Resolution 07-01 Requiring Fast Food Restaurants to Provide Nutritional Information Food Labels

Introduced by: Caitilin Kelly, M.D., Indiana ACP Health and Public Policy Committee Chair, and Second District Medical Society

Referred to: Reference Committee IV

Whereas, Indiana has the fourth highest level of adult obesity in the nation at 26 percent, the 15th highest overweight levels for high school students at 11.5 percent, and the 17th highest overweight levels of low-income children ages 2-5 at 12.7 percent; and

Whereas, the state spent an estimated $264 per person in 2003 on medical-costs related to obesity, which was the 22nd highest amount in the nation;

Whereas, nearly 119 million American adults, 65 percent of the population, are currently overweight or obese and the direct and indirect costs of obesity in America are more than $117 billion per year; and

Whereas, marketplace food portions, especially in fast food restaurants, have increased in size and now exceed federal standards; and

Whereas, portion sizes began to grow in the 1970s, rose sharply in the 1980s, and have continued in parallel with increasing body weights; and

Whereas food eaten away from home now accounts for up to 42 percent of Americans' calorie intake, and a recent study has shown that the increase in restaurant and fast food consumption has occurred at the same time as the rise in obesity; and

Whereas, giving patients knowledge of what they are eating is the first step to changing unhealthy eating patterns and habits; therefore, be it

RESOLVED, that the ISMA seek legislation requiring all fast food restaurants to package and dispense each fast food item in a wrapper or container that has the food’s complete nutritional information printed on it (similar to what is required for any food item sold in a grocery store).

Resolution 07-02 Taser Sales to the General Public

Introduced by: Caitilin Kelly, M.D., Indiana ACP Health and Public Policy Committee Chair, Second District Medical Society and Monroe-Owen County Medical Society

Referred to: Reference Committee II

Whereas, Taser International is releasing a taser model C2 intended for use by the general public; and

Whereas, the safety of the current taser model used by law enforcement has not been fully established in multiple special situations including its use on pregnant women, children, elderly people, people with heart, neurological and psychiatric disorders, intoxicated people and those taking multiple legal or illegal drugs; and

Whereas, a study recently published in the Journal of the American College of Cardiology, (Vol.48, no.4, 2006, pp799-804.) suggests that the use of a taser presents cardiac risks that require further investigation in humans; and

Whereas, the Potomac Institute for Policy Studies strongly recommends that additional studies be conducted at the organism, organ, tissue and cell levels; and

Whereas, the C2 model has been prohibited by Hawaii, Massachusetts, Michigan, New Jersey, New York, Rhode Island and Wisconsin and is also prohibited by the cities of Annapolis, Baltimore, Chicago, New York City, Philadelphia, Washington, D.C. and Howard County, Md.; and

Whereas, the same concerns for health risks with appropriate use and abuse by law enforcement would likely be magnified many times with use by a less well-trained general public; therefore, be it

RESOLVED, that until more in-depth and detailed studies have been performed on tasers, the ISMA support legislation prohibiting the sale of tasers to the general public.

Resolution 07-03 Informing Physicians when Mediciation Substitutions are Made

Introduced by: Caitilin Kelly, M.D., Indiana ACP Health and Public Policy Committee Chair, Second District Medical Society and Monroe-Owen County Medical Society

Referred to: Reference Committee II

Whereas, Indiana law requires a pharmacist to substitute a lower price generic drug, if available, on all prescriptions filled under the Medicaid program, Children's Health Insurance Program or Medicare; and

Whereas, the pharmacist must notify the patient but not the physician of any substitution; and

Whereas, there are clinical situations in which making a substitution could pose a health risk to the patient (for example, a particular patient my have been shown to have inferior seizure control with a generic medication); and

Whereas, informing the physician of the non-requested substitution would give the physician a chance to intervene and request the appropriate drug through already established channels; therefore, be it

RESOLVED, that the ISMA seek legislation that would require a pharmacist to notify a physician of any non-requested medication substitutions for Medicaid patients.

Resolution 07-04 Limiting Pharmaceutical Company Involvement in the Formulation of Clinical Guidelines

Introduced by: Caitilin Kelly, M.D., Indiana ACP Health and Public Policy Committee Chair, Second District Medical Society and Monroe-Owen County Medical Society

Referred to: Reference Committe II

Whereas, pay-for-performance programs will use evidenced-based guidelines written by specialty societies; and

Whereas, the formulation of such guidelines should be based solely on objective analysis of available data; and

Whereas, there is currently evidence that pharmaceutical companies are influencing the content of these guidelines to promote their products (as an example, after Lilly donated over $2 million to various critical care groups, final guidelines in the treatment of sepsis gave Xigris a class B rating whereas established therapies for sepsis such as antibiotics, fluids and vasopressors received lower ratings of grade D or E); therefore, be it

RESOLVED, that the ISMA and ACP support policies that prohibit the pharmaceutical and medical device industries from directly or indirectly funding or influencing practice guidelines.

