| Date post: | 06-Jul-2018 |
| Category: |
Documents |
| Upload: | association-of-american-physicians-and-surgeons |
| View: | 217 times |
| Download: | 0 times |
of 72
8/17/2019 AAPS News 1974
1/72
974
INDEX
AAPS
NEWS
L TT RS
nd ULLETINS
J NU RY THROUGH
DECEMBER
NL
- News Letter
EB
- Emergency Bulletin
8
- Information Bulletin
LB
- Legislative Bulletin
Name
or Item Index No.
Type
Dote
Name or Item
Index
No.
Type
Dote
AAPS Amendment
8
NL August
AMA and PSRO (Being hurt by lawmakers)
NL
October
AAPS Annual Meeting
6
NL
June
American Medical Association 7
NL
July
8
NL August
American Medical News 2
NL
January
9
NL
September
3
NL
February-Morch
NL
October
6
NL
June
12
NL
November
11
NL
October
13
NL
December
13
NL
December
AAPS By-Lows
3 NL February-Morch
AMPAC 11
NL
October
AAPS Copy for Newspaper Ads
3 NL February-Morch
Anthony,
E.E.,
M.D.
12
NL
November
AAPS Dues Raise 5 NL Moy
Anthony, Mrs. Jackie
3
NL
February-Morch
AAPS House
of
Delegofes
5 NL
Moy
12
NL
November
9
NL September
13
NL
December
AAPS Index
11
l
October
Anderson,
Jomes L.,
M.D.
4
NL
April
AAPS Lawsuit
6
NL
June
Arlington Heights Herold
9
NL September
7
NL July
Ashbrook, John, Representative
11
NL
October
12
NL
November
Association of American Medical Colleges
11
NL October
AAPS News Letters 2
NL
January
Auerbach, Stuart
7
NL July
AAPS
Ohio Chapter
NL
October
AAPS Pamphlets
8
NL August
AAPS Political Action Organization 13
NL
December
Babb, Forrest, J., M.D.
5
NL
Moy
AAPS
Private Doctors Institute
3
NL February-Morch
Ball, F.M., M.D.
7
NL July
4
NL
April
Ballantine, H. Thomas, Jr., M.D.
NL
January
13
NL December
Bennett, Wallace, Senator
NL
January
AAPS
PSRO
Pledge Cord
EB
1-4-7 4
5
NL
Moy
AAPS
Resolutions
NL February-Morch
6
NL
June
8
NL August
7
NL July
9
NL September
9
NL
September
13
NL December
Blackburn, Benjamin 8., Representative
NL January
AAPS
Speakers Bureau 7
NL July
Bloke, Jomes M. M.D.
6
NL
June
13 NL December
7
NL July
AAPS Woman s Auxil iary
3 NL February-Morch
Bonner, Poul, M.D.
5
NL Moy
12
NL November
Boyd,
Elmo, M.D.
NL January
American Association of Medical Society Executives
7 NL July
Boyle, Joseph F., M.D.
NL January
American Bar Association Meeting
8
NL
August
5
NL Moy
American College
of
Radiology
6 NL June
Bradley, Wayne
7 NL July
AMA
Advisory Committee on
PSRO
4
NL
April
Brazoria County (Texas Medical Society)
3 NL
February-March
AMA
Anaheim Meeting Report
2
NL
January
Breo Dennis
13
NL
December
AMA
Annual
Convention - June 6
NL
June
Broyhill, Joel, Representative
2
NL January
AMA
Boord
of
Trustees
EB
1-4-7 4
Budd, John
H.
13 NL
December
NL
January
Buerger, Wolter, M.D.
2
NL
January
6
NL
June
9
NL
September
7
NL
July
12
NL November
13
NL
December
Bullington, Robert, M.D.
9
NL
September
AMA Chicago Convention
7
NL
July
12
NL
November
AMA-HEW PSRO Contracts
7
NL
July
AMA House of Delegates
l
EB
l-4-74
2
NL
January
Calcasieu Parish Medical Society
13
NL December
6
NL
June Lake Charles, Louisiana)
7
NL
July
California Medical Association
5
NL Moy
AMA
Medicredit Bi
II
NL
October Comalier,
C
Willard, M.D.
2
NL January
AMA Newsletter
4
NL
April Campbell, Garland, M.D.
12
NL November
AMA
Policy on
PSRO
7
NL July Campbell, Mrs. Juanita 12 NL November
8/17/2019 AAPS News 1974
2/72
ame
or Item
Index No.
Type Dote
ome or Item
Index No.
Type
Dote
Campbell,
R.L.,
M.D. 9
NL September
Ford, Gerald, President
9
NL
September
12
NL
November
Ford, Gerald, Vice-President
7
NL
July
Carter, E.K., M.D.
5
NL May
Franklin County (Ohio) Academy Council
NL October
r
6
NL June
Fulton, Richard, Representative
11
NL October
Corter, Tim Lee, M.D., Representative
12
NL
November
G
Castro, Fidel
11
NL October
Gabler, Mrs. Mel
9
NL
September
Charleston (South Carolina) County Medical Society 5
NL May
13
NL December
Chenault, John M., M.D.
NL January
Gardner, Hoyt D., M.D. 6 NL June
4
NL April
7
NL July
6
NL June
Grady, John L., M.D.
12 NL
November
7
NL July
Green, Edith, Represenfative
9
NL
September
Citizens for Quality Medicine
5
NL May
Grevos. Theodore, M.D.
2 NL January
Clinton County (Iowa) Medical Society
3
NL
February-March
Griffith, J. Keller, M.D.
9 NL
September
Cloud, Daniel, M.D.
6
NL June
12 NL November
7
NL July
Griffiths, Martha, Representative
9 NL
September
Colomb, James
3
NL
February-March
H
Comprehensive Health Insurance Plan (CHIP)
3
NL
February-March
HMO's
3
NL
February-March
Constantine, Jay
6
NL
June
13
NL
December
9
NL September
HR-9375
Rarick
Bill)
E
l 4 74
Council of Medical Staffs
3
NL
February-Morch
5 NL May
5 NL Moy HR-16204 The National Health Policy) 9 NL September
6
NL June
10
E
9-20-74
Coury, John J., M.D.
2
NL January
Holl County Medical Society
13
NL
December
Coy, Mrs. Betty
12
NL
November
(Grand Island, Nebraska)
Crone, David, M.D.
7
NL July
Hampton, H. Phillip, M.D.
2
NL
January
Crane, Philip, Representative
2
NL January
Harvey, Daryl
P.,
M.D.
NL
January
7
NL July
Hawk, John, M.D.
6
NL
June
8
NL August
Hayes, Donald R., M.D.
2
NL
January
9
NL
September
Hayes. Thomas B., M.D.
2
NL
January
13
NL
December Health. Education Welfare. Department of
3
NL
February-March
Crosthwait, Joe M., M.D.
2
NL
January 5
NL May
Cullum, Albert, M.D.
12
NL
November 13
NL
December
Cullum, Mrs. Mary Beth
12
NL
November
Heard, John P., M.D.
2
NL
January
Curtis, Corl T., Senator
5
NL
May 6
NL
June
Henry. Patrick
6
NL
June
Decker. Barry, M.D.
5
NL Moy
Hicks, Nancy
11
NL
October
Delaurentis , Joseph, M.D. 2
NL
January
Hildebrand, William B., M.D. 2
NL
January
Delegates Nomination; Notice of 5
NL May
7
NL July
Derwinski, Edward J., Representative
NL
January
Hill-Burton Funds
NL
October
NL
February-March
Himler, George. M.D.
NL
January
Doering, Elsie
L.
12
NL
November
Hines, Harry K., M.D.
7
NL July
Dole Robert Senator
12
NL
November
Holden, Raymond T
.
M.D.
2
NL
January
Dorrity, Thomas G., M.D.
5
NL
May
6
NL
June
12
NL
November
7
NL
July
E
Holland, John, M.D.
3
NL
February-Morch
Edwards, Charles C.,
M.D. 2
NL January
Hospital-Physician Relationship
12
NL
November
(HEW's Assistant Secretory of Health)
3
NL February-March
House Committee on Interstate and Foreign
9
NL
September
7 NL July
Commerce
Emergency Medical Core Review Organ ization 6
NL June
10
E
9-20-74
EMC RO)
House Ways and Means Committee
5
NL May
Emerson, Ralph S., M.D.
2
NL
January
Howard, Ernest, B., M.D.
2
NL
January
Engelke, Otto K . M.D. 2
NL
January
4
NL
April
England, Robert G., M.D.
