENT!ELECT!!

James!M.!Perrin,!MD,!is!professor!of!pediatrics!at!Harvard!Medical!School!and!former!director!of!

the!Division!of!General!Pediatrics!at!the!MassGeneral!Hospital!for!Children!and!past!associate!

chair!of!pediatrics!for!research!at!MGH.!!He!founded!the!MGH!Center!for!Child!and!Adolescent!

Health!Policy,!a!multidisciplinary!research!and!training!center!with!an!active!fellowship!program!

in!general!pediatrics,!and!directed!the!center!for!over!15!years.!!He!is!presidentMelect!of!the!

American!Academy!of!Pediatrics,!former!chair!of!its!Committee!on!Children!with!Disabilities,!and!

past!president!of!the!Ambulatory!(Academic)!Pediatric!Association.!!For!the!American!Academy!

of!Pediatrics,!he!also!coMchaired!a!committee!to!develop!practice!guidelines!for!attention!deficit!

hyperactivity!disorder!and!then!a!group!advising!the!AAP!on!the!implementation!of!the!

guidelines.!His!research!has!examined!asthma,!middle!ear!disease,!children’s!hospitalization,!

health!insurance,!and!childhood!chronic!illness!and!disabilities,!with!recent!emphases!on!

epidemiology!of!childhood!chronic!illness!and!organization!of!services!for!the!care!of!children!

and!adolescents!with!chronic!health!conditions.!!He!heads!the!Clinical!Coordinating!Center!

(based!at!the!MGH)!for!the!national!Autism!Treatment!Network!and!the!Autism!Intervention!

Research!Network!on!Physical!Health,!a!multisite!collaborative!aiming!to!improve!evidenceM

based!care!for!children!and!adolescents!with!autism!spectrum!disorders.!!He!also!directed!the!

Evidence!Working!Group!reporting!to!the!Maternal!and!Child!Health!Bureau!for!the!Secretary’s!

Advisory!Committee!on!Heritable!Disorders!and!Genetic!Diseases!in!Newborns!and!Children.!!Dr.!

Perrin!was!the!founding!editor!of!Academic!Pediatrics!(formerly!known!as!Ambulatory!

Pediatrics),!the!journal!of!the!Academic!Pediatric!Association.!!!

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Dr.!Perrin!has!served!on!Institute!of!Medicine!Committees!on!Maternal!and!Child!Health!under!

Health!Care!Reform,!Quality!of!LongMTermMCare!Services!in!Home!and!CommunityMBased!

Settings,!Enhancing!Federal!Healthcare!Quality!Programs,!and!Disability!in!America;!the!National!

Commission!on!Childhood!Disability;!and!the!Disability!Policy!Panel!of!the!National!Academy!of!

Social!Insurance.!!His!experience!includes!two!years!in!Washington!working!on!rural!primary!

care!development!and!migrant!health.!!After!his!fellowship!at!the!University!of!Rochester,!he!

developed!and!ran!a!rural!community!health!center!in!farming!communities!between!Rochester!

and!Buffalo.!!!

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He!received!a!Robert!Wood!Johnson!Foundation!Investigator!Award!in!Health!Policy!Research.!!

He!also!served!as!a!member!of!the!National!Advisory!Council!for!the!Agency!for!Healthcare!

Research!and!Quality.!!A!graduate!of!Harvard!College!and!Case!Western!Reserve!University!

School!of!Medicine,!he!had!his!residency!and!fellowship!training!at!the!University!of!Rochester!

and!has!also!been!on!the!faculties!of!the!University!of!Rochester!and!Vanderbilt!University.!

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Speaker!Biographies!

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ANNA!ROSENQUIST,!MD!

PEDIATRICIAN!AND!COMFOUNDER!OF!RFDASH!!

Dr.!Rosenquist!became!interested!in!children's!health!in!high!school!when!she!worked!as!a!Girls'!