Resolution 07-05 Pay Attention, Drive Alert Campaigns

Introduced by: Ed Probst, M.D., David Welsh, M.D., and Fourth District Medical Society

Referred to: Reference Committee IV

Whereas, safe operation of a motor vehicle requires full and complete attention; and

Whereas, many accidents, some resulting in injury and deaths, occur because of the lack of drivers’ full attention; and

Whereas, cell phoning while driving has become commonplace and distracts from a driver’s full attention; and

Whereas, drivers on cell phones are usually talking to someone who is not driving; and

Whereas, education is preferred to legislation; therefore, be it

RESOLVED, that the ISMA undertake an educational campaign among its membership and the public to promote awareness of the dangers of driving while talking on cell phones; and be it further

RESOLVED, that the ISMA undertake a campaign to discourage all citizens from talking to a driver of a vehicle on a cell phone; and be it further

RESOLVED, that the ISMA encourage the state of Indiana, insurance companies, and others to promote similar campaigns; and be it further

RESOLVED, that the Indiana AMA delegation introduce similar resolutions ( if not already in place) to the AMA, substituting “Surgeon General” for “state of Indiana” in the third resolve.

 

Resolution 07-06 Member Insurance Plan

Introduced by: Indianapolis Medical Society

Referred to: Reference Committee III

Whereas , the ISMA provides member insurance as a member service; and,

Whereas, this insurance should be a benefit of membership and not a revenue generator for the ISMA; and

Whereas, the current relationship with the lowest cost vendor results in a revenue stream to the ISMA with increased costs passed along to members; therefore, be it

RESOLVED, that ISMA explore innovative options for an insurance plan that would work with hospital systems and another payer to negotiate competitive rates for ISMA insureds.

 

Resolution 07-07 Reaffirming the ISMA Position on Family Violence

Introduced by: ISMA Family Violence Committee

Referred to: Reference Committee IV

WHEREAS, the mission of the ISMA includes advocacy for patients; and

WHEREAS, victims of family violence are often the most vulnerable and the least able to advocate for themselves; and

WHEREAS, Resolution 97-17 is set to expire in 2007; therefore, be it

RESOLVED that the ISMA support and advocate for measures that will strengthen the protection of children and endangered adults from acts of abuse; and be it further

RESOLVED that the ISMA oppose all state and federal legislation and actions that will in any way hinder, obstruct or weaken the ability of law enforcement agencies to investigate suspected cases of abuse of children and endangered adults.

 

Resolution 07-08 Revising the ISMA Dr. Kathleen Galbraith Legacy Leadership Award

Introduced by: ISMA Family Violence Committe

Referred to: Reference Committee I

Whereas, the ISMA has sought to recognize the significant contributions of individual Hoosiers and of individual Indiana physicians to the health and well being of our fellow citizens through the development of awards; and

Whereas, the Family Violence Committee expresses its appreciation for the efforts of the House of Delegates and the reference committee at the 2006 ISMA Convention to recognize the late Kathleen Galbraith, M.D., for her contributions to the medical profession through her dedication to patients and leadership in the ISMA; and

Whereas, the final amended Resolution 06-23 created the ISMA Dr. Kathleen Galbraith Legacy Leadership Award, which inadvertently conflicts with the existing ISMA Physician Community Service Award and the Patient Health Advocate Award; and

Whereas, the original intent of the Family Violence Committee was to create an award tailored to recognize Dr. Galbraith’s commitment to advocate for the younger members of our community; therefore, be it

RESOLVED that the purpose of the ISMA Dr. Kathleen Galbraith Legacy Leadership Award be revised to acknowledge a legislator, physician or layperson whose significant contributions have sought to promote the health and safety of the younger members of our communities by addressing issues of endangerment and/or violence; and be it

RESOLVED, that all nominations be submitted by an ISMA committee, commission or member in good standing and will consist of a letter detailing the qualifications of the nominated individual; and be it further

RESOLVED, that the awardee will be selected by the Executive Committee; and be it further

RESOLVED, that the award be presented annually at the House of Delegates if a suitable recipient is identified.

 

Resolution 07-09 Health Professions Bureau Web site for Renewal of Medical and State Controlled Substances Licenses

Introduced by: Mitchell Travis, M.D.

Referred to: Reference Committe III

Whereas, many states are experiencing a migration of physicians from their states for cost and convenience issues related to practice; and

Whereas, physicians in Indiana have similar concerns regarding ease and cost of maintaining a practice; and

Whereas, physicians recognize that Internet commerce is increasingly used by state governments; and

Whereas, physicians believe that Internet commerce is a means used by the Health Professions Bureau to lower overhead and provide services to physicians at a lower cost; and

Whereas, physicians are being surcharged, in addition to the usual cost of their licenses, for both an “Enhanced Fee” of $2.50 and an “Instant Fee” of $6.27 (which can increase the cost of medical licenses and controlled substance licenses by 3 percent) when the Internet should actually lower physician costs; therefore, be it

RESOLVED, that the ISMA vigorously request that the Indiana Health Professions Bureau remove all additional fees and surcharges attached to the cost of both the Indiana State Controlled Substances License and Indiana State Medical License so as to keep their costs at or below (due to decreased overhead from online renewal) $60 and $200 respectively.

 

Resolution 07-10 Telephone Devices and Auto Accidents

Introduced by: Edward Probst, M.D.

Referred to: Reference Committee IV

Whereas, the use of cell phones while driving causes an estimated 4,000 accidents daily nationwide; and

Whereas, the safety of citizens on the road is at increased risk due to driver inattention; and

Whereas, Resolution 97-51, which is set to expire, promotes education about the dangers of talking on cell phones while driving; and

Whereas, Resolution 97-51 should continue as ISMA policy; therefore, be it

RESOLVED, that the ISMA encourage investigation and education regarding the dangers of operating a telephonic device while driving.

 

Resolution 07-11 Medical Office and Health Facility Safety & Security

Introduced by: David Welsh, M.D.

