Board Meeting Minutes

American Academy of Emergency Medicine
Minutes of Board of Directors Meeting
Orlando, Florida
February 22, 2001

IN ATTENDANCE: Robert McNamara, MD; Joseph Wood, MD; Drew Fenton, MD; Howard Blumstein, MD; William Durkin, MD; Gregory Hall, DO; Antoine Kazzi, MD; Christopher Minas, MD; Margaret O'Leary, MD; Tom Scaletta, MD; Tobey Williams, MD; Leslie Zun, MD. Staff: Eric Lanke and Kay Whalen.

Dr. Wood began the meeting by welcoming all Board members and guests and by stating that Dr. McNamara and two other Board members had not yet arrived. Therefore, Dr. Wood presided over the meeting until Dr. McNamara arrived.

I. Approval of December 20, 2000 Conference Call Minutes

Dr. Wood turned the Board's attention to the December 20, 2000 draft minutes included in the agenda packet. He asked if any Board members had corrections to the minutes. There being none, Dr. Durkin moved and Dr. Fenton seconded that the December 20, 2000 Board of Directors conference call minutes be approved. MOTION PASSED UNANIMOUSLY.

III. Treasurer's Report

Dr. Fenton then drew the Board's attention to the draft copy of the 2000 audit which was distributed at the meeting. He noted that exclusive of a $7,400 net loss for AAEM's investment in AAEM Services, AAEM had realized a net income of $597 for general operations in 2000. Dr. Fenton also stated that this year's auditing firm had been selected at the recommendation of the Audit & Finance Committee. Dr. O'Leary, chair of the committee, had interviewed three prospective firms and recommended that Ritz, Holman, Butala, Fine once again be retained to perform AAEM's audit.

Dr. Fenton also noted that, at the recommendation of the Audit & Finance Committee, AAEM has invested in one $100,000 CD at M&I Bank and one $100,000 CD at Firstar Bank.

Dr. Blumstein moved and Dr. Durkin seconded that the Treasurer's Report be approved. MOTION PASSED UNANIMOUSLY.

IV. Membership Report

Dr. Wood then drew the Board's attention to the membership report included in the agenda materials. Membership numbers were once again higher than the previous year. The largest gain was in the Resident membership category. The Associate category also increased as physicians who had joined as residents, graduated from their residency programs and became associate members before taking their Board examinations.

At this point, Dr. McNamara, Dr. O'Leary and Dr. Williams arrived and Dr. McNamara took over as chair of the meeting.

Dr. McNamara then addressed the request from AAEM member, Luiz Mineiro, MD, for emeritus status. Since Dr. Mineiro has met all of the criteria for AAEM emeritus status, Dr. Durkin moved and Dr. Scaletta seconded that Dr. Mineiro be granted emeritus status. MOTION PASSED UNANIMOUSLY.

II. President's Report

Dr. McNamara then apologized for not being at the start of the meeting. Earlier in the day, he had spoken to approximately 200 residents in Philadelphia (Peter Rosen, MD, was also a speaker at the conference) and had trouble leaving Philadelphia due to weather complications. He also reported that he had spoken in Saginaw, Michigan and at Beth Israel in Manhattan. He received a good reception at both places.

Dr. McNamara then noted that AAEM had received a letter from the Residency Review Committee in response to the letter AAEM had sent to the RRC regarding the improper "moonlighting" situation of a particular residency program. The RRC replied that it was interested in investigating the program, but it needed a resident that had been affected by the impropriety to contact them.

Representatives from the Office of the Inspector General (OIG) had met with Dr. McNamara regarding the physician staffing industry. The OIG had begun investigating this area due to the request of the Emergency Department Practice Management Association (EDPMA) to allow staffing companies to be given a Medicare provider number. These representatives will be attending the Scientific Assembly in order to learn of AAEM members' experiences with physician staffing groups. The OIG's report is due in August.

Dr. McNamara had also met with representatives from the General Accounting Office (GAO) via conference call earlier in the week. The GAO is studying the EMTALA mandate and its impact in EDs regarding the regulatory burden as well as economic issues. AAEM will be sending the GAO more information on these issues.

In addition, Dr. McNamara had been working with AAEM's Washington representative as well as Dr. Durkin on the possible effects that Stark II will have on emergency care.

V. Scientific Assembly Update

Ms. Whalen reported that AAEM will have over 350 registrants at the Scientific Assembly. In addition, we will have 26 exhibitors.

VI. Proposed Position Statements

Emergency Physicians Credentialing Position Statement

Dr. Scaletta moved and Dr. McNamara seconded that the position statement on Emergency Physician Credentialing, included in the agenda packet, be approved. Dr. Scaletta noted that this position statement had been drafted to parallel our mission statement. Dr. Zun moved and Dr. Kazzi seconded that the following bullet be incorporated into this position statement:

Documentation of ABEM or AOBEM board status, and for those not yet ABEM or AOBEM certified, completion of an ACGME or AOA-approved postgraduate training program in Emergency Medicine.

