Board Meeting Minutes

American Academy of Emergency Medicine
Minutes of Board of Directors Meeting
Miami, Florida
February 19, 2004

IN ATTENDANCE: Joseph Wood, MD, JD; Robert McNamara, MD; A. Antoine Kazzi, MD; Tom Scaletta, MD; Howard Blumstein, MD; William Durkin, Jr., MD; James Li, MD; Raymond Roberge, MD; Kevin Rodgers, MD; Ghazala Sharieff, MD; Jesse Pines, MD. Absent: Carol Barsky, MD; Larry Weiss, MD. Guests: David Millstein, Mike Pendergast, Tobey Williams, Ziad Kazzi. Staff: Kay Whalen, Beth Wilson and Kathi Ream.

Dr. Wood welcomed the Board and AAEM members in attendance to the Board meeting and to Miami . He then began the meeting with the President's Report.

President's Report

Dr. Wood reported that since the last Board meeting, AAEM had scored a tremendous victory for physicians in Emergency Medicine. AAEM had joined with three physicians in California in a lawsuit against Team Health. He then outlined the facts of the case in which three physicians had worked at Mt. Diablo Hospital . During their tenure with the hospital, the emergency department contract had been held by different CMGs. Most recently, the contract had been held and lost by Team Health. The physicians involved in the case chose to stay at the hospital and work for the new contract holder. Team Health chose to enforce the non-compete contract clause and to sue the physicians. The physicians sought help from AAEM. AAEM joined the physicians in a countersuit against Team Health. In addition, AAEM asked ACEP to join the suit, but ACEP needed additional information before joining the suit. Team Health has recently offered a settlement which the physicians and AAEM found acceptable.

Dr. McNamara stated that AAEM owed Dr. Wood a debt of gratitude for his work on this issue. Dr. Wood also introduced David Millstein, the attorney who represented the Mt. Diablo physicians and AAEM on this matter. Mr. Millstein stated that the physicians involved in the case were very grateful for AAEM's participation and for the end of the suit.

Dr. Wood noted that AAEM planned to establish a foundation so that members would be able to contribute to various causes affecting emergency physicians.

Approval of November 17, 2003 Minutes

The Board then reviewed the draft November 17, 2003 minutes that had been included in the agenda materials. Dr. Pines moved and Dr. Rodgers seconded that the November 17, 2003 minutes be approved. Dr. Durkin noted that the bylaws change in the minutes had not had the appropriate number of affirmative votes for a bylaws change. Dr. Scaletta moved and Dr. Pines seconded that the following bylaws change be adopted:

8.15 Past Presidents Council Representative
This Council shall consist of all past presidents of AAEM. The Council will meet immediately following an AAEM Officers election to elect one of its members to become a voting participant on the AAEM Executive Committee and Board.

8.1 Authority
The Officers of AAEM will consist of a President, Immediate Past President, Vice-President, Secretary-Treasurer and Past Presidents Council Representative. These Officers are responsible for the day to day operations of the AAEM. Directors are responsible for the direction of AAEM and long-term planning. Any tie vote of the Executive Committee may be decided by the President.

8.2 Composition
The voting members of the Board shall consist of the President, Immediate Past President, Vice-President, Secretary-Treasurer, the Past Presidents Council Representative, the Resident Representative and the Directors. There shall be no more than nine (9) Directors. Additional Directors may be added by a two-thirds majority of the Board.

MOTION PASSED 10-1. The bylaws change is adopted.

The Board then voted on the original motion to approve the November 17, 2003 minutes. MOTION PASSED UNANIMOUSLY.

Treasurer's Report

Dr. Scaletta then highlighted AAEM's 2003 financial experience. This year has been AAEM's most successful financially to date due primarily to the Sitges/Barcelona meeting. The final figures are not yet available, but are predicted to be in excess of $200,000. Dr. Blumstein moved and Dr. Durkin seconded that the 2003 financial report be accepted. MOTION PASSED UNANIMOUSLY.

Dr. Scaletta then noted that, as AAEM increases in size, the organization's programmatic activities also increase. Therefore, Executive Director, Inc. was asked to provide a budget for an additional staff person. Ms. Whalen reported that the annual cost of an additional staff person would be $75,000 annually. After discussion, Dr. Rodgers moved and Dr. Sharieff seconded that AAEM approve the additional annual fee of $75,000 for an additional staff person. MOTION PASSED UNANIMOUSLY.

