Memorandum

To:	2005 Council
From:	Dean Wilkerson, JD, MBA, CAE Council Secretary
Date:	August 24, 2005
Subj:	Action on 2002 Resolutions

This report summarizes the actions taken by the Board of Directors on the 20 resolutions adopted by the 2002 Council. Two resolutions were referred to the Board and four were referred to the Council Steering Committee. The Council also adopted 6 amendments to the Council Standing Rules. These amendments did not require adoption by the Board.

Resolution 1 Allowing International Members to Continue as Active Members

RESOLVED, That the same courtesy be extended to international members as was extended to active members by allowing those who were international members prior to January 1, 2000 to transfer their membership to the active membership category; and be it further

RESOLVED, That the Bylaws, Article IV – Membership, Section 2.1 – Active Members, criterion # 6 be amended to read: 6) Active or International membership in the College at any time prior to close of business December 31, 1999.

Action: The Bylaws were revised in October 2002.

Resolution 3 Chapter Membership for Retired Members

RESOLVED, That the Bylaws, Article VI – Chapters, Section 3 – Qualifications be amended to read: "The membership of a chapter shall consist of members of the College who meet the qualifications for membership in that chapter. To qualify for membership in a chapter, a person must be a member of the College and have residential or professional ties to that chapter’s jurisdiction. Likewise, with the exception of members who are retired from active medical practice regardless of membership class, each member of the College must hold membership in a chapter in which the member resides or practices if one exists. If membership is transferred to a new chapter, dues for the new chapter shall not be required until the member’s next anniversary date.

A member with professional and/or residential ties in multiple chapters may hold membership in these chapters, providing the member pays full chapter dues in each chapter. Such members with multiple chapter memberships shall designate which single chapter membership shall count for purposes of councillor allotment. A member of a chapter who retires from active medical practice regardless of membership class and changes his/her state of residence may retain membership in a chapter of prior professional practice/residence. , and may designate that chapter for purposes of councillor allotment, if he/she so chooses.

A member of a chapter who changes residential or professional location may remain a member of that chapter if there is no chapter at the new location."

Action: The Bylaws were revised in October 2002.

Resolution 16 Commendation for Michael L. Carius, MD, FACEP

Action: A framed resolution was presented to Dr. Carius.

Resolution 17 Commendation for Toni A. Mitchell, MD, FACEP

Action: A framed resolution was presented to Dr. Mitchell.

Resolution 18 Commendation for Robert W. Schaferemeyer, MD, FACEP

Action: A framed resolution was presented to Dr. Schafermeyer.

Resolution 26 Mutual Recognition and Collaboration with AAEM

RESOLVED, That ACEP continue to actively pursue collaboration with the American Academy of Emergency Medicine on issues in which such collaboration may be of mutual benefit.

Action: AAEM was invited to participate on a project led by ACEP to revise the curriculum for fourth year medical student emergency medicine rotations. AAEM’s president, Joe Wood, MD, FACEP, FAAEM was appointed to the Professional Liability Task Force. AAEM was also asked to participate with ACEP and other emergency medicine organizations to provide funding for printing and distribution of an Institute of Medicine report on the future of emergency care in the United States.

Resolution 28 Egregious Expert Testimony

RESOLVED, That ACEP will develop a peer review system to identify egregious testimony and individuals providing egregious testimony as an expert on the practice of emergency medicine, and report back to the 2003 Council meeting on its progress.

Action: The resolution was assigned to the Professional Liability Task Force. The task force presented a preliminary report to the Board in February 2003. A procedure to review testimony regarding the standard of care in emergency medicine was developed and received legal review. The Board of Directors reviewed the procedure at its September and October 2003 meetings and was adopted in October. A report to the Council regarding the work of the task force was provided to the 2003 Council.

Based on the advice of ACEP’s legal counsel, the procedure to review testimony regarding the standard of care will be used only to publicize examples of expert witness testimony regarding standards of care that are false, misleading, or without medical foundation. Such testimony, once identified, will be publicized in ACEP communication vehicles without mention of the name of the person providing the testimony or any other identifying information. This procedure will be used as an educational tool and not as a punitive measure against any individual.

