Category Archives: AAP

Iowa House Advances Child Safety and Health Legislation

On March 14 and 15, the Iowa House unanimously passed three bills to improve child safety and provide access to health care. The bills, all of which Iowa-AAP supports, will proceed to the Iowa Senate. Here are brief summaries of the legislation:


Children exposed to dangerous drugs. HF 543 provides that a parent, guardian, custodian, or other household member who unlawfully uses, possesses, manufactures, cultivates, or distributes a dangerous drug in the presence of a child can be subject to a Child in Need of Assistance proceeding and/or a founded child abuse report. The bill defines “dangerous drug” to include amphetamine, methamphetamine, cocaine, heroin, and opium or opiates. “In the presence of a child” means in the child’s “physical presence” or “occurring under other circumstances in which a reasonably prudent person would know that the use, possession, manufacture, cultivation, or distribution may be seen, smelled, ingested, or heard by a child.”


The bill also requires a health practitioner involved in the delivery or care of a newborn or infant to report to the Iowa Department of Human Services if he or she discovers “physical or behavioral symptoms that are consistent with the effects of prenatal drug exposure or a fetal alcohol spectrum disorder.”


Insurance coverage for applied behavior analysis. HF 215 requires that certain individual and group health insurance policies for public employees who are not state employees cover applied behavior analysis for the treatment of autism spectrum disorder for children 18 years old or younger. Treatment must be provided by a board-certified behavior analyst or by a licensed physician or psychologist. The bill allows insurers to set annual maximum benefits that are not less than $30,000 for a child through age 6, $25,000 for a child 7 through 13, and $12,500 for a youth 14 through 18. The bill allows a plan to impose deductibles and coinsurance charges. The bill becomes effective on January 1, 2018.


Youth athlete concussion. HF 563 requires coaches to have training in CPR and the use of an automated defibrillator by July 2018. The bill states findings on concussions, their frequency in sports and recreational activities, and potential consequences. The bill requires the state’s athletic associations to work together to develop training materials, guidelines, and protocols on concussions and distribute information sheets on concussions to parents and guardians. The bill further mandates removing an athlete from a contest if he or she shows signs, symptoms, or behaviors consistent with a concussion or brain injury.


Under legislative rules, the bills must pass out of a Senate Committee by March 31 to remain eligible for final passage. Since a companion bill on autism coverage has already passed a Senate committee, HF 215 is not subject to this deadline.


Update: The Iowa Legislature approved the drugs and autism bills, which the Governor has signed.The Senate Human Resources Committee approved the concussion bill, but the full Senate did not vote on it before session’s end.  

Divided Senate Subcommittee Advances Gun Bill

Divided Senate Subcommittee Advances Gun Bill

After an hour of public testimony from supporters and opponents, a subcommittee advanced an omnibus gun bill (HF 517) to the Senate Judiciary Committee by a 2-1 vote. Senators Dan Dawson (R-Council Bluffs) and Brad Zaun (R-Urbandale) supported the bill, which Janet Petersen (D-Des Moines) opposed – while raising multiple questions about its meaning and consequences.


The Des Moines Register reported on the competing testimony. Bill proponents Included a father and two young daughters, who have lobbied for removing Iowa’s minimum age of 14 for possessing a pistol or revolver. Others stressed the primacy of the rights to bear arms and to act in self-defense, with one speaker maintaining that “self-defense is the most basic of human rights.”


Opponents argued the bill would increase the risk of deaths and injuries because of expanded “stand your ground” rights, more gun carrying in public spaces, and removal of the 14-year-old minimum age limit. Several speakers urged legislators to err on the side of public safety in balancing competing rights.


Representing Iowa-AAP, Steve Scott warned in his testimony that removing the 14-year minimum age would lead to more accidental injuries and deaths. He cited an October 2016 study by the Associated Press and USA Today finding at least one child being accidentally killed by a firearm every two days from January 1 to June 30, 2016.


While recognizing many parents will provide the hands-on supervision required by HF 517, Scott insisted others will not. He cited the fatal consequences of parental failure to protect children in Iowa Child Death Review Team’s most recent report. The report found dozens of preventable child deaths resulting from unsupervised swimming, unsafe sleep positions, failure to use car seats, absence of smoke alarms, and unsecured firearms. Scott noted that the difficulty for anyone in supervising children handling firearms due to their physical and emotional immaturity, the inherent danger of firearms, and potential harm during only a few distracted seconds.


The Senate Judiciary Committee is scheduled to vote on HF 517 on Thursday, March 16 at 11 a.m.


