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AAPS Newsletters from 1974

AAPS Newsletters from 1974

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The newsletters of the Association of American Physicians and Surgeons from 1974. The AAPS has been the voice of private physicians since 1943.
The newsletters of the Association of American Physicians and Surgeons from 1974. The AAPS has been the voice of private physicians since 1943.

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04/04/2011

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THEVOICEFORPRIVATEDOCTORS
IndexNo.2January,1974,Volume28,No.1
Spe~ial
AMAMeetingReport
Acomprehensive,in-depthreviewofthePSROcontroversyattheAMAClinicalMeeting,Anaheim,California,inDecember.AAPSalonehastheded-icationtoprincipleandthecapacityforactionwhichmakessuchareportasthispossible.PleaseurgeatleastoneotherdoctortojoinAAPSnowandstrengthentheefforttosaveU.S.medicine-DonaldQuinlan,M.D.,President.
AMAH,ouseofDelegatesV·otesForAbolishingThePSROLaw
MembersoftheAmericanMedicalAssociationHouseofDelegatesclimaxedatumultuousclinicalmeetingatAna-heim,California,inDecemberbyrebuffing,withoutadissentingvote,repeatedexhortationsofAMAofficers,trusteesandhigh-levelstafftoreassertwithoutchangetheAssociation'spolicyofcollaborationwithgovernmenttoimposePSROcontrolsonthenation'sphysiciansandtheirMedicareandMedicaidpatients.
AAPSLawsuitSupported
MuchinterestwasevidentattheAMAClinicalMeet-ingintheAAPSlawsuittodeclarethePSROlawuncon-stitutional.Oneresolution(No.29introducedbyVirginia)specificallycalledforAMAtosupportthesuit.SeveraldelegatesalsourgedAMAtosupportthesuit.TheVirginiaresolutionresolved"thattheAmericanMedicalAssociationpubliclyannounceitsapprovalofthelawsuitinitiatedbytheAssociationofAmericanPhy-siciansandSurgeons,andthatthemembershipbeen-couragedtouseeverypracticalmeanstobringaboutasuccessfulterminationofthislawsuit..."TheReferenceCommitteeonlyindirectlyacknowledg-edthesubjectbydisposingofResolutionNo.36(urgingastudyofPSROconstitutionality)inthesewords:"YourcommitteeisalsowellawarethatthematterofResolution36isalreadythesubjectofcourtactionin-stitutedbymembersoftheprofession,sothatadoptionofthisresolution...wouldbeacostlyduplicationotjudicialreviewofthelawwhichisalreadyunderway."
TheHouseonDec.
5,1973,
made
it
clearthebestcourse
of
actionwas
to
abolishthePSROlaw.DelegatesamendedareportoftheBoard
of
TrusteesandCouncilonMedicalSer-vice(ReportEE)
to
makeitclearthat:"TheconsideredopinionofthisHouse
of
Delegates
is
thatthebestinterests
of
theAmericanpeo-ple,ourpatients,wouldbeservedbyrepealofthepresentPSROlegislation."
TheamendmenttoReportEEalsodirectedtheBoardofTrusteesto"worktoinformthepublicandlegislatorsastothepotentialdeleteriouseffectsofthislawonthequality,confidentialityandcostofmedicalcare."ThiswasarenewalofapreviousHousedirectivewhichAMAExecutiveVicePresidentErnestB.Howard,M.D.,saidwaswrongandadmittedhehaddeclinedtocarryout.
INSIDE
TextofAMAPSROAmendment
AMAExecutiveBacksDown
~eferenceCommitteePSRODebate
HouseofDelegatesDebate
Rep.Crane'sSpeech-"PSRORepealisPossible"
AtLargeAMATrusteeElections
AMAHeadquartersStay
Dr.HeardIsBoardCandidate
Dr.RetiresinPSROProtest
 
