REPORT OF THE AMERICAN MEDICAL ASSOCIATION DELEGATION A-2019

Subject: Annual Report Presented by: Bruce L. Storms, MD – Delegation Chair Sherri Baker, MD – Delegation Vice-Chair Donna Bartlett, Director of Operations (Staff Liaison)

1 REVIEW OF 2018 ACTIVITIES: 2 At the August 12, 2018 Board of Trustees meeting, Dr. Storms informed the Board that recent changes 3 had taken place with the Heart of America Caucus (HOA) which included Oklahoma, Kansas, Arkansas 4 and Missouri. Arkansas notified the HOA after the AMA 2018 Annual Meeting that they were 5 withdrawing from the HOA and joining the Southeast Caucus effective immediately. He then noted that 6 the Oklahoma delegation recently held phone conferences with Southeast about the possibility of 7 Oklahoma joining Southeast and the Oklahoma Delegation believes it is in the best interest going 8 forward to leave the HOA and join Southeast. The change will not go into effect until the close of the 9 2018 Interim Meeting. 10 11 The following physicians served on the Oklahoma American Medical Association (AMA) Delegation 12 for 2018. 13 Delegates: Sherri Baker, MD, Jack Beller, MD, Jay Gregory, MD, and Bruce L. Storms, MD. 14 Alternate Delegates: Peter Aran, MD, Jenny Boyer, MD, Kevin Taubman, MD, and Woody Jenkins, 15 MD. 16 Students: 17 18 AMA 2018 Annual Meeting – June 8-13 (Chicago, IL): 19 20 The 2018 AMA Annual Meeting took place in Chicago June 8-13, 2018 at the Hyatt Regency Hotel. 21 All four (4) OSMA/AMA Delegates, as well as all four (4) of the Alternate Delegates, attended the 22 meeting along with Jean Hausheer, MD, President, Larry Bookman, MD, President Elect and Mary 23 Clark, MD, Speaker. Several Specialty Society delegates represented Oklahoma, including: Jane Fitch, 24 MD, American Society of Anesthesiologists; Robert McCaffree, MD, American College of Chest 25 Physicians; and Lynn Mitchell, MD, American Medical Group Association. 26 27 Eudy Bosley, MD represented the OSMA Resident/Fellow Section (RFS) and Christopher Sudduth, 28 MD, the OSMA Young Physicians Section (YPS). Medical students representing the OSMA Medical 29 Student Section (MSS) from Oklahoma were: Annah Baykal, Samantha Beck, Crystal Goree, Chelsea 30 McKenzie, Mayra Salazar-Valdivia and Krishna Manohar). 31 32 OSMA Staff members present were Wes Glinsmann, Executive Director, Donna Bartlett, Director of 33 Operations and Jeff Kelton, Membership Manager. Donna Bartlett served as staff liaison for the Heart 34 of America Caucus (HOA). 35 36 AMA 2018 Annual Meeting Highlights: 37 At the 2018 Annual Meeting, the House of Delegates some new policies: 38 39 Opposition to separating children from their caregivers at the border 40 Delegates voted to oppose the practice of separating migrating children from their caregivers at the U.S. 41 border, a practice on the rise and one that physicians said could cause trauma in children. Report of the AMA Delegation A-2019 Page 2

1 Advancing gender equity in medicine 2 Documented gaps exist in compensation and career advancement between male physicians and their 3 female counterparts, even after accounting for other factors and characteristics.

4 Promoting diversity in the U.S. medical workforce 5 With large areas of the country facing a physician shortage, the AMA called on the government to clear 6 the backlog for conversion from H1-B visas for physicians to permanent resident status.

7 Reporting child abuse and neglect in military families 8 Rates of maltreatment of military children continue to climb. In the past five years alone, military child 9 abuse and neglect rose from 4.8 incidents per 1,000 children to 7.2 incidents.

10 Increasing access to naloxone on commercial airlines 11 The Federal Aviation Administration requires commercial air carriers to carry onboard emergency 12 medical kits, but the opioid overdose antidote—naloxone—is not a required item in these kits.

13 Ensuring free access to feminine hygiene products for incarcerated women 14 The AMA will work with state and specialty societies to advocate for free access to feminine hygiene 15 products for incarcerated women and will encourage the Internal Revenue Service to classify feminine 16 hygiene products as medical necessities.

17 Opposing lock-out provisions in Medicaid waivers 18 As states pursue waivers to modify and tailor their Medicaid programs, the AMA announced its 19 opposition to “lock-out” provisions that terminate Medicaid patients’ coverage—for up to six months in 20 some states—for failure to comply with administrative requirements.

