CMA House of Delegates Report

CMA HOUSE OF DELEGATES 2022

Michael Schrader, MD, PhD

The 151st California Medical Association House of Delegates convened at LA Live on October 21, 2022 after a two

year Covid hiatus. Our SFMMS District VIII Delegation was there to represent our members. As compared to the previous two years we were able to renew friendships and create new alliances. We had compelling Major Issues where we pushed for new policy and the election of Dr. Lawrence Cheung to Vice-Speaker of the HoD.

Prior to the convening of the HoD there were well-attended conferences on climate change and reproductive rights. There is a strong core of advocates in the CMA for climate change activism. They want the AMA to establish climate change as a public health crisis and have supported bills in the California State Legislature to address preparedness for catastrophic heat events and accurate collection of data about heat-related morbidity and mortality. SFMMS endorsed bill AB 2238 (L. Rivas) - “Statewide extreme heat ranking system” that was signed into law by Governor Newsom this year.

Reproductive rights and the repercussions of the Supreme Court Dobbs Decision were a major focus of the CMA HoD beginning with the pre-HoD briefing by Planned Parenthood and other experts. The issues are the right of patients to make reproductive choices and the role of the physician/patient relationship in forming individual decisions. The consequences of the Dobbs decision include catastrophic effects on the health of women with pregnancy complications, legal jeopardy for physicians and patients, and complications for residency programs that require abortion and pregnancy management training to maintain accreditation.

This year there were three Major Issues presented to the HoD: Health Care Reform, Physician Workforce, and Mental Health. These were remarkably similar to the three Major Issues that were considered in 2017. The Mental Health Major Issue was educational only and therefore did not have policy recommendations attached. The Health Care Reform and Physician Workforce Major Issues offered some surprises.

The Health Care Reform Major Issue was directed primarily to Medi-Cal reform. Approximately one-third of Californians are

insured by Medi-Cal and approximately half of California children are covered by Medi-Cal. The low reimbursement rates for Medi-Cal have created a two-tier system of coverage with access problems for Medi-Cal patients. The thrust of the Recommendations for this Major Issue were to increase Medi-Cal funding to parity with comparable insurance plans. The key to raising Medi-Cal funding is to establish a secure source of funding that is not vulnerable to state budget revenue fluctuations. SFMMS Past-Presidents Drs. Man-Kit Leung, Lawrence Cheung, Brian Grady, Shannon Udovic-Constant, George Fouras, and Kimberly Newell Green. Our SFMMS Delegation proposed an amendment to tax the sales of alcoholic beverages with revenue earmarked for Medi-Cal reimbursement to providers. This amendment was ruled out of order, but you have not heard the last of this. The Physician Workforce Major Issue ended up primarily addressing reproductive rights. The Council of Delegate Chairs met in May shortly after the leak of the Justice Alito decision about the Dobbs decision. Our SFMMS Delegation initiated the proposal of reproductive rights for a Major Issue at the CDC. Ultimately reproductive rights were not selected as a Major Issue as Delegation Chairs chose the above issues. When the Major Issues were published reproductive rights were piggybacked on to Physician Workforce almost as an additional Major Issue. You may draw your own conclusions about the effect of SFMMS advocacy but we were the vanguard. We made two amendments by addition to the Recommendations, both about establishing telemedicine abortion shield laws: medical abortion using mifopristone/misoprostol prescribed across state lines via telemedicine. This was not adopted as CMA policy but our advocacy will continue. We have submitted a resolution to the Year Round Resolution process. AMA President Dr. Jack Resneck of UCSF addressed the CMA HoD about issues including violence against physicians, physician burnout, pending Medicare payment cuts, administrative burden, racial justice and equity access to healthcare, and political intrusion into the physician/patient relationship. We invited Dr. Resneck to address our Delegation at our lunch meeting following the Saturday morning session. We discussed our SFMMS Delegation efforts to address violence toward physicians and healthcare workers.

