Download The Florida Pediatrician May 2003 - Florida Chapter

The Florida
The Newsletter of the Florida Pediatric Society/
Florida Chapter American Academy of Pediatrics
Pediatrician
May 2003
Volume XXVI Number
In this issue............
THE SCIENTIFIC PAGE
WHO’S WHO
Page 9
Page 2
THE PRESIDENT’S PAGE
FROM THE FCAAP
SPECIAL ARTICLE
SARS
Page 11
Page 3
THE EDITORIAL PAGE
Page 20
THE HISTORY
CORNER
COMMITTEE REPORT
WOMEN’S SECTION
Page 13
Page 5
Page 21
C.A.T.C.H.
FROM THE
RESIDENTS’ SECTION
THE GRASS ROOTS
Page 18
Page 23
Page 14
Page 6
Add-a-‘Pearl’
MANAGED CARE
FROM THE
DEPARTMENT CHAIRMEN
Page 25
Page 15
Page 7
ANNUAL MEETING
SPECIAL REPORT
NEW RESIDENCY
Page 16
Page 30
PROS REPORT
UPCOMING CME
Page 8
RISK MANAGEMENT
REACH OUT
AND READ
Page 8
Page 17
FROM THE AAP
Page 32
2
WHO’S WHO in the Florida Pediatric Society/Florida Chapter American Academy of Pediatrics
EXECUTIVE COMMITTEE
Office rs
Chapter President
D e b or ah M ul li ga n -S m i th , M .D .
Coral Springs, FL
( e- m ai l: de b m sm i @ a o l. co m )
Chapter President Elect
D a v id M ar cu s , M .D .
Ft. Lauderdale, FL
( e- m ai l: st ar do c 5 5@ a o l .c o m )
First Vice President
P a tr ic ia B la n c o, M D
Sarasota, FL
( e- m ai l: pb la n c od @ h o tm a il .c o m )
Second Vice President
J o se D e lT o ro -S i lv e st ry , M D
Ft. Lauderdale, FL
( e- m ai l: Jo rg e _ de lt or o@ p e d ia tr ix .c o m )
Immediate Past President
R ic h ar d L . B u cc ia re ll i, M .D .
Gainesville, FL
(e-mail: [email protected])
Regional Representatives
Region I
T h o m a s T ru m a n , M D
Tallahassee, FL
Re gion II
J a m e s W a l er , M D
Jacksonville, FL
Re gion III
J yo ti B ud a n ia , M D
Gainesville, FL
Re gion IV
L lo yd W e r k , M D
Orlando, FL
Region V
C a r ol Li ll y, M D
Tampa, FL
R e g io n VI
J o h n D o n a ld s o n, M D
Ft. Myers, FL
Re gion VII
M a rs h a ll O hr in g , M D
Hollywood, FL
Re gion VIII
K i m b er ly S ch w a rt z, M D
Miami, FL
Ex-Officio Members
U. Florida Pediatric Chairman
T e rr y F lo tt e, M D .
Gaineville, FL
U. Miami Pediatric Chairman
R . R o d ne y H o w el l, M .D .
Miami, FL
U . South Florida Pediatric Chairman
R o b e rt D . C h ri st en s e n, M D
Tampa, FL
Nova Southeastern U. Pediatric Chairman
E d wa rd P ac k er , D .O .
Ft. Lauderdale, FL
EXECUTIVE OFFICE
Executive Vice President
Louis B. St. Petery, Jr., M.D.
1132 Lee Avenue
Tallahassee, FL 32303
(Ph)850/224-3939
(Fax)850/224-8802
( e-mail:[email protected])
Membership Director
Edith J. Gibson-Lovingood
(Ph)850-562-0011
(e-mail: [email protected])
Legislative Liaison
Mrs. Nancy Moreau
(Ph)850/942-7031
(e-mail: [email protected])
Page 2
COMMITTEE STRUCTURE
Key Strategic Plan Chairmen
Advocacy Committee
Richard L. Bucciarelli, MD/Tom Benton, MD
Gainesvil le, FL
Communications Committee
Deborah Mulligan-Smith, MD
Coral Springs, FL
Practice Support Committee
Jerome Isaac, MD/Edward Zissman, MD
Sarasota, FL/Altamonte Springs, FL
Member and Leader Development Committee
Patricia Blanco, MD
Tampa, FL
Liaison Representatives and
Sub-Committees
Breast Feeding Coordinators
Arnold L. Tanis, MD
Hollywood, FL
Joan Meek, MD
Orlando, FL
Child Abuse and Neglect Committee
Jay Whitworth, MD
Jacksonville, FL
CATCH
Karen Toker, MD
Jacksonville, FL
Deise Granado-Villar, MD
Coral Gables, FL
Child Health Financing and Pediatric Practice
Edward N. Zissman, MD
Altamonte Springs, FL
CHEC
Ramon Rodriguez-Torres, MD
Miami, FL
Collaborative Research/PROS Network Subc ommittee
Lloyd Werk, MD
Orlando, FL
CPT-4
Edward N. Zissman, MD
Altamonte Springs, FL
Envinmental Health, Drugs, and Toxicology
Charles F. Weiss, M.D.
Siesta Key, FL
Home Health Care
F. Lane France, M.D.
Tampa, FL
FMA Board of Governors
Randall Bertolette, MD
Vero Beach, FL
Federal Access Legislation
Susan Griffis, MD
DeLand, FL
Healthy Kids Corporation
Louis B. St. Petery, Jr., M.D.
Tallahassee, FL
Pediatric Critical Care and Emergency Services
Phyllis Stenklyft MD
Jacksonville, FL
Jeffrey Sussmane, MD
Miami, FL
Residents Section
Sharon Dabrow, MD
Tampa FL
Lloyd Werk, MD
Orlando, FL
School Health/Sports Medicine
Rani Gereige, M.D.
St. Petersburg, FL
Wom en’s Section
Shakra Junejo, MD
Apalachicola, FL
Cou ncil of Pa st Pre sidents
Edward N. Zissman, M.D.
Edward T. Williams, III, M.D.
John S. Curran, M.D.
David A. Cimino, M.D.
Robert F. Colyer, M.D.
George a. Dell, M.D.
Kenneth H. Morse, M.D.
Robert H. Threlkel, M.D.
Arnold L. Tanis, M.D.
Gary M. Bong, M.D.
Council of Pediatric Specialty Societies
Lawrence Friedman, MD
(Florida Regional Soci etyof Adolescent Medici ne)
Michael Paul Pruitt, MD
(Florida Societyof Adolescent Psychiatry)
Andrew Kairalla, MD
(Florida Soci ety of Neonatol ogists)
Jorge M. Giroud, MD
(Florida Associ ation of Pediatric Cardiologists)
Jorge I. Ramirez, MD
(Florida Soci ety of Pediatric Nephrologists)
David E. Drucker, MD
(Florida Association of Adolescent Psychiatry)
E-Mail
Barrett, Douglas, M.D.
[email protected]
Bauer, Charles, MD
[email protected]
Benton, Thomas, MD
[email protected]
Berget, Bruce, MD
[email protected]
Blavo, Cyril, DO
[email protected]
Budania, Jyoti, MD
[email protected]
Christensen, Robert, MD
[email protected]
Cimino, David A., MD
[email protected]
Curran, John, MD
[email protected]
Dabrow, Sharon, MD
[email protected]
Del Toro-Silvestry, Jorge, MD
[email protected]
Drucker, David, MD
[email protected]
Flotte, Terence R, MD
[email protected]
Friedman, Lawrence, MD
[email protected]
France, F. Lane, MD
[email protected]
George, Donald E., MD
[email protected]
Gereige, Rani S., M.D.
[email protected]
Giroud, Jorge, MD
[email protected]
Griffis, Susan, MD
[email protected]
Granado-Villa, Deise, MD
[email protected]
Howell, Rodney, M.D.
[email protected]
Isaac, Jerome, MD
[email protected]
Junejo, Shakra, MD
[email protected]
Kairalla, Andrew, MD
[email protected]
Katz, Lorne, MD
[email protected]
Lilly, Carol, MD
[email protected]
Meek, Joan, MD
[email protected]
Miilov, David, MD
[email protected]
Ohring, Marshall, MD
[email protected]
Pomerance, Herbert, MD
[email protected]
Reese, Randall, MD
[email protected]
Rodriguez-Torres, Ramon, MD
[email protected]
Schwartz, Kimberly, MD
[email protected]
Stenklyft, Phyll is, MD
[email protected]
Sussmane, Jeffrey, MD
[email protected]
Truman, Thomas, MD
[email protected]
Waler, James, MD
jawaler@hotmail,com
Weiss, Charles, MD
[email protected]
Werk, Lloyd, MD
[email protected]
Whitworth, Jay, MD
[email protected]
Yee, Patrick, MD
[email protected]
Wood, David, M.D.
[email protected]
The President’s Page
D
ear Colleagues:
It is hard to believe that this will be the last time that I write to you as your
President. The past two years have certainly flown by rapidly. The opportunity that you
gave me to serve as President is one I will not forget.