Club!counselor!with!high!risk!girls!in!Athens,!Georgia.!During!medical!school!she!worked!at!

summer!camp!in!West!Philadelphia,!teaching!children!nutritional!pearls!such!as!!"JuicyMJuice!is!

not!a!fruit."!She!did!her!residency!training!in!pediatrics!at!Massachusetts!General!Hospital!for!

Children,!and!led!the!resident!advocacy!group!there,!coMorganizing!the!first!Residents'!Day!at!the!

State!House!in!2006.!!As!a!primary!care!pediatrician!at!Harvard!Vanguard,!she!now!confronts!the!

obesity!epidemic!at!the!individual!level!on!a!daily!basis,!and!has!particular!clinical!interest!in!the!

areas!of!infant!nutrition!and!adolescent!mental!health.!She!sits!on!the!Legislative!Committee!of!

the!Massachusetts!Chapter!of!the!American!Academy!of!Pediatrics!and!is!their!representative!

on!the!MPHAMsponsored!Act!FRESH!Campaign.!

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ROBERT!SEGE,!M.D.,!PH.D.!!

PEDIATRICIAN,!BMC!

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Dr.!Sege!is!a!practicing!pediatrician,!Chief!of!the!Division!of!Family!and!Child!Adovcacy,!and!

medical!director!of!the!Child!Protection!Team!at!BMC!and!a!Professor!of!Pediatrics!at!Boston!

University.!He!serves!as!a!member!of!American!Academy!of!Pediatrics’!Committee!on!Child!

Abuse!and!Neglect,!and!the!Centers!for!Disease!Control!and!Prevention’s!Knowledge!to!Action!

think!tank!on!child!maltreatment!prevention.!!He!led!the!development!of!Connected!Kids:!Safe,!

Strong!Secure!program!for!the!American!Academy!of!Pediatrics!(www.aap.org/connectedkids),!

and!received!the!American!Academy!of!Pediatrics’!2008!Fellow!Achievement!Award!for!his!work!

on!youth!violence!prevention.!!!!

!Dr.!Sege!has!written!many!scientific!articles,!and!spoken!widely!on!a!variety!of!topics!

related!to!the!prevention,!identification!and!treatment!of!youth!violence,!bullying,!child!abuse!

and!neglect.!!In!the!prevention!arena,!he!teaches!about!evidenceMbased!approaches!to!child!

maltreatment!and!violence!prevention!that!use!new!scientific!knowledge!to!support!parents,!

children!and!teens!in!realizing!their!hopes!and!dreams.!!

Dr!Sege!received!his!BS!degree!from!Yale!college,!his!PhD!from!MIT,!his!MD!from!

Harvard!Medical!School!and!completed!his!pediatric!residency!at!Children’s!Hospital!Boston.!He!

is!boardMcertified!in!general!pediatrics!and!in!child!abuse!pediatrics.!

Bob!lives!in!the!Boston!area,!where!he!met!his!wife!Karen!over!30!years!ago.!They!have!three!

young!adult!children.!Bob!is!an!avid!swimmer,!he!especially!likes!open!water!swimming.!He!has!

ducked!his!head!into!the!Arctic!Ocean,!swam!around!an!island!in!New!York!Harbor,!and!entered!

a!swim!races!in!the!Boston’s!Charles!River!and!the!Boston!Harbor.!

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Speaker!Biographies!

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RICHARD!MORIARTY!MD!

PROFESSOR!OF!CLINICAL!PEDIATRICS,!UMASS!MEDICAL!SCHOOL! Dr.!Moriarty!graduated!from!Colby!College,!UVM!Medical!School,!trained!in!pediatrics!at!Johns!

Hopkins!and!University!of!Rochester!and!practiced!primary!care!pediatrics!in!the!US!Navy!for!10!

years!before!doing!a!pediatric!infectious!disease!fellowship!at!Walter!Reed!Army!Medical!

