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Professional News
AMA Finds Compromise On Liability Reform Strategy
Psychiatric News
Volume 39 Number 1 page 1-21
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Hawaii Lt. Gov. Duke Aiona (third from right) poses with APA President Marcia Goin, M.D., and members of the AMA Section Council on Psychiatry at a reception hosted by the section council, the Hawaii Psychiatric Medical Association, and the Hawaii Medical Association during last month's AMA meeting in Honolulu. WIth Aiona and Goin are (from left) Jeffrey Akaka, M.D., also of the Hawaii Psychiatric Medical Association; David Fassler, M.D.; Saul Levin, M.D.; and James Nininger, M.D. See stories above and on pages 20 and 21.

And it was the source of a narrowly averted rift in the “house of medicine.”

At issue was whether the AMA should pursue “specialty-specific” liability reform legislation seeking relief for specialties hardest hit by spiraling liability premiums or tort reform benefiting all physicians uniformly.

Following vigorous debate in hearings before a reference committee (the body that hears testimony prior to debate on the house floor), delegates approved a resolution reaffirming that liability reform was the AMA’s highest legislative priority and resolving that the organization will not pursue federal medical liability legislation that would “divide or diminish” the voice of the AMA.

The resolution was a careful finessing of a debate that threatened to pit specialties advocating for “specialty-specific” liability reform legislation against state medical societies in states that have already passed effective liability-reform legislation.

Specifically at issue was the American College of Obstetrics and Gynecology’s (ACOG) support for the Help Efficient, Accessible, Low-Cost, Timely Healthcare Act of 2003 (S 607). The bill, sponsored by Sen. John Ensign (R-Nev.) and Sen. Judd Gregg (R-N.H.), would grant relief from exorbitant malpractice awards first to those specialties, such as ob-gyn, most affected by soaring premiums.

Katherine Fitzgerald, M.D., chair of the AMA Section Council on Obstetrics-Gynecology, told physicians at the meeting that ACOG’s support for S 607 was designed to get medicine’s “nose under the tent” of tort reform, since legislation seeking relief for all physicians—especially the Patients First Act of 2003 (S 11), which is supported by the AMA—appears to be short of the votes necessary for passage.

Testifying in reference committee hearings on the subject, Fitzgerald said her specialty was in dire need of relief. “We are not just bleeding, we are hemorrhaging,” she said. “This strategy is an incremental approach.”

But AMA officials and state medical societies said provisions in the Ensign-Gregg bill threatened to supercede state laws that have stringent liability restrictions and could undo state laws holding HMOs liable in malpractice cases.

“The AMA believes that no federal law is better than a bad federal law,” said AMA President Donald Palmisano, M.D., in the same reference committee. “We will do nothing that will destroy proven, effective state reforms.”

Palmisano reiterated the AMA’s support of S 11, which provides professional liability tort reform for all physicians. The reference committee report on the hearing cited previous AMA policy stating that liability reform based on the California Medical Injury Compensation Reform Act (MICRA) is “integral to health system reform.” That policy includes, prominently, a $250,000 ceiling on noneconomic damages.

Some specialty organizations argued, however, that to rule out an incremental strategy would tie the organization’s hands in what is bound to be a difficult political battle for liability reform. For that reason, the original language in the house resolution that would have prohibited the AMA from pursuing “specialty-specific” liability reform legislation was removed.

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Listening to proceedings during the House of Delegates meeting are John McIntyre, M.D., and David Fassler, M.D., of the Section Council on Psychiatry.

John McIntyre, M.D., chair of the Section Council on Psychiatry, explained that the approved resolution leaves AMA the flexibility to seek whatever strategy might work to attain liability reform—including an incremental strategy—as long as it does not “divide or diminish the voice of medicine.”

“The overriding feeling in the House of Delegates was that medicine must remain together on this issue,” McIntyre said.

The meeting was a landmark of sorts for psychiatry with Jeremy Lazarus, M.D., serving as vice speaker—the first psychiatrist to be on the AMA board since 1929, he said.

