Tuesday, April 18, 2017

Mayoral candidate Will McLeod

Candidates for elected city offices were all asked the same questions by the Bexar County Medical Society and have submitted answers to those questions as shown below. 
This information is provided as a service from the Bexar County Medical Society, but is not an endorsement.
BCMS does not make endorsements of any candidates for office nor of elected officials. 

 Will McLeod, 
Candidate for mayor
2017 Mayoral/City Council Candidates
Health Care Questions


1.   Despite affecting everyone in this community, "community health and wellness" has not been a big priority at City Hall. "Community health and wellness" had one third of the ranking that "streets" received in community input via SpeakUPSanAntonio. Yet it impacts our well being, workforce, economic development and the prosperity of San Antonio.
What health-related areas do you think deserve increased attention, priority, and local resources, and, if elected, how would you elevate the discussion of these health issues at City Hall and lead effective action to improve health and healthcare in our community?

 First of all, fixing our infrastructure is important, because without sidewalk accessibility, people often are discouraged from walking, and instead drive their automobiles. Even vegans can be obese, so we need to encourage walking throughout the city.  Bus stops can be consolidated to speed up public transportation and encourage walking.  But mandates or taxes on certain foods or beverages are regressive, not successful, and shouldn't be instituted. 

2.  Bexar County is the primary source of funding for indigent health care in our area through the Bexar County Hospital District and University Health System. How would you, if elected, promote cooperative efforts to increase services and access to care for the citizens of San Antonio?

 The discussion starts with the legislature up in Washington, D.C. to expand Medicare QMB program to include all persons who are currently receiving Social Security Disability Income, and all that has to be done is raise the maximum allowable income to receive QMB to reflect the current Social Security benefit amount plus the SGA limit (which is $1,170 a month for non blind individuals and $1,950 for blind individuals) 
So the co pay and premiums are paid for at the State level.  For SSI, they already qualify for this service, because of their income limits.

3.  The disparity of health care between our poorest and wealthiest zip codes/districts is quite striking (Bexar County Health Collaborative 2016 report). How would you, if elected, reduce health disparities and improve health outcomes for our lower income communities/citizens?

Expanding eligibility for Medicare QMB will close that gap. People cannot see doctors because they cannot afford the co pay.  When we expand the eligibility for Medicare QMB more people will see their doctor as it will become much more affordable.

4.  San Antonio has a high incidence of obesity and diabetes mellitus and has been ranked as high as second in the nation for obesity in recent years. Past city efforts attempting to improve these rates, such as trying to reduce the prevalence of sugary drinks in our community, have been met with controversy. What ideas do you have to reduce the incidence of these chronic health issues?

 I support walking and physical education, as exercise is the fastest way to burn calories.  Government has not business in restricting consumer choices of sugary drinks. That practice is as frowned upon as the British trying to tax tea. As someone who drink chocolate milk had chocolate cake for lunch in 5th grade, and ate a chicken, or steak during dinner, I was skinny for my age.  Because I was physically active. Since the population is 60 percent Hispanic and we have a lot of restaurants serving Mexican food, it is very fattening so the question I have to the people who think of taxing food or drinks to curb "obesity" is should we be mandating Japanese food because in Okinawa, Japan people are thin and live longer? 


5According to the CDC, child abuse and neglect are serious problems that can have lasting harmful effects on its victims. The goal in preventing child abuse and neglect is clear — to stop this violence from happening in the first place. What local policies, resources and efforts will you support to promote safe, stable, nurturing relationships and environments for all children and families?

First of all, Child Protective Services should hire people that can do the job with passing a background check and on the job training, college or university schooling should not be required.  Child Protective Services was trying to do just that, but according to some career politicians with a hidden agenda, that wasn't good enough despite the staff shortages. We need to have the school districts be more involved with the parents of minor children, and that will have to be taken place at each independent school district around San Antonio. As Mayor, I would have our new police chief that I will bring to the city, handle truancy issues and hold the parents that are not providing the parental guidance for their children accountable.  Our next police chief will not be there for photo ops cheering his defiance of enforcing the laws of the City of San Antonio but enforce his job, hold SAPD accountable, and provide monthly status reports to the city council.  Also, the $1 million dollar playground that Taylor and Nirenburg voted for next to Joe's Volcano will be torn down protecting children from child predators.  We have to protect the children from sex offenders and after what happened in Rockville, Maryland last month we need to be enforcing our Immigration laws. San Antonio will not be a sanctuary city. 

