Board Meeting Minutes

American Academy of Emergency Medicine
Minutes of Board of Directors Meeting
Chicago, Illinois
May 25-26, 2005

In Attendance: A. Antoine Kazzi, MD; Joseph Wood, MD, JD; Tom Scaletta, MD; William Durkin, Jr., MD; Robert McNamara, MD; Howard Blumstein, MD; Tracy Boykin, MD; Anthony DeMond, MD; Stephen Hayden, MD; James Li, MD; Kevin Rodgers, MD; Larry Weiss, MD, JD; Joel Schofer, MD. Absent: Ghazala Sharieff, MD; Richard Shih, MD. Guest: Mark Reiter, MD. Staff: Kay Whalen, Janet Wilson.

Dr. Kazzi welcomed the board members and guest, Mark Reiter, MD, to the board meeting and turned their attention to the first agenda item.

Approval of April 4, 2005 Minutes

Dr. Kazzi asked if there were any corrections or changes to the draft minutes included in the agenda materials. There being none, Dr. Wood moved and Dr. Durkin seconded that the April 4, 2005 minutes be approved as drafted. MOTION PASSED UNANIMOUSLY.

President's Report

Dr. Kazzi had recently presented to a number of residency programs including programs in Fresno, Los Angeles and the New York area. He had also attended and presented at the New York ACEP meeting. Dr. Kazzi attended the French society meeting and Dr. Lex represented AAEM in Argentina.

Other board members volunteered to give presentations to residency programs. Staff will forward updated slide sets to them.

We are expecting over 1,000 registrants at the Congress in Nice, France. The educational planning is going well, but we continue to have challenges with the management of the Congress. SAEM is once again a co-organizer as is CORD.

At this point, Dr. Li arrived.

The PhyAmerica issue has been settled to the satisfaction of the affected physicians. After much discussion regarding the legal fees for this situation, Dr. Wood moved and Dr. McNamara seconded that AAEM will fund up to $5,000 to reimburse those physicians with travel costs. MOTION PASSED UNANIMOUSLY. Then, Dr. Wood moved and Dr. McNamara seconded that Randy Brotherhood be engaged to draft correspondence to accompany any payments made. MOTION PASSED UNANIMOUSLY.

AAEM continues to fight for ABEM and AOBEM board certification. Hearings in Kentucky went well. AAEM was represented by Dr. Dan Danzl.

Dr. Mark Reiter has been appointed to the AMA Council of Legislative Affairs.

New Cases

The number of requests from AAEM members and non-members to help them fight the corporate practice of medicine has increased greatly since the Minnesota case. One such case is Rhode Island. Dr. Rodgers moved and Dr. Durkin seconded that Dr. McNamara compose an affidavit of support for those involved in the Rhode Island case. MOTION PASSED UNANIMOUSLY.

Treasurer's Report

Dr. Durkin reported that AAEM appears to be on budget at this point in time. He reminded the board that $65 from each member's dues helps fund the Scientific Assembly. Surveys of the membership have indicated that this is an extremely valuable member benefit. Dr. Blumstein moved and Dr. Scaletta seconded that the treasurer's report be approved. MOTION PASSED UNANIMOUSLY.

Executive Director's Report

Ms. Whalen presented the membership report which included a breakdown of membership by state, including the number of board certified physicians in each state. Full voting membership is ten percent ahead of the previous year's pace.

Position Statements

The board then discussed the draft position statement on screening and redirection of emergency department patients. Dr. McNamara moved and Dr. DeMond seconded that the following position statement be adopted:

AAEM Position Statement
on Screening and Redirection of Emergency Department Patients

The primary duty of an emergency department is to care for the most severely ill patients. With increasing emergency department patient volume the care of bona fide emergencies may be compromised if physician, nursing and other resources are occupied with the care of non-emergencies. Therefore, it is the position of the American Academy of Emergency Medicine that the direction of patients who do not have medical emergencies away from an emergency department is ethical. The determination of a non-emergency requires the performance of an appropriate medical screening examination by a qualified provider. If a hospital enacts such a program, AAEM encourages the hospital to provide referral or access to alternative sources of care for such patients.

However, while redirection of individuals without emergencies is an ethical practice, AAEM does not believe it is in the best interests of the hospital, the emergency physicians, or the community at large to deny patients access to care, and would rather hospitals create systems to accommodate all persons presenting to its ED.

MOTION PASSED 10-3.

The board then reviewed the draft position statement on emergency department crowding. Dr. Blumstein moved and Dr. Boykin seconded that the following position statement be adopted with changes from the original draft:

AAEM Position Statement on Emergency Department Crowding

Background

• Annual visit volume to U.S. emergency departments continues to increase,
• The number of U.S. emergency departments continues to decrease,
• ED crowding is a serious nationwide problem that has multiple causes,
• ED crowding is a result of decreasing total hospital and health systems capacity and inability to meet the demand for care, and
• A growing body of evidence suggests that ED crowding results in a decrease in the quality of care, including increased medical errors, delayed diagnosis, increased pain and suffering, disability, and in some cases death.

