Official Statement

On February 11th, 2021, Dr. Princess Dennar, the first Black female program director at Tulane University School of Medicine, was terminated from her position with Tulane’s Med-Peds residency without warning or clear cause. Since then, evidence has emerged that this termination may have been the culmination of years of racist and sexist mistreatment against Dr. Dennar and minoritized residents in the program; or, indeed, retaliation against Dr. Dennar for speaking out and filing complaints about this mistreatment.

National APAMSA stands in solidarity with Dr. Dennar, our Tulane chapter, the Tulane community, and our Black colleagues in medicine. Too often, healthcare is a hostile field for minoritized trainees and leaders – those who are best equipped to care for patients marginalized by that very same system. We cannot allow this insidious violence to continue.

We urge our members to educate themselves about what is happening in Tulane – a situation that could very well be happening in their home institutions – and to take the following actions in support of Dr. Dennar:

1. Sign and circulate Tulane’s letter to Tulane administration with specific demands for clarification, transparency, and accountability (signee identities remain private and protected);

2. Sign and circulate this national letter of support with specific demands for clarification, transparency, and accountability from Tulane and the ACGME (signatures displayed);

3. Customize and send this email to the ACGME (link automatically opens an email for you);

4. If in a position to do so, contribute to the GoFundMe for Dr. Dennar’s legal costs;

5. Follow @MedPeds21 and @TheTulane7 to stay updated

If you have questions or concerns, please contact the main organizers at Tulane University School of Medicine, the S.L.A.M Coalition (SNMA, LAMSA, APAMSA, MSPA) at slam.tusom@gmail.com.

In solidarity,

Your National APAMSA Board

February 19, 2021
Liz Richter
Acting Administrator
Centers for Medicare & Medicaid Services
U.S. Department of Health and Human Services
7500 Security Boulevard
Baltimore, MD 21244

Dear Acting Administrator Richter:

As the Biden Administration begins to take aggressive steps to deploy the COVID-19 vaccine across the nation, we are writing to seek your assistance with urgent Medicare and Medicaid vaccine reimbursement concerns that could significantly impact the ability to reach the people most in need of the vaccine.

Federally Qualified Health Centers (FQHCs or “health centers”) work tirelessly to ensure access to timely, affordable care for all individuals, regardless of ability to pay. We appreciate the confidence the Biden Administration has placed in health centers to deliver the COVID-19 vaccine to the most vulnerable communities. However, it is critical that health centers have the tools and resources they need to do their part. To ensure their continued ability to fulfill this commitment, we are writing with an important request.

In recognition of the critical role FQHCs are playing on the front lines of the pandemic, we request that CMS establish FQHC-specific COVID-19 vaccine administration reimbursement policiesfor Medicare and Medicaid, ensuring that health centers have the resources they need to keep their doors open. Existing federal regulations, including the COVID-19 Interim Final Rule that went into effect on November 2, 2020,

and other guidance will leave health centers severely challenged at the worst possible time. It is imperative that health center reimbursement rates account for the increased costs associated with the COVID-19 vaccine. Such costs may include factors such as hiring additional or temporary staff; training; outreach and vaccine hesitancy related activities; storage capacity; altered, temporary, or rented facilities; PPE and other equipment; IT systems interfacing; outdoor and overnight capacities; security; cleaning and disposal; patient transportation; and lost revenues for redeploying staff. Furthermore, the vaccine’s short shelf life requires health centers to strategically schedule appointments, perform additional outreach for both doses, and dedicate staff for patient monitoring while complying with social distancing and occupancy guidelines.

Below you will find our specific policy recommendations:

Medicare

Serving over 2 million Medicare beneficiaries a year, health centers are positioned to meet the goal of vaccinating the 65 and older population as quickly as possible. Under current Medicare regulations, health centers are reimbursed for vaccine administration through their Medicare Cost Report, which takes 12 to 18 months for processing and payment. We request that the agency establish the following:

• An interim payment for COVID-19 vaccine administration based on the Medicare Part B Physician Fee Schedule to ensure they receive reimbursement in a timely manner — and before 2022. • A revised reimbursement rate for FQHCs at 100 percent of reasonable costs for the COVID-19 vaccine administration given the additional costs to administer the COVID-19 vaccine.