Legislative Report

Kathi Ream, AAEM's Director of Government Affairs, updated AAEM's Board and members on AAEM's recent legislative activities. First, Ms. Ream reported on the Medical Liability Reform Legislation (S. 2061). There is a new direction on this issue by the Senate Republicans. Specialty groups are endorsing this as part of a broader strategy. AAEM's Executive Committee will discuss this legislation with Dr. Palmisano during a meeting with him on the following day.

Dr. McNamara moved and Dr. Roberge seconded that the Executive Committee be empowered to decide if AAEM should endorse S. 2061. MOTION PASSED 10-0-1.

Ms. Ream also discussed the Rohrabacher Bill (H.R. 3722) regarding undocumented aliens and the Stroke Bill (H.R. 3658). She also reminded the Board about the activities of the legislative Action Center . In addition, she plans to produce an electronic newsletter.

Exhibitor Requirements

Dr. McNamara reminded the Board that AAEM has a policy in place that does not allow organizations to exhibit if they have restrictive covenants in their contracts with physicians. However, one potential exhibitor, TIVA, has asked AAEM to reconsider this position for locum tenens. TIVA's President, Mike Pendergast, discussed this situation with the Board. Dr. Wood asked Mr. Pendergast to draft a policy on this issue for the Board to consider. Dr. Scaletta volunteered to work with Mr. Pendergast on this issue.

Malpractice Insurance Option

Dr. Wood then asked Tobey Williams, MD, an AAEM member in Florida , to discuss a physician-owned malpractice insurance consortium that was in its formative stages. Dr. Williams then outlined the consortium's premise which included coverage of ABEM/AOBEM certified physicians. He hopes to have more information to share by the end of April.

Position Statement on Pay and Press-Ganey Scores

Dr. Scaletta then introduced a draft position statement that addressed the issue of compensation based on patient satisfaction scores. Dr. Scaletta moved and Dr. Blumstein seconded that the following position statement be adopted:

Position Statement on Pay and Press-Ganey Scores

Whereas the American Academy of Emergency Medicine believes that providing high-quality, efficient emergency care while maintaining excellent physician-patient relationships is at the core of a professionally satisfying career in emergency medicine; and  

Whereas the Academy recognizes the importance of exemplary customer service in both the business and clinical practice of emergency medicine; and

Whereas more and more employers rely on customer satisfaction surveys to determine the quality of patient-physician interactions;

AAEM proposes the following guidelines to ensure a fair and equitable workplace is maintained for the practicing emergency physicians:

1. The use of customer satisfaction scores to compare physicians must be statistically valid and the method of use fully disclosed before implementation.

2. Low customer satisfaction scores cannot be the sole basis to discontinue employment without an adequate opportunity for the physician to improve and without following the AAEM position on due process.

3. If customer satisfaction surveys are used to determine financial compensation, this must be in form of additional compensation (i.e., bonuses) and the formula applied to all physicians in a fair and equal manner.

After a lengthy discussion, Dr. McNamara moved and Dr. Blumstein seconded that the draft position statement on Pay and Press-Ganey Scores be referred to the Practice Committee with the charge that a position paper on this issue be developed and presented at the next in-person Board meeting. MOTION PASSED 6-3-2 .

Medical Screening and Redirection on ED Patients Position Statement

Dr. McNamara introduced a draft position statement on redirection of patients. Then Dr. McNamara moved and Dr. Durkin seconded that the following position statement be adopted:

Medical Screening and Redirection of ED Patients Position Statement

In a time of limited resources and ever increasing ED patient volumes the first duty of an ED is to the most severely ill patients. The care of bona fide emergencies may be compromised if physician, nursing and other resources are tied up with the care of non-emergencies.

Therefore, it is the position of the AAEM that the direction of patients who do not have medical emergencies away from an ED is ethical as long as a proper medical screening examination has been performed by a qualified provider. AAEM encourages hospitals enacting such a program to provide referral or access to alternative sources of care for such patients.

After much discussion, Dr. Durkin moved and Dr. Sharieff seconded that the draft position statement on Medical Screening and Redirection of ED Patients be referred to the Practice Committee. MOTION PASSED UNANIMOUSLY.

Controlled Substance Abuse Database

Dr. Wood then presented a suggestion from Alan Sorkey regarding a controlled substance abuse database. Dr. Li moved and Dr. Blumstein seconded that the issue of a controlled substance database be referred to the Government Affairs Committee. MOTION PASSED UNANIMOUSLY. Kathi Ream will serve as a resource to this Committee on this issue.

