MEDICAL SOCIETY OF VIRGINIA HOUSE OF DELEGATES Report of Reference Committee 3. Dr. Atul Marathe, Chair

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1 Page DISCLAIMER The following is a preliminary report of actions taken by the House of Delegates at its 2018 Annual Meeting and should not be considered final. Only the Official Proceedings of the House of Delegates reflect official policy of the Society. MEDICAL SOCIETY OF VIRGINIA HOUSE OF DELEGATES Report of Reference Committee 3 Dr. Atul Marathe, Chair The Reference Committee recommends the following consent calendar for acceptance: RECOMMENDED FOR ADOPTION AS AMENDED OR SUBSTITUTED Nutrition Prohibiting Conversion Therapy in Those Under Age Support Expanded Good Samaritan Overdose Immunity Laws Expansion of Drug Takeback Programs Address the Dangers of Head Trauma and Other Potential Injuries in Sports Address the Obesity Crisis Through a Soda Tax RECOMMENDED FOR NOT ADOPTION Support Opioid Education in Virginia Public Schools RECOMMENDED ADOPTION IN LIEU OF Firearm Risk Harm Reduction Limit Sales of Bump Stocks Limit Sales of Firearms Limit Sales of Large Capacity Magazines Promote Background Checks on Gun Sales

2 Page ) NUTRITION Mr. Speaker, your Reference Committee recommends that Resolution be adopted as amended. RESOLVED, the MSV shall be engaged to encourage currently scientifically sound evidence-based nutritional guidelines advocated for in all spheres for the all citizens of the Commonwealth of Virginia and advocate for the availability of nutritionally healthy food and beverages be and, when able, serve as an advocate for the availability of food and beverages that are nutritionally healthy, particularly for the young and or underserved, and be it further RESOLVED, the MSV will serve as an advocate for education and, when able, provide support for efforts to improve nutritional patterns and eating habits to effect and impact population health change. Resolution asks that our Medical Society of Virginia support efforts to improve the availability of nutritious food in Virginia. Your Reference Committee heard supportive testimony on Resolution Your Reference Committee heard testimony stating that nutrition is a fundamental patient need that must be met to ensure overall patient health. Your Reference Committee did not hear opposing testimony. Your Reference Committee agreed with the testimony and appreciated the intention of the resolution. Your reference committee suggested amendments to refer to evidence-based nutritional guidelines. 2) PROHIBITING CONVERSION THERAPY IN THOSE UNDER AGE 18 Mr. Speaker, your Reference Committee recommends that Resolution be adopted as amended. RESOLVED, that the MSV oppose the use of conversion therapy or any similar practice, including but not limited to reparative therapy, ex-gay therapy, or sexual orientation change efforts, in those under age 18 by health care providers, and let it be further RESOLVED, that the MSV support legislation that bans conversion therapy use, and let it be further RESOLVED, that the MSV advocate for resources aimed at supporting LGBTQ youth to promote self and social acceptance. Resolution asks that our Medical Society of Virginia oppose conversion therapy as a medical practice. Your Reference Committee heard supportive testimony on Resolution Testimony supported removing specific references to healthcare providers to clarify opposition to conversion therapy in any setting. The medical student section offered to amend the resolution to remove the second and third resolved clauses. Your Reference Committee also heard opposing testimony that urged caution and had concerns regarding parent choice.

3 Page Your Reference Committee agreed with the medical student section to remove the second and third resolved clauses. The reference committee believes the first resolved clause best represents a healthfocused policy to protect patients. The second resolved clause is a legislative directive and therefore not appropriate to be included in policy. They also agreed that the resolution should support prohibition on all conversion therapy, not only conversion therapy specific to healthcare providers. The reference committee therefore offered an amendment to remove reference to healthcare providers. 3) SUPPORT OPIOID EDUCATION IN VIRGINIA PUBLIC SCHOOLS Mr. Speaker, your Reference Committee recommends that resolution be not adopted. Policy be amended to include the intent of as follows: RESOLVED, that the Medical Society of Virginia support the creation of statewide educational resources for Virginia public schools regarding the opioid crisis and opioid overdose, and be it further RESOLVED, that the Medical Society of Virginia support Virginia public schools in establishing a curriculum to educate students on opioid overdose, including identifying symptoms of overdose, treating overdose, and providing support for victims of opioid abuse/overdose as amended: The Medical Society supports educational programs in Virginia s schools regarding substance abuse prevention. Such educational programs should include curricula specific to opioid addiction, specifically identifying symptoms of overdose, treating overdose, and providing support for persons experiencing opioid misuse/overdose. Resolution asks that our Medical Society of Virginia support opioid education in public schools. Your Reference Committee heard supportive testimony on Resolution Your Reference Committee heard testimony from the medical student section in support of the staff recommendation to amend current policy in lieu of the resolution. Your Reference Committee heard no opposing testimony. Your Reference Committee discussed the importance of education programs in Virginia schools specific to opioid education, as well as considerations for capacity of schools to comply with additional requirements. The Medical Society has existing policy related to educational programs in Virginia schools. In lieu of adopting this resolution, the reference committee discussed amending existing policy to include the intention of the resolution, as suggested by the staff recommendation and accepted by the medical student section. Accordingly, your Reference Committee recommends this resolution be not adopted and policy be amended. 4) SUPPORT EXPANDED GOOD SAMARITAN OVERDOSE IMMUNITY LAWS Mr. Speaker, your Reference Committee recommends that Resolution be adopted as amended.