Update: Both chambers approved the gun bill, which the Governor signed on April 13. 

Vaccine Exemption Bill Dies in Committee

Vaccine Exemption Bill Dies in Committee

March 2 is the end of the Iowa Legislature’s first “funnel”: the date by which most policy bills must advance through committee in order to receive further consideration. One of the casualties of the funnel deadline is HF 7, which would allow an exemption from compulsory immunization based on someone’s “personal conviction.” (For more information on this legislation, visit here).


By a 2-1 vote, a House Human Resources subcommittee approved the legislation after a hearing on January 24. The subcommittee acted despite organizational opposition and statements against it, including testimony by Dr. Nathan Boonstra, a UnityPoint infectious disease expert and an Iowa-AAP board member. Dr. Boonstra warned that adding unvaccinated children to a classroom dramatically increases the risk of disease for others around them who might not be able to be vaccinated — particularly children with special medical needs like congenital heart disease or severe asthma.


HF 7 reportedly faced bipartisan opposition from a significant majority of the House Human Resources Committee. As a result, the committee chair, Rep. Joel Fry (pictured), did not bring the bill up for a vote — leading it to its demise at funnel’s end.

Divided Iowa House Panel Advances Gun Bill

Divided Iowa House Panel Advances Gun Bill

Despite widespread opposition in a hearing on February 23, by a 2-1 vote, a subcommittee advanced to the House Judiciary Committee legislation, HSB 133, that vastly expands gun rights.  Almost two dozen spoke against the bill, criticizing many of its provisions, including those:


  •  Removing a minimum age for possessing a revolver or pistol
  • Expanding “stand your ground” rights
  • Increasing risks from expanding the right to carry firearms in public spaces, like schools, hospitals, and the Capitol
  • Creating a lifetime permit to carry weapons
  • Removing the obligation to obtain a permit to acquire a firearm
  • Making records of permit holders confidential

The bill’s provision expanding the right to use lethal force drew the most criticism, with warnings of increased deaths and risk to people of color. Two opponents of this provision are quoted in a Des Moines Register article.


The Iowa-AAP has registered against the bill, objecting to a provision allowing a child of any age to possess a pistol or revolver. Opposing this provision on behalf of Iowa-AAP and Blank Hospital, pediatrician Dr. Amy Shriver (pictured) noted how 18,000 children are killed by firearms annually in the United States. Citing her clinical experience, Dr. Shriver contended that most children under the current limit of 14 years old lacked the maturity to safely use handguns.


The American Academy of Pediatrics believes that, “The absence of guns in homes and communities is the most reliable and effective measure to prevent firearm-related injuries in children and adolescents.” The Iowa-AAP will continue its opposition to the bill, including at a March 2 legislative breakfast co-hosted with Blank Hospital.


Update: Both chambers approved the gun bill, which the Governor signed on April 13. 

Iowa-AAP Opposes Bill Restricting Communication About Firearms

The Iowa-AAP has registered against new legislation (SF 254) restricting a health professional’s communications with patients about firearms. The legislation provides that a licensed health professional “shall not inquire about or otherwise request information about a patient’s or client’s ownership or possession of firearms.” A health professional violating this proscription could be guilty of a serious misdemeanor – punishable by up to a one-year sentence and fine of $1,875.


If enacted, SF 254 would be only the second state law imposing such a constraint on health professional communications with patients. The law disregards research showing the important role pediatricians and other physicians can play in protecting children from firearm injury or death. According to the American Academy of Pediatrics, “asking a parent a question about gun ownership can open up an opportunity to educate parents about potential dangers to which their child is exposed.” Such “anticipatory guidance” is a “major component” of pediatric care helping patients and their families “know what to watch for in the future.”


Further, the Iowa bill likely violates the First Amendment Right to free speech – as Florida just learned after six costly years of unsuccessful litigation defending a similar law. A 2011 Florida law proscribed medical professionals from inquiring about a patient or family member’s ownership of a firearm or ammunition unless relevant to personal safety. It also directed that medical professionals refrain from “unnecessarily harassing” patients about firearms.


Soon after the law’s enactment, doctors and medical groups secured a federal court order enjoining its enforcement. Subsequent court and appellate actions led to a February 16 decision by the 11th Circuit Court of Appeals  finding that the Florida law violated the First Amendment’s guarantee of free speech.  In a 10-1 decision and 90-page decision, the court also declared the “unnecessary harassment” provision unconstitutionally vague under the Fourteenth Amendment.