Expert Witness Policy

The Board then discussed the AAEM expert witness policy that is currently in place and debated whether to expand the policy to include additional AAEM leaders. Dr. Li moved and Dr. Roberge seconded that any member with an official capacity within AAEM be subject to the expert witness policy. MOTION WITHDRAWN.

Then, Dr. Kazzi moved and Dr. McNamara seconded that the Medical Legal Affairs Committee address the issue of which AAEM members should be subject to AAEM's expert witness policy and make a recommendation to the Board. MOTION PASSED 8-1-2 .

Membership Report

Ms. Whalen reported that the 2004 paid membership numbers are currently 8.5% ahead of the previous year's pace despite the fact that the membership recruitment mailing had been sent in January rather than November.

The Board then reviewed the individuals nominated for honorary international membership. Dr. Kazzi moved and Dr. McNamara seconded that Alberto Jose Machado, MD, (Argentina) and Mauricio Saldarriaga, MD, (Costa Rica) be accepted as honorary members. MOTION PASSED UNANIMOUSLY.

The Board then reviewed the request of a member to have his dues waived because of his international charity medical work. Dr. Li moved and Dr. Sharieff seconded that any AAEM member who volunteers for international charity medical work for three months or more may, on request, be granted a dues waiver for the year. MOTION PASSED UNANIMOUSLY.

Next, the Board discussed the request of a member to have his dues deferred. Staff will contact the member to see what he is actually requesting.

Misleading Advertising

The Board then reviewed a draft policy submitted by Dr. Weiss. Dr. Li moved and Dr. Roberge seconded that the following policy be adopted:

Misleading Advertising Policy

The American Academy of Emergency Medicine firmly opposes misleading advertising of professional expertise in Emergency Medicine by physicians who are not board certified. Therefore, physicians practicing in the United States may not advertise that they are board certified in Emergency Medicine unless (1) the board is approved by the American Board of Emergency Medicine (ABEM), or (2) the board is approved by the American Osteopathic Board of Emergency Medicine (AOBEM) or (3) the board is approved by the Royal College of Physicians and Surgeons of Canada.

MOTION PASSED UNANIMOUSLY.

Bylaws Change - Associate Board Member

The Board then discussed the advantages and disadvantages of creating a position on the Board for an Associate member. Dr. Rodgers moved and Dr. Pines seconded that the following bylaws change be adopted:

Addition of an Associate Member Position to the Board of Directors

8.2 Composition
The voting members of the Board shall consist of the President, Immediate Past President, Vice-President, Secretary-Treasurer, the Past Presidents Council Representative, the Resident Representative, Associate Member Director and the Directors. There shall be no more than nine (9) Directors including the Associate Member Director . Additional Directors may be added by a two-thirds majority of the Board.

8.3 Election Procedure
Any member of AAEM can nominate a board certified, full voting member of AAEM for any position, but only board-certified, full voting Members of AAEM can vote. The exception to this rule pertains to the Associate Member Director. Any Associate Member can nominate another Associate Member for the Associate Member Director's position on the Board of Directors. The exact mechanics of the voting process will involve nominations during a period that will end at 90 days before the start of the next Scientific Assembly. A candidates' forum will be held at the Scientific Assembly. Voting will occur with a written ballot - one person, one vote, by proxy or in-person at the Scientific Assembly. Each Full Voting Member of the Academy shall have one vote for President, one vote for Vice-President, one vote for Secretary-Treasurer and one vote for each open Director position. Each Associate Member of the Academy shall have one vote for the Associate Member Director's position. Each Resident Member will have one vote for the Resident Representative to the Board of Directors. This election will be completed during the Scientific Assembly. Officers and Directors will take their posts at the conclusion of the meeting.

8.4 Terms of Office
The term of the office of the President, Vice-President and Secretary-Treasurer shall be two years. The term of the office of the Resident Representative and Associate Member Director shall be one year. Term limitations are established at two consecutive terms for each office. Each Director serves for three years and there is a two consecutive term limit.

MOTION FAILED 8-1-2 . (Bylaws change requires 10 affirmative votes.)

New Business

Dr. Ziad Kazzi then presented a request for funds from the AAEM Resident Section for the publication of toxicology handbook. Dr. McNamara moved and Dr. Durkin seconded that AAEM approve an expense of $5,100 to publish 2,000 copies of a toxicology handbook. MOTION PASSED UNANIMOUSLY. While outside funding should be sought, AAEM will provide funding if none is found.

Dr. Antoine Kazzi then briefly reported on the PhyAmerica bankruptcy situation in Florida.

There being no further business, the meeting was adjourned.

Respectfully submitted,

Kay Whalen
Executive Director