13
NL
December
6
NL
June
Eversole, Urban H., M.D.
2
NL
January
Howard, Bert, M.D.
7
NL
July
NL
October
Federal Drug Administration (FDA)
Hu man
vents
2 NL
January
5
NL
MAY
Federal Register
NL
February-Morch
Hunter, Robert
B.,
M.D.
2
NL
January
3
Federal Register (November 29, 197 4)
13
NL
December
5
NL May
Fenick, John, M.D.
12
NL
November
7
NL
July
Florida Legislature on PSRO
6
NL
June
Florida Medical Association
5
NL Moy Illinois Academy of Family Physicians 3 NL February-Morch
8/17/2019 AAPS News 1974
3/72
ameor ltem
Index No.
Type
Dote
ame
or Item
Index No.
Type
Dote
Illinois Professional Standards Review Organization
3 NL
February-Morch
Mode, Arthur
S.,
M.D.
6
NL
June
Illinois State Medical Society
11
NL
October
Montgomery County (Ohio) Medical Society
5
NL
Moy
r·
Illinois State Medical Society House of Delegates 3
NL
February-March
N
Indiana Chapter of AAPS
5
NL
Moy
Notional Health Insurance NL
April
13
NL
December
13
NL
December
Involuntary Servitude
11
NL
October
National Professional Standards Review Council
6
NL
June
7
NL
July
Joggord, Robert
S.,
M.D.
9
NL September
Nelson, Gaylord, Senator
11
NL
October
12
NL
November
Nelson, Joe T., M.D.
6
NL June
Javits, Jacob, Senator
11
NL
October
7
NL July
Jirka, Frank J., M.D.
6
NL June
Nesbitt,
Tom
E., M.D.
2
NL
January
7
NL July
7
NL July
Johnson, Charles W., M.D.
12
NL
November
New York Times,
The
2
NL
January
Johnson & Johnson
5
NL May
11
NL
October
Jofinson, J.W., M.D.
2
NL January
Nixon, Richard M., President
3 NL
February-Marc
Johnson, Lee L., M.D.
11
NL October
Joint Commission on Accreditation of Hospitals
8
NL August
Oath of Hipprocrates
5
NL May
Julian, Mrs. Lil
12
NL
November
Ochota, Leszek, M.D.
13 NL December
Juliana, ister
8
NL
August
Orlondella, A.W., M.D.
NL April
OSHA (Occupational Safety and Health 9
NL
September
Kefauver Law
5 NL May
Adminisrrotion
Kennedy, Edward, Senator
2 NL
January
P
NL April
P.L.
92 603
13
NL
December
NL October
Pockwood, Robert, Senator
3
NL
February-March
Kennedy-Mills Bill (not Health Insurance) 5 NL
May
Palmer, Richard E., M.D. 2
NL
January
Kernodle, John R., M.D.
2
NL January
NL
April
6 NL
June
Pamlico Albermorle Medical Society 13 NL
December
Killeen, Raymond, M.D. NL January
(Washington, N.C.)
Kondracke, Morton
9
NL September
Pamphlet Rack Order
Form
12
NL
November
9 NL September
Parker, Thomas, M.D. NL
January
Kramer, Maurice
13
NL December
7 NL July
Parrott, Max, M.D. 2
NL
January
6
NL
June
Leithort, Poul W., M.D.
9
NL September
7
NL
July
11
NL October
Pell, Claiborne, Senator
11
NL October
12
NL November
Pell, Wilbur F., Jr., Judge
12
NL
November
Little, Arthur., Inc.
4
NL April
Perk, Ralph, Ma yor o f Cleveland
11
NL
October
Louisiana State Medical
ociety
5
NL May
Lynch, William· J., Judge
Pinellas County Medical Society
13
NL
December
12
NL November
(St. Petersburg, Florida)
M
Porterfield, John D., M.D.
8
NL
August
McDonald, Lawrence, M.D.
12
NL
November
Pottawatomie County Medical Society 13
NL
December
McGovern, George, Senator
11
NL
October
(Shawnee, Oklahoma)
McMahon, R.R.
12
NL
November
Powell, J. Enoch
8
NL
August
McMillen, Thomas
R.,
Judge
12
NL
November
9 NL
September
Maccarter, Paul, M.D.
4
NL
April
12
NL
November
Macoupin County (Illinois) Medical Society
11
NL
October
13
NL December
Marshall, Matthew, Jr., M.D.
NL January
PSRO
E
1-4-74
Mortin, George
B.,
Jr., M.D.
7
NL July
2
NL January
Medicaid
NL April
3
NL February-Morc
5
NL Moy
4
NL
April
Medical Society of Georgia
5
NL Moy
5
NL May
Medical World News
2
NL January
6
NL June
Medicare
NL April
7
NL July
5
NL Moy
8
NL
August
Meiling, Richard L., M.D.
2 NL
January
12
NL
November
Meyer, Morgan, M.D.
2 NL
January
13
NL December
Miller, Joe D.
NL
April
PSRO
Contract Awards
8
NL
August
Miller, W. Charles, M.D.
NL January
PSRO* The
Great £.'olitical 2ickness
. 3ip
Qff
7
NL
July
Mills, Wilbur, Representative
3
NL February-March
and Order Form
5
NL
Moy
PSRO: Organization for Regional
Peer
Review
,
NL
April
9
NL September
PSRO - Phyllis Schlafly on Spectrum
6
NL
June
11
NL October
"PSRO
and Public Relations
1
EB
9 20 74
8/17/2019 AAPS News 1974
4/72
~, crne or Item
Index No.
Type
Dote
Name or Item
Index No.
T· Pe
Dote
Smoot, Don
8
NL August
September
NL
Quinlan, Donald, M.D. 2 NL
January
12
NL
November
NL
Moy
13
NL
December
6
NL June
Social Security Bulletin
3
NL
February-Morch
8 NL
August
South Coast Community Hospital
(South Laguna, 4 NL
April
9
NL September
California)
11
NL
October
South Carolina Medical Association
5
NL
May
12
NL November
Spence, Mrs. Betty
9
NL
September
Quinlan, Mrs. Mary
12
NL
November
St.
Joseph Hospital (Illinois)
8
NL
August
Stock, Paul F.
12
NL
November
R
Stanbery, Morie, M.D.
12
NL
November
Stewart, Jomes H., M.D.
6
NL June
July
Stone, Joseph
8
NL August
Rorick Comments on AMA Capitulation
7
NL
NL July
Sweeney, Donald
N.,
Jr., M.D.
2
NL
January
Rorick, John R., Representative
7
8
NL August
9
NL September
December
Tennessee Medico Association
5
NL Moy
13
NL
Rial, William Y., M.D. July
6
NL
June
7
NL
Texes Medical Association
5
NL Moy
Richmond (Virginia) Academy of Family Physicians
5
NL
Moy
September
To the Roots of Inflation
7
NL July
Rogers, Fronk, M.D . 9
NL
NL
November
Today's Woman
E
1-4-7 4
12
December
Todd, Malcolm
C.,
M.D.
NL January
13
NL
7
NL July
Rogers, Poul, Representative
9
NL September
11
NL
October
10
E
9-20-7 4
13
NL
December
Roth, Russell,
B.,
M.D.
NL January
Februo ry-Morch
Tschantz, Robert E., M.D.
NL July
3
NL
5
NL
Moy
U
Roy, William, M.D. Representative 12
NL
November
Russian Request for AAPS News Letters
6
NL June
Ullman, Al Representative 2
NL January
S
11
NL October
S-2994 Another Kennedy Bili to Control Medicine
4
NL
April
IJ
S Supreme Court
12
NL November
S-3585 (students to practice 2 years after 11
NL
October
Utilization Review Regulations
13
NL December
graduation where HEW Secretary orders)
W
Sa' ey, W. Col:ier, M.D.
NL
January
Sammons, Jame:'. M.
M.O.
NL
January
Wall Street Journal, The
2
NL
January
NL
Februo ry-Morcr·
Washington Post
7
NL July
4
NL
April
Washington Reeort on Medicine & Health
4
NL
April
6
NL
June
We,nberger, Caspar, Secretory of HEW NL
January
7
NL
July
3
NL
February-Morch
Samuelson, D.R.,
M.D.
11
NL
October
4 NL
April
Schenken, John R , M.D.
2
NL
January
5
NL
May
7
NL
July
Weston, C. Tucker, M.D.
