THE VOICE FOR PRIVATE DOCTORS

Index No.2 January, 1974, Volume 28, No.1

Spe~ial AMA Meeting Report

A comprehensive, in-depth review of the PSRO controversy at the AMA Clinical Meeting, Anaheim, California, in December. AAPS alone has the dedication to principle and the capacity for action

which makes such a report as this possible. Please urge at least one other doctor to join AAPS now and strengthen the effort to save U.S. medicine - Donald Quinlan, M.D., President.

AMA H,ouse of Delegates V·otes

For Abolishing The PSRO Law

Members of the American Medical Association House of Delegates climaxed a tumultuous clinical meeting at Anaheim, California, in December by rebuffing, without a dissenting vote, repeated exhortations of AMA officers, trustees and high-level staff to reassert without change the Association's policy of collaboration with government to impose PSRO controls on the nation's physicians and their Medicare and Medicaid patients.

AAPS Lawsuit Supported

Much interest was evident at the AMA Clinical Meeting in the AAPS lawsuit to declare the PSRO law unconstitutional. One resolution (No. 29 introduced by Virginia) specifically called for AMA to support the suit. Several delegates also urged AMA to support the suit.

The Virginia resolution resolved "that the American Medical Association publicly announce its approval of the lawsuit initiated by the Association of American Physicians and Surgeons, and that the membership be encouraged to use every practical means to bring about a successful termination of this lawsuit ... "

The Reference Committee only indirectly acknowledged the subject by disposing of Resolution No. 36 (urging a study of PSRO constitutionality) in these words:

"Your committee is also well aware that the matter of Resolution 36 is already the subject of court action instituted by members of the profession, so that adoption of this resolution ... would be a costly duplication ot judicial review of the law which is already under way."

The House on Dec. 5, 1973, made it clear the best course of action was to abolish the PSRO law. Delegates amended a report of the Board of Trustees and Council on Medical Service (Report EE) to make it clear that: "The considered opinion of this House of Delegates is that the best interests of the American people, our patients, would be served by repeal of the present PSRO legislation."

The amendment to Report EE also directed the Board of Trustees to "work to inform the public and legislators as to the potential deleterious effects of this law on the quality, confidentiality and cost of medical care." This was a renewal of a previous House directive which AMA Executive Vice President Ernest B. Howard, M.D., said was wrong and admitted he had declined to carry out.

INSIDE
• Text of AMA PSRO Amendment
• AMA Executive Backs Down
• ~eference Committee PSRO Debate
• House of Delegates Debate
• Rep. Crane's Speech - "PSRO Repeal
is Possible"
• At Large AMA Trustee Elections
• AMA Headquarters Stay
• Dr. Heard Is Board Candidate
• Dr. Retires in PSRO Protest A month after the Anaheim meeting, members of the Board of Trustees were claiming they were so confused over action of the House of Delegates they could reach no specific agreement on abolition of PSRO or on implementation of the House order to tell the public about the bad provisions of the PSRO law.

They professed to be confused because parts of Report EE as amended appeared to conf.ict with other parts as crlqincllv drafted. Specifically, they indicated belief that the statement of the amendment that PSRO should be abolished was incompatible with the concluding statement of Report EE which recommended the AMA "continue to exert its (PSROl leadership by supporting constructive amendments to the PSRO law, coupled with continuation of the effort to develop appropriate rules and regulations."

Meet in Puerto Rico

The Board and selected members of the executive staff early in Jcnucry journeyed to Puerto Rico to meditate on what had happened at Anaheim and, as one source put it, "to ponder what position the AMA could take without losing credibility."

The Board could arrive at no conclusions at Puerto Rico. The entire subject of PSRO and Report EE - "left up in the air" at Puerto Rico - will be discussed again by the Board and staff at a meeting in Chicago late this January.

Many members of the AMA House of Delegates will be surprised to find out that trustees have adopted confusion as a reason for failure to map out a campaign aimed at abolishing PSRO by persuading Congress to repeal the law.

If anything was made clear at Anaheim, it was this: The overwhelming majority of delegates, alternates and other physicians at the meetin:g want the PSRO law abolished, and in that desire, they reflect the wishes of an overwhelming majority of "the doctors back home."

AMA officers, trustees and executive staff went to Anaheim evidently expecting to convince the House of Delegates that the best thing to do wos to let the Board continue the policy of collaboration and support amendments to the law.

The House of Delegates said no, that was not the best thing to do. The House witJwut dissent said the best thing to do is repeal the law.

When the amendment to Report EE wos adopted, Carrolf Witten, M.D., Louisville, Ky., Delegate from the Section on Family and General Practice, observed that the amendment "makes it quite clear that it is our intent to work for repeal." No one disagreed.

Theodore Grevas, M.D., Delegate from Rock Island, lll., warned the House that "failure to repeal the law at this time is never to repeal it."

It was a'so clear at Anaheim that practically every physician, including all AMA officers and trustees, asserts that PSRO is a bod low. That fact prompted john P. Heard, M.D., President of the DeKalb County (Georgia) Medical Society, to observe: "I think it woold be immoral to support a law we believe to be a bad low."

(Note: Although the trustees claim confusion now, there was little if any immediately following the Anaheim meet-

ing, even in the AMA headquarters. The Wall Street Journal, The New York Times, Medical World News, Human Events, and even the American Medical News agreed that the House had voted to seek repeal of PSRO. In the Dec. 10, 1973, issue of American Medical News, a headline on a story about events at Anaheim proclaimed: "AMA Expands PSRO Policy to Seek Repeal." An editorial in the same issue contains this paragraph:

"Are the AMA's twin goals of PSRO repeal and exerting leadership in implementing the law incompatible? No. Not incompatible, but admittedly difficult." Dr. Howard, AMA Executive Vice President, reportedly approves all stories and editorials that appear in American Medical News.

Asks Board Ignore Repeal

After the clinical meeting in Anaheim and before the Board and staff session in Puerto Rico, a memorandum was distributed to members of the Council on Medical Service by the Council Chairman William B. Hildebrand, M.D. The memorandum said that Dr. Hildebrand and Council members C. Willard Camalier, M.D., and Donald R. Hayes, M.D., had met in Washington, D.C., with H. Phillip Hampton, M.D., Chairman of the Council on Legislation, and the Executive Committee of the AMA Board of Trustees "to discuss the interpretation to the amended Report EE as passed by the House of Delegates at Anaheim."

The memorandum said those who met couldn't come up with an interpretation because of "diametrically opposed points of view" in the amended Board report. Dr. Hildebrand's memorandum said that as a consequence it would be recommended to the Board that no action seeking PSRO repeal be taken. The memorandum said it would be recommended that only the last paragraph of amended Report EE be implemented. That paragraph would have left AMA committed to continuing collaboration with government, to supporting "constructive" amendments to PSRO and to attempting to influence HEW in drafting rules and regulations to put PSRO into effect, but not to worklnq for repeal.

The recommendation to ignore the House decision that the best course of action is to abolish PSRO was not accepted by the Board at Puerto Rico, according to AMA sources.

The Board also ruled out suggestions that a special session of the House of Delegates be called to "clarify Report EE"; that the Board solicit opinions on the question of abolition of PSRO from other organizations, such as AAPS; that AMA members be polled to find out how they feel about repealing PSRO; that delegates from the six states that drafted the repeal amendment to Report EE be called in to explain what they expected to result from the amendment.

The Board agreed, however, that AMA's Washington lobbyists should be instructed to inform members of Congress about the deleterious provisions of the PSRO law. The Board also directed the staff to draft a "white paper" on PSRO for discussion at the next Board meeting. Tom E. Nesbitt, M.D., Speaker of the House, Malcolm C. Todd, M.D., AMA President Elect, and Richard E. Palmer, M.D., Board Vice Chairman, were assigned to oversee preparation of the paper.

Not As Planned

The House of Delegates meeting in Anaheim did not, apparently, proceed as planned. In the past, the House

almost always has gone along with the desires of trustees and the Association's administration on major issues, even though it sometimes has had reservations about doing so. Resolutions and reports were usually considered according to patterns laid out in advance. Often, satellite meetings were set up and artfully guided by the AMA administration. Rarely, if ever did the results turn out differently than planned. At Anaheim, a sote.ltte meeting was organized for Saturday, December 1,1973, to promote collaboration with PSRO (every originally scheduled speaker was a PSRO booster, and some were full or part-time employees of HEW). Report EE of the Board of Trustees and Council on Medical Service was drafted to reaffirm the policy of collaboration, but the report was not made available to delegates until the opening day of the House meeting. It was expected that the numerous antiPSRO reso'utions would be shunted to the Board and that Report EE would be adopted with minimum debate and without substantive change.

However, there was pervasive grumbling during the meeting about PSRO collaboration and many calls for support of AAPS efforts to abolish PSRO by challenging its constitutionality in federal court. There was widespread support for repeal. The grumbling was not taken seriously at first by the trustees because in the past at Cincinnati and New York meetings, the AMA management had succeeded in getting its way on the PSRO issue and it was expected to do so again this time.

But that strategy began coming unglued at the special Dec. 1 satellite meeting designed to promote P SRO and reinforce collaboration. A wave of protest at the unrepresentative nature of that satellite meeting force the last-minute inclusion of one _ but only one _ opponent of PSRO. That was J. W. Johnson, M.D., who was elected President of the San Diego County Medical Society on a platform vigorously opposing PSRO. His Association of over 2,000 physicians is on record for repeal. He called PSRO the "seed of destruction of civilized humane medical care." And he said he had heard that if PSRO .is abolished some, thing worse would follow, "but I've tried and tried and I just can't think of anything worse." Dr. Johnson's direct and unevasive criticism of PSRO was obviously - from the amount of applause he received - the point of view shared by most of the physician audience. It also presaged things to come.

That Saturday PSRO satellite meeting disc'osed to physicians the degree of authoritarianism they could expect from HEW officials responsible for enforcing PSRO. The unmistakable attitude of Henry P. Simmons, M.D., Deputy Assistant Secretary for HEW and director of HEW's PSRO office, was that "things will be done our way" whether doctors like it or not. And this is "your last opportunity" to do as the bureaucrats say to avoid something worse.

Prior to the meeting all delegates and alternate delegates had been sent a letter by Donald Quinlan, M.D., President of the AAPS, which refuted a charge by Sen. Wallace Bennett (R., Utah) that the AAPS had pushed the panic button on PSRO. To prove the accuracy of the AAPS criticism of PSRO, a copy of the law was enclosed with Dr. Quinlan's letter.

Unexpected Development

Sunday, December 2, brought a new, unexpected development - - an open letter to the House of Delegates

signed by 34 U.S. Representatives urging the AMA House of Delegates to adopt a PSRO repeal resolution to help those in Congress who are working toward that goal. That open letter was so unsettling to trustees and officers that there is evidence they spent the next two days !!Ying to get signers to withdraw their signatures and attempting to discredit its urgent message.

Dr. Heard later told MPS he had been informed that "several congressmen weI'S threatened with loss of AMPAC support if they did not remove their names from the petition (letter) to the AMA House asking for AMA to go on record for repeal of PSRO."

The letter from the congressmen said: "That section (PSRO section of Public Law 92-603) will require you to practice according to computerized standards, rather than using your best medical judgment in treating your patients. It will deprive your patients of their right to privacy, it will impose severe fines for medical innovation.

"Some of you have urged AMA participation in implementation of PSRO so you can control the administration of the low. But PSRO is the law of the land; it is the working of Congress and its implementation is the responsibilty of the Department of Health, Education and Welfare. Even if you help implement the law, you will not control it. The only way to ovoid the law's bad effects is to repeal it.

"The PSRO section is bad law; it will be bad for the doctor and bad for the patient. It should be repealed. Unfortunotely, although many of us in Congress want to work for the repeal of PSRO, we have been handicapped by the AMA's failure to continue its active opposition to the low. Some of us have already introduced bills to repeal PSRO, but if we are to be successful we need your help. We strongly urge the House of Delegates to pass a resolution specifically colling for the repeal of PSRO and committing the all-out efforts of the American Medical Association to that end." (Emphasis added.)

The AMA member most responsible for the letter was Dr. Heard, who is a member of the AAPS. The idea for the letter developed during a conversotion between Dr. Heard and his Congressman, Rep. Benjamin B. B'ackburn. When the letter arrived at Anaheim on Sunday, Jack E. Shields, M.D., delegate from Brownstown, Indiana, obtained permission for Dr. Heard, who is nof a delegate, to read the open letter to the House.

Strong Support Unwelcome

Officers and trustees did not welcome such strong support for abolishing a law which these same trustees and officers have said is a bad low, - unless they have the power of enforcement.

Their reaction to the letter astonished many delegates and prompted one, Stanley S. Peterson, M.D., Springfield, Mo., to observe that was a classic example of why doctors are concerned about the AMA. He said AMA leaders ought to do what is right.

Robert B. Hunter, M.D., a trustee and AMA's chief PSRO spokesman, who is also paid for serving on HEW Secretary Caspar Weinberger's National PSRO Council, was topped by trustees to dispose of the letter on Monday, Dec. 3, at the Reference Committee hearing

on PSRO reports and resolutions. It was noted that two congressmen, Rep. Joel Broyhill of Virginia and Rep. Edward Derwinski of Illinois, had been persuaded to withdraw their names.

Dr. Hunter, in an obvious attempt to convince delegates pursuit of repeal would be unwise and fruitless, said AMA Washington lobbyists sought out Rep. AI Ullman, liberal Oregonian and ranking Democrat on the House Ways and Means Committee, a man who has never been known as a champion of medical freedom. According to Dr. Hunter, Rep. Ullman was "obviously disturbed" that the open letter had been submitted to the House of Delegates. He was quoted in effect as saying that he and all Democrats on Ways and Means would oppose repeal.

Rep. Herman Schneebe'i of Pennsylvania, ranking Republican on the Committee, was quoted as saying repeal "is unlikely to succeed" and adding he knew of no Senate sentiment for repeal.

Consequently, when the Reference Committee met, the Q1!1y documents not in opposition to PSRO were Report A and Report EE of the Board of Trustees and Council on Medical Service.

Witnesses opposed to PSRO and favoring abolition of the law either by repeal or by means of the AAPS lawsuit outnumbered those supporting the law and the position of the AMA administration by nearly two to one. That was evident at the Reference Committee and in the House of Delegates.

Committee Echoes Board

But the Reference Committee, as seasoned observers expected, did not heed the plea of those who sought a policy in support of abolition. It recommended that all opposition resolutions be filed and Report EE be adopted unchanged. The Committee, echoing the Board of Trustees, told the House that:

Text of PSRO Repeal Amend1ment

It is clear the AMA House of Delegates at the meeting in Anaheim voted for abolition of the PSRO law. This action came on a vote, without dissent, adopting an amendment to Report EE. This report as authored by the Board of Trustees and Council on Medical Service, was intended to continue the Board policy of collaboration. The text of the amendment for repeal follows.

"The AMA affirms the following principles:

"1. That the medical profession remains firmly committed to the principle of peer review, under professional direction, and

"2. That medical society programs of proven effectiveness should not be dismantled by PSRO implementation, and

"3. That the association suggests that each hospital medical staff, working with the local medical society, continue to develop its own peer review based upon principles of sound medical practice and documentable object-

AMA lobbyists then went to Sen. Bennett, the chief congressional sponsor of PSRO, who was depicted as recoiling in horror at the thought of repeal and who responded with a threat that if repeal passed Congress, he would "strongly urge the President to veto the legislation."

The Dec. 3 Reference Committee session heard testimony on 10 resolutions opposing PSRO, half of them demanding abolition of this dangerous law. Only one resolution sympathetic to the collaborationist policy of the Board of Trustees was introduced (No. 15 from the Michigan delegation) and it was withdrawn at the Reference Committee hearing. That resolUtion, incidentally, was in conflict with the position of the Michigan State Medical Society House of Delegates, which favors repeal of PSRO.

tive criteria, so as to certify that objective review of quality and utl'lzotion does take place; to make these review procedures sufficiently strong as to be unassailable by any outside party or parties; and that the local and state medical socleties take all legal steps to resist the intrusion of any third party into the practice of medicine, and

"4. That this House of Delegates, as individual physicians and through the Board of Trustees and its Council on Legislation, work to inform the public and legislators as to the potential deleterious effects of this law on the quality, confidentiality, and cost of medical care; and the hope that the Congress in their wisdom will respond by either repeal, modification, or interpretation of ru!es which will protect the public.

"The considered opinion of the House of Delegates is that the best interests of the American people, our patients, would be served by the repeal of the present PSRO legislation. It is also believed that this is consistent with our long-standing policy and opposition to this legis'ation prior to passage."

• Attempts to repeal PSRO "would be fruitless."

• A policy of repeal or one of nonparticipation would hinder efforts to amend the PSRO law or to modify regulations.

• Such a position would weaken AMA efforts to influence pending and future health legislation.

• PSRO repeal would still leave the medical profession subject to other legislative controls.

• Adoption of Report EE would not deny possibility of eventual action for repeal ... "should such action become more viable and appropriate." (Emphasis added.)

The committee report was an unmistakable signal that abolition of PSRO was not acceptable to trustees,

officers and the Executive Vice President. Being committed to a policy of collaboration with government to force PSRO controls an physicians and their patients, they did not intend to change.

The AMA's early decision to help HEW implement the PSRO program was noted with pleasure by Charles C. Edwards, M.D., HEW's Assistant Secretary for Health, in an address to the House of Delegates. He applauded AMA and other organizations for recognizing "both the problems and the potential of PSRO." He said the Association would be making a mistake if it reversed its policy of leadership in implementing PSRO. Later at a news conference, Dr. Edwards.__argued that PSRO wou'd not curtail medical innovation. He said he could think of no "meaningful medical advances in the past 20 years that wouldn't have come about under PSRO." But the government's top doctor ominously warned that innovation could be stifled if the medical profession did not assume a dominant role in operation of the PSRO program.

Another Surprise

The morning of Wednesday, Dec. 5, brought another unnerving surprise to the Board and AMA management. A substantial number of AMA delegates who are also AAPS members arranged for Rep. Philip Crane (R., lll.) - primary circulator of the letter appealing to AMA to support repeal - - to come to Anaheim. He was given permission to speak to the House of Delegates at the morning session on Wednesday. He said it is "gbsolutely not true" that a campaign to repeal PSRO would be fruitless. He strongly disputed arguments that the AMA would weaken its influence on other legislative matters if it pursued repeal.

Rep. Crane's speech "turned the House around." Delegates from six states -- California, Illinois, Michigan, Kentucky, Louisiana and New York - joined in drafting the amendment to Report EE that put the House of Delegates clearly on the side of abolition of PSRO by repeal.

Otto K. Enqelke, M.D., De'ecote from Ann Arbor, Mich., arose to "especially thank Congressman Crane for appearing before us at this session and getting us back on the track." Dr. Engelke urged the House to adopt the Michigan - State Medical Society position to comp+'qn for repeal "through all methods available," including support of the Rarick Bill (H.R. 9375).

Note: Rep. Crane's speech - the most important of the entire Clinical Meeting -- was briefly mentioned near the end of the American Medical News story on the meeting. Dr. Edwards, however, was given a separate, full-blown story in the AMA newspaper.)

The amendment to Report EE, subsequently adopted without a dissenting vote, put the AMA unequivocally in opposition to PSRO for the first time. But it did more than that. It stated the belief that medical society peer review programs of "proven effectiveness" should not "be dismantled by PSRO implementation." And it urged state and local medico I societies to "take all legal steps to resist the intrusion of any third party into the practice of medicine."

As one means of carrying out that House policy, state medical associations are invited to join AAPS in its lawsuit to outlaw PSRO by filling amicus curiae briefs in support of the

suit.

AMA Executive F,orced To Back Down

Contained in Report EE of the AMA Board of Trustees and Council on Medical Service, submitted to the House of De'eqotes at Anaheim, Calif., is the statement that "at all times the House of Delegates determines Association policy" and that "it is the role of the Councils, committees, and the Board of Trustees to implement this policy."

During the PSRO hearing before the Reference Committee at Anaheim, Board Chairman James Sammons, M.D., declared emphatically: "You can't sit here today and leave this room with the mistaken belief that the office of the Executive Vice President or any other staff employee of this Association is not devoting his time and effort to carrying out the will of this House. Gentlemen, I hope the record reflects that henceforth."

These statements were subjected to ques: tion during debate at the Reference Committee on Monday, Dec. 3, 1973.

One who questioned them was John P. Heard, M.D., President of the DeKalb County (Go.) Medical Society. Dr. Heard pointed out that the House of Delegates at the 1973 Annual Convention in New York had directed the AMA to oppose facets of PSRO which "act to the deterioration of quality care" and that the Association "publicize such deleterious facets:'

Dr. Heard said he had written AMA headquarters more than once inquiring what was being done to carry out that directive. He said he received equivocal and

unresponsive answers from Executive Vice President Ernest B. Howard, M.D.

Stated House Was Wrong

Dr. Heard said that at a conference in Atlanta, Dr.

Howard stated the House of Delegates was wrong in directing that the deleterious facets of PSRO be publicized and that the staff had decided it was impossib'e to carry out the directive. Dr. Heard said Dr. Howard commented that the law was too complex for the public to understand. Later, Dr. Heard said, he received a letter from Dr. Howard in which he stated that he had, indeed, made such statements in Atlanta.