Referred to: Reference Committee III

Whereas, health care is one of the professions most affected by workplace violence, with patients or outsiders most likely to be the source; and

Whereas, “Violence Prevention at Work: a Business Perspective,” (Am J Prev Med 2001; 20(2) categorizes health care violence as Type II, defined as “committed on an employee by a client, customer, patient or inmate” and is prompted by client anger or frustration; and

Whereas, Bureau of Labor Statistics data show that in 2000, 48 percent of all non-fatal injuries from occupational assaults and violent acts occurred in health care and social services; and

Whereas, American Medical News reported statistics from the Department of Justice’s (DOJ) national Crime Victimization Survey for 1993-1999 that indicated a rate of 16.2 violent incidents per 1,000 doctors; 21.9 per 1,000 nurses, and 68.2 per 1,000 mental health professionals; and

Whereas, instances of violence in the health care workplace are generally under-reported, according to the DOJ; therefore, be it

RESOLVED, that the ISMA work with the Indiana Hospital&Health Association and other interested organizations to promote workplace safety for physicians and other health care workers.

 

Resolution 07-12 Support of Gay Marriage

Introduced by: William Buffie, M.D.

Referred to: Reference Committee II

Whereas, we live in a multicultural society wherein all people are created equal in the eyes of God and our constitution; and

Whereas, the principle of separation of church and state is essential to uphold in our diverse society; and

Whereas, to be consistent with the above, it is necessary that personal interpretation of one’s own individual scripture should not be a basis for deciding whether homosexuality is determined by orientation or choice; and

Whereas, the medical literature supports the probability that science and genetics are likely to eventually prove that homosexuality is a function of biological orientation rather than choice; and

Whereas, the ISMA is a body that is to be guided in its decision making by science, reason and public policy standards that promote the health and well-being of all Indiana citizens; and

Whereas, there is a substantial body of medical literature that recognizes the health benefits of a legally sanctioned marital relationship; therefore, be it

RESOLVED, that the ISMA formally oppose legislation proposing a ban against gay marriage, or any measures compromising the medical/legal rights or societal/moral standing of homosexuals.

 

Resolution 07-13 Establishing Medical Homes

Introduced by: Mary Ian McAteer, M.D.

Referred to: Reference Committee III

Whereas, the ISMA is a proven leader in developing health care policy to benefit every person in the state of Indiana; and

Whereas, the concept of a medical home has been adopted as a way to guide and define the child health care system and/or improve the health of all children; and

Whereas, the medical care of infants, children and adolescents ideally should be accessible, continuous, comprehensive, family-centered, coordinated, compassionate and culturally effective; and

Whereas the medical care should be delivered or directed by well-trained physicians who provide primary care and help to manage and facilitate essentially all aspects of pediatric care; and

Whereas, the physician should be known to the child and family, and should be able to develop a partnership of mutual responsibility and trust; and

Whereas physicians should seek to improve the effectiveness and efficiency of health care for all children and strive to attain a medical home for every child and adult in their communities; therefore, be it

RESOLVED, that the ISMA educate its members and the public about the medical home concept; and be it further

RESOLVED, that the ISMA discuss with ancillary organizations representing nurse practitioners, physician assistants, pharmacists, etc., the importance of a medical home for patients.

 

Resolution 07-14 Civil Legal System

Introduced by: P.K. Samaddar, M.D.

Referred to: Reference Committee II

Whereas, the United States law system is based in part upon that of England; and

Whereas, substantial differences have evolved over the past two centuries in the procedural methods regarding the manner in which civil tort cases are adjudicated; and

Whereas, the current English procedural system requires the unsuccessful plaintiff to compensate the defendant for both pain and suffering and attorney fees; and

Whereas, this change in the law would protect Indiana citizens from higher insurance rates for health and liability and result in fewer lawsuits; therefore, be it

RESOLVED, the ISMA seek legislation in the Indiana General Assembly to implement a civil tort system similar to that of England.

 

Resolution 07-15 Methadone Deaths

Introduced by: Vidya Kora, M.D.

Referred to: Reference Committee IV

Whereas, methadone is a narcotic used to treat opioid addiction and chronic pain; and

Whereas, methadone-associated deaths have increased dramatically in the United States and in certain Indiana communities in close proximity to methadone clinics; and

Whereas, methadone is currently being diverted by the recipients of this medication for financial gain; and

Whereas, methadone has significant cardiac arrythmogenic effects resulting in sudden cardiac deaths; and

Whereas, methadone used in conjunction with marijuana, alcohol and benzodiazepines can be potentially lethal; therefore, be it

RESOLVED, that the ISMA support or introduce legislation to control the widespread use of methadone, and substitute it with safer alternatives for pain control and treatment of opioid addiction.

 

Resolution 07-16 Electronic Health Records

Introduced by: Mary Ian McAteer, M.D.

Referred to: Reference Committee III

Whereas, there are many different electronic health record (EHR) systems on the market; and

Whereas, sharing of data among physicians is important to the care of patients; and

Whereas, many of the EHR systems on the market are not compatible with other systems, which prohibits the sharing of patient information among treating physicians; therefore, be it

RESOLVED, that the ISMA educate its members about the various EHR products that are compatible with hospital systems and state information systems; and be it further

RESOLVED, that the ISMA educate its members about alternative SECURE means of communication when EHR is not available; and be it further

RESOLVED, that the ISMA continue to monitor the effectiveness of various EHR products and publish its findings for members.

 

Resolution 07-17 Hospital Peer Review

Introduced by: Mary Vanko, M.D.