Governance reform was also addressed. We heard a presentation from Dr. Holly Yang at our Delegation meeting about the Governance Technical Advisory Committee (GTAC) and she later addressed the HoD. Our delegate, Dr. Roger Eng, is also on the GTAC. Our SFMMS Delegation has specific proposals for CMA governance reform with the primary aim of rebalancing the power of the CMA Board of Trustees with the County and Specialty Delegations. The influence of our SFMMS Delegation on CMA leadership was reaffirmed by the honoring of Dr. Peter Bretan as twoterm President of the CMA, the announcement of BoT Chair, Dr. Shannon Udovic-Constant, to run for CMA President-elect next year, and the election of Dr. Lawrence Cheung to Vice-Speaker of the HoD. New CMA President Donald Hernandez, a hospitalist in Santa Cruz, was installed, and pediatrician Richard Pan was honored for his service as a state senator with strong leadership on multiple important health issues. And last but far from least, SFMMS past-president Dr. George Fouras was elected CALPAC secretary/treasurer, an important slot in CMA’s advocacy with our state’s legislators.

Our SFMMS District VIII Delegation has a strong voice at the CMA. We welcome the opportunity to represent our SFMMS members. We welcome your ideas and resolutions. We have opportunities for members who would like to become involved with our delegation.

SFMMS 2022 HOD ATTENDEES:

Ameena Ahmed, MD, Delegate, vice-Chair Gordon Fung, MD, Delegate John Maa, MD, Delegate Jessica Duhe, MD, Delegate Ian McLachlan, MD, Delegate Michael Schrader, MD, Delegation Chair Brian Grady, MD, Delegate Roger Eng, MD, Delegate George Fouras, MD, Delegate Kim Newell Green, MD, Delegate Man-Kit Leung, MD, Delegate Monique Schaulis, MD, Delegate Dennis Song, MD, Delegate Haining (Helen) Yu, MD, Delegate Cathlin Milligan, MD, Alternate Javaid Khan, MD, Alternate Charles Windon, MD, Alternate Larry Bedard, MD, Guest Mel Blaustein, MD, Alternate

Dr. Schrader chairs the SFMMS delegation (with Dr. Ameena Ahmed, newly-elected vice-chair) and is president-elect of the SFMMS.

Editor Gordon L. Fung, MD, PhD, FACC, FACP Managing Editor Steve Heilig, MPH Production Maureen Erwin

SFMMS OFFICERS

President Michael C. Schrader, MD, PhD, FACP President-elect Heyman Oo, MD, MPH Secretary Jason Nau, MD Treasurer Dennis Song, MD Immediate Past President

Monique Schaulis, MD, MPH

SFMMS STAFF

Executive Director

Conrad Amenta Associate Executive Director, Public Health and Education

Steve Heilig, MPH Director of Operations and Governance

Ian Knox Director of Engagement

Molly Baldridge, MPH

2022 SFMMS BOARD OF DIRECTORS

Edward Alfrey, MD Melinda Aquino, MD Ayanna Bennett, MD Julie Bokser, MD Kristina Casadei, MD Anne Cummings, MD Manal Elkarra, MD Mihal Emberton, MD Beth Griffiths, MD Robert A. Harvey, MD Harrison Hines, MD Ian McLachlan, MD Jason R. Nau, MD Heyman Oo, MD Sarita Satpathy, MD Monique Schaulis, MD Michael C. Schrader, MD Yalda Shahram, MD Neeru Singh, MD Dennis Song, MD Kristen Swann, MD Kenneth Tai, MD Melanie Thompson, DO Matthew D. Willis, MD, MPH Joseph W. Woo, MD Andrea Yeung, MD

For questions regarding journal, including possible submissions, contact Steve Heilig: Heilig@sfmms.org

Cover Art:

“Intensive Care”

by Cynthia Fletcher, 20x16, oil on panel, 2021, from her Coronavirus series.