As President, I was able to appreciate more completely the challenges facing
Pediatricians 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 insulated
from many of the pressures and complexities of practice. This opportunity has taught me more about the practice
of pediatrics in the State of Florida than I ever could have imagined. Learning and understanding the issues you are
facing in your in daily practice has helped me represent you better in Florida and also at the national level as Chair
of the AAP Committee on Federal Governmental Affairs and now the Subcommittee on Access to Care. Without
a doubt, I will continue to seek your help and input as I continue to work on the issues of access to quality pediatric
care 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 my
former Chief Resident, Dr. Louis St. Petery, Executive Vice President of the Chapter. Unless you become an officer
in this organization, you can never fully appreciate what Louis does for us. Louis provides the valuable institutional
memory and stability to the Chapter without which we would be lost and terribly ineffective. His dedication and
the hours he commits to our mission far exceeds his compensation. He does it because he is truly an advocate for
pediatricians 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 the
future. And the future Chapter leadership will be even better! President-Elect, Deborah Mulligan-Smith, is a very
capable 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 for
successfully 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 to
achieve these last two years. I had higher expectations for us; however, I do recognize that we were in the most
difficult fiscal times the state has faced in over fifty years! For the last two regular sessions and three special
sessions, we were relegated to playing defense and I think we did it pretty well. There are so many more things that
we could have done for Pediatricians and families, if the budget and the political will of many of our legislators were
better. But we had to play the hand we were dealt.
(See President, page 26 <)
Page 3
FPIC ad
The Editorial Page
It’s a Difficult Time
Y
es, it is a difficult time. I sit here writing this piece in mid-April. There are two trouble zones: a
big international one, and a smaller one here in Florida.
The international problem is of course the larger one, with hundreds of thousands of our
young men and women still “in harm’s way”. Two big questions arise: should we be doing this “...in harm’s
way...”
and 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 to
the security of the American people and should be removed, also correctly so! Yes, both groups
are right, each in its own argument. Yet, there is a third group, one with whiter hair and longer memories, which
remembers back before we fought World War II. We remember the “great appeaser”. We remember Neville
Chamberlain and his umbrella, mouthing over and over “peace in our time”, to be obtained by giving Hitler that first
expansion he wanted, since “that will satisfy him” and peace will prevail.. I don’t think one has to be a veteran of
WWII to understand this, although many of our younger people do not even recognize the name. The older group
lives 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 to
looters 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 cry
that the benefit goes mostly to the upper earners of the country. Does this sound a little like the almost completely
discredited concept of “trickle down economy”? In any event, the next few years will find the federal budget cutting
back 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 belong
really to the states (that’s also us). We may pay end up paying less tax to the federal government, but be forced to
pay 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 the
other 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 back
on programs, and the ones must susceptible are child health and education. I would be preaching “Florida has
...sizeable
to the choir if I pointed out that basically,
deficit...”
these are the most important facets of
EDITORIAL OFFICE
civilization! Bear in mind that we have
Herbert H. Pomerance, M.D., Editor
no state income tax, and no real chance
Carol Lilly, M.D., Associate Editor
of having one.
Department of Pediatrics
Is it any wonder, then, that this editorial has a kind of
University of South Florida College of Medicine MDC
somber tone? Of course, we can add that our country will
15
Tampa, FL 33612
prevail, and our children will prevail, and things aren’t half
(Ph)813/259-8802
as bad as theylook! It’s just hard to say it and smile at the
(Fax)813/259-8748
same time.
-The EditorG
e-mail: [email protected]
(Please address all correspondence, including
Page 5
The Grass Roots
THE REGIONAL REPRESENTATIVES REPORT
(Each month, we provide reports from two of our eight regions)
Region III repo rts:
The Broward C ounty Ped iatric Society was honored to
Along with Drs. Cartwright, de Miranda, Montgomery,
have the President Elect of the Academy of Pediatrics, Dr. Carden
Payne and Zanga, I traveled to Chicago for the AAP Chapter Forum
Johnston, speak at our last meeting on February 27th in Fort
to put forth the proposition that the Same Sex Co-Parenting Adoption
Lauderdale. He gave an overview of the Academy’s positions and
Policy is flawed and should be rescinded. This was in response to my
strategies for action in the coming year. A network is being
personal conviction as well as to represent others who share this view.
developed to find D octors who have c onne ctions and ac cess to
Request denied. Instead, the following resolution was
impo rtant po litical figures. T wo were identified at our meeting!
passed: “The Chapter Forum of the Academy (representing the
The Joe DiMaggio Children’s Hospital 14th annual
grassroots leadership), add(s) its support to the AAP policy, ‘CoPed iatric Symp osium was held in November in Ft. Lauderdale and
parent or Second-Parent Adoption by Same-Sex Parents’. The
attracted a record 240 registrants who heard interesting talks by
Chapter Forum commends the National AAP for remaining true to its
nationally renowne d speakers on a variety of P ediatric topics.
mission of acting in the best interest of children wherever they are.”
The Joe DiMaggio Children’s Hospital celebrated it’s 10 th
There are still a few of us blades of grass who don’t agree with this.
anniversary recently. It is presently searching for a Pediatric
Ok, we lost that one. How about: “The Academy suspend
Cardiac Surgeon to complement its cadre of Pediatric subany support for homosexual or same-sex “co-parent” adoption until
specialists.
longitudinal, well designed, case-controlled studies of statistically
Rallies were held recently both in Palm Beach and
adequate sample size exist which can confirm that such arrangements
Broward
in support of implementation of Gov ernor B ush’s task
are truly in the best interest of the children involved.”
force
recommendations
o n med ical malpractice reform.
Request denied. The prevailing opinion is that there is not
Ped
iatricians
and
their
staff
participated in both rallies.
good scientific data to support this policy (I sat next to Lou Cooper
Marshall Ohring, M.D.
who says this. It was repeated throughout the meeting). It just doesn’t
Region
VII RepresentativeG
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 wellbeing of children.”
In an effort to appease the supporters of the 17 resolutions
opposing the policy and perhaps hoping that over time the policy
REGISTRATION
would garner wider support, the Chapter Forum voted to: “Pursue a
course of providing a full range of available scientific literature on
Have you registered yet for the
parenting, including same-sex parenting, plus providing educational
opportunities where the issues can be discussed in the AAP tradition
Annual Meeting
of unbiased scientific inquiry, respect for colleagues, and concern for
in Orlando, June 20-22, 2003?
children.” This causes me to ask: where is that report from the Task
Important Business
CME Credit
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
[email protected] or 5612 NW 43RD ST, GAINESVILLE, FL
32653-3332 if you do not support this AAP policy.
Thomas Benton, M.D., FAAP
Region III Representative
[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] G
Page 6
Region VII reports:
From the Department Chairmen
The Department of Pediatrics at the University of Miami
R. Rodney Howell, M. D.
Professor and Chairman
Department of Pediatrics
University 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 MiamiDade 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 NIHfunded 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.G
Page 7
Collaborative Research
and PROS
PROS practices have
ignored recruitment
materials and
(See PROS, page 28 <)
Page 8
Reach out
and Read
Report
Representatives from throughout the nation met
in chilly Chicago in early April to discuss the status of
old and current projects, review proposed studies, and
determine the future of our AAP practice network.
Established in 1986, the practice based research
network consists of about 1700 pediatric practitioners
from almost 600 practices located in all 50 states, Puerto
Rico and Canada. Our mission has remained firm: to
improve the health of children by conducting
collaborative practice-based research to enhance primary
care practice. PROS practitioners and researchers work
together to generate research questions, design study
materials and protocols, obtain research funding, collect
study data, analyze collected data, and publish results.
This collaboration is accomplished through AAP
chapter-based groups of practitioners recruited and
maintained by pediatrician chapter coordinators, who in
turn meet twice a year with PROS research staff and
consultants.
Analysis of the data collected by the LAND
study (4351 mother/baby pairs enrolled by 113 PROS
practices – 4 in Florida) reveal insights on maternal
readiness for discharge, maternal depression, and
practitioners practicing beliefs. Three LAND abstracts
were accepted for presentation at the 2003 Pedatric
Academic Societies meeting in Seattle, WA in May. If
your practice participated in the study and you are
interested in contributing further (for example, writing
and / or editing a manuscript), contact us ASAP.
How is the Safety Check project coming along?
Recruitment of practices has started and already 698
eligible patients have been enrolled. Regretfully, many
New Collaboration
Between FPS Foundation and ROR
Recently, the Florida Pediatric Society (FPS)
Foundation agreed to serve as the fiscal agent for the
newly formed Reach Out and Read (ROR) Florida
Coalition. This collaboration fits naturally with the FPS
Foundation’s goals to nurture programs to benefit the
children in Florida so that they may attain optimal
physical, mental, and social health and well-being.
The ROR Florida Coalition seeks to make early
childhood literacy an integral part of pediatric primary
care throughout Florida. More than 70 pediatric
practices, family practices, and community medical
centers throughout Florida are ROR sites – serving
more than 60,000 children per year.
Several randomized, controlled studies
demonstrate the ROR program significantly improves
parent attitudes about books, parent-child reading
activities, and child vocabulary. The program was
created to most benefit low-income families presenting
at well-child visits for their children 6 months through
5 years of age.
The Reach Out and Read model has three
parts:
1.
At each well-child visit, the pediatrician or
primary care provider speaks with a child’s
2.
