AMA to advocate on gender definition, sexual assault treatment
(Updated at 6:30 p.m. ET)
The American Medical Association's House of Delegates on Tuesday set the group's stance on several controversial healthcare policies including gender definition and the detention of migrant children, while also addressing emergency departments' response to sexual assault victims.
The AMA will launch educational campaigns for state and federal lawmakers about the "medical spectrum of gender," as the Trump administration reportedly plans to define sex as "a person's status as male or female based on immutable biological traits identifiable by or before birth" in Title IX. The New York Times first reported the executive branch's plans in October.
Physicians are particularly concerned about public health consequences for transgender people or those born with intersex traits if sex is narrowly defined.
"Sex and gender are more complex than previously assumed," said Dr. William Kobler, an AMA board of trustees member. "It is essential to acknowledge that an individual's gender identity may not align with the sex assigned to them at birth."
Caitlin Oakley, national spokesperson for HHS, said Tuesday that the department doesn't comment on "alleged, leaked documents that purport to indicate the status of deliberations or the focus of the department."
A federal district judge in North Texas shortly before the close of the Obama administration sided with plaintiffs to immediately block implementation of the Obama administration's broader definition of sex.
"The court order remains in full force and effect today and HHS is bound by it as we continue to review the issue," she said in a statement. "Everyone deserves to be treated with respect and HHS's Office for Civil Rights will continue to vigorously enforce all laws as written and passed by Congress, prohibiting discrimination in healthcare on the basis of race, color, religion, national origin, sex, age, and disability."
The AMA at the interim meeting also said it will push for major state and federal population surveys, as well as claims databases for government and private health insurers, to include people's sexual orientations and gender identities.
The AMA's policy includes the U.S. census and the U.S. Census Bureau's Current Population Survey so physicians, public health experts and researchers can understand health disparities.
"The AMA will advocate against the removal of demographic data inclusive of sexual and gender identity from public health surveys and registries without plans for updating measures of these data," AMA board member Dr. William McDade said.
The AMA once again blasted the Trump administration's halted family separation policy as well as any weakening of the 1997 Flores settlement—which barred long-term detention of children and set standards of treatment and care. The AMA is opposed to government officials dispensing psychotropic drugs to detained migrant children without their parents' permission.
"While immigrant children have experienced multiple emotional traumas on their travels to the U.S., the AMA only supports the practice of administering psychotropic drugs when there has been an evaluation by appropriate medical personnel, and with parental consent or court order in the case of imminent danger to the child or others," Kobler said.
On the question of homelessness and access to treatment for homeless people, the AMA wants policymakers to make identification cards free or much cheaper for the homeless population, so Medicaid enrollment is easier and patients can get medical treatment more readily.
The delegates noted that 36% of the homeless population suffers from severe mental illness or chronic substance use, while pharmacists in 43 states can require photo IDs before dispensing drugs.
More than 50% of homeless people have been denied housing or shelter because they lacked ID, according to the National Law Center on Homelessness and Poverty.
"It is outrageous that the small fees associated with getting a birth certificate or state ID are preventing homeless Americans from receiving access to care and services they desperately need," said Dr. E. Scott Ferguson, an AMA board of trustees member. "The AMA has long prioritized access to care as key to improving the health of the nation."
As the rate of sexually transmitted diseases and sexual assaults spike across the country, the AMA wants emergency departments to hire more staffers who can give medical forensic examinations and post-exposure prophylaxis for HIV as well as do HIV testing.
Citing U.S. Justice Department 2016 data of nearly 324,000 reports of rape or sexual assault in that year alone, the AMA noted that sexual assault survivors account for about 65,000 to 90,000 emergency department visits annually.
The delegates are pushing for greater access in emergency rooms to sexual assault nurse examiners and other trained clinicians.
Survivors require a medical forensic examination within 72 hours of their assault in order to provide evidence critical for prosecuting their attackers.
"It is also essential that these patients are offered HIV testing and post-exposure prophylaxis within 72 hours," Ferguson said. "However, it can be difficult for emergency physicians to simultaneously oversee these very necessary and specific multiple-hour examinations while also caring for emergent patients."
The delegates also addressed drug imports, taking the step of supporting U.S. patients if they purchase prescription medications in-person for personal use from licensed Canadian pharmacies. The policy does not apply to mail-order or online drug purchases and imports.
As gun control continues to roil policymakers, AMA urged states to tighten their reporting of relevant records to the National Instant Criminal Background Check System (NICS). The delegates also expanded the AMA policy on the ban on proliferation of firearms that can't be detected in airport screening to include 3D-printed firearms.
The AMA will also work with the U.S. Food and Drug Administration (FDA), whose administrator Scott Gottlieb is cracking down on tobacco and vaping industries, and others to push for a ban and restrictions marketing of e-cigarettes and vaping devices to minors under 21.
The group called the use of these devices "an urgent public health epidemic."
"The AMA is committed to keeping harmful tobacco products out of the hands of young people and we will continue to urge the FDA to ban flavors, as well as marketing practices, that enhance the appeal of these products to youth," said Dr. Albert J. Osbahr, III, member of the AMA board of trustees. "We believe more stringent policies will help protect our nation's youth from the harmful effects of tobacco use."
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