Board Meeting Minutes

American Academy of Emergency Medicine
Minutes of Board of Directors Meeting
San Francisco, California
May 16-17, 2006

In Attendance: Tom Scaletta, MD; Larry Weiss, MD, JD; Howard Blumstein, MD; Joseph Wood, MD, JD; Robert McNamara, MD; Anthony DeMond, MD; Stephen Hayden, MD; David Kramer, MD; James Li, MD; Kevin Rodgers, MD; Richard Shih, MD; Mark Reiter, MD. Absent: Tracy Boykin, MD; Andy Walker, MD; Brian Potts, MD. Guest: Todd Taylor, MD. Staff: Kay Whalen and Janet Wilson.

Dr. Scaletta began by welcoming everyone to the meeting including Dr. Todd Taylor, ACEP Council Speaker and AAEM member. He then turned the board's attention to the first agenda item.

Approval of February 16, 2006 Minutes

There being no corrections to the draft minutes included in the agenda materials, Dr. Wood moved and Dr. Hayden seconded that the February 16, 2006 minutes be approved as drafted. MOTION PASSED UNANIMOUSLY.

President's Report

Dr. Scaletta reported on the various meetings that the AAEM leadership would be participating in within the next week.

The planning for MEMC4 is moving forward. The site has not yet been determined, but Sorrento and Sicily are being considered. The roles of AAEM and EuSEM will be defined in the near future. Both Drs. Scaletta and Wood have been invited to the EuSEM Congress in Crete this fall. Dr. Rodgers moved and Dr. Kramer seconded that, if not supported by EuSEM, AAEM financially support travel to Crete for Drs. Scaletta and Wood. MOTION PASSED UNANIMOUSLY.

Dr. Scaletta then reviewed the correspondence that had been sent to Northwest Community Hospital, JCAHO and Illinois Department of Health. The board had discussed this correspondence via e-mail.

At this point, Dr. Weiss arrived.

Dr. McNamara reported that legal counsel has been identified for the case in Texas. In addition, the executive committee of the Pennsylvania Medical Society is requesting additional information for a case in that state.

Dr. Scaletta then reported on the recent situation in Tennessee. There had been a bill before the state legislature that would make restrictive covenants legal in that state. The Tennessee Chapter of AAEM had worked to give emergency medicine physicians an exemption to the bill. The vote should be held in the near future. Neither Tennessee ACEP nor the Tennessee Medical Society had worked to either defeat the original bill or exclude emergency medicine physicians from the bill. Dr. Kramer moved and Dr. Wood seconded that AAEM formally commend the Tennessee AAEM state chapter for their efforts. MOTION PASSED UNANIMOUSLY.

At this time, Dr. Taylor interjected that the Tennessee ACEP chapter had been working to defeat this bill. Dr. Weiss responded that that had not been our understanding, but hoped that this was true.

Dr. Hayden reported that JEM had received a submission of a white paper on improving ED service quality. JEM will not be able to publish the entire paper due to its length, but may be able to publish the position statement. Since the board had not yet approved this white paper, Dr. Kramer moved and Dr. McNamara seconded that the attached white paper on Improving Service Quality By Understanding Emergency Department Flow be approved. MOTION PASSED UNANIMOUSLY.

At this point, Dr. Reiter arrived.

Dr. Scaletta then noted that the Practice Guidelines Committee was looking for guidance on a process to approve practice guidelines. As the board liaison to this committee, Dr. Hayden will keep the board informed of any guidelines that the committee is working on.

Dr. McNamara then presented a request for AAEM to endorse a bill against direct-to-consumer advertising from pharmaceutical companies, the Public Health Protection Act. The board discussed the issue and after discussion, which included comments stating that this was not an issue core to AAEM's mission, Dr. Li moved and Dr. Kramer seconded that AAEM support the Public Health Protection Act. MOTION FAILED 4-6-1.

At this point, Dr. Blumstein arrived.

Executive Director's Report

Ms. Whalen drew the board's attention to the membership numbers included in the board materials. Full voting membership is 7.3% ahead of the previous year's pace. Membership in the associate category is slightly behind last year.

Next, Ms. Whalen presented requests from two members for emeritus status. Dr. Distefano met AAEM's qualifications for emeritus membership. Dr. McNamara moved and Dr. Hayden seconded that Dr. Distefano be granted emeritus status. MOTION PASSED UNANIMOUSLY. Dr. Hunsaker does not meet the membership requirements since her 2005 dues were not paid. Dr. McNamara moved and Dr. DeMond seconded that Dr. Hunsaker's request for emeritus status be approved if her 2005 dues are paid. MOTION PASSED UNANIMOUSLY.