The court decision is a landmark one, with implications beyond Florida — as noted in a New York Times article. In a statement expressing delight with the court decision, the American Academy of Pediatrics president Fernando Stein, M.D. declares,  “Pediatricians routinely counsel families about firearm safety just as they offer guidance on seat belt use, helmets and parental tobacco use to reduce the risk of injury to children where they live and play. These are all topics that families should feel very comfortable talking about with their pediatrician.”


As of February 18, Blank Hospital, the Iowa Medical Society, and the Iowa Psychological Association have also registered against SF 254, which has been referred to the Senate Human Resources Committee. A subcommittee has not been appointed.


Update: This legislation did not advance. 

Fireworks Bill Advances Despite Opposition

Despite fifty minutes of largely critical testimony on February 6, a divided Senate subcommittee approved legislation (SSB 1051) to legalize sales of fireworks in Iowa. The sales can occur in tents or buildings in time periods overlapping July 4 and January 1. Senators Jake Chapman (R-Adel) and Jason Schultz (R-Schlesweig) supported the bill, which Senator Janet Petersen (D-Des Moines) opposed.


Representatives of health organizations, local government, firefighters, veterans, and EMS personnel spoke against the legislation, citing:


* The high risk of injuries to children (e.g., the rate of child injuries from fireworks is six times higher in Missouri, — where sales are legal – than in Iowa)

* The increased risk of anxiety and PTSD from fireworks

* The inherent hazardous character of fireworks and the difficulty of ensuring a safe distance

* The increased demand on EMS and firefighters, especially in rural areas dependent on volunteers

* The lack of an opt-out option for local governments



The Iowa-AAP has registered against the legislation, which now goes before the Senate State Government Committee.  The Des Moines Register has a long report on the hearing.

Divided Subcommittee Advances Immunization Exemption Bill

Divided Subcommittee Advances Immunization Exemption Bill

Over the objections of Rep. Beth Wessel-Kroeschell (D-Ames), the Iowa-AAP, and 20 other health and education groups, Reps. Steven Holt (R-Denison) and Sandy Salmon (R-Janesville) advanced legislation (HF 7) weakening Iowa’s compulsory immunization law — described in an earlier post. The House Human Resources Committee will now consider whether to add to medical and religious exemptions from compulsory immunization a new one because of “personal conviction.”


While taking no position on the legislation, the Iowa Department of Public Health’s liaison Deborah Thompson cited several concerns. In a three-page statement, she warned the new provision would lead to fewer immunizations, putting children at greater risk of infection – particularly those unable to be immunized because of age and medical conditions. Citing the experience in other states, she warned of a likely increase in infection rates and the resultant costs.


Dr. Nathan Boonstra, an infectious disease expert at Blank Hospital and a board member of the Iowa-AAP (pictured), addressed the committee — warning that withholding vaccines from a child raises the risk of infection not just for that child, but also for many others, particularly in a school setting.  Adding unvaccinated children increases the risk of disease for others around them dramatically — particularly for children with special medical needs like congenital heart disease or severe asthma. He further maintained scientific research has shown vaccines as safe and effective.


Rep. Wessel-Kroeschell agreed with the two experts – noting the adverse effects on children and communities from the bill’s exemption.


Without responding to the arguments against the bill, Reps. Holt and Salmon insisted it was necessary as a matter of “freedom” because no one should be forced by government to put something into their body.


The Iowa-AAP has registered against the legislation and its president Dr. Marguerite Oetting has developed a statement on the importance of immunizations. Iowa-AAP will also be working with a broad coalition of organizations to persuade the House Human Resources Committee to oppose the bill.


Update: This legislation stalled in the House Human Resources Committee (more). 

Iowa-AAP Opposes Bill Expanding Immunization Exemptions

The Iowa Chapter of the American Academy of Pediatrics is opposing legislation (HF 7) that would allow an exemption from the state’s compulsory immunization law based on someone’s “personal conviction.” Current Iowa law (Iowa Code 139A.8) allows for exemptions only if (1) a medical professional attests that immunizing would be “injurious” or (2) immunization would conflict with the “tenets or practices” of a person’s “recognized religious denomination.”


An American Academy of Pediatrics statement on childhood immunization calls it one of the “crown achievements” in public health and a major component of pediatric health care and disease prevention. The statement recommends permitting only medical exemptions to school entry immunization requirements.


Sixteen states currently allow conscientious or philosophical exemptions to compulsory immunizations. Such laws were blamed for a 2014 outbreak of measles in California and other states – the worst in 20 years.


Several other medical and educational organizations have registered against HF 7. The House Human Resources will consider the bill; it is not yet assigned to a subcommittee.


Update: This legislation stalled in the House Human Resources Committee (more).