AmonthaftertheAnaheimmeeting,membersoftheBoardofTrusteeswereclaimingtheyweresoconfusedoveractionoftheHouseofDelegatestheycouldreachnospecificagreementonabolitionofPSROoronimple-mentationoftheHouseordertotellthepublicaboutthebadprovisionsofthePSROlaw.Theyprofessedto
be
confusedbecausepartsofReportEEasamendedappearedtoconf.ictwithotherpartsas
crlqincllv
drafted.Specifically,theyindicatedbe-liefthatthestatementoftheamendmentthatPSROshouldbeabolishedwasincompatiblewiththeconcludingstate-mentofReportEEwhichrecommendedtheAMA"continuetoexertits(PSROlleadershipbysupportingconstruc-tiveamendmentstothePSROlaw,coupledwithcon-tinuationoftheefforttodevelopappropriaterulesandregulations."
MeetinPuertoRico
TheBoardandselectedmembersoftheexecutivestaffearlyinJcnucryjourneyedtoPuertoRicotomeditateonwhathadhappenedatAnaheimand,asonesourceputit,"toponderwhatpositiontheAMAcouldtakewithoutlosingcredibility."TheBoardcouldarriveatnoconclusionsatPuertoRico.TheentiresubjectofPSROandReportEE-"leftupintheair"atPuertoRico-willbediscussedagainbytheBoardandstaffatameetinginChicagolatethisJanuary.ManymembersoftheAMAHouseofDelegateswillbesurprisedtofindoutthattrusteeshaveadoptedconfusionasareasonforfailuretomapoutacampaignaimedatabolishingPSRObypersuadingCongresstorepealthe
law.
If
anythingwasmadeclearatAnaheim,
it
wasthis:Theoverwhelmingmajority
of
dele-gates,alternatesandotherphysicians
at
themeetin:gwantthe
PSRO
lawabolished,andinthatdesire,theyreflectthewishes
of
anover-whelmingmajorityof"thedoctorsbackhome."
AMAofficers,trusteesandexecutive
staff
wenttoAnaheimevidentlyexpectingtoconvincetheHouseofDelegatesthatthebestthingtodowos
to
lettheBoardcontinuethepolicyofcollaborationandsupportamend-mentstothelaw.
TheHouse
of
Delegatessaid
no,
that
was
not
thebestthing
to
do.TheHouse
witJwut
dissentsaidthebestthing
to
do
is
repeal
the
law.
WhentheamendmenttoReportEEwosadopted,Car-rolfWitten,M.D.,Louisville,
Ky.,
Delegatefrom
the
Sec-tiononFamilyandGeneralPractice,observedthattheamendment"makesitquiteclearthatitisourintenttoworkforrepeal."Noonedisagreed.TheodoreGrevas,M.D.,DelegatefromRockIsland,lll.,warnedtheHousethat"failure
to
repealthelawatthistimeisnevertorepeal
it."
Itwasa'soclearatAnaheimthatpracticallyeveryphysician,includingallAMAofficersandtrustees,assertsthatPSROisabodlow.ThatfactpromptedjohnP.Heard,M.D.,PresidentoftheDeKalbCounty(Georgia)MedicalSociety,toobserve:"Ithinkitwoold
be
immoraltosupportalawwebelieveto
be
abadlow."(Note:Althoughthetrusteesclaimconfusionnow,therewaslittleifanyimmediatelyfollowingtheAnaheimmeet-ing,evenintheAMAheadquarters.TheWallStreetJournal,TheNewYorkTimes,MedicalWorldNews,HumanEvents,andeventheAmericanMedicalNewsagreedthattheHousehadvotedtoseekrepealofPSRO.IntheDec.10,1973,issueofAmericanMedicalNews,aheadlineonastoryabouteventsatAnaheimpro-claimed:"AMAExpandsPSROPolicytoSeekRepeal."Aneditorialinthesameissuecontainsthisparagraph:"AretheAMA'stwingoalsofPSROrepealandexertingleadershipinimplementingthelawincompatible?No.Notincompatible,butadmittedlydifficult."Dr.Howard,AMAExecutiveVicePresident,reportedlyapprovesallstoriesandeditorialsthatappearinAmericanMedicalNews.
AsksBoardIgnoreRepeal
AftertheclinicalmeetinginAnaheimandbeforetheBoardandstaffsessioninPuertoRico,amemorandumwasdistributedtomembersoftheCouncilonMedicalServicebytheCouncilChairmanWilliamB.Hildebrand,M.D.ThememorandumsaidthatDr.HildebrandandCouncilmembersC.WillardCamalier,M.D.,andDonaldR.Hayes,M.D.,hadmetinWashington,D.C.,withH.PhillipHampton,M.D.,ChairmanoftheCouncilonLeg-islation,andtheExecutiveCommitteeoftheAMABoardofTrustees"todiscusstheinterpretationtotheamendedReportEEaspassedbytheHouseofDelegatesatAna-heim."Thememorandumsaidthosewhometcouldn'tcomeupwithaninterpretationbecauseof"diametricallyopposedpointsofview"intheamendedBoardreport.Dr.Hilde-brand'smemorandumsaidthatasaconsequence
it
wouldberecommendedtotheBoardthatnoactionseekingPSROrepealbetaken.Thememorandumsaiditwould
be
rec-ommendedthatonlythelastparagraphofamendedReportEEbeimplemented.ThatparagraphwouldhaveleftAMAcommittedtocontinuingcollaborationwithgovernment,tosupporting"constructive"amendmentstoPSROandtoattemptingtoinfluenceHEWindraftingrulesandregulationstoputPSROintoeffect,butnotto
worklnq
forrepeal.
Therecommendation
to
ignoretheHousedecisionthatthebestcourse
of
action
is
to
abolish
PSRO
wasnotacceptedbytheBoardatPuertoRico,according
to
AMAsources.
TheBoardalsoruledoutsuggestionsthataspecialsessionoftheHouseofDelegatesbecalledto"clarifyReportEE";thattheBoardsolicitopinionsonthequestionofabolitionofPSROfromotherorganizations,suchasAAPS;thatAMAmembersbepolledtofindouthowtheyfeelaboutrepealingPSRO;thatdelegatesfromthesixstatesthatdraftedtherepealamendmenttoReportEEbecalledintoexplainwhattheyexpectedtoresultfromtheamendment.TheBoardagreed,however,thatAMA'sWashingtonlobbyistsshouldbeinstructedtoinformmembersofCon-gressaboutthedeleteriousprovisionsofthePSROlaw.TheBoardalsodirectedthestafftodrafta"whitepaper"onPSROfordiscussionatthenextBoardmeeting.TomE.Nesbitt,M.D.,SpeakeroftheHouse,Malcolm
C.
Todd,M.D.,AMAPresidentElect,andRichardE.Pal-mer,M.D.,BoardViceChairman,wereassignedtooverseepreparationofthepaper.
NotAsPlanned
TheHouseofDelegatesmeetinginAnaheimdidnot,apparently,proceedasplanned.Inthepast,theHouse
 