Young Physicians Task Force

Dr. Kramer presented the proposal from the task force to start an AAEM Young Physicians Section. If this proposal is accepted, the AAEM bylaws will also need to be changed. Dr. McNamara moved and Dr. Rodgers seconded that the following Young Physicians Section bylaws be approved:

Bylaws of the Young Physicians Section
Of the American Academy of Emergency Medicine

  Article I: Purpose and Mission

1.1 Purpose and Mission
This Young Physicians Section is constituted and formed for the purpose of promoting the professional development of its members and providing them with education regarding the principles and activities of the American Academy of Emergency Medicine. As a section of the Academy, all activities of the Section will be in accordance with the standards established by the Academy. The purpose and mission statement of the Academy also extend to the Young Physicians Section.

1.2 Duration
The term of existence of the Section shall be perpetual unless dissolved according to the bylaws of the Academy.

Article II: Membership and Privileges

2.1 Section Membership
All Emergency Medicine Residency-Trained Associate or Voting members of the Academy who are under 40 years of age or are within the first seven years of professional practice after residency or fellowship training shall be eligible for membership in the Young Physicians Section.

2.2 Voting Privileges
All members of the Section shall be entitled to vote for officers and directors and to vote to change the bylaws in accordance with the procedures outlined in these bylaws.

2.3 Obligations of Members
By virtue of membership, each member of the Section agrees to be bound by these bylaws and all lawful rules and practices adopted by the board of directors of the Section and of the Academy.

2.4 Action on Behalf of the Section
Only the officers of the Section, the board of directors of the Section, and other authorized agents of the Section may state policies or positions on behalf of the Section.

Article III: Resignation

3.1 Resignation
Membership in the section requires membership in AAEM. Membership in the section shall be terminated immediately upon termination of membership in AAEM.

Article IV: Assessments

4.1 Dues
Annual dues shall be determined by the officers and board and AAEM executive committee for the ensuing year.

4.2 Non-Payment
The executive committee shall establish policies with regard to nonpayment of dues.

Article V: Meetings

5.1 Annual and Special Meetings
There will be a formal meeting of the Young Physicians Section at the Academy's Scientific Assembly each year. Other meetings throughout the year will be held as circumstances and needs dictate, as determined by the executive committee. Special meetings may be called by the executive committee at its discretion.

5.2 Voting
Any voting member may be represented in person or by proxy at any meeting, but each voting member shall be entitled to only one vote.

Article VI: Officers and Board of Directors

6.1 Officers
The officers of the Section shall consist of a president, immediate past president, vice president, and secretary-treasurer. These officers are responsible for the day-to-day operations of the Section.

6.2 Board of Directors
The board of directors shall consist of the Section president, immediate past president, vice president, secretary-treasurer, AAEM Resident and Student Association representative, AAEM Board of Directors Liaison, and up to three other directors. The board of directors is responsible for the direction of the Section and long-term planning.

6.3 AAEM Resident and Student Association Representative
The Section Board of Directors shall include a representative of the AAEM Resident and Student Association. This member shall be nominated by the AAEM-RSA Board of Directors and approved by vote of the Section Executive Committee. This board position shall remain vacant if the AAEM-RSA fails to provide a nominee or if no nominee is accepted by majority vote of the Executive Committee.

6.4 AAEM Board of Directors Liaison
The Section Board of Directors shall include a liaison from the AAEM Board of Directors. This liaison shall be nominated by the AAEM Board of Directors and approved by vote of the Section Executive Committee. This board position shall remain vacant if the AAEM Board of Directors fails to provide a nominee or if no nominee is accepted by majority vote of the Executive Committee.

6.5 Election Procedure
Any Section member may nominate another eligible member (including him or herself) for an open position on the board of directors, except for the AAEM-RSA representative or the AAEM BOD Liaison. To be eligible for nomination, the member must meet the requirements for membership in the section, as outlined in Article II, throughout the duration of the term for which he or she is nominated. Members of the Academy in their final year of accredited emergency residency training or fellowship training may not be nominated as an officer, but may be nominated for any other position for which they would otherwise be eligible as a member of the Section.

Nominations may be made during a period that will end 90 days before the start of the next Scientific Assembly. Voting will be undertaken by written ballot: one vote per person, either in person at the Scientific Assembly or by proxy. Each voting member shall have one vote for each open position of president, vice-president, secretary-treasurer, and each open director position, except for the positions of AAEM-RSA representative or AAEM BOD Liaison. Each open board position will be filled by the nominee receiving the most votes. An uncontested open position will be filled by the nominee regardless of the number of votes received for that position. Elections will be completed during the Scientific Assembly. Officers and directors will take their posts at the conclusion of the meeting. No officer or board member may hold more than one position on the board at a time.

6.6 Terms of Office
The term of all board members is one year. Term limitations are established at two consecutive terms for each office. A term will not count towards the term limitation unless the member shall have served at least 11 months in that position.