When Dr. Heard finished his remarks at the Reference Committee, an angry Dr. Howard accused him of a personal attack on him and challenged Dr. Heard to produce such a letter so everyone present could know exactly what he, Dr. Howard, had said - "if you have the letter with you, which I don't suppose you have."

Dr. Heard left the meeting, returned shortly and was recognized to speak. He read a letter to him from Dr. Howard dated Nov. 15, 1973, in which Dr. Howard said:

"Unfortunately, at the time of the meeting (in Atlanta) did not have the exact wording of this substitute resolution with me. If I had had the wording, I would have indicated my agreement with it. The discussion at the Atlanta meeting concerned the wisdom of attempting to persuade the public to support our concern about PSRO. I

indicated that such an effort would fail because the public wou'd not understand the technical implications of this comp'ex act and because there was no implementation at this time to which one could refer. Believing that the House had directed that kind of a campaign, I said I felt the House was wrong. However, having reviewed that House action since my return to Chicago, it is apparent that the House did not direct such an unrealizable campaign and my comment in Atlanta, therefore, was incorrect."

When Dr. Heard had finished, Dr. Howard acknowledged he was forced "to eat crow gracefully," to admit he had indeed accused the House of being wrong and had said staff could nut carry out the mandate of the House.

It was not the first time that Dr. Howard had put down on paper that the House mandate to publicize the bad aspects of the PSRO law would not be carried out. On Oct. 5, 1973, he wrote to Dr. Heard declaring a response by Tom Nesbitt, M.D., Speaker of the House, was "a perfect answer" to Dr. Heard's inquiry about what was being done to publicize the de'eterious facets of the law.

Won't Pursue Effort

"In effect," Dr. Howard said, "we pointed out the probable deleterious facets of the PSRO legislation in our

testimony and in numerous public statements at the time it was under consideration in the Congress. We are in no position to pursue that effort today prior tOCiiiY implementation of the law. The examples that you suggest which would be deleterious (invasion of confidentiality ... etc .... etc.) cannot be proven to exist today since there is no PSRO in the nation. There is no 'rule book for medical care.' There is no proof to which we can point that PSRO wil,l 'dehumanize' medical care. In other words, we do not have the documentable data to support our misgivings (I share them!).

"I think there is no question whatever that the public would not be responsive to nor would the public listen to our protestations about the probable adverse affects of PSRO at this time in our history. I agree with you that we must have the public behind us if repeal or significant change of this law becomes possible. We win not have that public support, however, if we act in a manner that is considered irresponsible by most public leaders."

Members of the House of Delegates obviously do not share Dr. Howard's opinions. Once again at Anaheim, the House directed the Board of Trustees to "work to inform the public and legislators as to the potential deleterious effects of this law on the quality, confidentiality and cost of medical care."

(ongressmlln (rllne Detlllres

Tbllt PSRD Repelll Is

"I can assure you probably 90 per cent of the members of the United States Congress today haven't the fuzziest idea what a PSRO is. They don't understand the concept. They don't understand even that they cast a vote on it."

That pungent observation opened the address of Rep.

Philip Crane (R., 111.) to the AMA House of Delegates Wednesday morning, Dec. 5, 1973, an address that did much to awaken members of the House that it is possible Congress can be persuaded to repeal PSRO.

Rep. Crane helped nullify vigorous efforts of trustees, officers and high-level staff to block adoption by the House of a policy favoring PSRO repeal. And that's what happened. Shortly after Rep. Crane's speech, the House approved a statement that "the best interests of the American people, our patients, would be served by the repeal of the present PSRO legislation."

(Note: The Board of Trustees, pleading lack of money, said it would not print Rep. Crane's speech for the benefit of delegates and alternates. A month later, members of the Board and selected headquarters staff flew to Puerto Rico for a Board meeting.)

Rep. Crane chided AMA leadership for conceding the premise of medicine's enemies.

"The very worst approach you can take is to concede your opponent's premise at the outset," he said. "And in my judgment that's what the Administration has done, that's what the medical profession has done, the health insurance people have done it, hospital associations have done it. You have implicitly accepted Teddy's (Sen. Edward Kennedy) analysis of the problem - that there is, indeed, a health crisis, and your response to that is 'we have a better approach to dealing with that crisis'."

Possible

Rep. Crane said that from talking to physicians he had concluded that no one in the medical profession will defend in principle the concept of PSRO. "The objections to PSROs are abundantly plain to you, but there are two critical ones that strike me that are overriding. One is this idea that you can have laymen or you can have bureaucrats . . . impinging their judgments on the best professional judgment of the people most immediately related to the problems - and that's the people in the medical profession. In addition, the potential for invasion of patients files, in my judgement, is a clear violation of the Hippocratic Oath and your professional commitment. We have this Ellsberg case where they broke into a psychiatrist's office to get files, and believe me, you've got a potential in PSRO to let bureaucrats into anybody's files. , can assure you that if you brought this point convlnclnqly home to politicians, you've got a sensitive nerve ending there you can put your finger on with a view to getting po'iticians to understand the inadvisability of this kind of legislation."

Lot of Repeal Support

Rep. Crane took issue with the argument of AMA leadership that attempts to repeal PSRO would be fruitless, a position AMA management said was buttressed by ranking members of the House Ways and Means Committee.

"Well," said Rep. Crane, "I can assure you the Ways and Means Committee is not the exclusive committee to talk to on this. There is potentially a whale of a lot of support in that Congress for outright repeal. What support is not there is primarily based on a lack of understanding of what's happened - and that even includes members of the Ways and Means Committee who don't understand what PSRO is all about.

"This is not a lost battle. There is no rearon why you cannot explore a variety of options available to you simultaneously. You don't have to give up on the idea of repeal only because you think what is better, or preferable, or more likely or viable politically is an attempt to clean up a bad law. You can do both simultaneously."

In an apparent reference to the lawsuit filed by AAPS in federal court to outlaw PSRO, Rep. Crane said that another option open to the AMA was to "contemplate working through the courts."

Rep. Crane also attacked the position of the Board of Trustees that a policy of nonparticipation would render fruitless efforts by the AMA to amend PSRO or modify regulations.

"THAT IS ABSOLUTELY NOT TRUE," he said.

He pointed out that members of Congress are responsive to their local constituencies. Furthermore, he said, "you can go on record as a national body condemning on princlple what you know in your hearts to be wrong and what you know does violence to your professional ethics."

Patients Should Be Alerted

Rep. Crane urged physicians to alert their patients to the dangers of the PSRO law. "Patients are voters," he pointed out. "And if you alert them to the danger, then you can generate a great deal of political influence and that will magnify your impact considerably."

The Illinois Congressman also shot down the AMA management argument that repeal of PSRO would leave

House Debate

the medical profession still subject to other legislative controls, present and future.

"Well, to be sure that's a possibility," said Rep. Crane.

"But let me just tell you one other thing, and that is, J! we are going to draw the battle lines on principles - and in my judgment that's how they should be drawn - the best way calculated to permit the government intrusion that could ultimately destroy your profession is to get compliance. You draw those battle lines on the basis of the professional judgment of the physician versus the gun that's being pointed at your head by government ... and if the public ever sees that battle drawn on those lines, I can assure you they will be on your side.

"And I can assure you beyond that, that once they are on your side, the politicians will back off in a hurry."

Rep. Crane cautioned against the despair of "inevitability". "I think the most pernicious doctrine in Washington today is a certain feeling of despair over the inevitability of legislation. That doctrine of inevitability is the most pernicious dogma that Karl Marx ever advanced."

"I'm telling you:' he said, "there are good ideas and right principles, and if you people who are most immediately affected will not be in the vanguard of fighting that battle, then to be sure, we may be down the tube; it may be simply a matter of time and they'll take us salami style - a slice today and a slice tomorrow and a slice the next day."

Rep. Crane made it clear that even if the AMA did not come out for repeal of PSRO, "I and a number of my colleagues will continue to wage that battle because patients are going to be concerned about this."

There WIIS No Middle Ground on PSRD

One of the striking things about debate over PSRO at the AMA Clinical Meeting in Anaheim, Calif., was that there was no middle ground - physicians either wanted the AMA to work to abolish the law by repeal or court action or they wanted it retained, with AMA continuing collaboratio n on implementation. Here are excerpts from pro and can arguments during the Dec. 5 session of the House of Delegates.

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James M. Sammons, M.D., Chairman, Board of Trustees (granted special permission to address the House):

"Tuesday a week ago, your President and I were in Washington and met with the leadership on both sides of the aisle in the House of Representatives and we met with the leadership of the Finance Committee of the Senate. We asked, What in your opinion is the politicai viability, the chance of success of Mr. Rarick's bill or similar bills asking for repeal of PSRO?' The uniformity of their answers I think is important. Uniformly it was that it has absolutely no political viability whatsoever. We asked why. The answers given us were - (1) the law has not even been put into effect . . . and is not going to be repealed until it has been tried; (2) with massive expenditures (for Medicare and Medicaid) we must have some assurance that quality is being delivered, and (3) we must have some control over the ever expanding utilization." Dr. Sammons added they were assured PSRO amendments would be given "adequate hearings."

W. Charles Miller, M.D., New Orleans, La.: "I would like to thank those who selected Disneyland - the land

of fantasy - as the appropriate setting to discuss the matter we have today. Loulslcnc deeply feels that for those who feel that they can control federal law once it is started and can amend it to their satisfaction and can indeed exist with it, we suggest you are indeed in fantasyland. We further feel ... this organization should be responsive to the people back home. The position the AMA has taken on PSRO has encouraged people to look for other sources to defend their positions and their rights." Dr. Miller then submitted an amendment to Report EE to add a repeal section. The substance of his proposal was later adopted.

Morgan Meyer, M.D., Lombard, 111.: Offered two amendments to Report EE. One, finally adopted, called for PSRO repeal. The other said that amendments to PSRO should be pursued "with all vigor simultaneously with the strong efforts at total repeal of the PSRO law." Dr. Meyer said his amendments "would encompass the somewhat splintered atmosphere we've had in the House and the splintered atmosphere we've had back at home ... "

Otto K. Engelke, M.D., Ann Arbor, Mich.: "I want especially to thank Congressman Crane for appearing

before us at this session and getting us back on the track." Dr. Engelke said abolition of PSRO should be given top priority by the AMA.

Matthew Marshall, Jr., M.D., Pittsburgh, Pa.: He noted that the Pennsylvania delegation overwhelmingly rejected the proposition to repeal PSRO and added that physicians would be able to control PSROs.

Joseph F. Boyle, M.D., Los Angeles: Agreed that repeal would be in the best interests of the people "but I don't think it's feasible." Apparently referring to the Senate Finance Committee members, he said "they did know exactly what they were passing" when they voted for PSRO. Dr. Boyle took charge of amending Report EE. Also he said the report should be amended (as it later was)' to include, ornonq other things, mention that AMA was firmly committed to professional peer review and that hospital staffs should develop "unassailable" peer review programs. "AMA," he said, "should in no way indicate or imply it is opposed to those physicians and physicians' organizations, state medical societies, county medical societies and others, who do believe they wish to spend their major energy in attempting to effect repeal of PSRO."

John R. Schenken, M.D., Omaha, Neb.: Disputed Dr.

Boyle's contention that members of the Senate Finance Committee knew what was in the PSRO amendment to H.R. 1. "That just isn't true. Senator Curtis (Sen. Carl T. Curtis, Nebraska Repub"ican and member of the committee) told me that it wasn't true. The majority of the Finance Commitee didn't know what was in PSRO any more than members of the House Ways and Means Committee knew. Only a few knew exactly what was in the bill." Dr. Schenken noted that the Nebraska House of Delegates unanimously supported the Rarick Bill for repeal of PSRO. He said the primary thrust of AMA should be toward repeal "and all other mechanisms must be subsidiary to this thrust." He added that "many congress-

Reference Committee Debate

men will be mightily encouraged if our primary thrust is toward repeaL" (His statement was greeted with loud applause from the delegates.)

Richard l. Meiling, M.D., Columbus, Ohio: Noting that Ohio State Medical Association has developed a successful computerized peer review system "for protection of the public," he said the Ohio Association does not support PSRO and "hopes that it might be repealed."

Donald N. Sweeney, Jr., M.D., Detroit, Mich.: ''We in Michi~an are very pleased to see that the primary thrust of the information and the conversation this morning is toward repeal. We feel as other members of this House do - that our doctors back home feel that we should be workinq for repeaL" He added the primary goal of AMA should be repeal, with freedom to work for amendments to PSRO and to influence rules and regulations until repeal can be accomplished.

Thomas Parker, M.D., Greenville, S.C.: "Now is the time for action. Continuing to do what we're doing is not action. Action is support of H.R. 9375 (the Rarick Bill to abolish PSRO). Action is support of the lawsuit of AAPS to have the law declared unconstitutional ... You have got to go on the offensive. The absolutely essential action we've got to take is to seek repeal and support our friends and then do whatever else we can."

Russell B. Roth, M.D., AMA President: "1 would ~ the striking message I got from hearing Congressman' Crane this morning is of fong-range importance rather than short-range application to this problem. The message I got from him was that I shou'd, if there were any conceivable way possible for me to do it, go home to my district and send someone to Congress from that district of a like mind to Congressman Crone," Dr. Roth sang a ditty he often sings to a Porgy and Bess tune, the import of which is that we're stuck with PSRO and there's nothing that can be done about it.

PSRD Generlltes long Argument

The meeting of the Reference Committee that heard argu ments for and against PSRO was one of the longest on record, testifying to the importance of the subject to physic ians at the meeting. Here are excerpts of testimony at that Dec. 3 meeting.

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H. Thomas Ballantine, Jr., M.D., Boston, Mass.: He brought gasps of disbelief from many at the Reference Committee when he said he had talked to Sen. Wallace Bennett (R., Utah), chief Senate sponsor of PSRO, and the Senator told him the constitutionality of the PSRO "aw had been tested many times.

John Heard, M.D., Atlanta, Ga.: Dr. Heard chided the AMA trustees and executive staff for refusing to carry out a 1973 mandate of the House, of Delegates to publicize the deleterious facets of the PSRO law. He supported abolition of PSRO, declaring flit would be immoral to support a law we believe to be a bad law."

Raymond Killeen, M.D., Los Angeles: He criticized AMA administration for scheduling a pro-PSRO meeting the day before the House of Delegates met and said he resented action of the Board of Trustees in not making' Report EE available' to delegates before the day the House convened. "This House of Delegates," he said, "has a

right to know what kind of propaganda is going to be sent out from the AMA itself."

Robert B. Hunter, M.D., Sedro Woolley, Wash., a trustee and chairman of a Board committee promoting PSRO collaboration: "The Board of Trustees needs no defense. The federal government believes it will be at least three years before they issue rules and regulations on this PSRO implementation. It is impossible to advance until certain information is released (by government)."

Edward Wiater, M .. D., los Angeles: ''The main reason PSRO is of such interest is because we are questioning the policy we took under a crisis type of situation a year ago when we decided to take a leadership role in implementing the law. And what do we say about the law - it's a bad law. We decided on a leadership role in implementing a bad law. That's a paradox. If the AMA had decided to work for repeal before passage (of PSRO) we would not be in the trouble we are in today. We're not getting very for suggesting rules and regulations. All

options have not been stated in Report EE - for excrnp'e, chalieIlging the constitutionality of this law. We have an obligation to challenge its constitutionality on behalf of our patients." He noted that the Los Angeles County Medical Society, which opposes PSRO, has been studying the law for months, "whereas this Report EE was created over the weekend."

Joseph De Laurentis, M.D., Wilmington, Del.. He noted that virtually everyone, inc'uding the AMA, has branded PSRO a bad law. "I am convinced that if we hold this law to be harmful rather than helpful, our proper course is to begin an energetic campaign seeking repeal of the law." He urged AMA to abandon programs aimed at forming PSRO groups, adding that the fact that HEW would form PSROs "should not dissuade us." He said:

"There is no reason to suspect that PSROs which we form will in the long run be operated in a different fashion than those the government forms. PSRO is not our institution. It never was and never will be."

Edwin R. Wunderlich, M.D., Los Angeles: Reported that the 1O,000-member LACMA had adopted a policy that the Association would "not apply for, sponsor or endorse any PSRO organization in the country" and that LACMA districts and LACMA membership, including hospital staffs, were counseled on the advisability of such action.

Elmo Boyd, M.D., Shreveport, La.: ''Why should we endorse something again just because we blindly endorsed it the first time." Dr. Boyd noted news story that Sen. Bennett hod verbolly fogged AAPS for criticizing PSRO and had made certain assertions about the law. Dr. Boyd read what he described as "an English translation" of the law to refute Sen. Bennett. He alsa said the House action at Cincinnati - accepting the Board of Trustees policy of collaboration - was not based on "informed consent."

John J. Coury, M.D., Port Huron, Mich.: He withdrew Resolution 15 of Michigan delegation supporting position of AMA trustees "and present to you the wisdom of our House of Delegates," which favors abolition of PSRO.

Urban H. Eversole, M.D., Boston, Moss.: He said he was "speaking for the entire New England de'egation" in endorsing Report EE of the trustees and asserting "we must continue to exert leadership even more Vigorously." He said of himself and his colleagues: "Neither do we think we are violating vaunted New England conscience by supporting a totally bad law because we do not believe that the bosic precept of it is bod."

Ralph S. Emerson, M.D., Roslyn Heights, N.Y.: He argued that "you can't test the constitutionality of something that hasn't even started." He said support of Report EE "is the only oractical, sensible approach we can tcke-"

George Himler, M.D., New York, N.Y.: The author of the notorious Himler Report that advocated downgrading private practice, fee-for-service and free choice said "you're smoking opium" to believe PSRO-type controls would be wiped out by abolition of PSRO. He said he was not sure doctors would control PSRO at the local level. "Until the time we know it is not going to work this way, I think we would be damned fools to say we were going to worle for repeal of this and we are going to oppose it."

Willard C. Scrivner M.D., East St. Louis, 111., a member of the National Professional Standards Review Council:

"A feeble effort at repeal would be ill advised."

Jack Schreiber, M.D., Canfield, Ohio.. "I am skeptical that the law can be changed by amendment. The doctors back home know one thing - it's a bad law. A vote for repeal would be an expression to our doctors, who are in a mild state of revolt, that we are going to do our best to repeal it."

Joe M. Crosthwait, M.D., Midwest City, Okla.: He said PSRO was designed to correct ill-conceived financing of Medicare and Medicaid. "The solution of bureaucrats is to pass more bad legislation - hence PSRO. This law was not passed in the wisdom of Congress but was the abortion of a handful of staff bureaucrats of the Senate Finance Committee. We must look to repeal to protect our patients from the imminent danger to the quality of their health care."

Thomas Porker, M.D., Greenville, S.c.: Advocating repeal of PSRO, Dr. Parker said that Board Report Z at the Clinical Meeting in Cincinnati in 1972 which put AMA on the road to collaboration "caused consternation because it was an about face from opposition to support" of PSRO. But Dr. Parker emphasized that Report Z originated in the Board of Trustees, not the House of Delegates.

J. W. Johnson, M.D., La Jolla, Calif.: He said members of San Diego Medical Society were polled on PSRO and more than 50% responded. Asked whether the state or county societies should form PSRO groups, 530 said no and 330 said yes. But when asked whether the society should work for repeal of PSRO, 714 voted for repeal and 134 said no. "The results of a poll depend on how the questions are asked," Dr. Johnson said.

W. Collier Salley, M.D., Gloucester, Va.: He urged adoption of the Virginia resolution calling for repeal of PSRO and support of the AAPS lawsuit to abolish the law by challenging its constitutionality.

Daryl P. Harvey, M.D., Glasgow, Ky.: PSRO is "another product of a negative federation, a concubine in the harem of socialism." He said support for PSRO amounts to "socio-economic malpractice" and the law should be repealed. He re'axed tensions by punctuating pertinent points with repeated witticisms.

Theodore Grevos, M.D., Rock Island, III.: "Failure to repeal the law at this time is never to repeal the law." He said he hoped the Reference Committee in its summation "does not alienate some organizations that have been fighting for repeal, such as AAPS and CMS."

James M. Sammons, M.D., AMA Board Chairman: He made plea for retaining policy of "leadership" in implementing PSRO. He argued that repeal "is not viable." He brought a round of laughter with a slip of the tongue. "A position totally and unequivocally dedicated to repeal of this law is fraught with an exercise in fruition ... ah ... frustration."

Walter Buerger, M.D., Covina, Calif.: He urged delegates to "stand on principle" and seek abolition of PSRO. "If we do fight for repeal, we will not stand alone." For example, he said, he had a letter from Gov. Ronald Reagan saying PSRO will destroy the existing voluntary utilization review system and replace it with a less effective system which will increase health care costs, deprive Ca'ifornia of effective control of expenditures and violate the constitution. He pointed out PSRO was enacted "almost without notice."

John M. Wood, M.D., Englewood, Colo., President of were "for less visible but for more threatening" to-the

the American Association of Foundations of Medical Care, medical profession than "national heolrh insurance in

an organization seeking money from HEW: He urged its draft, PSRO in its draft and HMOs in their draft." He

support of Board Report EE without change. did not elaborate, but he added he hoped "when we leave here we have a clear position where we stand in

Russell Roth, M.D., AMA President: He said other things respect to the totality of professional review."