3.
parents and/or caregiver regarding the
importance of reading aloud daily to their
children;
During the well-child visit, the pediatrician or
primary care provider gives the child a free,
developmentally appropriate and culturally
sensitive book to take home; and
In the waiting room, volunteers read aloud to the
young children – modeling this behavior to
(See Reach out and Read, page 28 <)
The Scientific Page
Pediatrician Involvement, Florida Youth Suicide Prevention Prototype Project,
and Broward One Community Partnership.
Deborah M ulligan-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 services
and outcomes can only be accomplished through the
systematic, coordinated efforts of agencies, funding
organizations, service providers, families and
professional groups. Pediatricians and family medicine
practitioners play a key role in early intervention for
mental health conditions, including suicide ideation and
severe emotional disturbance.
The Institute for Child Health Policy at Nova
Southeastern University (ICHP-NSU) is focusing on
improvement of child mental health screening and
referral within the continuum of service from emergency
response to therapeutic and rehabilitative care. Through
its involvement in the One Community Child Mental
Health Initiative and the Florida Youth Suicide
Prevention Prototype Project (YSPPP), the Institute is
developing collaborative research initiatives that address
child mental health.
The Florida Youth Suicide Prevention Prototype
Project (YSPPP) builds on the Florida State Suicide
Prevention Task Force, Preventing Suicide in Florida:
a White Paper. The YSPPP considers the continuum of
community-based youth suicide prevention,
intervention, and postvention by cutting across the
public/private sectors. Among the objectives of the
YSPPP is to “increase the use of schools, primary care
providers, clergy and work places as access and referral
points for mental health, health, and substance abuse
treatment centers.”
The Broward County One Community Child
Mental Health Initiative seeks to develop a system of
care that will sustain and support children with serious
emotional disturbance within this community in a least
restrictive and clinically appropriate environment. A
singularly important objective of the One Community
Partnership is to coordinate efforts of primary care and
behavioral health services to establish “a single point of
entry” for children with severe emotional disabilities
and their families; the intent is to facilitate and
streamline access to services and promote the use of
assessments that focus on discovering individual
strengths and preferences.
Exploring the Link Between Child Mental Health
and Suicide
In Florida, Mental Health conditions rank third
among all reasons for hospital discharges. White
children are more than twice as likely as Black children
to have a mental health-related primary diagnosis. After
psychoses, the leading mental health diagnoses among
children are associated with suicide risk: depressive
disorders in younger children and substance abuse or
dependence 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 with
primary diagnoses that were mental health related were
self-inflicted. (Figure 2) However, data collection and
reporting has to improve to accurately capture the full
picture. Of the 2,644 primary diagnoses for Broward
15-24 year olds, only 3% contained a valid e-code
(external cause of injury). Therefore, this graph likely
under-represents the number of patients with both an
injury and a mental health diagnosis.
The pediatrician’s role, especially acute care
specialists and those that are hospital based, cannot be
underestimated in the effort to improve reporting.
While primary care pediatricians struggle with
prevention and early identification, tertiary care doctors
must do their part to inform prevention planning through
accurate reporting.
Pediatricians and Mental Health
The role of pediatricians and family medicine
practitioners has been identified as key for early
intervention of mental health conditions, including
(See Scientific, next page <)
Page 9
Scientific
(= continued from page 9)
suicide ideation and severe emotional disturbance. In an
effort to better understand perceptions and practices of
primary care physicians in mental health and mental
health services in their communities a survey tool was
designed and implemented. This survey gathers data on
suicide risk and other mental health screening and
referral practices, as well as primary physician’s
perceptions of and experiences with the mental health
care system in Broward and Alachua counties. We are
complementing the quantitative survey, with key
informant interviews with pediatricians and family
medicine practitioners, to obtain qualitative information
to support and to explain survey findings. The
interviewer elicits open ended responses about the use of
youth mental health referral practices, and barriers to
effective mental health referral practices, as identified by
primary care physicians.
This undertaking is of great significance because
we understand that without insight from primary care
providers it is doubtful that we will be able to identify
the true magnitude of the mental health community
needs for the pediatrician and their patients. Results
from these studies will provide a basis for future studies
in the interaction between medical care providers and
mental health providers, an area that has been
understudied.
We extend our thanks to the Alachua and
Broward pediatric community for their cooperation and
commitment to families as demonstrated by their
responsiveness.G
Page 10
Figure 1.
Primary M ental Health Diagnoses
in Broward Pediatric Discharges
Figure 2:
Pediatric Injury and Mental Health Diagnoses
Special Article
SARS Information
Robert S. Baltimore, M.D., FAAP
Memb er, AAP Committee on Infectious Diseases
The recent outbreak of severe acute respiratory
syndrome (SARS) has prompted the Academy to
evaluate what is known about the disease, particularly
with regard to children. Information about SARS is
evolving rapidly, and pediatricians are encouraged to
access the Web sites listed below for up-to-date
information.
Evolution of SARS
On Feb. 11, the Chinese Ministry of Health
notified the World Health Organization (WHO) that 305
cases of acute respiratory syndrome of unknown
etiology had occurred in six municipalities in
Guangdong province in southern China from Nov. 16,
2002, to Feb. 9, 2003. During late February 2003, an
outbreak of a similar respiratory illness was reported in
Hong Kong among workers at a hospital. On March 12,
WHO issued a global alert about the outbreak and
instituted worldwide surveillance for SARS.
Subsequently, there has been spread to other countries,
but at this time all cases can be traced to contact with
individuals from Asian countries. However, a few of
these cases appear to be the result of community spread
from an individual whose illness could be traced to Asia.
The agent of the disease appears from early
reports to be a member of the coronavirus family, but
this is still being investigated. There is no proven
effective treatment for this virus. Although various
therapies including using intravenous ribavirin and
steroids have been administered to SARS patients, the
efficacy of these therapies has not been determined. For
treatment of suspected cases, consultation with an
infectious diseases expert should be sought.
Current case definition
On 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 radiographic
findings of either pneumonia or acute respiratory
distress syndrome) and
<
travel within 10 days of onset of symptoms to an
area with documented or suspected community
transmission of SARS. or
<
Close contact within 10 days of onset of
symptoms with either a person with a respiratory
illness who traveled to a SARS area or a person
known to be a suspect SARS case.
This case definition will be updated as new
information becomes available. (See Centers for Disease
Control and Prevention (CDC) Web site below.)
In the first approximately 2,300 cases of
individuals who met the case definition, the fatality rate
was about 4% and infections in children were
uncommon (approximately 2% of SARS cases in the
Canadian data, 14% in early U.S. data). It is unclear, so
far, if the small number of children represents host
resistance to infection, illness too mild to come to
medical attention or lack of contact with infected
individuals.
WHO, CDC and other public health agencies
worldwide are continuing to investigate this
multicountry outbreak. The number of SARS cases and
countries reporting such cases continue to increase
worldwide. In the absence of a complete understanding
of SARS' etiology and how SARS is transmitted, efforts
to limit transmission in the United States have focused
on early identification of potential cases through
surveillance and implementation of infection-control
measures in health care settings and the community.
Infection-control precautions, which include standard,
contact and airborne precautions, should be instituted
immediately for people who meet the case definition.
Materials sent to diagnostic laboratories require
high-level precautions against dissemination. Specimens
require special handling, and laboratories must be
contacted in advance of sending any specimens from
suspect cases in order to apply the appropriate
precautions.
CDC has developed interim infection-control
guidelines for use in U.S. health care and household
settings. These recommendations are based on
experience in the United States to date and will be
revised as more information becomes available.
Infection-control practitioners and clinicians providing
medical care for patients with suspected SARS should
(Continued next page <)
Page 11
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 the
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
Page 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 Reports
Report 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-profit
entity formed over two years go to address growing
community concerns surrounding quality of life issues
and to take the lead in improving efforts to identify and
obtain resources that could serve the needs of Franklin
County.
Awareness of the community's needs,
conceptualization and final incorporation as a non-profit
organization eligible for public funding took more than
two years, yet once formed, the organization grew
rapidly and is considered by many in the community to
be more effective than any other of its type in Franklin
County.
FPI's purpose is to promote a better life for
children and families in Franklin County. Through the
usefulness of several action committees, a highly
motivated and committed volunteer group continues to
serve the organization and works hard to distribute food
and medicine, mentor children, extend job-training
opportunities and proactively participate in addressing
health and social service issues within the community.
Action committees dedicated to the Franklins
Promise effort include:
<
Health and Nutrition
<
Recreation
<
Social Services
<
Education, and
<
Elders
The Health and Nutrition committee has taken
the responsibility for coordinating community needs by
working with professionals from county health
department management and staff personnel. In order to
focus a course of action, FPI facilitated countywide
needs assessment of health, nutrition and social services
that was the first ever initiated in Franklin County.
Work on the yearlong assessment consisted primarily of
data collection surveys, focus group discussions and
statistical analysis of health status indicators.
Documentation that was developed, which defined the
needs and available resources to promote good standards
of health and nutrition, now forms the baseline for
strategic health planning in the County and for further
exploration of funding options that agencies may find
most helpful in advocating for additional resources.
So far, five grant applications from FPI have
been supported to help the Franklin Health Department
and the Franklin County Medical Society improve health
and social services in the community. An indigent drug
assistance program allows FPI volunteers to keep
high-risk individuals on maintenance drugs. The
volunteers assist medical providers in conducting a
weekly primary care clinic; and they assisted health
department staff in developing a bioterorrism
preparedness program that includes small pox
vaccinations.