Referred to: Reference Committee II

Whereas, summary suspension from a hospital medical staff disrupts practice and patient care, and causes havoc with insurance rates and participation in plans, and potentially ruins a physician's reputation nationwide as a result of a listing in the National Practitioners Data Bank; and

Whereas, physicians have limited rights in administrative proceedings at hospitals; and

Whereas, hospital medical staff executive committees are often composed of employed and contracted physicians easily manipulated by hospital administration; therefore, be it

RESOLVED, that the ISMA support legislation requiring that:

• A physician who has been suspended from hospital privileges receive a fair hearing within 30 days
• The hearing be conducted by three board-certified specialists not affiliated with the hospital in question
• The physician be immediately reappointed to the hospital staff with full privileges if the hearing panel supports the physician
• The costs of the physician’s defense be paid by the hospital

 

Resolution 07-18 Tax on Unhealthy Food Consumption

Introduced by: Steven Rupert, D.O.

Referred to: Reference Committee IV

Whereas, the concept of taxing foods that are high in fat and low in nutrition was first promoted in the 1980s; and

Whereas, such a tax could serve as a deterrent to consumption of unhealthy foods; and

Whereas, the consequences of consuming unhealthy foods are extreme, as indicated by the fact that 60 percent of adult Hoosiers and 16 percent of children are overweight; and

Whereas, eating unhealthy foods contributes not only to obesity, but to heart disease, hypercholesterolemia and diabetes; and

Whereas, revenue from a tax on unhealthy foods could be earmarked for SCHIP funding and obesity prevention; therefore, be it

RESOLVED, that the ISMA support a tax on foods and beverages that are high in fats and sugars and low in nutrition with the revenue being allocated to improving the health of Hoosiers.

 

Resolution 07-19 Increase in the Alcohol Tax

Introduced by: Steven Rupert, D.O.

Referred to: Reference Committee II

Whereas, an increase in the alcohol tax could reduce alcohol consumption, which causes fetal alcohol syndrome and contributes to injuries and deaths due to drunk driving; and

Whereas, alcohol use, when excessive, can adversely affect all systems in the body; and

Whereas, society ultimately pays for the consequences of alcohol use and abuse, and

Whereas, revenue from increasing the tax on alcohol could be allocated to improving the health of Hoosiers; therefore, be it

RESOLVED, that the ISMA support increasing the tax on alcohol with revenue from the tax allocated to improving the health of Hoosiers.

 

Resolution 07-20 Comprehensive Treatment of Sexual Assault Patients in Indiana

Introduced by: Don Henry, M.D.

Referred to: Reference Committee II

Whereas, physicians in emergency departments have a professional and ethical responsibility to treat victims of sexual assault; and

Whereas, adherence to these recognized standards of good patient care is frequently incomplete; and

Whereas, failure to treat patients appropriately in this context exposes patients to additional risk of complications after an already traumatic event; and

Whereas, many physicians are constrained by hospital policies, on penalty of dismissal, from providing comprehensive care; and

Whereas, patients in such emergencies often have little or no choice as to the facility for treatment; and

Whereas, the ISMA has endorsed federal legislation to this effect; therefore, be it

RESOLVED, t hat the ISMA support state legislation that requires all facilities in Indiana rendering emergency care to provide the following services to sexual assault patients:

1. Treatment of trauma
2. Testing and prophylaxis for sexually transmitted disease
3. Collection of forensic evidence
4. Accurate, factual information about and on-site availability of emergency contraception for patients capable of pregnancy

 

Resolution 07-21 Dispensing of Emergency Contraception

Introduced by: Don Henry, M.D.

Referred to: Reference Committee II

Whereas, emergency contraception ( A Plan B @ ) is an FDA-approved medication for prevention of pregnancy; and

Whereas, numerous incidents have occurred wherein pharmacists refused to fill prescriptions for emergency contraception; and

Whereas, pharmacists are in no position to evaluate patients fully regarding the appropriateness of their prescription medication; and

Whereas, refusal to either fill a prescription or direct a patient to another pharmacy where it is available interferes with the physician-patient relationship and is tantamount to practicing medicine without a license; and

Whereas, the Indiana General Assembly considered a bill in the last session that would give legal protection to pharmacists who refuse to fill certain prescriptions and, therefore, need a message from organized medicine that this is an unacceptable practice; therefore, be it

RESOLVED, t hat ISMA oppose any legislation providing for a A conscience clause @ allowing pharmacists to refuse to fill (or, alternatively, to at least direct a patient to another pharmacy that will fill) a prescription for Plan B.

 

Resolution 07-22 "Trap" Legislation

Introduced by: Don Henry, M.D.

Referred to: Reference Committee III

Whereas, it has become a common political stratagem for opponents of legal medical procedures to attempt to impose burdensome regulations to hamper physicians in providing these services, or to provide a legal basis for harassment of physicians and patients to discourage these procedures; and

Whereas, such regulations or proposed regulations have included, but are not limited to:

• Requirements for non-indicated imaging procedures
• Requirements for patients to view real-time procedures for the purpose of influencing their decisions
• Requirements for informed consent not consistent with evidence-based medicine (i.e., "fetal pain relief")
• Requirements for waiting periods
• Discriminatory regulations for dedicated facilities ; and

Whereas, these regulations are unrelated to patient safety and have a transparent political agenda; and

Whereas, t hese regulations are intended to harass physicians and patients with burdensome compliance issues and medico-legal complications; and

Whereas, such regulations are generally drafted by the medically untrained without input from professional societies and often are ambiguously worded, resulting in additional medico-legal exposure to the community at large; therefore, be it

RESOLVED, that ISMA oppose all health care regulation motivated by ideology rather than legitimate patient care, physician safety or quality issues.