4 Page RESOLVED, that the Medical Society of Virginia amend its current policy Good Samaritan Protection for Overdose Witness as follows: The Medical Society of Virginia supports granting Good Samaritan protection for those who call when witnessing a possible drug overdose, including protection from arrest for persons, under the influence or with simple possession, reporting a possible overdose. Resolution asks that our Medical Society of Virginia amend existing policy on Good Samaritan overdose immunity laws to include protection from arrest. Your Reference Committee heard supportive testimony on Resolution Your Reference Committee heard testimony that supports prioritizing the prevention of a fatal overdose over a criminal arrest. Your Reference Committee also heard opposing testimony that cautioned supporting a policy that could limit law enforcement action to appropriately respond to criminal activity. Your Reference Committee discussed the implications of protection from arrest on both criminal activity prevention and incentive for reporting overdoses. The reference committee determined that, as healthcare providers, the health of the person experiencing the overdose should be prioritized, while maintaining the ability of law enforcement to protect against criminal activity. The reference committee ultimately suggested an amendment to clarify that protection from arrest should only apply to persons with no intent to distribute illicit substances. 5) EXPANSION OF DRUG TAKEBACK PROGRAMS Mr. Speaker, your Reference Committee recommends that Resolution be adopt as amended. RESOLVED, that the Medical Society of Virginia supports the expansion of Drug Take-Back programs and other such diversion prevention programs, safe disposal options, or disposal sites, as well as increasing public awareness about the availability of such programs statewide. Resolution asks that our Medical Society of Virginia support prescription drug take-back programs. Your Reference Committee heard supportive testimony on Resolution Your Reference Committee heard testimony that supported the resolution but also highlighted that several types of drug disposal were not mentioned. Testimony suggested an amendment to addresses additional methods of drug disposal to best incorporate all available disposal opportunities. Your Reference Committee heard no opposing testimony. Your Reference Committee agreed with testimony offering an amendment to include additional programs for drug disposal to ensure the resolution refers to all available methods. 6) ADDRESS THE DANGERS OF HEAD TRAUMA AND OTHER POTENTIAL INJURIES IN SPORTS

5 Page Mr. Speaker, your Reference Committee recommends that Resolution be adopted as amended. RESOLVED, that the Medical Society of Virginia support requiring recommending schools and organized sports programs in the Commonwealth of Virginia to educate students and parents on the risks of participating in sports, including but not limited to brain injury, spinal cord injury, internal organ injuries, and broken bones. Resolution asks that our Medical Society of Virginia adopt a new policy requiring public schools to provide education on the risks of sports participation. Your Reference Committee heard supportive testimony on Resolution Your Reference Committee heard testimony supporting additional opportunities for students and parents to learn about the risks of participating in sports. Testimony also suggested that additional sports participation risks be included. Your Reference Committee heard no opposing testimony. Your Reference Committee discussed existing law that requires local public school districts to provide education regarding sports injury risks. The reference committee was concerned that current law does not cover sports participation outside of public schools and, as such, not all students and parents have an opportunity to receive this education. As such, the reference committee amended to reference all organized sports programs, including organized sports not covered by the Virginia Board of Education. The reference committee also considered the potential cost and staff time to provide this education and therefore amended the language to recommend providing this education instead of establishing a requirement. 7) ADDRESS THE OBESITY CRISIS THROUGH A SODA TAX Mr. Speaker, your Reference Committee recommends that Resolution be adopted as amended. RESOLVED, that the Medical Society of Virginia support a statewide tax on sugar-sweetened beverages as a measure to help decrease obesity, and be it further RESOLVED, that the funds generated by such a tax would should be used to develop effective and evidence-based approaches to addressing childhood obesity or health education. Resolution asks that our Medical Society of Virginia support a state tax on sugar-sweetened beverages. Your Reference Committee heard supportive testimony on Resolution Your Reference Committee heard testimony that supported efforts to reduce obesity and suggested tax revenue could be dedicated to health education. Your Reference Committee also heard opposing testimony that questioned the strength of studies linking sugar-sweetened beverages to obesity. Additional testimony included concerns regarding the definition of sugar-sweetened beverages. Your Reference Committee considered the testimony and determined that the potential health benefits to patients are significant enough to support a tax to incentivize decreased consumption. The reference