The Recreation committee, working through the
Chronic Disease Intervention Program at the County
Health Department, identified funding sources enabling
walkway exercise paths to be developed within the
community. The leader of the Recreation committee is
taking responsibility for organizing and coaching the
only high school tennis team in the county; and several
computers have also been brought into schools through
donations to this organization.
When the local food bank suddenly closed its
doors, a volunteer pastor immediately took over food
distribution services; while the nutritionist on the
Health and Nutrition Committee reviewed food
packages provided nutritional expertise.
The social services are streamlined by way of
regular dialogue offered through this organization
involving Healthy Start, Healthy Families, School
Readiness, Head Start, Even Start occupational services
and other social services organizations; the county
victim
(See Women’s, page 26 <)
Page 13
From the Resident Section
Laura P. Stadler, M.D.
Resident Chairperson for FL
USF P rogram 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 pro vide an exce llent variety of patient care exposure.
The program consists of 16 catego rical pe diatric 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
child ren's hosp itals in the U nited S tates. Fo r the co ver story of its
February 200 3 edition, Child magazine released results of a survey
it conducted of children's facilities across the natio n. All Children's
was tied for 16 th with W olfso n C hildren's Hospital in Jacksonville,
FL. That's the highest ranking of all children's facilities in the state
of Florida. T he first Child magazine survey of children's hospitals,
published in February of 2001, also ranked All Children's Hospital
in the 16 th spot nationw ide. T his honor places All Children's among
some very d istinguished compa ny.
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 o f 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 make s All Children's H ospital a
216-bed center of excellence for treatment of congenital and
chronic diseases. Th e Neo natal 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 p rovid es approximately 120 pediatric beds
including dialysis, NIC U (including EC MO), and P ICU . Research
occurs in outpatient clinics and includes bo th general pediatric and
HIV patients. The different hospitals provide residents with a
diverse exp erience 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 p ositions 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.
Resid ents gain outpatient clinical p ediatric experiences in
a wide variety of settings. They rotate through many teaching
centers, including the USF pediatric clinic, Genesis Clinic and the
ACH Clinic. R esidents 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. Seve ral residents
participate in the Rural Track at Lawton Chiles Co mmunity 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 expe rience.
Our Med icine-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 ge neral and sub specialty choices.
Dr Lynn Ringenberg, the program director, has been
missed since ea rly 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
mem bersh ip in the AAP. D r. Dabrow serve s as faculty adviso r to
the resident section of the A AP . In ad dition she has been
instrumental in the Reach Out and R ead 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 com mittee, please email him at GE RE IGE R@ allkids.o rg.
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
To morro ws, an AAP partnership with the Health Resources and
Services/Maternal and C hild H ealth 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
ped iatric clinic at All Children’s.
L au ra Stadle r, M D
University of South Florida Pediatrics
FL Chairperson, District X Chairperson
for Resident Section G
(See Resident, page 27 < )
Managed Care
Some Thoughts on M anaged Care
Edward N. Zissman, M.D.
Altamonte Springs, FL
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 20 02, the Academ y has signe d-on to
letters to Anthem, Aetna, Cigna, United Healthcare, Blue Cross Blue
Shield of Florida, B lue Cross B lue Shield of South Carolina,
CareFirst, Coventry Healthcare, Health Net, Humana, MA MS I,
Medical Mutual, One Health P lan, Pa cificare, P HC S, and W ellpoint.
W
hi
The Florida Pediatrician has had and continues to
le
have a policy to print an article on Managed Care in each
th
issue. This policy will be adhered to so long as suitab le
e
articles are submitted. Both sides of the issue will be
m
represented.
a
Publication of an article does not indicate any
n
endorsement of the opinion by The Florida Pediatrician or
a
by the FCAAP/FPS.G
g
Some issues of interest to pediatricians include:
e
"The undersigned medical asso ciations opp ose arbitrary and
d care area has been relatively quiet, there are several areas of note. unilateral code-collapsing and recoding p ractices that result in unfair
paym ent. W e encourage third parties to accept physician claims that
have been accurately rep orted using ap plicab le CP T code s and to
A. Renegotiating fees with third party payers.
report back to p hysicians and patients using the same cod es or
W hen meeting with third party payers to renegotiate the necessity for terminology, regardless of reimbursement methodology and levels.
Procedural descriptions should not be modified without appropriate
increased reimbursement, please consider the following:
1. The cost of employee benefits including, but not limited to, professional medical consultation. Use of inappropriately modified
data does not provide a proper basis for reimbursement, measuring
health insurance has inc reased about thirty percen t.
2. Employee salaries have increased greater than the cost of living. practice patterns, peer reviews or utilization reviews, or other related
3. The cost of professional liability insurance, where available, has uses. The AM A has as one of its priorities to encourage consistency
in the use of CPT cod es, guidelines and conventions, as well as to
increased twenty-five to thirty percent.
advocate the ad optio n of these stand ards.
4. HIP AA ha s added a new business expense
The undersigned medical associations object when health plans
5. Third party auditing has increased overhead.
seek to arbitrarily and unilaterally recode or inapp ropriately bundle
6. CLIA and OSHA expenses have increased.
codes and services. We feel compelled to identify specific CPT code
7. Vaccine costs have increased.
8. Vaccine administration costs have increased including additional bundling problems and seek to educate health plans and other payers
record keeping requirements and the mand ated use of "safety" in dealing with these pro blems."
needles and syringes.
Downco ding, bundling and lack of recognition of CPT modifiers by
B. Both the AAP and the AMA, in concert with other physician IBC:
Modifier –25 has be en de nied fo r the purpose of bundling.
organizations have been advocating on our behalf.
Mod ifier –25 is appended to indicate that on the day a procedure or
service identified by a CPT code was
1. HEALTH PLAN COM PLAINT FORM
In the summer of 2001, the AMA H ouse of Delegates directed performed, the patient’s condition required a significant, separately
the AM A to establish an electronic information clearinghouse so identifiable evaluation and management (E& M) service above and
physicians could report information about administrative disputes that beyond the other service provided or beyond the usual preoperative
they encounter with third-party payers. Consistent with this and postoperative care associated with the procedure that was
resolution, Private Sector Advocacy (PSA) developed the "H ealth perfo rmed .
(See Managed, Page 29 <)
Plan Complaint Form." This form serves as a tool for the collection
Page 15
of information related to the administratio n of health plan s by hea lth
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 numb er of co mpla ints and the aggregate
number of complaints or co ncerns by geo graphic and dem ographic
chara cteristics o f physician practices.
To submit a complaint to the AMA, go to
<http://www.am a-assn.o rg/ama/pub /catego ry/2387.html>
and click on Health Plan Complaint Form.
Note:
As a result of this initiative, the organizations have done as
follows:
Special Report
A New Residency Program
Edward E. Packe r, D.O
Chairman, Department of Pediatrics
Nova So utheastern College of Osteopathic Med icine
Palms West Hospital of Palm Beach County, Florida
is proud to announce the opening of a new pediatric
residency developed in conjunction with Nova
Southeastern University’s College of Osteopathic
Medicine in July 2003. Many graduates of Nova
Southeastern University and other institutions dedicated
to producing primary care physicians have expressed an
interest in finding a graduate program in pediatrics
devoted to the training of general pediatricians with an
interest in primary care. The new program at Palms
West Hospital was established to help provide training
for new primary care pediatricians prepared to meet the
challenges presented in both a general ambulatory
pediatric practice and the care of hospitalized pediatric
patients.
The American Osteopathic Association has
accredited the new pediatric residency established at
Palms West Hospital. The program was developed to
meet the special criteria of a “Fast-Track” training
program. A “Fast-Track” program meets the unique
licensure requirements needed for osteopathic physicians
in many states that require a physician to have completed
a traditional internship prior to applying for a license to
practice. Incorporated into the pediatric residency are
the core rotations of emergency medicine, internal
medicine, surgery, and obstetrics and gynecology. After
completion of the three-year pediatric residency, the
resident will be considered to have completed both an
internship and a pediatric residency in the three-year
time span.
Palms West Hospital boasts a newly expanded
pediatric unit with an active pediatric emergency room
staffed by specially trained pediatric emergency
physicians. The pediatric unit now has 24 private
pediatric beds and an eight bed pediatric intensive care
unit staffed by a team of pediatric critical care
specialists. The newly designed units house the latest in
pediatric equipment and are designed with rooms and
centers for research and education of the house staff.
The patient environment has been enhanced by the
addition of playrooms and child life services.
Specialized services at the Palms West pediatric
Page 16
residency are diverse with virtually every pediatric
medical and surgical specialist working as part of the
staff. This large array of specialists will allow the
residents to become experienced in all of the various
health care needs that are unique to the pediatric
population. Residents will work directly with the
various specialists in daily patient care, and be provided
opportunities to take elective rotations on most of the
pediatric specialized services.
All of the pediatric residents at Palms West Hospital
will maintain a small continuity of care practice in a
private office setting on the hospital campus. The
residents will learn to develop a pediatric practice, and
they will provide all aspects of care including phone
advice and prenatal counseling visits. The pediatric
residency will work in conjunction with the Palm Beach
County Health Department to care for children with
special needs including health issues related to poverty,
developmental disabilities, chronic illness, and HIV
infections. A rural program in Belle Glade, Florida will
serve as a permanent site where residents will care for
children in the rural environment.