MOTION TO ADD AMENDMENT PASSED 10-2.

The Board then voted on the original motion, to adopt the Emergency Physicians Credentialing Position Statement, as it now reads:

Whereas higher care quality, improved patient safety, and decreased medical legal risk can be directly linked to qualified Emergency Medicine specialists; and

Whereas emergency physicians should be involved in the process by which they are credentialed; and

Whereas AAEM has become the lead organization in promoting the practice of Emergency Medicine only by qualified practitioners;

Therefore be it resolved that AAEM asserts that health care organizations obtain, verify, and document the following information when credentialing emergency physicians for practice in emergency departments:

1. Documentation of ABEM or AOBEM board status and, for those not yet ABEM or AOBEM certified, completion of an ACGME or AOA-approved postgraduate training program in Emergency Medicine.
2. Lifetime medical licensure history.
3. Health care related employment/appointment history (including terminations, challenges or decisions pending, and voluntary resignations/relinquishments).
4. Past 12 months' clinical activity (approximate number of patients treated and clinical setting).
5. Previous 10-year malpractice history (including claims, suits, and settlements).
6. Sanctions by licensing or regulatory agencies.
7. Lifetime criminal record.
8. Signed professional references (attesting to adequacy of clinical knowledge, technical skills, judgment, communication skills, overall professional performance, and adherence to rules and bylaws) by emergency physicians who have observed the applicant first-hand.

AAEM already recognizes that ABEM or AOBEM certification provides training superior to that provided in ACLS and ATLS courses and, as such, those credentials should not be required of board-certified emergency physicians.

MOTION PASSED UNANIMOUSLY.

Emergency Physician-to-Patient ED Staffing Ratios Position Statement

Dr. Scaletta moved and Dr. Hall seconded that the Emergency Physician-to-Patient Staffing Ratios Position Statement be approved as drafted.

Dr. Kazzi moved and Dr. Durkin seconded that the phrase ". . .in the absence of physician extenders, the emergency physician staffing ratio. . ." be added to the language of the position statement. MOTION FAILED 3-9.

The original motion to adopt the Emergency Physician-to-Patient Staffing Ratios Position Statement which reads:

Whereas the volume of ED visits continues to rise and now exceeds 100 million in the United States annually; and

Whereas the scope of Emergency Medicine requires a high intensity of service for many conditions, especially during the first hour of treatment; and

Whereas emergency medicine involves patient evaluation, interval assessments, complex decision-making, time-intensive procedures, care coordination with primary care and consulting physicians, chart documentation, aftercare education, and inter-facility transfers; and

Whereas emergency patient work-ups are getting more involved due to admission prevention strategies of managed care organizations; and

Whereas emergency physicians provide a vital role in medical error reduction in one of the highest risk areas (according to the Institute of Medicine);

Therefore be it resolved that AAEM asserts that, as a guideline for comprehensive, moderate acuity emergency departments, the emergency physician staffing ratio should be based on the rate of patient influx such that the rate of 2.5 patients per physician per hour is not exceeded.

be adopted. MOTION PASSED 10-2.

Emergency Nurse-to-Patient ED Staffing Ratios

Dr. Scaletta moved and Dr. Wood seconded that the Emergency Nurse-to-Patient ED Staffing Ratio Position Statement which reads:

Whereas the volume of ED visits continues to rise and now exceeds 100 million in the United States annually; and

Whereas the scope of Emergency Medicine requires a high intensity of service for many conditions, especially during the first hour of treatment; and

Whereas emergency nursing involves patient evaluation, interval assessments, medication administration, procedure assistance, point-of-care testing, chart documentation, and aftercare education; and

Whereas emergency patient work-ups are getting more involved due to admission prevention strategies of managed care organizations; and

Whereas emergency nurses provide a vital role in medical error reduction in one of the highest risk areas (according to the Institute of Medicine); and

Whereas a reduced regular staffing pool results in the use of inexperienced nurses during crisis periods (e.g., influenza season);

Therefore be it resolved that AAEM asserts that, as a guideline for comprehensive, moderate acuity emergency departments, the minimum emergency nurse-to-patient staffing ratio should be 1:3 or based on the rate of patient influx such that the rate of 1.25 patients per nurse per hour is not exceeded. In addition, dedicated triage and charge nurses are necessary in higher volume departments.

be adopted. MOTION PASSED 11-1.

AAEM Position Statement on Unions in Emergency Medicine

Dr. McNamara moved and Dr. Durkin seconded that AAEM adopt the following position statement:

AAEM recognizes the right of emergency physicians to organize into collective bargaining units under the auspices of the National Labor Relations Board. AAEM acknowledges the presence of certain practice issues, such as economic exploitation and termination without cause, that may prompt the formation of unions in Emergency Medicine. We support AAEM members who form unions to improve patient care and their work environments. However, AAEM believes emergency physicians should preferably seek ownership of their practice by pursuing relief through existing laws and regulations including those prohibiting fee-splitting and, where applicable, the corporate practice of medicine. AAEM will provide assistance to emergency physicians who seek such ownership.

be adopted.