Medicaid

Health centers serve 1 in 5 Medicaid beneficiaries nationwide and need adequate compensation for the additional resources required to meet the demand for vaccinations. In recognition of the critical role health centers play for Medicaid patients, Congress established a specific payment methodology for health centers,

the FQHC Prospective Payment System (PPS). This payment system is central to the ability of health centers to provide a broad range of primary care services to Medicaid beneficiaries while serving other low income patients. Currently in some states, vaccine-only visits do not trigger a Medicaid billable visit for FQHCs, which means they do not receive the PPS reimbursement rate and, in some cases, receive a very low or no additional administration fee at all for administering the COVID-19 vaccine. As a result, we request that the agency do the following:

• Require states to cover COVID-19 vaccine administration and specimen collection as a mandatory service for FQHCs under Medicaid state plans. This would require a state to either: (a) increase the PPS rate to account for the “new” mandatory service or (b) create an alternative payment methodology (APM) to pay for vaccine administration outside of the PPS rate.

• Encourage states to propose APMs that provide additional payments for vaccine administration to compensate for the additional resources required to meet the demand for vaccinations related outreach and general administration.

• Provide flexibility for more health care professionals employed, or under contract, with health centers to trigger a “billable visit” for vaccine administration.

• Require states retroactively reimburse health centers for additional costs of COVID-19 vaccine administration should new payment policies be adopted.

We appreciate the administration’s attention to this important issue and look forward to working together to ensure our nation’s most vulnerable are able to access the COVID-19 vaccination.

Sincerely,

National Association of Community Health Centers(NACHC)

AIDS Foundation Chicago

The AIDS Institute

AIDS United

AMDA – The Society for Post-Acute and Long Term Care Medicine

American Academy of Family Physicians American Immunization Registry Association American Kidney Fund

American Muslim Health Professionals American Network of Community Options & Resources (ANCOR)

Asian & Pacific Islander American Health Forum

Asian Pacific American Medical Student Association (APAMSA)

Association of Asian Pacific Community Health Organizations

Association of Black Cardiologists

Association of Nurses in AIDS Care

Autistic Self Advocacy Network

Cascade AIDS Project

Casting for Recovery

Center for Disability Rights

The Center for Law and Social Policy (CLASP)

Christ Health Center

CommonSpirit Health

Disability Rights Education and Defense Fund (DREDF)

Empowering Pacific Islander Communities (EPIC)

Equality California

Familia Unida

Hep B United

Hepatitis B Foundation

Hispanic Federation

HIV Medicine Association

Howard Brown Health

Immunization Action Coalition

Immunize Nevada

Infectious Diseases Society of America International Association of Providers of AIDS Care (IAPAC)

International Community Health Services Justice in Aging

Los Angeles LGBT Center

Multi-State Partnership for Prevention National Alliance for Hispanic Health National Alliance of State and Territorial AIDS Directors

National Association of Pediatric Nurse Practitioners

National Association of Social Workers National Black Nurses Association

National Consumers League

National Council of Asian Pacific Americans (NCAPA)

National Council for Behavioral Health National Council of Jewish Women National Health Care for the Homeless Council National Organization of Black Elected Legislative Women

National Viral Hepatitis Roundtable

Nevada State Medical Association Nurses Who Vaccinate

Prism Health

RESULTS

Shriver Center on Poverty Law Sickweather

Silver State Equality-Nevada

South Dakota Public Health Association UnidosUS

Vaccinate Your Family

VaxCare

The Well Project

On January 28th, 84-year-old Vicha Ratanapakdee, a Thai American, was murdered while on his morning walk in the Anza Vista neighborhood of San Francisco. On February 3rd, a 64-year old Vietnamese grandmother was assaulted and robbed in San Jose in broad daylight. That same day, Noel Quintana, a Filipino-American, was slashed across the face on a subway in Manhattan.