6.7 Rules of Succession
Officers and directors shall hold office until a successor has been duly elected and takes office. In the event of a vacancy in the offices of vice president, secretary-treasurer or director due to death, resignation, or otherwise, the position shall be filled by appointment of the president and must be approved by the board of directors. In the event of similar vacancy in the office of president, the vice president will assume command for the unexpired term. If he or she is unable to take over the role of president, then succession falls to the secretary-treasurer of the Section. In the event of any succession, the succeeding officer will be eligible at the completion of the unexpired term of his or her predecessor for election to two full terms in that position.

6.8 Meetings of the Board
Meetings of the board of directors shall be open to the members of the Section. A closed executive session may be called by the board for just cause, but all voting must be in open session by open ballot. Special meetings of the board of directors may be called by or at the request of the executive committee, any four directors, or at the request of 20 percent of all of the voting members of the Section. Any member of the Section may submit any resolution or item for discussion and vote at any of the board meetings.

6.9 Quorum
At any meeting of the board of directors, a majority of the directors shall constitute a quorum for the transaction of business.

6.10 Resignation
A director or officer may resign at any time by giving written notice to the board, the president, or the secretary-treasurer of the Section. Unless otherwise specified in the notice, the resignation shall take effect upon receipt thereof by the board or such officer, and the acceptance of the resignation shall not be necessary to make it effective.

6.11 Presumption of Assent
A director of the Section who is present at a meeting of the board of directors at which action on any corporate matter is taken shall be presumed to have assented to the action unless his or her dissent to such action is registered with the person acting as secretary of the meeting before adjournment thereof or unless he or she shall forward such dissent by registered mail to the secretary-treasurer of the Section immediately after the adjournment of the meeting. Such right to dissent shall not apply to a director who voted in favor of such action.

6.12 Majority Action
Except as otherwise provided in these bylaws, every act or decision done or made by a majority of officers and directors present at any meeting duly held at which a quorum is present shall be the act of the board of directors. Voting may also be conducted by electronic mail.

6.13 Removal of an Officer or Director
Any officer or director may be removed from office by a vote passed by at least three-quarters of the entire board of directors. A recall requires a petition by one-third of the entire board of directors or ten percent of Section membership. If an officer or director misses three consecutive meetings of the board, the board may then, at its discretion, declare the position to be vacant.

Article VII: Committees of the Board

7.1 Executive Committee
The executive committee shall consist of the president, immediate past president, vice president, and secretary-treasurer. The executive committee shall have the authority to act on behalf of the board subject to ratification by the board. The executive committee shall meet at the call of the president, vice president or secretary-treasurer. A report of its actions shall be given to the board. Any tie vote of the executive committee may be decided by the president.

7.2 General Committees
The executive committee may appoint committees and task forces to address issues of the Section. Meetings shall be at the discretion of the committee chair. Each committee chairperson is responsible for an annual report to the officers and board of directors.

Article VIII: Accountability

8.1 Records
Minutes of the meetings of the board and books of account shall be open to inspection by any member of the Academy.

8.2 Rules of Order
The Section shall follow Dr. James E. Davis' Rules of Order.

Article IX: Indemnification

The directors and officers of the Section shall not be personally liable for any debts, liabilities, or other obligations of the Section or the Academy. The Academy shall defend current and former directors and officers against all claims, suits, actions, or other proceedings which arise as a result of such persons' position with the Section. The Academy shall hold harmless and indemnify each director and officer for reasonable expenses and liabilities incurred in all such proceedings. The Academy may maintain insurance, at its expense, for these purposes.

Article X: Amendments to Bylaws

These bylaws may be amended, repealed or altered in whole or in part by a vote passed by at least two-thirds of the entire board of directors or at least two-thirds of the voting members of the Academy.

MOTION PASSED UNANIMOUSLY.

Next Dr. Li moved and Dr. Rodgers seconded that the following AAEM bylaws changes be adopted:

Article XIV: Sections

14.1 Sections
The board of directors of the Academy may approve formation of membership sections by members of the Academy. Formation of a new section must be approved by a majority vote of the board of directors.

14.2 Section Bylaws
Sections are to write their own bylaws, and these must conform to the bylaws of the Academy. No section shall be created until the initial section bylaws are approved by the executive committee or the board of directors of the Academy. No section is permitted to act on behalf of the Academy without expressed written permission from the executive committee or the board of directors of the Academy. Changes to section bylaws must be approved by the governing board of the section and the AAEM executive committee.

14.3 Membership
Membership categories of a section are to be determined by the section bylaws. Members of a section will be required to be members of the Academy. A member may join any section for which they meet membership requirements providing the member pays any applicable dues for the section.

14.4 Dues and Assessments
The governing board of the section shall designate its own dues structure. Dues are subject to approval of the AAEM executive committee.

14.5 Section Funding
Sections will be disbursed funds for meeting, conference calls, and other activities from the Academy at the approval of the executive committee. When dues are collected for membership in a specific section above and beyond the dues of the Academy, the governing board of the section will have control over the disbursement of those funds.