11 NL
October
9
NL
September
Wiater, Edward, M.D
NL
January
Schneebeli, Herman, Representative
2
NL
January
6
NL
June
3
NL
February-Morch
Will National Health Plan Cut Standards?"
12
NL
November
Schreiber, Jack, M.D.
2 NL
January
Winter, F.D., M.D.
11
NL October
Scrivner, Willard C., M.D.
NL
January
Witten, Carroll, M.D. NL January
Senate Finance Committee
5
NL
Moy
Wood, Donald
E.,
M.D. NL
January
6
NL
June
6
NL June
9
NL
September
NL July
Shields, Jack
E.,
M.D.
NL
January
Wood, John M , M.D
2
NL
January
Simmons, Henry
P.,
M.D.
NL
January
Woolley, Fronk
K.
5
NL May
5
NL
May
8
NL
August
6
NL
June
9
NL
September
9
NL
September
12
NL
November
13
NL
December
13
NL
December
Smith F. Michael, Jr., M.D.
5 NL
Moy
Wunderlich, Edwin
R.,
M.D.
2
NL
January
8
NL
August
9 NL
September
Z
13
NL
December
Zimmerman, G.R., M.D.
11 NL
October
8/17/2019 AAPS News 1974
5/72
THE VOICE FOR
PRIV TE D O TO R S
Index
No.
2
January, 1974, Volume 28, No. l
Spe~ial M eeting Report
A comprehensive, in-depth review of the
PSRO
controversy at the
AMA
Clinical Meeting, Anaheim,
California, in December. AAPS alone has the ded
ication to principle and the capacity for action
which makes
such
a report
as
this possible.
Please
urge at least one other doctor
to
1om AAPS now
and strengthen the
effort
to save U.S. medicine -
Donald Quinlan, M.D., President.
M
H ouse
of
Delegates
Y·otes
For Abolishing
The
PSRO Law
Members
of
the American Medical Association House
of
Delegates climaxed a tumultuous clinical meeting at Ana
heim, California, in December by rebuffing, without a dissenting vote, repeated exhortations
of
AMA
officers, trustees
and high-level staff to reassert without change the Association's policy of collaboration with government to impose
PSRO
controls on the nation's physicians and their Medicare and Med icaid patients.
PS Lawsuit Supported
Much interest was evident
at
the
AMA
Clinical Meet
ing
in
the
AAPS
lawsuit to declare the
PSRO law
uncon
stitutional. One resolution (No. 29 introduced
by
Virginia)
specifically called for
AMA
to support the suit. Several
delegates also urged
AMA
to suppo-rt the suit.
The Virginia resolution resolved that the American
Medical Association publicly announce its approval of
the lawsuit initiated by the Association of American Phy-
sicians and Surgeons, and that the membership be en
couraged to
use
every practical means to bring about a
successful termination
of
this lawsuit
The Reference Committee only indirectly acknowledg
ed the subject by disposing of Resolution No. 36 (urging
a study
of PSRO
constitutionality)
in
these words,
Your committee is also well aware that the matter of
Resolution 36 is already the subject of court action in
stituted by members
of
the profession,
so
that adoption
of
this resolution would be a costly duplication
ot
judicial review
of
the
law
which
is
already under
way.
The House on Dec. 5, 1973, made it clear
the best course
of
action was to abolish the
PSRO law. Delegates amended a report of the
Board of Trustees and Council on Medical Ser-
vice (Report EE) to make it clear that: The
considered opinion
of this
House
of
Delegates
is
that
the best interests of the American peo-
ple, our patients, would be served
by
repeal
of
the
present PSRO legislation.
The amendment to Report also directed the Board
of
Trustees to
work
to inform the public and legislators
as
to the potential deleterious effects
of
this
law
on the
quality, confidentiality and cost
of
medical care. This
was a renewal of a previous House directive which
AMA
Executive Vice President Ernest B. Howard, M.D., said
was
wrong and admitted
he
had declined to carry out.
INSIDE
•
Text of
AMA PSRO
Amendment
AMA
Executive Backs Down
•
~eference Committee
PSRO
Debate
•
House of
Delegates Debate
Rep.
Crane's Speech - PSRO Repeal
is Possible
•
At
Large
AMA
Trustee Elections
•
AMA
Headquarters Stay
Dr. Heard Is Board Candidate
•
Dr. Retires in
PSRO
Protest
8/17/2019 AAPS News 1974
6/72
A month after the Anaheim meeting, members of the
Board
of Trustees
were claiming they were
so
confused
over action of the
House of
Delegates they could reach
no specific agreement
on
abolition
of PSRO or on
imple
mentation
of the House order to tell the public about the
bad provisions of the PSRO law.
They professed to be confused because parts of Report
EE as amended appeared to co_nf:ict with other parts
as
oriAinally drafted. Specifically, they indicated be
lief that the statement of the amendment that PSRO should
be abolished
was
incompatible with the concluding state
ment of Report
EE
which recommended the AMA "continue
to exert its
(PSROl
leadership
by
supporting construc
tive amendments to the
PSRO
law, coupled with con
tinuation
of
the effort to develop appropriate rules and
regulations."
Meet
in
Puerto Rico
The Board and selected members
of
the executive
staff early in January journeyed to Puerto
Rico
to meditate
on what had happened
at
Anaheim and,
as
one source
put it,
to
ponder what position the AMA could take
without losing credibility."
The Board could arrive at no conclusions at Puerto
Rico.
The
entire subject of
PSRO
and Report
EE
-
left
up in the air
at
Puerto
Rico
- will be discussed again
by the Board and staff
at
a meeting in Chicago late
this January.
Many members of the AMA
House
of Delegates will be
surprised to find out that trustees have adopted confusion
as
a reason
for
failure to map out a campaign aimed
at
abolishing
PSRO by
persuading Congress to repeal the
law.
If
anything was
made
clear at Anaheim,
it was this: The O'Verwhelming majori ty of dele-
gates, alternates
and
other physicians
at the
meeting
want
the
PSRO law abolished, and
in
that
desire,
they
reflect
the
wishes
of an
over-
whelming
majority
of
the
doctors
back home.
AMA officers, trustees and executive staff went to
Anaheim evidently expecting to convince the House of
Delegates that the best thing
to
do was to
let
the Board
continue the policy
of
collaboration and support amend
ments to the law.
The House of Delegates said no, that
was
not the best thing to do The House without
dissent said
the
best
thing t o is
repeal
the
law.
When the amendment to Report
EE
was adopted, Car
roll Witten, M.D., Louisville, Ky., Delegate from the Sec
tion on Family and General Practice, observed that the
amendment "makes it
quite clear
that it is
our intent to
work
for repeal." No one disagreed.
Theodore Grevas, M.D., Delegate from
Rock
Island,
Ill., warned the House that
failure
to repeal the law
at
this time
is
never to repeal it.
It was a'so clear at Anaheim
that
practically every
physician, including all AMA officers
and
trustees,
asserts
that
PSRO is
a bad law. That fact prompted John
P.
Heard, M.D., President
of
the DeKalb County (Georgia)
Medical Society, to observe:
I
think it would be immoral
to support a law we believe to be a
bod law.
(Note: Although the trustees claim confusion now, there
was little
if
any immediately following the Anaheim meet-
ing, even
in
the AMA headquarters.
The Wall
Street
Journa
1
The
New York Times, Medical
World
Hews,
Human Events, and even the American Medical News
agreed that the House had voted to seek repeal of PSRO.
In
the
Dec.
l
0,
1973,
issue of
American Medical News,
a headline on a story about events at Anaheim pro
claimed: AMA Expands PSRO Policy to Seek Repeal."
An editorial in the same issue contains this paragraph:
Are
the AMA's twin goals
of
PSRO repeal and exerting
leadership in implementing the law incompatible? No.
Not
incompatible, but admittedly difficult." Dr. Howard,
AMA Executive Vice President, reportedly approves all
stories and editorials that appear in American Medical
News.
Asks Board Ignore Repeal
After the clinical meeting in Anaheim and before the
Board and staff session in Puerto
Rico,
a memorandum
was distributed to members
of
the Council on Medical
Service by the Council Chairman William B. Hildebrand,
M.D.
The
memorandum said that Dr. Hildebrand and
Council members C
Willard
Camalier, M.D., and Donald
R Hayes, M.D., had met in Washington, D.C., with H.
Phillip Hampton, M.D., Chairman
of
the Council on Leg
islation, and the Executive Committee
of
the AMA Board
of Trustees to discuss
the interpretation to the amended
Report
EE
as
passed
by the
House
of Delegates
at
Ana
heim."