These deliberate and targeted acts of violence against Asian/Pacific Islander Americans (APIA) are part of a long history of racism that threatens our communities. APIA elders are particularly vulnerable and are now being attacked, physically and verbally, more so than ever since the onset of the COVID-19 pandemic. According to the Stop AAPI Hate National Report, over 2,000 anti-APIA incidents have been reported since early 2020, which does not account for the number of unreported and ignored cases.

APIA communities such as those in Oakland, CA are expecting a rise of robberies and burglaries ahead of the Lunar New Year celebration. The silence of the mainstream media exacerbates the model minority myth–Asians are assumed to be a monolith, “well-behaved,” and generally wealthier, healthier, and more educated–erasing concerns that many of us face: economic suffering and disproportionate mortality from COVID; mental health crises and stigma; and racist violence and police brutality. In response to these acts of anti-Asian violence, there have been calls from within our community for increased policing and punitive measures. While we firmly advocate for the protection of our communities, we emphasize that increased policing is harmful both to our own communities (ie the recent murder of Christian Hall, post-9/11 policing of South Asians) and those of our Black and brown siblings. Instead, we must invest in community-based interventions.

APAMSA denounces these and all acts of violence against our community, and we oppose racism in all its forms. Additionally, APAMSA reaffirms our calls for better reporting of and prevention against anti-APIA hate incidents as part of any anti-racist policy. We urge our members to both amplify and condemn anti-Asian violence and interrupt and call out anti-Black and all forms of racism. In this time of crisis, we urge our allies to show solidarity with APIA communities by speaking out against all forms of anti-APIA aggression and demanding our policymakers to pass inclusive and comprehensive anti-racist policies that not only address the concerns of APIA communities but those of all marginalized peoples.

In solidarity,

Your APAMSA National Board

In April 2020, APAMSA condemned the rising tide of anti-Asian violence and offered tools for our members to support one another as we faced COVID in the hospitals and racism on the streets. Since then, our community has suffered nearly a year of racist verbal and physical abuse that was sometimes, unfortunately, stoked by the federal administration.

Today, we thank President Biden for taking the important step to denounce anti-Asian racism within his first 100 days in office. In addition, we welcome his memorandum’s guidance for the Justice Department on how to better collect data and assist with reporting and preventing anti-Asian hate incidents.

For resources on how to respond to such incidents or where to receive support, please see https://www.apamsa.org/advocacy/official-statements/42620-coronavirus-resources & https://stopaapihate.org/

In solidarity,

APAMSA National Board

Today, APAMSA celebrates a new chapter in the United States, including the swearing-in of our first Asian American and Black woman Vice President.

As future health professionals, we anticipate a number of policies from President Biden and Vice President Harris today that will support Asian American/Pacific Islander communities through the ongoing pandemic and beyond, including:

• Reinstating the Directorate for Global Health Security and Biodefense

• Rejoining the World Health Organization

• Counting undocumented Americans in the U.S. Census

• Ending the Muslim travel ban

Finally, as we continue to serve our patients through this difficult time, we would like to point our members to these words from National Youth Poet Laureate Amanda Gorman:

…the new dawn blooms as we free it

for there is always light if only we’re brave enough to see it

if only we’re brave enough to be it.

National APAMSA is proud to sign onto the following petition for racial justice in eGFR reporting. Race is a sociological construct, not a biological fact, and race-based tests and therapies should no longer be an unquestioned part of our medical practices. We are passing on the following request from the petition authors for individuals to sign on to the petition:

Since June, numerous institutions across the country, including UCSF, have successfully eliminated race-based eGFR reporting, but it needs to happen in ALL hospitals. So, with this new, national petition, we are taking our demands to the National Kidney Foundation-American Society of Nephrology (NKF-ASN) and beyond.

If you haven’t already, please sign on to the National Petition for Racial Justice in eGFR reporting. Link for sharing: https://tinyurl.com/change-egfr

This is not just about eGFR, and it’s not just about 1 or 2 individually isolated problematic race-based equations or guidelines. It’s a whole system’s problem of weaponizing race as biology. And it’s not just about our institution. It’s all of healthcare. Thank you for considering signing on!

