JULY / AUG 2019 JULY / AUG A PUBLICATION FOR THE MEMBERS OF THE WASHINGTON STATE MEDICAL ASSOCIATION Health at Risk Washington physicians see the physical tolls of climate change PAGE 6 ® Washington Permanente Medical Group Called to care PROVIDER OPPORTUNITIES From the very beginning, we have thought Washington State about medicine di erently. As a Kaiser Permanente clinician, you Permanente Medicine empowers you to harness your will have the ability to become a calling to care. Washington Permanente Medical Group shareholder in our practice and enjoy (WPMG) is among the largest and most honored the following benefits: multi-specialty group practices in the Pacific Northwest. We are nearly 1,100 physicians, PAs, midwives, mental health specialists, osteopaths and optometrists focused • Full malpractice indemnification on prevention, evidence-based practices, and • Medical/dental/vision benefits patient-centered care. We are dedicated to building lifetime relationships with peers and patients in • Paid vacation Washington state’s richly diverse communities. • 401(k) & employer-paid contribution Many know the Pacific Northwest as an attractive tourist • Continuing medical education destination with beautiful scenery, friendly people, and a host of cultural and recreational opportunities. These • Long-term disability, long-term elements, and others, make Washington an excellent care benefits place to live. Join us and become part of something unique, For consideration or to apply, something special...something that matters. please visit: wpmgcareers.org We are an Equal Employment Opportunity Employer PHOTO CREDIT WSMA Reports contents July/August 2019 Features Vital Signs Climate Consequences / 2 Environmental health impacts patients, communities, and the state Legislature’s budget. WSMA Huddle / 3 Meet WSMA member Alan Melnick, MD; practices can go green with the AMA’s toolkit; members in the news. By the Numbers Bad for Your Health / 16 Pollution, extreme heat, bad water, and more will sicken more Washingtonians in the years ahead. Heartbeat Sound the Alarm / 17 A generation ago, physicians spoke up about the dangers of smoking. It’s time to start talking about climate change. BY MARK VOSSLER, MD COVER STORY Health at Risk / 6 Washington physicians see the physical tolls of climate change. BY RITA COLORITO Taking a Stand / 10 Health care systems address sustainability. BY PAT CURRY Protect Against Claims / 14 17 COVER: PETE RYAN; THIS PAGE (CLOCKWISE) SAM POSNIK/ISTOCK; RAMON SALINERO ON UNSPLASH. Honor your patients' right to informed decision-making. WSMA Reports is published bimonthly EXECUTIVE ART DIRECTION PRESIDENT-ELECT WSMA Reports, Volume 37, as the official publication of the DIRECTOR/CEO AND DESIGN Bill Hirota, MD Issue 4 July/August 2019 (USPS Washington State Medical Association. Jennifer Hanscom Erin Foster #21920) is published bimonthly 1ST VICE PRESIDENT for $100 per year by the Wash- EDITORIAL DIRECTOR ADVERTISING Nathan Schlicher, MD, JD SEATTLE OFFICE ington State Medical Association, Milana McLead [email protected] 2001 Sixth Avenue, Suite 2700 2ND VICE PRESIDENT 2001 Sixth Ave., Suite 2700, 206.441.9762 Seattle, WA 98121 MANAGING EDITOR Mika Sinanan, MD, PhD Seattle, WA 98121. Periodicals 206.441.9762 or 800.552.0612 Graham Short postage paid at Seattle, WA. SECRETARY- Fax: 206.441.5863 SENIOR EDITOR WSMA EXECUTIVE TREASURER POSTMASTER: Send address Pat Curry COMMITTEE: Katina Rue, DO changes to WSMA REPORTS, OLYMPIA OFFICE [email protected] CHAIR 2001 Sixth Ave., Suite 2700, 1800 Cooper Point Road SW, ASSISTANT 706.714.2808 Donna Smith, MD Seattle, WA 98121. Bldg 7, Suite A, Olympia, WA 98502 SECRETARY- To subscribe visit wsma.org. 360.352.4848 or 800.562.4546 DIGITAL EDITOR PRESIDENT TREASURER Fax: 360.352.4303 Katie Howard Tom Schaaf, MD Nariman Heshmati, MD © 2019 WSMA July/August 2019 wsma.org 1 V ITA L SIGNS uring last November’s board meeting, your WSMA trustees were considering the organization’s strategic plan and goals for the coming year. Thoughtful discussion led to one of our leaders posing the question: What should the WSMA be doing around climate change? There ensued a robust debate, which continued in the subsequent days by email. There were a range of views. Many wondered what WSMA’s role could or should be, while some questioned whether the WSMA should be in this space at all. Some shared concern about resources that might be required and others suggested staff Climate lead on the topic with some specific suggestions. No matter what, we know that the health of our environment is closely linked to the health of our communities. Who can forget the smoke from last summer’s Change wildfire season and how that impacted the health of Washingtonians? Already, state officials are predicting