Mayoral candidate John Velasquez

Candidates for elected city offices were all asked the same questions by the Bexar County Medical Society and have submitted answers to those questions as shown below. 
This information is provided as a service from the Bexar County Medical Society, but is not an endorsement.
BCMS does not make endorsements of any candidates for office nor of elected officials. 

John Velasquez
Mayoral candidate 
2017 Mayoral/City Council Candidates
Health Care Questions


1.   Despite affecting everyone in this community, "community health and wellness" has not been a big priority at City Hall. "Community health and wellness" had one third of the ranking that "streets" received in community input via SpeakUPSanAntonio. Yet it impacts our well being, workforce, economic development and the prosperity of San Antonio.
What health-related areas do you think deserve increased attention, priority, and local resources, and, if elected, how would you elevate the discussion of these health issues at City Hall and lead effective action to improve health and healthcare in our community?

San Antonio needs a comprehensive mental health plan, owned and operated by the city.  Federal and state funds for mental health are unreliable and seriously underfunded.  COSA must take care of its own citizens without relying on external funds.  Mental health impacts physical health and the well-being of the family and neighborhoods.  Mental health is related to crime.  Persons who are impacted by poverty/low wages and substance-issues can be impulsive and desperate, thus leading to criminal behavior.  Bullying impacts children’s mental health in serious ways, e.g. “David’s Bill”, and families need a way to respond.  Bullying impacts the LGBTQ+ community mental health.  Domestic violence against women impacts children and mothers’ mental health.  Kidnapped victims of sex trafficking have mental health problems.  Veterans who have PTSD and do not want to seek treatment at the Veterans’ Administration need a place to receive mental health treatment, especially given that veterans are committing suicide on a daily basis.  Families experiencing financial hardship need counseling to develop strategies to cope.  I am a clinical psychologist and I have seen and treated all these situations, so I know that mental health treatment can have a positive impact on all.  I am proposing reallocation of funds across all budgets, and if necessary, increase in sales tax to fund 100 new mental health clinics which would be open 24/7 on a walk-in basis.  Since ALL citizens of San Antonio would pay into this system, ALL citizens can access these clinics regardless of ability to pay and regardless of insurance.  Just as everyone has a place to go for urgent care of a broken arm, everyone should have a place to go for a broken heart and broken mind.  These clinics would be staff by LPC, MSW, psychiatrists, and psychologists.  Safety would be maintained by SAPD staffing.  These 100 clinics would be accessible by foot and bus routes.  Physicians and psychiatrists know the role of mental health on medical health.  The connection between the two is conclusive.  This is my number ONE priority.  I will press this issue on a daily matter, openly, during City Council meetings and during planning sessions.  I will not let other pressing matters divert my attention from mental health.
  

2.  Bexar County is the primary source of funding for indigent health care in our area through the Bexar County Hospital District and University Health System. How would you, if elected, promote cooperative efforts to increase services and access to care for the citizens of San Antonio?

I implemented a federal grant (2002-2005) that has been sustained at Presa Community Center, which partnered the City, the federal government, and UIW to increase capacity to serve the Southside through innovative strategies involving college students.  I have developed a model for indigent mental health care.  This model is fully funded through United Way and serves ANYONE who walks through the doors at Presa.  I have treated clients from a behavioral health model and their overall health has improved.  These methods improve health behaviors and health-seeking behaviors, such as making appointments and following through on physician directives and prescriptions.  In this period of time I have served thousands of clients.  Through a handful of behavioral health sessions, clients have improved health by seeking appropriate health care.  I would also lobby the state legislature to release Medicare and Medicaid dollars to serve indigent care through the 100 new mental health care clinics, which would serve San Antonio citizens on a walk-in basis.  This would serve indigent care.

  3.  The disparity of health care between our poorest and wealthiest zip codes/districts is quite striking (Bexar County Health Collaborative 2016 report). How would you, if elected, reduce health disparities and improve health outcomes for our lower income communities/citizens?

 A comprehensive review of the location of mental health resources would determine where the gaps are located.  The first, and perhaps the bulk of mental health clinics I propose to be constructed would target these areas first, and if necessary, only focus on these areas of disparity.  These areas will probably include the zip codes where economic empowerment are necessary.  