 

Resolution 07-23 Bylaws Amendment Clarifying ISMA Membership Eligibility Requirements

Introduced by: Commission on Constitution & Bylaws

Referred to: Reference Committee I

WHEREAS, ISMA Bylaws Section 1.0101 defines Regular Member:

The term "Regular Member" as used in these Bylaws shall be

1. A person who holds the degree of Doctor of Medicine or Bachelor of Medicine, or who holds an unrestricted license to practice medicine, except as specified in l.0303(b),
2. A member in good standing of a component county society and who has paid to this Association annual dues, provided; however, that
3. The person is a citizen of the United States of America, or has filed the declaration of intention of becoming a citizen and the first citizenship papers are in full force and effect.

WHEREAS, ISMA Bylaws Section 11.02 on Membership Qualifications states,

Each component county society shall be judge of the qualifications of its own members, but, as such societies are the only portals to regular membership in this Association, every reputable and legally registered physician who holds a degree of Doctor of Medicine, a degree of Bachelor of Medicine, or a degree of Doctor of Osteopathy and who holds a valid, unrestricted license to practice medicine and surgery in Indiana shall be eligible for membership.

Provided, however, that each component county society may deny membership in such society for infraction or violation of any law relating to the practice of medicine or of the Constitution and Bylaws of such society, the Constitution and Bylaws of the Indiana State Medical Association, the Constitution and Bylaws of the American Medical Association, or for a violation of the Principles of Medical Ethics of the Indiana State Medical Association; and may, after due notice and hearing, censor, suspend or expel any member for any such infraction. Before a charter is issued to any component county society, full and ample notice and opportunity shall be given to every physician in the county to become a member; and

WHEREAS, Section 1.0101 requires a degree OR licensure and Section 11.02 requires a degree AND licensure; and

WHEREAS, Indiana only issues a license to practice medicine and not a license to practice medicine and surgery; and

WHEREAS, these two ISMA Bylaws sections are inaccurate, inconsistent and contradictory; and

WHEREAS, ISMA Bylaws Section 17.01 provides, “These Bylaws may be amended by resolution as in 3.020701(b), which shall be treated as any other proposed amendment, at any meeting of the House of Delegates by a majority vote of all the voting members present. Amendments to the Bylaws must be submitted to the Association 60 days in advance of the meeting. These amendments must be presented to the Commission on Constitution and Bylaws prior to the meeting and are eligible for passage after lying on the table for one day;” and

WHEREAS, this Amendment has been timely submitted after having been previously presented to the Commission on Constitution and Bylaws and lying on the table for one day; therefore, be it

RESOLVED, that the following ISMA Bylaws provisions be amended to clarify their meaning and intent as follows:

Section 1.0101 Regular Member: The term "Regular Member" as used in these Bylaws shall be

1. A person who holds the degree of Doctor of Medicine or Bachelor of Medicine or Doctor of Osteopathy, or and who holds a n valid, unrestricted license to practice medicine, except as specified in l.0303(b),

Section 11.02 MEMBERSHIP QUALIFICATIONS: Each component county society shall be judge of the qualifications of its own members, but, as such societies are the only portals to regular membership in this Association, every reputable and legally registered physician who holds a degree of Doctor of Medicine, a degree of Bachelor of Medicine, or a degree of Doctor of Osteopathy and who holds a valid, unrestricted license to practice medicine and surgery in Indiana shall be eligible for membership.

 

Resolution 07-24 Bylaws Amendment Updating Adoption of AMA Principles of Medical Ethics

Introduced by: Commission on Constitution & Bylaws

Referred to: Reference Committee I

WHEREAS, ISMA Bylaws Section 18.01 states:

The Principles of Medical Ethics of the American Medical Association shall govern the conduct of members in their relations to each other and to the public.

AMERICAN MEDICAL ASSOCIATION PRINCIPLES OF MEDICAL ETHICS

Preamble:

The medical profession has long subscribed to a body of ethical statements developed primarily for the benefit of the patient. As a member of this profession, a physician must recognize responsibility to patients first and foremost, as well as to society, to other health professionals, and to self. The following Principles adopted by the American Medical Association are not laws, but standards of conduct which define the essentials of honorable behavior for the physician.

I. A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights.

II. A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities.

III. A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient.

IV. A physician shall respect the rights of patients, colleagues, and other health professionals, and shall safeguard patient confidences and privacy within the constraints of the law.

V. A physician shall continue to study, apply, and advance scientific knowledge, maintain a commitment to medical education, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated.

VI. A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care.

VII. A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health; and

WHEREAS, the AMA Principles of Medical Ethics have been expanded to include two additional provisions (numbers 8 and 9) which read as follows:

VIII. A physician shall, while caring for a patient, regard responsibility to the patient as paramount.

IX. A physician shall support access to medical care for all people.

WHEREAS, the ISMA does not have a Principles of Medical Ethics, but the AMA does; therefore, be it

RESOLVED, that ISMA Bylaws section 18.01 be amended to incorporate the most current version of the AMA Principles of Medical Ethics as follows:

PREAMBLE:

The medical profession has long subscribed to a body of ethical statements developed primarily for the benefit of the patient. As a member of this profession, a physician must recognize responsibility to patients first and foremost, as well as to society, to other health professionals, and to self. The following Principles adopted by the American Medical Association are not laws, but standards of conduct which define the essentials of honorable behavior for the physician.