The
memorandum said those who met couldn't come up
with an interpretation because
of
"diametrically opposed
points
of
view" in the amended Board report. Dr. Hilde
brand's memorandum said that as a consequence it would
be recommended to the Board that no action seekin
PSRO
repeal be taken. The memorandum said it woul rec·
ommended that only the last paragraph of amended
Report EE be implemented. That paragraph would have
left AMA committed to continuing collaboration with
government, to supporting "constructive" amendments
to PSRO and to attempting to influence HEW
In
drafting
rules and regulations to put PSRO into effect, but not
to workinQ
for
repeal.
The
recommendation to ignore the House
decision that the best course of action is to
abolish PSRO was
not
accepted
by the
Board
at
Puerto
Rico
according to
AMA
sources.
The
Board also ruled out suggestions that a speciaf
session of the House
of
Delegates be called to
clarify
Report
EE ;
that the Board solicit opinions on the question
of
abolition of PSRO from other organizations, such as
AAPS; that AMA members be polled to find out how they
feel about repea ing
PSRO;
that delegates from the six
states that drafted the repeal amendment to Report
EE
be
called in to explain what they expected to result from
the amendment.
The
Board agreed, however, that AMA's Washington
lobbyists should be instructed to inform members of Con
gress
about the deleterious provisions of the
PSRO
law.
The Board also directed the staff to draft a "white paper''
on PSRO for discussion at the next Board meeting. Tom
E. Nesbitt, M.D., Speaker of the House, Malcolm
C
Todd, M.D., AMA President Elect, and Richard E. Pal
mer, M.D., Board Vice Chairman, were assigned to
oversee preparation of the paper.
Not As Planned
The House
of Delegates meeting in Anaheim
did
not,
apparently, proceed as planned. In the past, the House
8/17/2019 AAPS News 1974
7/72
almost always
has
gone along with the desires of trus
tees and the Association's administration
on
major issues,
even though it sometimes
has
had reservations about do
ing
so.
Resolutions and reports were usually considered
according to patterns laid out in advance. Often, satellite
meetings were set up and artfully guided
by
the AMA
administration. Rarely, if ever did the results turn out differ
ently than planned. At Anaheim, a sate'.lite meeting was or
ganized for Saturday, December
1,
1973, to promote col
laboration with PSRO (every originally scheduled speaker
was a PSRO booster, and some were full or part-time em-
ployees
of
HEW). Report
EE
of
the Board of
Trustees
and
Council on Medical Service was drafted to reaffirm the
policy of collaboration, but the report was not made
available to delegates until the opening day o·f the
House meeting. It was expected that the numerous anti
PSRO resolutions would be shunted to the Board and that
Report EE would be adopted with minimum debate and
without substantive change.
However, there was pervasive grumbling during the
meeting about PSRO collaboration and many calls for
support of AAPS efforts
to
abolish
PSRO
by challenging
its constitutionality in federal court. There was wide
spread support for repeal. The grumbling was not taken
seriously at first
by
the trustees because in the past at
Cincinnati and
New
York meetings, the AMA management
had
succeeded in getting
its
way
on
the
PSRO
issue
and
it
was expected to do so again this time.
But that
strategy began coming unglued at
the
special Dec. 1 satellite
meeting
designed
to
promote PSRO
and
reinforce collaboration.
A wave
of
protest at the unrepresentative
nature of
that
satellite
meeting
force
the
last-minute inclusion of
one
-
but only
one _
opponent of
PSRO.
That was J
W. Johnson,
M.D. who was
elected President o
the San
Diego
County
Medical Society
on
a platform
vigorously opposing PSRO. His Association of
over 2,000 physicians is
o
record for repeal.
He called PSRO the seed
of
destruction of
civilized
humane medical
care.
And he
said
he had heard that if
PSRO .is abolished some
thing
worse wcnild follow,
but
I've tried
and
tried
and
I
just can't think of anything
worse.
Dr. Johnson's direct and unevasive criticism
of PSRO
was
obviously - from
the
amcnint
of applause
he
received -
the point
of
view
shared
by most of the
physician audience.
It also presaged
things
to come.
That Saturday PSRO satellite meeting disc'osed to
physicians the degree
of
authoritarianism they could ex
pect from HEW officials responsible for enforcing
PSRO.
The unmistakable attitude of Henry
P. Simmons,
M.D.,
Deputy Assistant Secretary
for HEW
and director of
HEW's PSRO office, was that "things will be done our
Y f''
whether doctors like it or not. And this
is your
last opportunity" to do as the bureaucrats say to avoid
something worse.
Prior to the meeting all delegates and alternate dele
gates had been sent a Jetter by Donald Quinlan, M.D.,
President of the AAPS, which refuted a charge by Sen.
Wallace Bennett
(R.,
Utah) that the AAPS had pushed
the panic button on PSRO. To prove the accuracy of the
AAPS criticism of PSRO, a copy of the aw was enclosed
with Dr. Quinlan's Jetter.
Unexpected Development
Sunday, December 2, brought a new, unexpected de
velopment - - on open letter to the House of Delegates
signed by 34 U.S. Representatives urging the AMA
House
of Delegates to adopt a PSRO repeal resolution to help
those in Congress who are working toward
that
goal
That open letter was so unsettling
to
trustees and officer
that there is evidence they spent the next
two
days _ly
ing to get signers to withdraw their signatures and at
tempting to discredit its urgent message.
Dr. Heard later told
AAPS
he
hod
been informed tha
"several congressmen were threatened with loss o
AMPAC support if they
did
not remove their names from
the petition (letter) to the AMA House asking for AMA to
go on record for repeal
of
PSRO."
The letter from the congressmen said: "That section
(PSRO section
of
Public Law 92-603) will require you t
practice according to computerized standards, rather than
using
your best medical judgment in treating your pa
tients. It will deprive your patients of their right to
privacy, it
will
impose severe fines for medical innova
tion.
"Some of you have urged AMA participation in im
plementation
of
PSRO so you can control the administra
tion
of
the law. But
PSRO
is the law of the land;
it
the working
of
Congress and its implementation is th
responsibilty of the Department
of
Health, Education an
Welfare.
Even
if
you help implement the law, you wi
not control it. The only way to avoid the law's ba
effects
is
to repeal it.
"The PSRO section is bad Jaw; it will be
bad
fo
the doctor and bad for the patient. It should be repea
ed. UnfortiJnately, although many of
us
in Congress wan
to work for the repeal
of
PSRO, we have been handicap
ped by the AMA's failure to continue its active opposition
to the law. Some of us have already introduced bill
to repeal PSRO, but if we are to be successful we need
your help. We strongly urge the House of Delegate
to pass a resolution specifically calling for the repea
of PSRO and committing the all-out efforts
of
the
American Medical Association to that end. (Emphasi
added.)
The
AMA
member most responsible
for
the Jetter was
Dr.
Heard, who
is
a member of the
AAPS.
The idea fo
the Jetter developed during a conversation between Dr
Heard and his Congressman, Rep. Benjamin
B.
B'ack
burn. When the letter arrived at Anaheim on Sunday
Jack E Shields, M.D., delegate from Brownstown, In
diana, obtained permission for Dr. Heard, who
is
no
a delegate, to read the open letter to the House.
Strong Support Unwelcome
Officers and trustees
did
not welcome such strong
support for abolishing a law which these same trustees
and officers have said
is
a bad law, - unless they have
the power of enforcement.
Their
reaction
to the
letter astonished
many
delegates
and
prompted one, Stanley S.
Peterson,
M.D.
Springfield,
Mo.
to observe
that was
a classic
example
of why doctors
are concerned about
the
AMA. He said
AMA
leaders
aught
to do
what
is right.
Robert B. Hunter, M.D., a trustee and AMA's chief
PSRO spokesman, who is also paid
for
serving on HEW
Secretary Caspar Weinberger's National PSRO Coun
cil, was tapped by trustees to dispose
of
the letter on
Monday, Dec. 3, at the Reference Committee hearing
8/17/2019 AAPS News 1974
8/72
on
PSRO
reports and resolutions. It was noted that two
congressmen,
Rep.
Joel Broyhill
of
Virginia and
Rep.
Edward Derwinski of Illinois, had been persuaded to
withdraw their
names.
Dr. Hunter,
in
an obvious attempt to convince dele
gates pursuit of repeal would be unwise and fruitless,
said AMA Washington lobbyists sought out Rep. Al Ull
man, liberal Oregonian and ranking Democrat on the
House
Ways and Means Committee, a
man
who has
never been known
as
a champion of medical freedom.