In solidarity,
Drs. Monica Hahn, Stephen Richmond, Juliana Morris, Nathan Kim, and Vanessa Grubb

On September 25th 2020, the Department of Homeland Security released a proposal to limit foreign student visas to two years. According to the proposal, after two years, the students will have to reapply for an extension to stay in the country and complete their education. The supposed purpose is to allow for increased accountability, identification of security threats, and oversight regarding the foreign students, such as discontinuing education for students who are “more likely to fail”. The proposal specifically targets students from 59 countries – those designated as “state sponsors of terrorism” and those with a high rate of visa overstays. The majority of these students are from African nations, China, India, Brazil, and Canada.

This proposal is not the first time Trump has attempted to decrease the number of foreign students and workers in the U.S.; in July of 2020, the administration attempted to remove all foreign students studying through online programs. This proposal may appear reasonable on its surface, but the vague criteria for discontinuation – such as “suspicion for potentially applying for additional immigration benefits” – allows too much room for for immigration officers to act on racism and xenophobia rather than national interest, and leaves international students to face the burden of uncertainty regarding their status and safety, as well as long and arduous re-application processes. Additionally, this proposal could deprive the country of high levels of revenue as well as future members of the skilled workforce, posing real consequences for the U.S. economy.

Finally, we are concerned that this proposal would disproportionately impact Asian American and Pacific Islander healthcare students. Nursing, physician, and scientist training programs all take longer than 2 years to complete, and our community makes up over 10% of the healthcare workforce. We stand opposed to this potential policy and to the treatment of our international students as threats, rather than assets, to our country.

In Solidarity,

National APAMSA

APAMSA mourns and condemns the murders of George Floyd (5/25/20), Breonna Taylor (3/13/20), Tony McDade (5/27/20), and Ahmaud Arbery (2/23/20).

We recognize that these senseless deaths are part of a long history of police brutality and violence against Black people in America. This is a public health issue: police brutality is a leading cause of death for young Black men in the United States, and the chronic stress associated with systemic racial inequity causes disproportionate suffering in Black communities through lower quality of life and mental health. Barriers to resources further exacerbate racial inequities in health outcomes for chronic diseases and acute illness alike, including COVID-19.

As Asian/Pacific Islander Americans, we recognize that anti-black racism is one of the foundations of injustice in the United States, and paves the way for racism against other people of color. Correspondingly, we know that Black activists paved the way for our communities in their fight for voting rights, for integration, for equality. So just as Black leaders have stood with us in solidarity against the anti-Asian racism exacerbated by this pandemic, we stand with them against anti-black racism and affirm that Black Lives Matter.

At the same time, we know that Asian communities have perpetrated anti-blackness, benefited from proximity to whiteness, and contributed to the oppression of Black communities. One of the police officers present at George Floyd’s murder was Asian; he was complicit, as many of us are, in his silence and inaction. We are committed to self-reflection, to identifying and rooting out anti-blackness within ourselves and our communities, and to learning from our Black colleagues.

Additionally, as future medical professionals, we are called to provide the best possible care for our patients, no matter who they are. Doing so, however, is impossible in a system where Black men are regularly and unjustly killed by law enforcement without consequence. This consistent failure to protect and serve Black communities directly undermines the work we do as healers for our Black patients. Thus, in our mission to “do no harm,” we must call out and work to dismantle racism in healthcare and in society more broadly. And we cannot do this alone: we need our institutions of learning to center the voices of our Black colleagues and teachers, recognize racism as a public health issue, and educate our next generation of healthcare leaders to combat racism throughout their careers.

Finally, as the leaders of APAMSA, we call on our members to stand with us, to learn more about these issues and the ways in which they have been complicit in anti-blackness, and to actively speak out and fight against racism. This is a difficult, emotionally challenging process, but we are all here to support each other as we improve our community, our society, and – most importantly – Black lives. To quote Angela Davis: “In a racist society, it is not enough to be non-racist. We must be antiracist.”

Actions:

• Join us in refraining from purchases on 7/7/20, aka #BlackoutDay2020

• Join our Anti-Blackness Workshop on 6/13 and/or UWashington’s workshop on 6/15!