----------------~-------

Physician Retires In Protest Over PSRO

In what must be classified as the most devastating indictment of the "police state" concept of the PSRO law, Thomas B. Hayes, M.D., a North Andover, Mass., surgeon, has announced he will quit practice March 1 in protest against the PSRO law. Dr. Hayes has practiced for 20 years in North Andover.

He wrote personal letters to more than 1,000 of his patients informing them of his decision, explaining that he refused to submit to the "police state" controls over the practice of private medicine embodied in the PSRO law.

Dr. Hayes is senior surgeon at Lawrence General Hospital. The news reports on Dr. Hayes' decision said other physicians at the hospital share Dr. Hayes' feelings about the law, but none has so for decided to

follow the surgeon's lead.

The local medical society, however, has declined to have anything to do with implementation of the PSRO law.

In describing his fundamental objections to the PSRO law, Dr. Hayes said:

"It's like a police state. They can come to my office, take my records, decide that I'm not practicing medicine according to the TUleS set down by the government. The government tells you what to do. They say you have to cure a certain disease in a certain numbeT of days, and if you don't you can get fined. A clerk in Boston, not a doctor, will decide whether a patient 30 miles away should stay in a hospital."

Votes At-Large

The AMA House of Delegates at the Clinical Meeting in Anaheim reversed a reference committee recommendation and voted to elect members of the Board of Trustees at large in the future. Currently, candidates run " for positions on the Board.

There is some question whether this Bylaw change in the method of electing trustees wi:1 affect election of trustees next June. The resolution adopted to provide at-large elections was referred to the Council on Constitution and Bylaws for appropriate language to be submitted at the Annual Convention. The House can then vote on the question again. If it approves of the change before balloting for trustees at the convention, delegates would be elected at large.

Terms of four members of the Board expire in June this year. A fifth spot will become vacant if Trustee Max Parrott, M.D., Port'and, Ore., is named PresidentElect. He has announced his candidacy.

John Robert Kernodle, M.D., whose terms expires this year, has resigned. Others whose terms expire this year are John M. Chenault, M.D., Decatur, A'a.; Raymond T. Holden, M.D., Washington, D.C., and Donald E. Wood, M.D., Indianapolis, Ind.

AMA Headquarters Stay

For the past few months, the AMA Board of Trustees has been seriously considering moving AMA headquarters from Chicago to Washington, D.C. A special committee has been studying the matter. The Board at its meeting in Anaheim, Calif., in December approved a recommendation of the committee that Association headquarters remain in Chicago.

However, the feeling apparently is that AMA needs to beef up its Washington operation. The Board approved a committee recommendation that trustees "expeditiously consider the possibility of increased support for the AMA Washington office."

The questionable effectiveness of the AMA's Washington lobbying activity has been subject to criticism recent.y.

Dr. Heard Is Board Candidate

Although the AMA Board of Trustees reportedly does not intend to fill the vacancy caused by the resignation of John R. Kernodle, M.D., friends of J. P. Heard, M.D., Decatur, Ga., are trying to prevail in the Board to appoint him to fill out the unexpired term which ends in June.

Whether the Board names someone to fill out the unexpired term or not, Dr. Heard - whose arguments for abolition of PSRO inspired many delegates at Anaheim - has announced he is a candidate for a full term on the Board at the election next June.

Bound News Letters Available

Spiral bound copies of 1973 AAPS News Letters and Bulletins are available from Association headquarters in Oak Brook. The price is $2.00 apiece. AAPS News Letters are valuable historical documents, containing

information that cannot be found els ere.

/'[--.' For Indiv. idu R ponsibil =: nd Liberty .

. LjIUl. V / / /'-( . D

<:» ~'<-"'("~L"'~~-V

Donald Quinlan; M.D.

President

PRIVATE DOCTORS INSTITUTE, Chicago, Illinois, April 18-20, 1974 ANNUAL MEETING, New Orleans, Louisiana, October 31-November 2, 1974

ASSOCIATION OF AMERICAN 'PHYSICIANS AND SURGEONS

2111 Enco Drive, Suite N-51 5. Oak Brook. lllinois 60521 312/325-7911 Frank K. Woolley, Executive Director

~EMERGERCY BULLETIH

ASSOCIATION OF AMERICAN PHYSICIANS AND SURGEONS. INC.

2111 Enco Drive, Suite N-515, Oak Brook, Illinois 60521

312/325-7911

Donald Quinlan, M.D., President Frank K. Woolley, Executive Director

Index No. 1

BULLETIN NO. 1-74 January 4, 1974

Re: PSRO

Members have expressed fear that the PSRO Law is now in effect and that they may get into trouble by taking care of Medicare, Medicaid and other patients for which payment may be made (in whole or in part) under this Act [Social Security Act as amended} (Section 1151).

THE LAW IS NOT NOW IN OPERATION

Simply Stated the Situation is:

1. The Secretary is faced with the AAPS lawsuit.

2. The Secretary has not implemented the PSRO Law as far as imposing rules and regulations with which physicians must comply or suffer some penalty, and

3. A physician may continue to care for patients without adverse affects until

such time as the Law is implemented by a rule published in the Federal Register.

The AAPS et al suit versus Weinberger, as defendant, is now being considered

by a three-judge federal court to determine whether the legislation is constitutional. While the lawsuit is pending in case the defendant tries to take action which adversely affects physicians, we will seek interim injunctive relief. The government filed a brief on December 11 in support of its request to dismiss the case and the Association's attorneys are currently preparing a legal brief in opposition thereto. After the court has received our reply, the government must respond to

our brief. We believe the defendant's attorneys have failed to satisfactorily

answer our complaint.

Even if AAPS et al had not filed suit, the Law is not now in operation and

cannot be put into operation until proper notice is published in the Federal Register.

There is only one place where the Law refers to January 1, 1974, and that is in Section l152(a) which says:

"The Secretary shall (1) not later than January 1, 1974, establish throughout the United States appropriate areas with respect to which Professional Standards Review Organizations may be designated and (2) at the earliest practicable date after designation of an area enter into an agreement with a qualified organization, etc."

He has established the areas, BUT rules and regulations to otherwise implement the Law have not been issued by the Secretary of HEW. Also, PSRO area designations are not final. Proposed area designations were published in the Federal Register December 20, 1973 and deadline for comments is January 21, 1974. Furthermore, the Secretary has not entered into any agreements with PSROs.

- 2 -

In accordance with the Law governing administrative procedure (Chapter 5 !55l et seq. U. S. Code annotated) the Secretary of HEW is required to publish in the Federal Register a substantive rule not less than 30 days before its effective date, except -- as otherwise provided by the agency for good cause found and published with the rule.

In addition, under Section l152(f)(1), the Secretary of HEW must notify all practicing physicians in a PSRO area before he enters into an agreement with a PSRO.

Even so, fear has been expressed that the Secretary may make the rule RETROACTIVE to January 1, 1974 or for that matter to October 30, 1972. When and if the law is implemented should he attempt to make it retroactive, he would be vulnerable to strong legal challenge. The reason being that this would constitute an imposition of standards that did not exist at the time the medical service was rendered.

Generally speaking, statutes dealing with matters of administrative law and affecting rights will be construed as prospective only in their application. A clear legislative expression is necessary to justify a retroactive application.

Our attorneys advise us there is no clear legislative expression justifying this Law being made retroactive.

TO DO

1. Sit tight.

2. Direct Bill.

3. Contribute to the AAPS Legal Defense Fund (card is enclosed).

4. Write your U. S. Representative and Senators to repeal the Law:

Note: Most do not even know what it does. Rarick (D., La.) has introduced HR-9375 for repeal. More than 10 others have filed similar bills.

5. Urge patients, local associations, etc., to write U. S. Representatives and Senators requesting repeal.

6. Write AMA urging Board of Trustees and Executive Staff to carry out the current mandate of the AMA House of Delegates to work for repeal of PSRO.

Note: Over the objections of the Board of Trustees and the Executive Staff the AMA House of Delegates, December 5, 1973, amended a Board proposal by inserting the following clear, unequivocal langauge:

"The considered opinion of the House of Delegates is that the best interests of the American people, our patients, would be served by the repeal of the present PSRO legislation."

~.-L--- A- ~ -=-': -- ~ ,

Thomas G. Dorrity, M.D., J.D. AAPS Legislative Chairman

~ I' //)'/1 //

~t'l~;It/ /f'l/:C:CC/f1ij

Frank K. Woolley, LL. B. :/ Executive Director

THE VOICE FOR PRIVATE DOCTORS

Medical Staff Council Joins AAPS in Lawsuit

The Council of Medical Staffs, a New Orleans-based rational organization representing medical staff physicians, has announced it will join in the lawsuit filed by AAPS et al in federal court to outlaw the Professional Standards Review Organization law.

CMS said it will shortly file an amicus curiae (friend of the court) brief in federal court in support of the AAPS et al suit against HEW Secretary Caspar Weinberger.

Like AAPS, CMS has consistently opposed the iniquitous PSRO law.

James Colomb, partner in the New Orleans law firm of Guste, Barnett, and Colomb, has been engaged by CMS to handle the amicus curiae proceedings.

Although a number of local and national medical organizations are supporting the AAPS' legal challenge of the constitutionality of PSRO with financial contributions, CMS is the first that has decided to join AAPS in attacking the law in federal court.

INSIDE
• Nixon Wants Doctors Permanently
Controlled
• AMA Trustees Turn Down Repeal
• Resolution Deadline
• Amendment to By-Laws
• Illinois Family Physicians Contribute
to AAPS Lawsuit
• Fiscal Irresponsibility Prevails in
Washington
• Gouging by Government
• Mailing Reminder
• Bring Your Wife Index No.9 February - March 1974, Volume 28, No.2

ISMS Votes To Work For Repeal 01 PSRO law

The Illinois State Medical Society House of Delegates, in a dramatic reversal of previous policy, has voted:

• To work diligently for repeal of the Professional Standards Review Oragnization law.

• To mount a massive statewide public information campaign to acquaint Illinois residents and Illinois congressmen and senators of the deleterious effects that can be expected from PSRO.

• To dismantle the Illinois Professional Standards Review Organization which ISMS created last year to help the federal government implement PSRO in Illinois.

• To establish a voluntary, physician-directed peer review system in Illinois that will function better than anything de vis e d by government and forced on the profession and the public.

The ISMS House of Delegates acted at a special meeting February 24 called for the explicit purpose of reexamining the society's policy on the controversial PSRO law in light of the increasing opposition of physicians in Illinois and across the nation to the viciously punitive nature and purpose of PSRO.

Not only did the House instruct the dismantling of the IPSRO, it voted to direct the Board of Trustees to encourage other medical groups that have applied for recognition as PSROs to withdraw their applications.

By its action, the Illinois State Medical Society, one of the four largest in the nation, became another in a growing list of medical associations that have heeded the repeated warnings of AAPS and awakened to the deadly peril that PSRO poses for the practice of private medicine and the freedom of physicians to make medical decisions for their patients without any kind of third party interference, govern ment or otherwise.

It is apparent that the AMA collaborationist position is becoming more and more unpopular.

Another noteworthy aspect of the ISMS House meet-

ing was the absence of AMA officers, trustees and highlevel staff. On several occasions in the past they have attended medical society meetings for the explicit purpose of lobbying to persuade them to vote down any move aimed at repeal of PSRO. Apparently they got the word they would not be welcome for that purpose, and they stayed away from the ISMS meeting. At least, they were not to be seen, according to ISMS sources.

Rep. Edward J. Derwinski (R-Ill.) attended the meeting and advised the ISMS trustees and delegates to work hard for repeal of PSRO.

It will be remembered that Mr. Derwinski was one of the original signers of a letter from some 40 members of Congress that was sent to the AMA House of Delegates in Anaheim last December urging the House to go on record unequivocally in favor of PSRO repeal.

Mr. Derwinski was one of two signers who yielded to pressure from AMA lobbyists and withdrew his name from the letter. Now he is saying what he really thinks, not what AMA officials want him to say. It is clear that when anyone understands what PSRO is all about they are opposed to it.

Meanwhile, local societies continue to' join the list of PSRO opponents. Latest to' add their names to the list are Clinton County (Iowa) Medical Society and Brazoria County (Texas) Medical Society,

Nixon Wants Doctors Permanently Controlled

Three times in three weeks, President Nixon told the nation's physicians in effect that they deserve no better than to be permanently burdened with oppressive government controls over their fees and the way they practice medicine.

Early in February, in a week when AMA officers and trustees met with the President in the White House, Mr. Nixon:

• Announced that his Administration intends to keep wage-price controls locked on physicians and hospitals but wi'l lift them on everything else except petroleum when the present wageprice control law expires April 30.

• Sent to Congress his new scheme to nationalize medicine ("an idea whose time has come in America," he called it). The scheme would allow states to set physicians' fees, drug prices and hospital charges and would extend those vicious, punitive PSRO controls beyond the e'derly and

indigent to encompass everyone - ql[ practicing physicians and ciI their patients.

Within two weeks after those anti-medicine actions, the President let the medical profession know again just how serious he was about suppression of physicians. He sent a message to Congress asking for an extension of authority to control doctor fees and hospital charges after April 30, and he made it clear he wants this bureaucratic power continued indefinitely or until medicine is nationalized and permanently bound in government controls.

"Our health insurance proposal would call for states to oversee the operation of insurance carriers and establish sound procedures for cost control," said the message. "Until these and other controls are in place, I recommend that our present authority to control health care could be continued. I am asking the Congress for such. authority."

The President's program for nationalizing medicine, titled the Comprehensive Health Insurance Plan (shortened to CHIP) - and everyone from buffalo county knows what this means - was introduced in the Senate as S-2970 by Sen. Robert Packwood (R-Ore.) and as HR-12684' by Rep. Wilbur Mills (D-Ark.) and Herman Schneebeli (RPc.). Mills said his name is on the bl'l because the President asked him to introduce it.

Three-Part Scheme

It is a three-part scheme. The first part would require employers to offer their full-time employees a health insurance program approved by HEW and containing specified benefits, including hospitalization, physicians' services, drugs, and limited mental health care and other services. Employers could supplement the basic program, but they could not offer a nonapproved plan. Employees could refuse coverage.

The second part of the program would cover lowincome families and those with unusually high medical

Combined News Letter

Due to an enormous amount of time being devoted by the AAPS staff to researching and compiling materials for the Association's PSRO lawsuit and assisting attorneys in meeting a March 11 deadline for replying to a government motion to dismiss the suit, we are combining the February and March issues of the News Letter into a single issue. The time devoted to' preparation of materials for the reply was important because the thoroughness of our response could be a critical factor in the outcome of the suit.

risks. This part of the program would be handled by the states under contract with carriers.

The third part of the Nixon program would alter Medicare by mandating the same benefits as the other parts of the program.

Medicaid would be cbcndoned,

Employees covered under the first part of the program would pay a fixed set of deductibles, while those in the low-income groups would pay a range of deductibles tied to income levels.

Medicare beneficiaries would also pay fixed deductibles, which would increase costs to the elderly.

HMOs would qualify as insurance plans provided they met government decreed standards.

The President said his plan would add about $6 billion to current health care costs, an estimate considered highly speculative.

The Administration's so-called CHIP plan would, for the first time in America, establish a universal, nationwide system of paying for health care by credit card. Participating physicians and hospitos would be required to accept the credit card as full or part payment for services. All participating physicians, therefore, would be required to accept assignments for all or a portion of their fees.

Physicians Classified

Physicians would fall into one of three classifications Full Participating Providers, Associate Participating Providers or Non-Pa rticipating Providers.

Physicians who elected to become full participating providers would agree to accept a patient's "healihcard" as the sole means of reimbursement and to accept the level of payment established by government as full reimbursement for patients under all three parts of the plan.

An associate participating provider would agree to the same conditions, with one exception - he could collect an additional fee from patients covered under the employer-employee insurance program if he gave prior notice to the patient. He would have to accept fixed fees as full payment for services to the indigent and elderly.

A non-participating provider, according to a White House information sheet, "would not be reimbursed from any approved plan for seruices provided."

It should be noted that physicans will not be able to ovoid government controls by electing to become a

non-participant in this scheme, although their fees would not be set by government. The Administration has been careful to include PSRO and to make it immediately applicable to services provided in physicians' offices. Further, the legislation proposes to amend PSRO so that it will apply to any patient eligible for reimbursement under any phase of the program.

The legislation proposes to grant state governments (through state laws and regulations) authority to exercise a wide range of edrnlnlstrotive functions by direction of the HEW Secretary, including certification of providers and "establishment of the reimbursement rates and standards applicable to payments ... by insurance plans ... for items and services provided within the state ... "

Misstatement of Fact

A document accompanying the bill when it was submitted to Congress contains what must be considered a classic misstatement of fact.

"It is also important to understand," said the document, "that the CHIP plan preserves basic freedoms for both the patient and doctor. The patient would continue to have a freedom of choice between doctors. The doctors would continue to work for their patients, not the federal government."

EVERY PHYSICIAN WHO VALUES HIS PROFESSIONAL FREEDOM MUST OPPOSE THIS LATEST ASSAULT ON THAT FREEDOM!

Contact your senators and congressman now. Demand that they oppose S-2970 and HR-12684 and all other legislative schemes to shackle physicians with oppressive government controls in the guise of helping the American people or any portion of them pay for health care.

AMENDMENTS TO BY-LAWS

A proposed amendment to the AAPS By-Laws will be before the House of Delegates for adoption at the Private Doctors Institute in April. It will amend the ByLaws by adding the following to Article 13, Paragraph B, Page 15, after the paragraph ending " ... and to any subsequent lawful order.":

"Moreover, the members of this Association subscribe to the ethics expressed in the Hippocratic Oath, to which physicians of our western civilization have bound themselves by the tradition of centuries, believing that the principles expressed therein have contributed to the strength and dignity of the doctorpatient relationship, to the preservation of the free enterprise system so essential to a free society, and to the physical and spiritual well-being of those who honor its stipulations."

AMA Trustees Tur.I Down Repeal

Officers and trustees of the AMA, apparently still suffering the dangerous hallucination that government bureaucrats won't harm you if you help them control you, have made it unmistakably clear that they will continue co'laborating to impose PSRO on the nation and have no intention of carrying out the directive of the AMA House of Delegates that PSRO should be repealed.

AMA officers and trustees have gone to extraordinary lengths to strengthen their collaborationist posture and to try to prove the House did not direct the Board of Trustees to pursue repeal, despite the fact that many AMA delegates and alternate delegates and others who attended the House meeting in December believe that is exactly what the House meant.

It has also been reported to AAPS that officials of AMA went to Washington early in February and told several members of Congress to ignore as "a lot of hot air" the action of the House of Delegates in Anaheim in adopting the position that the best interests of physicians and their patients would be served bu repeal of PSRO.

In a report from the Board of Trustees published in the February 4,1974, issue of American Medical News the Board had this to say to the AMA membership: "As it is, the Board has charted a course based on its interpretation of the House of Delegates action at the 1973 Clinical Convention that does not include an overt, immediate campaign for repeal of PSRO. Instead, the trustees will propose amendments to the law in an attempt to mitigate objectionable features." And if you doubt the trustees are still deluding themselves they can still get consideration from HEW officials by collaborating, they said this: "And they will coordinate AMA efforts to bring about an orderly implemention of the PSRO program."

A Number of Contradictions

Many physicians undoubtedly will detect several contradictions in the positions of the AMA on various related issues. For example, trustees and officers at Anaheim (and since) insisted that repeal was not "viable" and therefore shouldn't be tried. In the February 4 issue of Amercian Medical News, Board Chairman James H. Sammons, M.D., admitted trustees don't know whether amendment of PSRO is "viable" either, but he said it's worth trying.

But a more significant contradiction in the trustees' position on important issues shows up in their reaction to HEW's attempt to force pre-admission certification for hospitalization of Medicare and Medicaid patients. AMA trustees and officers were outraged and threatened suit

if HEW went ahead with the proposed requ'ction.

AMA President Russell Roth, M.D., attacked the proposal as legally, ethically and medically wrong, and a "direct threat to the medical care of the 35 million or so people who are covered by Medic~re and Medicaid." He pointed out hospital admissions for these patients would no longer be certified by a patient's physician but bu a committee. And that would constitute illegal interference in the practice of medicine, he said. Dr. Sammons was described as fuming. He said the issue is "who's going to make the medical judgment that Aunt Susie is sick enough to be treated in the hospital." He said he would have "wave doubts" about serving on such a review committee to decide whether to admit a patient he hadn't even seen.

ihe contradiction arises, glaringly, because everything Dr. Roth and Dr. Sammons said about the preadmission certification proposal can be said with equal accuracy about the PSRO law.

PSRO Even Worse

PSRO requires a committee to determine in advance whether hospitalization is medically necessary. The committee can overrule the judgment of the attending physician. Even worse, PSRO authorizes a committee to deny a patient the services of a particular specialist in certain circumstances and, further, would require a physician to assure a PSRO committee that another physician performing services for the attending physician's patient was not doing anything that was not medically necessary. All this obviously constitutes illegal, unethical and morally wrong interference in the practice of medicine.

But not only have AMA officers and trustees refused to join AAPS in its lawsuit to outlaw PSRO, shunned the very thought of filing suit on their own and steadfastly spurned House policy for repeal, they have pursued with unflagging dedication a course of collaboration with HEW in forcing PSRO controls on the nation's physicians and their patients.

