Memos of Opposition 2013


American Academy of Pediatrics, District II, New York State
Opposing Positions on Pending Legislation in New York State

Memo of Opposition for A.5124/S.4069
Retail Based Clinics

May 30, 2013

Contact: Elie Ward, Director of Policy & Advocacy

NYS AAP, District II, representing thousands of pediatricians across the state, opposes the introduction and support of retail-based clinics (RBCs) in New York State.  We do not believe that RBC’s, as they are currently constituted, can be an appropriate source of medical care for infants, children, and adolescents.

We strongly discourage their use by families with children because the AAP is committed to the medical home model.  The medical home model provides accessible, family-centered, comprehensive, continuous, coordinated, compassionate, and culturally effective care for which the pediatrician and the family share responsibility.

Given that the RBC is not a medical home model; the NYSAAP is particularly concerned with the effects of the following attributes of an RBC on health care for children and adolescents:

  • Fragmentation of care
  • Possible effects on quality of care
  • Provision of episodic care to children with special health care needs and chronic diseases, who may not be readily identifiable
  • Lack of access to and maintenance of a complete, accessible, central health record that contains all pertinent patient information.
  • Use of tests for the purposes of diagnosis without proper follow-up
  • Possible public health issues that could occur when patients with contagious diseases are in a commercial, retail environment with little or no isolation (e.g. fevers, rashes, mumps, measles, strep throat, etc).

Seeing children with “minor” conditions, as will often be the case in an RBC, can be misleading and problematic.  Many pediatricians use the opportunity of seeing a child for something minor to address issues in the family, discuss any problems with obesity or mental health issues, catch up on immunizations, identify undetected illness, and continue strengthening the relationship with the child and family.  These visits are important and provide an opportunity to work with patients and families to deal with a variety of other issues.  They are grouped as  “anticipatory guidance.”  Losing the opportunity for anticipatory guidance, weakens the role pediatrics in maintaining the health of all children, and working to strengthen the relationships within families and behalf of the child patient.

Whatever the sponsors believe will be gained by allowing the proliferation of RBC’s cannot equal what will be lost to children and families whose health and well-being can and are strengthened within a pediatric medical home.  Without strict requirements that RBC’s become part of a child’s medical home network, the details of which, we would happy to discuss with you going forward, and which are clearly absent from this legislation, we remain firmly opposed to expansion or support of RBC’s in New York.

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Memo of Opposition

Anti-immunization Legislative Proposals
May 30, 2013

Contact: Elie Ward, Director of Policy & Advocacy

The New York State Academy of Pediatrics, District II, strongly opposes all three of these anti-immunization legislative proposals.

A. 2690 proposes to expand medical exemptions.  There is no reason to expand the current legislation defining medical exemptions.  The existing state legislative and regulatory structure works well to protect those children who truly, for scientific and medical reasons, need to either delay or completely eschew required immunization. The proposed legislation is just another avenue for those who do not believe in immunization to avoid the existing requirement of public health law.  All children are better protected when higher percentages of children are immunized.  The approach taken by this legislation is unscientific, not evidenced based and antithetical to good medical practice.

A.06359/S.03934 proposes to create a “philosophic exemption” from required immunizations.  Again, this legislation is counter to all evidenced based science which supports required immunizations to keep all children healthy.  A “philosophic exemption” is just a way for misinformed and fearful parents to make dangerous decisions that will not only impact on the heath of their own children, but also the children in their neighborhood and those who share a classroom or sports or social activity with their children.

To protect the children of New York it is imperative that we continue to work to get all children immunized at the scheduled time.  We have already experienced outbreaks of whooping cough and measles in New York. Children have been sickened and many have been hospitalized because they or those around them have not been properly immunized.  A commitment to public health and the health of all children requires that we remain vigilant and assure that all children are immunized so that they and their siblings and classmates can be protected from dangerous, but fully preventable diseases.

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