Applications for residents are currently being
accepted. Pediatricians in the area of Palms West
Hospital who are interested in participating in the
training program are also being recruited. All interested
individuals should contact Edward E. Packer, D.O.,
FAAP, FACOP at 954-262-1702 or by E-mail at
[email protected]. G
Note:
Visit our society’s permanent website at:
http://www.fcaap.org
for all you want to know about our society, including
a 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 m alpractice insurance for its mem bers. In each issue, FPIC will present an article for our readers on ma tters pertaining to risk m anagem ent]
The Keys to Documenting Phone Calls
The most important phone call a physician ever
receives may be the one you or your staff forgets to
document. In today’s legal climate it has become even
more important to document all medically relevant
phone calls. All phone conversations need to be
documented in the patient’s chart regardless of whether
the call is received by you or your staff. Your office
should have an established procedure for dealing with
all calls. Failing to document a call is tantamount to
forfeiting evidence in the event a defense become
necessary.
When a patient calls your office with a problem,
have your staff document the phone call in the patient’s
chart. Be sure they include important details of the
conversations, including the time and date that the call
was received, who called, the person who received the
call, when the call was returned to the patient, and what
was discussed. In addition, vital patient information
and the condition or clinical status of the patient should
be noted at that time.
It does not matter what your office procedure
happens to be, what matters is that the phone call gets
documented in the patient’s chart.
Without
documentation, in the event of a claim, it is extremely
hard to defend details of discussions and specific
instructions. In most cases, if a phone call is not
documented and a claim is made and goes to court, it
becomes your word against the patient’s word. Without
documentation, the patient’s memory may carry more
credibility than that of you or your staff who may have
seen 20, 30, or more patients that day.
Remember to treat after-hour calls the same as any
telephone conversation. If you are on-call you may
want to consider establishing a procedure for these
phone calls to be documented in the patient’s chart as
part of the communication process. You may want to
consider designating one staff person to follow-up with
these patients and the on-call physician. Be sure your
staff
documents the salient portions of each
conversation and what treatment was rendered to each
Cliff Rapp, LHRM
Vice President of Risk Management, FPIC
patient. Protocols should also ensure that the
communication loop is completed such that each
patient receives a follow-up call.
The following are suggested elements to include
when 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 to
call back
· Signature or other information to determine advicegiver
· 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 on
the website for the AAP. The URL is:
http://www.aap.org/member/chapters/florida.htm
G
Page17
From the AAP
CHILDREN 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 in
children,” Dr. Abramson said. “If a smallpox attack did
occur are we really willing to let millions of children be
part of an emergency experiment? We need to be
prepared to help children at the time of an outbreak with
an effective vaccine at the right dose. Congress can see
to 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
FYI
The 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
extension.
For more information about HIPAA, contact Aiysha
Johnson at [email protected] or 800/433-9016 ext 4089G.
Bright Futures at the AAP
The American Academy of Pediatrics (AAP) is pleased
to announce that it was awarded two cooperative
agreements from the Maternal and Child Health Bureau
(MCHB), Health Resources and Services Administration
(HRSA), to promote the use of Bright Futures among
pediatric health care providers and the public. Bright
Futures, initiated by the MCHB over a decade ago, is a
philosophy and approach that is dedicated to the principle
that every child deserves to be healthy, and that optimal
health involves a trusting relationship between the health
professional, the child, the family, and the community. As
part of this initiative, Bright Futures: Guidelines for
Health Supervision of Infants, Children, and Adolescents
was developed to provide comprehensive health
supervision guidelines, including recommendations on
immunizations, routine health screening, and anticipatory
guidance. Topic specific Bright Futures materials are also
available.
The first cooperative agreement, the Bright Futures
Education Center (EC) focuses on revising the Bright
Futures guidelines; improving awareness of the
importance of preventive services among health care
professionals, public/private partners, communities, and
families; and developing materials to assist in
implementation of the guidelines. The second cooperative
agreement is the Bright Futures: Pediatric Implementation
Project (PIP). The purpose of the project is to examine
barriers to pediatric provider implementation of Bright
Futures guidelines and to develop new strategies to
improve implementation of the guidelines. The two AAP
programs will work closely together on joint project
activities including the development of a new website
(http://brightfutures.aap.org) and newsletter. Be on the
lookout for the new website (January 2003) and the
newsletter (March 2003).
If your practice or agency is currently using Bright
Futures we would like to hear from you. Our newsletters
will feature highlights from groups around the country who
are putting Bright Futures into practice. For more
information or to share how you are using Bright
Futures,please contact Darcy Steinberg, MPH, Director,
Bright Futures EC, at 800/433-9016, ext 7935
([email protected]) or Laura Thomas, MPH, CHES,
Manager, Bright Futures EC, at ext 4980
([email protected]). For questions regarding the Bright
Futures: PIP, please contact Linda B. Paul, MPH,
Manager, Bright Futures: PIP at ext 7787 ([email protected]).
To order Bright Futures materials please call 888/2271770 or log onto the Bright Futures website
(http://brightfutures.aap.org).G
Page 19
From the FCAAP
Gov. Jeb Bush declared Wednesday, March 26, 2003,
Suicide Prevention Day and announced a goal of
reducing suicide rates by one-third by 2005. "It is
something that is clearly preventible and if we believe in
the sanctity of life, we believe all life is precious, this
should be something we're actively involved in," Bush
said. "Suicide is a serious problem in our country and our
state. It is the ninth leading cause of death in Florida.
Florida is ranked 11th in the nation for suicide among all
age groups. In 2001 there were 2,200 suicide deaths in
Florida - that's more than double the number of
homicides." As part of the effort, schools will be given
kits that provide information on how to assist students
who pose a suicide risk. G
STATEMENT BY TOMMY G. THOMPSON
Secretary of Health and Human Services
Regarding New F ederal Privacy Regulations
From the time of Hippocrates, privacy in medical
care has been of prime importance to patients and to the
medical profession. Today, as electronic data
transmission is becoming ingrained in our health care
system, we have new challenges to insure that medical
privacy is secured. While many states have enacted laws
giving differing degrees of protection, there has never
before been a federal standard defining and ensuring
medical privacy. Now new federal standards are coming
into force to protect the personal health information of
every American patient.
Page 20
As of Monday, April 14, millions of health
plans, hospitals, doctors and other health care
providers around the country must comply with new
federal privacy regulations.
To develop these
regulations, the Department of Health and Human
Services went through an extensive process of
consultation and consensus that included reviewing and
considering more than 100,000 public comments.
These new federal health privacy regulations set a
national floor of privacy protections that will reassure
patients that their medical records are kept confidential.
The rules will help to ensure appropriate privacy
safeguards are in place as we harness information
technologies to improve the quality of care provided to
patients. Consumers will benefit from these new limits
on the way their personal medical records may be used
or disclosed by those entrusted with this sensitive
information.
The new rules also reflect a common-sense balance
between protecting patients' privacy and ensuring the
best quality care for patients. They do not interfere with
the ability of doctors to treat their patients, and they
allow important public health activities, such as tracking
infectious disease outbreaks and reporting adverse drug
events, to continue. Over the past two years, we've
worked aggressively to provide doctors, hospitals and
other covered entities with the information that they
need to comply with the rule. We've held a series of
regional conferences on the privacy regulations and
participated in hundreds of other conferences and
meetings with those affected by the regulations. We've
provided extensive guidance and other technical
assistance materials that clarify key provisions of the
rule, so those affected take the right steps but don't go
overboard at the expense of the quality of their patients'
care. Many of these materials, including an extensive
collection of frequently asked questions, are on our Web
site at http://www.hhs.gov/ocr/hipaa/assist.html.
We will continue our efforts to encourage covered
entities to comply with the regulations' requirements.
After all, this is the best way to ensure that patients get
the rights and protections that they expect. Of course, we
have all the enforcement options available to us under
the rule, including civil monetary penalties, and we will
use them as and when necessary to obtain our goal of
protecting the confidentiality of personal medical
information.G
The History Corner
PEDIATRICS IN FLORIDA
A TRADITION OF COMPASSIONATE CARING
Deborah Mulligan-Smith, M.D.
President Elect
[A continuation of the history of FPS/FCAAP, from the previous issue)
The past causes the present, and so the future.
1970 - 1980
An important contribution to the affairs of the
Chapter and Pediatric Society were periodic newsletters
by the Chapter Chairman and the President of the FPS.
The first of which was that by Dr. Bob Grayson, dated
February 1965.
< From a one or two page copy machine production, an
improved Newsletter of the FPS was formally
initiated (volume 1, July 1979) under the editorship
of Dr. Louis St. Petery.
A Tallahassee pediatrician, Dr. Louis St. Petery,
became Executive Secretary of the FPS and has filled
this position continually since then, with the current title
of Executive Vice President.
The terms of office of the officers of the two
organizations were not synchronized, and because the
FPS was continually active and successful in its
legislative advocacy, it became the dominant
organization in our state. During this time, however,
most other states combined their Pediatric Societies and
Chapters 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 cover
all 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 elected
representative from each district served on the
Executive Committee. This was initiated to improve
grass roots member participation, and to inform the
membership of the activities of the Executive
Committee and of the National Academy.