I. A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights.

II. A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities.

III. A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient.

IV. A physician shall respect the rights of patients, colleagues, and other health professionals, and shall safeguard patient confidences and privacy within the constraints of the law.

V. A physician shall continue to study, apply, and advance scientific knowledge, maintain a commitment to medical education, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated.

VI. A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care.

VII. A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health.

VIII. A physician shall, while caring for a patient, regard responsibility to the patient as paramount.

IX. A physician shall support access to medical care for all people.

Therefore, be it further RESOLVED, that ISMA Bylaws section 11.02 be amended as follows to incorporate the Preamble of the Principles of Medical Ethics of the American Medical Association:

Provided, however, that each component county society may deny membership in such society for infraction or violation of any law relating to the practice of medicine or of the Constitution and Bylaws of such society, the Constitution and Bylaws of the Indiana State Medical Association, the Constitution and Bylaws of the American Medical Association, or for a violation of the Preamble to the Principles of Medical Ethics of the Indiana State Medical Association American Medical Association; and may, after due notice and hearing, censor, suspend or expel any member for any such infraction. Before a charter is issued to any component county society, full and ample notice and opportunity shall be given to every physician in the county to become a member.

 

Resolution 07-25 Restrictions on Promotion and Advertising of Alcohol Products

Introduced by: Dick Huber, M.D.

Referred to: Reference Committee I

Whereas, alcohol is the most commonly used drug by youth (21 percent of Indiana 8 th graders report monthly use, 33 percent of 10th graders and 42 percent of 12 th graders); and

Whereas, boys first experiment around age 11, girls at age 13; and

Whereas, underage drinking is a factor in nearly half of all teen vehicle crashes; and

Whereas, the human brain is not considered developed until the mid-20s; and

Whereas, early alcohol use and abuse can cause permanent damage to an adolescent’s developing brain; and

Whereas, such effects include increased risks for social problems, depression, suicidal thoughts and violence, as well as reduced levels of abilities to reason, learn, memorize, make decisions, and control emotions and desires; and

Whereas, teenagers are subjected to the advertising and promotion of alcohol products that infer that fun, thrills and excitement will be the ultimate results; therefore, be it

RESOLVED, that the ISMA delegation introduce a resolution at the next annual AMA meeting to seek legislation based on current policy that would:

1. Limit the promotion and advertising of alcohol products to youth and young adults, similar to restrictions placed on tobacco products, and
2. Require alcoholic beverages to contain strong warnings of effects pertinent for our youth

 

Resolution 07-26 Physician Identification

Introduced by: Dick Huber, M.D.

Referred to: Reference Committee I

Whereas, health care facilities are inundated with personnel wearing white coats, scrubs or stethoscopes; and

Whereas, it is becoming more difficult for our patients to distinguish physicians and nurses from other health facility personnel; therefore, be it

RESOLVED, that the ISMA delegation introduce a resolution at the next annual AMA meeting that would request consideration of:

1. A restricted, easily recognized identification for medical and osteopathic physicians, and
2. The same identification for registered nurses

 

Resolution 07-27 Protecting Children from Second-hand Smoke and Fires

Introduced by: Dick Huber, M.D.

Referred to: Reference Committee IV

Whereas, parents, adults, physicians and governmental agencies share responsibility for protecting our children (06-32); and

Whereas, levels of particulate matter from one smoker in a car were found to be at least twice that of the smokiest bar; and

Whereas, cigarettes are the major cause of residential fire death and at least six states have laws requiring cigarettes to be ‘fire-safe’; and

Whereas, two states ( Arkansas and Louisiana) ban smoking in all cars when children are present; and

Whereas, at least six states prohibit foster parents from smoking in houses and vehicles when foster children are present; therefore, be it

RESOLVED, that the ISMA support legislation, policy, rules and regulations that would ban smoking in a vehicle with children; and be it further

RESOLVED, that the ISMA seek and support legislation, policy, rules and regulations that would protect children in foster or guardianship care from second-hand smoke in enclosed areas; and be it

RESOLVED, that the ISMA establish policy and seek legislation, rules and regulations that would require cigarettes to be “fire-safe” (self-extinguishing or Reduced Ignition Propensity, R.I.P.); and be it further

RESOLVED, that the ISMA delegation introduce a resolution at the next annual AMA meeting that would require all cigarettes be “fire-safe.”

 

Resolution 07-28 Smoking Bans in Indiana in Public Areas

Introduced by: Dick Huber, M.D.

Referred to: Reference Committee IV

Whereas, more than 12 states ban smoking in all workplaces, bars and restaurants; therefore, be it

RESOLVED, that the ISMA establish policy and support legislation, rules and regulations that would ban smoking in public places in Indiana.

 

Resolution 07-29 Restricting Use of Electronic Devices While Driving

Introduced by: Dick Huber, M.D.

Referred to: Reference Committee IV

Whereas, many distractions are responsible for vehicle crashes, some are considered minor and have shown to have little or no effect on a driver’s behavior, such as drinking beverages; and

Whereas, other activities are considered major distractions that require concentration and have great effects on driving, such as sending and receiving electronic messages; and

Whereas, using electronic devices while driving increases the risks of being involved in a crash by 400 percent; and

Whereas, the 15-minute interval prior to using an electronic device involves a similar increase in risk; and

Whereas, 60 percent of total cell phone use is “behind the wheel” use; and

Whereas, hands-free devices have not been shown to reduce those risks (ask not “Where are my hands?” but rather ask “Where is my head?”); and

Whereas, driving while texting (DWT) legislation is being considered in nine states in 2007; therefore, be it

RESOLVED, that the ISMA support legislation, policy, rules and regulations that restrict sending and receiving of electronic messages while driving; and be it further

RESOLVED, that the ISMA delegation introduce a resolution at the next annual AMA meeting that would seek and support legislation, policy, rules and regulations restricting the sending and receiving of electronic messages while driving.