14.6 Section Dissolution
Any section may be dissolved by a vote passed by at least two-thirds of the entire board of directors when the actions of a section are deemed to be in conflict with the bylaws, ethical principles, or the mission of the Academy.

MOTION PASSED UNANIMOUSLY.

ENA Collaboration

Dr. Scaletta reported that he had met with the ENA leadership to determine in which ways AAEM and ENA can work together. One area of collaboration would be to adopt a joint position statement on a code of professional conduct. Dr. Rodgers moved and Dr. Blumstein seconded that the following position statement be adopted.

Emergency Nurses Association and American Academy of Emergency Medicine
Joint Position on a Code of Professional Conduct

DATE: May, 2006
SUBMITTED BY:
Nancy Bonalumi, RN, MS, CEN; ENA President
Tom Scaletta, MD FAAEM; AAEM President

It is ideal for emergency nurses and physicians to practice in an optimal working environment where, working as a team, we can provide safe and excellent emergency patient care. Inappropriate behavior disrupts the operations of the emergency department and may affect one's ability to practice competently, create an uncomfortable environment, and adversely impact the community's confidence in the emergency department. Objective criteria can assist in clearly defining what constitutes inappropriate interpersonal interactions. It is our responsibility to take measures to terminate inappropriate actions on the part of a colleague or co-worker. This Code of Professional Conduct is not designed to dictate behavior, but to establish a set of minimum expectations and promote the development of professional ethics. Therefore, the Emergency Nurses Association and American Academy of Emergency Medicine expect their respective members to abide by the following Code of Professional Conduct.

ENA/AAEM Code of Professional Conduct

Inappropriate Conduct:

Professional demeanor requires that nurses and physicians refrain from any type of harassment, respect diversity, and abide by applicable laws, regulations, and rules that are not in direct conflict with delivering excellent patient care.

Workplace harassment creates a hostile environment that interferes significantly with an individual's ability to perform his or her job well or adversely affects workplace conditions. It can be described as any conduct that is unwelcome and offensive to either those who (a) are subjected to it or (b) witness it.

• Verbal harassment includes screaming, yelling, using foul language, or making threats of harm.
• Physical harassment constitutes unwelcome physical contact or invading another's personal space.
• Sexual harassment is defined as unwelcome acts or comments of a sexual nature including sexual advances, requests for sexual favors, and/or other verbal or physical conduct, including written communications or gestures, of an offensive nature.
• Retaliation for the reporting of violations of this Code is another form of harassment.

Disrespect for diversity includes disparaging remarks or actions in the workplace in regard to anyone's race, age, gender, disability, national origin, position, religion, or sexual orientation.

Laws and regulations at the local, state, and federal levels are not to be violated. Additionally, policies, procedures, or other rules of the hospital should be closely followed.

Appropriate Conduct:

Communication

• Introduces self to other members of the health care team
• Communicates plan of care to other providers
• Recognizes body language and tone of voice
• Responds to dissatisfied patients/co-workers with professionalism

Respect

• Acknowledging the value of each team member;
• Respecting another team member's time and responsibilities;
• Displaying common courtesy toward each other;
• Discussing issues or disagreements in a private place and in a prompt manner;

Honesty

• Being willing to admit a mistake;
• Remaining open minded and actively listen to others' opinions and perspectives;
• Taking time to give feedback and, when necessary, constructive criticism;

Integrity

• Sharing pertinent information whenever necessary to improve care quality;
• Responding to any questions regarding treatment choices and relaying changes in a patient's condition in a timely manner;
• Encouraging one another to speak to a supervisor or to use other appropriate procedures to address and behavior or quality of care concerns
• Working through proper channels to improve existing policies or processes

Problem Resolution:

If a person has observed or experienced behavior inconsistent with this Code of Professional Conduct, s/he is encouraged to privately discuss the concern with the offender. If the concerned person is uncomfortable with initiating a direct conversation, or if the behavior persists after a direct conversation, then the situation should be promptly reported to an immediate supervisor.

ENA and AAEM believe that any person accused of violating this Code should have the following rights:

• Presented with a written summary of the claims against him or her
• Given reasonable notice before a hearing
• Told the identity of his/her accuser(s)
• Information relating to accusation and investigation will be kept confidential by ENA and AAEM
• Receive a fair hearing before any membership action is taken

MOTION PASSED UNANIMOUSLY.

Dr. Scaletta then reported that the ENA had established a certification program for emergency nurses. Dr. Hayden moved and Dr. Shih seconded that AAEM encourage its members to create an award program to encourage achievement of the CEN credential. MOTION PASSED UNANIMOUSLY.