Center.!!He!then!spent!the!next!10!years!at!the!National!Naval!Medical!Center!in!Bethesda!

serving!as!chief!of!pediatrics!and!merging!the!military's!pediatrics!training!programs!at!Bethesda!

and!Walter!Reed.!!He!retired!from!the!Navy!and!moved!to!UMass!where!he!has!done!pediatric!

primary!care,!pediatric!infectious!disease,!travel!medicine!and!international!adoption.!!He!has!

worked!on!the!MA!Chapter!of!the!AAP!Immunization!Initiative!and!have!provided!continuing!

education!about!immunizations!around!the!state.!

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ALEX!B.!CALCAGNO!

DIRECTOR!OF!FEDERAL!AND!COMMUNITY!RELATIONS!

MASSACHUSETTS!MEDICAL!SOCIETY!!

Alex.!Calcagno!is!Director!of!Federal!and!Community!Relations!for!the!Massachusetts!Medical!

Society.!She!is!responsible!for!advocating!the!Medical!Society's!position!before!the!United!States!

Congress,!White!House!and!Executive!Agencies.!Prior!to!coming!to!the!Medical!Society!Alex.!was!

Assistant!Director!of!the!American!Academy!of!Pediatrics!Office!of!Government!Liaison!in!

Washington,!D.C.,!!where!she!lobbied!for!pediatricians!&!children’s!health!care!at!the!national!

level.!!Her!first!entry!into!the!political!arena!was!as!Assistant!Press!Secretary!for!United!States!

Representative!M.!Caldwell!Butler.!

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EDWARD!J.!BRENNAN,!JR,!ESQUIRE!

CHIEF!COUNSEL!

MASSACHUSETTS!CHAPTER!OF!THE!AAP!!!

Counselor! Brennan! is! a! health! care! attorney!who! represents! physicians,!medical! professional!

associations!and!health! service!entities! in! the!areas!of!general!health!care! law,!administrative!

needs,! risk! management,! regulatory! matters! and! government! relations.! ! Brennan! currently!

serves!as!General!and!Legislative!Counsel!to!several!medical!specialty!associations,!including!the!

Massachusetts! Chapter,! American! Academy! of! Pediatrics,! the! Massachusetts! Radiological!

Society! and! the! Massachusetts! Society! of! Anesthesiologists.! ! As! a! registered! lobbyist! for!

20!years,! he! has! represented! the! three! medical! specialty! associations,! in! addition! to! other!

clients,!on!Beacon!Hill!and!before!various!regulatory!agencies!of!the!Commonwealth.!!!

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Speaker!Biographies!

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!Firearms!Safety!

Gun!violence!is!a!public!health!threat!to!our!children.!Firearms!injuries!are!one!of!the!top!3!causes!of!death!among!

youths,!causing!twice!as!many!deaths!as!cancer,!five!times!as!many!as!heart!disease!and!15!times!as!many!as!infections.!

The!tragedy!at!Sandy!Hook!Elementary!School!in!Newtown,!CT!serves!as!a!stark!reminder!that!gun!violence!affects!

communities!nationwide.!Unfortunately,!while!outbursts!of!mass!violence!like!that!at!Sandy!Hook!are!relatively!rare,!the!

scourge!of!gun!violence!is!a!phenomenon!that!our!children!see!every!day.!

The!causes!of!gun!violence!are!varied!and!complex,!but!we!must!act!to!develop!comprehensive!responses!centered!on!

the!rights!of!children!and!families!to!be!safe!and!free!from!its!harmful!effects!in!their!lives!and!within!their!communities.!

Massachusetts!has!been!at!the!forefront!in!confronting!gun!safety!issues.!There!continues,!however,!to!be!a!need!to!

enact!commonsense!solutions!to!gun!violence,!and!close!loopholes!in!our!laws.!

There!are!several!bills!filed!this!session!of!the!Legislature!to!address!gun!safety.!The!Massachusetts!Chapter,!American!

Academy!of!Pediatrics!(MCAAP)!urges!the!House!and!Senate!to!enact!comprehensive!gun!safety!legislation!this!year!

that!would!include!the!following!principles:!