According to Dr. Hunter,
Rep.
Ul man was "obviously
disturbed" that the open letter had been submitted to
the House
of
Delegates.
He
was quoted in effect
as
say
ing that he and all Democrats on Ways and Means would
oppose repeal.
Rep.
Herman
Schneebe .i
of Pennsylvania, ranking
Re-
publican
on
the Committee, was quoted
as
saying repeal
"is unlikely to succeed" and adding he knew of no
Senate sentiment
for
repeal.
Consequently,
when
the Reference Com-
mittee
met
the
Q Jy documents not
in
opposi-
tian to PSRO were Report A and Report EE of
the
Board of Trustees
and
Council
on
Medical
Service.
Witnesses opposed to
PSRO
and favoring abolition
of
the law either by repeal
or
by means
of
the MPS law
suit outnumbered those supporting the law and the
position of the
M
administration
by
nearly two to
one. That was evident
at
the Reference Committee and in
the House of Delegates.
Committee Echoes oard
But
the Reference Committee,
as
seasoned observers
expected, did not heed the plea
of
those who sought a
policy in support
of
abolition. It recommended that all
opposition resolutions be filed and Report
EE
be adopted
unchanged.
The
Committee, echoing the Board
of
Trustees,
told the
House
that:
Text ·of
PSR Repeal mend
ment
It is clear the
M
House
of
Delegates
at
the meeting
in Anaheim voted
for
abolition
of
the PSRO law.
This
action
came
on
a vote, without dissent, adopting an amendment
to Report
EE.
This report
as
authored by the Board of
Trustees
and Council
on
Medical Service,
was
intended
to continue the Board policy
of
collaboration. The text of
the amendment
for
repeal follows.
"The AMA affirms the following principles:
"1. That the medical profession remains firmly commit
ted to the principle
of
peer review, under professional
direction, and
"2. That medical society programs
of
proven effect
iveness should not be dismantled by
PSRO
implement
ation, and
"3. That the association
suggests
that each hospital
medical staff, working with the local medical society,
continue to develop its own peer review based upon prin
ciples of sound medical practice and documentable object-
M
lobbyists then went to
Sen.
Bennett, the chief
congressional sponsor
of PSRO,
who was depicted
as
recoiling in horror
at
the thought of repeal and who
responded with a threat that
if
repeal passed Congress,
he
would "strongly urge the President to veto the leg
islation."
The
Dec. 3 Reference Committee session
heard
testimony on
10 resolutions opposing
PSRO
half of
them
demanding abolition of
this dangerous law. Only one resolution sym-
pathetic to the collaborationist policy
of the
Board
of
Trustees was introduced No. 15 from
the Michigan delegation)
and it
was withdrawn
at the Reference Committee hearing. That res-
olution, incidentally, was in conflict
with
the
position
of
the Michigan State Medical Society
House
of
Delegates, which favors repeal of
PSRO.
tive criteria,
so as
to certify that objective review of quality
and utilization does take place; to make
these
review
procedures sufficiently strong as to be unassailable by
any outside party
or
parties; and that the local and state
medical societ es take a ll legal steps to
resist
the intrusion
of
any third party into the practice
of
medicine, and
"4. That this
House
of
Delegates,
as
individual phy
sicians and through the Board
of
Trustees
and
its Coun
cil on Legislation, work to inform the public and legisla
tors as to the potential deleterious effects
of
this law on
the quality, confidentiality, and cost of medical care; and
the hope that the Congress in their wisdom will respond
by either repeal, modification,
or
interpretation
of
ru es
which will protect the public.
"The considered opinion
of
the House
of
Delegates is
that the best interests
of
the American people, our patients,
would be served by the repeal
of
the present
PSRO
leg
islation. It is also believed that this
is
consistent with our
long-standing policy and opposition to this legis'ation
prior to passage."
• Attempts to repeal PSRO "would be fruitless."
• A policy
of
repeal
or
one
of
nonparticipation
would hinder efforts to amend the
PSRO
law or
to modify regulations.
•
Such
a position would weaken
M
efforts to
influence pending and future health legislation.
• PSRO repeal would still leave the medical pro
fession
subject to other legislative controls.
• Adoption
of
Report
EE
would not deny possibility
of
eventual action
for
repeal "should such
action become more viable and appropriate."
(Emphasis added.)
The committee report was an unmistakable signal
that abolition
of PSRO
was not acceptable to trustees,
8/17/2019 AAPS News 1974
9/72
officers and the Executive Vice President. Being committed
to a policy of collaboration with government to force
PSRO controls an physicians and their patients, they did
not intend to change.
The AMA's
early
decision
to
help HEW implement
the PSRO program was noted with pleasure
by
Charles
C.
Edwards, M.D., HEW's Assistant Secretary for Health,
in an address
to
the House of Delegates. He
applauded
AMA
and
other organizations for recognizing both
the problems and the potential of PSRO. He said the
Association would be making a mistake
if
it reversed
its policy
of
leadership in implementing PSRO. Later
at a news conference, Dr. Edwards_ argued that PSRO
wou:d not curtail medical innovation. He said he could
think of no meaningful medical advances in the past
20 years
that wouldn't
have come
about
under PSRO.
But the government's
top
doctor ominously warned
that
innovation could be stifled
if
the medical profession
did not assume a dominant role in operation
of
the PSRO
program.
Another Surprise
The morning of Wednesday, Dec. 5 brought another
unnerving surprise to the Board and AMA management.
A substantial number of AMA delegates who are t1lso
AAPS members arranged
for
Rep. Philip Crane R., 111. -
primary circulator of the letter
appealing to
AMA
to
support repeal - - to come to Anaheim. He was given
permission
to
speak to the House of Delegates at the
morning session on Wednesday. He said it
is
gbsolutely
not true
that
a campaign to repeal PSRO would be fruit
less. He stronqly disputed arquments that the AMA
would weaken its influence on other legislative matters
it it pursued repeal.
Rep. Crane s speech ..
turned
the H ;:,ise
around. Delegates from six states · Cali-
fornia, Illinois, Michigan, Kentucky,
Louisiana
and
New
York joined
in
drafting the
amend-
ment to
Report EE that put
the House of Dele-
gates clearly
on
the side of abolition o PSRO
by repeal.
Otto K. l::nqelke, M.D., De'.eqate from Ann Arbor, Mic
arose to especially thank Congressman Crane for
pearing betore us at this session and getting us ba
on the track. Dr. Engelke urged the House to ad
the Michigan State Medica l Society position to wmp 'C
tor
repeal
through all
methods
available,
includ
support of the Rarick Bill H.R. 9375).
Note: Rep. Crane's speech - the most important
of
entire Clinical Meeting -- was
briefly
mentioned n
the end of the American
Medical
News story on
meeting. Dr. Edwards, however, was given a separa
full-blown story in the AMA newspaper.)
The amendment to Report
EE,
subsequently adop
without a dissenting vote, put the AMA unequivocally
opposition to
PSRO
for the first time. But it did more th
that. It stated the belief that medical society peer
view programs of proven effectiveness should
be dismantled
by
PSRO implementation. And
it
urg
state and local medical societies to take all le
steps to resist the intrusion of any third party into
practice of medicine.''
As one means
of
carrying out that House
policy, state medical associations are invited
to join AAPS
in
its lawsuit to outlaw PSRO by
filling amicus
curi e
briefs
in
support
of
the
suit.
M Executive f orced To Back Down
Contained in Report EE of the AMA Board of Trustees
and Council on Medical Service, submitted to the House
of
De'.egates
at
Anaheim, Calif.,
is
the statement
that
at all times the House of Delegates determines As
sociation policy and that it is the role of the Coun
cils, committees, and the Board of Trustees
to
implement
this policy.
During the
PSRO
hearing before the Reference Com
mittee
at
Anaheim, Board Chairman James Sammons,
M.D., declared emphat ically: You can't sit here today
and
leave this room with the mistaken belief
that
the
office of the Executive Vice President or any other staff
employee of this Association
is
not devoting his time
and
effort to carrying
out
the will of this House. Gentlemen,
I hope the record reflects
that
henceforth.
These statements
were subjected
to ques.-
tion during
debate
at the
Reference Committee
on Monday,
Dec. 3, 1973.
One
who questioned them was John
P.
Heard, M.D.,
President of the DeKalb County (Ga.) Medical Society.
