Memorandum

To:	2004 Council
From:	Dean Wilkerson, JD, MBA, CAE Council Secretary
Date:	September 8, 2004
Subj:	Action on 2001 Resolutions

This report summarizes the actions taken by the Board of Directors on the 29 resolutions adopted by the 2001 Council. One resolution was referred to the Board and 2 were referred to the Council Steering Committee.

Resolution 1 Procedures for Addressing Ethics and Other Disciplinary Charges
This was an amendment to the College Manual that replaced the entire section "Procedures for Addressing Ethics and Other Disciplinary Charges." The College Manual was revised in October 2001.

Resolution 4 Career Membership
RESOLVED, That ACEP study the creation of an alternate process to pay dues that would afford lifetime membership in the College by allowing members to pay a one-time, lifetime, prorated membership fee; and be it further

RESOLVED, That the ACEP Board of Directors report on this issue at the 2002 Council meeting.

The resolution was referred to the Membership Committee for review. A report was distributed to the 2002 Council.

After careful study the committee recommended that no such category be created. Several advantages for such a category of membership were reviewed, including potential enhanced member retention, dues revenue stability as a result of improved member retention, reduced costs related to retention of members (including costs for mailing, billing statements and processing payments), financial savings for members utilizing this membership category, and providing members special status that recognizes members who demonstrate long-term loyalty. Several other professional organizations provide such a membership category. These include the American Medical Association (AMA), the American Academy of Physical Medicine and Rehabilitation (AAPMR) and the College of American Pathologists (CAP). However, for all of these organizations, only a very small percentage of their membership takes advantage of this category: AMA 1,800 of 280,000 members (0.64%); AAPMR 8 of 6,365 members (0.13%); and CAP 47 of 9,738 members (0.48%). Using the most optimistic percentage (i.e., AMA 0.64%) to apply to ACEP in an attempt to predict member interest, this would be the equivalent of only 13 members utilizing a lifetime membership category. In addition, it is extremely important to note that none of these organizations have state chapters. ACEP state chapter dues range from $25 to $350 per year. In view of ACEP's requirement for chapter membership, before ACEP could implement a lifetime dues structure, each chapter would need to approve and implement a lifetime dues structure, which could result in a significant loss of revenue to those chapters with dues at the higher end. Similarly, it is not uncommon for emergency physicians to move from one state to another during their professional career. A mechanism to transfer lifetime state chapter dues from one chapter to another would need to be developed; accounting and record keeping would be problematic. Data indicates that the current average length of ACEP membership is 11 years. Determining a monetary value for lifetime membership in national ACEP based on this figure could severely underestimate the true length of ACEP membership in the future given that emergency medicine remains an extremely popular specialty for medical students and the number of emergency medicine residencies continues to expand. The average length of membership in ACEP will naturally increase for individuals who are residency-trained and board-certified in emergency medicine.

Resolution 5 Commendation for Michael D. Bishop, MD, FACEP
A framed resolution was presented to Dr. Bishop.

Resolution 6 Commendation for Michael T. Rapp, MD, FACEP
A framed resolution was presented to Dr. Rapp.

Resolution 7 Commendation for Robert W. Schafermeyer, MD, FACEP
A framed resolution was presented to Dr. Schafermeyer.

Resolution 9 Online Council Business
RESOLVED, That ACEP explore the development of procedures, including parliamentary procedure, technical components, and possible changes to College Bylaws and Council Standing Rules necessary to allow online submission of resolutions, discussion and debate of those resolutions; and be it further

RESOLVED, That a full report on the potential for use of online technology for conducting Council business, including management of resolutions, be presented to the 2002 Council during its meeting in Seattle.

The Board of Directors referred this resolution to the Steering Committee. The Steering Committee discussed it at their January 2002 meeting and a subcommittee was assigned. The subcommittee completed its work and a report was provided to the 2002 Council. Several online mechanisms have been developed to facilitate the work of the Council in between meetings. The Council officers and the Steering Committee continue to discuss and implement ways to increase efficiency and stimulate discussion by the councillors.