another tough fire season for our state. For many physician practices and hospital emergency rooms, that will mean Stirs Up seeing more patients whose health conditions are worse due to smoke inhalation. The elderly and the very young are the most vulnerable, as always. People with a Perfect asthma or other pulmonary problems are more likely to have their health further compromised by poor air quality. It’s no surprise the medical community is concerned about the impact of Storm climate change on patients and community health. According to a study in the Journal of the American Heart Association, when dense smoke is present, people over the age of 65 are 42 percent more likely to visit the emergency department for heart attacks and their cardiovascular risk is 40 percent higher. In real terms, this means wildfires are creating a public health crisis that is keeping pace with the increasing frequency and size of these events. Climate change also has an immediate impact on our state’s resources. In this year’s legislative session, state legislators approved $50 million more for wildfire prevention. That’s the largest appropriation in the state’s history, and it puts additional pressure on state dollars. And that pressure puts the squeeze on WSMA’s priority asks, such as increasing Medicaid reimbursements or eliminating a B&O tax increase. Clearly, the impact of climate change on health is a nuanced issue with a multitude of voices and opinions. But at its core, our concern is to help shape a comprehensive approach to environmental challenges so that we can strive to protect the health of patients. A good place to start is getting smart on the topic. Hopefully, this issue of WSMA Reports will prompt more conversation. Have some thoughts on the matter? Write me at [email protected]. Jennifer Hanscom WSMA Executive Director / CEO ANDREA PEER PHOTOGRAPHY; ILLUSTRATION: FREEPIK.COM 2 WSMA Reports July/August 2019 huddle Touching base with need-to-know news for WSMA members Member Profile Dr. Alan Melnick testifying at the Alan Melnick, MD, 2017 WSMA Annual Meeting. MPH, CPH Works at: Clark County Public Health Specialty: Public Health and General Preventive Medicine, Family Medicine (double-boarded) Why WSMA: The WSMA is the voice of Washington physicians, who are essential in protecting and promoting the health of the public. I joined the WSMA knowing that it is a key partner in strengthening ties between the governmental public health system and practicing physicians, and that it takes a leadership role in developing policies to improve the health of all The WSMA is the voice of Washington“ Washington residents. physicians, who are essential Proud moment: Two recently: Working in protecting and promoting the with community partners, including health of the public.” physicians, to control the recent measles outbreak, and working with the WSMA to pass a bill removing the personal medicine because of its upstream, barriers resulting from hierarchical exemption from school requirements for preventive approach in addressing the workplace cultures. the MMR vaccine, thereby helping protect social determinants of health. Washingtonians from future vaccine- “The Status Syndrome,” written by an preventable disease outbreaks. Best advice I ever got: Understanding epidemiologist, analyzes how position in that positional/professional authority can social hierarchy is a determinant of health. Top concerns in medicine: In my be intimidating, and that given the power “The Healing of America” describes how specialty—adequate funding for dynamics, other team members might not industrialized countries achieved universal foundational public health services. In feel safe giving me critical feedback (which access and better health outcomes. health care—health disparities, inequities could adversely affect patient safety), and in access to health care, and the impact “The Ghost Map” tells the story of Dr. that I couldn’t be as effective working alone. of social determinants, such as housing, John Snow, a public health pioneer, who Thus, if I were going to be a successful education, and employment, on health. investigated and determined the cause of physician leader, I needed to learn how cholera outbreaks in mid-19th century. to listen to, honor, and respect my non- What inspires me about being in medicine: “The Immortal Life of Ability to make positive difference in peoples’ physician team members. This is a lesson I continue to learn. Henrietta Lacks” tells the story lives and in the health of communities. of the origin of HeLa cells, Why I became a physician: I began college Pet peeve: Right now, misinformation and raises questions about as an engineering student, but realized I about measles and immunization that research involving human