Standardize!the!way!guns!are!purchased!such!as!requiring!background!checks!regardless!of!venue!or!situation!of!sale:!

• Close!an!existing!loophole!in!order!to!require!gun!purchasers!to!undergo!background!checks!at!gun!shows.!

• Require!the!private!sale!of!firearms!to!occur!at!the!business!of!a!licensed!dealer!so!the!sale!can!be!tracked!

electronically.!

• Enhance!background!checks!by!bringing!Massachusetts!into!compliance!with!the!National!Instant!Criminal!

Background!Check!System,!and!require!courts!to!transmit!all!required!mental!health!adjudications!and!order!

to!the!state’s!information!system!for!firearms!licensure!only.!

Limit!the!risk!of!community!harm!by:!

• Reduce!access!to!high!capacity!rounds!of!ammunition.!

• Increase!penalties!for!violent!acts!using!a!firearm,!and!for!illegal!possession!and!carrying!of!firearms.!

Improve!behavioral!and!mental!health!services!for!children:!

• Fund!improved!access!to!mental!health!services!for!children,!including!identifying!symptoms!of!mental!health.!

• Adequately!fund!the!Massachusetts!Child!Psychiatric!Access!Program!(MCPAP):!most!mental!illness!begins!in!

childhood!and!early!diagnosis!and!treatment!can!help!keep!children!healthy!and!prevent!psychiatric!disability!

in!adulthood.!MCPAP!provides!access!to!psychiatric!consultation!to!pediatricians!for!medication,!treatment!

and!referral!for!children!who!exhibit!signs!of!behavioral!or!mental!health!concerns!during!pediatric!visits.!

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Issue!Background!–!Firearm!Safety!

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!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Massachusetts!Childhood!Vaccine!Program!!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Senate!Passed!Budget—Outside!Section!83A!!!!!!!

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! Immunizations!are!a!cornerstone!of!public!health.!!They!have!been!ranked!by!

the!Centers!for!Disease!Control!and!Prevention!(CDC)!as!one!of!the!ten!greatest!

public!health!achievements!of!the!20th!Century.!!!

BACKGROUND.!!For!over!100!years,!the!Massachusetts!Department!of!Public!Health,!

(MDPH)!has!distributed!all!of!the!routinely!recommended!childhood!vaccines,!freeO

ofOcharge,!to!all!health!providers!in!the!state.!!This!universal!distribution!has!

allowed!children!to!be!vaccinated!in!their!medical!home!regardless!of!whether!they!

have!insurance!or!not.!!Because!of!our!universal!distribution!of!vaccines,!the!

childhood!immunization!rates!in!Massachusetts!have!been!historically!among!the!

highest!in!the!nation!as!measured!by!the!National!Immunization!Survey.!!!

CRISIS.!Massachusetts!is!no!longer!considered!a!“vaccine!universal!distribution!

state.”!!Over!the!past!several!years,!several!factors!have!challenged!the!ability!of!

legislative!appropriations!to!keep!pace.!!As!a!result,!MDPH!can!no!longer!provide!all!

recommended!vaccines!to!our!residents.!!As!more!and!more!children!and!

adolescents!become!incompletely!immunized,!they!are!placed!at!risk!of!contracting!

serious!vaccineOpreventable!illnesses!and!of!infecting!those!around!them!as!well.!!!

PROPOSAL.!!Section!83A!of!the!Senate!passed!State!Budget!would!alleviate!the!

current!immunization!crisis!by!addressing!the!following!areas:!

• A!Vaccine!Purchase!Trust!Fund!would!be!established!which!would!create!a!stable!financing!framework!enabling!Massachusetts!to!guarantee!that!all!

children!0!O18!years!of!age!receive!all!of!the!vaccines!recommended!by!the!

federal!Advisory!Committee!on!Immunization!Practices,!which!sets!national!

standards!for!immunizations.!!This!proposal!represents!a!novel!publicO

private!collaboration!that!will!greatly!improve!child!health!while!saving!the!

Commonwealth!money!in!both!the!short!and!long!terms.!!!