Furthermore, it should be noted that AMA has filed suit to force the Cost of Living Council to abandon wageprice controls on physicians. These controls were described by Dr. Sammons as "nothing less than a blatant attempt by the social schemers at CLC to impose their will on the physicians and patients of America." A fuming Dr. Sammons added: "What right have they to tell us how to practice medicine? What right have they to tell the American people where and how they shall receive their medical care?"

What right indeed? What right do

they have to do these thinqs in the name of either price con t r 0 I or professional standards review?

Added Dr. Sammens, "These are net economic controls ... they are politlcol controls ... we intend tOo fight them down the line."

Just short of PSRO?

Did HEW Back Off?

Dr. Sammens told a meeting in Washingten that President Nixon at the insistence of AMA efficials had told HEW Secretary Caspar Weinberger to back away from the pre-admissien certificatien propose]. Later, AMA reported that HEW had said it would drop its proposal.

It developed, however, that HEW's intentions weren't exactly what AMA had been led to believe. In a February 7 news release, HEW said it would withdraw the proposal and extend the time for comment "to develop new alternative review procedures which meet the requirements of the law and can still be effectively implemented." But a February 12 announcement in the Federal Register, complained the AMA, "merely extends the time for comments on the original proposal."

What with all this, tegether with failure to persuade HEW to set up statewide PSRO areas, AMA efficials lately have been cemplaining that Administratien efficials just don't pay attentien to them.

Still, they keep insisting that by cella berating they have a chance to "mitigate objectionoble features" of the PSRO law, altheugh, as Dr. Reth admitted at a news conference January 25, "we (AMA offlclcls) decided tOo coopercte with HEW in the implementatien of the law, but I can tell you we've had very little cooperotion in return." He olso lamented that AMA has made "a deliberate effort to coopercte with HEW" ever the last four er five years, but "of late, we've had nething but rebuff after rebuff."

MAILING REMINDER

Mail fer AAPS continues to be sent to the Assoclotion's old address in Chicage - but it is no lenger being ferwarded to the Oak Brook. Illinois, address. As noted in the August, 1973, News Letter, the Chicage postmaster notified AAPS that ferwarding orders are cancelled after one year, and then mail is returned tOo the sender.

Please check your records to be sure they reflect the AAPS Oak Brook address as shewn at the bottom of the last page of this News Letter.

Illinois Family Physicians Contribute to AAPS Lawsuit

The lllinols Academy of Family Physicians has contributed $1,000.00 to help finance the Asseciatien's lawsuit in federal court challenging the censtitutienality of the PSRO law. The contrlbutlon had been authorized by the IAFP Cengress of Delegates if officlols of the Academy were convinced of AAPS's sincere and continuing effort.

In a letter to lllinois State Medical Society, John Helland, M.D., Chairman of the Academy Beard of Directors, said "it has new become apparent that this is, indeed, the fact, and it olso appears that there is considerable and ever grewing populcr support within the prefession fer the repeal of this legislatien ... "

Dr. Helland added: "This actien has been taken because of the recegnitien that excessive and perhaps inapprepriate control and regulatien interferes with the delivery of health care and may very well have the end result of diminishing the quality of health care being p;evided the public."

GOUGING BY GOVERNMENT

You can be sure that none of the members of Cengress nor any of the gevernment bureaucrats who accuse doctors of overchorqlnq will have a word tOo say abeut this kind of evidence of gevernment geuging.

Last year, AAPS paid $4.00 fer a year's subscription to an HEW publlcotion, the Social Security Bulletin. This year, the price skyrocketed to $10.45, an increase of 250%.

RESOLUTION DEADLINE

Resolutions fer considerotion by the House of Delegates at the Private Doctors Institute in April must be received at the AAPS office in Oak Brook, lllinols, net later than March 29. The Institute is scheduled fer April 18-20 at the Drake Hotel in downtown Chicage. Reselutions should be in regular resolution fermand, if possible, typewritten double spaced.

BRING YOUR WIFE

Mrs. Jackie Anthony, President of the Auxiliary to the AAPS which meets with us, urges you to please bring your wife to the April meeting. The advice and experience of our wives will be of great irnportonce in plans of the Auxiliary to supplement our heme town efforts tOo alert and crouse the public to the dangers to it inherent in the present Federal medical policies.

Fiscal Irresponsibility Prevails in Washington

President Nixon's inflationary $304 billion budget, with an estimated $9.4 billion deficit built in, demonstrates that fiscal irresponsibility is still the order of the day in Washington. Additlonol proof is the fact that more than a third of that budget - $111 billion - is proposed to be spent by the spendingest federal agency of them all, the Department of Heolth. Education and Welfare. That incredible $111 billion is a massive $14.3 billion more than the budget for the current fiscal year.

More dishearteninq than that is the fact that the HEW budqet of $111 billion is almost 10% of the total personal income of the American people. Furthermore, the $304 billion added to the total that will be spent by state and local governments means that qouernment taxes

and spends more than 40% of everything eueruone earns in America.

The President proposes to spend $28.6 billion on health programs in 1975, and that's more than $10 billion above the actual expenditures in 1973. The budget requests include $16.7 billion for Medicare and $6.6 billion for Medicaid, a total of $23.3 billion for the two programs, compared with actual expenditures of $14 billion in 1973.

Mr. Nixon also expects to spend $125 million in 1974 and 1975 promoting and developing numerous organizations incorrectly known as health maintenance organizations. And the budget for programs of Charles C. Edwards, M.D., Assistant HEW Secretary for Heolth. includes more than $58 mil [ion to 'get the PSRO program under way. The budget message gratuitously offers the opinion that "the quality and appropriateness of medical services will be improved through Professional Standards Review Organizations."

For Indivlduol Liberty and Responsibility, Donald Ouinlcn, M.D.

President

Enclosures. Politicians Are Not Doctors!

1 Page Flyer on Private Doctors Institute Reservation Card

PRIVATE DOCTORS INSTITUTE, Chicago, Illinois, April 18-20, 1974 ANNUAL MEETING, New Orleans, Louisiana, October 31-November 2, 1974

ASSOCIATION OF AMERICAN PHYSICIANS AND SURGEONS

2111 Enco Dnve. SUite N-51 5 Oak Brook. Illinois 6D521 312/325-7911 Frank K Woolley Executive Director

THE VOICE FOR PRIVATE DOCTORS

Index No.4 April, 1974, Volume 28, No.3

AAPS Says HEW Coer~es Patients

A memorandum of law filed by AAPS et al in the PSRO I awsuit accused the federal government of telling millions of Medicare and Medicaid patients that if they don't submit to government regulations, they or their doctors will have to pay for their health care, even though the regulations viol ate their constitutional rights.

The memorandum of law was filed March 11 in opposition to a government motion for summary judgment in favor of the defendant, HEW Secretary Caspar Weinberger.

AMA Board Names

Dr. Sammons EVP

In what Washington Report on Medicine & Health called "an awesome power play," the AMA Board of Trustees selected Chairman James H. 'Sammons, M.D., to succeed E. B. Howard, M.D., as AMA's Executive Vice President. Dr. Howard is slated to retire March 1, 1975. Dr. Sammons, 47, who ascended through AMPAC to AMA Board Chairman, beat out Richard S. Wilbur, M.D., in a bruising battle spanning five days and requiring 19 ballots. Final vote was 9 to 5.

Richard E. Palmer, M.D., was elevated from Vice Chairman to Chairman, replacing Dr. Sammons, who resigned from the Board to take on staff duties April 1. John M. Chenault, M.D., was elected Vice Chairman. His wife is on the AMPAC Board of Directors, noted Washington Report.

The Board also voted to abolish the position of Deputy EVP held by Dr. Wilbur, who was generally regarded at one time as the heir apparent to Dr. Howard.

Said Washington Report: "Wilbur forces are bitter about what they claim was a leading role in the coup by Joe D. Miller, Assistant Executive Vice President of AMA and guiding genius of AMPAC. Miller, the highest ranking non-physician in AMA, is now seen more firmly entrenched as a power behind the throne. The Sammons forces struck suddenly ... The election had been expected to take place next month ... Things to watch for will be the reaction of AMA rank-and-file to the power play and use of such 'gut issues' as PSRO and National Health Insurance by Sammons to consolidate his hold on the steering wheel."

The memorandum pointed out that PSRO could deny patients the treatment their physicians deemed necessary, could deny paitents freedom of choice of physicion, would jeopardize privacy and confidentiality of the physician-patient relationship, would force "norms" of diagnosis, care and treatment on physicians, and would subject physicians to coercive sanctions which would deter and hinder them in cdvislnq and treating their patients.

«In essence," said the memorandum, "the defendant Secretary is saynig to millions of elderly and indigent Americans, and the physicians who care for their health, that if they do not want to take the benefits of federal health care reimbursement under such regulatory conditions as Congress deems necessary, regardless of their private rights and interests that may thereby be burdened, they are free to pay for such health care themselves.

«That, of course, is not a realistic alternative for most of them. Fortunately, the Constitution and Courts of the United States forbid the defendant to present them with such a dilemma."

Under previous ruling of the three-judge federal

INSIDE

• AMA Board Names Dr. Sammons EVP

• New Bill Attracks Medical Freedom

• HEW Soliciting PSRO Contracts

• CMA Votes Repeal

• Prefer AAPS to AMPAC

court, the government was given 10 days to file a reply.

The extended discussion of cost control in Secretary Weinberger's written arguments in support of his motion for summary judgment, said the AAPS document, "Ieoves no doubt that the legislation in question was designed to limit the demand made upon the resources of such programs (Medicare and Medicaid) by circumscribing the health care services provided by physicians to patients who are eligible under them."

A NOVEL SCHEME

TO' that end, AAPS asserted, "Congress has created an elaborate and novel scheme of prior restraints on physicians' diagnosis, treatment and care of patients who are potential Medicare-Medicaid beneficiaries." Furthermore, said the memorandum, "Plaintiffs allege that subjecting their professional judgments and conduct to prior restraints on the basis of any system of pre-set norms of diagnosis, treatment and care will seriously impair their ability to render, and their patients' ability to receive, health care in accordance with the highest standards of medical practice."

HEW itself recognizes that PSRO will radically change medical practice in America, said the memorandum, citing a study - "PSRO: Organization for RegiQonal Peer Review" - conducted by Arthur D. Little, Inc., under contract with HEW. The study, released last year, concluded:

"Legal constraints, public demands, and professional attitudes made it impossible to justify two standards of medical care in our contempory society. The consulting panel (for the study) understood P.L. 92-603 to mandate professional review only for the beneficiaries of the Social Security Act. More importantly, the panel appreciated that this restriction, except in terms of dollar

support for the activity, is literally impossible.

"The norms of care and most of the forms of professional audit developed for federal beneficiaries under PSRO will ultimately be applied to all private medical services. In addition to their inherent resistance to separating 'federal care' from 'medical care: as evidenced by the common extension of utilization review to private hospital care, physicians are aware of the public and legal pressures to extend PSRO norms and reviews to the entire private health delivery system."

INTERFERES WITH RIGHTS

The memorandum said, "the Professional Standards Review Act constitutes an arbitrary, irrational and overbroad interference with the constitutionally protected rights of physicians and patients." It noted that if physicians do not conform their decisions to government imposed norms and other requirements, they will be subjected to a variety of sanctions set out in the law, including financial penalty, stigmatization through publicity, denial of the right to treat Medicare and Medicaid patients and harassment from PSROs and other organizations

having influence over the allegedly offending physicians.

Futhermore, the law does not recognize that "under any system of pre-set norms of medical diagnosis, treatment and care the government might create, there will be patients who do not fit the mold, are not average, and their physicians will have to depart from the norms in treating them-it they are courageous enough to run the risk of economic sanctions and professional stigmatization in the event that those in charge of enforcing compliance with the norms disagree with the departure."

Congressional sponsors of PSRO sought to justify its enactment by claiming it was necessary to control costs of Medicare and Medicaid and to curb fraud. But AAPS argued that "the Supreme Court has held in a variety of contexts that the state's interest in cost control and prevention of fraud, abuse, and overuse of public spending programs does not justify an overbroad and undiscriminating interference with the private rights and interests of those who are beneficiaries or recipients."

PSRO constitutes an assault on the confidentiality of private patient records, the memorandum charged, pointing out that physicians "will be required to disclose extensive data concerning each patient they treat ... " and PSRO's are empowered "to examine the 'pertinent' records of a physician and inspect the facilities in which he renders care .... "

Plaintiffs allege, according to the memorandum, "that the disclosures of confidential information required by this law will substantially hinder them in their treatment of their patients, and that this violation of the privacy of the physicianpatient relationship is not constitutionally justifiable ."

There is a long line of federal court cases beginning in 1889 clearly showing that such far-reaching infringement in the physician-patient relationship as authorized by PSRO violates fundamental constitutional principles.

The memorandum pointed out that a Supreme Court justice made these pertinent comments on the prevailing side in a recent case:

"The right of privacy has no more conspicuous place than in the physician-patient relationship, unless it be in the priest-penitent relation. It is one thing for a patient to agree that her physician may consult another physician about her case. It is quite a different matter for the state compulsorily to impose on that physician-patient relationship another layer, or as in this case, still a third layer of physicians. The right of privacy - the right to care for one's health and person and to seek out a physician of one's own choice protected by the Fourteenth Amendment - becomes only a matter of theory

not a reality when a multiple physician approval system is mandated by the Senate."

Medicine by committee was also questioned in another federal case, which said:

"With respect to the three-physician requirement, plaintiffs further contend it infringes upon the fundamental right of physicians to administer necessary health care to their patients. They assert that the First, Ninth and Fourteenth Amendments protect the right of physicians as well as every other citizen to pursue his chosen pro-

fession free from necessary interference from the state.

"Undoubtedly, physicians should be free to practice their profession and to exercise their professional discretion subject only to such regulations as are necessary for the protection of legitimate public interests. It is undeniable in this case that the disputed provision infringes upon this right. In fact, the provision seeks to subordinate the attending physician's judgment to that of two other physicians without any showing that it effectively advances a legitimate state interest ... "

Ilt~\V Soli~iting PSHO Contra~ts

It's later than you think!

HEW, with the AMA standing in the wings and eager to get in the act, is now ready to start imposing PSRO controls on the nation's elderly and indigent and the physicians who take care of them.

The federal agency said that now that the 203 PSRO areas have been established, it is soliciting contracts:

• With prospective PSROs to plan the way they will be set up and run.

• With PSROs on a "conditional designation" basis.

• With statewide "Support Centers," such as medical foundations organized and controlled by state medical associations, to "stimulate and support the development and operation" of PSROs and the PSRO program.

Thus, the flimsily disguised lure of federal dollars is dangled before state medical associations to trap them into becoming, indirectly, paid agents of HEW to force PSRO controls on physicians and patients in their states. (A number have, like AMA, asserted a willingness to be trapped to get federal dollcrs.) And being paid by HEW, they will do HEW's bidding. Support Centers, said HEW, will carry out their assignments "in a manner consistenl with the legislative intent (as interpreted by HEW, naturally) and the policies of the Secretary (of HEW)." (Note:

In many cases medical society and foundation executives are the same, and medical society executives have met nationally to figure out the best way to siphon federal money into society coffers.)

BATTLED LOSING CAUSE

AMA battled a losing cause trying to force HEW to recognize statewide PSROs all over the country. The Support Center idea was seen as a sop to the AMA and those medical society executives hungry for a share of the millions of tax dollars that will be spent through PSROs to control doctors and force them to practice medicine under bureaucratic edict.

The AMA doesn't want to be denied a slice of the tax pie either. The March 18, 1974, AMA Newsletter

noted the Board of Trustees had approved a proposal to develop guidelines of care, "to be funded by HEW." Said the newsletter, "the criteria, which will be used by PSROs, are being developed by national medical specialty societes through the AMA Advisory Committee on PSRO." Criteria means the norms of medical practice that will be forced on physicians and the conditions under which they will be required to practice.

BOTH HANDS OUT

That's only one AMA hand out. The other has been out for months for money from HEW to operate a PSRO personnel training program. In this light, it should be remembered by all physicians that it will be lay employees (the kind AMA wants to train) who will do most of the PSRO dirty work - snooping through private medical records in physicians' offices, taking steps to force doctors to justify their case-by-case Medicare/Medicaid medical decisions, turning in physicians for real or fancied infractions of the law or regulations and reporting them to HEW for discipline, and calling on numerous public and private organizations to help harass physicians into complying with directives and regulations.

Physicians should also be warned that HEW plans a much deeper involvement in the practice of private medicine through PSROs than deciding whether a particular medical procedure was necessary. HEW intends also to rule whether the procedure was the right one for the ailment. If you doubt it, read OPSR Memo #3, March, 1974, from the Office of Professional Standards Review in HEW.

That memo clearly states that conditional designation contracts with budding PSROs will require them to review "the quality, necessity and gpprop'riateness of medical care provided ... "

In addition, HEW intends to force the use of 1'I0nphysician health care practitioners in the PSRO review system. That could mean chiropractors, since they now are defined as physicians in the Sociol Security Law.

The House of Delegates of the 24,280-member California Medical Association - second largest in the nation - thunderingly rejected the AMA collaborationist position (an increasingly minority position) and adopted what the leadership stated was a "clear, clarion call for repeal" of PSRO. Obviously, they do not buy the de-

featest posture of AMA trustees and officers. They pro- Enclosures: One page, two sides brochure on Private

claimed that the House vote calling for repeal "could Doctors Institute

not be ignored or misinterpreted" by the AMA. Reservation Card

PRIVATE DOCTORS INSTITUTE, Chicago, Illinois, April 18-20, 1974 ANN UAL MEETING, New Orleans, Louisiana, October 31-November 2, 1974

New Bill Attacks Medical Freedom

Sen. Edward M. (Ted) Kennedy and his ideological fellow travelers, are determined to destroy private medical practice one way or another. It is apparent that his collaboration with labor bosses, whose bidding he does without question, isn't going to yield the full-scale socialized medicine they so passionately want.

So, Ted Kennedy is going to try to destroy private medicine another way . He has introduced legislation (S. 2994) designed to wipe out medical freedom in the guise of health planning.

S. 2994 is as vicious in concept as the dangerous and deadly PSRO law. It would create health planning agencies within prescribed areas of each state. They would function under direction of state health commissions, which, in turn, would be regulated and controlled by the Secretary of HEW.

These statewide commissions, serving as agents of HEW, would:

• Certify all existing and proposed health services, wielding power to decide which would and which would not be certified.

• Determine how existing and proposed services would be organized, allocated and distributed.

• License all health facilities and all "health care delivery personnel." Apparently they would usurp the authority of other state agencies, including medical examining boards.

• Set standards for health care facilities and "review" the "performance of health services."

• Fix rates "to be used for reimbursement for health services" and "regulate all reimbursement of health care providers ... "

CMA

Votes

Repeal

While AMA trustees and officers keep telling everyone they don't intend to carry out the House of Delegates directive for repeal of PSRO because repeal isn't "viable," medical societies keep demanding PSRO repeal.

The House of Delegates also took recognition of the AAPS lawsuit in federal court challenging constitutionality of PSRO. Delegates instructed CMA officers to explore the possibility of legal action against PSRO.

(Note: Physicians should be aware that when AMA leaders declare that repeal of PSRO isn't "viable," all they are saying is that they don't intend to undertake the lobbying effort that would be necessary to turn congressional sentiment against repeal into the majority vote that could achieve repeal. Veteran lobbyists know that thousands of bills have passed state legislatures and Congress over the years that were opposed by a majority of members when they were introduced. When a veteran of the lobby wars says a particular legislative goal isn't possible before he tries, what he is saying is either that he doesn't intend to try or that he isn't adequate for the task.)

Entire Society Joins AAPS

All 28 members of the Chillicothe (Ohio) County Medical Society have become members of the AAPS. In a move spearheaded by Paul MacCarter, M.D., the members of the society decided to join the AAPS rather than contribute to the Ohio Medical Political Action Committee, a satellite of the American Medical Political Action Committee.

In other action in support of AAPS programs to protect the practice of private medicine, the medical staff of the South Coast Community Hospital in South Laguna, California, donated $500 to help in the AAPS lawsuit seeking to overturn the PSRO law. The contribution was sent in by A. W. Orlandella, M.D., Chief of staff.

Veteran AAPS Member Dies

James L. Anderson, M.D., Miami, Fla., specialist in neurology and psychiatry, has died. Dr. Anderson, who had retired from active practice, served as a member of the AAPS House of Delegates for several years. He was a member of the Association for 29 years, having joined in 1945, two years after AAPS was founded.

For Individual

Responsibility,

Donald Quinlan, M.D. President

ASSOCIATION OF AMERICAN PHYSICIANS AND SURGEONS

2111 Enco Drive. SUite N-51 5 Oak Brook lllinois 6D521 312/325-7911 Frank K Woolley Executive Director

THE VOICE FOR PRIVATE DOCTORS

Index No. 5 May, 1974, Volume 28, No.4

Senator Bennett Ballyhoos PSRO; AAPS Again Calls For Repeal

What was billed as a hearing on implementation of PSRO by the Senate Finance Committee's Subcommittee on Health May 8-9 turned out to be a forum for Sen Wallace Bennett (R-Utah) to ballyhoo PSRO, sweet talk witnesses who support PSRO (like AMA's Robert Hunter, M. D.) and to rail at those who denounce it as bad law and seek to abolish it (such as AAPS witnesses).