 

Resolution 07-30 Eliminating Specialty Sections and Delegates

Introduced by: Dick Huber, M.D.

Referred to: Reference Committee I

Whereas, specialty section delegates do not have a vote in the ISMA House of Delegates and seldom attend ISMA House of Delegates meetings; therefore, be it

RESOLVED, that the ISMA eliminate specialty sections and their delegates at the ISMA House of Delegates.

 

Resolution 07-31 Vitamin D Recommendation

Introduced by: Stacie Wenk, D.O.

Referred to: Reference Committee IV

Whereas, bone loss is a devastating disease affecting approximately 55 percent of men and women over age 50; and

Whereas, approximately 1 million fractures occur yearly due to osteoporosis, with 20-30 percent of women and men (respectively) dying within the first year following a hip fracture and another 20-25 percent requiring nursing home placement; and

Whereas, calcium and vitamin D are well recognized as major contributing components to healthy bone maintenance (In the past year, SEVERAL studies have shown many additional benefits of vitamin D supplementation. These include, but are not limited to: improvement of sarcopenia, improved balance, reduction of macular degeneration, mood elevation (particularly in SAD) and possibly dementia, reduction in all cancers in women); therefore, be it

RESOLVED, that the ISMA work with the Indiana Health Care Association to establish policy for all incoming nursing home residents to have a 25-OH vitamin D level drawn, and receive treatment for low levels (below 35 per NOF recommendations), followed by maintenance doses; and be it further

RESOLVED, that the ISMA work with Indiana Medicaid to identify the benefits of vitamin D for all nursing home residents and cover the costs for those residents to receive a minimum of 1000 units of vitamin D (in the D3 formulation) daily for maintenance as well as to afford the previously mentioned benefits.

 

Resolution 07-32 Conflict of Interest

Introduced by: Roger Jones, M.D.

Referred to: Reference Committee III

Whereas, a “conflict of interest” is a situation in which someone in a position of trust has competing professional or personal interests, and such competing interests can make it difficult to fulfill his or her duties impartially; and

Whereas, a conflict of interest exists even if no unethical or improper act results from it, and a conflict of interest can create an appearance of impropriety that can undermine confidence in the person, profession or court system; and

Whereas, medical providers often serve on multiple committees, boards, administrative staffs of medical organizations simultaneously; and

Whereas, providers often actively participate in matters in which a “conflict of interest” exists and do not abstain from participating; and

Whereas, no third-party oversight exists to ensure that ethical behavior is followed in medical institutions/organizations; and

Whereas, medical institutions/organizations have bylaws that are often not followed and not enforced, with no oversight by third-parties; therefore, be it

RESOLVED, that the ISMA encourage county medical societies and hospital boards to adopt policy that would require:

• Ethical conduct by anyone taking part in the operations or governance of the medical society or hospital board in any capacity and be subject to reprimand in cases deemed unethical
• Disclosure of any conflict of interest by members. Should there be a conflict of interest, that member (s) should abstain from any decision-making process or voting procedure.
• Members to serve on only one board or committee of a medical organization at the same time
• The location of medical organization meetings be held at a time and place that does not present a conflict of interest for those attending and would encourage a majority of participants to attend

 

Resolution 07-33 Sham Peer Review

Introduced by: Roger Jones, M.D.

Referred to: Reference Committee III

Whereas, the ISMA supports fair and unbiased peer review in the interest of improving the safety and quality of patient care; and

Whereas, the Health Care Quality Improvement Act (HCQIA) of 1986 has created an environment in which those who conduct or participate in sham peer review (bad faith peer review) enjoy substantial immunity; and

Whereas, substantive due process in peer review corrective actions is often lacking in the hospital setting; and

Whereas, medical providers are often targeted via sham peer review and careers are often ruined as a result; and

Whereas, in recognition of the fact that sham peer review is a growing problem nationwide; therefore, be it

RESOLVED, that the ISMA oppose the practice of sham peer review; and be it further

RESOLVED, that the ISMA establish policy that those who conduct or participate in sham peer review engage in unethical and/or unprofessional conduct; and be it further

RESOLVED, that the ISMA support legislation that extends existing “Whistleblower” and “Patient Advocate” laws to physicians who are employees of hospitals, managed care organizations, states and federal institutions to all physicians in Indiana; and be it further

RESOLVED, that the ISMA seek legislation that would authorize the Indiana Medical Licensing Board to take appropriate action, including a license review, against individual medical providers, ambulatory surgery centers and hospitals in Indiana for unethical/unprofessional practices.

 

Resolution 07-34 Universal Health Insurance in Indiana

Introduced by: Robert Stone, M.D., and Monroe/Owen Co. Medical Society

Referred to: Reference Committee II

Whereas, there are over 850,000 Hoosiers without any health insurance coverage; and

Whereas, The Institute of Medicine has determined that those without health insurance live sicker and die younger; and

Whereas, Indiana has one of the highest rates of bankruptcy due to medical causes, affecting 77,000 Hoosiers; and

Whereas, the prospect of significant health care reform at the federal level is poor; and

Whereas, Indiana has a history of passing innovative health care legislation with the passage of the Medical Malpractice Act in 1975; therefore, be it

RESOLVED, that the ISMA support passage of legislation by the Indiana General Assembly that would provide all citizens with health insurance coverage, improve affordability, ensure patients’ choice of medical providers, and focus on disease prevention and health promotion; and be it further

RESOLVED, that any such legislation to provide all citizens with health insurance coverage also achieve reduction in health insurance administrative costs by requiring uniform administrative processes including, but not limited to, claim submission, procedure authorization, prescription drug access and claim payment.