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!!!!!!!!!!!!Currently,!an!assessment!is!charged!to!Massachusetts!insurers!for!the!cost!of!

stateOsupplied!childhood!vaccines!which!are!purchased!at!a!reduced!price!

the!state!receives!under!the!federal!contract.!!This!financing!system!has!been!

successfully!implemented!via!state!budget!language!for!the!last!four!years,!

saving!the!Commonwealth!approximately!$49.5!million!last!year!alone.!!

The Massachusetts Chapter

Issue!Background!–!MA!Vaccine!Program!

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Section!83A!of!the!Senate!Budget!would!make!permanent!this!novel!publicO

private!financing!mechanism,!and!establish!a!Vaccine!Purchase!Trust!Fund!

ensuring!access!to!all!recommended!childhood!vaccines.!

• Massachusetts Immunization Registry. The bills would also provide funding for the Massachusetts immunization registry authorized by M.G.L. c. 111, Section 24M. Because of a lack of funding, Massachusetts is one of only 3 states without a fully operational registry. The immunization registry will create a statewide data repository of all immunizations that can interact via data exchange with electronic health records. The registry will help ensure high immunization rates for children and adults and will allow for the tracking of the approximately 3.5 million doses of vaccine distributed by the MDPH annually. The registry will generate cost savings by reducing waste associated with over-immunization and by ensuring timely administration of disease-preventing vaccines.

Benefits of the Childhood Vaccine Program:

• Would restore a seamless, equitable universal vaccine program for children; expanding for the first time to include HPV and the booster dose of meningococcal vaccines.

• Would guarantee access to all recommended vaccines for children. • Would roll out the pilot Massachusetts immunization registry which assists

providers in keeping immunizations up-to-date by identifying those who are not vaccinated.

• Would keep family vaccine records in a secure, centralized, accessible location. • Would provide an essential infrastructure for responding to natural disasters,

bioterrorism events, influenza pandemics and other emergencies. • Would save money: All childhood vaccines would be purchased at the federal

discount rate (on average 40% less than if purchased by the private sector) and would be fully funded via assessment of insurers. If 3rd party payers were to reimburse providers at the private purchase price, they could pay up to $19 million dollars more per year in MA for childhood vaccines.

• Stable funding for the immunization registry would save over $5.5 million per year by reducing vaccine wastage ($2 M per year), duplicate immunization ($1 M per year), and provider administrative costs ($2.5 M per year).

• Would guarantee that Massachusetts maintains one of the highest childhood vaccination rates in the country.

The Massachusetts Chapter, American Academy of Pediatrics, would respectfully request that you contact the budget conferees to urge the adoption of the Senate passed outside Section 83A, Childhood Vaccine Program, as part of the state budget. The provisions of Outside Section 83A of the Senate passed budget have also been filed as separate bills, H.2012, which is before the Public Health Committee and S. 534, which is before the Health Care Financing Committee. !

Issue!Background!–!MA!Vaccine!Program!