A new Council Technology Task Force was appointed by the speaker in 2003. An initial meeting was held at the Scientific Assembly. The task force will continue its work in 2004 with input from the Steering Committee. The task force provided suggestions for changes to the Council notebook on CD and technology innovations to consider for the 2004 Council meeting. A number of their suggestions are being implemented.

Resolution 10 Commercial Sponsorships
RESOLVED, That the ACEP Board of Directors continue initiatives to develop and implement policies on self-disclosure of compliance by sponsors, grant providers, advertisers, and exhibitors at ACEP meetings with ACEP physicians' rights policies, including: "Emergency Physicians Rights and Responsibilities," "Emergency Physician Contractual Relationships," "Agreements Restricting the Practice of Emergency Medicine," and "Compensation Arrangements for Emergency Physicians."

The Board discussed this resolution at their February 2002 and April 2002 meetings. The policy statement "Promotion of College Policies on Contracting and Compensation" was approved by the Board in April 2002.

In June 2003, the Board of Directors discussed options for implementing a formal program that emergency physician staffing groups could follow if they wished to promote their compliance with ACEP policies on emergency physician contracts and compensation issues as described in the policy "Promotion of College Policies on Contracting and Compensation." The Board expressed overall support several of the options presented and requested staff to continue development of these options including a process to objectively investigate compliance if a complaint is filed.

Resolution 17(03) Certificate of Compliance was submitted to 2003 Council and referred to the Board of Directors. This resolution proposes to require any staffing group exhibitor, advertiser, or sponsor to sign the certificate and comply with its terms in order to participate in any ACEP activity. A request for an Advisory Opinion from the Federal Trade Commission (FTC) was filed with the FTC on October 10, 2003.

In January 2004, the Board discussed a draft policy "Disclosure of Adherence to ACEP Contact Policies, however, postponed any action on the policy statement pending a response from the FTC regarding resolution 17(03).

An advisory opinion was issued by the FTC on August 30, 2004. The Board will discuss the advisory opinion at their September 2004 meeting and a report will be distributed to the 2004 Council.

Resolution 11 American Triage Scale
RESOLVED, That ACEP further explore the possibility of establishing a standardized triage scale for use in the United States and report on the results of this effort at the 2002 Council meeting.

The resolution was referred to the Emergency Medicine Practice Committee to review prior recommendations and work on this issue. The Board discussed the committee's recommendations at their October 2002 meeting and approved the development of a task force. The Emergency Nurses Association (ENA) was invited to co-chair the task force. The task force met in Chicago in July 2003 and discussed the research on triage and the pros and cons of triage standardization. The task force's recommendation was discussed by the Board at their September 2003 meeting and the policy statement "Triage Scale Standardization" was approved. The task force has continued its work in 2004.

Resolution 13 Emerging Professional Liability Crisis
RESOLVED, That ACEP study the causes and scope of the emerging professional liability crisis in emergency care, including its potential ill effects on physicians and consumers; and be it further RESOLVED, That ACEP address the growing malpractice crisis, including working with state and federal regulatory agencies, other provider organizations, consumer groups, and malpractice insurers to develop short and long-term resolutions including tort reform.

The resolution was referred to the Medical-Legal Committee, Federal Government Affairs Committee, and the State Legislative/Regulatory Committee to incorporate into an existing objective assigned to the Medical-Legal Committee and State Legislative/Regulatory Committee on this issue. Numerous articles on this issue were published in ACEP News. A summary of all state professional liability laws was developed that is now available from the State Legislative Office Clearinghouse. A summary of tort reform legislative recommendations based largely on the California Medical Injury Compensation Act of 1975 (MICRA) was also developed. ACEP continues to monitor and provide resources as requested in states with acute professional liability availability and affordability issues. In April 2002 the Board reaffirmed that ACEP should continue to educate the membership about current vehicles for addressing unqualified expert witnesses or inaccurate testimony. The Board also discussed the professional liability survey results and recommendations.

