News in brief - Jan. 5, 2004

AMA to draft model scope legislation - AMA to look to change bankruptcy law - Visa complications slowing down noncitizen physicians - AMA to study drug price controls - Iraqi physicians visiting the United States - Residency programs in trouble - Ky. hospital given immunity in malpractice case

AMA to draft model scope legislation

With states every year contending with health care workers who are not medical doctors trying to expand their scope of practice, the AMA Advocacy Resource Center will continue to make sure they have the tools to combat efforts that physicians see as being dangerous to patients.

The House of Delegates asked the resource center to continue to work with state and specialty societies to draft model legislation ensuring that training, experience and demonstrated competence determine a nonphysician's scope of practice. The information will be distributed to state medical and specialty societies.

"Training and expertise are key," Altoona, Pa., hand surgeon Andrew W. Gurman, MD, testified during the AMA's December 2003 meeting. "If we establish reasonable guidelines for training, it is real advocacy for our patients."

AMA to look to change bankruptcy law

The American Medical Association will propose changes to bankruptcy laws that are consistent with medical liability reform, including further strengthening of bankruptcy laws by protecting an individual's personal assets from being used to pay excessive liability awards and establishing a minimum homestead exemption. A report on the progress is expected at the next Annual Meeting in June.

Visa complications slowing down noncitizen physicians

The American Medical Association will work to minimize the time it takes international medical graduates to get a visa to participate in a U.S. residency program or practice medicine here, according to policy approved by delegates at last month's Interim Meeting.

According to testimony at the meeting, residency programs appear to be the most affected by the increased security procedures imposed since the Sept. 11, 2001, World Trade Center attack.

"In our residency program, we still haven't gotten the last two residents, and other residents are having to pick up their slack and cover their rotations," said Gregory Ayers, MD, chief resident at Baptist Health System, Birmingham, Ala.

"This affects all residents and medical education," he added.

Delegates also worried that residency programs no longer would be quite so willing to take in international medical graduates from certain countries in the future unless the visa process is made more efficient.

"Next year, they won't be willing to give spots to people from these countries," said Busharat Ahmad, MD, a Michigan delegate. "It's important to make sure Homeland Security is not bypassed, but we have to see if we can streamline the process."

AMA to study drug price controls

The American Medical Association will study the possibility of suggesting legislation that would create government-negotiated price reductions for pharmaceuticals, according to action taken at the organization's Interim Meeting in Honolulu last month.

The proposal was referred to the Board of Trustees for further investigation because the legislation would essentially call for price controls on drugs -- which is contrary to the AMA's long-standing tradition of supporting market-based solutions. Some physicians, however, believe that patient care is being hampered by high drug prices and that a solution must be found, particularly since the recent approval of a Medicare drug benefit.

"This really needs to be looked at," said orthopedic surgeon Peter Lavine, MD, a Washington, D.C., delegate. "We need to look into allowing Medicare to negotiate with drug companies to buy in bulk and reimportation to make drugs cheaper, because when they're looking for money to pay for the new Medicare drug benefit, which is totally unaffordable, physicians are going to be on the chopping block."

Iraqi physicians visiting the United States

Dr. Quraish Al-Kasir, president of the Society of Iraqi Surgeons, and his wife, Dr. Nahla Dawood, a gynecologist, attended the AMA Interim Meeting as guests of the American Society of Plastic Surgeons and the International Confederation for Plastic, Reconstructive and Aesthetic Plastic Surgery. They are part of a group of six Iraqi physicians who are in the United States for nine weeks observing burn care, microscopic and endoscopic procedures, hand surgery and other reconstructive procedures. During their stay, the physicians also will travel to medical centers across the country as visiting clinicians. At the AMA meeting, Dr. Al-Kasir spoke with members of the AMA Surgical Caucus about the state of medical care and the physician community in Iraq.

Residency programs in trouble

Eastern Virginia Medical School's obstetrics-gynecology resident program has been put on probation by the Accreditation Council for Graduate Medical Education. The ACGME also has threatened Martin Luther King Jr./Drew Medical Center's neonatology resident program with closure.

The ob-gyn program was the only resident program at EVMS to be cited by the ACGME. Doug Gardner, spokesman for EVMS, said the program's primary problems were with record-keeping, such as tracking the number of procedures each student performed. Their teaching format also was found to be out of line with ACGME requirements because topics were being taught through seminars rather than lectures, he said.

EVMS has hired an outside consultant to do an internal review of the program, Gardner said, with the goal of getting the program on solid ground before an ACGME site visit in June. The program's accreditation will be reviewed by the ACGME Resident Review Committee for ob-gyn in the fall of 2004.

The King/Drew neonatology program is the third to be put on the chopping block at the medical center, operated by the L.A. County Dept. of Health. The ACGME last year pulled accreditation for the general surgery and radiology resident programs. Both are slated to close in June.

John Wallace, assistant director of the Los Angeles County Dept. of Health, said the hospital would appeal closure of its neonatology program, but if the appeal is denied, it too could close in June.

Alternative training programs are being sought for affected residents.

Ky. hospital given immunity in malpractice case

A judge has dismissed the University of Kentucky hospital from a malpractice lawsuit, saying the hospital had sovereign immunity because it is government-owned, attorneys in the case reported.

A Kentucky man sued the hospital, two doctors and a scrub technician, claiming a towel was left inside him following surgery. But the hospital cited a 1997 state Supreme Court ruling that gave the university sovereign immunity in a wrongful death case because it is government-owned.

At a hearing last month, Fayette County (Ky.) Circuit Court Judge Pamela Goodwine dismissed the hospital from the malpractice case. The doctors and technician still can be sued, and the patient's attorney said the suit would continue against those parties.