TMA Files Suit

To Outlaw PSRO

Texas Medical Association filed suit in U.S. District Court in Austin, Tex., May 8 challenging the constitutionality of the PSRO law. The suit, similar to the one filed last June by AAPS, also charged that HEW's PSRO regulations are "arbitrary, capricious and discriminatory," and that enforcement of PSRO will undermine the rights of physicians and their patients.

The TMA complaint alleged that if HEW is allowed to proceed with implementation of the PSRO law, Texas physicians will suffer "irreparable harm and injury."

The Texas Medical Association is the first medical association to follow the AAPS lead and attack constitutionality of PSRO in federal court, although others, including California Medical Association, have flirted with the idea.

The Council of Medical Staffs has filed amicus curiae proceedings in support of the AAPS suit.

T.M.A. also has raised dues by $50.00 a year and is assessing members $100.00 each for pursuing the PSRO lawsuit.

There was abundant evidence that the hearing was set up as a sounding board for Senator Bennett to let him get into the record a lot of favorable things about PSRO (even things that were not true) and to attempt to counter the lengthy and growing I ist of criticisms of the law.

Senator Bennett, for example, is not a member of the subcommittee, but he made speeches propagandizing PSRO, harangued adverse witnesses, praised those supporting PSRO, interrupted other senators, conducted most of the questioning by prior arrangement with several senators to yield to him the time they had been allotted for questioning witnesses, and even went so far as to put words in the mouth of one reluctant witness who repeatedly refused to say what Senator Bennett wanted him to say.

When it came time for AAPS to testify, President Donald Quinlan, M.D., wasted no time stating-the Association position. "Our testimony," he said "will demonstrate the basic concept of this law is coercive and punitive. Therefore, it cannot be satisfactorily amended. It should NOT be implemented. It should be abolished. Weare asking the federal court to declare it unconstitutional and we are asking Congress to repeal it."

INSIDE
• Misrepresentations Mark Debate
• AAPS Dues Raised
• AAPS Delegates to be Nominated
• More Associations Favor PSRO Repeal
• Support for Lawsuit
• Oath is Available Later, he said: "1 can assure you, Mr. Chairman, most doctors in this country are not being fooled or hoodwinked into accepting a bad law just because someone says it's a god law. I can also promise you that the physician members of our organization are not going to turn tail and run just because someone in HEW or in Congress snarls at them.

"We are going to continue to tell the truth about this law. It is a bad law. We know that misrepresentations about it by its promoters and propagandists will continue because it is so bad there has to be a cover up."

Dr. Quinlan also said that:

• The PSRO law will require "standardized" medical care for Medicare and Medicaid patients.

• Physicians will be forced to "subordinate their best medical judgment of what is 'medically necessary' for their patients" and when doctors are overruled by government functionaries they "will be obligated to use their influence to convince their own patients the government is right and they, the doctors, are therefore wrong."

• In certain cases, the patient may be denied the doctor or hospital of his choice.

• "Doctors licensed by the states who are now free and ethically obligated .to practice medicine of the highest quality will be forced to follow central government bureaucratic direction and, therefore, be denied the right of providing patients with the best care of which they are capable."

• The purpose of PSRO is to entrap doctors in a system of government-imposed controls, but it will be patients who will be trapped. "They, not the doctors, will suffer most because medicine compressed into a standardized mold by political pressure will not be first-class care. Who will be deprived of first-class care? Obviously the patient, not the doctor".

• "The essence, the substance, the very purpose of this law is control. It is intended to smother the medical profession in uniformity established by bureaucratic fiat."

• PSRO will "condone wholesale violation of the privacy 01 records of any patient of any physician who takes care of Medicare or Medicaid patients." Officials are now hiding the truth. The plain truth about confidentiality is "that this pernicious law is a vast and unholy grant of power to the Secretary of HEW to acquire confidential information from records of any patient and to

use it in whatever manner he decides will further, in his opinion, the purposes of the law ... the plain truth is that the PSRO law will protect individuals who rifle patient records for use by PSROs and HEW, not punish them."

WOOLLEY, BENNETT CLASH

When AAPS Executive Director Frank Woolley, in response to a question by Sen. Carl Curtis (R-Neb.), referred to a study of PSRO commissioned by HEW before the law was enacted as HEW's PSRO "Bible," Senator Bennett interrupted to shout angrily: "I challenge that."

Mr. Woolley was referring to a study by Barry Decker, M.D., and Paul Bonner which was published in book form under the title: "PSRO-Organization for Regional Peer Review." In his testimony, Dr. Quinlan had noted that Dr. Becker and Mr. Bonner, as HEW contractors, clearly stated that PSRO will result in rationing of medical care, is the precursor to control of all medical care, should apply to all private practice, and is designed to insure uniformity, modify individual behavior, and systematically impose constraints on physicians.

Mr. Woolley quoted directly from the book to prove these assertions and said the "HEW Bible" is that being used as reference in drafting rules and regulations.

Senator Bennett heatedly argued that the study was nothing more than "a private contract" to which HEW was not bound. He said copies had never been distributed to the Senate Finance Committee and HEW officials had never referred to it. The senator suddenly acquired considerable knowledge about a book of which he had feigned ignorance when questioning an earlier witness.

Mr. Woolley pointed out it was not a private contract but a public contract and that HEW representatives actively participated in development of conclusions for the book.

When Senator Curtis was allowed to continue questioning, he asked Mr. Woolley whether he concurred in the statement that "there are no new requirements for review in the PSRO law."

"That, of course is not true at all," responded Mr. Woolley. He said, for example, that before PSRO physician participation in review activities was voluntary. Presumably participation is voluntary under PSRO, but practically it is involuntary. He pointed out that a physician can now avoid involvement with government by billing Medicare and Medicaid patients directly, but under PSRO, he cannot escape the requirements of the law by direct billing. He said the PSRO law will force physicians

to become government agents, requtnng them to police other physicians performing services for their patients. There are now no preadmission reo quirements but PSRO sets up such requirements. And PSRO introduces a new and odious obligation on physicians to conform to norms of diagnosis and treatment.

Mr. Woolley pointed out logically that if there were no differences there would be no need for PSRO, so "why don't you repeal it?"

Misrepresentation Continued

The hearing was also the occasion for PSRO propagandists such as Senator Bennett, HEW Secretary Caspar Weinberger and Henry Simmons, M.D., HEW'~ PSRO chief, to continue misrepresentations about the law that has been characteristic of its supporters since its inception. Mr. Weinberger, for example, told the subcommittee that "there is nothing in the statute that requires, nor will it be administered in any way, that will change the existing confidentiality of the physician-patient relationship." He called PSRO a mechanism for "assuring that the quality of medical care delivered to people eligible under this statute is high" and that there will not be "an unnecessary or, wasteful or improper payment of taxpayers dollars ... "

The hearing was also the occasion for official representatives of the AMA to submit meekly to a senatorial tongue lashing and to apologize, in effect, for trying to inform the profession and the public how bad PSRO is.

AMA President Russell Roth said: "I think a" of us are distressed in that it (the AMA informational kit on PSRO) has perhaps intensified an adversary atmosphere ... " Dr. Hunter said part of the kit was "needlessly inflammatory" and had been withdrawn by AMA.

AMA's schizoid attitude toward PSRO was glaringly evident at the hearing. Dr. Roth observed, as AAPS has said repeatedly, that "as understanding of the PSRO law spreads, resistance to it grows." He said in spite of efforts of many, including AMA, to sell the profession on PSROs, doctors aren't buying it. "The fault does not lie with the sincerity or intensity of the effort to cooperate," he said, "it lies with the basic ineptitude of the statute."

Understanding of the law, however, has not persuaded the AMA leadership to get on the repeal bandwagon (at least 20 state medical associations have called for PSRO repeal). Dr. Roth remarked that "responsible accomplishment of a successful program is the objective of all of us." He confessed that AMA's effort to "line up enthusiasm and cooperation and willingness of organizations to apply for "an active role in PSRO" had failed.

"It hasn't happened," he lamented. "And it's going the other way at an alarming rate." Dr. Roth said he found it "distressing to us" that so many state societies were going for repeal. "My suggestion is that you need the troops to win this war, and we're losing the troops."

AAPS was not entirely alone among medical organizations in the belief that the law is so bad in its basic concept that the only cure is repeal. Joseph F. Boyle, M.D., Speaker of the California Medical Association House of Delegates, said resolutions adopted by CMA "express the deep concern of our members over the absolutely disastrous effects on patient care that they foresee will very surely and very rapidly follow upon the heels of the implementation of PSRO." He added: " ... our association has concluded that Section 249F of Public Law 92-603, PSRO, represents bad law that cannot be amended satisfactorily except by its outright repeaL"

Misrepresentation Marks Debate

"One of the less admirable aspects of the debate over national izing medicine is that the arguments are often laced with fraud, deceit and misrepresentations," AAPS President Donald Quinlan, M.D., told the House Ways and Means Committee April 26, as the committee opened hearings on various proposals to nationalize U.S. medicine.

"The protagonists of government interference in the private doctor-patient-hospital relationship proclaim government programs are needed because there is a crisis in health care," Doctor Quinlan said.

"They loudly trumpet that health care is a right.

"And they assert they are moved to act in response to public clamor for a change in the health care system."

Doctor Quinlan emphasized, however, "There is no health care crisis in the United States. There is no public outcry for change. There is no public demand for Congress to dismantle our present system and build a European-style system on the wreckage.

"But there is widespread despair over the bureaucratic bungling and rising costs that characterize Medicare and Medicaid."

The AAPS President told the committee that As-

sociation members "are appalled that Congress is now considering further political intereference into the private lives of citizens in the form of socialization of medical care for all patterned after the failures of Europe. Stripped of the excess legalistic language, the proponents of socialized medicine in America seek to use the power of Congress to force everyone to pay more to government and get less due to bureaucratic interference, and all because of a trumped-up 'crisis' in health care. There is no crisis in medical care in America except to the extent that it has been created artificially by government intervention and propaganda. We hope this Committee will dig for the facts. For example: How many of the witnesses who will appear before this Committee promoting more political direction and control of medical care are government employees? How' many are being subsidized by the Federal Government or are seeking money out of the Federal Treasury? With 40% of everyone's earnings in the United States already being confiscated and spent through the political process someone has to stop the plunder. And you, the members of Congress, can do it."

Confidence Shaken

Doctor Quinlan said that at a time when the American people are having their confidence in the political process of self-government shaken to its very roots, "it is unbelievable that a proposal for embarking on a spendthrift program of unimaginable billions for socialized medicine would be seriously advanced at this time, based on the assumption that all Americans should be dependent on government employees for medical care." He said that all of these proposals for politicalized medicine are based on an assumption which is fraudulent. The assumption consists of two parts:

First that all citizens, not just people over 65 years of age and people with low incomes, are incompetent to contract effectively, efficiently, and satisfactorily with other private citizens for the medical and hospital services they want. This is not only a fraud but an insult to the millions of selfreliant Americans who produce the goods and services upon which government depends.

Second that only government employees are competent to choose the proper and appropriate physician and hospital for any citizen and determine what is medically necessary for him. Furthermore, that substituting the choices of government clerks will result in more and better service at less cost. In other words, the assumption is that politicalized medical care, with control by government employees, is better than private care.

Doctor Quinlan challenged proponents of national-

ized medicine to point to any proof either. in this

"",:"",i~f~, ~""

country or abroad that their assumption is' vali~. He

said the fact is there is not a medical crisis but there is definitely a dollar crisis in the United States.

"Government is spending more than it takes in in taxes and is creating inflation," he said. "Housewives are being forced to pay 15% more for groceries and other supplies this month than they were in the same month a year ago. And who has piled this inflationary problem squarely upon the American housewife-the bureaucracy of the federal government which these proposals before you would empower to spend even more money. Huge additional spending through government when government spending is the source of grinding inflation which hurts low and fixed income citizens is absurd.

"HEW is scheduled to spend $111 billions 'in 1975 without any more authority. That is more than all spending for defense-more than all the profits of all corporations after taxes and more than all the government spent for everything in 1960. Such wild spending, not doctors, is the basis of inflation.

"1 repeat: There is no public demand for change."

Clever Demagoguery

Doctor Quinlan declared that the assertion has been made so often that health care is a right that it has become a cliche. "No one endeavors to define the term," he said. "It is just solemnly intoned as one of the eternal truths of mankind.

"What it is is a clever bit of demagoguery. It is clearly intended to whip up an emotional response and, since it is used in the context of government medicine, it is intended to evoke the feeling in people that a right is being denied to them and the government will guarantee that right by nationalizing medicine. You know and I know that no one has a claim against the services of a physician unless the physician agrees to it. Under normal circumstances, a contract between a patient and a doctor can be terminated by the doctor with notice and by the patient at any time. No one, not even the government, can constitutionally interfere in that contract. If anyone has a right to my services, it must be enforceable by law even against my wishes. Obviously, no such right exists. The government may wish to pay for my services on behalf of a patient, but that does not translate into a right."

The AAPS President stated that "it seems to us a distortion of our value system that health care would be proclaimed as a right at the same time a denial of rights to medical care has been written into the law (PSRO) and has become a key part of several of the proposals before you."

Thomas G. Dorrity, M.D., Memphis, Tennessee, Chairman of the AAPS Legislative Committee, told the Ways and Means Committee that many Americans have been puzzled from time to time by the manner in which Congress has acted on important public issues. "Medicare, in our opinion, is a classic example of Congressional decision which was not grounded on a studied evaluation of the consequences of the decision," Doctor Dorrity said. "Most members of Congress now realize this.

"Over and over again in the years before Medicare was enacted, Congress was warned by medical, insurance and financial experts that the program would be enormously more costly than its proponents claimed. HEW's own actuary told this committee that Medicare would swiftly go bankrupt unless taxes were increased or benefits curtailed or both.

"Congress ignored these warnings - and sure enough costs went up and taxes went up and the price of Medicare is now nine times original estimates, and irresponsible people are blaming doctors. The fact is that Congress dropped the Medicare bomb on a nation that was wholly unprepared. That program created and turned loose a huge artificial demand for hospital and medical care, a new demand that could not be satisfied with the manpower and facilities available. Costs accelerated, naturally, as doctors and others said they would. Medicare, pouring billions of new dollars into the economy, was highly inflationary.

"Let me emphasize to this committee that Medicare is classic in another way-it is clear and irrefutable proof that Congress by unwise decisions can fan inflation but Congress cannot prevent costs rising in an inflationary economy."

National Disaster

Translate Medicare into a program for everyone, Doctor Dorrity said. "At an average government expenditure of $600, (which is slightly less than actual per capita Medicare spending) the initial cost of such a program for 210 million Americans would be not $40 billion or $80 billion but $126 billion. And if you take the Kennedy-Mills bill and strip out the deductibles and coinsurance that so displease Senator Kennedy, you're not talking just about socialized medicine, you're proposing national disaster.

"But suppose Congress goes ahead, unmindful ~f consequences, and confiscates enough of the earnzngs of the American people to put this kind of reckless program-even at $126 billion-into effect. The tragedy of that act would not just be a financial calamity; it would be a disaster of another order. It would force the citizens of the nation to suffer a progressive deterioration of the quality of

health care under the guise of gwmg them something for nothing through the political process. Also, it would further undermine individual responsibility and strengthen bureaucratic control.

"The demand for health care created by such a program would be so overwhelming that the system would swiftly degenerate into mediocrity; it would become a bureaucratically operated fiasco. There are not enough doctors or hospitals and other facilities to even begin to cope with the demand that would follow the enactment of such a program.

"We hope the members of Congress are wise enough to heed the lesson of Medicare. We trust that the members of this Committee will not want to be responsible for imposing on everyone a govermentcontrolled program of health care that will explosively drive up costs by unleashing an uncontrollable artificial demand and, as its tragic result, debase the quality of medical care for all Americans. America can do better than follow the patterns of failure of Europe."

AAPS Dues Are Raised To 550

Dues for regular AAPS membership have been increased from $35 a year to $50, effective for 1975 dues. The dues increase was approved by the House of Delegates in April by adoption of a resolution declaring that "all costs of all things have risen disproportionately in the past several years" and "it is a fact that more funds are needed by AAPS to carry out progressively increasing activities more in number and greater in cost and expense." The resolution added that Association dues have "remained constant for many, many years as compared to increased membership dues of practically all other organizations.

Sustaining membership was increased from $75 to $100, Builder at $200 and Life at $1,000 were not changed.

The House also adopted resolutions:

• Urging repeal of the so-called Kefauver law which "confers unjustified authority on the FDA to interfere with the judgment of practicing physicians in their choice of therapeutic agents .

• Approving item - by -jtern reimbursement for money spent by the Public Relations Committee for projects approved by the Executive Committee.

• Directing the Board, the Finance Committee or a special committee to develop a membership card that will allow a member to pay a desig-

nated amount in addition to regular dues that can be forwarded to a local chapter for its financial assistance.

Alaskans Ask Repeal

Citizens for Quality Medicine, an Alaska-based organizatioh dedicated to keeping open the grea·test variety of choices to users of medical services and products, has joined with several other groups to launch a campaign for repeal of PSRO. Target date for an avalanche of telegrams to Congress is June 3, but the campaign will go through June. The campaign will concentrate on members of the House Ways and Means Committee in an effort to get them to report out HR 9375 or any other bill to repeal PSRO.

AAPS members can help the campaign by sending telegrams to their congressmen and to Rep. Wilbur Mills (R.-Ark.), Chairman of the Ways and Means Committee.

AAPS To Be

Delegates NODlinated

Enclosed with this News Letter is a form for the nomination of candidates for membership in the AAPS House of Delegates. The Association Bylaws provide for nomination and election of delegates every two years. It must be accomplished before the 1974 Annual M~eting October 31 - November 2 in New Orleans, La.

This is an important assignment. Every member is urged to nominate several AAPS members and return the list of nominees to AAPS headquarters promptly.

After the Nominating Committee has verified availability of the candidates, ballots will be sent out for the election in July.

More Associations Favor PSRO Repeal

Two more state medical associations - Florida and South Carolina - have joined the growing throng of associations taking formal action favoring repeal of PSRO.

The South Carolina association also voted against participation in PSRO and for support of the AAPS lawsuit to abolish PSRO.

The Medical Society of Georgia withdrew an application for a PSRO contract. Among county medical societies, the Montgomery County (Ohio) Medical Society went on record in opposition to PSRO.

Support For Lawsuit

The Tennessee Medical Association, The Charleston (S.c.) Medical Society, and the Richmond (Va.) Academy of Family Physicians have made financial contributions to AAPS to help in the lawsuit challenging constitutionality of the PSRO law.

K. K. Carter, M.D., President of the TMA, wrote:

"I believe the legal mechanism is the way to attack the government and realize it is expensive. I think we agree that something must be done to halt the regulation and direction of medicine by nonmedical people in government, and I agree that the legal process is the process of choice."

Oath Is Available

Copies of the Oath of Hippocrates suitable for framing are available from Johnson & Johnson, 501 George Street, New Brunswick, New Jersey 08903.

AAPS Members Elected

F. Michael Smith, Jr., M.D., Thibodaux, La. has been elected President-elect of the Louisiana State Medical Society. Dr. Smith, a specialist in family practice and obstetrics and gynecology, has been a member of AAPS since 1967.

Forrest J. Babb, M.D., West Lafayette, Indiana, a family practitioner, has been elected President of the Indiana Chapter of AAPS. Dr. Babb joined AAPS in 1962.

For Individual Liberty and Responsibility,

Donald Quinlan, M.D. President

Enclosure: Notice of Nomination of Delegates

ANNUAL MEETING, New Orleans, Louisiana, October 31-November 2, 1974

ASSOCIATION OF AMERICAN PHYSICIANS AND SURGEONS

2111 Enco Drive, SUite N-515, Oak Brook, lllinois 60521 312/325-7911 Frank K Woolley. Executive Director

THE VOICE FOR PRIVATE DOCTORS

But That's PSRO

Index No.6.

June, 1974, Volume 28, No.5

Friendly Witness "Bouqht"

One of the most difficult problems to be overcome in generating public support for abolishing PSRO will be convincing people that this horrendous law is as bad as it really is. It is so hard to believe that any group of Americans-even those politicians with an un governable appetite for power-would deliberately and with malice aforethought set about enacting a law to deny other Americans the best medical care their doc-

AAPS Suit Hearing Set For September

The three-judge federal court trying the AAPS lawsuit against HEW Secretary Caspar Weinberger challenging constitutionality of the PSRO law has set oral 'arguments in the case for 2 p.m. September 17, 1974.

The hearing had been set for June 12, but it apparently was set over until September because of the illness of two of the judges and because of the summer recess.

Meanwhile, AAPS will, if necessary, seek to obtain preliminary relief to bar HEW from any action to interfere with patients or physicians before the courts finally decide the case. AAPS will not tolerate interference with patients' right to receive or physicians' right to give their best medical judgment and care on a confidential basis.

The hearing in September will be on the question of whether the court should grant the government's motion to dismiss the suit. Written briefs have been filed by AAPS in opposition to the motion and by the government in support of the motion.

INSIDE

• AAPS Suit Hearing

• House May Alter AMA PSRO Policy

• Eleven in Race for AMA Board

• Worth Remembering

• Solons Ask Repeal

• Reds Interested in AAPS

• Truth Makes Him Angry

tors can give them. It is so hard to believe anyone would want to give government bureaucrats the power to make medical decisions and to punish doctors who disobey their orders.