6 Page committee discussed studies demonstrating that even artificially sweetened beverages are correlated with obesity. As such, your reference committee amended the resolution to include all sweetened beverages to include diet beverages. In lieu of resolutions , , , , , your Reference Committee recommends amending existing policy as follows: Control of Violent Use of Firearms The Medical Society of Virginia supports methods to control the misuse and violent use of firearms, including: 1. Prohibiting firearm ownership by: a. Those convicted of a felony b. Those convicted of a violent misdemeanor c. Those subject to a domestic violence restraining order 2. Banning the sale of bump stocks 3. Supporting universal background checks for all gun sales 8) FIREARM RISK HARM REDUCTION Mr. Speaker, your Reference Committee recommends that Resolution be not adopted. RESOLVED, that the Medical Society of Virginia reaffirm policy ; and furthermore be it RESOLVED, that the Medical Society of Virginia support prohibiting gun ownership by individuals convicted of prior violent misdemeanors; and furthermore be it RESOLVED, that the Medical Society of Virginia oppose requiring reciprocal concealed carry permits in Virginia. Resolution asks that our Medical Society of Virginia clarify its policy on firearms by prohibiting ownership for those individuals convicted of certain crimes and opposing reciprocal concealed carry permits. Your Reference Committee heard supportive testimony on Resolution Your Reference Committee heard testimony that the American College of Physicians strongly supports the resolution. There was also testimony supporting the second resolved. Your Reference Committee also heard opposing testimony stating that it is unnecessary to reaffirm a policy that was adopted last year at the 2017 HOD. Furthermore, the reference committee heard testimony opposing the third resolved clause as individuals living on the Virginia state border often cross state lines, including for work, and may be unduly burdened by opposing reciprocal concealed carry permits. amend current policy to in lieu of adopting new policy.

7 Page ) LIMIT SALES OF BUMP STOCKS Mr. Speaker, your Reference Committee recommends that Resolution be not adopted. RESOLVED, that the Medical Society of Virginia will support limits to the sale and ownership of bump stocks. Resolution asks that our Medical Society of Virginia clarify its policy on firearms by supporting limitations on bump stocks. Your Reference Committee heard supportive testimony on Resolution Your Reference Committee heard specific testimony that supports the resolution with an amendment to ban instead of limit the sale of bump stocks. Your Reference Committee also heard opposing testimony that cautioned that positive results may be limited. amend current policy in lieu of adopting new policy. 10) LIMIT SALES OF FIREARMS Mr. Speaker, your Reference Committee recommends that Resolution be not adopted. RESOLVED, that the Medical Society of Virginia will support limits to the sale and ownership and firearms with features designed to increase their rapid firing ability, as defined in H.R of the 103rd Congress. Resolution asks that our Medical Society of Virginia clarify its policy on firearms by supporting limitations on certain firearms. Your Reference Committee heard no supportive testimony on Resolution Your Reference Committee also heard opposing testimony that this proposed policy specifies a law that has features that are cosmetic and are not related to rapid fire ability. Furthermore, there is concern that if the goal is to eliminate semi-automatic guns, the resolution should more accurately state its opposition. amend current policy in lieu of adopting new policy. 11) LIMIT SALES OF LARGE CAPACITY MAGAZINES

8 Page Mr. Speaker, your Reference Committee recommends that Resolution be not adopted. RESOLVED, that the Medical Society of Virginia will support limits to the sale and ownership of large capacity magazines. Resolution asks that our Medical Society of Virginia clarify its policy on firearms by supporting limitations on the capacity of magazines. Your Reference Committee heard supportive testimony on Resolution Your Reference Committee also heard opposing testimony that stated if you limit magazine capacity, unintended types of guns may be limited. Testimony included concerns that vague definitions could be misinterpreted to be more expansive than intended. amend current policy in lieu of adopting new policy. 12) PROMOTE BACKGROUND CHECKS ON GUN SALES Mr. Speaker, your Reference Committee recommends that Resolution be not adopted. RESOLVED, that the Medical Society of Virginia will support uniform/universal background checks for gun sales. Resolution asks that our Medical Society of Virginia clarify its policy on firearms. Your Reference Committee heard supportive testimony on Resolution Your Reference Committee heard testimony that supported this proposed policy for not only gun shows but also to include all gun sales. Furthermore, it was stated that it is time for physicians to take leadership on this issue. Your Reference Committee also heard opposing testimony that would not support this proposed resolution as stated for all gun sales but could support if limited to gun shows. amend current policy in lieu of adopting new policy.

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