4.  San Antonio has a high incidence of obesity and diabetes mellitus and has been ranked as high as second in the nation for obesity in recent years. Past city efforts attempting to improve these rates, such as trying to reduce the prevalence of sugary drinks in our community, have been met with controversy. What ideas do you have to reduce the incidence of these chronic health issues?

Ban the availability of soda in the public schools.  Work with HEB and other grocers to limit/eliminate marketing and advertising of sodas.  Ban the use of plastic bottles, which would limit the availability of sodas.  Encourage other cities within and near COSA to do the same. 

5.  According to the CDC, child abuse and neglect are serious problems that can have lasting harmful effects on its victims. The goal in preventing child abuse and neglect is clear — to stop this violence from happening in the first place. What local policies, resources and efforts will you support to promote safe, stable, nurturing relationships and environments for all children and families?

Ban the use of spanking in the City of San Antonio.  Make it a crime to touch inappropriately or hit a child, similar to the laws governing conduct between adults.  Require violators to seek mental health, rather than imprisonment or fines.  Provide mental health care for child victims of abuse through the system of mental health clinics I would construct.  Improve the minimum wage to a “living wage”, thus parents would not have to work so many hours and be away from the home.  My estimate is that $15/hour is probably not enough.  Based on the vast inequity between the haves and the have nots, I would negotiate with the “haves” to receive less of the benefits of taxation and income to insure that more money is available to more people.  

2017 Candidate Questionnaire

2017 Mayoral/City Council Candidates
Health Care Questions


1.   Despite affecting everyone in this community, "community health and wellness" has not been a big priority at City Hall. "Community health and wellness" had one third of the ranking that "streets" received in community input via SpeakUPSanAntonio. Yet it impacts our well being, workforce, economic development and the prosperity of San Antonio.
What health-related areas do you think deserve increased attention, priority, and local resources, and, if elected, how would you elevate the discussion of these health issues at City Hall and lead effective action to improve health and healthcare in our community?





2.  Bexar County is the primary source of funding for indigent health care in our area through the Bexar County Hospital District and University Health System. How would you, if elected, promote cooperative efforts to increase services and access to care for the citizens of San Antonio?





3.  The disparity of health care between our poorest and wealthiest zip codes/districts is quite striking (Bexar County Health Collaborative 2016 report). How would you, if elected, reduce health disparities and improve health outcomes for our lower income communities/citizens?





4.  San Antonio has a high incidence of obesity and diabetes mellitus and has been ranked as high as second in the nation for obesity in recent years. Past city efforts attempting to improve these rates, such as trying to reduce the prevalence of sugary drinks in our community, have been met with controversy. What ideas do you have to reduce the incidence of these chronic health issues?





5According to the CDC, child abuse and neglect are serious problems that can have lasting harmful effects on its victims. The goal in preventing child abuse and neglect is clear — to stop this violence from happening in the first place. What local policies, resources and efforts will you support to promote safe, stable, nurturing relationships and environments for all children and families?


Walk with a Doc on April 23

Friday, April 7, 2017

SAMHD Health Advisory


San Antonio Metropolitan Health District

HEALTH ADVISORY UPDATE: MUMPS

April 7, 2017
As of April 7, 2017, Bexar County has reported 9 cases of mumps in 2017, compared to 1 reported each year for the previous 2 years. According to the Centers for Disease Control and Prevention, 37 states are reporting over 1,100 cases of mumps so far this year.

Due to the communicable nature of this disease, please consider mumps as a diagnosis for any patient presenting with the following symptoms: Unilateral or bilateral swelling of the parotid or salivary glands preceded by a lowgrade fever, myalgia, malaise, or headache. Complications of mumps include: orchitis, encephalitis, meningitis, oophoritis and/or mastitis, and deafness.

Diagnostic Testing:

All individuals suspected of having mumps should be tested and reported to the local health department. Individuals previously vaccinated may not develop detectable IgM antibodies; therefore collecting a buccal swab for RT-PCR testing is preferred. PCR specimen should be collected as soon as mumps is suspected (maximum 7 days after parotitis onset). PCR testing for mumps is available through commercial laboratories. Massage the parotid gland area for 30 seconds before swabbing.