< The AAP Chapter Forum was initiated in 1977 and
has continued to gain in importance as the method of
communication for the general membership and the
AAP Executive Board. Our
current Editor of the Florida Pediatrician was one
of the members of the five-person Task Force which
created the Forum. The Chapter Chair (later called
the Chapter President) and the Alternate Chair, (Vice
President) attended the Annual Chapter Officers
Forum to learn about and discuss issues concerning
child health and child well being.
1980 – 2000
The 1980's dawned with a rapidly growing
membership, augmented by many Cuban and Central
American pediatricians who emigrated to the United
States and Miami area to escape the political changes in
their native countries. The University of Miami had been
particularly helpful in the late 60's and 70's in preparing
these pediatricians for taking the Florida licensing
<
examinations through review sessions in Spanish and
English.
< During a ten-year period, the Chapter membership
nearly tripled from 555 in 1980 to 1463 members in
1990.
< A major accomplishment of the nineties, anticipated
in the constitution approved in the seventies, was the
amalgamation of the FPS and the Florida Chapter in
1994. By-laws, the long sought goal were achieved.
< In addition to the Regional Representatives, a strong
Legislative Committee was formed under the
leadership of Dr. Bob Stempfel of Miami.
< A Child Advocate, Dr. Gerold Schiebler, was made
an ex-officio voting member of the Executive
Committee.
< 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 in
English and Spanish via satellite to the nations of
Central America, South America, and the Caribbean.
< The annual attendance of pediatricians at Miami
Beach numbered as many as 1,700, and estimates of
15,008 physicians attended via satellite.
< Drs. Reed Bell and Donald Ian MacDonald were
appointed to positions in the Federal Alcohol, Drug
Abuse and Mental Health Administration. Dr.
MacDonald was Administrator of this Agency for
several years during the Bush administration
(Continued next page)
Page 21
<
<
<
<
<
<
<
History
( = continued from previous page)
<
<
<
Drs. Reed Bell and Donald Ian MacDonald were
appointed to positions in the Federal Alcohol, Drug
Abuse and Mental Health Administration. Dr.
MacDonald was Administrator of this Agency for
several years during the Bush administration.
Pediatrician, clinician, cardiologist, educator,
administrator, advocate, lobbyist, politician, and
friend of children, Dr. Gerry Schiebler, took a
sabbatical as University of Florida Chair to become
the first head of the CMS to secure a firm beginning.
Dr. Gerry Schiebler was recognized in 1993 by the
AMA and AAP, jointly, with the Jacobi Award, given
for contributions to the practice of pediatrics, for
<
excellence in teaching and for advocacy in behalf of
children.
In 1994, the Newsletter was taken over by Herbert
Pomerance of USF, Tampa, who assumed the role of
editor. The Newsletter, now entitled "The Florida
Pediatrician" runs some 25 or more pages,
professionally printed on glossy hard paper, and
supported by advertising of pediatric products.
1990s, FPS President Dr. Ken Morse and Chapter
President Dr. David Cimino arranged for a single
slate of officers for the combined organizations.
In the early 90's another creative insurance
innovation was introduced by Steven Freedman,
PhD, an honorary member of the FPS and AAP.
Through Freedman and the Society's efforts, the
Healthy Kids Corporation Act was passed. This
provided for health insurance through the school
system, starting in Volusia County (Daytona), and
now being offered in county school systems
throughout the state.
1993 – 1994, AAP Chapter Award for outstanding
Chapter activities is received.
In l995 Dr. John Curran assumed the office of the
combined presidency of the joined organizations
for the first time.
On his retirement as chair of the FPS/Chapter
Legislative Committee in 1995, Bob Stempfel was
honored by the Florida Legislature with a joint
resolution of the House and Senate recognizing his
outstanding contributions to child health.
In 1997 Dick Boothby, a continuously involved
pediatrician from Jacksonville, delivered an account
of the history of the Florida Regional Perinatal
Program, of which he was the first chairman. He
recounted that in the early 1970's at which time there
were 5 neonatologists in the state, the infant
mortality rate was 19 per thousand live births. With
a grant of $50,000 from the Florida Regional
Medical Program, a multi-disciplined steering
committee was formed to improve the care of high
risk newborns. The five neonatologists in the initial
committee were Drs. Eduardo Bancalari, Miami,
John Curran, Tampa, Don Eitzman, Gainesville, Don
Garrison, Jacksonville, and Ed Westmark, Pensacola.
At the time of Dick Boothby's report (1997), there
were over 100 neonatologists (perinatologists), and
an infant mortality rate of 7.5 in 1995.
1998, the new Title XXI program, the State
Children's Health Insurance Program (SCHIP) is
implemented. Florida was one of the first to have its
plan of implementation approved by the Federal
Government.G
[To be continued in next issue]
Note:
If you are a Fellow of the American Academy of
Pediatrics, you are automatically a member of the Florida
Pediatric Society/Florida Chapter of the American
Academy of Pediatrics, and you automatically receive
The Florida Pediatrician. If you have not already done
so, please pay your annual Florida dues, billed through
the Academy Office. G
REGISTRATION
Have you registered yet for the
Annual Meeting
in Orlando, June 20-22, 2003?
Important Business
CME Credit
The CATCH Corner
David L. Wood, M.D.
North Florida Regional CATCH Facilitator
University of Florida/Jacksonville
It is with great pleasure that,
C.A.T.C.H.
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 (Escam bia, San ta Rosa , Okalo osa, Walton, H olmes,
Jackson, Washington, Bay, Calhoun, Gulf, Gadsden, Liberty,
Franklin, Leon and Wakulla)
Julia St. Petery, M.D.
1132 L ee Avenue
Tallahassee, FL 32303
Phone: 850-224-8830
Fax: 850-224-8802
Email: [email protected]
DIST RIC T II (Duva l, Clay, St. John s, Nassau and Bake r)
David L. Wood, M.D., MPH
Chief, Division of Community Pediatrics
University of Florida Health Science Center/
Jacksonville
655 W est 8 th Street, 5 th Floor
Jacksonville, FL 32209
Phone: 904-244-6150
Fax: 904-244-5240
Email: [email protected]
DISTRICT III (Alac hua , Volusia, Flagler, Putnam, Ma rion, Citrus,
Levy, Dixie,Taylor, Jefferson, Madison, Hamilton, Union, Suwanee,
Columbia, Lafayette, Gilchrist and Bradford)
G. Neal Wiggins, M.D.
809 North Stone Street
Deland, FL 32720
Phone: 386-734-6423
Email: [email protected]
DISTRICT IV (Orange, Polk, Seminole, Lake, Sumter, Brevard,
Osceola, Indian River, St. Lucie and Okeechobee)
Robert Cooper, M.D.
Chief, Division of G enera l Acad emicPed iatrics,
Nemo urs Children’s ClinicArn old Palmer Hospital for Children and
W omen
89 W est Copeland
Orlando, FL 32806
Phone: 407-649-9111, Ext. 48812
Fax: 407-843-8505
Email: Rcooper@ nemours.org
DISTRICT V (Hillsborough, Pinellas, Pasco and Hernando)
Mudra Kumar, M.D.
USF Dep artment of Pediatrics
17 Davis Boulevard, Suite 200
Tampa, FL 33606
Phone: 813-272-2268 (TGH)
727-892-8266(ACH)
Fax: 813-272-2269
Email: kumarm@ allkids.org
DISTRICT VI (Collier, Lee, Charlotte, Hardee, Sarasota,
Ma natee, H endry, Desoto , Highla nds an d Gla des)
Martha Valiant, M.D.
Public Health Unit Director
P.O. Box 70
Labelle, FL 33935
Phone: 941-674-4056, Ext.119
Fax: 863-674-4076
Email: [email protected]
DIST RIC T V II (Broward, Palm Beach and Martin)
Eric Cameron, M.D.
Palghat Alamedri, M.D.
Memo rial Primary Care Center
4105 Pembroke Road
Hollywood, FL 33021
Phone: 954-985-1551, Ext. 2021
Fax: 954-985-1434
Email: [email protected]
DIST RIC T V III (Dade and Mo nroe)
Gloria Riefkohl, M.D.
Miami Children’s Hospital
Division of Preventive Medicine
Community Health Program
3100 S.W. 62 nd Avenue
Miami, FL 33155
Phone: 305-663-6853
Fax: 305-669-6542
Email: [email protected]
(Continued next page <)
Page 23
C.A.T.C.H.
(=Continued from previous page)
Improving Access to the Medical Home for Children
with Special Health Care Needs. There have been
many CATCH projects that have focused on improving
access to a medical home for children with special
health care needs (CHSCN). Our own Karen Toker,
MD, the prior North Florida Regional CATCH
Coordinator, received a CATCH grant last year to
improve access for CHSCN in the Jacksonville
community. Her proposal was to organize the child
health community through the local Commission for
Children with Special Health Care Needs and create a
plan for a system of care that would make the medical
home more accessible for CSHCNs. Thus far Dr. Toker
has been able to convene several community-wide
organizational meetings, which have included
community pediatricians and public and private
providers of allied and special services for CSHCN.
She is fielding a survey to assess pediatrician’s
willingness to provide a comprehensive medical home
for additional CSHCNs. Based on this information and
other input they will write a plan and a larger grant that
will allow funding for training and support for
pediatricians to do case management, developmental
screening 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 provide
funds to a pediatrician to mobilize their local community
with the goal of improving access to health or other
services for children.
