Working closely with psychiatrists throughout the House of Delegates, APA and the American Academy of Child and Adolescent Psychiatry (AACAP) delegations continued to further the priorities of the Association at the AMA’s winter meeting last month in San Francisco. In addition, senior delegates, along with APA President Richard Harding, M.D., met with the AMA’s top elected leadership, reaffirming both associations’ strong mutual interests on behalf of patients and physicians.
The delegation pursued vital issues, as well as several less visible issues, beginning with a change in the delegation’s leadership.
At a meeting of the AMA Section Council on Psychiatry, which is composed of the delegates and alternate delegates of APA and AACAP, along with invited representatives of allied psychiatric organizations, Harding announced the retirement of Section Council Chair Joseph T. English, M.D.
English, who has chaired the section council since 1996, will remain as a senior delegate for APA, but will concentrate on his new AMA appointment as a commissioner on the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) (Psychiatric News, July 20, 2001). He remains chair of psychiatry and behavioral health sciences at St. Vincent’s Catholic Medical Centers of New York.
On behalf of AACAP President Marilyn Benoit, M.D., Harding renominated David Fassler, M.D., AACAP delegate, as vice chair of the section council. Fassler’s nomination was also unanimously approved.
APA and AACAP jointly introduced two resolutions at the meeting, both of which received favorable testimony and action by the AMA’s policy-setting body, the House of Delegates.
The first resolution, suggested by APA Speaker Nada Stotland, M.D., asked that the AMA recommend to the television industry that when a physician appears on TV, either as a guest speaker or as a medical commentator, he or she be identified in printed text with their appropriate initials, either M.D. or D.O.
During debate on the issue, Stotland testified in support of the resolution, as did others who echoed concerns that the generic term of "doctor" used by the media is often, at best, misleading.
The house approved a stronger wording of the resolution, calling on all media to identify appropriately not just physicians but also other health professionals "with their appropriate degrees after their names."
The second resolution introduced by APA/AACAP asked that the AMA request that new accreditation standards proposed by JCAHO be accompanied by cost estimates of implementation and ongoing compliance for small, medium, and large hospitals and/or other health care facilities. The house voted to revise existing AMA policy to include cost estimates and to request that JCAHO promulgate information on its standards-development model.
With the aftereffects of September 11 on the minds of many in attendance, a significant amount of time and thought was devoted to treating those affected by the terrorist attacks and in combating bioterrorism (see story below). A resolution introduced by the District of Columbia Medical Society called for the AMA to encourage primary care, emergency medicine, and psychiatric physicians to conduct joint educational programs and improve clinical collaboration to diagnose and treat depression, anxiety, and PTSD associated with September 11.
After considerable testimony before the house, the resolution was combined with several other resolutions and reports dealing with the aftermath of the terrorist attacks, and adopted by the house as AMA policy.
Once again, privacy was a central issue of the meeting. Two resolutions challenged the need for the Department of Health and Human Services’ (HHS) privacy regulations, born out of the Health Insurance Portability and Accountability Act (HIPAA). APA President Harding, delegate John McIntyre M.D., and alternate delegate Jeffrey Akaka, M.D., provided strong and persuasive reference committee testimony, reaffirming APA’s position on the critical need to protect the privacy and confidentiality of medical records.
A substitute resolution was proposed, in lieu of both the original resolutions, which called on the AMA to continue to "make it an urgent priority to undertake a comprehensive review" of the privacy regulations, including the costs of implementing them, and asked that the AMA communicate any urgently needed changes to HHS and Congress for prompt action, including any necessary delay in implementation. The house adopted the substitute resolution.
Evidence-based performance measures on the use of seclusion and restraint were strongly supported in a report of the AMA’s Board of Trustees. The report calls on the AMA to continue its efforts to rescind the July 1999 interim final rule of the Centers for Medicare and Medicaid Services governing the use of seclusion and restraint and requiring face-to-face evaluations within a set time period.
The house also adopted an amended report by the AMA Council on Scientific Affairs (CSA) in support of universal HIV testing for pregnant women, including patient notification of the right of refusal. The CSA, of which APA delegate Carolyn Robinowitz, M.D., is a member, called for universal testing as a routine component of perinatal care to be accompanied by basic counseling and awareness of treatment options. Along with the input of Robinowitz, American Academy of Psychiatry and the Law representative Robert Phillips, M.D., testified, representing psychiatry’s position on the issue. The delegation’s testimony was significantly aided by background materials provided by APA’s Commission on AIDS and its staff.
Delegation members were again active in the workings of the House of Delegates, as well as testifying in front of the various reference committees, each of which is charged with conducting various aspects of the house’s business.
In addition to the work of Robinowitz on the CSA, Section Council Vice Chair Fassler and APA Joint Commission on Government Relations Chair Jeremy Lazarus, M.D., who serves in the House of Delegates as a Colorado Medical Society delegate, served on the select committee investigating the firing of former AMA executive vice president E. Ratcliffe (Andy) Anderson Jr., M.D., and Anderson’s subsequent suit against the AMA (Psychiatric News, July 20, 2001). APA alternate delegate Judy Linger, M.D., served on the reference committee that heard the report of the select committee and advanced several recommendations, involving changes in the AMA’s internal governance.
In addition, APA alternate delegate, Saul Levin, M.D., served on the reference committee that dealt with policy issues involving scientific affairs.
Chair Scully told Psychiatric News that the section council will look to the future to continue and broaden its visibility and participation in the house. Scully is looking for "operational improvements that will enhance the delegation’s overall effectiveness in a cost-conscious manner."
The complete proceedings of the Interim 2001 Meeting of the AMA’s House of Delegates is available on the Web at www.ama-assn.org/ama/pub/category/6068.html. ▪