The high cost of a controversial bill in the California State Senate that would require pediatricians, in thousands of health screenings per year, to question kids on family gun ownership landed the measure yesterday in what is euphemistically called the “bone yard” of the state legislature, giving it one more hurdle to clear before heading to the full Senate.

Californians balked last year when Assemblyman Darrell Steinberg, D-Sacramento, proposed a substantially similar bill to Senate Bill 765 by Sen. Wesley Chesbro, D-Santa Rosa. Sent to the “suspense file” in the Senate Appropriations Committee yesterday, SB 765 resurrects a concept eventually removed from the vetoed Steinberg bill — codification of the American Academy of Pediatrics publication “Recommendations for preventive pediatric health care.” That report specifically includes recommendations made in the AAP’s 1999 publication, “The Role of the Pediatrician in Youth Violence Prevention in Clinical Practice,” which outlines measures to be taken by pediatricians in violence prevention, including advocacy of gun-control proposals.

Since the bill incurs an estimated annual cost of $8.6 million, it was automatically sent to the suspense file, as are all bills proposing costs of $150,000 or more.

According to the AAP, the violence-prevention publication “establishes an agenda for making this a routine part of pediatric practice in four major areas: clinical services, community advocacy, research and education. This broad agenda builds on a still-evolving body of knowledge, but the urgency of youth violence prevention requires further and immediate action by pediatricians.”

“Because many pediatricians encounter children and youth who are experiencing or are at risk for violence, pediatricians are well situated to intervene,” states the document. “Prevention of youth violence requires that pediatricians recognize violence-related risk factors and diagnose and treat violence-related problems at all stages of child development.”

Among the screening criteria listed in the report to identify “risk factors for violence among their patients” are:

  • “family stresses that could lead to violence (e.g., unemployment, divorce or death);

  • appropriate supervision and care and support systems (e.g., child care arrangements, the family and social network);
  • disciplinary attitudes and practices of the parents or caregivers (particularly about corporal punishment and physical/emotional abuse);
  • exposure to violence in the home (domestic violence or child abuse), school or community;
  • degree of exposure to media violence;
  • access to firearms (especially handguns) in their or a neighbor’s home, or the community.”
  • The Chesbro bill is intended to allay the concerns of the federal Health Care Financing Administration, according to the assemblyman’s staff. Currently, some participants in the state’s health-care program, Medi-Cal, are treated according to the AAP guidelines, but others are not. The agency sent a letter saying treatment for Medi-Cal beneficiaries should be the same across the board. Such a change would result in 248,000 more health screens for children ages 0-12, and 17,000 more for children ages 13-20, who use the state’s low-income health-care program, staff said.

    While acknowledging the importance of health care and safety for children, a public-policy group believes the bill sets a “dangerous precedent.” SB 765 requires the AAP recommendations to be used when setting state health-care standards and that those standards “shall be updated as necessary to be consistent with any changes made by the American Academy of Pediatrics.”

    “It asks state legislators to abdicate their right to set state policy,” said Karen Holgate of Capitol Resource Institute.

    According to the bill, the AAP recommendations would be included only after review by the state board that approves the health standards.

    “While the [violence-prevention recommendations] may be legitimate areas of concern, one wonders about the appropriateness of requiring all pediatricians to grill their patients about their homes and families without due cause,” Holgate continued.

    The AAP report begins by stating, “Each child and family is unique; therefore, these Recommendations for Preventive Pediatric Health Care are designed for the care of children who are receiving competent parenting, have no manifestations of any important health problems, and are growing and developing in satisfactory fashion. Additional visits may become necessary if circumstances suggest variations from normal.”

    Consistent with its health-screening requirements referred to by the Chesbro bill, the AAP also includes a sweeping gun-control proposal in its list of model legislation. Titled the “Protection of Children from Handguns Act,” one measure states that, “except in the hands of law enforcement officers or others specifically authorized by law, handguns serve no legitimate or lawful purpose, and constitute a hazard to the public health and welfare of the people, and especially of the children, of this State. [O]nly the prohibition of the manufacture, sale, and possession of handguns will remove handguns from the homes and streets of this State, thereby reducing the risks of injury and death to children from handguns.”

    The proposal would impose felony criminal penalties amounting up to $10,000 and/or two years in prison for manufacturing handguns and up to $2,500 and/or two years in prison for people who “enter into commerce, ship, transport, transfer, sell, sell at a gunshow, lease, or distribute” handguns. Possession of a handgun would qualify as a misdemeanor and result in up to a $1,000 fine and/or one year in prison for each offense.

    Like its predecessor, SB 765 is expected to be approved by the Senate and will likely move from the Appropriations Committee to the full Senate in late May.

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    When pediatricians become politicians

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