“There was a time when psychiatry distanced itself somewhat from the rest of medicine,” Lazarus said. “But in the last 25 years there has been much more of a convergence. We are very well integrated into the house of medicine, with a lot of psychiatrists represented in the state medical societies, as well as the section council.”

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Several resolutions supported by APA and members of the Section Council on Psychiatry were approved by the house easily or with minor revisions and amendments.

Three resolutions focusing on nondiscriminatory coverage of mental illness and substance abuse in public and private programs were “reaffirmed”—indicating that the resolutions expressed policy already adopted by the house.

“Nondiscrimination is part of the AMA’s charge,” McIntyre said. “It is not something we are struggling over with the house of medicine any longer. Our APA members think of this as APA policy, but they should know that it is also AMA policy.”

The house approved a resolution regarding collection of physician- and patient-specific data by pharmaceutical companies. The resolution calls on the AMA to “explore the current scope of physician- and/or patient-specific data collected by the pharmaceutical industry, the current use of such data, and the impact of such practices on the cost and quality of health care.”

It also requests the AMA to “explore the recent incidents where identifiable patient data were apparently purchased, procured, and/or otherwise obtained and used for marketing purposes.”

During reference committee hearings, David Fassler, M.D., vice chair of the Section Council on Psychiatry and a delegate of the American Academy of Child and Adolescent Psychiatry (AACAP), testified on behalf of the resolution.

“Every day physicians are visited by pharmaceutical sales representatives who know exactly how many prescriptions they write for each and every medication in a particular class,” said Fassler. “The information is used to reinforce certain behaviors and to develop targeted detailing efforts to influence prescribing patterns.”

The resolution was submitted by APA, AACAP, the American Academy of Pain Medicine, and the American Academy of Psychiatry and the Law.

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• Nearly unanimous support was heard for a resolution submitted by the American Society of Addiction Medicine and several state delegations that advocated repeal of the Uniform Individual Accident and Sickness Policy Provision Law. That law prohibits insurance coverage of treatment for injuries sustained as a consequence of an individual being intoxicated or under the influence of drugs in some 37 states. The resolution was approved without debate on the house floor.

• A resolution was passed calling on the AMA to “continue to work with state and specialty societies to draft model legislation that deals with nonphysician independent practitioners’ scope of practice, reflecting the goal of ensuring that nonphysician scope of practice is determined by training, experience, and demonstrated competence.”

That resolution also calls on the AMA to “distribute to state medical and specialty societies the model legislation as a framework to deal with questions regarding nonphysician independent practitioners’ scope of practice.”

• Another resolution passed by the house requests the AMA to study the status of abuse by adolescents of over-the-counter medications containing dextromethorphan. The resolution asks the AMA to “strongly request that the Food and Drug Administration, the Drug Enforcement Agency, and other appropriate government authorities use every means possible to halt bulk sales of dextromethorphan over the Internet.”

“The Section Council on Psychiatry feels very positive about the support we experienced for our patients,” said McIntyre. “The issues that are important to psychiatry are the issues that are important to the leadership of the House of Delegates.”

More information on the interim meeting of the House of Delegates is posted online at www.ama-assn.org/ama/pub/category/11023.html.

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Hawaii Lt. Gov. Duke Aiona (third from right) poses with APA President Marcia Goin, M.D., and members of the AMA Section Council on Psychiatry at a reception hosted by the section council, the Hawaii Psychiatric Medical Association, and the Hawaii Medical Association during last month's AMA meeting in Honolulu. WIth Aiona and Goin are (from left) Jeffrey Akaka, M.D., also of the Hawaii Psychiatric Medical Association; David Fassler, M.D.; Saul Levin, M.D.; and James Nininger, M.D. See stories above and on pages 20 and 21.

Anchor for JumpAnchor for Jump

Listening to proceedings during the House of Delegates meeting are John McIntyre, M.D., and David Fassler, M.D., of the Section Council on Psychiatry.

John McIntyre, M.D., chair of the Section Council on Psychiatry, explained that the approved resolution leaves AMA the flexibility to seek whatever strategy might work to attain liability reform—including an incremental strategy—as long as it does not “divide or diminish the voice of medicine.”

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