Action on 1999 Resolutions

Memorandum

To: 2002 Council
From: Colin C. Rorrie, Jr., PhD, CAE
Council Secretary
Date: August 23, 2002
Subj: Board Action on 1999 Resolutions

This report summarizes the actions taken by the Board of Directors on the 21 resolutions adopted by the 1999 Council, the two resolutions referred to the Board of Directors, and the resolution referred to the Steering Committee.

Resolution 1 Fellowship - AOBEM and ABP
The resolution amended the Bylaws to include the American Osteopathic Board of Emergency Medicine and the American Board of Pediatrics in consideration of Fellow status. The Bylaws were revised in October 1999.

Resolution 3 Vacancies
The resolution amended the Bylaws to address vacancies and recall for the Board of Directors, officers, and Council officers. The Bylaws were revised in October 1999.

Resolution 4 Streamlining Bylaws
The resolution amended the Bylaws revising some sections and by removing some sections to include them in the College Manual and Council Standing Rules documents. The Bylaws were revised in October 1999.

Resolution 5 College Manual
The resolution created the College Manual document and provided some revisions to the proposed draft. The College Manual was finalized in October 1999.

Resolution 6 Council Standing Rules
The resolution revised the Council Standing Rules and provided some revisions to the proposed draft. The Council Standing Rules were revised in October 1999.

Resolution 7 Availability of Hospital Emergency Department On-Call Specialists
RESOLVED, That ACEP in cooperation with other medical specialty societies, the American Medical Association, the American Hospital Association, and other interested parties develop and promote appropriate solutions to the dwindling availability of on-call specialists to hospital emergency departments; and be it further

RESOLVED, That ACEP submit an appropriate resolution to the American Medical Association House of Delegates outlining the issues and calling for the AMA to develop and promote appropriate solutions to the dwindling availability of on-call specialists to hospital emergency departments.

A resolution on this subject was submitted to the AMA House of Delegates at the December 1998 Interim Meeting. A report was generated by the AMA for the June 1999 Annual Meeting. The report included language as submitted by the College's resolution and the proposed solutions that were developed and promoted by the AMA are supported by the College. The AMA Section Council on Emergency Medicine supported approval of the report at the December 1999 Interim Meeting.

The AMA House of Delegates approved the Council on Medical Service Report "On-Call Physicians." The action of the AMA House of Delegates resulted in the AMA establishing and participating in a task force with the American Hospital Association, American College of Emergency Physicians, other appropriate medical specialty societies, medical staff representatives and other interested parties to delineate: a) the responsibilities of those physicians on-call to the emergency department; b) mechanisms for payment for care provided by an on-call physician to the emergency department; and c) enforcement options for medical staff on-call requirements to ensure appropriate medical care for all emergency department patients in light of EMTALA requirements. A report was issued; however, the AMA has not taken further action due to budgetary constraints.

Resolution 8 False Claims Act
RESOLVED, That ACEP continue its work on the subject of compliance, including the Federal False Claims Act, and increase its efforts to disseminate information on this topic to its members.

A 30-page report on compliance was developed and made available to the membership, and was included in the member's only section of the Web site. The College also submitted comments to the OIG regarding the compliance issues related to small groups and individual physicians. Information on this topic is continually shared with the membership through various communication vehicles. The Reimbursement Committee continues to monitor the issue and make recommendations to the Board as needed.

Resolution 9 Federation of State Medical Boards Recommendations
RESOLVED, That a Task Force be appointed to develop strategies and tools to aid chapters and individual physicians in responding to the Federation of State Medical Board's recommendations in "Maintaining State-Based Medical Licensure and Discipline: A Blueprint for Uniform and Effective Regulation of the Medical Profession." and be it further

RESOLVED, That ACEP consider establishing a formal relationship with the Federation of State Medical Boards.

A task force was appointed to study the issues and a detailed report of their findings and recommendations was provided to the 2000 Council. Additionally, a letter was sent from the president to the FSMB requesting the establishment of a formal liaison relationship. In response to that letter, on June 5, 2000, the ACEP and EMRA presidents, and ACEP staff, met with the executive vice president of the FSMB to explore developing a formal relationship. The FSMB executive vice president concurred that a liaison relationship between ACEP and FSMB would be beneficial to both organizations. The FSMB agreed to keep ACEP apprised of potential collaborative efforts. The ACEP president, EMRA president and president-elect, and the Council speaker attended the FSMB Symposium on September 6, 2000. A change in leadership at the FSMB occurred in early 2001. In April 2001 the interim CEO of the FSMB met with the ACEP Board of Directors. He provided an overview of the organizational structure, member boards, policy development process,

and current activities. He also discussed postgraduate training programs and requirements and resident licensure. The ACEP Board reiterated its desire to establish a formal liaison relationship with the FSMB. Since that time the FSMB has not contacted ACEP and staff are continuing efforts to establish a formal liaison. All FSMB policies are available on their Web site.

