Counsel for the profession

Ability to win in court a key part of AMA's mission

At any given time the AMA is a plaintiff, defendant or ``friend of the court'' in lawsuits pending around the country.

For most of us, that would be a legal nightmare. For the AMA, it's essential to serving as the nation's leading advocate for the medical profession.

Two recent courtroom victories demonstrate just how varied the AMA's litigation picture is. They also point up the importance of the Association's readiness to litigate when the only recourse is to go to court.

The victory with the most direct impact on practicing physicians involves the U.S. Drug Enforcement Agency.

In 1993, the DEA nearly quadrupled physician registration fees in order to pay for its drug diversion control program. It did so without justifying the increase and by sidestepping the process that would have allowed physicians to examine and comment on the proposal.

The AMA and other organizations filed suit. Last month an appellate court ordered the DEA to initiate a meaningful comment and review process on the increase. It's an important precedent that may not only result in lower fees, but may also prevent other government agencies from taking such highhanded actions.

The second victory is a bit different from the AMA's usual advocacy work but is well worth noting. In this case, the AMA was a defendant, along with the Medical Society of the State of New York, three county medical societies and others. The lawsuit, brought by a group of chiropractors, claimed that the defendants were part of a wide-ranging conspiracy to keep the chiropractors out of managed care networks.

The AMA and the state and county medical societies ``won'' when they were dropped from the case after the plaintiffs repeatedly failed to show good reason why they should be included in the lawsuit. (The case will continue, but without the organized medicine defendants.)

The judge noted that the claims against the AMA were based in part on the plaintiffs' misquoting an AMA letter. In addition, he called the plaintiff's claim that AMA has a stranglehold on the dissemination of medical information ``ludicrous.''

The AMA's early success in this case saved money that can be better used for physician and patient advocacy.

These cases join a long list of notable AMA legal victories, including two last year. In one case supported by the AMA, Minnesota's 2% provider tax on out-of-state physicians was overturned. Another AMA legal action saved nearly $2 million for 300 medical practices involved in a Medicare payment flap.

Among significant actions still pending are AMA amicus briefs opposing physician-assisted suicide, economic credentialing and physician deselections from managed care plans without due process.

The AMA is on the lookout for new cases as well. The Association recently established the AMA/State Medical Society Litigation Center, a consortium funded by the AMA and a large number of state societies. Working together, the groups can underwrite significant and precedent-setting cases involving inappropriate government regulation, provider taxes and coverage decisions.

Favorable verdicts are never a certainty, but one thing is: The AMA always can expect to be involved in litigation.