almostalwayshasgonealongwiththedesiresoftrus-teesandtheAssociation'sadministrationonmajorissues,eventhoughitsometimeshashadreservationsaboutdo-ingso.Resolutionsandreportswereusuallyconsideredaccordingtopatternslaidoutinadvance.Often,satellitemeetingsweresetupandartfullyguidedbytheAMAadministration.Rarely,ifeverdidtheresultsturnoutdiffer-entlythanplanned.AtAnaheim,a
sote.ltte
meetingwasor-ganizedforSaturday,December1,1973,topromotecol-laborationwithPSRO(everyoriginallyscheduledspeakerwasaPSRObooster,andsomewerefullorpart-timeem-ployeesofHEW).ReportEEoftheBoardofTrusteesandCouncilonMedicalServicewasdraftedtoreaffirmthepolicyofcollaboration,butthereportwasnotmadeavailabletodelegatesuntiltheopeningdayoftheHousemeeting.Itwasexpectedthatthenumerousanti-PSROreso'utionswouldbeshuntedtotheBoardandthatReportEEwouldbeadoptedwithminimumdebateandwithoutsubstantivechange.However,therewaspervasivegrumblingduringthemeetingaboutPSROcollaborationandmanycallsforsupportofAAPSeffortstoabolishPSRObychallengingitsconstitutionalityinfederalcourt.Therewaswide-spreadsupportforrepeal.ThegrumblingwasnottakenseriouslyatfirstbythetrusteesbecauseinthepastatCincinnatiandNewYorkmeetings,theAMAmanagementhadsucceededingettingitswayonthePSROissueanditwasexpectedtodosoagainthistime.
ButthatstrategybegancomingungluedatthespecialDec.
1
satellitemeetingdesignedtopromote
PSRO
andreinforcecollaboration.Awave
of
protestattheunrepresentativenature
of
thatsatellitemeetingforcethelast-minuteinclusion
of
one_butonlyone_opponent
of
PSRO.
Thatwas
J.
W.
Johnson,
M.D.,
whowaselectedPresident
of
theSanDiegoCountyMedicalSociety
on
aplatformvigorouslyopposing
PSRO.
HisAssociation
of
over2,000physiciansisonrecordforrepeal.HecalledPSROthe"seed
of
destruction
of
civilizedhumanemedicalcare."Andhesaidhehadheardthat
if
PSRO
.isabolished
some,
thingworsewouldfollow,"butI'vetriedandtriedand
I
justcan'tthink
of
anythingworse."Dr.Johnson'sdirectandunevasivecriticism
of
PSROwasobviously-fromtheamount
of
applausehereceived-thepoint
of
viewsharedbymost
of
thephysicianaudience.
It
alsopresagedthings
to
come.
ThatSaturdayPSROsatellitemeetingdisc'osedtophysiciansthedegreeofauthoritarianismtheycouldex-pectfromHEWofficialsresponsibleforenforcingPSRO.TheunmistakableattitudeofHenryP.Simmons,M.D.,DeputyAssistantSecretaryforHEWanddirectorofHEW'sPSROoffice,wasthat"thingswillbedoneourway"whetherdoctorslikeitornot.Andthisis"yourlastopportunity"todoasthebureaucratssaytoavoidsomethingworse.Priortothemeetingalldelegatesandalternatedele-gateshadbeensentaletterbyDonaldQuinlan,M.D.,PresidentoftheAAPS,whichrefutedachargebySen.WallaceBennett(R.,Utah)thattheAAPShadpushedthepanicbuttononPSRO.ToprovetheaccuracyoftheAAPScriticismofPSRO,acopyofthelawwasenclosedwithDr.Quinlan'sletter.