The College has joined with IDEX, a national network firm that shares expert witness information. IDEX provides services such as expert witness case history, information on professional disciplinary action taken against an expert’s license to practice, and transcript searches for ACEP members or their attorneys at a reduced fee.

The Professional Liability Task Force developed an expert witness reaffirmation statement for College members to sign reaffirming their commitment to the highest standards of conduct and integrity as an expert witness. The reaffirmation statement was approved by the Board in September 2003.

ACEP also continues to inform members about the use of the Daubert hearing to screen the scientific validity of medical testimony.

A comprehensive communication plan regarding ACEP’s professional liability initiatives has been developed. An all member mailing was sent in early 2004 that described each of these efforts, including the standard of care review procedures and the expert witness reaffirmation statement.

Resolution 29 American Heart Association ACLS Course

RESOLVED, That educational and instructional tools, such as ACLS, PALS, APLS, ATLS, and other similar courses are guidelines and are not standards of care.

Action: The resolution is a policy statement and was added to the 2003 Policy Compendium.

Resolution 30 Tort Reform

RESOLVED, That ACEP explore the benefits of becoming a member of the Health Care Liability Alliance and the American Tort Reform Association.

Action: ACEP became a member of both organizations.

Resolution 31 Prohibition of Balance Billing

RESOLVED, That it is the position of ACEP to oppose laws that ban the balance billing of commercial, non-contracted, emergency department patients; and be it further

RESOLVED, That ACEP seek an expert legal opinion describing the legal theories, costs, and likelihood of success of legal action to overturn or prevent future laws that ban balance billing and submit this report to the Board of Directors for a recommendation for further legal or legislative action.

Action: The first resolved is a policy statement and was added to the 2003 Policy Compendium. A legal opinion was obtained, summarized, and distributed at the 2003 Council meeting. The legal opinion is privileged and confidential information.

Resolution 32 Treatment of Sexual Assault

RESOLVED, That it is the position of ACEP that a victim of sexual assault should be offered prophylaxis for sexually transmitted diseases, subject to informed consent and consistent with current treatment guidelines; and be it further

RESOLVED, That ACEP will incorporate the above in its current policy statement titled, "Management of the Patient with the Complaint of Sexual Assault"; and be it further

RESOLVED, That it is the position of ACEP that a victim of sexual assault should be offered prophylaxis for pregnancy, subject to informed consent and consistent with current treatment guidelines. Physicians and allied health practitioners who find this morally objectionable or who practice at hospitals that prohibit prophylaxis or contraception should offer to refer victims of sexual assault to another provider who can provide these services in a timely fashion; and be it further

RESOLVED, That ACEP will incorporate the above in its current policy statement titled, "Management of the Patient with the Complaint of Sexual Assault."

Action: The resolution was referred to the Emergency Medicine Practice Committee for review in conjunction with the current policy statement "Management of the Patient with the Complaint of Sexual Assault." The policy statement was revised as directed.

Resolution 33 Malpractice Reform

RESOLVED, That the American College of Emergency Physicians does hereby affirm its concurrence with the practice of holding judges accountable for the quality of scientific evidence presented in jury deliberations as to cause-effect relationships and in assignment of damages in cases related to medical practice.

Action: The resolution is a policy statement and was added to the 2003 Policy Compendium.

Resolution 34 Funding for EMTALA-Mandated Physician Services

RESOLVED, That the American College of Emergency Physicians collaborate as appropriate with organizations whose members are affected by EMTALA to lobby the federal government to fund EMTALA-mandated services not covered by current funding mechanisms; and be it further

RESOLVED, That the American College of Emergency Physicians ask the American Medical Association to make it a legislative priority to ensure that EMTALA-mandated physician services are funded; and be it further

RESOLVED, That the Board of Directors report back to the 2003 Council on progress to date.

Action: The issue was included in ACEP’s legislative and regulatory priorities for 2003. It was also discussed with the AMA leadership. A report was provided to the 2003 Council.