The CATCH grants also
commonly result in a plan or proposal for a larger
project. Many have been successful at having a major
improvement in services for children, especially poor or
disadvantaged children.
Medical Home Collaborative for CSCHN. Providing
access for all children to comprehensive medical homes
is also major emphasis of the AAP, Title V and child
health advocates. Another Medical Home-focused
project is also in Jacksonville (pardon my geographic
bias, but as they say…’write what you know.’ Deise will
get her chance in the next Florida Pediatrician!!). The
Florida Children’s Medical Services, local CMS in
Jacksonville and 3 pediatric practices in Jacksonville, for
a team, one of 11 State Title V agencies/pediatric
practice teams chosen to participate in a national learning
Page 24
collaborative developed by the National Initiative for
Children’s Healthcare Quality (NICHQ), the Center for
Medical Home Improvement (CMHI) and the United
States Maternal and Child Health Bureau (USMCHB)
Division of Services for Children with Special
Healthcare Needs.
The collaborative is a tremendous opportunity to
learn and identify how we, as primary care providers for
CHSCN, can support and improve on our provision of
the comprehensive medical home. The three practices
participating in the collaborative are Dr. David Weiss, a
pediatrician in solo private practice; Dr. Olin B. “Chip”
Mauldin, of the University of Florida Pediatric Center at
Andrew Robinson Elementary School; and Dr. Sandra
Morales, of the University of Florida Pediatric Center at
San Jose. In addition to the physician/leaders, each
practice team will consist of an office staff member and
a parent of a child with special health care needs.
The teams will work together for twelve months
during which they will attend three two-day Learning
Sessions, participate in action periods between Learning
Sessions and maintain continuous contact with the
collaborative faculty members, each other and the
collaborative organizations. The offices will assess their
own provision of the medical home as defined by the
Center for Medical Home Improvement
(www.medicalhomeimprovement.org). I encourage all
of you to take the test! When I took the test with our
residents we found outthat we have a lot to learn and do
in our clinics to improve our provision care to CHSCN.
As part of the process the Title V programs will seek to
improve their understanding of community-based
primary care practice as it relates to children with
special health care needs and how they can better
support pediatricians’ practices.
“The Learning
Collaborative … goals are consistent with the Healthy
People 2010 objective that every child with special
health care needs will receive comprehensive care in a
Medical Home.” according to Phyllis Sloyer, Director
of Florida’s CMS Network and Related Programs, “The
second purpose of the collaborative is to foster strong
relationships between Title V (CMS) programs and the
primary care communities within the state.”G
Add-a-Pearl
...from Chu ck W eiss
[Here are 10 questions from Chuck. Try them! Answers on Page 27 ]
OBESITY AND “TYPE 2"DIABETES CONTROL
Questions and Answers
1. Two years ago the UK Childhood Cancer Study
found what researchers called “weak evidence of
borderline statistical significance”that breast feeding
reduced childhood cancer risks. The repeat survey
of 3376 mothers with
children who died of
cancer found no evidence of the claim.
T F
The International Diabetes Foundation (IDF) states that primary
care physicians/pediatricians need to manage their patients blood
glucose levels much m ore aggressively if the global explosio n in
type 2 diabetes prevalence is to be slowed.1 Many doctors are “too
com place nt“ about the nee d for close co ntrol of glucose levels.
Unfortunately, this lack of motivation is being p assed on to patients.
It is inapp ropriate to say to a pa tient you’ve just go t mild diabetes
and you don’t nee d insulin.
Diabetes specialists try to reduce pe ople’s bloo d glucose lev els
to norm al, acco rding to the ID F. They mu st 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
acco unts for 10 % o f the European he alth care bud get. Professor
Albe rti, 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 see ing it in fat white
childre n.” . . . studies show that reducing the blood glucose control
2. In a recent report by Harris Interactive, 110 million
people look for health information online, and 90
percent of those surveyed want to communicate
online with their physicians.
T F
3. Most Florida Pediatricians have and use the Online
Doctor-Patient Communication tool.
T F
4. Throat clearing can be the first sign of pediatric
asthma.
T F
5. Doctors are “too aggressive” about type 2 diabetes
control .
T F
6. Increasing rates of type 2 diabetes in adolescents is
particularly worryissome.
T F
7. Depression in adolescence does not influence risk of
obesity.
T F
8. Some academic researchers report a high prevalence
of impaired glucose tolerance in severely obese
children and adolescents
T F
9. Soft drinks are the major source of caffeine in
caffeine consumption and altered sleep patterns in
teenagers. It may be reasonable to limit the caffeine
content and restrict the type of beverages promoted
to teenagers.
T F
10. The administration of vaccines containing thiomersal
does not appear to raise
blood mercury
concentrations above safe levels and
ethylmercury seems to be eliminated rapidly via the
stools.
T F
marker Hb1c by just 1% cuts the risk of MI by 14% and the risk of
eye and kidney da mage by nearly 45 %. Typ e 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 p ersistenc e of obesity. 2 A depressed mood present
at the first interview, based on a modified Center for E pidemiolo gic
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 o bese child fro m be com ing mo re ob ese.
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
(= continued from page 3)
Women’s
Nonetheless, we did make some significant progress.
The Medicaid fee increase, although modest, has moved
reimbursement closer to being acceptable for some
services, but there is still more to do. We have had some
success with legislation aimed at making the
environment in Florida safer for children, but there is
still more that can be done. We have begun to streamline
the KidCare program to make it friendlier to families
and pediatricians, but there is still more that must be
done.
To strengthen our position, we have reached out to
other child and family advocates within the state to build
a broad-based coalition to address these challenges
successfully. All members of the coalition have a
common goal: access to affordable, quality pediatric care
for all of Florida’s children. Each member of the
coalition is dedicated to improving the administrative
structure of the KidCare program to make it seamless for
families and Pediatricians. Each member of the
coalition sees Pediatricians as the best qualified to
deliver that quality care to children. And each member
of the coalition understands that full access to quality
care will not occur in Florida until Pediatricians are
adequately and appropriately reimbursed from all
components of the KidCare program.
In closing, I want to thank all of you for your active
participation in the Chapter, but most of all, I want to
thank you for allowing me to be your President.
( = continued from page 13)
advocate and violence folks have the opportunity to
communicate with providers and improve awareness in
the community.
The organization helped recruit new mental health
service providers in the community, collaborated with
Juvenile Justice in conducting a public forum with
families and adolescents and obtained grants for the
teenage pregnancy prevention through the library
program. The library also received funds for a reading
enhancement program.
The best part was, in my opinion, the celebration of
children this past March. Franklin's Promise presented
the Franklin County Board of County Commissioners'
with a resolution supporting children, community
initiatives serving children, and declaring Thursday
March 20th Children's Day. The Board adopted the
resolution acknowledging that every dollar used to fund
children's initiatives is a dollar well spent and a
significant investment in the future of the community,
the state and the nation. On Children's Day in the
playground of Chapman Elementary School in
Apalachicola, about eighty-seven children attended to
two hours of fun and games. Volunteers from Franklin's
Promise manned the booths. The celebration was a great
success. And I expect continuing success on the part of
the community through the initiative of Franklin's
Promise, Inc. G
With warmest regards,
REGISTRATION
Richard L. Bucciarelli, M.D.G
Have you registered yet for the
Annual Meeting
in Orlando, June 20-22, 2003?
Important Business
CME Credit
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.
reasonable complaint will find its way into print!G
Page 26
Any
Resident
Pearls
( = continued from page 14)
( = continued from page 25)
Top Ten Reasons why you should become a member of
the Resident Section
10) To receive free journals and other resources available
to AAP members
9) To use the resident section web page
www.aap.org/sections/resident
8) To learn how the AAP affects legislation through a
health policy elective at the
national AAP office
7) To get INVOLVED in the community whether by
service, advocacy, or politics
6) To lobby for children’s issues
5) To learn about new job opportunities
4) To meet life-long mentors and colleagues
3) To meet and build relationships with residents from
across the country
2) To participate in the Florida Chapter AAP Annual
Meeting
** 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
that of young cancer patients on chem otherapy. The JAM A offers
a sobering glimp se of what life is like for an obese youngster. They
are teased about their size, have trouble playing sports and suffer
physical ailmen ts 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 mad e 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 measure s. Obe se
youths scored an average of 67 points out of 100. 16 points lower
than a group of 400 mo stly normal weight children. The obese
childre n’s scores were similar to the quality of life self-ratings from
a previously published study of about 100 p ediatric cancer p atients.
Girls and boys in the study ap peared to be eq ually adversely
affected by ob esity.
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
ortho ped ic problems caused by excess weight. Even in the absence
of this conditions, \, children and parents reported a low quality of
life.
Rep ortedly parental assessmen ts rated their child rens’ wellbeing 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 b e used outside of experim ental settings.
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
Impaire d Gluc ose Tolerance Common in Obese Children and
Ado lescents. 4
Researchers at the Yale University School of Med icine report
a high prevalence of impaired glucose toleranc e in severely obese
children and adolescents. Among 55 obese children, 25% had
impaired glucose toleranc e, as did 21 % o f the 112 o bese
adolesce nts. 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 U niversity 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
G
Page 27
Paid Advertisement
PROS
(=continued from page 8)
routine well child check up season (April – August) is
upon us. We need your help now!! Are you interested
in testing some new, brief screening and counseling
tools for violence prevention and reading promotion?