Dr. Heard pointed
out that
the House of Delegates at
the 1973 Annual Convention in New York
had
directed
the AMA to oppose facets of PSRO which act to the de
terioration of quality care and that the Association
publicize
such deleterious facets.''
Dr. Heard said he
had
written AMA headquarters
more than once inquiring
what
was being done to car
ry out
that
directive. He said· he received equivocal and
unresponsive answers from Executive Vice President Ern
B. Howard, M.D.
Stated House
Was
Wrong
Dr. Heard said that at a conference
in
Atlanta,
Howard stated the House of Delegates was wro
in directing
that
the deleterious facets of PSRO
publicized and
that
the staff had decided
it
was imp
sib'e to carry out the directive. Dr. Heard said Dr. Howa
commented that the law was too complex
for
the pub
to understand. Later, Dr. Heard said, he received a
ter from Dr.
Howard
in which he stated
that
he had,
deed, made
such
statements
in
Atlanta.
When Dr. Heard finished his remarks at
the Reference Ccnnmittee, an angry Dr. Howard
accused
him of
a personal
attack
on
him
and
challenged Dr. Heard to produce
such
a letter
so
everyone present could
know
exactly
what
he, Dr. Howard, had said if you have the
letter with you, which I don't suppose you
have.
Dr. Heard left the meeting, returned shortly and w
recognized to speak. He read a letter to him from
Howard dated Nov. 15, 1973,
in
which Dr. Howard sa
Unfortunately, at the time of the meeting (in Atlan
did
not have the exact wording of this substitute reso
tion with me. If I
had had
the
wording,
I would have
dicated my agreement with it. The discussion at the
Atlan
meeting concerned the wisdom of attempting
to
p
suade the public to support our concern about PSRO
8/17/2019 AAPS News 1974
10/72
indicated
that such
an
effort
would
fail
because the
public wou'.d not understand the technical implications
of this complex act and because there was no implementa
tion
at
this time to, which one could refer. Believing that
the House had directed that kind of a campaign, I said I
felt the House was wrong. However, having reviewed that
House action since my return to Chicago, it
is apparent
that the House did not direct such an unrealizable cam
paign and my comment in Atlanta, therefore, was incor
rect."
When
Dr. Heard
had
finished, Dr. Howard
acknowledged
he
was forced
to
eat
crow grace-
fully, to
admit he had indeed
accused
the
House
of
being wrong
and had
said
staff
could
not carry
out the mandate
of
the
House.
It was not the first time
that
Dr. Howard had put down
on
paper that
the
House
mandate to publicize the
bad
aspects
of
the
PSRO law
would not be carried out. On Oct.
5 1973, he wrote to Dr. Heard declaring a response
by
Tom Nesbitt, M.D., Speaker of the House, was a perfect
answer" to Dr. Heard's inquiry
about what
was being
done
to
publicize the deleterious facets
of
the law.
Won't
Pursue Effort
In effect,
Dr. Howard said,
we
pointed out the prob
able deleterious facets of the
PSRO
legislation in our
testimony and
in
numerous public statements
at
the
time
it
was under consideration in the Congress.
We are
in no position to pursue
that
effort
today prior
toany
implementation of the law. The examples
that
you sug
gest which would be deleterious (invasion of confidenti
ality etc etc.) cannot be proven
to
exist today
since there is no PSRO in the nation. There is no 'rule
book
for
medical care.' There
is
no
proof to
which we
can
point that PSRO wil,I
'dehumanize' medical care.
In
other words, we do not have the documentable
data to
support our
misQivinQs I
share them ).
I
think there
is
no question whatever
that
the public
would not be responsive to nor would the public listen to
our protestations about the probable adverse affects of
PSRO at
this time
in our
history. I agree with you
that
we
must
have the public behind
us if
repeal
or
significant
change
of
this
law
becomes possible. We wi:I not have
that
public support, however, if we act
in
a manner that
is
considered irresponsible
by
most public leaders."
Members of the House of Delegates obvi-
ously do not share Dr. Howard's opinions. Once
again at Anaheim, the House directed the Board
of
Trustees
to
work
to inform the
public
and
legislators as to
the
potential deleterious
effects
of this
law
on the
quality, confidentiality
and
cost
of
medical care.
ongressman
rane
Declares
That PSRO
Repeal Is
Possible
I can assure you probably
90
per cent of the members
of the United States Congress today haven't the fuzziest
idea what a PSRO
is.
They don't understand the concept.
They
don't
understand even that they cast a vote on it.
That pungent observation opened the address of
Rep.
Philip Crane R., Ill.)
to
the AMA House of Delegates
Wednesday morning, Dec.
5
1973,
an
address that did
much
to
awaken members of the House that it is possible
Congress can be persuaded to repeal PSRO.
Rep.
Crane helped nullify vigorous efforts of trustees,
officers and high-level staff to block
adoption
by the
House of a policy favoring PSRO repeal. And that's what
happened. Shortly after
Rep.
Crane's speech, the House
approved a statement
that the
best interests
of
the
American people, our patients, would be served
by
the
repeal of the present PSRO legislation."
(Note:
The
Board of Trustees, pleading lack
of
money,
said
it
would not print
Rep.
Crane's speech
for
the benefit
of delegates and alternates. A month later, members of
the Board and selected headquarters staff flew
to
Puerto
Rico
for
a Board meeting.)
Rep.
Crane chided
AMA
leadership
for
conceding the
premise of medicine's enemies.
The
very worst approach you can
take
is
to concede your opponent's premise
at
the out-
set, he said.
And
in my
judgment
that's
what
the
Administration has done, that's what
the
medical profession has done,
the
health insur-
ance people have done it, hospital associations
have done it.
You
have implicitly accepted
Teddy's (Sen. Edward Kennedy) analysis
o the
problem -
that
there is indeed, a
health
crisis,
and
your response to
that
is 'we have a better
approach to dealing
with that crisis'.
Rep.
Crane said
that
from
talking to
physicians he
had concluded that no one in the medical profession will
defend in principle the concept
of
PSRO.
"The objections
to PSROs are abundantly plain
to
you, but there are two
critical ones
that
strike
me that
are overriding.
One is
this idea that you can have laymen
or you
can have
bureaucrats impinging thei r judgments on the best
professional judgment
of
the people most immediately
related to the problems -
and
that's the people in the
medical profession. In
addition,
the potential
for
invasion
of patients files,
in
my judgement,
is
a clear violation of
the Hippocratic
Oath and your
professional commitment.
We
have this Ellsberg case where they broke into a psy
chiatrist's office
to
get files, and believe me, you've got
a potential in PSRO to let bureaucrats into anybody's files.
I can assure you that if you brought this point convincingly
home to politicians, you've
got a sensitive nerve ending
there you can put your finger on with a view to getting
po'iticians to understand the inadvisability of this kind
of
legislation."
Lot of Repeal Support
Rep. Crane took issue with the argument
of AMA
leader
ship that attempts to repeal PSRO would be fruitless, a
position AMA management said was buttressed by rank
ing members of the House Ways and Means Committee.
Well, said Rep. Crane, I
can
assure you
the Ways and
Means Committee
is not the
exclusive
committee
to
talk
to
on
this.
There
is potentially a
whale of
a lot of support
in
that
Congress for outright repeal.
What
support
is not there is
primarily based
on
a lack
of
understanding of what's happened - and that
even
includes
members
of
the Ways and
Means
Committee who
don't
understand what
PSRO
is all about.
8/17/2019 AAPS News 1974
11/72
This is not a lost battle.
There
is no rea-
son why you cannot
explore a
variety
of
options
available
to you simultaneously.
You
don't
have
to
give
up on the idea of
repeal
only
because
you think
what
is better,
or
preferable,
or
more
likely
or viable
politically is
an attempt to clean
up
a
bad
law. You
can
do both
simultaneously.
In on
apparent
reference
to
the lawsuit
filed by
AAPS
in federal court to outlaw
PSRO, Rep.
Crone said
that
another option open to fhe AMA was to contemplate
working through the courts.''
Rep. Crone also attacked the position
of
the Board
of
Trustees
that
a policy
of
nonporticipotion would render
fruitless efforts by the AMA to amend PSRO or modify
regulations.
THAT
IS ABSOLUTELY NOT
TRUE,
he
said.
He pointed out
that
members
of
Congress ore re
sponsive to their local constituencies. Furthermore, he said,
you
con
go
on record as a notional body condemning
on principle
what
you know in
your
hearts
to be
wrong
and what you know does violence to your professional
ethics.
Patients Should Be Alerted
Rep.
Crone urged physicians to alert their patients to
the dangers of the
PSRO
low. Patients ore voters, he
pointed out.
