Medical errors, governance likely to engender debate

Delegates will contemplate several responses to the Institute of Medicine's medical errors report during the AMA's Annual Meeting this month.

By Bonnie A. Booth, amednews staff. June 12, 2000.

The last time the AMA House of Delegates gathered, the Institute of Medicine's report on medical errors had just been released and physicians were just beginning to digest it and the accompanying calls for action.

Six months later, it's clear the IOM report will generate considerable debate at the AMA's Annual Meeting later this month.

A series of resolutions before the house call for liability reforms and extension of peer review protections to limit risks faced by physicians and other health workers who report errors in care. Some also urge renewed focus on arbitration and mediation as alternatives to the tort system for addressing patient injuries.

Not all the IOM report-inspired resolutions take a defensive posture, however. Some urge the Association to take steps to ensure techniques proven to enhance patient safety are widely adopted.

Also on the quality agenda are two other AMA initiatives.

The Board of Trustees, which earlier this year announced its decision to discontinue the Association's controversial physician accreditation program, will outline for delegates its strategy to lay that program to rest and yet continue to be active in setting standards for physicians.

The board also will recommend discontinuing the Association's Clinical Practice Guideline Recognition Program. That program, launched in June 1999, was designed to evaluate and give a seal to guidelines developed according to specific criteria. But it never really got off the ground, and a new national resource provides much of the data necessary for physicians and others to judge the quality of a specific guideline.

Governance to be debated

The business of organized medicine is also likely to engender some heated debate as delegates take a look at the final report of the house's task force on membership and get a first look at a report for transforming the House of Medicine.

The membership task force was created in 1997 to find ways to increase recruitment and retention in the AMA. It has offered up several suggestions in interim reports since its inception. In its final report, the task force is recommending that an ad hoc Advisory Committee on Membership to the Board of Trustees be created. It is also recommending that Federation members that collect dues for the AMA have a primary partnership agreement with the Association and that the AMA create a centralized membership billing and processing unit that will offer services to interested components of the Federation.

And while those suggestions are likely to generate some controversy, even more is likely from the report of the Commission on Unity. The commission, charged with developing a detailed plan to transform the Federation, is putting forth its first substantial report since it was established in December 1998.

The report calls for a new governance structure for the Federation -- one that would have a core organization and a congress of participating organizations. While the core organization would have members, those members would join through one or more of the participating organizations -- most likely state or specialty societies.

A full agenda

In other business, delegates will:

Consider a Council on Ethical and Judicial Affairs report that outlines the limitations on physicians' ability to choose who they treat. Instead, it emphasizes their opinion that a patient's greater need for service corresponds with a stronger obligation for care.
Once again deal with the CEJA policy on gifts from industry, which is widely recognized as being the AMA's most ignored ethical opinion. A resolution from the Nebraska delegation calls on the AMA to remind all U.S. doctors about the current AMA guidelines on gifts from the pharmaceutical industry.
Consider a resolution from the New York delegation asking the AMA to encourage all national specialty organizations to adopt standards modeled on those of the American Assn. of Neurological Surgeons that promote fair and honest expert testimony. The delegation believes the developed rules should subject doctors who provide testimony in bad faith or without scientific validity to scrutiny by the appropriate state licensure board.
Consider a Council on Medical Education report that calls on labor organizations that represent residents to adhere to the AMA's principle's of medical ethics, which includes a prohibition on strikes that affect patient care. In a historic ruling last year, the National Labor Relations Board ruled that residents at private hospitals are employees and students who are covered by the National Labor Relations Act. The NLRB ruling, which reversed a 23-year-old precedent, was criticized by the Assn. of American Medical Colleges as an invitation for labor organizations to meddle in educational decisions.
Contemplate a Council on Medical Education recommendation to freeze the number of U.S. graduates from allopathic and osteopathic schools to 1997 levels. In 1998, allopathic graduates increased 0.4% to 15,953 from 15,887 in 1997 and osteopathic graduates increased 4.8% to 2,110 from 2,013 in 1997.

The council's report also recommends AMA raise awareness among groups advocating cutbacks in resident training programs to the fact that 12% of first-year residents are physicians who are retraining in other specialties. That percentage has been stable over the past five years.

Vida Foubister, Jay Greene and Linda Prager contributed to this report.