Finally, Dr. Scaletta reported that he had been asked to represent AAEM on a joint expert panel that includes representation from AAEM, ACEP and ENA to provide an opinion to JCAHO on the proposed rule that requires pharmacist approval on all non-emergency prescriptions written in the ED. Dr. Scaletta moved and Dr. Reiter seconded that the following letter be approved:

Dennis S. O'Leary, MD
President
Joint Commission on Accreditation of Healthcare Organizations
One Renaissance Blvd
Oakbrook Terrace, IL 60181

Dear Dr. O'Leary:

The American College of Emergency Physicians (ACEP), the American Academy of Emergency Medicine (AAEM) and the Emergency Nurses Association (ENA) represent over 50,000 emergency physicians and nurses, and have long been advocates of the initiatives of the JCAHO to improve the quality of patient care in the nation's hospitals.

Our collective members have served on a variety of JCAHO committees and have been consultants to the JCAHO on a number of medical quality projects and will continue to assist your organization whenever requested.

This correspondence is to express our grave concern regarding JCAHO's medication reconciliation standard (MM 4.10) and National Patient Safety Goal 8 that will seriously impact the ability of already overtaxed emergency departments (EDs) to effectively care for our patients while, at the same time, will not improve the quality of patient care or patient safety for the over 110 million patients we see annually.

The specific elements of the medication reconciliation standards that are problematic include the current mandate for review by a pharmacist of essentially all drugs administered in the ED (even Tylenol for febrile children) and the NPSG requirement for compilation and dissemination of drug lists for essentially all patients presenting for care in the ED.

On the May 10, 2006 conference call convened by the JCAHO concerning these two issues representatives from ACEP, AAEM and ENA, along with the others invited to participate, made the case that first dose drug review was not warranted when a physician was in attendance who was caring for the patient.

In support of our contention that first dose review by a pharmacist is not needed when an emergency physician is in attendance, we would refer you to two reports from the USP databases noting very low rates of medication errors in the ED:

http://www.usp.org/patientSafety/resources/ posters/posterEmergencyDept.html and http://www.usp.org/patientSafety/resources/ posters/posterEmergencyDept5yr.html

Specifically, even if the five-year ED error rates as determined in the second study were under-reported by a factor of 100, the rate of medication errors that "may have resulted in patient harm" is one per 9,487 ED patient visits and one per 18,975 drug administrations(based on other literature indicating approximately two drugs per ED patients).

Regarding the compilation of a drug list for essentially each ED patient and the dissemination of that list to either the admitting physician or the primary care physician if the patient is discharged, it is contended that:

1. EDs would be disproportionately burdened with this task because of the large number of patients seen in the ED compared to other areas of the hospital

2. For the vast majority of patients, the compilation of a comprehensive medication list will not be germane to the patient's visit in the ED

3. The majority of medications administered in the ED are given on a one or two time basis and, as such, drug interactions with prior medications are highly unlikely

4. ED medications are fundamentally not danger-prone drugs (mostly pain medications, antibiotics and GI medications) and those that are (thrombolytics, blood, etc) are administered using tight protocols

5. Primary care physicians are the appropriate physicians to determine all of thedrugs that their patients are taking and they are in the best position to modify medications based on their knowledge of the patient

When we posed a question to the JCAHO about the medication list for ED patients we were told that any patient receiving a drug in the ED, must have a medication list made for them and if the patient is not able to provide the list of medications they are taking it is the ED staff's responsibility to contact the patient's pharmacy, physician(s), or family members.

Historically, these two requirements mandated by the JCAHO are unprecedented in their impact on the day-to-day operation of hospitals and, in particular, their EDs. Just the fact that the JCAHO gave hospitals a year to prepare for the implementation of these mandates reflects the magnitude of the required changes and their unprecedented nature.

It is our position, based on the available data and the views of our constituencies, that the following occur:

1. Medication administration in the ED not require first dose review by a pharmacist because a licensed independent practitioner (the emergency physician who ordered the drug based on his/her assessment of the patient) is in attendance. We support that a pharmacist be readily available (by phone or otherwise) for consultation should it be sought by emergency physicians and nurses.

2. Reconciliation of medication lists be limited to patients admitted to the hospital and conducted by in-patient personnel.

Again, please let us reiterate that our goals and those of the JCAHO are in sync - we want safe, effective care for our patients. We strongly feel that no matter how well intentioned, the first dose review and medication reconciliation as outlined for the ED will not meaningfully contribute to our mutual goals and only serve to slow receipt of timely care for our patients.

Sincerely,

Frederick C. Blum, MD, FACEP, FAAP
President, American College of Emergency Physicians

Nancy Bonalumi, RN, MS, CEN
President, Emergency Nurses Association

Tom Scaletta, MD, FAAEM
President, American Academy of Emergency Medicine

Copy:
Richard J. Croteau, MD, Executive Director for Patient Safety Initiatives, Joint Commission International Center for Patient Safety, JCAHO

Joyce B. Marshall, Senior Research Associate, Division of Standards and Survey Methods, JCAHO

Robert A. Wise, MD, Vice President, Division of Standards and Survey Methods, JCAHO

Patti Zidlicky, RN, BS, MBA, Associate Project Director, Division of Standards, JCAHO

MOTION PASSED UNANIMOUSLY.