• Join our national Anti-Racism Working Group.

• Donate:

  • George Floyd’s family’s fundraiser

  • Louisville Community Bail Fund

  • Minnesota Freedom Fund

• Speak out:

  • Sign this petition for #Asians4BlackLives

  • For Breonna Taylor

  • 2020 police brutality actions/resources masterlist

  • Allyship masterlist

  • BlackLivesMatter action masterlist

• Talk about racism with your families:

  • Conversation starters

  • Helpful roadmap

  • Compiled resources for convos w/ South Asian families

  • Letters for Black Lives translated into various Asian languages (also has videos if you can’t read!)

• Learn more:

  • #Asians4BlackLives official statement

  • Anti-black racism in healthcare / How to make black lives matter for COVID

  • Black/Asian feminist solidarity reading list

  • Asian Accountability To Black People: A very basic incomplete resource: bit.ly/aznsplzdobetter

  • API/Black Solidarity and Anti-Racism Resource List

  • http://antiracismforbeginners.com/

  • Nat’l Resource List:

  • Mini-Syllabus on Policing in the US

  • Free Online Course about African American History

In solidarity,

National APAMSA

Since SARS-CoV2 surfaced in Wuhan, China late last year, the pandemic has accelerated at an alarming pace and has now claimed more than 50,000 lives in the United States alone. Amid increasing reports of racist confrontations and widespread shortages of personal protective equipment (PPE), ventilators, hospital beds, testing kits, and healthcare workers, APAMSA is committed to supporting its members and assisting in nationwide efforts. Below, we provide resources for member students to stay informed and recommendations on how to get involved with your local community efforts.

Stay informed:

The situation continues to evolve at a rapid pace, with scientific data and policy guidelines being updated on a daily basis. In addition to conventional news sources, the following are great summative and digestible resources to stay up to date:

Harvard’s COVID curriculum for medical students

Kaiser Family Foundation’s COVID policy watch

Donating Medical Supplies:

Nationwide shortages of protective equipment have placed frontline healthcare workers at risk for contraction of COVID-19. Students who are able can contribute to supply efforts in the following ways:

1) Donate PPE to hospitals in your area

• DonatePPE.org

• GetUsPPE.org

• Covid19.give.providence.org

2) Make masks that local healthcare providers can use in situations where using an N95 respirator is not required (see instructional videos below). APAMSA will provide $50 grants to 5 chapters that organize mask-making drives! Please contact our Community Outreach Director Anthony Nguyen at outreach@apamsa.org if you are interested in this grant or if you would like National Board’s support in organizing a drive!

• How to Sew a Surgical Face Mask for Hospitals

• How to Make String Ties for a Cloth Face Mask

• How to Sew a Medical Face Mask with Ties

• JOANN Stores are Handing Out Free Fabric Supplies at Curbside to Anyone Sewing Face Masks at Home

Volunteer Opportunities:

Medical students are in a unique position during this pandemic. While several schools have offered early graduation to allow fourth year students to assist on the frontlines, junior students can also assist with community efforts in meaningful ways.

1) Those who are not volunteering on the front lines must stay at home to flatten the curve and minimize the burden on hospitals.

2) Volunteer and donate:

• Masterlist Sheet of Medical student volunteer opportunities – What is your school or chapter doing to combat COVID-19? Add it to this list!

• Donate to nonprofits supporting public health on various fronts

3) Disseminate multilingual resources to help patients who face language barriers to care, such as this AA and NHPI In-Language Resources for Coronavirus (COVID-19) compiled by the Asian and Pacific Islander American Health Forum (APIAHF)

Responding to Acts of Hatred:

With the virus initially breaking out in China and several high-profile figures referring to COVID-19 as “the Chinese virus”, there has been an increase in news reports of hate crimes against Asian & Pacific Islander Americans (APIA). APAMSA explicitly condemns these unconscionable acts and calls on members and peer organizations to help combat this hatred.