The Professional Liability Task Force was appointed and presented their first recommendations to the Board in October 2002. The Board accepted the task force recommendations, including the continuation of the task for the next year. The task force's charge was to: provide information to chapters on issues important in tort reform; provide education to members on the facts and issues of tort reform; evaluate and work with coalitions to best assist with tort reform; review and discuss improving ACEP's expert witness policy and processes; develop message statements that support the inter-relationship of patient safety, patient access, and professional liability; and provide information to members about the professional liability insurance industry. In February 2003 the task force presented a preliminary report to the Board and sought guidance on recommendations that should be implemented immediately and those that warrant further development. The task force is also exploring the development of an expert witness deposition repository. A recommendation is expected for the September or October 2003 Board meeting. A report regarding the work of the task force was provided to the 2003 Council.

ACEP continues to lobby for passage of federal legislation that would limit medical malpractice claims. The bill would cap non-economic "pain and suffering" damages at $250,000, limit punitive damages, restrict attorneys' fees and allow awards to be paid in installments rather than all at once. ACEP supports President Bush's plan to limit medical malpractice awards in lawsuits against doctors and insurance companies. Under the president's plan the amount patients could be awarded for non-economic damages, such as compensation for pain and suffering, would be limited to $250,000.

ACEP continued its work with the AMA on the liability crisis. In July 2002 ACEP staff attended the AMA Professional Liability Insurance Steering Committee meeting. The group discussed legislative efforts at the state and national level.

The Board of Directors has continued discussions regarding professional liability and expert witness testimony since 2001 and continues to file amicus briefs and provide support to members who are involved in malpractice litigation. In February 2002 ACEP filed an amicus brief in an appeal of a Louisiana case in which an expert witness was qualified by the court but did not qualify under ACEP's guidelines.

In June 2003 ACEP participated in a professional liability summit meeting, convened by the American Association of Neurological Surgeons/Congress of Neurological Surgeons (AANS/CNS), to discuss federal caps on medical liability. The chair of the AANS/CNS Professional Liability Task Force was invited to make a presentation to the ACEP Board of Directors in July 2003. At that meeting the Board of Directors pledged $1 million to join the coalition. ACEP past president George Molzen, MD, FACEP, and ACEP president J. Brian Hancock, MD, FACEP, represent the College on this coalition. Dr. Molzen and Dr. Hancock provide an update regarding the work of the coalition at the 2003 Council meeting.

See also Actions on 2002 Resolutions report for additional information regarding ACEP's professional liability initiatives.

Resolution 14 Fair and Equitable Emergency Medicine Practice Environments
RESOLVED, That the Council commend the ACEP Board of Directors and the Emergency Medicine Practice Committee on the development of the "Emergency Physician Rights and Responsibilities" information paper and endorse the principles outlined in the document as a priority for the College; and be it further

RESOLVED, That ACEP continue to study what steps should be taken by ACEP to more strongly encourage a fair and equitable practice environment and report back to the Council by Scientific Assembly 2002; and be it further

RESOLVED, That ACEP continue its efforts to promote the adoption of the principles outlined in the ACEP "Emergency Physician Rights and Responsibilities" statement by the various emergency medicine contract management groups, the American Hospital Association, and other pertinent organizations and report back on the progress by Scientific Assembly 2002.

The resolution was referred to the Communications Department and Public Relations Committee. Numerous articles have appeared in ACEP publications. The Board promotes the policy during chapter and residency visits. A letter was sent from the president to various emergency medicine groups encouraging their compliance with ACEP's policies, particularly "Emergency Physician Rights and Responsibilities." In April 2002 the Board also adopted the policy statement, "Promotion of College Policies on Contracting and Compensation." The Board continues to discuss additional promotion strategies. EMRA distributed the policy to its members and promotes the concepts through its publications.

Resolution 15 JCAHO Mandate for Inpatients
RESOLVED, In order to maintain emergency department efficiency, preparedness and patient safety, emergency departments should not be utilized as an extension of the intensive care and other inpatient units for admitted patients. Therefore, hospitals have the responsibility to ensure the prompt transfer of patients admitted to inpatient units as soon as the treating emergency physician makes such a decision. Hospital regulatory and accrediting bodies should mandate this prompt transfer as one of their standards; and be it further

RESOLVED, That ACEP meet with appropriate regulatory agencies, the American Medical Association, the American Hospital Association, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and other interested parties to establish monitoring criteria and standards that are consistent with ACEP's policy, "Boarding of Admitted and Intensive Care Patients in the Emergency Department;" and be it further

RESOLVED, That the ACEP Board of Directors report back to the Council on the issue of boarding of admitted and intensive care patients in the emergency department by the 2002 Council meeting.