Request from AAEM Member

Dr. Blumstein reported that an AAEM member had contacted AAEM regarding due process and other concerns at the residency program at Lincoln Hospital. After much discussion, the board felt that the RRC would already be aware of the situation there and was the appropriate organization to address these concerns.

Treasurer's Report

Dr. Blumstein reported that financial information through the month of April had been included in the agenda materials. Since AAEM had taken the financial risk for the Congress, AAEM had lost money on the Mediterranean Congress in 2005. That loss had, fortunately, been offset by the profit of the 2003 Congress. Despite this, AAEM is in sound fiscal health.

At this point, the board went into executive session and Dr. Taylor left the meeting.

After the executive session, the board resumed the AAEM board meeting.

AAEM Services Board of Directors

Dr. Scaletta reported that the AAEM Services board was currently comprised of Tom Scaletta, MD, Robert McNamara, MD, and William T. Durkin, Jr., MD. If the AAEM board wants to reconstitute this board, they may do so. Dr. McNamara moved and Dr. Scaletta seconded that the AAEM Services board include Drs. Scaletta, McNamara, Weiss and Reiter. MOTION PASSED UNANIMOUSLY.

AAEM Foundation Board

Dr. Scaletta then stated that the AAEM board could reconstitute the AAEM Foundation board if it so desires. Dr. Hayden moved and Dr. Blumstein seconded that the AAEM Foundation board be composed of the same individuals that currently serve on the AAEM board. MOTION PASSED UNANIMOUSLY.

Bylaws Change

Dr. Li presented a bylaws change to eliminate the need for the full board to vote on emeritus membership requests. Dr. Li moved and Dr. Shih seconded that Section 4.5 of the bylaws be amended to read as follows:

4.5 Emeritus Membership

. . . members meeting these requirements who wish to change their membership status must specifically request transfer to emeritus status.

MOTION PASSED UNANIMOUSLY.

LLSA

Dr. McNamara then reminded the board of the e-mail discussion it had in reference to AAEM member concerns regarding the LLSA. Since AAEM does not have a seat on ABEM and, therefore, cannot provide input into this process, it was decided that nothing could be done at this time.

EMS Mission Statement

Dr. Scaletta reported that he had asked Dr. Li to edit the mission statement submitted by the EMS committee. After reviewing the draft included in the agenda materials, Dr. Blumstein moved and Dr. Wood seconded that the following mission statement be approved:

American Academy of Emergency Medicine
Emergency Medical Services Committee
Mission Statement
Revised 2/17/06 (at Scientific Assembly meeting)
Final Draft for Approval

The mission of the American Academy of Emergency Medicine Emergency Medical Services ( EMS ) Committee is to promote working relationships between emergency physicians and emergency out-of-hospital personnel.

To this end, this committee will communicate important EMS-related issues to the Academy's membership, provide membership education on EMS-relevant topics, collaborate with EMS professional societies, and, when needed, advocate for the Academy's core values within the realm of out-of-hospital emergency services.

MOTION PASSED UNANIMOUSLY.

At this point, the board meeting adjourned for the evening.

The board meeting resumed at 8:15 am, May 17, 2006.

NAEMSP Helicopter Dispatch Statement

Dr. Scaletta welcomed everyone back to the AAEM board meeting and turned the board's attention to the next agenda item. Dr. Scaletta moved and Dr. Hayden seconded that the AAEM board endorse the attached NAEMSP Helicopter Dispatch Statement. MOTION PASSED 11-1.

Patient Satisfaction Position Statement

The board then turned its attention to the position statement put forward by the customer satisfaction subcommittee. Dr. McNamara moved and Dr. Scaletta seconded that the following position statement be approved:

PATIENT SATISFACTION SURVEYS IN THE EMERGENCY DEPARTMENT

The American Academy of Emergency Medicine believes that a healthy physician-patient relationship is a core principle of the practice of emergency medicine. There is a growing trend to use patient satisfaction surveys as a tool to assess the quality of this interaction. As more organizations are using these questionnaires in their determinations of compensation and employment decisions, the Academy endorses the following recommendations to prevent the improper use of this information.

1. The fundamental goals of patient satisfaction surveys in emergency medicine are to measure patient perceptions of the interaction with the physician and health care team, recognize outstanding care delivery, and explore opportunities for improvement.

2. If the patient satisfaction surveys are used for determining compensation or making employment decisions, then

(a) the physician scoring and ranking methodology, statistical validity, and survey questions about the physician-patient interaction must be made available to the physicians prior to program implementation.

