Pictured at the White House Eisenhower Executive Office Building from Left to Right. Drs. Tracy and Luks, Mses. Keith and Volin, Drs. Ford, Hedrick and Olutoye.

APSA Pediatric Surgeons Meet with White House Advisor on Fetal and Maternal Health

APSA fetal surgery leaders Francois Luks, MD PhD, Holly Hedrick, MD, and Oluyinka Olutoye, MD PhD, joined by APSA Past President Henri Ford, MD MHA, President-Elect Thomas Tracy M MBA and the Medical Director of ACS Advocacy Patrick V. Bailey, MD MLS JD, were part of the Fetal and Pediatric Advisory Delegation that met last week with White House Advisors. Delegation members, (including Tippi Mackenzie MD, who could not attend), shared their collective thoughts that restrictive laws regarding reproductive health pose a threat to pregnant women and the health and safety of their fetuses.

In the wake of the US Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision (“the Dobbs decision”) in 2022, health professionals have been grappling with subsequent legislation from various states that affect medical decision-making and treatment for fetal and maternal health.

To inform policymakers of the implications of current and proposed laws, pediatric surgeons and fetal specialists representing both the American College of Surgeons (ACS) and the American Pediatric Surgical Association (APSA) met with White House health policy advisors on August 8th to discuss how the Dobbs decision is challenging the safety and autonomy of mothers. The focus for the meeting on August 8 with Katie Keith, Senior Advisor and Lina Volin, Chief of Staff and Advisor, to the White House Gender Policy Council, was to share their expert perspectives based on their unique perspective on the health of children, from before birth until well into adolescence and (young) adulthood. As fetal surgeons, they emphasized that the safety and autonomy of the mother is always the number one priority in the mother/fetus dyad and their belief that the Dobbs decision is a threat to the mother’s safety and autonomy.

The group expressed concern that the restrictive laws regarding reproductive health pose a threat to pregnant women, as well as the health and safety of their unborn children. They specifically noted:

• The Dobbsruling creates ambiguity. Fetal surgery is associated with a risk of fetal demise and pregnancy loss, which might be interpreted as termination. As such, physicians may be discouraged from intervening when indicated for fear of causing pregnancy loss and suffering legal consequences; or, conversely, may over-use medical intervention based on the on the principle that “everything must be done” to save the fetus.
• Multiple gestationsmay lead to complex decisions. Fetal intervention may be withheld if only one twin appears sick for fear of harming the other, even if intervention would benefit both; conversely, fetal intervention on a sick twin may be seen as “doing everything possible” but pose a risk to the unaffected twin.
• Unclear interpretation of a law meant to preserve fetal life at all costs may introduce misinformation and hamper medical progress. Fear of prosecution may interfere with a physician’s ability to offer evidence-based medical information and may discourage innovation, hampering current and future forms of fetal intervention.

The meeting grew out of conversations on the impact of Dobbs on those pediatric surgeons who specialize in fetal intervention held at the most recent APSA meeting in June 2023. During preparatory discussions with Biden administration staff, they expressed an interest in meeting with surgeons who specialize in fetal surgery to become educated on the state of the art in fetal interventions.

Those in attendance engaged in a robust conversation and were able to provide a background on both the impact Dobbs on their practices, and the uncertainty Dobbs has created when providing prenatal counseling. It is anticipated that further input will be sought after Ms. Keith and Ms. Volin determine how these important considerations fit into the Biden administrations broader policy agenda.