21 22 23 Oklahoma Sponsored Resolutions: 24 25 The following resolution was sponsored by the Oklahoma Delegation and submitted to the AMA-2018 26 Annual Meeting for consideration by the AMA House of Delegates: 27 Oklahoma Resolution 6 – Recording Law Reform 28 29 This resolution was forwarded to the AMA (A-18) as Resolution 232 and referred to Rules and 30 Credentials Committee to re-affirm. The AMA is in the process of drafting model state legislation 31 requiring consent of all parties to the recording of a physician-patient conversation. 32 33 RESOLVED, the AMA draft model state legislation requiring consent of all parties to the 34 recording of a physician-patient conversation. 35 Oklahoma Resolution 9 – Human Trafficking/Slavery Awareness 36 37 This resolution was forwarded to the AMA (A-18) as Resolution 015 and referred to Constitution and 38 Bylaws Committee. The resolution passed with amendments and for further study by the AMA. AMA 39 staff updated a list of physician resources related to this topic and posted on the AMA website. 40 Report of the AMA Delegation A-2019 Page 3

1 RESOLVED, that the Oklahoma State Medical Association instruct its AMA Delegation to 2 ask for an AMA study on the effectiveness of physician education to ensure that physicians are 3 trained to report suspected cases of human trafficking/slavery to the appropriate authorities 4 while assuring victims have the medical, legal, and social resources they need and develop a 5 plan of action to improve recognition of victims of human trafficking/slavery to increase the 6 identification, referral, and rescue rate. 7 8 Oklahoma Resolution 12 – Support for Reauthorization of the Supplemental Nutrition Assistance Program 9 10 This resolution was forwarded to the AMA (A-18) as Resolution 233 and referred to Reference 11 Committee B (Legislation). The resolution passed without change. The AMA wrote to Senate Majority 12 Leader McConnell and Senate Minority Leader Schumer in support of the preservation and 13 strengthening of the SNAP program as part of efforts to enact the 2018 Farm Bill. As of October 1, 14 negotiations were deadlocked on the bill with the major remaining disagreement an effort to impose 15 work requirements for SNAP beneficiaries. 16 17 RESOLVED, the Oklahoma State Medical Association Council on Legislation and Lobbyist 18 Team actively urge the Oklahoma Congressional Delegation to preserve and protect the 19 Supplemental Nutrition Assistance Program through the reauthorization of the 2018 Farm Bill 20 in order for Oklahomans to live healthy and productive lives, and be it further 21 RESOLVED, the American Medical Association actively lobby Congress to preserve and 22 protect the Supplemental Nutrition Assistance Program through the reauthorization of the 2018 23 Farm Bill in order for Americans to live healthy and productive lives, and be it further 24 RESOLVED, that AMA Policy D-150.975, which calls for action to remove sugar-sweetened 25 beverages from the Supplemental Nutrition Assistance Program, be reaffirmed, and be it further 26 RESOLVED, that AMA Policy H-150.937, which in part aims to replace calorie-rich, nutrient- 27 poor food with nutrient-dense food within the Supplemental Nutrition Assistance Program, be 28 reaffirmed. 29 30 Oklahoma Resolution 14 - Support for the Primary Care Enhancement Act 31 32 This resolution was forwarded to the AMA (A-18) as Resolution 234 and referred to Reference 33 Committee B (Legislation). The AMA Board of Trustees sent a letter to the House of 34 Representatives and Senate authors/leaders in strong support. 35 36 RESOLVED, the Oklahoma State Medical Association Council on Legislation and Lobbyist 37 Team actively urge the Oklahoma Congressional Delegation to enable patients, providers and 38 employers who use Health Savings Accounts (HSAs) to take advantage of innovative Direct 39 Primary Care (DPC) medical homes to improve health outcomes and reduce costs through 40 passage of the Primary Care Enhancement Act, and be it further 41 RESOLVED, that our American Medical Association, pursuant to H-385.912, actively lobby 42 Congress to pass the Primary Care Enhancement Act. 43 44 Report of the AMA Delegation A-2019 Page 4

