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Sammons departure portends organizational changes.

Sammons Departure Portends Organizational Changes

The AMA House of Delegates met early last December in the balmy surroundings of Honolulu. As is customary for meetings of the House of Delegates, the agenda was long, though few of the items were expected to attract very heated debate. Despite the relaxed environment, and the inclination of delegates to enjoy the "hang-loose" atmosphere, the minor earthquake that briefly shook a session of the House will come to characterize the meeting.

Sammons Steps Down

From time to time, internal affairs become the driving force that occupies the attention of the membership structure of the AMA. Such an upheaval occurred in 1973-74, when it was discovered that the AMA was near bankruptcy. An internal convulsion at that time saw the removal of the then executive vice president as well as his heir apparent. It was after these convulsions, and in response to the deteriorated state of the AMA, that James H. Sammons, MD, Chairman of the Board of Trustees, ascended to the position of executive vice president in 1974.

Under Dr. Sammons' leadership, a period ensued of retrenchment, of identification of organizational mission, and, finally, of dedication to representation of physicians and medicine in all forums. The era has brought the AMA to solvency, but it also has elevated the organization to unprecedented influence in Washington and on the national scene generally. Dr. Sammons' personal style, while pugnacious, has proved to be highly effective. At the same time, Dr. Sammons created within the organization an infrastructure of individuals who reflected and duplicated his style and who enjoyed the sense of empowerment and prerogatives of close association with the executive vice president.

Before the December meeting, investigative reporting by a Chicago newspaper had already made it clear that something was awry at the AMA. Evidence had emerged of financial irregularities involving key members of the AMA staff and of laxity on the part of the executive vice president in overseeing the activities in question. However, no impropriety on the part of Dr. Sammons was found or suggested. The AMA Board of Trustees and the House publicly reaffirmed their support of Dr. Sammons. However, Dr. Sammons publicly announced his retirement in 1991, a step that he had mentioned to the Board of Trustees about a year ago. The individuals involved in the allegations are no longer with the AMA. Subsequent to the meeting, Dr. Sammons announced that he was retiring effective immediately so that the AMA could resume its normal functioning and put the scandal behind it.

The difficulties of the executive vice president consumed an inordinate amount of the House's time, as they have of AMA staff time for the past few months. But a large agenda still had to be dealt with. High on that agenda was analysis of congressional action on physician payment reform. The American Medical Association has claimed a significant victory through recognition of resource-based relative value scales as a component of payment reform and in the avoidance of inclusion of expenditure targets and mandatory assignment. However, some critical observers of the Washington scene note that the Medicare volume performance standards contained in the final bill and the eventual restriction on balance billing to 115 percent of an approved national fee schedule have the potential to achieve the same ends as the unwelcome ethods, only carrying a different label.

AIDS Policy

The House of Delegates adopted a comprehensive AIDS policy that:

* Recommended contact-tracing and notification of needle partners.

* Recommended that the AMA Council on Medical Service study the cost of care for patients in each stage of HIV infection and estimate the number of people in each stage now and in five years.

* Pledged ongoing support for funding for research, education, and patient care, as well as for alternatives to inpatient care.

* Vowed to work with other physician groups, public health officials, and universities to advance training for primary care MDs and specialists.

* Encouraged MDs to provide information to patients about HIV prevention and to become more involved in the care of HIV-infected patients.

* Endorsed institutional indemnification of medical students and resident physicians infected as a result of patient contact.

* Said AMA would consult with appropriate federal agencies and drug manufacturers about the expansion of AIDS rugs.

* Urged MDs to take comprehensive and thorough sex and drug histories in a nonjudgmental fashion.

* Asked federal and state agencies to establish rigorous proficiency testing and quality control procedures for testing labs frequently and regularly.

* Reaffirmed its commitment to mandatory testing of inmates in federal and state prisons and supported mandatory testing of all newborns in high prevalence areas.

* Encouraged state legislation to establish requirements for reporting and case follow-up for serious contagious isease, including HIV infection.

* Requested that the Food and Drug Administration address the problem of readable instructions for condoms.

* Recommended that the FDA not allow home test kits for HIV.

First Step to NHI?

The AMA began addressing the question of health care coverage for the 37 million Americans without health insurance and the equal number with inadequate insurance through a call for ensuring access to health care for those individuals through a combination of employer-sponsored coverage and other private affordable approaches, such as risk pools, and restructuring Medicaid and Medicare programs. Many knowledgeable individuals suspect that the AMA call for Congress to undertake this proposal will prove to be the first step leading to mandatory national health insurance.

Practice Guidelines

The lagging development of practice guidelines is just now beginning to reach the attention of the House of Delegates. The various groups involved in the process (the AMA, the specialty societies, the RAND Corp., and the Consortium of Academic Medical Centers) have yet to reach an accord on how to proceed. The lack of consensus on what to term the process signals philosophical differences that will clearly influence how they are to be used. Various players use terms such as parameters, guidelines, criteria, and standards that have subtle distinctions and that may be translated into how they are used with respect to authorization for payment for services. We can safely predict a significant battle over these definitions in future years.

Other Matters

In a surprise move, the House deferred action on a much ballyhooed patient bill of rights until its June 1990 meeting. There was some evidence that the draining of staff energy by the financial scandal had led to an ill-prepared proposal, but very real concerns were raised. Some thought that the specifics of the proposal would lead to increased legal difficulties for the AMA and for the medical profession. Some delegates said that the proposal merely summarizes already existing AMA policy, so that the delay causes no problems. The House also voted to reject a proposal to specifically prohibit discrimination against gays in the granting of membership in the AMA. While there was some concern that the proposal, if adopted, would suggest AMA approval of so-called alternative life-styles, the sentiment was that the proposal was unnecessary, as there was no evidence of such discrimination to be overcome.

Frank A. Riddick Jr., MD, FACPE, is delegate and James E. Hartfield, MD, FACPE, is alternate delegate for the American College of Physician Executives. Dr. Riddick is Medical Director, Ochsner Clinic, New Orleans, La. Dr. Hartfield is Associate Vice President, Clinical Affairs, University of South Florida College of Medicine, Tampa. Dr. Riddick now steps down as a delegate, having served as the College representative since 1984, when the College was first recognized by the AMA. Beginning in 1990, Dr. Hartfield will serve as the College delegate. The alternative delegate will be Mark A. Doyne, MD, FACPE, Chief Medical Officer, St. Thomas Hospital, Nashville, Tenn.
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Title Annotation:James Sammons resignation from the American Medical Association
Author:Hartfield, James E.
Publication:Physician Executive
Date:Mar 1, 1990
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