UnexpectedDevelopment
Sunday,December2,broughtanew,unexpectedde-velopment--anopenlettertotheHouseofDelegatessignedby34U.S.RepresentativesurgingtheAMAHouseofDelegatestoadoptaPSROrepealresolutiontohelpthoseinCongresswhoareworkingtowardthatgoal.Thatopenletterwassounsettlingtotrusteesandofficersthatthereisevidencetheyspentthenexttwodays
!!Y-
ingtogetsignerstowithdrawtheirsignaturesandat-temptingtodiscredititsurgentmessage.Dr.HeardlatertoldMPShehadbeeninformedthat"severalcongressmen
weI'S
threatenedwithlossofAMPACsupportiftheydidnotremovetheirnamesfromthepetition(letter)totheAMAHouseaskingforAMAtogoonrecordforrepealofPSRO."Theletterfromthecongressmensaid:"Thatsection(PSROsectionofPublicLaw92-603)willrequireyoutopracticeaccordingtocomputerizedstandards,ratherthanusingyourbestmedicaljudgmentintreatingyourpa-tients.Itwilldepriveyourpatientsoftheirrighttoprivacy,itwillimposeseverefinesformedicalinnova-tion."SomeofyouhaveurgedAMAparticipationinim-plementationofPSROsoyoucancontroltheadministra-tionofthelow.ButPSROisthelawoftheland;itistheworkingofCongressanditsimplementationistheresponsibiltyoftheDepartmentofHealth,EducationandWelfare.Evenifyouhelpimplementthelaw,youwillnotcontrolit.Theonlywaytoovoidthelaw'sbadeffectsistorepealit."ThePSROsectionisbadlaw;itwillbebadforthedoctorandbadforthepatient.Itshouldberepeal-ed.Unfortunotely,althoughmanyofusinCongresswanttoworkfortherepealofPSRO,wehavebeenhandicap-pedbytheAMA'sfailuretocontinueitsactiveoppositiontothelow.SomeofushavealreadyintroducedbillstorepealPSRO,butifweare
to
besuccessfulweneedyourhelp.WestronglyurgetheHouseofDelegatestopassaresolutionspecificallycollingfortherepealofPSROandcommittingtheall-outeffortsoftheAmericanMedicalAssociationtothatend."(Emphasisadded.)TheAMAmembermostresponsiblefortheletterwasDr.Heard,whoisamemberoftheAAPS.TheideafortheletterdevelopedduringaconversotionbetweenDr.HeardandhisCongressman,Rep.BenjaminB.B'ack-burn.WhentheletterarrivedatAnaheimonSunday,JackE.Shields,M.D.,delegatefromBrownstown,In-diana,obtainedpermissionforDr.Heard,whoisnofadelegate,toreadtheopenlettertotheHouse.
StrongSupportUnwelcome
Officersandtrusteesdidnotwelcomesuchstrongsupportforabolishingalawwhichthesesametrusteesandofficershavesaidisabadlow,-unlesstheyhavethepowerofenforcement.
Theirreaction
to
theletterastonishedmanydelegatesandpromptedone,Stanley
S.
Peterson,
M.D.,
Springfield,Mo.,
to
observethatwasaclassicexample
of
whydoctorsareconcernedabouttheAMA.HesaidAMAleadersought
to
dowhatisright.
RobertB.Hunter,M.D.,atrusteeandAMA'schiefPSROspokesman,whoisalsopaidforservingonHEWSecretaryCasparWeinberger'sNationalPSROCoun-cil,wastoppedbytrusteestodisposeoftheletteronMonday,Dec.3,attheReferenceCommitteehearing

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