The resolution was referred to Public Affairs staff. Meetings were held with the AMA, AHA, and the JCAHO. In January 2002 ACEP President Dr. Michael Carius convened a meeting in DC to discuss ED crowding. Participants included several ACEP members and representatives from the JCAHO, AHA, AMA, the Federation of American Hospitals, the Emergency Nurses Association, and the Centers for Medicare and Medicaid Services (CMS). The group agreed that additional work on best practices was an immediate short-term goal while additional research and policy formulation was identified as a longer-term objective.

In April 2002 the American Hospital Association issued a press release acknowledging, "a majority of the nation's emergency departments are full, often operating 'at' or 'over' their capacity," according to a survey from The Lewin Group, Inc. conducted for the AHA. More than 1,500 hospitals responded to the survey, representing 36 percent of hospitals with ED services. The survey found that more than six out of 10 hospitals felt that they are filled to capacity and cannot easily accommodate additional patients. Lack of critical care beds was the number one reason cited for diverting ambulances.

In June and December 2002 the JCAHO held roundtable discussions on the issue of ED crowding. ACEP was invited to participate in those discussions, which identified some of the major contributing factors to ED overcrowding. In February 2003 the JCAHO announced that proposed hospital leadership standards addressing ED overcrowding would be out for review. The standards establish expectations for hospitals regarding preparations for managing increased patient volume. In late February 2003 a JCAHO subsidiary convened a national symposium, "Condition Critical: Meeting the Challenge of ED Overcrowding" in Boston. More than 400 health care leaders from across the country attended, seeking solutions to the growing crisis. The initiatives by JCAHO are in large measure due to ACEP's work in bringing ED crowding to their attention. In April 2003 Dr. Molzen approved a public education communication on emergency department crowding to be distributed in ED waiting rooms. The document answered commonly asked questions from consumers about the causes of crowding and directs patients and family members to contact their legislators about the problem.

Resolution 16 Patient Safety
RESOLVED, That ACEP continue the Patient Safety Task Force.

The task force that was assigned in FY 00-01 continued. An objective of the task force was to review the implementation status of the recommendations from the final report, monitor activity, and discuss potential next steps. The task force provided a report to the Board that was distributed at the 2002 Council meeting.

In 2002, the Council adopted Resolution 35(02) directing the Board to consider patient and physician safety in developing strategies for 2003-04 in the areas of physician wellness, ED overcrowding, and liability. The resolution also asked the Board to report to the 2003 Council the progress made in implementing the recommendations of the 2001 Patient Safety Task Force report. This resolution was included in the strategies developed for FY 03-04 and a report was provided to the 2003 Council listing each of the recommendations from the task force and included an update on their implementation.

Resolution 18 Standard of Care
RESOLVED, That the ACEP Board of Directors develop a mechanism to identify and provide an evidence-based, timely, and visible response to statements by other entities promulgating standards of care and treatments that impact the practice of emergency medicine.

The resolution was referred to the Clinical Policies Committee. In June 2002 the Board reviewed the committee's findings. The Board agreed that the current process for the expedited development of policy statements has proven successful. The committee works on 10-13 clinical policies simultaneously. Development time for policy statements is considerably less than for clinical policy development. Recognition of ACEP's expertise in the area of clinical policy development has increased over the years among other organizations. ACEP frequently receives requests for members to serve on joint guideline development panels, to review and comment on draft policies from other organizations, and to review guidelines developed by other organizations for possible endorsement.

The participation of ACEP members as liaisons to other organizations has allowed the emergency medicine perspective to be included in many other guidelines and ACEP has gained recognition and respect for emergency medicine with other professional organizations, evidenced by organizations' approaching ACEP for comments or endorsement of their guidelines.