And if
you alert them
to
the danger, then
you
con generate a great deal
of
political influence and
that will
magnify
your
impact considerably.
The Illinois Congressman also shot down the AMA
management argument
that
repeal oi
?SRO
would leave
House Debate
the medical profession still subject
to
other legislative
controls, present and future.
Well, to
be sure that's a possib ility, said
Rep.
Crone.
But
let me just tell
you
one other thing,
and
that
is,
Jf
we ore
going to draw
the
bottle
lines on principles -
and in my judgment that's
how
they should be drown -
the best way calculated
to
permit the government intrusion
that could ultimately destroy your profession
is to
get
compliance. You draw those bottle lines on the basis of
the professional judgment of the physician versus the
gun that's being pointed
at
your
head
by
government
. . . and if the public ever
sees that
bottle drown on
those lines, I con assure you they will be on your side.
And
I con assure you beyond that,
that
once they
are on your side, the politicians
will
bock
off
in a hurry.
Rep. Crane
cautioned
against
the
despair
of inevitability .
I think
the most pernicious
doctrine
in Washington today
is
a certain feel-
ing of despair over the inevitability of legisla-
tion. That doctrine
of inevitability
is the
most
pernicious dogma
that
Karl Marx ever advanc-
ed.
I'm
telling you,
he said, there ore good ideas and
right principles, and if you people who ore most immedi
ately affected will not be
in
the vanguard
of
fighting
that
bottle, then
to
be sure, we may be down the tube;
it may be simply a matter of time and they'll toke us
salami style - a slice today and a slice tomorrow and
a slice the next day.
Rep.
Crone mode it clear that even if the AMA did
not come out
for
repeal
of
PSRO,
I
and
a number
of
my colleagues will continue
to
wage that bottle because
patients ore going to be concerned about this.
There Was
No
iddle
round
on
PSRO
One of the striking things about debate over PSRO at the
AMA
Clinical Meeting in Anaheim, Calif., was that there
was no middle ground - physicians either wonted the AM A
to
work to abolish the
low
by repeal or court action or
they wonted it retained, with AMA continuing colloborotion on implementation. Here ore excerpts from pro and con
arguments during the Dec. 5
session of
the House
of
Delegates.
James M. Sammons, M.D., Chairman, Boord of Trus
tees (granted special permission
to
address the House):
Tuesday a week ago,
your
President and I were in
Washington
and
met with the leadership on both sides
of
the aisle in the House
of
Representatives and
we
met
with the leadership
of
the Finance Committee
of
the
Senate.
We
asked,
'What
in
your
opinion
is
the politicoi
viability, the chance of
success
of Mr. Rorick's
bill
or
similar bills asking
for
repeal
of
PSRO? The uniformity
of their answers I think
is
important. Uniformly it was
that
it
hos absolutely no political
viability
whatsoever.
We asked why. The answers given us were - (l) the low
hos not even been put into effect . . . and
is
not
going
to be repealed until it hos been tried; (2) with massive
expenditures (for Medicare and Medicaid) we must hove
some assurance that quality is being delivered, and
(3)
we must hove some control over the ever expanding
util izat ion. Dr. Sommons added they were assured PSRO
amendments would be given adequate hearings.
W.
Charles Miller, M.D.,
New
Orleans, Lo.: I would
like
to
thank those who selected Disneyland - the land
of fantasy - as the appropriate setting to discuss the
matter we hove today. Louisiana
deeply
feels that
for
those who feel
that
they con control federal
low
once
it is
started and con amend
it to
their satisfaction
and
con indeed exist with it, we suggest
you ore
indeed in
fantosylond.
We
further feel this organization should
be responsive to the people bock home. The position the
AMA
hos token on
PSRO
hos encouraged people
to
look
for
other sources
to
defend their positions
and
their
rights. Dr.
Miller
then submitted
on
amendment
to Re-
port EE
to
odd
a repeal section. The substance
of
his
proposal was
later
adopted.
Morgan Meyer, M.D., Lombard, Ill.: Offered two amend
ments
to
Report
EE.
One, finally adopted, called for PSRO
repeal. The other said that amendments to PSRO should
be pursued with all vigor simultaneously with the strong
efforts at total repeal of the
PSRO low.
Dr. Meyer said
his amendments would encompass the somewhat splinter
ed atmosphere we've hod in the House and the splintered
atmosphere we've hod bock at home
Otto
K.
Engelke, M.D., Ann Arbor, Mich.: I wont
especially
to
thank Congressman Crone
for appearing
8/17/2019 AAPS News 1974
12/72
before us at this session and getting us back on the
track.
Dr. Engelke said abolition of PSRO should be
given top priority by the AMA.
Matthew Marshall, Jr., M.D., Pittsburgh, Pa.:
He
noted
that the Pennsylvania delegation overwhelmingly reiected
the proposition to repeal PSRO and
added
that physicians
would be able to control PSROs.
Joseph
F
Boyle, M.D.,
Los
Angeles: Agreed that repeal
would be in the best interests of the people
but
I don't
think it's feasible." Apparently referring to the Senate
Finance Committee members, he said
they
did know
exactly what they were passing" when they voted for
PSRO.
Dr. Boyle took charge of amending Report EE.
Also he said the report should be amended as it later
was)' to include, am~ng other things, mention that
AMA
was firmly committed to professional peer review and
that hospital staffs should develop "unassailable" peer
review programs. AMA,
he
said, "should in no way
indicate
or
imply it
is
opposed to those physicians and
physicians' organizations, state medical societies, county
medical societies and others, who do believe they wish
to spend their maior energy in attempting to effect
re-
peal of PSRO."
John R Schenken, M.D., Omaha, Neb.: Disputed Dr.
Boyle's contention that members
of
the Senate Finance
Committee knew what was in the PSRO amendment to
H.R.
l .
"That iust isn't true. Senator Curtis
Sen.
Carl
T.
Curtis, Nebraska Repub'ican and member
of
the com
mittee) told me that it wasn't true. The maiority of the
Finance Commitee
didn't
know
what
was in PSRO any
more than members of the House Ways and Means Com
mittee knew. Only a few knew exactly what was
in
the
bill.
Dr. Schenken noted that the Nebraska House of
Delegates unanimously supported the Rarick Bill for
re-
peal
of
PSRO. He said the primary thrust
of
AMA should
be toward repeal and all other mechanisms
must be
subsidiary to this thrust." He added that "many congress-
Reference ommittee Debate
men will be mightily encouraged if our primary thrust is
toward repeal." (His statement was greeted with loud
applause from the delegates.)
Richard
L.
Meiling,
M.D.
Columbus, Ohio:
Noting
that
Ohio State Medical Association has developed a success-
ful computerized peer review system for protection of
the public," he said the Ohio Association does not sup
port PSRO and "hopes that it might be repealed."
Donald N. Sweeney, Jr., M.D. Detroit, Mich.:
We
in
MichiQan are very pleased to
see
that the primary thrust
of
the information
and
the conversation this morning
is
toward repeal. We feel as other members of this House
do - that our doctors back home feel
that
we should be
workinQ for repeal." He added the primary goal
of
AMA
should be repeal, with freedom to work
for
amendments
to PSRO and
to influence rules
and
regulations until re
peal can be accomplished.
Thomas Parker,
M.D.
Greenville, S.C.: Now is the time
for action. Continuing
to
do
what
we're doing
is
not action.
Action is support
of
H.R. 9375 (the Rarick Bill
to
abolish
PSRO). Action is support of the lawsuit of AAPS to have
the law declared unconstitutional You have got to
go on the offensive. The absolutely essential action we've
got to take is to seek repeal and support our friends and
then do whatever else we
can.
Russell
B
Roth, M.D. AMA President:
I would
say the
striking message I got from hearing Congressman· Crone
this morning is of long-range importance rather than
short-range application to this problem. The message I
got
from him was
that
I should, if there were
any
con
ceivable way possible for
me
to
do
it, go home to my
district and send someone to Congress
from that
district
of
a like mind to Congressman Crane. Dr.
Roth
sang a
ditty he often sings to a Porgy
and
Bess tune, the import
of which is that we're stuck with
PSRO and
there's nothing
that can be done
about
it.
PSRO Generates
long
rgument
The
meeting
of
the Reference Committee that heard arguments for and against
PSRO
was one of the longest
on
record, testifying to the importance
of
the subject
to
physic ions
at
the meeting. Here are excerpts of testimony at
that
Dec. 3 meeting.