Resolution 10 Ultrasound Imaging
RESOLVED, That ACEP affirm ultrasound imaging is within the scope of practice of appropriately trained physician specialists; and be it further

RESOLVED, That ACEP policy on ultrasound acknowledge that broad and diverse use and application of ultrasound imaging technologies does exist in medical practice; and be it further

RESOLVED, That ACEP policy on ultrasound imaging affirm that privileging of the physician to perform ultrasound imaging procedures in a hospital setting should be a function of hospital medical staff and should be specifically delineated on the Department's Delineation of Privileges form; and be it further

RESOLVED, That ACEP policy on ultrasound imaging state that each hospital medical staff should review and approve criteria for granting ultrasound privileges based upon background and training for the use of ultrasound technology and ensure that these criteria are in accordance with recommended training and education standards developed by each physician's respective specialty society; and be it further

RESOLVED, That ACEP through its AMA delegation and other vehicles, promote this policy to other medical specialty societies, the AMA House of Delegates, and other appropriate entities.

The resolution was assigned to the Emergency Medicine Practice Committee to review the current policy and make a recommendation to the Board for changes to the policy consistent with the resolution. In June 2001 the Board adopted the revised policy "Use of Ultrasound Imaging by Emergency Physicians." In June 2001 the Board also adopted the "2001 Emergency Ultrasound Guidelines" developed by the Ultrasound Section. ACEP submitted a resolution to the AMA House of Delegates on the subject of ultrasound credentialing criteria and it was adopted at the December 1999 Interim Meeting. ACEP cosponsored a resolution on ultrasound reimbursement at the June 2000 meeting of the AMA House of Delegates. The AMA adopted the resolution.

Resolution 12 Educational Program Addressing Underinsured and Uninsured
RESOLVED, That ACEP continue to work with the AMA, other organizations and key policy leaders on developing and implementing an educational forum on the issue of medically uninsured and underinsured; and be it further

RESOLVED, That national ACEP convene an educational program in the next year on the issue of the medically underinsured and uninsured.

A task force was appointed to assist with the planning and development of a conference on the underinsured and uninsured. The conference "National Congress for Preserving America's Healthcare Safety Net" was held on September 19, 2000. Proceedings from the conference were published by ACEP.

Resolution 14 Domestic Violence
RESOLVED, That ACEP encourage emergency personnel to screen patients for domestic violence and appropriately refer those patients who indicate domestic violence may be a problem in their lives.

The resolution is a policy statement. It has been included in the Policy Compendium.

Resolution 15 Promotion of Health Care Insurance
RESOLVED, That ACEP formulate and implement a strategic plan to promote expansion of health insurance coverage for the uninsured and underinsured; and be it further

RESOLVED, That ACEP continue to work with state, federal, and private agencies to expand health insurance coverage for the uninsured and underinsured; and be it further

RESOLVED, That a report of these efforts be provided at the 2000 Council meeting.

This resolution is linked with Resolution 12. A health policy report, "Emergency Medicine and the Debate Over the Uninsured: A Report from the Task Force on Health Care and the Uninsured" was developed and included in the published proceedings of the educational conference "National Congress for Preserving America's Healthcare Safety Net." The report included several principles developed by the task force, including the urgent need to expand health insurance coverage.

Resolution 16 Safe Boating Practices
RESOLVED, That the American College of Emergency Physicians promote and endorse safe boating and personal watercraft practices; and be it further

RESOLVED, That ACEP promote educating both passengers and operators about the dangers of alcohol intoxication while boating or using personal watercraft.

The Trauma Care and Injury Control Committee was assigned an objective for 99-00 to review the current policy on drunk boating. The committee prepared a revised policy that included the language from this resolution in their recommendation to the Board. The Board adopted the revised policy at their September 2000 meeting.

Resolution 17 Membership
RESOLVED, That ACEP continue to work with chapters to develop and further refine membership retention efforts including identifying and publicizing successful membership retention practices of other chapters.

The Membership Committee and ACEP Member Services staff continue to work with chapters on membership retention activities. The Connection is used to publicize successful chapter membership programs and activities. Membership retention has also been discussed on chapter audio conferences and was included as a topic at the 2000 Leadership/ Legislative Issues Conference.

Resolution 19 Commendation for Nancy J. Auer, MD, FACEP
A framed resolution was presented to Dr. Auer.

Resolution 20 Commendation for Stephen J. Dresnick, MD, FACEP
A framed resolution was presented to Dr. Dresnick.