Resolution 07-35 Proper Reimbursement for Vaccine

Introduced by: Windel Stracener, M.D., and the IAFP

Referred to: Reference Committee IV

Whereas, contracts with some insurance companies provide for reimbursement of vaccines that is less than the cost to the physician for those vaccines; and

Whereas, it is not financially feasible to provide the administration of those vaccines at a net loss; and

Whereas, such inadequate reimbursement results in the loss of access to that service by the beneficiaries; therefore, be it

RESOLVED, that the ISMA work with primary care physician organizations, including the Indiana Academy of Family Physicians, to seek dialogue with payers that reimburse at less than the cost of vaccines and urge a reimbursement rate for physicians that covers at least the cost of the vaccine, storage and handling involved in administration of the vaccine; and be it further

RESOLVED, that should dialogue with payers not result in a change in the reimbursement rate to cover at least the cost of vaccine, storage and handling involved, that the ISMA work with the appropriate legislative body for action resulting in a reimbursement rate for physicians that covers at least the cost of the vaccine, storage and handling involved in administration of the vaccine.

 

Resolution 07-36 Fixing the Conversion Factor

Introduced by: Windel Stracener, M.D., and the IAFP

Referre to: Reference Committee III

Whereas, it is well documented that American society spends far more on its health care system, with much poorer results, than any other industrialized nation; and

Whereas, multiple studies have shown that nations with strong primary care have less costly health care and better health outcomes; and

Whereas, in the U.S., primary care, pediatrics, internal medicine and family medicine physicians have seen significant reductions in their relative income; and

Whereas, in recent years medical student interest in entering primary care has plummeted; and

Whereas, one factor in this income decline has been the inappropriate use of the Resource Based Relative Value System (RBRVS) created by Congress, Medicare and the RUC process; and

Whereas, many insurance companies pay significantly higher values for procedures than they do for cognitive services by using multiple conversion factors in their payment formulas; and

Whereas, this use of multiple conversion factors has evolved into a major influence in the current huge disparity of incomes between procedural physicians and primary care; therefore, be it

RESOLVED, that the ISMA initiate dialogue with Indiana’s insurance companies to resolve the payment disparity between procedural and primary care physicians and develop possible solutions regarding this payment disparity; and be it further

RESOLVED, that if appropriate dialogue with Indiana’s insurance companies does not work to resolve the payment disparity between procedural and primary care physicians, the ISMA work with the appropriate legislative body to resolve the payment disparity between procedural and primary care physicians.

Resolution 07-37 Restrictions for Indoor Tanning Facilities

Introduced by: Deborah J. Armstrong, M.D., Ph.D.

Referred to: Reference Committee III

Whereas, the U.S. Department of Health and Human Services has declared ultraviolet radiation from the sun and artificial sources a known carcinogen; and

Whereas, the World Health Organization supports prohibiting teenagers from indoor tanning; and

Whereas, the American Academy of Dermatology opposes indoor tanning and supports a ban on the production and sale of indoor tanning equipment for non-medical purposes; and

Whereas, exposure to ultraviolet light is a recognized risk factor for development of melanoma; and

Whereas, exposure to ultraviolet light is associated with an increased risk for both basal cell carcinoma and squamous cell carcinoma; and

Whereas, indoor tanning lamps emit ultraviolet light at levels far greater than the sun; and

Whereas, the U.S. Food and Drug Administration has not banned the sale and use of tanning equipment for non-medical purposes; therefore, be it

RESOLVED, that the ISMA support the American Academy of Dermatology’s position that there be restrictions on indoor tanning facilities including:

• Prohibiting minors from using tanning devices
• Posting the surgeon general’s warning on all tanning devices
• Prohibiting a person or facility from advertising the use of any ultraviolet A or ultraviolet B tanning device using words such as “safe,” “safe tanning,” “no harmful rays,” “no adverse effect” or similar wording or concepts

Resolution 07-38 Pesticide Use in Indiana Schools

Introduced by: John Ellis, M.D.

Referred to: Reference Committee IV

Whereas, the health and safety of the children of Indiana are a high priority for the ISMA; and

Whereas, pesticides represent a definite health hazard to all who come in contact with them; and

Whereas, children are at increased vulnerability to toxins, including pesticides, by virtue of their rapid growth and development and small body mass; and

Whereas, the Indiana Pesticide Review Board has promulgated guidelines on appropriate use of pesticides in schools (Indiana Pest Control Policy Recommendations); and

Whereas, the guidelines have been voluntary, resulting in extremely limited compliance by Indiana school districts despite their commitment to comply; therefore, be it

RESOLVED, that the ISMA task the School Health Committee to provide any available credible information on the status of compliance in each school district in Indiana for review and action of the ISMA Board; and be it further

RESOLVED, that the ISMA work with the Indiana Pesticide Review Board, the Indiana Chapter of the AAP and the AAFP, the Indiana Department of Health, the Indiana Department of Education, the Indiana Department of Environmental Management, Improving Kids’ Environment and/ or other appropriate entities to improve compliance of Indiana school districts with the current and future Indiana Pest Control Policy Recommendations regarding the safe and effective use of pesticides or other pest control methods.