2013 Issues to Watch

State Legislatures and Governors Significant changes in leadership and partisan control will take effect when state legislatures convene in 2013, and AAP chapter advocates will see many new faces in state capitols. Over half of all state legislators across the country will have served 2 or fewer years in their current office when the 2013 state legislative sessions convene. In addition, 5 new governors will take office next year. 11 governorships were up for grabs in the 2012 election cycle, and all incumbents seeking reelection won. The only change in partisan control of gubernatorial seats was in North Carolina, where retiring Democratic Governor Beverly Purdue was replaced by Republican Pat McCrory. There are now 27 state legislatures controlled in both chambers by Republicans. in 19 states, Democrats control both chambers of the legislature. Only 3 states - Iowa, Kentucky, and New Hampshire - are split, with Democrats having a majority in 1 chamber of the legislature, and Republicans controlling the other. The Virginia Senate is ostensibly tied 20-20, but with tie votes broken by the Republican lieutenant governor and with Republicans in control of the house, it is effectively under one-party control. The Nebraska legislature is a "unicameral" or single-chamber legislature that is technically nonpartisan. With this swing towards one party control in state legislatures, 25 of the 50 states will have veto-proof majorities in 2013. However, in only 3 of these states (Arkansas, Missouri, and Rhode Island) will these supermajorities have a governor of the opposing party. A number of pediatricians successfully won election to state legislatures in 2012. Andy Eisen, MD, FAAP (D) won election to the Nevada Assembly. Incumbent California Assembly member Richard Pan, MD, MPH, FAAP (D) returns to office after defeating his challenger. John Rusche, MD, FAAP (D), Minority Leader of the Idaho House, won reelection in a reapportioned district. Incumbent Texas House member Mark Shelton, MD, FAAP (R) narrowly lost his bid for the Texas Senate. As such, he vacates his House seat, which he has held since 2008. Senator William Purcell, MD, FAAP (D-North Carolina) and Representative Jim Pilliod, MD, FAAP (R-New Hampshire) did not seek reelection after serving in their respective seats for many years. Concussions in Student Athletes: Traumatic Brain Injury Prevention As new research outlining the long-lasting negative impact of concussions on the developing brain is published, states are continuing to debate and refine laws designed to protect student athletes who suffer concussions on the playing field. By the end of 2012, 42 states and the District of Columbia had passed legislation that addressed concussions in student athletes. These bills vary from laws that simply require schools adopt a concussion management policy to more prescriptive laws that stipulate who can clear an athlete prior to returning to play and address potential school and physician liability concerns. AAP chapters are encouraged to continue to work closely with physician partners including state medical societies and state affiliates of the American Academy of Neurology and the American Academy for Physical Medicine and Rehabilitation to ensure that children are receiving clearance from a physician prior to returning to play after a concussion. Emergency Contraception In November, the Academy released its revised policy statement on emergency contraception, recommending that pediatricians provide advance prescriptions for sexually active adolescents as

a means of preventing unplanned pregnancies following contraceptive failure, unprotected sexual intercourse, or sexual assault. The statement recommends that at the policy level, pediatricians should advocate for increased nonprescription access to emergency contraception for teenagers regardless of age and for insurance coverage of emergency contraception to reduce cost barriers. Lending further support to advancing this issue, the American Congress of Obstetricians and Gynecologists announced a new policy supporting the availability of hormonal birth control pills being made over-the-counter without prescription. While emergency contraception is available in every state for young women age 17 and older, state law varies greatly regarding the availability of emergency contraception younger women. Further, laws on the state level also vary (and in some instances, are not well defined) regarding the ability of young women to consent to on own for reproductive health services. State legislatures may see a new emphasis on these issues in 2013. Epinephrine in Schools Over the past few decades, the number of attacks of life-threatening anaphylaxis in school–aged children has risen. Because anaphylaxis, usually caused by a severe food allergy, can cause imminent death, it is important that school staff members are equipped to administer aid immediately. At particular risk are children with no previous anaphylaxis diagnosis and without an emergency medical plan on file with school administration. Since 2011, Georgia, Illinois, Maryland, Missouri, Utah, and Virginia have enacted legislation that allow for schools to stock epinephrine in schools to be administered in case of a suspected anaphylactic attack. These laws also allow trained, unlicensed assistive personnel, including teaching staff and coaches, to administer the medication in the absence of a school physician or nurse. AAP chapters are encouraged to work with coalition partners including the Food Allergy and Anaphylaxis Network and the American Academy of Allergy Asthma and Immunology (AAAAI) to advance advocacy efforts that ensure that these types of bills protect the liability of physicians who prescribe the medication to schools, the school nurses who administer and train unlicensed school staff in administration of the medication, and school districts that adopt the programs. More information on these potential partners is available at www.foodallergy.org and www.aaaai.org. Firearm Safety Counseling On June 29, 2012, US District Judge Marcia G. Cooke (Southern District of Florida-Miami) granted a permanent injunction blocking the enforcement of a Florida law that would have restricted pediatricians from asking about firearms in the home, citing the law as unconstitutional. The legislation, signed into law by Florida Governor Rick Scott in June 2011, would have restricted the ability of physicians, nurses, and other medical staff from asking a patient and patient’s parents about firearms and would have sent physicians accused of violating the law before the Florida Board of Medicine for disciplinary action. Following the passage of the law, the Florida chapters of the American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), and the American College of Physicians (ACP), along with 6 individual physicians filed suit against the law, because it substantially curtailed their First Amendment rights to exchange information with patients about gun safety. In her ruling, the judge sided with the AAP, AAFP, and ACP by ruling that the law interfered in the patient-physician relationship by limiting the ability of physicians to their counsel patients and parents on the importance of storing firearms safely. The judge ruled that the law also harmed patients by imposing restrictions that prevent them from hearing important preventive health messages from their physicians. The state of Florida has appealed the ruling to the US Court of Appeals for the 10th Circuit. The Court of Appeals is expected to decide whether to hear oral arguments in the case sometime in