Oklahoma Resolution 16 – Education for Recovering Patients On Opiate Use After Sobriety 1 2 This resolution was forwarded to the AMA (A-18) as Resolution 511 and referred to Reference 3 Committee E. The resolution was amended and adopted and the AMA policy database updated. 4 5 RESOLVED, that OSMA AMA Delegation ask AMA to implement an appropriate education 6 program for recovering opioid abuse patients and their friends/families that opioid use after 7 significant sobriety time can result in overdose and death, whereby amending Policy D-95.987. 8 9 2018 Interim Meeting –November 10-14 in National Harbor, Maryland 10 11 Hundreds of physicians, medical students, residents and fellows met at the Gaylord National Resort & 12 Conference Center in National Harbor, Maryland November 9-13, 2018, to consider a wide array of 13 proposals designed to help fulfill the AMA's core mission of promoting medicine and improving public 14 health. AMA Delegates attending the Interim Meeting were Sherri Baker, MD, Jack Beller, MD, Jay 15 Gregory, MD and Bruce Storms, MD. Alternate Delegates attending were Peter Aran, MD, Jenny 16 Boyer, MD, Kevin Taubman, MD and Woody Jenkins, MD. OSMA President Jean Hausheer, MD, was 17 seated as an Alternate Delegate. OSMA President-elect, Larry Bookman, MD also attended the 18 meeting. Several Specialty Society delegates represented Oklahoma, including: Jane Fitch, MD, 19 American Society of Anesthesiologists and Lynn Mitchell, MD, American Medical Group Association. 20 21 Eudy Bosley, MD represented the AMA Resident and Fellow Section (RFS) and Geoffrey Chow, MD, 22 Young Physician Section (YPS). Medical student representatives for the OSMA Medical Student 23 Section were Brendan Bailey, OSU-Tulsa; Samantha Beck, OU-OKC; Ben Chadek-Feeley, OSU-Tulsa; 24 Jazeb Ifikhar, OU-Tulsa; Krishna Manohar, OU-OKC; Chelsea McKenzie, OU-Tulsa; Jacob Rogers, 25 OU-OKC; and Mayra Salazar-Valdivia, OSU-Tulsa. 26 27 OSMA Staff members Wes Glinsmann, Executive Director and Donna Bartlett, Director of Operations 28 attended the AMA interim meeting. 29 30 AMA 2018 Interim Meeting Highlights: 31 Below are some on the new policies adopted: 32 33 • Urge the Centers for Medicare & Medicaid Services to assist physician practices seeking to 34 qualify for and sustain medical home status with financial and other resources. 35 • Advocate that all payers support and assist PCMH transformation and maintenance efforts 36 recognizing that payer support is crucial to the long-term sustainability of delivery reform. 37 • Encourage health agencies, health systems, and other stakeholders to support and assist patient- 38 centered medical home transformation and maintenance efforts. 39 • Support education of physicians about the effective use of HIV post-exposure prophylaxis and 40 the U.S. PEP clinical practice guidelines. 41 • Support increased access to, and coverage for, PEP for HIV, as well as enhanced public 42 education on its effective use. 43 • Recognize that among the homeless population, lack of identification serves as a barrier to 44 accessing medical care and fundamental services that support health. 45 • Support legislative and policy changes that streamline, simplify and reduce or eliminate the cost 46 of obtaining identification cards for the homeless population. 47 Report of the AMA Delegation A-2019 Page 5

1 2 CONCLUSION: 3 4 The AMA delegate apportionment is based on AMA membership records as of December 31st with one 5 delegate apportioned for every 1,000, or fraction thereof, of AMA members within the state of 6 Oklahoma. Although only 23% of OSMA members paid their AMA dues through their county society 7 or the OSMA, AMA shows Oklahoma’s 2017 AMA membership number was 3,673 which was an 8 increase of 255 over the 2016 membership number. The AMA membership number includes students, 9 residents, life members and a number of physicians who join the AMA directly. This number entitled 10 Oklahoma to four (4) delegates and four (4) alternates for the 2018 year. 11 The 2019 AMA Annual Meeting will be held June 7-12 at the Hyatt Regency Hotel in Chicago, IL.

12 The Interim Meeting will be held at the Manchester Grand Hyatt in San Diego, California on 13 November 16-19, 2019.

14 The Oklahoma AMA Delegation will meet on Saturday, April 6th, following the OSMA House of 15 Delegates to discuss plans for the upcoming AMA Annual and Interim meetings. All physicians, 16 residents and medical students attending the 2019 AMA Annual Meeting are invited to participate in the 17 delegation’s planning meeting. 18 19 Respectfully submitted, 20 21 Bruce L. Storms, MD, Chair 22 Sherri Baker, MD, Vice-Chair 23 Donna Bartlett, Director of Operations (Staff Liaison)