(b) only surveys with excellent reliability and validity should be used to measure patient satisfaction. In order for survey results to accurately represent the practice of any individual physician, survey samples must be adequately powered to detect differences in individual physician performance.

(c) the results of the patient satisfaction surveys and sample size as a percentage of all patients cared for by a physician should be provided to the physician.

(d) the use of the surveys must be detailed in employment contracts.

MOTION PASSED 10-2.

Expert Witness Policy

Dr. Blumstein outlined the activity of the AAEM remarkable testimony website. He noted that some AAEM members felt that in addition to posting testimony to the site, the testimony be forwarded to the appropriate state medical board. Dr. McNamara moved and Dr. Scaletta seconded that AAEM empower the malpractice task force to develop appropriate wording for the website that would reserve the right to report testimony to the appropriate state medical board and to create a model letter that members could us if they so chose. MOTION PASSED UNANIMOUSLY.

Resident and Teachers Compact

Dr. Kramer presented the above compact and asked the board for endorsement. Dr. McNamara moved and Dr. Weiss seconded that AAEM endorse the following:

Compact Between Resident Physicians and Their Teachers
January 2006
www.aamc.org/residentcompact

The Compact Between Resident Physicians and Their Teachers is a declaration of the fundamental principles of graduate medical education (GME) and the major commitments of both residents and faculty to the educational process, to each other and to the patients they serve. The Compact's purpose is to provide institutional GME sponsors, program directors and residents with a model statement that will foster more open communication, clarify expectations and re-energize the commitment to the primary educational mission of training tomorrow's doctors.

The Compact was originated by the AAMC and its principles are supported by the

following organizations:

Accreditation Council for Graduate Medical Education
American Academy of Allergy , Asthma and Immunology
American Academy of Dermatology
American Academy of Family Physicians
American Academy of Physical Medicine and Rehabilitation
American Association for Thoracic Surgery
American Board of Medical Specialties
American College of Obstetricians and Gynecologists
American College of Physicians
American Gastroenterological Association
American Hospital Association, Committee on Health Professions
American Medical Women's Association
American Orthopaedic Association
American Osteopathic Association
American Pediatric Society
American Society for Reproductive Medicine
Association of Academic Health Centers
Association of Academic Physiatrists
Association of American Medical Colleges
Association of Departments of Family Medicine
Association of Medical School Pediatric Department Chairs
Association of Professors of Dermatology
Association of Professors of Gynecology and Obstetrics
Association of University Anesthesiologists
Association of University Professors of Ophthalmology
Association of University Radiologists
Council of Medical Specialty Societies
Federation of State Medical Boards
National Board of Medical Examiners®
National Resident Matching Program
Society of Chairmen of Academic Radiology Departments
Society of Teachers of Family Medicine
Society of University Otolaryngologists-Head and Neck Surgeons

Compact Between Resident Physicians and Their Teachers

Residency is an integral component of the formal education of physicians. In order to practice medicine independently, physicians must receive a medical degree and complete a supervised period of residency training in a specialty area. To meet their educational goals, resident physicians must participate actively in the care of patients and must assume progressively more responsibility for that care as they advance through their training. In supervising resident education, faculty must ensure that trainees acquire the knowledge and special skills of their respective disciplines while adhering to the highest standards of quality and safety in the delivery of patient care services. In addition, faculty are charged with nurturing those values and behaviors that strengthen the doctor-patient relationship and that sustain the profession of medicine as an ethical enterprise.

Core Tenets of Residency Education

Excellence in Medical Education

Institutional sponsors of residency programs and program faculty must be committed to maintaining high standards of educational quality. Resident physicians are first and foremost learners. Accordingly, a resident's educational needs should be the primary determinant of any assigned patient care services. Residents must, however, remain mindful of their oath as physicians and recognize that their responsibilities to their patients always take priority over purely educational considerations.

Highest Quality Patient Care and Safety

Preparing future physicians to meet patients' expectations for optimal care requires that they learn in clinical settings epitomizing the highest standards of medical practice. Indeed, the primary obligation of institutions and individuals providing resident education is the provision of high quality, safe patient care. By allowing resident physicians to participate in the care of their patients, faculty accept an obligation to ensure high quality medical care in all learning environments.

Respect for Residents' Well-Being

Fundamental to the ethic of medicine is respect for every individual. In keeping with their status as trainees, resident physicians are especially vulnerable and their well-being must be accorded the highest priority. Given the uncommon stresses inherent in fulfilling the demands of their training program, residents must be allowed sufficient opportunities to meet personal and family obligations, to pursue recreational activities, and to obtain adequate rest.

Commitments of Faculty

1. As role models for our residents, we will maintain the highest standards of care, respect the needs and expectations of patients, and embrace the contributions of all members of the healthcare team.

2. We pledge our utmost effort to ensure that all components of the educational program for resident physicians are of high quality, including our own contributions as teachers.