ACEP worked with a number of organizations on uncompensated care due to EMTALA mandates. First, funds were requested from the Emergency Medicine Foundation (EMF) to conduct a joint research study with the American Hospital Association (AHA) to assess the level of EMTALA-induced uncompensated care provided by EDs. The Foundation agreed to allocate $35,000 for the study. Negotiations continued with the AHA through November 2002 when the two organizations mutually agreed to not pursue a joint study.

ACEP assessed costs and benefits of developing our own survey to quantify the amount of uncompensated care provided by emergency physicians. A proposal was drafted and circulated to relevant committees and Board members, and renewed discussions will be held with EMF to determine if the proposed changes will require a new request for funding.

Using results from its new survey instrument "The Patient Care Physician Survey," the American Medical Association (AMA) reported on the number of hours that physicians spend providing care mandated by EMTALA, and the financial impact of that care on physicians. In 2001, more than 30 percent of all physicians, and 95.2 percent of emergency medicine physicians, provided care covered by EMTALA in a typical week of practice. Across all specialties, EMTALA-related bad debt amounted to $12,300 per self-employed physician in 2000, or nearly $4.2 billion in the aggregate amount.

ACEP collaborated with the AMA and the Alliance for Specialty Medicine to urge Congress to pass legislation to establish a national advisory committee to address EMTALA requirements and funding, as well as enforcement and other issues. The recently passed House version of the Medicare Drug Bill (H.R. 1 Sec. 944 - 945) provides the statutory authority for the EMTALA advisory committee, and it has been reported that the House-Senate conference committee has agreed to this provision.

ACEP was successful in the reintroduction of the Health Care Safety Net Oversight Act of 2003 (SNOPAC), S.732, introduced by Senators Baucus and Hatch, amends Title XI of the Social Security Act to create an independent and nonpartisan commission to assess the health care needs of the uninsured and to monitor the financial stability of the Nation's health care safety net. The Commission, which would include an emergency physician, will review of the health care safety net programs and report annually to Congress, the Comptroller General, and the Secretary of Health and Human Services on the health care needs of the uninsured and the financial and infrastructure stability of the core health care safety net of the United States. This bill, passed by the Senate last year, lays important groundwork by recognizing EMTALA-related care as a federal safety net program. This acknowledgement on the part of the federal government is crucial to efforts to seek funding for health care provided under this mandate.

While ACEP efforts continued to educate lawmakers about the increased burdens imposed by EMTALA on long-term viability of many of the nation’s EDs and on patient access, ACEP’s major advocacy focus, along with our medical specialty society partners, has been physician payment and medical liability reform. These two challenges alone, coming at a time when the federal deficit is growing, the war in Iraq is very costly, and Congress wrestles with what will ultimately be a huge new entitlement in the form of Medicare outpatient drug coverage, are consuming an inordinate amount of resources. However, we continue to press forward on a variety of fronts to work with influential policy experts (GAO’s 2003 report on ED crowding, IOM series of reports in 2002-03 on uninsured) to warn Congress and the public that EDs cannot sustain the growing level of uncompensated care indefinitely.

Resolution 35 Patient Safety

RESOLVED, That the ACEP Board of Directors consider patient and physician safety in developing strategies for 2003-4 in the areas of physician wellness, ED overcrowding, and liability; and be it further

RESOLVED, That the ACEP Board of Directors report to the 2003 Council the progress made in implementing the recommendations of the 2001 Patient Safety Task Force Report.

Action: The resolution was included in the strategies developed for FY 03-04. A report was provided to the 2003 Council listing each of the recommendations from the task force and included an update on their implementation.

Standing Rules Resolutions
Standing Rules Resolutions do not require adoption by the Board of Directors.

Resolution 19 Consent Calendar

The resolution amended the "Consent Calendar" section of the Council Standing Rules. Action: The Standing Rules were revised in October 2002.

Resolution 20 Declared Floor Candidates

The resolution amended the "Nominations" section of the Council Standing Rules to clarify the campaign privileges for candidates who make known their candidacy prior to the Council meeting.