Clinical policies currently being developed are evidence-based. This process is in keeping with the practice of a majority of other professional societies. The committee believes there is value to the membership in using the evidence-based approach in clinical policies and reporting when there is no evidence to support a particular practice that perhaps is being promoted in other areas of medicine. Industry standards mandate that clinical policies be revised on a scheduled basis, usually every three years, but no longer than five years. ACEP's clinical policies are on a three-year review cycle. The Clinical Policies Committee carefully reviews policies as they come up for review to determine if there is value in updating or archiving them. Standards of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) require demonstration of adherence to clinical guidelines. JCAHO is also emphasizing compliance with national practice guidelines and the use of established clinical practice guidelines to manage and optimize care in disease-specific care certification.

Resolution 19 International Medical Graduates Participation in U.S. Emergency Medicine Residency Programs
RESOLVED, That ACEP support emergency medicine educational opportunities, not related to allocation of U.S. emergency medicine residency training positions, for international physicians to enhance emergency medicine in their native countries; and be it further

RESOLVED, That ACEP work with EMRA to gather and disseminate information designed specifically for international medical school graduates in order to guide them in pursuit of an emergency medical career in their native countries; and be it further

RESOLVED, That ACEP work with EMRA to encourage exchange program opportunities for both international and American emergency medicine residents, medical students, and emergency physicians.

The resolution was referred to the Academic Affairs Committee to work with the International Section and EMRA. The International Section has created an international exchange program, which has been promoted through section activities, the section newsletter, and the web site. International elective rotations, and "observational" fellowships, funded by the participant, are publicized on the web site (when known). The section has also developed a handbook, "Emergent Field Medicine," that is useful for practicing emergency medicine in a foreign country. Another work in progress is the creation of a web site database for U.S. physicians who desire to participate in an international emergency medicine program. Phase 2 of the project will include a database of international physicians and students who want to participate in U.S. programs. EMRA's web site also links to these databases and EMRA also refers such inquiries to the International Section.

Resolution 20 Medical Education Debt
RESOLVED, That ACEP lobby appropriate state and federal agencies for inclusion of emergency physicians in medical education debt repayment programs, including but not limited to state programs, the National Public Health Service, rural and underserved regional grant programs, and other grant/scholarship programs.

The resolution was referred to the current Rural Workforce Task Force to integrate into the assigned objectives. The task force continued its work during FY 02-03. Public Affairs and Chapter & State Relations staff continued to provide materials and resources as requested.

An information paper, "A Rational Approach to Debt Management and Financial Planning," was prepared by the Academic Affairs Committee and submitted to the Board in September 2003 for review and comment. The finalized paper is now available for distribution.

Resolution 21 Rural Emergency Medicine Departments
RESOLVED, That ACEP investigate the root causes related to the difficulty of securing board-certified emergency physician staffing for medically underserved and rural areas. The causes studied should include, but not be limited to educational, financial, and resident candidate selection factors; and be it further

RESOLVED, That ACEP investigate methods to improve educational opportunities in rural and underserved environments.

The resolution was referred to the current Rural Workforce Task Force to integrate into the assigned objectives. The task force continued its work in FY 02-03. A Rural Emergency Medicine Summit was held in March 2003 and the Rural Workforce Task Force presented its report to the Board in September 2003. The Board approved the recommendations from the summit meeting and the president assigned recommendations that require additional work to the 03-04 committee objectives. Many of the recommendations from the summit have now been completed. The proceedings from the summit were submitted to Annals of Emergency Medicine for potential publication.

The Rural Task Force continued its work in FY 03-04. In September 2004, the Board will discuss ACEP's continuing role in addressing the issues of emergency medicine practice in rural emergency departments.

Resolution 22 Sexual Assault Nurse Examiner Programs
RESOLVED, That ACEP assume a leadership role in organizing formal collaboration with key stakeholders including clinical, legal, forensic, judicial, advocacy, and law enforcement organizations to establish areas of cooperation, mutual training, standardization, and continuous quality improvement for the benefit of the sexually assaulted patient.

The resolution was referred to the Emergency Medicine Practice Committee to determine if any further work needs to be done. In October 2002 the Board approved the committee's recommendations that the College not support a new initiative (task force and development of materials, etc.) relative to the sexual assault patient and that ACEP continue to support emergency medicine academic organizations as they ensure proper training of emergency medicine residents in the evaluation and management of the sexual assault victim.