The project involves minimal paperwork and last only 2
– 4 weeks. Its results will lead to new recommendations
on how we as pediatricians provide guidance on these
and other safety & developmental issues.
We are actively enrolling practices in PROS CARES
(Child Abuse Recognition Experience Study).
Clinicians complete a postcard size survey when seeing
children presenting with an injury and a longer survey if
the child has a high likelihood of abuse. Outcomes are
then monitored. By collecting this information from
many practices across the nation, we expect a pattern to
emerge that will help inform our decision-making.
New projects in the pipeline include identifying
timing of pubertal changes in boys, creating tools to help
clinicians update immunizations, and improving the
effectiveness of anticipatory guidance. Keep an eye out
for future developments.
If you are interested in working on a PROS study at
any level (enrolling patients to designing projects),
contact us at [email protected] or call 800-433-9016,
extension 7626. Further, please contact me if you are
interested in having a 12-minute slide presentation about
PROS at your local hospital or pediatric society meeting.
Respectfully submitted,
Lloyd N. Werk, MD, MPH, FAAP
Email: [email protected]
407-650-7177G
TAMPA OPPORTUNITY
Ne w ly Created Position! Se e pa tients in our state-o fthe-a rt facilities Saturday and S und ay 1p-11p and 2 -3
we ekdays 5p-11p . Your d ays are for hobbies, fun, or
just relax ing! AHP works in conc ert with the patient’s
prim ary care physician. Must be BC Pediatrician w ith
at least 3 yrs expe rience. Fast p aced e nviron me nt,
full benefits package and excellent compensation.
To become a p art of this exciting, unique practice,
email your C V to HR @ afterhourspediatrics.com or
fax your CV to 813.622.7589. Visit us on the web at
http ://ww w .afterho urspediatrics.c om . EO E 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 the
activities of individual sites in Florida through
technical assistance and training, legislative
advocacy, fundraising, and expanded visibility. You
can learn more about Reach Out and Read at
www.reachoutandread.org.
The partnership
between the FPS Foundation and the ROR Florida
Coalition promises to promote the healthy
development of young children in Florida. Can the
statewide presence of the Florida Pediatric Society
Foundation similarly help an organization you work
with?
Respectfully submitted,
Lloyd N. Werk, MD, MPH, FAAP
Nemours Foundation
Lee Sanders, MD, MPH, FAAP
University of Miami
Page 28
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 536 70 - 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 5 1701 - insertion of
non-indwelling bladder catheter (e.g., straight catheterization
for residual urine) and CPT code 51702 - insertion of
temporary indwelling blad der catheter; simple (e.g., Fo ley)
• CPT code 69210 - removal imp acted cerum en (sep arate
procedure), one or both ears; with E&M services; and
• CPT code series 99381 - 993 97 - preventive medicine
services with E& M services.
There has been a lack of recognition or improper
assignment of Mod ifier –59 which was developed for the
Med icare National Correct Coding Initiative explicitly for the
purpo se of identifying services not typically performed
together. Modifier –59 is appended to indicate that under
certain circumstances the physician may need to indicate that
a procedure or service was distinct or independent from other
service s performed on the same day.
Highmark has also repeatedly failed to recognize various
CPT co des:
Examples include:
• CPT code 99050 - services requested after office hours
in addition to basic service; and
• CPT code 99058 - office services provided on an
emergency basis; and
• CPT code 99215 - office or other outpatient visit for the
evaluation and management of an established patient;
downcoded to CPT code 99214 - office or other
outpatient visit for the evaluation and management of an
established p atient.
The undersigned medical associations have received
com plaints concerning Emp ire B lueC ross BlueS hield's
inapp ropriate bundling of CPT code series 99381 - 99387 and
99391- 99397 - preventive m edicine services with ap propriate
CPT code series 99201 - 99205, and 99211 - 99215 – office
/ outpatient E& M services:
This practice is inco nsistent with CPT guidelines and
conventions as stated within the CPT B ook. “If an
abnormality/ies is/are encountered or a preexisting
problem addressed in the p rocess of performing this
preventive medicine evaluation and management service
and if the problem / abno rmality is significant eno ugh to
require additional work to perform the key components of
a problem-oriented E&M service, then the appropriate
Office / Outp atient code 99201 - 99215 should also be
reported. Modifier –25 should be added to the Office /
Outpatient code to indicate that a significant separately
identifiab le Evaluation and Management service was
provided by the same physician on the same day as the
preventive medicine service. The app ropriate preventive
medicine service is additionally reported.”
Downco ding, bundling and lack of recognition of CPT
modifiers by BCBSK S:
Mo difier –25 has been denied for the purpose of bundling.
Examples include:
• CPT code 90471 - immunization administration
(includes percutaneous, intradermal, subcutaneous,
intramuscular and jet injections); one vaccine (single or
combination vaccine / toxoid ); with preventive medicine
E&M services; and
• CPT code 90472 - immunization administration
(includes percutaneous, intradermal, subcutaneous,
intramuscular and jet injections and/or intranasal or oral
administration); two or more single or combination
vaccines / toxoid s); with preventive medicine E&M
services.
Instead of rewarding physicians and non-physician
healthcare professionals for providing necessary patient care
efficiently during the same visit, BCBS KS is penalizing
physicians and non-physician healthcare professionals for
providing quality, efficient care to patients that is consistent
with current medical guidelines and standards. The
undersigned medical associations are opposed to health plan
payment policy that requires a patient to come back for a
subsequent visit for necessary care wh en this treatment could
have been provided during the original visit as this practice
jeopardizes quality patient care and safety, and threatens the
patient-physician relationship.
3. PROMPT PAY BROCHURES
As part of its Campaign to Promo te Timely Payment, the
A M A is working with state medical associations to develop
prompt payment brochures that are state-specific. Brochures
were developed to educate both physicians and patients about
their state's prompt payment laws. Click on the links below to
see samples of the brochures developed by the FMA and the
AMA:
< h t t p : / / w w w . a m a
assn.org/ama1/pub/upload/mm/36 8/floridapatientbro2.pdf>
Florida
Every pediatrician who deals w ith managed care should
be regularly accessing the A AP .org M emb ers O nly Cha nnel to
study the information under reimb ursem ent activities.
4. ME DICA ID ISSUES
As of this time, any Florida Medicaid changes are
unclear. It appears that circumcisions will no longer be
covered. The prop osed fee increase is promised but not as yet
delivered.
I welcome questions concerning managed care issues at
[email protected].
Page 29
GENERAL PEDIATRIC UPDATE IX
and
FLORIDA CHAPTER AAP ANNUAL BUSINESS
MEETING
and
FLORIDA PEDIATRIC ALUMNI ASSOCOATION, INC.
ANNUAL MEETING
JUNE 20-22, 2003
HILTON IN THE WALT DISNEY WORLD
RESORT
LAKE BUENA VISTA, FL
FEATURING E. STEPHEN EDWARDS, MD, FAAP
PRESIDENT, AAP
Annual Meetings include Florida Pediatric Alu,mni Association, Inc.,
University of Miami/Jackson Memorial Hospital Pediatric Alumni,
and University of South Florida Pediatric Alumni
APPROVED FOR 12.5 CATEGORY I CME CREDITS
For More Information, contact Florida Pediatric Society at 850-224-3939 or visit us
on the web at www.fcaap.org
REGISTER NOW
REGISTRATION FORM
GENERAL PEDIATRIC UPDATE IX
June 20, 21, and 22, 2003
Hilton in the Walt Disney World Resort, Lake Buena Vista, FL
Name: (Please Print)
Mailing Address:
City, State, Zip:
Phone: (
)
E-Mail Address:
I will be attending the following:
Friday, June 20 Welcome Dinner
$10 - spouse
$5 - per child
Saturday, June21 Florida Chapter AAP Annual Business Meeting.
and Alumni Luncheons (No Charge)
Saturday, June 21 Reception
(No Charge)
______#Adults_____#Children
______#Attendees
______#Adults______#Children
Saturday, June 21 Florida Pediatric Alumni Assoc. Dinner
(Charge for this dinner to he determined)
______#Adults
Saturday, June21 Children’s Dinner
(Charge for this dinner to be determined)
______#Children
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 mention
the 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.
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:
Dates:
Place:
Credit:
Practical Pediatrics
May 16-18, 2003
Anchorage Marriott Downtown, Anchorage, AK
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) 4339016, ext 6796 or 7657
Program:
Dates:
Place:
Credit:
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:
Dates:
Place:
Credit:
27 th Annual Florida Suncoast Conference
June 27-29, 2003
Trade Winds Island Grand Resort, St. Pete Beach
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
Program:
Dates:
Place:
Credit:
Practical Pediatrics
August 29-31, 2003
Seattle, Washington
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
Practical Pediatrics
October 10-12, 2003
Toronto, Ontario, Canada
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:
Dates:
Place:
Credit:
Practical Pediatrics
November 14-16, 2003
Tempe, Arizona
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
Page 32
The Florida Pediatrician
c/o USF Department of Pediatrics
12901 Bruce B. Downs Boulevard
MDC Box 15CE
Tampa, FL 33612
Non-Profit Org.
U.S. Postage
PAID
Permit No. 1632
Tampa, Florida