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The growth of the APA delegation to the AMA Section Council on Psychiatry to three delegates and three alternates, combined with successful outreach to other psychiatric specialty society representatives, strengthened the voice of psychiatry as never before at the AMA's most recent House of Delegates meeting this June in Chicago.
The enhanced stature of the section council, which consists of representatives of APA and the American Academy of Child and Adolescent Psychiatry (AACAP), was evident. "When I was appointed delegate about two years ago, I said that with the help of the APA membership, we would give them not a delegate, but a delegation. We have," remarked former APA president Joseph T. English, M.D., chair of the Section Council on Psychiatry. "The more APA members join the AMA and make APA their designated specialty society, the more influence we will have."
English noted that "just about every resolution that we supported got passed, and almost every candidate we supported got elected. On a number of important matters the delegation met with the leadership of the AMA Board of Trustees and received a prompt and effective response related to the matters discussed."
Two of three psychiatrist candidates for positions on House of Delegates councils supported by the section council were elected, while the third narrowly lost. Jo-Ellyn Ryall, M.D., was elected to the AMA's Council on Constitution and Bylaws, and Sukhmani Gill, M.D., was elected to the resident physician position on the Council on Medical Service. Emmanuel Cassimatis, M.D., barely lost his race for a seat on the Council on Medical Education.
In the wider AMA election, Thomas Reardon, M.D., chair of the AMA Board of Trustees, defeated past board chair Raymond Scalettar, M.D., for president-elect. Richard Corlin, M.D., and John Knote, M.D., were re-elected unanimously as speaker and vice speaker, respectively.
The House of Delegates adopted three resolutions jointly sponsored by APA and AACAP. These included a resolution stating that utilization review decisions denying payment for medically necessary care constitute "the practice of medicine" and that medical directors of managed care plans should therefore be subject to all state medical licensing requirements, board review, and disciplinary rules. AMA delegate and former APA president John McIntyre, M.D., participated in the debate.
Another jointly sponsored resolution adopted by the house asked the AMA to reaffirm its opposition to the incarceration of youth in adult correctional facilities. The third resolution adopted asked that the AMA collaborate with state and local medical societies and appropriate specialty groups to review and update national guidelines on the safe and appropriate use of seclusion and restraint for children and adolescents.
The house adopted a report strongly endorsed by APA President Rodrigo Muņoz, M.D., affirming the AMA's support for individually selected and purchased health insurance (Psychiatric News, July 3). The report offered 17 recommendations to promote this approach.
The house adopted a resolution asking the AMA, in collaboration with specialty organizations, to urge the Food and Drug Administration to survey physicians regarding the impact of direct advertising of prescription drugs to patients. The original resolution, which had singled out direct advertising of prescription drugs to "the mentally ill," was revised at the request of Judy Linger, M.D., a section council alternate. Linger asked that the reference be dropped as potentially stigmatizing to the mentally ill.
The Sunbeam crisis continued to haunt the AMA despite the strong actions taken last year and the appointment this year of a new executive vice president, E. Ratcliffe Anderson Jr., M.D. (Psychiatric News, June 19). The potential economic impact of the pending $20 million lawsuit by Sunbeam against the AMA for breach of contract led many delegates to express the view that the matter would not truly be laid to rest until the litigation was resolved.
In the house's Reference Committee on Constitution and Bylaws, American Academy of Psychiatry and the Law representative Howard Zonana, M.D., testified in favor of a resolution recommending that physicians refrain from sexual or romantic interaction with key third parties, which were defined to include spouses, guardians, parents, siblings, or anyone emotionally close to the patient.
AMA delegate Jerry Wiener, M.D., another former APA president, testified favorably on an AMA Board of Trustees report on confidentiality which was subsequently adopted by the house. The measure affirmed that "there exists a basic right of patients to privacy of their medical information and records." It also recommended, however, that the AMA "guard against the imposition of unduly restrictive barriers to patient records that would impede or prevent access to data needed for medical or public health research," according to an executive summary of the measure. The resolution affirmed that "whenever possible, de-identified data should be used for these purposes." A number of other matters related to confidentiality were referred back to the AMA Board of Trustees for further review.
Following extended testimony, the House of Delegates adopted an AMA Board of Trustees report on Medicare's evaluation and management documentation guidelines. APA's Linger provided testimony. A key part of the report as adopted was that physicians be protected from criminal and civil penalties relating to fraud due to differences in interpretation or inadvertent coding errors. The primary concern expressed by delegates was that under current federal law, physicians may stand accused of billing fraud without evidence of intent to defraud.
The house adopted a resolution asking the AMA to investigate why generic Ativan (lorazepam) had suddenly become exorbitantly expensive, in some cases 30 times more expensive than it had been only last year. The huge price increase has had the effect of making the medication inaccessible to some patients, several delegates commented.
The house rejected a resolution intended to raise questions about the efficacy of needle exchange in curbing the spread of HIV, thus affirming the AMA position in favor of needle exchange programs.