Resolution 24 Workforce Shortage in Emergency Medicine
RESOLVED, That ACEP work with other emergency medicine organizations, including EMRA, SAEM, and CORD to use existing workforce data to identify current and future need for board certified emergency physicians and recommend strategies based on this projected need to ensure appropriate numbers of emergency medicine residency graduates to meet this need; and be it further

RESOLVED, That ACEP lobby Congress and the federal government to eliminate barriers to creating adequate numbers of emergency medicine residency positions and achieving optimal funding for those positions.

The resolution was referred to the Academic Affairs Committee to integrate into the current assigned objective on collaboration with EMRA, SAEM, and CORD. A meeting was held in May 2002 with SAEM and CORD representatives. Although SAEM elected not to collaborate at the committee level but to continue communication at the Board level, CORD agreed to continue collaborating with the Academic Affairs Committee on appropriate projects and issues. The Academic Affairs Committee was assigned several objectives for FY 02-03 and 03-04 regarding workforce issues. In September 2003 the Board approved the dissemination of the survey results on curricula gaps. The results indicate gaps primarily in practice management topics such as reimbursement and research. Recommendations were to develop a packet of information relating to these topics on ACEP's Web site for residency programs to access. The packet would be most useful in modular formats, and should include resources and tools, and serve as a clearinghouse.

A collaborative task force was appointed to develop standardized guidelines and processes for the structure, curriculum, and evaluation of 3rd and 4th year medical school emergency medicine rotations.

The Academic Affairs Committee continued collaboration efforts with other emergency medicine organizations to integrate efforts and share resources to achieve common academic goals, particularly related to identifying current and future needs for board certified emergency physicians as described in this resolution. In addition to sharing committee objectives among emergency medicine organizations, a collaborative task force was established and a collaborative policy was approved by the Board in September 2003.

The resolution was also referred to Public Affairs staff and was included on the legislative and regulatory priorities agenda.

Resolution 25 Point-of-Care Testing
RESOLVED, That ACEP work with appropriate regulatory agencies to streamline the requirements for point-of-care testing such that documentation and quality control does not present a severe burden on emergency department staff, yet ensures appropriate quality control measures and addresses patient safety.

The resolution was referred to Public Affairs staff and it was included on the legislative and regulatory priorities agenda.

Resolution 26 Emergency Care as an Essential Public Service
RESOLVED, That ACEP shall champion the principle that emergency care is an essential public service and make this a key concept in its advocacy efforts on behalf of America's emergency medical services safety net.

The resolution was referred to the State Legislative/Regulatory Committee to integrate into current assigned objectives. It was also referred to Communications and Public Relations staff to continue to include the message in communications activities. The State Legislative/Regulatory Committee developed model state legislation based on the California Chapter initiatives relating to establishing emergency medical care as an essential public service. ACEP's position on this issue was provided to the American Public Health Association and the APHA adopted the following policy statement in November 2001: "The American Public Health Association, 1) considers community hospital emergency departments as essential resources for public health, especially in times of disaster and terrorist attacks; 2) supports the principles embodied in ACEP's policy "Responsibilities of Acute Care Hospitals to the Community;" and 3) will work in cooperation with ACEP to advocate for monitoring emergency department closures and their impact on access to health care."

Resolution 29 Funding of Emergency Health Care for Foreign Nationals
RESOLVED, That ACEP reaffirms that emergency departments are an essential part of the health care safety net for all populations, including foreign nationals; and be it further

RESOLVED, That in its ongoing advocacy efforts, ACEP recognizes uncompensated care for foreign nationals as one example of the many factors that threaten the health care safety net.

The resolution was referred to Chapter & State Relations staff to continue to provide resources to chapters, and to Public Affairs staff to continue advocacy efforts. It was also referred to the Ethics Committee to provide assistance as needed. The president reviewed a letter from an ACEP member to the editor of AMNews that addressed the Texas Attorney General's decision to criminally prosecute any health care provider in a state funded clinic who provides care to undocumented aliens.

Resolution 30 Inconsistent EMTALA Enforcement
RESOLVED, That ACEP solicit member input to formulate and submit recommendations for the Centers for Medicare and Medicaid Services (CMS) EMTALA advisory process and other appropriate bodies, including recommendations for clarifying medical staff on call responsibilities, obtaining greater consistency of EMTALA enforcement among all the CMS regional offices, protection of peer review confidentiality, and utilizing consultative peer review for issues involving medical decision making.