After a long discussion, Dr. Kazzi moved and Dr. Wood seconded that the question be called. MOTION PASSED UNANIMOUSLY. The Board then voted on the original motion. MOTION PASSED 11-1.

VII. Bylaws Revision Requiring ABEM/AOBEM Continuous Certification for All AAEM Officers/Board Members

Dr. Fenton moved and Dr. Fenton seconded that the following be added to AAEM's bylaws:

8.14 Board Certification

Board members are required to maintain their board certification status throughout the length of their terms of office. Any Board member who allows his/her board certification status to expire will automatically be retired from the Board.

MOTION PASSED 11-0-1.

VIII. Policy Amendment: AAEM Non-Discrimination Position Statement on Practice Track vs. Residency Trained EM Physicians

Dr. McNamara then drew the Board's attention to the proposed amendment to AAEM's Non-Discrimination policy as proposed by AAEM Resident Section Board Member David Huang, MD.

Dr. McNamara moved and Dr. Kazzi seconded that AAEM adapt its AAEM Non-Discrimination Position Statement on Practice Track vs. Residency Trained EM Physicians by adding the following paragraph:

This is to recognize the fact that there is a period of time in the early formation of every specialty where no formal residencies exist, and that it was therefore appropriate to create a time-limited practice track for the founders of the specialty to become board certified. Currently and for the future, in the interest of patient welfare, accredited Emergency Medicine residency training is the only acceptable pathway to ABEM/AOBEM certification.

MOTION PASSED 9-3.

IX. Strategic Plan

Dr. McNamara then asked the Board members to give a brief update on various areas of the Strategic Plan.

Membership

Dr. Durkin reported that the Committee planned to meet during the Scientific Assembly.

Liaison Activities

Dr. Zun reported that the Committee had completed its task by asking for liaison relationships with appropriate organizations.

Preferred Specialty Society

This Committee had been disbanded since its charge was incorporated into other areas.

Ethics Policy

Dr. Wood reported that his Committee would be looking into membership ethics issues.

Business Knowledge/Education

Dr. O'Leary reported that the group needed to reach a consensus on business knowledge.

Partnership with Public

Dr. Scaletta noted that the organization needed to reexamine whether AAEM can fund a PR campaign.

Legislative Action

Dr. Kazzi reported that AAEM has set up a key contact legislative network.

Benchmarks

Dr. Scaletta noted that the Board had just approved the Committee's work in this area.

X. www.911emergency.org

Dr. McNamara reported that the idea of a website listing EDs that were staffed by board certified EPs 24/7 had come from our strategic plan of two years ago. This website is now functional and will serve as the entry page to our on-line text for the public. This site will be cited in the April issue of Ladies Home Journal.

XI. AAEM Services Update

Dr. McNamara announced that AAEM Services had sold its first two sets of templates. These templates will be featured during the Scientific Assembly.

Dr. McNamara also noted that AAEM will purchase Dr. Moss' share of AAEM Services in the near future.

XII. New Business

ABEM Survey

Dr. McNamara then drew the Board's attention to the results of the AAEM survey on the changes proposed by ABEM. The AAEM Executive Committee will be meeting with them during the Scientific Assembly and will be providing ABEM with feedback from AAEM members.

Most survey respondents agreed that continuous certification is a good idea. However, AAEM's members objected strongly to the 7 year rather than the 10 year increment. They also strongly objected to the requirement of a clinical director verifying clinical competency for emergency physicians.

Amiodarone

Dr. McNamara will appoint a working task force to put together a position statement on the use of amiodarone.

McCain Bill

Dr. McNamara reported that the McCain Bill was similar to the Norwood Bill regarding the prudent layperson rule and the one hour post stabilization call. The AMA is supporting this Bill. Dr. McNamara moved and Dr. Wood seconded that AAEM sign on as a sponsor to the McCain Bill. MOTION PASSED UNANIMOUSLY.

EMTALA Amendment

Dr. Durkin and Dr. McNamara discussed draft wording developed in conjunction with Washington Counsel to add a payment provision to the EMTALA statute. Dr. McNamara moved and Dr. Durkin seconded that the Board support moving forth on this amendment. MOTION PASSED UNANIMOUSLY.

Marfan Syndrome Materials

Dr. Scaletta reported that he had reviewed materials produced by the Marfan Syndrome Foundation and found them to be worthwhile. Dr. Wood moved and Dr. Williams seconded that AAEM endorse the Marfan Syndrome materials. MOTION PASSED UNANIMOUSLY.

There being no further business, Dr. Wood moved and Dr. Hall seconded that the meeting be adjourned. MOTION PASSED UNANIMOUSLY.

Respectfully submitted,

Kay Whalen
Organizational Director