But That's PSRO

And if the public finds it hard to believe how bad this law is, physicians may find it difficult to believe the lengths to which politicians bent on destruction of medical freedom will go to achieve it.

Nevertheless, AAPS has evidence that:

• Witnesses have been "bought" with tax money by members of the Senate Finance Committee staff to testify in support of PSRq because there were too many voluntary witnesses signed up to denounce PSRO at a subcommittee hearing.

• One influential member of the Finance Committee staff - Jay Constantine - has made the cold, blunt statement that "I don't care what I have to do to organized medicine to make this thing work."

• Threats appear to be a substantial part of the repertoire of bureaucrats and politicians to try to compel doctors to drop their opposition to PSRO and make it work the way the bureaucrats want it to work.

Not long ago, a member of the National Professional Standards Review Council-the organization of physicians intended to create the appearance that the medical profession will have a lot to say about PSRO rules and regulations-addressed a medical meeting in St. Louis about NPSRC activities. He said the first time he met Jay Constantine, he asked why successful voluntary peer review programs had to be pushed aside to bring in PSRO. He said Constantine looked him in the eye and said: HI don't care what I have to do to organized medicine to make this thing (PSRO) work."

Throw You To Wolves

Later, the Council member related, Constantine told him the Senate Finance Committee staff was "getting heat from the libera Is in the Senate" and that if there weren't "enough" PSROs going by the time of the AMA Annual Convention in June, "I'm going to urge the Senator (Senator Wallace Bennett of Utah) to get an amendment to his amendment (PSRO is known as the Bennett amendment) or throw you to the wolves."

AAPS has also been reliably informed that Constantine telephoned the Executive Director of a state medical society to invite him or someone representing the society to testify favorably for PSRO at a subcommittee hearing because there were so many more opposition witnesses than supporters. The society executive told Constantine, AAPS was informed, that the society could not afford the expense, and Constantine responded by offering to pick up the tab from Finance Committee funds. A representative of the society did testify, primarily on the operations of a medical foundation in his state, and expenses to the hearing were paid from tax funds.

This small society is one that already had accepted Federal subsidization to operate an HEW Emergency Medical Care Review Organization (EMCRO) program. It received $210,000 for the current study.

None of the members of the Finance Committee, nor any other member of Congress, House or Senate, for that matter, seems remotely concerned over Consta'ntine's obsessive interest in forcing PSRO on the medical profession and the American people. But a few doctors, at least, find it a bit odd, and ominous, that a paid employee of a congressional committee

should be so deeply and personally involved in the enforcement of this one law. Could it be because, as the member of the National Council observed, "I think he .has the most rigid type of obsession against organized medicine."

Threats & Intimidation

Threats, intimidation and misrepresentation have become standard weapons of those determined to force the medical profession to drink the PSRO poison. To no avail, AAPS called Congress' attention to these threats when the Association testified against PSRO May 9 before the Health Subcommittee of the Senate Finance Comimttee.

AAPS President Donald Quinlan, M.D., noted that at an American College of Radiology meeting last January attended by Senator Bennett, Constantine and Henry Simmons, M.D., chief of HEW's PSRO offioe, threat after threat was tossed at physicians that if they didn't knuckle under and accept PSRO, the wrath of Congress and the bureaucracy will descend on them and they will get something a lot worse.

Senator Bennett, for example, threatened that unless PSROs work (presumably to the satisfaction of politicians and bureeucrets), Congress probably wlll consider national health programs as instruments for changing the entire health care delivery system rather than primarily funding mechanisms.

Asked Dr. Quinlan: "If PSRO had a" the virtues claimed for it, why would such tactics (threats and intimidation) be necessary?"

He added that AAPS isn't going to turn tail and run (or withdraw and rewrite anti-PSRO pamphlets and speeches) just because someone in Congress or the bureaucracy snarls or threatens.

These threats are made as if there were no constitutional limit or restraint on governmental intrusion into the private affairs of citizens. Those who indulge in such threats tried to leave the impression they believe there is no way to put a stop to tyrannical government and that it is undesirable even to try.

AAPS, however, is determined to find out through legal means whether politicians have become so powerful that they can with impunity suspend or ignore the limitations of the Constitution.

House May Alter AMA PSRO Policy

As the time approached for the opening of the annual meeting of the AMA House of Delegates at the Palmer House in Chicago, it became less and less certain that the Delegates would permit the AMA leadership to continue collaborating with HEW to force PSRO on the unwilling profession and unknowing public.

By June 10, a total of 13 resolutions calling on AMA to work for outright repeal of PSRO had been sent to AMA for introduction in the House by nine states and one individual. There is no equivocating or hedging in these resolutions. In effect, they want officers, trustees and staff to quit using the weak excuse that repeal is "not viable" because that is no more than an excuse to keep on collaborating with the enemy.

The position. that repeal is not viable also becomes increasingly hard to defend in light of the fact that 44 bills for repeal of PSRO have been introduced by 100 members of the House and Senate. Obviously these members of Congress believe repeal is possible. What they would like is some help from the AMA.

Further, it has long been apparent that the position of the AMA trustees and staff represents a viewpoint that is far in the minority among AMA members. And there are some physicians who believe that the contin.uing policy of collaboration and refusal to work for repeal is pursued in defiance of the wishes of the House of Delegates.

By June 10, these states had introduced repeal resolutions - Idaho, Oklahoma, Indiana, Nebraska, California, Louisiana, Florida, South Carolina and Georgia. Another was submitted by Edward J. Wiater, M.D., California delegate.

Of special interest was a Board of Trustees report on PSRO activities of the AMA, a report that contains a glaringly false statement, namely that the AMA had carried on "three years of concerted opposition" to PSRO before it was enacted.

As a "progress report on PSRO, the document fails to note that AAPS had filed suit attacking constitutionality of PSRO, that the Council of Medical Staffs had filed an amicus curiae brief in support of AAPS and that the Texas Medical Association has also filed suit in federal court challenging constitutionality of the law. AMA specifically adpoted the basis for relief asserted by AAPS in its complaint filed in Illinois in June a year ago. Significantly, the TMA complaint certified that 76.5% of all practicing physicians responding to a TMA poll stated they supported "the policy of seeking repeal" of PSRO. Only 8.6% were recorded as not supporting repeal.

The AMA progress report noted that AMA has offered legal assistance to any state society seeking to overturn PSRO area designations. Significantly, however, AMA has not offered to help any society, like Texas, that wants to file suit to outlaw PSRO on grounds it is an unconstitutional invasion of the rights of patients and doctors.

Eleven In Race For AMA Board

Eleven AMA members were announced candidates for six seats on the Board of Trustees, and a 12th was being urged by associates to get into the race. The terms of three incumbents expire this year and there are three vacancies to be filled.

Incumbents seeking new three-year terms are John M. Chenault, M.D., Decatur, Ala.; Raymond T. Holden, M.D., Washington, D.C., and Donald E. Wood, M.D., Indianapolis, Ind. John R. Kernodle, M.D., resigned in January, and James H. Sammons, M.D., resigned recently when the Board chose him to succeed E. B. Howard, M.D., as Executive Vice President. The other vacancy resulted from the decision of Max Parrott, M.D., Portland, Ore., to run for President-Elect.

Besides the three incumbents seeking re-election, candidates for the Board are: Daniel Cloud, ·M.D., Phoenix, Ariz.; John Heard, M.D., Decatur, Ga.; James H. Stewart, M.D., New Orleans, La.; Hoyt D. Gardner, M.D., Louisville, Ky.; John Hawk, M.D., Charleston, S.c.; Frank J. Jirka, M.D., Berwyn, 111.; Joe T. Nelson M.D., Weatherford, Tex., and James M. Blake, M.D., Schenectady, N.Y.

Worth Remembering

"Collaboration with PSROs in the hope of avoiding harsher legislation is ill-fated, futile and dumb!"

That was the opening sentence of a letter to the American Medical News June 10 by Arthur S. Mode, M.D., Greenwich, Conn. Dr. Mode urged physicians to stand firm against PSRO and tell the world "we won't cooperate with something bad" so doctors can "preserve our integrity."

Dr. Mode's closing observation is worth remembering. "One thing Patrick Henry never said was: 'Give me some money today and I'll fight for liberty tomorrow'. "

SOLONS ASK REPEAL

The Florida Legislature has adopted a resolution memorializing Congress to repeal the PSRO law. It is the third time a legislature has called for PSRO repeal. Similar resolutions have been adopted by legislatures in Tennessee and Kentucky.

Reds Interested In AAPS

The following letter was received at AAPS headquarters recently from the director of a government library in Moscow, Russia:

"Our library makes efforts to purchase periodical publications of your country on medicine and related subjects. Would you be so kind as to send us sample copies of two current issues of your publication, AAPS Newsletter, in order we could examine and decide whether or not we should purchase your publication. Thank you in advance for your kind attention to this matter."

Truth Makes Him Angry

We've just encountered a slightly altered version of the old saying that "the truth shall make you free." This one is "the truth will make you mad."

An APPS member in New York spoke to a colleague who had not sent in his AAPS dues and received an unusual response.

The colleague said he would mail in his dues okay, but he didn't want to read AAPS publications anymore because they make him very angry. The reason they make him angry, he said, is that what they say is all true.

CORRECTION

The May 1974 AAPS News Letter erroneously reported that a contribution was made by the Tennessee Medical Association to the AAPS lawsuit challenging the constitutionality of PSRO. The contribution was made personally by TMA president E. K. Carter, M.D. He, in no way committed TMA to support the AAPS lawsuit.

For Individual Liberty and Responsibility,

Donald Quinlan, M.D. President

Enclosure: Annual Meeting Brochure

ANNUAL MEETING, New Orleans, louisiana, October 31-November 2, 1974

ASSOCIATION OF AMERICAN PHYSICIANS AND SURGEONS

2111 Enco Dnve. SUite N·515 Oak Brook llhnois 60521 312/325·7911 Frank K Woolley Executive Director

THE VOICE FOR PRIVATE DOCTORS

Facto/Life

Index No.7 July, 1974, Volume 28, No.6

AAPS Suit Best Way To Stop PSRO

The AAPS lawsuit challenging constitutionality of PSRO has emerged as the most feasible means of abolishing this authoritarian law.

That became a fact of life for the medical profession when the American Medical Association House of Delegates on Ju ne 26 ignominiously voted to surrender the nation's physicians to government tyranny. As the House acted, AMA leaders were quietly

negotiating multimillion dollar contracts with HEW to develop PSRO standards that will be forced on the nation's physicians and to train PSRO personnel who will order physicia ns around. The House action, sum marily rejectinq the hope and desire of a vast mojority of U.S. physicians that the AMA would work for repeal of the iniquitous PSRO law, was a thu ndering proclamation to the American people, to all AMA members and to every other doctor in the country that they must look elsewhere for protection from oppressive government intervention in the practice of private medicine.

New PSRO Pamphlet From AAPS Aimed at Patients

Enclosed with this News Letter is a new AAPS pamphlet -PSRO: The Great £olitical ~ickness B_ip Qff - designed as another weapon in the continuing fight to abolish the malignant PSRO law. This new pamphlet is specifically

intended to be used to educate the people, your pat~ents, on the evils of PSRO and what they can do to help abolish it.

AAPS members are urged to obtain this pamphlet in quantity for distribution to their patients and to place the pamphlet in the hands of their colleagues who are not mem bers of AAPS.

This carefully prepared pamphlet disclosing the truth about this vicious law is availabe from AAPS at cost: $12 for 100, $22 for 200, $50 for 500 and $90 for 1,000.

For further information, see story elswhere in this News Letter.

INSIDE

• New AMA Policy on PSRO

• Patients Respond To PSRO Pamphlet

• Board Is Warned That MDs Are Discontented

• Rep. Rarick Comments On AMA's Capitulation

• AAPS Speakers Bureau

When they do look elsewhere they will see that there is a nationwide organization of doctors left that will not abandon principle nor trade it for any amount of government money. That organization is the Association of American Physicians and Surgeons. AAPS, unlike the AMA, will not surrender cbjectly to the govern ment intervention ists whose overridi ng ambition is to destroy medical freedom. AAPS, unlike the AMA, will never collaborate with the enemies of medical freedom and will never help fasten upon physicians the yoke of gove rnment control.

AAPS will continue to press its lawsuit to abolish PSRO; AAPS will continue to work for congressional repeal of this evil law; AAPS will continue to expose misrepresentations about PSRO spread by HEW officials and others; AAPS will cantin ue to disseminate the truth about this vicious and punitive law by distribution of the AAPS News Letter, pamphlets and other materials.

All AMA component medical societies and all individual physician members of the AMA who embark on active programs aimed at repeal of PSRO should note and note well that they can coun t on all-out. czpposition from the leadership of the AMA - - members of the Board of Trustees and high-level staff. Even before the final capitulation of the House of Delegates at the Annual Convention in Chicago, AMA lobbyists on orders from AMA headquarters were charging through the Senate and House office buildings buttonholing members of Congress in a frenzied effort to keep them from introducing or sponsoring legislation to repeal PSRO.

Incredible as it was, AMA lobbyists were engaged in this f ren zied business of preservi ng th is horrendous law when It was the official position of the AMA that repeal would serve the best interests of the American people and when no less tha n 20 component state medical society and scores of county societies were on record unequivocally favoring outright repeal. Since it is now official policy of AMA not to work for repeal, there is every reason to assume AMA lobbyists, spending AMA members' dues money, will be even bolder in trying to pressure Senators and Representatives to oppose PSRO repeal.

MILLIONS AT STAKE

It is now obvious why trustees and staff were so desperate to manipulate the House of Delegates into rejecting repeal and adopting a quisling policy of collaboration with government to force PSRO controls on the nation.

Millions of dollars of contracts with HEW were at stake!

Under one million-dollar contract, AMA will develop sta ndards of diagnosis a nd treatment :0 be forced on physicia ns and their patients by enforcement of the iniquitous PSRO law. AMA will also split $2.8 million with other organzations to train PSRO personnel whose orders will have to be obeyed by physicians.

Most delegates did not know that such contracts were pending when the AMA leaders concocted a parliamentary scheme by which the House was bomboozled into adopting an unequivocal collaborationist policy which, one physician observed, made the AMA a department of HEW.

But the contracts between AMA and HEW were signed Ju ne 29 - - just three worki ng ~ys after the House of Delegates vote.

It is likely that HEW and AMA officials will try to deny that the fate of these contracts so far as AMA is concerned rode on the outcome of the balloting at the House meetin g. But it would be absurd to claim that HEW would give more than a million dollars to help implement PSRO to an organization that was trying to get the law repealed.

While the HEW-AMA contracts were kept quiet, it was well known that HEW was negotiating with 128 organizations for PSRO planning contracts, statewide support center contracts or conditional PSRO contracts. At the same time the AMA-HEW contracts were disclosed, HEW a nnou nced it had siqned contracts with 119 medical organizations for a total of about $25 million.

FAILS WITH FORD

Even Vice President Gerald Ford, who addressed the House of Delegates, was not immune to the pressure tactics of the AMA leadership. David Crane, M.D., Indianapolis, Ind., psychiatrist and brother of Illinois Rep. Phil Crane, told the Reference Committee considering PSRO resolutions that he was informed that Wayne Bradley, Assistant Director of theAMA's Washington office, had tried to persuade Mr. Ford to tell AMA delegates that in his opinion repeal of PSRO

could not succeed. Dr. Crane invited Bradley to step forward and deny the report if it was not true. Bradley did not deny it nor did anyone try to pretend that he ~cted on his o~ witho ut instructions from AMA officials. But conservative, anti-PSRO delegates, even before Dr. Crane spoke, heard obout Bradley's ploy, took steps, and it failed. Mr. Ford mentioned PSRO only to say that to him the initials meant "Politicians Should Remain Out."

The vote committing AMA to forsake the nation's physicians and the American people, their patients, in favor of becoming a handmaiden of government in imposing punitive federal controls over patients and doctors was engineered by politicolly astute AMA leaders who knew how to exploit delegates' confusion and turn it to the advantage of those passionately opposed to abolishing PSRO.

The victory for the pro-PSRO forces was also achieved by the defection of a significant number of delegates who defied th e express pol icy of thei r state associations to vote for repeal of PSRO.

The carefu Ily planned strategy to surrender the AMA without reservation to government dominion caught anti-PSRO delegates by surprise. When the report of Reference Committee A, whose chairman, according to House Speaker Tom E. Nesbitt, M.D., was carefully chosen, came up for floor consideration, a number of delegates were prepared to offer amendments to instruct the Board of Trustees to work for repeal of PSRO. But Speaker Nesbitt recognized William B. Hildebrand, M.D., Chairman of the Council on Medical Service, although numerous delegates had been waiting patiently at microphones for recognition.

Dr. Hildebrand, speaking for the Council on Medical Service, said that since it was the fourth time in two years the pros and cons of PSRO had been debated and, as someone else had said, "the clock is ticki ng," he therefore moved the question, a parliamentary maneuver to choke off discussion before it started and bring the reference committee report to an immediate vote. Dr. Hildebrand's motion carried by a surprising 202 to 24 vote.

NO CHANCE TO AMEND

There was evidence that many delegates did not comprehend what was happening. Even more failed to understand that voting to prohibit debate also barred amendments to the committee report. Nevertheless, after requests for a secret ballot or a recorded roll call vote were rejected, the report was adopted by a standing vote of 185 to 57.

Thomas Parker, M.D., delegate from Greenville, S.c., and an AAPS member, described the event as "the most outrageous abuse of parliamentary procedu re and collusion { have seen so for. " And John R. Schen ken, M.D., delegate from Omaha, Neb., and also an AAPS member, requested that he be recorded as voting against the report of Reference Committee A because "{ don't want to be recorded as voting for

tyranny. " Later, Or. Schenken expressed his belief that AMA delegates "have voted themselves into economic, political and professional bondage."

Dr. Nesbitt's role in this episode is open to serious question. He is an avowed protagonist of PSRO, a declared opponent of repeal and noncompliance. In a letter dated April 29, 1974, to Sen. Wallace F. Ben nett (R-Utah), Dr. Nesbitt told Senator Bennett he had just engaged in three days of debate on PSRO, "at which time," he emphasized, "I strongly supported efforts to implement Section 249-F of P.L. 92-603 (as opposed to the concepts of 'repeal' and 'noncompliance')." He said further that he had represented the AMA at two annual meetings of state medical associations and "my stance at these two meetings was also in support of the implementation of PSRO."

"support center" contract to help HEW force PSRO on Pen nsylvania physicia ns.

Dr. Nesbitt performed his task well. Not only did he recognize Dr. Hildebrand first as planned, he stalled the afternoo n meeting of the House until the votes were available to carry out the leadership plan. The House had recessed after tedious maneuvering to a specific time -- 12:57 p.m. -but the Pennsylvania and New York delegations, a total of 30 members, were tardy in returning from lunch. Instead of calling the House to order at the time certain and proceeding with PSRO, Dr. Nesbitt stalled 15 or 20 minutes until arrival of those two delegations, most of whose members could be counted on to support the pro-PSRO position of AMA trustees, officers and staff.

By action of the House of Delegates, the policy of the AMA

"RESOLVED, That if ongoing evaluation of the PSRO program reveals that it does, in fact, adversely affect the quality of patient care, or conflict with Association policy, +be Board of Trustees be instructed to use all legal and legislative means to rectify these shortcomings."

New AMA Policy on PSRO

Dr. Nesbitt, openly prej udiced for implementation of PSRO and against its repeal, to have acted ethically should have disqualified himself from presiding over House consideration of any matter involving this controversial law. Instead, he was an active participant in the political manipulations that flimflam med delegates into adopting _g_policy inimical to the best interests of patients and doctors and favorable to the purpose sgof HEW.

Had Dr. Nesbitt disqualified himself, would Vice Speaker William Y. Rial, M.D., Swarthmore, Po., disqualified himself, too? A foundation set up by the Pennsylvania Medical Society got the first PSRO contract out of HEW -- a fat $250,000

effort directed at amending those sections of the law which present potential dangers in the areas of confidentiality, malpractice, development of norms, quality of care, and the authority of the Secretary of HEW; and be it further

"RESOLVE D, That the Association should continue its efforts to achieve legislation which allows the profession to perform peer review in accordance with the profession's philosophy and the best interest of the patient; and be it fu rthe r

"RESOLVED, That individual state associations which elect non-participation shall mot be precluded from such a position by this Association's policy statement, but should be urged to develop effective non-PSRO review programs which embody the principles endorsed by the profession as constructive alternatives to PSRO; and be it further

The AMA's latest policy on PSRO established by action of the House of Delegates at the Annual Convention in June was interpreted by numerous observers and delegates as a straddling policy -- an attempt to strike a compromise between pro- and anti-PSRO forces, a "something-for-everybody" position. In fact, some delegates justified their vote for the Reference Committee report by saying that "it had something for everyone."

However, anyone who studies the document carefully must conclude that it is a crafty, cleverly deceptive statement which offers absolutely nothing to the foes of PSRO who want that heinous law abolished. The fact is that report was designed as an affirmation of the role of PSRO quisling being played by the AMA leadership. Its adoption had the effect of expunging the previous House statement that repeal of PSRO would serve the best interests of the American people.