Action: The Standing Rules were revised in October 2002.

Resolution 21 Election Procedures

The resolution amended the "Election Procedures" section of the Council Standing Rules. Action: The Standing Rules were revised in October 2002.

Resolution 23 Reports to the Council

The resolution amended the "Reports" section of the Council Standing Rules to provide direction to authors of reports who are asked, or who petition to address the Council.

Action: The Standing Rules were revised in October 2002.

Resolution 24 Voting Immediately

The resolution amended the "Voting Immediately" section of the Council Standing Rules to allow the opportunity for testimony on both sides of an issue before the motion to vote immediately is in order.

Action: The Standing Rules were revised in October 2002.

Resolution 25 Voting on Resolutions and Motions

The resolution amended the "Voting on Resolutions and Motions" section of the Council Standing Rules to provide clarification regarding the use of electronic voting.

Action: The Standing Rules were revised in October 2002.

Resolutions Referred to the Board of Directors

Resolution 13 Alternative Associate Membership Status

The Council referred Substitute Resolution 13 to the Board of Directors:

RESOLVED, That the issue of ACEP involvement of physicians who are not currently eligible for membership in ACEP be referred to the Board of Directors. Findings are to be reported to the Council at its 2003 meeting.

Action: The resolution was assigned to the Membership Committee. A report was provided to the 2003 Council. The Membership Committee remained undecided on the best alternative for an alternate category of membership. However, in accordance with the charge given them by the Board, the committee developed resolution language for possible submission to the 2003 Council.

The Board of Directors reviewed the report and resolutions provided by the Membership Committee and thoroughly debated the issue. Discussion by the Board centered on the best course of action for the College and the specialty in the years ahead. The Board noted that the extensive debate on the Council floor in 2002 mirrored the Council debate that occurred in 1997. Concern for the impact on small chapters, the need to be inclusive of our colleagues in emergency medicine, the shortage of emergency physicians in rural areas, etc. were similarly argued in 1997. Members of the Membership Committee agreed that the future practitioners of emergency medicine should be residency trained and that, as a College, any category of membership should reinforce our belief that those joining for the first time ought to be residency trained in our specialty.

When the decision was made to move to criteria-based membership, leaders realized that the College would encounter difficulties during the early years of implementing these new membership criteria. Understanding the need to include all physicians practicing emergency medicine at that time, the College undertook an extensive two-year membership campaign, providing the opportunity for all non-board certified emergency physicians to join the College. Additionally, the new criteria allowed for any former active member of the College to rejoin at any time.

After much discussion and debate, the Board of Directors determined that the best course of action for the future of the College and the specialty of emergency medicine was to reinforce the decision made by the Council in 1997. The Board of Directors recognizes that significant workforce issues continue to plague the specialty, especially in rural and underserved areas. However, changing our Bylaws now is not the appropriate solution for this problem. It is clear that future practitioners of emergency medicine must be residency trained in the specialty. The Board of Directors believes that ACEP’s criteria-based membership serves us well. Additionally, in reviewing the opportunities offered to non-members, the Board of Directors believes there is adequate access to all educational products and College publications to afford non-members the opportunity to keep abreast of developments in the specialty, both clinically and organizationally.

In summary, the Board of Directors concluded that the existing membership categories serve the College and the specialty well and that appropriate opportunities currently exist for non-member involvement. Accordingly, the Board of Directors recommended no changes in the College’s current membership structure.

Resolution 27 College Officer Expert Testimony

RESOLVED, That no officer of ACEP, whether elected or appointed, shall provide expert testimony in medical malpractice litigation during the tenure of his or her term in office. The term "Officer of ACEP," shall include but not be limited to the president, immediate past president, president-elect, vice president, secretary-treasurer, Council speaker, Council vice speaker, and members of the Board of Directors.

Action: The Board adopted the policy statement "Board Member and Council Officer Expert Testimony" in September 2002, which prohibits providing expert testimony during or for two years after his or her term. The Board discussed the referred resolution and revised the policy statement in February 2003.