3. In fulfilling our responsibility to nurture both the intellectual and the personal development of residents, we commit to fostering academic excellence, exemplary professionalism, cultural sensitivity, and a commitment to maintaining competence through life-long learning.

4. We will demonstrate respect for all residents as individuals, without regard to gender, race, national origin, religion, disability or sexual orientation; and we will cultivate a culture of tolerance among the entire staff.

5. We will do our utmost to ensure that resident physicians have opportunities to participate in patient care activities of sufficient variety and with sufficient frequency to achieve the competencies required by their chosen discipline. We also will do our utmost to ensure that residents are not assigned excessive clinical responsibilities and are not overburdened with services of little or no educational value.

6. We will provide resident physicians with opportunities to exercise graded, progressive responsibility for the care of patients, so that they can learn how to practice their specialty and recognize when, and under what circumstances, they should seek assistance from colleagues. We will do our utmost to prepare residents to function effectively as members of healthcare teams.

7. In fulfilling the essential responsibility we have to our patients, we will ensure that residents receive appropriate supervision for all of the care they provide during their training.

8. We will evaluate each resident's performance on a regular basis, provide appropriate verbal and written feedback, and document achievement of the competencies required to meet all educational objectives.

9. We will ensure that resident physicians have opportunities to partake in required conferences, seminars and other non-patient care learning experiences and that they have sufficient time to pursue the independent, self-directed learning essential for acquiring the knowledge, skills, attitudes, and behaviors required for practice.

10. We will nurture and support residents in their role as teachers of other residents and of medical students.

Commitments of Residents

1. We acknowledge our fundamental obligation as physicians-to place our patients' welfare uppermost; quality health care and patient safety will always be our prime objectives.

2. We pledge our utmost effort to acquire the knowledge, clinical skills, attitudes and behaviors required to fulfill all objectives of the educational program and to achieve the competencies deemed appropriate for our chosen discipline.

3. We embrace the professional values of honesty, compassion, integrity, and dependability.

4. We will adhere to the highest standards of the medical profession and pledge to conduct ourselves accordingly in all of our interactions. We will demonstrate respect for all patients and members of the health care team without regard to gender, race, national origin, religion, economic status, disability or sexual orientation.

5. As physicians in training, we learn most from being involved in the direct care of patients and from the guidance of faculty and other members of the healthcare team. We understand the need for faculty to supervise all of our interactions with patients.

6. We accept our obligation to secure direct assistance from faculty or appropriately experienced residents whenever we are confronted with high-risk situations or with clinical decisions that exceed our confidence or skill to handle alone.

7. We welcome candid and constructive feedback from faculty and all others who observe our performance, recognizing that objective assessments are indispensable guides to improving our skills as physicians.

8. We also will provide candid and constructive feedback on the performance of our fellow residents, of students, and of faculty, recognizing our life-long obligation as physicians to participate in peer evaluation and quality improvement.

9. We recognize the rapid pace of change in medical knowledge and the consequent need to prepare ourselves to maintain our expertise and competency throughout our professional lifetimes.

10. In fulfilling our own obligations as professionals, we pledge to assist both medical students and fellow residents in meeting their professional obligations by serving as their teachers and role models.

This compact serves both as a pledge and as a reminder to resident physicians and their teachers that their conduct in fulfilling their obligations to one another is the medium through which the profession perpetuates its standards and inculcates its ethical values.

For more information, go to www.aamc.org/residentcompact

MOTION PASSED UNANIMOUSLY.

Universal Health Care

Dr. McNamara reported that an AAEM member had asked him to bring the following resolution to the board. Therefore, Dr. McNamara moved that AAEM adopt the following resolution:

AAEM Policy Statement on Universal Coverage and National Healthcare

Whereas there are currently more than 43,000,000 uninsured people in the United States , and

Whereas we have vast disparities in the availability and delivery of healthcare in this country, and,

Whereas the growing numbers of uninsured flood our emergency rooms and make it difficult for us to provide essential emergency care for those who truly need it, and,

Whereas this problem can only be addressed through a national, comprehensive and affordable plan that will assure access to healthcare to everyone in this country

Therefore be it resolved that AAEM that supports and will attempt to help implement, a National Health Insurance program providing universal coverage and comprehensive benefits to everyone in the United States.

MOTION DIED FOR LACK OF A SECOND.

Job Bank Procedure

Ms. Whalen outlined the current AAEM job bank procedure and asked that the board consider modifying this procedure. Dr. Wood moved and Dr. Reiter seconded that the job bank be placed on a members only section of the website so that candidates could contact potential employers directly without using staff as a go-between. MOTION PASSED UNANIMOUSLY.

New Business

There being no new business, the board meeting was adjourned and the strategic planning meeting commenced.

Respectfully submitted,

Kay Whalen
Executive Director