Resolution 21 Commendation for John C. Moorhead, MD, FACEP
A framed resolution was presented to Dr. Moorhead.

Resolution 22 Commendation for Benson S. Munger, PhD
A framed resolution was presented to Dr. Munger.

Resolution 23 Resident Physician Safeguards in the Event of a Residency Program Closure
RESOLVED, That ACEP work with other appropriate organizations and agencies to develop strategies for resident physicians to complete their training in the event of residency program closures; and be it further

RESOLVED, That a report be provided to the 2000 Council regarding the progress of these efforts.

The resolution was referred to the Academic Affairs Committee to explore opportunities for working with other organizations and agencies. In July 2000 the committee submitted a draft policy to the Board and it included recommendations from the Council of Residency Directors (CORD). The Board agreed with the principles contained in the draft and also discussed various issues regarding ACEP's role in emergency medicine residency program closures. The issue continued as an objective for the Academic Affairs Committee in FY 00-01. An update on this resolution was provided to the 2000 Council. Further discussions were held with CORD and although CORD agreed with the committee's efforts, it declined to develop a joint policy with ACEP. In December 2000 the CORD Board approved the "CORD Guidelines on Residents within Closed Programs." The Academic Affairs Committee reviewed the CORD guidelines and agreed that it adequately addresses the problem of displaced residents. The ACEP Board of Directors reviewed the CORD guidelines in June 2001 and agreed with the committee's assessment. The guidelines were accepted as information in lieu of endorsement or adoption. A report was provided to the 2001 Council.

Resolution 26 Commendation for Ricardo Martinez, MD
A framed resolution was sent to Dr. Martinez.

Resolution 27 Telephone Triage of Emergency Patients to Alternative Methods of Care
RESOLVED, That ACEP appoint a task force to define, study, and make recommendations about quality issues related to telephone and online or internet triage, products, policies, and procedures, and provide a report to the 2000 Council.

The resolution was referred to the Emergency Medicine Practice Department for review. The Board of Directors adopted the revised policy statement "Providing Telephone Advice from the Emergency Department" in July 2000. The policy states that "& Most medical conditions cannot be accurately diagnosed by the telephone& Callers should be advised that EDs are available at all times to assess their condition." ACEP's "Telemedicine in Emergency Medicine" Information Paper also addresses the issue.

Referred Resolutions (to the Board of Directors)

Resolution 2, Principles of Ethics
RESOLVED, That Article XI, Section 2 of the ACEP Bylaws be revised by the addition of the following:

8. The College shall indemnify the accuser or accusers, for all actions that arise from the filing of such charges, provided that the member has acted in "good faith" and in accordance with the College Bylaws.

The resolution was referred to the Ethics Committee. At their June 2000 meeting the Board of Directors agreed with the Ethics Committee recommendations that the College should not indemnify members of the College who bring ethics charges and that the Bylaws should be amended to require that, upon acceptance of membership, members agree to: a) abide by the process outlined in the Bylaws and the College Manual for processing of ethics charges; and b) refrain from taking any legal action against the College or a member who files an ethics charge against them unless and until they have exhausted the administrative remedies afforded by the ethics charges procedure.

Resolution 25, Practice Sites in Definition of Emergency Medicine
RESOLVED, That the Board revise the Definition of Emergency Medicine to include a broad, flexible description of emergency medicine that includes examples of specific practice sites outside hospital emergency departments.

The resolution was referred to the Emergency Medicine Practice Committee. The Board reviewed a draft revision to the policy "Definition of Emergency Medicine." Comments were also received from the Academic Affairs Committee and the Government Services Chapter. The Board of Directors adopted the revised policy statement "Definition of Emergency Medicine" in April 2001.

Referred Resolutions (to the Council Steering Committee)

Resolution 24, C-Mail
RESOLVED, That the ACEP Council Officers, in conjunction with Council committees and members, develop guidelines for the use of Council E-mail (C-Mail) to be included in the Council Standing Rules; and be it further

RESOLVED, That this process include:

  1. a discussion of a role or mechanism for a central 'clearing house' for assimilation, organization and dissemination of materials for councillors; and
  2. guidelines for the use of C-mail by the College, Council, individuals councillors, and other related organizations and individuals; and
  3. identification of materials acceptable and examples of those not acceptable for dissemination on C-Mail (such as solicitations for non-profit, political, or other personal matters); and
  4. a mechanism for updating and changing the guidelines based upon Council needs and notifying members of modifications.

The Steering Committee discussed this resolution at their January 9, 2000 meeting. The Steering Committee continues to review technology issues related to conducting Council business. Any recommendations for inclusion in the Council Standing Rules will be prepared as resolutions for the Council to consider. The Standing Rules can only be amended by resolution.

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