The resolution was referred to the Federal Government Affairs Committee to review and seek input from California. It was also referred to the Medical-Legal Committee to provide assistance on peer review issues. On June 28, 2002 ACEP submitted a comment letter to CMS stating that ACEP supports the attempt to reign in the scope of EMTALA, but also expressed concern about uneven EMTALA enforcement. ACEP made the following recommendations: prompt peer review by emergency physicians to assess possible EMTALA violations; the creation of a "bright line" delineating that EMTALA applies in any case of an outpatient or incoming patient who comes to the ED and for whom a request for emergency care is made, until that patient is stabilized or admitted; that the language of the proposed regulation recognize that hospitals also may have limited financial resources that preclude them from allocating significant sums of money for on-call physicians' ED coverage; that CMS appoint an advisory committee of emergency physicians, EMS first responders, medical specialists, nurses and hospitals "to address the need to finance this unfunded mandate."

Resources are provided to members as requested. ACEP education programs and communication vehicles continue to address EMTALA regulations and its impact on emergency medicine.

Resolution 32 Reimbursement of Emergency Physician-Performed X-ray Interpretations
RESOLVED, That ACEP perform a risk/benefit analysis regarding whether to request further clarification of current x-ray interpretation reimbursement rules for Medicare beneficiaries treated in the emergency department; and be it further

RESOLVED, That based on the results of the risk/benefit analysis, ACEP work with appropriate agencies regarding this issue.

The resolution was referred to the Reimbursement Committee and to Public Affairs staff to continue advocacy efforts. A risk/benefit analysis was undertaken regarding whether to approach the federal regulatory agencies for further clarification of the current billing rules for diagnostic test interpretations. It was determined that the current regulatory rules are favorable for emergency physicians and the OIG's opinions support the emergency medicine perspective. It is not likely that any significant improvements are achievable and there is a real chance that further scrutiny may be harmful to ACEP members. The current rules on billing for diagnostic interpretation should assist emergency physicians in obtaining favorable results at the facility level. Additional tools, such as the Foley and Lardner opinion letter obtained in 2001, have proven helpful as well. Staff continue to develop materials to assist members achieve favorable outcomes at the facility level, but it is not recommended that a national approach be attempted.

Resolution 33 Emergency Department Overcrowding: Support in Seeking Local Solutions
RESOLVED, That the College adopt a specific strategy to coordinate all activities related to emergency department and hospital crowding in order to support state efforts in this area; and be it further

RESOLVED, That ACEP analyze information and experiences to develop a resource tool that will aid chapters in efforts to seek solutions to emergency department and hospital crowding at the local level; and be it further

RESOLVED, That such a resource tool include clearly delineated components essential to such chapter initiatives, data collection methodology and environmental assessment steps needed to define the problem locally, political and organizational alliances necessary to mobilize responses on a local level, effective public relations and media tactics, and any other steps integral to an effective effort to mitigate the ED crowding problem; and be it further

RESOLVED, That the Board of Directors report to chapter leaders on emergency department and hospital crowding initiatives by the 2002 Leadership/Legislative Issues Conference.

The Crowding Resources Task Force was appointed. A draft report was developed and distributed at the Leadership/Legislative Issues Conference. The final report was distributed to the 2002 Council. ACEP has addressed the crowding issue in numerous ways, including participating in a web cast program coordinated by the Kaiser Family Foundation, and distributing packets of information to chapter presidents, chapter executives, and members as requested. Annals of Emergency Medicine and other ACEP publications have reported on and discussed various ED crowding problems and initiatives.

Resolution 34 Commendation for Joseph F. Waeckerle, MD, FACEP
A framed resolution was sent to Dr. Waeckerle.

Resolution 35 Response to Terrorism
RESOLVED, That the American College of Emergency Physicians condemn acts of terrorism throughout the world and specifically the recent acts of terrorism on September 11, 2001, and will not give in to fear and terrorism; and be it further

RESOLVED, That the American College of Emergency Physicians commend all emergency medicine personnel who volunteered their efforts in the heroic rescue and medical response to the acts of terrorism on September 11, 2001.