Here is the text of the new policy of PSRO collaboration:

"RESOLVED, That this House of Delegates instruct the Board of Trustees of the Association to direct its efforts to achieve constructive amendments to the PSRO law and to ensure appropriate regulations and directives, with particular

is now to seek "constructive" amendments to the PSRO law and "to ensure appropriate regulations and directives." But the basic, evil concept of PSRO now has the AMA's full support, and the House majority has announced to the American people that the AMA no longer believes PSRO repeal would serve the best interests of the public.

One way to test who will be served by the pro-PSRO policy adopted by the House is to ask yourself who was happy with the outcome. It certainly wasn't the growing legion of physicians who want this evil law abolished. But one who was gladdened was Charles C. Edwards, M.D., Assistant HEW Secretary for Health. And that should be a thundering

message to all physicians who cherish freedom for themselves and their patients. Dr. Edwards, whose office has [urisdiction over implementation of PSRO, is so deeply and ardently com mitted to locki ng PSRO controls on the medical profession that he has approved pamphlets prepared by subordinates and distributed to every doctor in the country that con tai n f.19grant misrepresentations about the PRSO law.

Dr. Edwards, whose staff members were conspicuously present during the House meeting in Chicago, must have been apprehensive at the prospect of a vote directing AMA trustees and staff to work for repeal. But when it was over, Dr. Edwards, known as a liberal in the arena of medical politics, gave audible expression to his heartfelt pleasure.

HEW DOUBLES PEAK

"Because of this action by the House of Delegates," he said in a prepared statement, "the AMA will now be able to work closely with the Department of HEW on shaping a quality assurance program based on the concept of peer review that truly represents the best interests of both the physicia n and his patients."

This is typical standard HEW doublespeak.

Government-ordered surveillance is not peer review. Government control cannot assure quality. On the contrary, it will guarantee a deterioration in quality. The only peer review that will serve the best interests of the physician and his patients is true peer review voluntarily undertaken by physicians. The best way for HEW to serve the interests of physicians and patients is to abandon PSRO and stop governmental interference in the practice of private medicine altogether. As Mr. Ford said, "i'o/iticians S_hould Bemain Qut." This includes Or. Edwards, who is obviously a politician.

Although the AMA has formally rejected abolition of PSRO in favor of a clear-cut policy of collaboration with government in shackling patients and doctors with freedom-shattering, quality-crippling PSRO controls, let no one suppose that the AMA policy is no longer schizoidal and ambivalent. Perplexed members can only wonder why trustees, staff and a majority of the House were so eager to preserve PSRO within the Medicare and Medicaid programs but at the same time voted to do everything possible to eliminate PSRO provisions from any national health programs before Congress.

There is an additional puzzling contradiction in the new AMA PSRO policy. While embracing PSRO, the new policy declares the AMA "should continue its efforts to achieve legislation which allows the profession to perform peer review in accordance with the profession'S philosophy and the best interest of the patient." Obviously PSRO, so ardently championed by trustees and staff and endorsed by the House majority, will not allow doctors to perform peer review in accordance withthe best interest of patients and, obviously, it is in conflict with AMA leadership'S interpretation of the profession's peer review philosophy.

WHAT HAPPENED?

Bewildered doctors allover the country are asking what happened in the House of Delegates last month. Stuart

Auerbach, reporter for the Washington Post, tapped his know ledge of the modus operandi of the Washington bureaucracy and medical politicians and came up with an answer. Surprised by the success of the motion to shut off debate and by the lopsided 185 to 57 vote to cast the AMA lot on the side of governmental tyranny over the practice of medicine, Mr. Auerbach decided that "Weinberger must have offered them a lot of money."

As it turned out, the AMA hierarchy, which had already sacrificed the Association's independence by acceptin g money from the federal government, had its hand out for another million dollars of HEW money to help HEW in forcing PSRO on doctors and patients. And at the time of the meeting, 128 physician groups in 46 states had applied for PSRO money. Incredibly, in some states in which the state medical association strongly supported PSRO repeal, organizations sponsored by the state associations had applied for PSRO g rants and contracts.

SERVE TWO MASTERS

In many cases, the decision to accept PSRO money and thus to surrender to government control has originated with state a nd local medical society executives who have convinced themselves that if enough federal money is avo ilable there is no impropriety in serving two masters -- the medical society and a government-controlled PSRO agency. The obvious conflict of interest is no more of a handicap to them than it is to Robert B. Hunter, M.D., who is accepting

-federol money to serve on an HEW PSRO agency, the National Professional Standards Review Council, and simultaneously representing the AMA membership as a trustee. Dr. Hunter has become one of the nation's most dedicated PSRO hucksters, which is great comfort to all who advocate subjugation of medicine to government.

But some medical society executives, who fougl:2! government intervention for years, have admitted pangs~ conscience at thei r role in establishi ng and running foundations that get federal money and as a consequence take orders from government clerks. But the obvious conflict of interest leaves most of them unmoved. They are willing to throwaway their society's independence so long as they get a cut of the PSRO millions.

While AMA's national-state political machine becomes well oiled with government money, the nation's practicing physicia ns, busy taking care of patients, are unaware that the collaborationist policies of the AMA leadership is undermining the very system of medicine that gives the practicin g physician the opportunity to devote his time and skills to caring for patients without becoming engulfed in bu rea ucratic paperwork and without the necessity for carrying out orders of governr:nent clerks.

The magic word in this Political Sickness Rip Off known as PSRO is money -- millions of dollars of federal tax money. It is becoming increosinqly apparent that if the independence and freedom of medicine is obliterated it will be through the connivance of medical politicians who will sell them out for government money.

Some physicians will recall a meeting of the AMA House of Delegates in Boston in 1970 when a delegate, noting that Jay Constantine of the Senate Finance Committee staff had estimated $240 million would be available for PSRO administration, exclaimed: "We can't let this kind of money get away from the medical associations to be handled by someone else."

And a few months later at Hershey, Pa. the American Association of Medical Society Executives conducted a program on "grantmanship" -- how to get government money and how to manipulate medical society members who object to that kind of sellout.

Is the federal treasury one of the "new sources of reven ue" that AMA Executive Vice President Bert Howard, M.D. told a reference committee last month that the Association must find in lieu of raising dues again?

One is also prompted to ask: Is a quarter of a billion dollars sufficient to induce medical politicians and medical organization executives to abandon principle and sell out the freedom and independence of physicians and the best interests of their patients?

INSTRUCTIONS IGNORED

No doubt physicians whose state associations had taken a firm stand for PSRO repeal will be astounded to know that some AMA delegates ignored or failed to carry out instructions to stand fast for an AMA policy to work for repea I. At least 20 state associations were committed to seeki ng repeal. More than 100 delegates from those associations were seated in the House. Nearly 50 of them, nevertheless, voted against repeal and for a policy of helping destroy

medical freedom by forcing PSRO controls on an unsuspecting public and an unwilling profession.

The nine-member Ohio delegation, for example, was instructed to vote for a clear-cut policy of repeal. AAPS was reliably informed, however, that only two Ohio delegates did not vote for the collaborationist recommendations of the Reference Committee. They were Harry K. Hines, M.D., Cincinnati, and Robert E. Tschantz, M.D., Canton.

Californians reported to AAPS that many delegates from that state, led by six lame duck delegates, repudiated the strong a nti-PSRO policy of the California Medical Association and voted to support the AMA leadership's policy of helping HEW fo rce PSRO's vicious controls on patients and doctors.

Delegates from Texas, that cradle of medical conservatism, also broke ranks to turn against their own colleagues who are so strongly opposed to PSRO that TMA is the only state association in the nation to file a lawsuit to overturn PSRO on constitutional grounds, following the lead of AAPS which filed suit to outlaw PSRO a year ago. Reportedly only one delegate from Texas stood up to vote against the reference com mittee report, and at least half voted for the gag motion to shut off discussion of PSRO. A source close to the TMA delegation said there was confusion in the ranks -- and subsequent anger that delegates "did not get to vote the way they wa nted to vote." He added: "We were snookered by some people who railroaded the whole thing."

He could have added that the American people olso were snookered by the medical politicians who are running the AMA.

Patients Respond To PSRO Pamphlet

A South Carolina member of AAPS has been making effective use of the Association's new potient pamphlet - "PSRO: The Great folitical i1ickness Rip Qff."

F. M. Ball, M.D., Charleston, picked up some copies of the pamphlet while attending the AMA Convention in Chicago last month. In a subsequent letter he said: "I am writing to get more copies of the new brochure -- PSRO: The Great Eolitical ~ickness Eip Qff. This little folder ... has been well received by my patients in the last 24 hours in my office and I need more of them."

Dr. Ball added that while seeing patients he wears a lapel button with the words "Repeal PSRO." The button almost always catches the attention and arouses the curiostiy of the patient. When he asks for information, Dr. Ball said, "I give him the 'Rip Off' folder."

This new brochure, a copy of which is enclosed herein, is available from AAPS headquarters in quantity at cost (see item on Page 1 of this News Letter).

"PSRO: The Great Eolitical ~ickness ~ip Qff" was painstakingly prepared over a considerable period of time. The truth and accuracy of every statement in the pamphlet was meticulously verified and documented before the copy was sent to the pri nter.

The pamphlet delineates "The Frightening Consequences of PSRO" for Americans, pointing out that this law gives government agents the power to:

• Deny you the right to choose your own doctor,

• Deny you and your doctor the right to decide what is "medically necessary" and "medically appropriate" for you,

• Deny you the right to have the kind of medica I care your doctor thinks is best for you,

• Deny you the right to talk to your doctor in confidence about your illness.

Board is Warned that MDs Are Discontented

Although the AMA House of Delegates rnojority, led by the trustees and staff, gave the cause of medical freedom a tragic setback at the AMA's annual meeting last month, the delegates gave the Association leadership clear warning that there is dissatisfaction throughout the membership with the manner in which officers and trustees are discharging their obligations.

Item: Two members of the Board of Trustees were defeated for reelection -- a ra re occu rrence. Only one incumbent, Raymond T. Holden, M.D., of Washington, D.C., was returned to the Board. John M. Chenault, M.D., Decatur, Ala., and Donald E. Wood, M.D., Indianapolis, Ind., were voted off the Board. New members elected were James M. Blake, M.D., Schenectady, N.Y.; Daniel Cloud, M.D., Phoenix, Ariz.; Hoyt Gardner, M.D., Louisville, Ky. Frank Jirka, M.D., Berwyn, 111., was elected for a two-year term to succeed James M. Sammons, M.D.,who is Executive Vice President designate, and Joe T. Nelson, M.D., Weatherford, Tex., was elected for one year to succeed Max Parrott, M.D., who resigned to run for President Elect.

Item: Dr. Parrott, a member of the Board of Trustees, won election as President Elect by a mere two votes, 121 to 119, against Richard S. Wilbur, M.D., who got into the race only about 48 hours before the vote. Dr. Wilbur, former Deputy Executive Vice President, was once considered the heir apparent to Executive EVP E.B. Howard, M.D. But after one of the most devisive conflicts in Board history, Dr. Wilbur was dumped in favor of Dr. Sammons. Fifteen ballots were required during two days of a Board meeting to choose Dr. Sammons.

Item: A "gag rule" proposed by AMA leadership was resoundingly defeated by the House. The proposal would have required 30 days notice before a nonmember could speak to a meeting of the House of Delegates. Trustees and staff proposed the "gag rule," as it was quickly labeled, because of the unscheduled appearance of Rep. Phil Crone before the House in Anaheim, Calif. Rep. Crane was credited with turning the House around and influencing members to vote for repeal of PSRO. During deliberation of the "gag rule," Speaker Tom Nesbitt was overruled overwhelmingly when he tried to proceed with consideration of the proposal against the wishes of a majority of members.

Item: The House of Delegates refused to act on a proposal designed to increase designated representation of specialty societies in the House. The proposal was referred for further study.

Item: The House directed simultaneous election of Board members, a change strongly opposed by incumbent trustees and staff who wanted retention of the traditional "slot" method.

Rep. Rarick Comments On AMA's Capitulation

The following commentary on the AMA House of Delegates vote favoring more government interference with physicia ns in the practice of private medicine and their patients was inserted into the Congressional Record for June 27, 1974.

Hon. John R. Rarick Of Louisia na

In the House of Representatives Thursday, June 27,1974

Mr. Speaker, the American people in their struggle to • preserve individual liberty, were handed a rnojor setback by theAmerican Medicol Association's action in opposing repeal of the Professional Standards Review Organizations -PSRO's.

It is truly unfortunate that the once prestigious American Med ica I Association has now gone on record as compromising the personal privacy of patients' medical records and endorsing political medicine.

Under the PSRO scheme, patients' medical records must be computerized in order that HEW can lay down norms to prescribe "equal health care guidelines." This is tantamount to inviting a political overseer into every doctor's examining room thus making the physician but a delivery tool, prescribing not according to his training, experience, and ethics, but rather adhering to bureaucratic fiat.

Ironically, the mojor reason suggested for surrenderon this critical issue of patients' privacy was that the medical lobby feared that defense of patients' privacy would cost the AMA money. Nothing was mentioned about the concern for patients' rights.

Even more ironic, by the American Medical Association's compromise to accept Government oversight, the AMA has destroyed its own purpose and effectiveness with both its member doctors and the American people. AMA has now reduced its stature to being but a department of HEW - rather than representing the wishes of its members to the Washington bureaucrats, it has now assumed the role of representing the Washington bureaucrats to its members and

the American people. .

Thus, another major bridge has been. established to destroy historic private medicine as we Americans have known it and usher in socialized medicine. Time will tell whether the medical patients of America and their physicians will bow to the AMA's cop out or continue the fight to repeal PSRO.

The delegates swiftly voted, 185 to 57, their approval of a resolution pushing for some amendments to the PSRO law, but not ca II ing for its repeal.

Perha ps AMA will favor placing doctors offices in post offices -- another Federal service supposedly in the public's interest, that is provided HEW wants it and, it saves AMA money. I include a related newsclipping: From the Washington Post, June 27, 1974, By Stuart Auerbach.

CHICAGO, June -- Despite threats of a membership revolt, the ruling body of the American Medical Association today heeded its leadership and voted not to wage an all-out war against a government-run doctors review program.

The vote supporting Professional Standards Review Organizations (PSROs) - which a committee of the AMA's House of Delegates said had created an "almost schizophrenic division" among doctors - was overwhelming and taken without debate.

AMA trustees and officers had spent most of the organization's annual meeting warning members that fighting PSROs would waste the AMA's money and was doomed to failure.

Some officials even predicted that a war against PSROs could mean the end of the AMA as the voice of medicine to the public and Congress.

"I was not willing to see funds committed on behalf of repeal," said Or. Malcolm C. Todd of Long Beach, Calif., the AMA's president-elect. "It would taken quite a bit of our resources and I doubt that it would have been successful."

Todd's view was echoed in state caucuses today by such other influential AMA officers as Or. Robert B. Hunter of Sedro Woolley, Wash., a trustee and head of the AMA's PSRO committee, and Or. W. B. Hildebrc'ld, of Manasha, Wis., ch airman of the House of Deieqates' committee on medical services.

Nevertheless, it appeared un til this afternoon that substantial number of AMA delegates would insist that the organization push for repeal of the PSRO legislatio'n and would refuse to comply with its implementation.

The delegates swiftly voted, 185 to 57, their approval of a resolution pushing for some amendments to the PSRO law, but not calling for its repeal.

"The delegates finally had enough time to talk it out," said Or. George B. Martin, Jr. of Thief River Falls, Minn., chairman of the committee that held a 41/2-hour hearing, listening to 64 speakers, on the PSRO issue Monday.

While most delegates appeared satisfied with the decision, at least one -- Or. John R. Schenken of Omaha -- demanded that his name be specifically recorded in opposition to PSROs.

"I don't want my name recorded as being in favor of tyranny," he said.

Hunter said he thought two state medical societies Nebraska and Louisiana -- were still "adamant" against PSROs and might refuse to cooperate with the federal effort.

"But a majority of physicians across the country will work with the government," Todd said.

In Washington, Or. Charles C. Edwards, Assistant Secretary for Health of the Department of Health, Education and Welfare, commended the AMA delegates for their "responsive and constructive position."

PSRO legislation was passed in 1972 to allow the government to monitor the quality and cost of treatment given to patients in two large federally financed programs - Medicaid and Medicare. It probably will be expanded in any national insurance bill to include the entire population.

Earlier, the AMA delegates voted to "exert all efforts" to amend or repeal the Kefauver-Harris amendment to the pure food and drug laws which requires new drugs to be proved safe and effective before they are allowed on the market.

Delegates argued that the amendment is keeping new drug s off the market. The AMA gets about one-third of its revenue from drug company advertising in its journals.

AAPSSPEAKERSBUREAU

The need for dissemination of the truth about public issues that vitally affect the practice of private medicine has never been more urgent than it is now. For that reason, AAPS maintains a Speakers Bureau, with knowledgeable, top-notch speakers available for appeara nces before meetings of medical societies or other physicians groups or before non-physician audiences to bring out the truth about such issues as PSRO, national health legislation,hospital-physician relationship and health maintenance organizations.

AAPS members are urged to develop speaking engagements for AAPS representatives before physician and non-physician organizations. When the opportunity arises for the use of an AAPS speaker to make the truth about these issues known, contact Association headquarters in Oak Brook, Illinois.

It is imperative, however, that you allow a reasona ble time for the selection of an appropriate speaker and for that speaker to make the necessary orra nge ments for the assignment.

For Individual Liberty and Responsibility,

~~L

Donald Quinlan, M.D. President

Enclosures: Political Sickness Rip Off Pamphlet Pamphlet Order Form

Thus, undue emphasis was placed on consumption to the disadvantage of savings and production, and of a sound currency. Instead of producing in order to consume, the mood of society thereafter became one of con" suming in order to produce. To reverse the process, therefore. rcq ui res a new kind of thinking, a new psychology. Inflation may be construed as demand far outstripping supply, but it is also supply prevented from matching demand.

. Certainly cut non-defense spending to the bone if necessary (as urged by President Nixon, not for the first time. on May 28 in his interim economic report), but at the same time increase the supply factor' of the monetary 'equation by freeing industry of all bureaucratic meddling and persecution. This would include repeal of the costly and ineffectual antitrust taws anti those taxes (such as the progressive income and inheritance taxes) that raise the level of industrial costs and hinder capital accumulation, and are levied not primarily for revenue but for redistributing weaith.

Admittedly this is an ambitious program, but if a real solution requires "a change of attitudes," the hackneyed notion that only government action can cure inflation must be abandoned and liberal, unconditional reliance placed for the very first time on free markets. RAYMOND V. McNALLY

London, June 8, 1974

•

THE NEW YORK TIMES

SATURDAY, JUNE 22,1974

Letters to the Editor

Copyrighted, 1974 New York Times Company

Reprinted with permission

To the Roots of Inflation

To the Editor:

Your report by Michael C. Jensen on June 7 of the warning by the panel of prominent economists that world inflation is approaching the "crisis stage" cited the various factors contributing. to it and pointed out that "government borrowing and govern-

, ment-guaranteed borrowing to pay for social programs were dominating the long-term capital markets which provide the benchmark for other credit markets."

But the remarks of Albert Sommers, chief economist of the Conference Board, also quoted by the report; tended to raise the level of thinking, '0 embrace deeper and wider impliQlt-< tions: The real roots of inflation, Mr. Sommers said, He in "a profound historical shift in the social conditions and value systems of democratic cap~jtalism." And because of the "explosion of expectations that carry demand for output far beyond their finite resources," he concludes that "a reat solution can only be found in a change of attitudes."

This is easier said than done. The groundwork for runaway inflation was' laid some forty years ago when classical economics was ditched for the Marx - Keynes syndrome. From that time, the dubious "full employment" concept, implemented by budget deficits and high taxation, was assiduously promoted by the entire liberal fraternity.

ANNUAL MEETING, New Orleans, Louisiana, October 31-November 2, 1974

ASSOCIATION OF AMERICAN PHYSICIANS AND SURGEONS

2111 Enco Dnve. SUite N-515. Oak Brook, tumors 60521 312/325-7911 Frank K Woolley Executive Director

THE VOICE FOR PRIVATE DOCTORS

Index No.8 August, 1974, Volume 28, No.7

May Lose Accreditation

JeAH Rules Against Enforced Bylaws

The Accreditation Committee of the Joint Commission on Accreditation of Hospitals has issued a ruling which has the potential for enormously strengthening the position of hospital staff physicians who resist attempts by hospital administrators and boards to grab control over medical staffs and the practice of medicine in their hospitals.

Thrust of the ruling is that a hospital governing body risks loss of accreditation if it adopts and seeks to enforce bylaws or amendments to staff bylaws that have not been approved by the medical staff.

The Accreditation Committee acted on a complaint filed by members of the staff of St. Joseph Hospital in Chicago. They charged the governing body acted contrary to accreditation standards when it unilaterally rewrote staff bylaws and attempted to force staff physicians to agree to them.

Members of the AAPS spearheaded resistance to this blatant bid for power -over staff physicians and their medical decisions. One of them, AAPS President Donald Quinlan, M.D., filed suit against the hospital after the administration refused to renew his privileges. Dr. Quinlan would not agree to be bound by terms of bylaws the staff had not approved and, specifically, he would not agree to give the hospital administration a blank check authorization to amend the bylaws at will without consent of the staff. Dr. Quinlan's suit is pending.

