During the 2017 National Conference of Constituency Leaders (NCCL) held here April 27-29, AAFP members from the five constituency groups -- women; minorities; new physicians; international medical graduates (IMGs); and lesbian, gay, bisexual and transgender (LGBT) physicians and those who support LGBT issues -- acted on resolutions considered by the Reference Committee on Advocacy.
National Conference of Constituency Leaders general registrant Anita Ravi, M.D., M.P.H., of New York, N.Y., testifies during the Reference Committee on Advocacy hearing in support of one of four resolutions addressing health care for immigrants.
Among those actions, delegates adopted four resolutions or substitute resolutions during the April 29 business session that sought to safeguard the health of immigrants.
"AAP (the American Academy of Pediatrics) has a policy statement on the health impact of the detention of children,"(pediatrics.aappublications.org) NCCL general registrant Anita Ravi, M.D., M.P.H., of New York, N.Y., testified during the April 28 reference committee hearing. "As family physicians, we can speak up for children and women, as well."
Released in March, that AAP policy statement endorsed the "humane treatment of all immigrant children seeking safe haven in the United States." The statement reported that 59,692 unaccompanied children and 77,674 children in family units were detained by Customs and Border Protection (CBP) in 2016. Also according to the policy statement, nearly 60 percent of detained children from Mexico, El Salvador, Guatemala and Honduras who were surveyed by the United Nations High Commission for Refugees in 2013 had "fear sufficient to merit protection under international law," and nearly 80 percent cited violence as the main reason for leaving their home country.
- Delegates to the National Conference of Constituency Leaders adopted four resolutions or substitute resolutions that sought to safeguard the health of immigrants.
- When immigrants avoid care because of concerns about their immigration status, it poses a public health risk to everyone because such patients are then not treated for communicable diseases, said delegates.
- Delegates also urged the Academy to support constituent chapters seeking to end prior authorization requirements for buprenorphine and to oppose legislation that allows insurers to opt out of providing maternity and reproductive health care coverage.
NCCL delegates adopted a resolution that called for the Academy to develop its own policy statement that would oppose detention of families seeking safe haven, expansion of family immigration detention and separation of parents from their children.
Delegates also sought support for immigrant physicians, adopting a substitute resolution that called for the Academy to
- oppose legislation or executive orders that create barriers for immigrant and nonimmigrant physicians with work visas who practice in the United States,
- create a policy statement regarding the important role physicians with visa waivers play in both alleviating the nation's physician shortage and increasing access to care in underserved areas, and
- use its social media platforms to highlight stories of its immigrant and nonimmigrant family physicians on work visas.
Roshan Najafi, M.D., a minority constituent from Seattle, offered the case of her Iranian cousin as an example during the reference committee discussion. She said her cousin had excelled in medical school and worked hard to match into a U.S. residency program. But now, said Najafi, a third-year resident at the University of Washington who is a U.S. citizen, her cousin faces uncertainty about her future.
"She didn't feel like she belonged in her own country," Najafi said, "and now she feels as if she doesn't belong in the United States, either."
The AAFP released a statement in January that took issue with the administration's attempt to ban travelers from certain countries, citing the hardship such restrictions would create for international physicians and medical students.
Delegates also adopted a resolution that called for the AAFP to create a policy statement supporting the provision of health care for all patients, regardless of immigration status. In addition, the measure called for the creation of a toolkit to address gaps surrounding immigrant health care (including legal rights and clinical care) and development of a policy statement opposing the required collection or reporting of immigration status data, and it further urged the Academy to lobby for legislation that ensures continued access to care for undocumented immigrants and their families, as well as to oppose legislation that would decrease access.
New physician delegate Rupal Bhingradia, M.D., of Jersey City, N.J., testifies before the Reference Committee on Advocacy. Bhingradia was co-author of a resolution that focused on the care of women and children in the family immigration detention system.
Syeachia Dennis, M.D., a minority delegate from Tulsa, Okla., said many immigrant patients avoid care and are reluctant to sign up for Medicaid because of concerns about their legal status. David Hoelting, M.D., an LGBT delegate from Pender, Neb., said it is especially concerning that pregnant women are avoiding prenatal care.
"It's costing lives," he said.
New physician delegate Elizabeth Salisbury-Afshar, M.D., M.P.H., pointed out that among those lost lives are infants who would otherwise have been born here as U.S. citizens. Salisbury-Afshar, who is medical director of behavioral health at the Chicago Department of Public Health, also noted that when immigrants avoid care because of concerns about their immigration status, it poses a public health risk to the general population because these patients are not then treated for communicable diseases.
On a related issue, delegates adopted a measure calling for the Academy to write the administration a letter opposing President Donald Trump's executive order regarding sanctuary cities.(www.whitehouse.gov)
New physician delegate Arthur Ohannessian, M.D., of Los Angeles, said his city has seen a 25 percent drop in reports of domestic violence events since the order was signed in January, and prosecutors in some cities are having a hard time getting victims to testify for fear of being detained.
Delegates also adopted a substitute resolution that urged the Academy to support constituent chapters seeking to end prior authorization requirements for buprenorphine through their state legislatures.
David Goodman, M.D., an LGBT delegate from Minneapolis, said his practice is required to obtain prior authorization not only for initiation of buprenorphine but for administration of maintenance doses, too. Delaying the medication, he said, puts patients at risk for relapse.
Finally, delegates adopted a resolution that called for the AAFP to oppose legislation allowing insurers to opt out of providing maternity and reproductive health care coverage and to issue a statement affirming that both types of services are essential to general health and should be covered by health plans. The Academy has previously gone on record as opposing any and all efforts "that seek to identify, isolate and hinder access to legal, safe and effective health care services to women."
"If they're going to keep covering Viagra, they need to keep covering reproductive health," said Tess Garcia, M.D., an LGBT delegate from Grain Valley, Mo.
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