2013. The Academy has provided its support in favor of plaintiffs in an amicus brief in the case, which was written by the American Medical Association and joined by 8 other medical specialty societies. Gun Violence Prevention Over the past 10 to 15 years, the trend in state gun policy has been to loosen restrictions to make it easier to buy and carry firearms in public. On December 14th, a man opened fire in a Connecticut elementary school, killing 20 children and 6 staff members. This unthinkable tragedy, along with a mass shooting at a movie theater in Aurora, Colorado earlier in the year, has led lawmakers to call for a renewed focus on measures to tighten gun restrictions. Potential new laws to protect children include safe storage laws, laws restricting the unregulated sale of weapons and ammunition at gun shows and via the Internet, buy back programs, and bans on assault weapons and high capacity ammunition magazines. In the newly revised policy statement "Firearm-Related Injuries Affecting the Pediatric Population released in October 2012, the Academy renewed its commitment to the strongest possible firearm regulations, including a ban on assault weapons. The federal Assault Weapons Ban expired in 2004 and since that time only a handful of states have taken up this issue. In absence of passage of broad federal initiatives, look for states to take the lead in enacting stronger gun regulations in 2013. Immunizations Favorable media coverage has had a profound effect on the ongoing public discussion and political debate concerning issues of vaccine safety, with numerous editorial boards rejecting the proponents of the autism-and-vaccines theory and unfounded criticism of vaccine safety. As a result of this more positive environment, fewer state legislatures are introducing bills to permit personal belief exemptions from school entry immunization requirements or to restrict thimerosal containing vaccines relative to recent years. While data published in September 2012 in the New England Journal of Medicine examining exemptions demonstrated an increase in exemption rates for school years 2005 to 2011, it is important to note that no state has expanded school immunization exemption laws since 2003, and that the direction of public policy on the state level is to tighten nonmedical exemption policies and require that parents applying for them are appropriately informed of the risk of vaccine preventable disease. Washington enacted legislation in 2011 to require applicants for exemptions to meet additional requirements, and receive information about the risks of vaccine preventable disease. Following their lead, similar legislation was enacted in 2012 in California and Vermont. The California bill, sponsored by Dr Richard Pan, a Fellow of the Academy and member of the state Assembly, passed both chambers of the legislature and was signed into law in September 2012. The legislation enacted in Vermont creates similar risk communication requirements for patients seeking an exemption, adds new reporting requirements for schools to monitor the number of exemptions being sought, and allows the Department of Health to suspend the philosophical exemption for a specific vaccine series if those vaccination rates fall below 90% in the state. As introduced, the bill would have repealed the existing philosophical exemption statute altogether, but was later removed from the bill. Additionally, New Mexico announced that it will strictly interpret its existing statute regarding immunization exemptions, and will no longer issue exemptions for reasons other than religion, as defined in current law. It is expected that more states will take similar actions in 2013. For more information, see the section on childhood immunizations later in this report.