Testing Method among Individuals Vaccinated Against Mumps

Testing Method
Ideal Collection Time Frame
Notes
PCR
1- 3 days after parotitis and up to 7 days
Not affected by previous vaccination. Directly detects viral RNA and is not immune response dependant.
IgG
NA
IgG may peak a very high response prior to IgM response in vaccinated individuals if collected within 3 days of parotitis onset; must interpret carefully and look at timing of collection from onset of symptoms.
IgM
3-5 days after parotitis onset
IgM collected prior to 3 days after onset may be negative and
should not be used to rule out mumps.


Interpretation of Serology Results for Mumps

Mumps exposure history
IgM
IgG
Comments
References

Unvaccinated; no history of mumps


+


+ or −
IgM may be detected for weeks to months, 80 – 100% of serum samples IgM positive; low levels of IgG may be present at symptom onset.
Meurman et al. 1982; Sakata et al. 1985; Rota et al. 2013


1–dose vaccine history


+ or


Likely
+
Approximately 50% of serum samples collected 1–10 days after symptom onset were IgM- positive; 50%–80% of serum samples collected >10 days after symptom onset were IgM- positive.

Narita et al. 1998; Jin et al. 2004; Krause et al. 2007; Rota et al. 2013


2–dose vaccine history


+ or


Likely
+
13%–46% of serum samples collected less than 3 days after symptom onset were IgM- positive.  71% of serum samples collected >3 days were IgM positive.

Bitsko et al. 2008; Rota et al. 2009

Reporting:

Healthcare providers and laboratories should promptly report all suspected cases of mumps to the respective local health department prior to receiving laboratory results:

Bexar County Residents:            Other County Residents:

San Antonio Metropolitan Health District          Texas Department of State Health Services Phone: (210) 207-8876                                             Health Service Region 8
Fax: (210) 207-8807                                                 Phone: (210) 949-2000 or (210) 949-2121

Infection Control:

Mumps is transmitted from person to person by respiratory droplets or saliva. The incubation period is 16-18 days (range of 12-25 days) from exposure to onset of parotitis. Persons are contagious from 3 days before to 5 days after onset of parotitis.


People suspected of having mumps should be told to stay home from work, school, daycare, and any public outings (e.g., church, grocery store) until 5 days have passed since onset of parotitis. Mumps can be prevented with 2 doses of MMR vaccine. All healthcare facilities should ensure that they have updated documentation of mumps immunity status for all staff, not just healthcare providers. Documentation of immunity includes written record of receipt of 2 MMRs, positive serological titers, or birth prior to 1957 (although healthcare facilities should consider vaccinating unvaccinated personnel born before 1957 who do not have laboratory evidence of mumps immunity).

Thursday, April 6, 2017

TMA Leadership College Reference Form

Description: TMA+Tag_BW.jpgTMA Leadership College
Reference Form



INSTRUCTIONS

The TMA Leadership College (TMALC) was established in 2010 as part of Texas Medical Association’s effort to ensure strong and sustainable physician leadership within organized medicine. TMALC graduates will be thought leaders who can close the divide among clinicians and health care policymakers and serve as trusted leaders within their local communities.

The applicant listed in Section A of this document is submitting an application to participate in the 2017-18 program. Candidates are asked to provide two recommendations from physician references who are familiar with past and/or potential leadership experiences. The TMALC Executive Committee will utilize these references as part of the scholar selection process.

On behalf of TMA and this applicant, thank you for your time and investment in our future physician leaders.  Applications are due by June 1, 2017.

SECTION A — CANDIDATE INFORMATION




Last Name:      
First Name:      
M.I.:      
Designation:      
Preferred Mailing Address:      
Apartment/Unit No.:      
City:      
State:      
ZIP:      
Phone:      
E-mail:      


SECTION B — REFERENCE INFORMATION

Full Name:        
Relationship:      
Company/Organization/Practice:      
Address:      
E-mail:      
City:      
State:      
ZIP:      
Phone:      






SECTION C – NOMINEE ASSESSMENT

1. What three leadership traits will this individual bring to the TMA Leadership College?
     

     

     






2. In your experience, why should this physician be selected to participate in the TMA Leadership College?
      
























3. Any Additional Comments?
      

















SECTION D — SUBMISSION

Application submission deadline is June 1, 2017.
Thank you for participating in the leadership selection process. Your input will be invaluable. Please return this reference form to the TMALC applicant, or forward directly to TMA via the following:


+ MAIL
TMA Leadership College
401 W. 15th St.
Austin, TX 78701-1608
8 E-MAIL

6 FAX
 TMA Leadership College
 (512) 370-1693