The APSA experts and attendees included:

• Holly L. Hedrick, MD, FACS, Louise Schnaufer Endowed Chair in Pediatric Surgery at Children’s Hospital of Philadelphia, PA
• Francois I. Luks, MD, PhD, FACS, Murray Beardsley Professor of Pediatric Surgery at the Alpert Medical School of Brown University in Providence, RI
• Oluyinka O. Olutoye, MD, PhD, FACS, Thomas Boles, Jr. Chair of Pediatric Surgery at The Ohio State University in Columbus
• Tippi Mackenzie, MD, FACS, John G. Bowes Distinguished Professor in Stem Cell and Tissue Biology and professor of surgery at the University of California, San Francisco
• Henri R. Ford, MD, MHA, FACS, Deanand Chief Academic Officer, University of Miami Miller School of Medicine, President-Elect, ACS, Past President, APSA
• Thomas F. Tracy Jr., MD, MBA, FACS, APSA Executive Director and President-Elect APSA
• Patrick V. Bailey, MD, MLS, JD FACS, Medical Director, Advocacy, ACS Division of Advocacy and Health Policy

APSA Members at the White House

Statement from the American Pediatric Surgical Association Board of Governors 

As pediatric trauma surgeons, when a call goes out about an injured child, we are ready. We gather our teams and we plan, prepare and wait in our trauma bays for the victim to arrive. We have trained for this, practiced it, and, unfortunately, lived these resuscitations over and over and over in emergency rooms across the United States. When the weapon used to perpetrate harm is an assault rifle, often the victim does not even make it alive to our doors. The injury inflicted by an assault rifle is so massive and widespread the victim dies at the scene.

In the massacre that happened in Uvalde, TX, the victims were 9 and 10 year old children, averaging about 60 pounds in weight. The damage and injuries that these children sustained were so extreme and widespread that their own parents could not recognize them. DNA samples from their parents were required to identify the children.

The American Pediatric Surgical Association (APSA) calls for a new federal Assault Weapons Ban on military-style firearms. During the decade of the previous ban, public mass shootings and deaths decreased. Although these mass shootings are a small percentage of overall gun deaths each year, they have been used to perpetrate mass shootings of children and adults in public places that should be safe such as schools, grocery stores, theaters and churches. These weapons have the capacity for rapid fire and large numbers of rounds between reloads which increases their lethality and the number of victims. They have been used in many locations including Newtown, San Bernardino, Las Vegas, Sutherland Springs, Parkland, and most recently in Uvalde, each incident killing more than a dozen people.

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These resources have been aggregated by the APSA Health Policy and Advocacy Committee for the convenience of the APSA membership. The committee’s goal is to inform members, non-member professionals, learners and parents about APSA’s position on current advocacy issues in children’s surgical care. They also aim to provide useful resources, further information and advocacy opportunities for various children’s advocacy issues, both within and outside of APSA. As pediatric surgeons, these issues are of the utmost importance to us, as they relate to the well-being of children. Your feedback is welcome.

Advocacy Issues of Focus

April – National Child Abuse Prevention Month
May – Mental Health Awareness Month
June – Gun Violence Awareness Month
September – National Childhood Cancer Awareness Month

SurgeonsVoice

SurgeonsVoice is the American College of Surgeons Professional Association’s (ACSPA) nationwide, interactive advocacy program that provides surgeons with tools and resources to contact Congress and strengthen surgery’s impact in Washington, DC, and across the country. Taking action on issues of importance to you via the SurgeonsVoice online action center is vital to making your voice heard in Washington.

Advocacy Topics

1. Vaccinations

1. CDC Vaccination Schedule
2. AAP Healthychildren.org Vaccination Info Page
3. Letter on VACCINES Act

2. Gun Violence

1. APSA Statement on Firearms
2. APSA survey on Firearms
3. Giffords Center
   1. Gun Violence Statistics page 
   2. Gun Law Factsheet page
4. EveryTown for Gun Safety Statistics Page

3. Child Abuse

1. APSA Statement on “Child Abuse and the Pediatric Surgeon”
2. AAP Guidelines on “The Evaluation of Suspected Child Physical Abuse” by AAP Committee on Child Abuse and Neglect
3. National Children’s Alliance – National Statistics on Child Abuse

4. Opioid Reduction

1. AAP National Factsheet
2. AAP Poster regarding medication storage and disposal 
3. Effective Pain Control for Children
4. Pain Management Plan
5. Evaluation Form

5. Drowning Prevention

1. AAP Statement on Prevention on Drowning
2. CDC Drowning Prevention