1. Your safety and the safety of others takes top priority. In response to active situations in which you or someone else is being harassed or attacked, some nonviolent approaches have involved de-escalation and/or intervening by offering support to the person being targeted.

• Hollaback! and Asian Americans Advancing Justice are hosting one-hour Bystander Intervention Training where you can learn more strategies to support those facing anti-APIA discrimination. There are six remaining training sessions next month. (We do not officially endorse any specific resource, as many organizations are addressing this issue)

2. Report hate crimes law enforcement or through online forms:

• Asian Pacific Policy and Planning Council

• StandAgainstHatred.org

• Call 1-800-771-7755 (Hotline for those in New York)

3. Be mindful of the language you use to talk about COVID-19

• This includes encouraging others to avoid language that equates Asian Americans with the virus or with the Chinese government, and discouraging jokes/memes that scapegoat APIA communities.

4) Demand your elected officials, campus leaders, and hospital administrators publicly denounce racism against APIA’s and enact policies that ensure protection and safety from racist violence.

5) Support APIA businesses that are struggling to attract customers due to stigma surrounding the virus.

6) Check in with APIA friends/colleagues and offer support.

In solidarity,

National APAMSA

On January 30 the U.S. State Department updated the travel advisory for China to “Level 4: Do Not Travel due to novel coronavirus first identified in Wuhan, China.” Following this advisory, President Trump declared the coronavirus a public health emergency in the United States and signed a proclamation suspending entry of non-U.S. citizens who have traveled to China in the 14 days preceding their attempted entry, except for immediate family of U.S. citizens or lawful permanent residents.

The President also mandated quarantine and medical screening of U.S. citizens upon their return to the U.S. Those who have been in China’s Hubei Province in the 14 days preceding their return will be subject to 14 days of mandatory quarantine. Those who have been to other areas of mainland China in the 14 days preceding their return will be subject to screening at the airport of entry and to heightened monitoring for 14 days.

Although a national response to this outbreak is certainly warranted, we are concerned that policies restricting international travel and collaboration may further escalate tensions by fomenting xenophobia out of proportion to the domestic threat of the outbreak. Through this approach, the U.S. is continuing a decades-old tradition of public health policies that encourage the blanket portrayal of Asian immigrants as carriers of terrible diseases. The American Civil Liberties Union also warned that these drastic measures may impinge on civil liberties. Jay Stanley, a ACLU political analyst, urges that “any detention of travelers and citizens must be scientifically justified and no more intrusive on civil liberties than absolutely necessary.” Plus, it is still unclear how much benefit would be gained from these restrictions and quarantines in addition to promoting basic hygiene practices alone.

In recent weeks there has been an increase in media reports of aggression against APIA (Asian Pacific Islander American) community members, particularly those of Chinese descent. These incidents have occasionally become violent, as in the cases of a man who assaulted a Chinese woman in a New York City subway, and an Asian American teen who was hospitalized following an assault by fellow high school students accusing him of having coronavirus. Similarly, there has been a rise in microaggressive actions targeting APIA students on university campuses, including demeaning comments from faculty and peers about Chinese dining and cultural practices. And some news outlets themselves have depicted the outbreak in ways that feed this paranoia, including using images of people wearing face masks without proper context and using blanket images of local Chinatowns in stories about the virus.

We are also alarmed that there is no longer a federal official in charge of coordinating our national response to global health crises and pandemics. The Trump administration eliminated this office two years ago, leaving us with a patchwork of agencies struggling to mount an organized response to the coronavirus outbreak. We therefore call for immediate reinstatement of this position, as this would improve dissemination of information to local governments hoping to respond to cases that emerge. This would also strengthen our ability to collaborate closely with international health organizations and follow their recommendations as more data on the coronavirus becomes available through medical journals such as the Journal of the American Medical Association (JAMA) and the New England Journal of Medicine (NEJM).

Together we can quell this global outbreak through the work of many agencies collaborating to limit its spread while developing a vaccine or novel antivirals, not by closing borders in ways that feed fear and prejudice.

Asian Pacific American Medical Student Association (APAMSA)

Student National Medical Association (SNMA)

American Medical Student Association (AMSA)