2017 Congress of Delegates

Delegates Address Violence in Health Care, Homelessness

September 18, 2017 02:07 pm Chris Crawford San Antonio –

Delegates to the 2017 Congress of Delegates (COD) here addressed a number of issues, including violence in health care, using so-called Housing First approaches to aid homeless individuals and treating substance abuse in incarcerated populations.  

Louisiana AFP alternate delegate James Taylor, M.D., of Zachary, testifies during a reference committee discussion on violence in the workplace about a patient with uncontrolled schizophrenia who kicked his way through a Sheetrock wall at Taylor's practice.

Tackling Violence in Health Care

Members who participated in the Reference Committee on Health of the Public and Science hearing on Sept. 11 discussed a proposal asking the AAFP to offer members tools to prepare for potential violence in the workplace, adopting a substitute resolution during the following day's business session that tweaked the original measure's wording but retained its substance.

The substitute resolution called on the AAFP to survey members to quantify and characterize instances of violence against family physicians in the workplace and elsewhere related to medical practice. Furthermore, the measure asked the Academy to create and promote a violence-in-the-workplace educational toolkit, including training on de-escalating confrontations, dealing with an active shooter and how to promote metal detectors.  

Story highlights
  • The 2017 Congress of Delegates' Reference Committee on Health of the Public and Science hearing on Sept. 11 included discussion of a proposal asking the AAFP to offer members tools to prepare for potential violence in the workplace.
  • Another measure discussed asked the AAFP to advocate for policies supporting so-called Housing First approaches to aiding homeless individuals.
  • A third measure delegates considered focused on treating opioid use disorder in incarcerated populations.

Colorado AFP President and resolution author Monica Morris, D.O., of Westminster, said that while doing research to prepare to write the resolution, she learned that health care workers are second only to law enforcement personnel when it comes to industries most frequently subjected to violence in the United States.

Morris explained that she wrote the resolution after three of her practice partners had their lives threatened by patients from January to March of this year. "Talking around to other docs in the area, so many related their personal stories of being threatened by patients," she said. "One even had to close his practice and relocate his family as a result. This made me wonder how prevalent this problem is in a field where we sacrifice much to help other people.

"Let's raise awareness of our common experiences to take better care of ourselves and our patients. We all deserve to be safe at work."

Louisiana AFP alternate delegate James Taylor, M.D., of Zachary, spoke about an incident at his practice when a patient with uncontrolled schizophrenia kicked his way through a Sheetrock wall. When Taylor called the police, they told him because the patient was under a physician's emergency certificate, he couldn't touch the patient unless the patient was physically harming someone.

"I would like to see this Academy advocate for situations that if the patient is hostile, we can treat that patient as we would treat any other hostile person. Being mentally ill does not give you an excuse to hit someone," Taylor said.

Staff in that situation could have benefitted from de-escalation training, he added, which the resolution's toolkit would include.

General registrant Carrie Pierce, M.D., of Klamath Falls, Ore., said that although de-escalation training might not prevent all deadly conflicts, family physicians who received this training likely would be better prepared to de-escalate tense situations before they become violent.

"If we can know how to bring them back down from that escalating anger, we would still be able to serve those patients and keep them in our practice and protect ourselves," she said.

Taking "Housing First" Approach

Another measure delegates adopted asked the AAFP to advocate for policies supporting so-called Housing First approaches to aiding homeless people, including those that encourage Medicaid agencies and Medicaid health plans to use funds specifically for this purpose. The U.S. Interagency Council on Homelessness defines Housing First as an approach in which people experiencing homelessness are offered permanent housing with few or no treatment preconditions, behavioral contingencies, or barriers.

General registrant Tobie-Lynn Smith, M.D., M.P.H., speaks about her firsthand experience treating homeless patients as medical director for Baltimore's Health Care for the Homeless program.

The AAFP's homelessness policy statement says that homelessness affects both individuals and their families and is hazardous to mental, nutritional and overall health. Additionally, the Academy supports legislation and programs that develop social and health-related resources for people affected by homelessness and has urged members to care for this at-risk population.