It is the position of the American Academy of Emergency Medicine that:

• ED crowding represents a failure of multiple hospital systems to address patient access to health care. It is not a problem confined only to the ED. In addition, ED crowding reflects broader disparities in access to primary care.
• Emergency physicians and health policy researchers should continue to study the problem of ED crowding and possible solutions.
• ED crowding negatively affects emergency care providers, threatening the well-being, performance and retention of this vital work force.
  
  
• The Academy calls on hospitals and health care systems to:
• Create, test, and refine strategies to alleviate ED crowding,
• Assign priority for inpatient beds to patients admitted from the ED,
• Keep the public and community informed about patient flow, expected wait times, and care available in local EDs.
  
  
• The Academy calls on federal, state and local governments to:
• Provide reasonable and rapid access to primary care for all under- and uninsured individuals,
• Increase significantly reimbursements to EDs and hospitals for all care rendered in Emergency Departments,
• Finance increases in hospital capacity, including expansion of: ED space and personnel, number of staffed hospital beds, ancillary services and availability of specialists.

MOTION PASSED UNANIMOUSLY.

Next, the board discussed AAEM's current position statement on tPA. Dr. Wood moved and Dr. Hayden seconded that Dr. Kazzi appoint a committee to review the AAEM position statement on tPA and to examine the most recent literature to determine if updates need to be made to this position statement. MOTION PASSED UNANIMOUSLY.

The board then reviewed the findings of the AAEM Services Task Force. Dr. McNamara moved and Dr. Wood seconded that AAEM accept and adopt the following recommendations:

MOTION PASSED UNANIMOUSLY.

AAEM Resident and Student Association

Dr. Schofer reported that AAEM\RSA has officially been established. In addition, the results of the election to their board are now final. Dr. Reiter will serve as president. It had been gratifying to see the large number of members who had nominated themselves for the AAEM\RSA board.

At this point, the meeting was adjourned for the day and resumed the following morning.

Dr. Reiter reported that the AAEM/RSA was working on a geographical contact list to assist residents looking for their first job.

The resident section party at SAEM had once again been a success as had the EM student meeting at UCI.

Ethics Policy

Dr. Wood reported that the AAEM ethics policy had been used for the first time. Dr. Kazzi had asked the executive committee to review a case since none of the executive committee knew those involved. The committee felt that the expert testimony was appropriate. Dr. Scaletta will communicate this to the complainant.

AAEM/ACEP Joint Task Force

Drs. Blumstein, Scaletta and Wood serve on this task force for AAEM. The first meeting is currently being scheduled.

Legislative Report

Dr. McNamara presented H.R. 2356, the Preserving Patient Access to Physicians Act of 2005, for approval. Dr. Durkin moved and Dr. McNamara seconded that AAEM endorse H.R. 2356. MOTION PASSED UNANIMOUSLY.

Next, Dr. McNamara reported that a coalition was being formed that would fight against dropping people from the Medicaid rolls which would contribute to crowding in the ED. Dr. McNamara moved and Dr. Wood seconded that AAEM join the above referenced coalition. MOTION PASSED UNANIMOUSLY.

International Initiatives

Dr. Kazzi reported that the dates of the Ibero-American Congress are April 18-21, 2006. This congress will take place in Buenos Aires.

Badges at the Scientific Assembly

After discussion, the board decided that, rather than providing ribbons for board members, speakers, etc. at the Scientific Assembly, this information be displayed on the badge itself.

Scientific Assembly Registration Fees

Based on member feedback, registration for the Scientific Assembly will remain free. However, the board discussed the amount of the refundable deposit for this meeting. Dr. McNamara moved and Dr. Wood seconded that the refundable fee for the Scientific Assembly be set at $100 for full voting and associate members and at $50 for residents and students. MOTION PASSED UNANIMOUSLY.

Tort Reform White Paper

Dr. Weiss then presented the tort reform white paper that had been drafted by Drs. Weiss and Li. Dr. Weiss also discussed several modifications to this white paper. Dr. McNamara moved and Dr. Durkin seconded that the draft tort reform paper with modifications be adopted. MOTION PASSED 12-1.

Committees and Task Forces

Dr. Kazzi then reviewed the activities of various committees and task forces as well as the discussions at the committee meetings that were held at the SAEM meeting.

State Chapter Update

Dr. Kazzi reported that CAL/AAEM and CAL/ACEP were discussing ways in which those organizations can work together.

AAEM Foundation

Ms. Whalen reported that the February fundraiser for the AAEM Foundation netted approximately $22,498.

Unity Proposal

The board then discussed the best way for AAEM and ACEP to work together on legislative issues. After much discussion, Dr. Wood moved and Dr. Li seconded that the following proposal be sent to the AAEM membership for comment:

Proposal to Promote Unity in Organized EM

Whereas, there now exists two competing general professional societies, the AAEM and the ACEP, in the specialty of Emergency Medicine; and

Whereas, at the federal and state level there exist certain issues where the specialty and the organizations would mutually benefit from a cooperative effort; and

Whereas, there exist other issues mostly internal to the specialty of EM that are best handled by one or the other organization; therefore be it

Resolved, that the AAEM board of directors approves of the below steps and will request of the ACEP that the two organizations take the following steps towards greater unity between these societies:

MOTION PASSED UNANIMOUSLY.

There being no more business, the meeting was adjourned.

Respectfully submitted,

Kay Whalen
Executive Director