ACEP communications included the message of this resolution.

Resolution 36 Weapons of Mass Destruction Preparedness Plan
RESOLVED, That the Board of Directors form a multidisciplinary task force to evaluate and monitor initiatives beneficial in strengthening preparedness of the emergency medicine community to assess and respond to weapons of mass destruction events; and be it further

RESOLVED, That the task force develop a strategic plan to include short and long term goals to promote education, research, protection of health care workers, and a coordinated emergency medicine community response plan for weapons of mass destruction events; and be it further

RESOLVED, That the Board of Directors evaluate the recommendations in the final report of the Nuclear, Biological and Chemical Task Force and assign appropriate College resources to support both initial and continuing education of the emergency medicine community in response to weapons of mass destruction events; and be it further

RESOLVED, That the task force provide a report of their assessment and strategic plan for College preparedness for weapons of mass destruction events as soon as possible, but no later than the 2002 Council meeting.

The Terrorism Response Task Force was appointed. The final report from the task force was approved by the Board in October 2002 and distributed to the 2002 Council. Additionally, the State Legislative/Regulatory Committee promoted aggressive participation by ACEP chapters in state terrorism preparedness and response efforts. Public Affairs staff successfully worked with Congress to gain recognition of emergency physicians as first responders in government-sponsored bioterrorism training programs and to promote development of a national real-time anti-bioterrorism communications network among hospitals, state health labs, and federal government agencies. These provisions were included in the House-passed bioterrorism preparedness bill (H.R.3448), the Public Health Security and Bioterrorism Preparedness and Response Act of 2001, which became Public Law No: 107-188. In June 2002, Nancy Auer, MD, FACEP, chair of the Terrorism Response Task Force, represented ACEP at the bill signing ceremony held at the White House. A comprehensive bioterrorism section was developed on acep.org. ACEP's leadership role was promoted in various College communication vehicles and by the lay media.

Resolution 37 Commendation for Louise B. Andrew, MD, JD, FACEP
A framed resolution was sent to Dr. Andrew.

Resolution 38 Commendation for Lily C. Conrad, MD, FACEP
A framed resolution was sent to Dr. Conrad.

Referred Resolutions

Resolution 2 Election Procedures
RESOLVED, That the "Election Procedures" section of the Council Standing Rules be amended as follows:

"....When no candidate receives a majority vote and/or additional vacancies remain to be filled, some positions are filled and a(some) vacancy(vacancies) exist(s) all candidates will remain on the ballot for a subsequent vote. If no candidate is elected after this subsequent ballot, then the candidate who received the lowest number of votes on the inconclusive ballot will be deleted from the next ballot. This procedure will be repeated until at least one candidate receives a majority vote. If nominations have been closed with but a single candidate in cases of a single position being open or multiple candidates which equals the exact number of open positions, the speaker shall declare the candidate or candidates elected to office."

The resolution was referred to the Steering Committee. A resolution was submitted to the 2002 Council and was adopted.

Resolution 3 Invalid Ballots
RESOLVED, That the "Election Procedures" section of the Council Standing Rules be amended as follows:

"Elections of the Board of Directors and Council Officers shall be by a majority vote of the councillors voting. Voting shall be by written or electronic ballot. A councillor's individual vote shall be voided if the number of invalid ballots is enough to alter the outcome (e.g., if adding the number of invalid ballots to the votes received by any candidate for the Board of Directors or Council office would change the outcome of the election, or if the total number of invalid ballots is greater than ten percent (10%) of the total number of councillors credentialed at the Council meeting). A ballot shall be considered invalid if there are more or fewer votes on the that ballot for candidates than open positions or if a councillor votes for the same candidate more than once on that ballot the required number on a particular ballot..."

The resolution was referred to the Steering Committee. A resolution was submitted to the 2002 Council and was adopted.

Resolution 28 Filming in the Emergency Department
RESOLVED, That ACEP opposes media recording for public broadcast of patient care in the emergency department.

The resolution was referred to the Board of Directors. In February 2002 the Board adopted the following policy statement: "Resolved, that the American College of Emergency Physicians discourages the filming of television programs in emergency departments except when patients and staff members can give fully informed consent prior to their participation."

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