Washington AFP delegate Russell Maier, M.D., of Yakima, testified that multiple private insurers, managed care organizations (MCOs) and Medicaid insurers have recognized that placing homeless individuals into Housing First programs actually saves money and improves health.

"Despite this evidence-based practice and policy, some states don't provide direct funds for Housing First," Maier said. "This resolution explicitly asks the AAFP to work with Medicaid to fund this practice and work with MCOs and other Medicaid insurers on Housing First programs."

John Heafner, M.P.H., of St. Louis, Mo., speaking on behalf of students and residents, explained that the 2017 National Congress of Student Members passed a similar resolution(10 page PDF) supporting a Housing First approach to homelessness.

"In order to better achieve the triple aim of improving population health, saving money and providing better care for patients, the Housing First program would be beneficial," said Heafner, who was elected student Board member by the student congress in July and confirmed by the COD during its Sept. 12 business session. "So, we would like to push the AAFP to take its stance to the next level."

As medical director for Baltimore's Health Care for the Homeless program, general registrant Tobie-Lynn Smith, M.D., M.P.H., has firsthand experience with this issue. Smith also serves on the AAFP's subcommittee for health equity.

"My thought is: We need to stand for something," she said during the hearing. "We know by giving someone housing first, they'll better manage their addiction and behavioral health. This resolution is timely, as the AAFP is in the process of revising its homeless policy. Having the support of the Congress of Delegates standing for Housing First, which we know is going to help our patients, will have a huge impact."

Treating Substance Abuse in Jails, Prisons

Delegates also adopted a substitute resolution that focused on treating opioid use disorder in incarcerated populations.

The measure tasked the AAFP with advocating for legislation, standards, policies and related funding to increase access at U.S. correctional facilities to evidence-based treatment for opioid use disorder, including medication-assisted treatment.

Furthermore, the resolution called for correctional facilities to collaborate with community resources such as addiction treatment providers, case managers, social workers and pharmacies to support postincarceration treatment plans.

Finally, the resolution asked the Academy to update its "Incarceration and Health: A Family Medicine Perspective" http://www.aafp.org/about/policies/all/incarcerationandhealth.html position paper to include use of medication-assisted treatment as an evidence-based best practice for inmates who have opioid use disorder.

General registrant Lucinda Grande, M.D., of Olympia, Wash., co-authored the resolution, which she said also has been submitted to the Washington State Medical Association and the AMA.

"I've been disturbed for years about the high risk of opioid overdose death following prison release," she said. "People die because they've lost their tolerance and can no longer handle their usual dose."

General registrant Sheri Talley, M.D., of Fort Stockton, Texas, began her testimony by explaining that she was recently regional medical director for the Texas Department of Criminal Justice. Texas has the dubious distinction of having one of the highest rates of incarceration in the country, she said.

According to Talley, it would be difficult to convince the established leadership of the state's prisons and jails to approve opioid-based therapy for inmates with substance abuse disorder; the only medication Texas facilities carry on their formularies related to opioid use disorder is naloxone.

But advocacy from major medical organizations such as the AAFP could help these types of institutions rethink their approaches to treating the growing opioid epidemic in incarcerated populations, Talley suggested.

"So, we speak strongly in favor of this resolution," she concluded.

Additional Issues

Delegates also adopted measures that called on the AAFP to

  • oppose legislation allowing insurers to opt out of maternity and reproductive health coverage,
  • advocate that Congress pass legislation making it illegal for military commissaries to sell tobacco products to those younger than 21,
  • advocate against justice system officials' policies and practices of incentivizing defendants to seek family planning services such as sterilization and contraception, and
  • issue a statement opposing the administration's policy banning transgender individuals from serving in the U.S. armed forces.

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Additional Resources
Congress of Delegates: Day Three(storify.com)

Congress of Delegates: Day Two(storify.com)

Congress of Delegates: Day One(storify.com)