Resolutions Referred to the Steering Committee

Resolution 6 Election of President-Elect by the Council

The Council referred Substitute Resolution 6(02) to the Steering Committee:

RESOLVED, That the ACEP 2002 Council endorses the concept of direct election of the president-elect by the Council; and be it further

RESOLVED, That direct election of the president-elect by the Council be referred to the Steering Committee for development of a resolution to be disseminated by March 2003 and submitted to the Council for consideration at the 2003 Council meeting.

Action: The Steering Committee and the Bylaws Committee prepared a draft resolution that was distributed to the Council on c-mail by the end of March 2003 and was submitted to the Council for consideration at the 2003 Council meeting. The Council defeated the resolution.

A resolution was also submitted to the 2004 Council for election of the president-elect by the Council. It was adopted by the Council and the Board. The Council will elect the president-elect beginning with the 2005 Council meeting.

Resolution 7 Council Officer Terms

RESOLVED, That the last sentence of Article X – Officers/Executive Director, Section 10 – Speaker of the Bylaws be amended to read : "No speaker may serve more than two consecutive terms."; and be it further

RESOLVED, That the last sentence of Article X – Officers/Executive Director, Section 11 – Vice Speaker of the Bylaws be amended to read: "No vice speaker may serve more than two consecutive terms."

Action: The resolution proposed to amend the Bylaws to limit the speaker and vice speaker to serve only one term. The Steering Committee discussed the resolution at their January 2003 meeting and agreed to resubmit it as written to the 2003 Council. The Council adopted the resolution.

Resolution 12 Public (Non-Physician) Member on the ACEP Board of Directors

The Council referred Amended Resolution 12(02) to the Steering Committee:

RESOLVED, That the Steering Committee draft appropriate Bylaws language to implement the addition of a public, non-physician position on the ACEP Board of Directors.

Action: The Steering Committee discussed the resolution at their January 2003 meeting. Numerous concerns were expressed regarding the resolution and the Steering Committee decided not to resubmit the resolution to the 2003 Council.

Resolution 22 Reference Committees

The Council referred Amended Resolution 22(02) to the Steering Committee:

RESOLVED, That the Council Standing Rules, "Reference Committees" section be amended to read: "Each resolution properly submitted at or prior to the convening of the Council meeting will be assigned by the speaker to a specific Reference Committee for deliberation and recommendation. Reference Committee meetings are open to all members of the College, its committees, and invited guests of the Reference Committee. After all testimony is presented to a Reference Committee, the chair may discontinue floor discussion while the committee prepares its report for the Council.

Each Reference Committee will make recommendations on each resolution assigned to it in a written Reference Committee report. The speaker will open for discussion each resolution or matter which is the immediate subject of the Reference Committee report. The effect is to permit full consideration of the business at hand, unrestricted to any specific motion for its disposal. Any appropriate motion for amendment or disposition may be made from the floor. In the absence of such a motion, the speaker will state the question in accordance with the recommendation of the Reference Committee. If the recommendation is referral, or amended language, the primary motion on the table is the recommendation of the Reference Committee. Ddefeat of the recommendation to refer does not place the original resolution before the Council for discussion. If a recommendation to refer is defeated, A a motion must be made to amend reconsider the original resolution by substitution of the original resolution before it can be discussed."

Other information on the conduct of Reference Committees and examples of method of disposition of their recommendations by the Council are outlined elsewhere in the Council Manual."

Action: The intent of the resolution was to clarify the process when the reference committee’s recommendation to refer a resolution is defeated and codifies the current practice of the Council. The Steering Committee discussed the resolution at their January 2003 meeting. In consultation with ACEP’s parliamentarian, Jim Slaughter, JD, the Steering Committee agreed that the Reference Committee’s recommendations to refer should be proposed at the beginning of their report. It was also agreed that if the motion to refer were defeated, the original resolution should come before the Council for consideration. Changing to this process did not require a change to the Standing Rules; however, a section in the Councillor Handbook was modified to describe the process. The process was implemented at the 2003 Council meeting.

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