I strongly endorse the views and challenge expressed by our president in his column "The HMO M.O." in the January 3 issue. I am baffled, however, by the fact that nobody in organized medicine has ever made an official policy statement that the "Principles of Medical Ethics" apply to the practice of administrative medicine. There are three sections of these principles that apply directly to the practices that Dr. Eist highlights:

"Section 1. A physician shall be dedicated to providing competent medical service with compassion and respect for human dignity.

"Section 2. A physician shall deal honestly with patients and colleagues, and strive to expose those physicians deficient in character or competence, or who engage in fraud or deception. . . .

"Section 4. A physician shall respect the rights of patients, of colleagues, and of other health professionals, and shall safeguard patient confidences within the constraints of the law."

Despite this clear and direct application, the AMA completely ignored any mention of the practice of administrative medicine when it presented its "Ethical Guidelines in Managed Care" in 1995. To my knowledge, the only organization that has taken a clear stand that physicians in administrative positions are bound by the same ethical obligations to patients as are treating physicians is the Medical Board of California in its powerful 1996 statement "The Physician-Patient Relationship." The board clearly asserts, "The policies expressed herein apply to all physicians in California, as well as those who make decisions which affect California consumers, including health plan medical directors and other physicians employed by or contracting with such plans."

I strongly urge APA to follow the lead of the California Medical Board and apply "The Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry" to medical administrators and reviewers in no uncertain terms. Let's quit acting like helpless victims and assert our rights and duties as professionals.

Michael V. DeLollis, M.D.
Fresno, Calif.

(Psychiatric News, March 7, 1997)