H
Thomas Ballantine, Jr., M.D., Boston, Mass.: He
brought gasos of disbelief from many at the Reference
Committee when he said he had talked to Sen. Wallace
Bennett R., Utah), chief Senate sponsor of PSRO, and
the Senator told him the constitutionality of the PSRO 'aw
had been tested many times.
John Heard, M.D., Atlanta, Ga.: Dr. Heard chided the
AMA
trustees and executive staff for refusing to carry out
a 1973 mandate of the House. of Delegates to publicize
the deleterious facets of the PSRO law. He supported
abolition of PSRO, declaring
it
would be immoral to
support a law we believe to be a bad law.
Raymond Killeen, M.D.,
Los
Angeles: He criticized AMA
administration for scheduling a pro-PSRO meeting the
day
before the House of Delegates met and said he
resented action of the Board of Trustees in not making
Report available· to delegates before the day the House
convened. "This House of Delegates," he said, "has a
right to know what kind of
propaganda
is going to e
sent out from the AMA itself."
Robert B. Hunter, M.D., Sedro Woolley, Wash., a trus
tee and chairman of a Board committee promoting PSRO
collaboration: "The Board of Trustees needs no defense.
The federal government believes it
will
be
at
least three
years before they
issue
rules and regulations
on
this PSRO
implementation. It
is
impossible
to
advance until certain
information is released (by government)."
Edward Wiater, M:D.,
Los
Angeles: "The main reason
PSRO
is of
such interest
is
because
we are
questioning
the policy we took under a crisis type
of
situation a
year
ago when we decided to take a leadership ro e in im
plementing the law. And what do we say about the law
- it's a bad law. We decided on a leadership role in
implementing a bad law. That's a paradox. If the AMA
had decided to work for repeal before passage (of PSRO)
we would not be in the trouble we are in today. We're
not getting very far suggesting rules and regulations. All
8/17/2019 AAPS News 1974
13/72
options have not been stated in Report
EE
- for examp'e,
challenging the constitutionality of this law.
We
have an
obligation to challenge its constitutionality on behalf of
our patients. He noted that the
Los
Angeles County Medi
cal Society, which opposes PSRO has been studying the
law
for
months, whereas this Report
EE
was created over
the weekend.
Joseph De laurentis, M.D., Wilmington, Del.: He noted
that virtually everyone, inc'uding the AMA has branded
PSRO a bad law. I am convinced that if we hold this
law
to be harmful rather than helpful, our proper course
i.s
to
begin an energetic campaign seeking repeal
of
the
law. He urged
AMA
to abandon programs aimed at
forming
PSRO
groups,
adding
that the fact that HEW
would form
PSROs
should not dissuade us. He said:
There is no reason to suspect that PSROs which we form
will in the long run e operated in a different fashion
than those the government forms. PSRO
is
not our institu
tion. It never was and never will
be.
Edwin
R.
Wunderlich, M.D.,
Los
Angeles: Reported that
the 10,000-member LACMA had adopted a policy that
the Association would not
apply
for, sponsor
or
endorse
any
PSRO
organization in the country and that LACMA
districts and LACMA membership, including hospital staffs,
were counseled on the advisability
of
such
action.
Etmo Boyd, M.D., Shreveport, lo.: Why should we en
dorse something again just because we blindly endorsed
it the first time. Dr. Boyd noted news story that Sen.
Bennett had verbally fogged AAPS for criticizing PSRO
and had mode certain assertions about the law. Dr. Boyd
read
what
he described as on English trC'nslation of the
low
to refute Sen. Bennett. He also said th House action
at Cincinnati - accepting the Board of Trustees policy of
collaboration - was not based on informed consent.
John J. Coury, M.D., Port Huron, Mich.: He withdrew
Resolution 15 of Michigan delegation supporting position
of
AMA
trustees and present
to
you the wisdom of our
House
of
Delegates,'' which favors abolition
of
PSRO.
Urban H. Eversole, M.O., Boston, Moss.: He said he was
speaking
for
the entire New England de'egation in
endorsing Report EE
of
the trustees and asserting
we
must continue to exert leadership even more vigorously.
He said
of
himself and his colleagues: Neither do we
think we are violating vaunted
New
England conscience
by
supporting a
totally
bad law
because we do not believe
that the basic precept of
it
is bad.
Ralph
S.
Emerson, M.O., Roslyn Heights, N.Y.: He argued
that
you
can't test the constitutionality
of
something
that
hasn't even started. He said support
of
Report
EE
''is the only oracticol, sensible approach we can take·
George Himler, M.O., New York, N.Y.: The author of
the notorious Himler Report
that
advocated downgrading
privafe practice, fee-for-service and free choice said
you're
smoking
opium
t believe PSRO-type controls
would be wiped out
by
abolition of PSRO. He said he was
not sure doctors would control
PSRO
at the local level.
Until the time we know it is not going to work this way,
I think we would be damned fools to say we were going
to
work for repeal of this and we ore going to oppose it.
Willard
C. Scrivner
M.O.
East St. Louis 111. a member
of the
Notional
Professional Standards Review Council:
A feeble effort
at
repeal would be ill advised.
Jack Schreiber, M.D., Canfield, Ohio:
I
am skeptical
that the law can be changed by amendment. The doctors
back home know one thing - it's a
bad
law. A vote for
repeal would be an expression to our doctors, who are
in a mild state
of
revolt,
that
we are going to do our best
to repeal it.''
Joe M. Crosthwait, M.D., Midwest City, Okla.: He said
PSRO was
designed to correct ill-conceived financing of
Medicare and Medicaid. The solution of bureaucrats is
to pass more bad legislation - hence PSRO.
This
law was
not passed
in
the wisdom
of
Congress but was the abortion
of a handful
of
staff bureaucrats
of
the Senate Finance
Committee.
We
must
look to repeal to protect our patients
from the imminent danger
to
the quality
of
their health
care.
Thomas Parker, M.D., Greenville, S.C.: Advocating re
peal of PSRO Dr. Parker said that Board Report Z at
the Clinical Meeting in Cincinnati in 1972 which put AMA
on the road to collaboration caused consternation be
cause it was an about face from opposition to support
of
PSRO.
But Dr. Parker emphasized that Report Z
originated in the Board of Trustees not the House of
Delegates.
J.
W.
Johnson, M.D.,
La
Jolla, Calif.:
He
said members
of San
Diego Medical Society were polled on
PSRO
and
more than
50%
responded. Asked whether the state
or
county societies should form
PSRO
groups, 530 said no
and 330 said yes.
But
when asked whether the society
should work
for
repeal
of PSRO
714 voted
for
repeal
and 134 said no. The results
of
a poll depend on how
the questions are asked, Dr. Johnson said.
W. Collier Salley, M.D., Gloucester, Va.: He urged
adoption of the Virginia resolution calling for repeal of
PSRO and support of the AAPS lawsuit to abolish the law
by challenging its constitutionality.
Daryl P. Harvey, M.D., Glasgow, Ky.:
PSRO
is another
product
of
a negative federation, a concubine in the
harem of socialism. He said support
for
PSRO amounts to
socio-economic malpractice and the
law
should be re
pealed. He re'axed tensions by punctuating pertinent
points with repeated witticisms.
Theodore Grevas, M.D., Rock Island, Ill.: Failure to
repeal the law at this time is never to repeal the
law.
He said he hoped the Reference Committee in its sum-
mation does not alienate some organizations that have
been fighting for repeal, such as AAPS and CMS.
James
M.
Sammons, M.D.,
AMA
Board Chairman: He
made plea for retaining policy
of
leadership in imple
menting PSRO. He argued that repeal is not viable.
He brought a round of laughter with a slip of the tongue.
A
position totally and unequivocally dedicated to repeal
of this law
is
fraught with an exercise in fruition ah
frustration.''
Waite:· Buerger, M.D., Covina, Calif.:
He
urged dele
gates to stand
on
principle and
seek
abolition
of PSRO.
If
we
do
fight
for
repeal, we will not stand alone. For ex
ample,
he
said,
he
had a letter from Gov. Ronald Reagan
saying
PSRO
will destroy the existing voluntary utilization
review
system
and replace it with a
less
effective
system
which will increase health care costs deprive Ca'ifornia
of
effective control
of
expenditures and violate the con
stitution. He pointed out
PSRO
was
enacted almost with
out notice.
8/17/2019 AAPS News 1974
14/72
John
M. Wood, M.D.
Englewood, Colo., President of were
far
less visible but far more threaten ing to the
the American Association of Foundati