AAPS has encouraged Dr. Quinlan and his colleagues in their resistance to the arbitrary, dictatorial decision of the St. Joseph Hospital administration (inspired by the ambitions of

INSIDE

• Strong New Orleans Meeting

• Most PSROs Tied to Medical Societies

• M.D.s Approve PSROs

• Resolution Deadline Set

• I!> PSRO For Lawyers Coming?

• Amendments to By-Laws

• Interest High in Delegate Vote

an administrator who precipitated the conflict and then left the institution). In addition, AAPS has drafted and distributed a pamphlet delineating the rights of medical staffs and how these rights can be defended. The pamphlet also contains a model ~et of bylaws designed to define the responsibilities of staff physicians as well as their rights, based on the fact that staff physicians are independent contractors responsible for their own medical decisions,

TEXT OF RULING

This important ruling stands as proof of the validity of AAPS' historic position that physicians don't have to let others push them around, regardless of who tries it -government, hospital, or insurance company. This far-reaching ruling was disclosed in a July 10,1974, letter from John D, Porterfield, M.D., JCAH Director, to Sister Juliana, St. Joseph Hospital Administrator. Following is the text of the letter.

Reference is made to my letter of January 24, 1974, to you advising of a complaint lodged with the Joint Commission on Accreditation of Hospitals by certain members of the Medical Staff of St. Joseph Hospital concerning actions taken by the Governing Body of that institution allegedly in conflict with hospital accreditation standards.

Mr. Joseph Stone, Associate Director of the Joint Commission, and I met with you, members of the Governing Board, and the current Executive Committee of the Medical Staff on January 31,1974. Subsequently we met, on February 8, 1974, with a number of the members of the Medical Staff who had filed the complaint.

Following a review of our notes of these two meetings and other pertinent documents, the matter was placed before the Accreditation Committee of the Board of Commissioners for consideration, I have now to advise you of the decision of that body.

The Accreditation Committee Voted:

1) that St. Joseph Hospital authorities be informed that the ratification by a governing body of medical staff bylaws which have not been formally adopted by the Medical Staff in uccordance with existing bylaws did occur at St. Joseph Hospital and is not in

conformance with hospital accreditation standards (emphasis added);

2) that the Joint Commission urge that the St. Joseph Hospital Medical Staff, in consultation with the Governing Body, develop medical staff bylaws which, when duly adopted by the Medical Staff, are ratified by the Governing Body without unilateral amendment (emphasis added);

3) that there be concurrence between St. Joseph Hospital Governing Body and Medical Staff that actions taken on Medical Staff matters during the period when the inapp_ropriately enacted medical staff bylaws (emphasis added) have been followed be accepted and not reconsidered;

4) that the accredited status of St. Joseph Hospital presently enioved be continued on condition that the above steps are taken (emphosis added);

5) that the resurvey for continued accreditation now scheduled for the last quarter of J 974 be deferred until the second quarter of 1975;

6) that the proper adoption (emphasis added) of medical staff bylaws by the Medical Staff and their ratification by the Governing Body be effected by March 1, 1975.

It was the sense of the Committee action and my own recommendation that the Medical Staff of St. Joseph Hospital with primary affiliation to that institution work actively, openly, and in good faith to devise effective bylaws in the interest of the quality of patient care and to do this in continuing concert with

the Governing Body. The goal is to achieve a collegial self-government which recognizes the responsibility of the Medical Staff for the quality of medical care and equally its accountability to the Governing Body, which has responsibility for the proper operation of the hospital. If the Medical Staff fails to exercise this function properly and in timely fashion, the Governing Body then has no recourse but to effect medical staff bylaws on its own initiative.

If the Joint Commission staff can in any way be helpful in this exercise, please f,"el free to call on us.

NATIONWIDE MOVEMENT

The move to reduce staff physicians to a status subservient to hospital administrations has become nationwide, sparked by a misinterpretation of the celebrated Darling case in Illinois. Some of the misinterpretation has been deliberate. As a consequence, numerous hospital officials have been inspired to seek dictatorial control over hospital staffs on the erroneous proposition that the administration is wholly responsible for medical decisions in the hospital and, theretore, must exercise such control.

While the JCAH ruling applied to the situation at St.

Joseph Hospital and was not generalized, it is, nevertheless, clearly a repudiation of the stand taken by many hospital officials that the medical staff is subservient to the cdrninistrction.

But more than that, it is further proof that when physicians understand their rights and are determined to defend them, they can find a way to do it -- and win. Every ethical doctor should stand up for his rights and refuse to permit third parties to substitute their judgment for his.

AAPS Planning Strong Meeting at New Orleans

Are you tired of being pushed around?

Most doctors are. They are tired of being pushed around by government, by insurance companies, by hospital admi nistrations. And the prospect of being pushed around by PSROs looms larger in physicians' practice.

By attending the AAPS Annual Meeting in New Orleans October 31 - November 2, doctors will receive information relative to self protection in addition to valuable knowledge about other problems,

The roster of speakers will include:

• The Hon. J. Enoch Powell, former British Minister of Health, who will bring into sharp focus the similarity of events which led to socialized medicine in England and the events that point in that direction in America. Mr. Powell is considered one of the world cuthorities on government control of medicine. He served as British Minister of Health 1960 to 1963, trying to make the National Health Service work. He concluded that "by its very nature" it could not work.

• Dan Smoot, writer, lecturer, radio and television commentator and publisher of the incisive The Dan Smoot Report. Mr. Smoot will discuss the ideological similarity between the infamous OSHA law and the

iniquitous PSRO law and explain how relating the two can enlist businessmen on the side of ethical medicine.

• The Hon. John Rarick, Congressman from Louisiana and chief sponsor of one of the first bills introduced in Congress to repeal PSRO. He will talk about the prospects for avoiding tyranny by abolishing PSRO.

• Donald Quinlan, M.D., AAPS President, who will discuss the necessity for ethical physicians to organize to avoid being pushed around.

• F. Michael Smith, M.D., President-Elect of the Louisiana State Medical Society. Dr. Smith will speak on how state medical societies can be a positive force for ethical medicine.

Panels will probe problems and how to solve them involving such subjects as hospital-physician relationship, PSROs, HMOs, compulsory nationalized medicine, membership recruitment and organizing an AAPS chapter and a speakers bureau.

If you're tired of being pushed around, plan to attend the AAPS Annual Meeting in New Orleans and find out how to avoid it.

Fill out the reservation form on the enclosed Annual Meeting _!.!yer today.

Paid Agents of HEW

Most PSROs Tied to Medical Societies

At least 77% of the medical orqanizations that so for have accepted contracts which make them paid agents of HEW in forcing PSROs on the nation's physicians and their patients have direct and obvious ties to state or county medical societies. Undoubtedly others also are satellites of medical societies.

Announcement of PSRO contracts between HEW, AMA and 115 other medical organizations was deferred until the AMA House of Delegates voted in June for all-out collaboration with HEW in imposing the iniquitous PSRO law on the country. Many doctors are convinced that the millions of dollars of PSRO money available to the AMA, and county medical societies, directly and indirectly, was the bribe that got HEW the favorable PSRO vote it wanted from the AMA AMA House of Delegates.

For past, present and future collaboration, the AMA was awarded substantially more than a million dollars to help develop standards of medical practice that will be forced on doctors and to train PSRO personnel who will push doctors around.

HEW also announced the awarding of PSRO contracts totaling $20,850,000 to 115 medical organizations, the overwhelming majority of whom have direct ties to state and county medical societies.

In some instances, the executive ( director of a medical society also serves as the executive of the Q!ganization that has accepted tax money to become Q.I2.S1gent of HEW and subject to the orders of HEW officials.

HOW'S THAT FOR A MONUMENTAL CASE OF CONFLICT OF INTEREST!

STRICTLY LEGAL

In awarding certain contracts, HEW may be stretching the provisions of the PSRO law. The law (Section 1152 (f) (1)) requires the Secretary of HEW to notify area physicians "in the case of agreements ... under which any organization is designated as the Professional Standards Review Organization for any area .:" Section 1151 (f) (2) gives area physicians a chance by ballot to veto such an agreement.

The law also makes it mandatory that the Secretary designate each PSRO as a conditional PSRO before he can enter into an agreement with an organization to become a fully functioning PSRO. The conditional PSROs must serve a trial period up to 24 months to give the Secretary opportunity to determine whether they are capable of performing as PSROs.

Nothing in the law requires the Secretary to notify physicians he intends to enter into an agreement with an organization designating it as a conditional PSRO. Further, nothing in the law permits physicians to block a conditional agreement by referendum.

However, in the case of 11 organizations -- which will get $13,244,000 of HEW money -- the Secretary has notified physicians in each area and given them an opportunity to object to any agreement with these organizations. He has published notices in the Federal Register that these 11 are to be designated as the PSRO for the area, not as conditional PSROs.

MDs Approve PSROs

A mojority of physicians in New Mexico and in the Sacramento, Calif., area approved HEW agreements with PSRO organizations in balloting conducted in July, according to HEW's Professional Standards Review Office.

When HEW notified physicians in these areas that the agency intended to enter into agreements with the Greater Sacramento Professional Standards Review Organization and the Professional Standards Review Organization, State of New Mexico, more than 10 per cent of the physicians in New Mexico and in the Sacramento area obiected in writing to HEW.

HEW then conducted a poll to determine whether more than 50 per cent of the physicians believed that the organizations were not representative of the area physicians.

HEW's PSRO office reported these votes to AAPS:

New Mexico -- Yes (organization is reprsentative) 726.

No (is not representative) 264.

Sacramento -- Yes 581.

No 450.

The PSRO office at HEW said the votes clear the way for HEW to enter into PSRO agreements with these organizations.

According to the PR department of HEW's PSRO office, the agency's legal staff claims it doesn't matter what the notice in the Federal Register says because the law clearly requires PSROs first to serve trial periods as conditional PSROs. Therefore, say the lawyers, the 11 organizations must be designated and serve as conditional PSROs.

That does not, however, answer the question why physicians were given opportunity to ballot on conditional PSROs when the law clearly does not permit it. It would appear that in each case, the Secretary must give area physicians a second chance to veto an agreement at the time he is ready to enter into agreement with the organizations designating them fully functioning PSROs. If he does not, a case could be made that he is violating the law and depriving physicians of a statutory right.

Among the 115 HEW PSRO agreements were 13 for a total of $2.085,492 that went to organizations designated as PSRO "support centers" that will be paid by HEW "for the purpose of accelerating the development of the PSRO program." All but one of these 13 organizations that are being paid by HEW to force PSRO controls on patients and doctors either are state medical societies or were organized by the state society or have other medical society connections.

Planning agreements -- preliminary to the designation of an organization as a conditional PSRO -- were awarded to 91 medical groups throughout the country. A cursory check indicated that no fewer than 69 were linked to a medical society. most having the same address as the society.

Following are announced PSRO consrcct awards. asterisks denoting a link with a state or county medical society.

STATEWIDE SUPPORT CENTERS

"Connecncut jaedicc! Institute, New Haven -Massachusetts Statewide Support, Boston "New Jersey Foundation for Health, Trenton

"Medical Society of the State of New York. Lake Success ·Maryland Foundation for Health Care, Baltimore "virqinio Professional Standards, Charlottesville "Pennsvlvonto Medical Care Foundation, Lemoyne

"North Carolina Medical Peer Review, Raleigh

Indiana Physicians Support Agency, Indianapolis ·Michigan State Medical Society, East Lansing

·Medical Advances Institute. Columbus

"Heolth Care Foundation of Missouri, Jefferson City ·United Foundations for Medical Core, San Francisco, Calif.

CONDITIONALLY DESIGNATED PSROs

Bov State PSRO. Inc.. Boston. Moss.

"Chorles River Health I Care- Foundation, Newton Lower Falls, Mass. *Prince Georges Foundation for Medical Care, Inc., Hyattsville, Md. *Mississippi Foundation for Medical Care, Inc., Jackson

Tennessee Foundation for Medical Care, Inc., Nashville *Foundation for Health Core Evaluation, Minneapolis, Minn. *Colorado Foundation for Me(jical Care, Denver

"Utah PSRO. Solt Lake City

*Wyoming Health Services Co., Inc. Cheyenne Son Joaquin Area PSRO. Stockton. Calif.

Multnomah Foundation for Medical Care, Portland, Oregon

PLANNING ORGANIZATIONS

*Connecticut Area II PSRO, Inc. New Hoven

Eastern Connecticut PSRO, Inc. Willemantic "Hartford County PSRO. Inc. Hartford. Conn. "PSRO of Fairfield County. lnc., Bridgeport. Conn.

*Central Massachusetts Health Core Foundation, Worcester *Western Massachusetts PSRO, lnc., Springfield

Southeastern Massachusetts Prof. Standards Review, lnc., Middleboro *New Hampshire Foundation for Medical Care, Concord

Pine Tree Organization for PSRO, Inc. Waterville, Moine "Rhode Islond PSRO. Inc .. Providence

"Vermont PSRO. Rutland

Area I - PSRO Region II, Morristown, New- Jersey *Essex Phvs.cicns' Review, East Orange, New Jersey

*Possaic Valley Professional Standards Review, Clifton, New Jersey Adirondack Prof. Standards Review Organization. Glens Foils, N.Y. "Area 9 PSRO of N.Y. State. lnc., Purchase

"Erie Region PSRO. Inc .. Buffalo. New York

$147.Bl0 $289.410 $193.000 $208.590

S97.350

S75,720 S243.290

S97.760 S196,650 $100.470 S134.320 SI06.680 $194.330

S3.205.680 S503.420 $212.458 $1.227.954 $1.626.305 SBB6.000

$2.700.000 $951.495 S604.502 $662.470 $662.848

$66.000 S63.800 S50.000 $5B.650 $64.000 $46.150 S·61.000 $56.000 $71.000 $62.000 $52.400 $46,100 $54.000 S37.OOO S52.000 S57.OOO $67.000

"Five-County Organization for Medical Care & PSR, New Hartford, N.Y. $52,000

"Genesee Region PSRO. Inc., Rochester. New York $77.000

"Kings County Health Core. Brooklyn. New York S64.500

*Nossau PhySicians Review, Garden City, New York $96,000

New York County Health Services. New. York City $86.300

"Richmond County. New York Professional Stds. Review. Staten Island $55.500

"PSRO of Central New York. Inc.; Syracuse $54.400

*Professional Standards Review Organization of Rockland, Nanuet, N.Y. $62,800

*The Bronx Medical Services Poundotion. Inc., Bronx, N.Y. $79,600

*Foundation for Medical Care of Puerto Rico, Santurce $45,200

*Delaware Foundation for Medical Care, W·"mington $45,150

"Notioncl Capitol Medical Foundation. Inc.. Washington. D.C. S55.000

"Boltirnore CIty Prof. Review Organization, Inc., Baltimore, MD. $52,555

"Central Maryland PSRO. Inc .. Baltimore $41.000

Delmorvo Foundation for Medical Core. Inc .. Salisbury. Maryland S55.720

Montgomery County. Md. Medical Core Foundation. lnc., Silver Spring $64.800

Southern Maryland Prof. Stds. Review Organization, Inc., Glen Burnie $36,555

"Allegheny PSRO. Pittsburgh. Penn. $B8.217

"Central Pennsylvonio Area II PSRO. Williamsport $47.175

*Eastern Pennsylvania Health Core Foundation, Inc., Allentown $65,000

Montgomery/Bucks Prof. Stds. Review Organization, Inc., Norristown, Penn. $54,000

"PSRO Areo XII Executive Committee, Philadelphia. Penn. $100;000

"Highlands PSRO Corporation. Johnstown. Penn. $46.600

"Southcentrol Pennsylvania PSRO. Lemoyne $54.000

"Soutbwestern Pennsylvania PSRO. Greensburg $62.500

*Northern Virginia Foundation, Alexandria $57,870

*West Virginia Medical Institute, Inc., Charleston $48,000

*Alabama Medical Review, lnc.. MontgolTlery $65,000

"Dode Monroe PSRO" Inc .. Miami. Florida $73.000

*Kentucky Peer Review Organization, Inc. Louisville $36,000

Piedmont Medical Foundation. lnc., Winston-Solem. N.C. $46,380

*South Carolina Medicol Core Foundation, Columbia $60,000

Shelby County Foundation for Medical Core. Inc .. Memphis. Tenn. $54.000

"Chicago Foundation for Medicol Core, Chicago S225.760

"Quad River Foundation for Meqical Core. Joliet. III. $46.135

Calumet Professional Review Orgonization. Highland. lnd, $39.200

"Indiana Area V PSRO. Indianapolis $51.620

Genesee Medical Corporation, Flint. Michigan $36.000

Upper Peninsula Quolity Assurance Association. Escanaba. Mich. $45.300

"4th Area Professional Standards Review Council, Toledo. Ohio $59.000

"Region X Professionol Review Systems. Columbus. Ohio $55.300

Medco Peer Review. Inc .. Cincinnati. Ohio $52.850

*Physicians' Peer Review, Cleveland, Ohio $63,000

"Region Six Peer Review Corp., Akron. Ohio $46.000

*Western Ohio Foundation f('lr Medical Core, Dayton $44,330

"The Foundation for Medical Core. Milwaukee. Wis. S36.345

*Wisconsin. Professionol Review, Madison $90,600

Professional Services Quality Council of Minnesota, Rochester $66,000

"Arkonscs Foundation for Medical Core. Fort Smith $65.000

Central Eastern Missouri Professional Review Organization, St. Louis $61,000

Mid-Missouri Foundation, Jefferson City $64,000

"Northwest Missouri PSRO Foundation. Kansas City. Missouri $49.500

Southeast Missouri Foundation, Cope Girardeau 554,440

"The Iowa Foundation for Medical Core. West Des Moines $45.500

"Kansas Foundation for Medical Core, lnc., Topeka $47.560

"South Dakota Foundation for Medical Core. Sioux Falls $51.000

East Central Los Angeles. Cclif., PSRO $7B.750

"Foundation for Medical Core of Santo Claro County. Son Jose, Calif. $74.000

"Kern County Medical Society. Bakersfield. Calif. $61.800

"North Boy PSRO, Son Rofael. Calif. $61,200

"Monterey County Medical Society. Solinas. Calif. $45.485

*Organizat.ion for PSR of Santa Barbaro/San Luis Obispo Counties, Santa Barbara. Calif.

"Redwood Coast Region PSRO. Santo Rosa. Calif. *Riverside County PSRO, Riverside, Calif.

"Son Francisco PSRO, Inc .• Son FranciSCO, Calif.

"PSRO of Son Matea Counrv, Son Mateo. Calif. ·Stanislaus Foundation for Medical Core, Modesto, Calif. "Ventura Area PSRO. lnc., Ventura. Calif.

~Pacific PSRO, Honolulu, Hawaii Nevada PSRO. Reno

*Alaska Professional Review Organization, Anchorage "Idaho Foundation for Medical Core. lnc.. Boise 'Greater Oregon PSRO. Portland

*Washington State Medicol Association. Seattle

$44.700 $74.500 $56.400 $57.000 $62.000 $50.242 $6B.590 $77,120 $38.200 $72.372 $51.200 $5B.500

$147.480

Resolutions Deadline Set

Deadline for sending in resolutions to be considered at the AAPS Annual Meeting in New Orleans is October 11. 1974. If AAPS members have resolutions they wish to be considered at the meeting they must reach Association headquarters in Oak Brook. 111.. on or before that date.

Is PSRO For Lawyers Coming?

Lawyers, like doctors, are threatened with destruction of professionalism by action of the federal government and must face the question whether they have the wisdom, courage, morality and ingenuity to cope with the threat.

That was the substance of AAPS Executive Director Frank K. Woolley's message to the American Bar Association at the ABA's Annual Convention in Honolulu this month.

Mr. Woolley warned the nation's lawyers that a grave threat to their professional freedom is posed by the possibility that Congress will extend to the legal profession the kind of controls that are now being imposed on doctors pursuant to the recen tly en acted Professi ona I Sta nda rds Review Organization law.

"If ethical attorneys realized the extent to which federal laws have been designed to question and interfere with the professional [udqrnent of physicians and surgeons," Mr. Woolley said, "they would more fully appreciate the threat posed by government to the traditional freedoms of the legal profession. "

He said the PSRO law created "an elaborate and novel scheme of prior restraints on physicians' diagnosis, treatment and care" of patients who are actual or potential beneficiaries of the Social Security program -- a total of more than 85 million out of the U.S. population· of 211 million.

"This law," Mr. Woolley said, "gives the Secretary of Health, Education and Welfare complete and final authority to regulate and control in the minutest detail the medical [udqrnent of all physicians who treat Medicare, Medicaid, disabled, maternal and child care patients who may receive from Social Security all or part of any funds for their hospital and medical services." He pointed out that physicians will be forced to accept standards of diagnosis and treatment set by agents of the federal government.

COMPARABLE CONTROLS

Mr. Woolley suggested lawyers who practice under a professional, ethical system similar to medicine could appreciate and understand the implications of the PSRO law if they would imagine practicing law under a comparable system of controls.

"Assume, for example," he said, "that for some reason the federal government decided that it was necessary to enhance the quality and lower the cost of your practice and the practice of lawyers generally because the government was subsidizing legal practice indirectly in some way or because Congress simply determined that, as it has in the case of some other laws, it was necessary to change the behavior of lawyers and raise the quality and lower the cost of legal practice."

Mr. Woolley said "comparable governmental interference with the exercise of independent [udqrnent by attorneys" could result in:

1. The U. S. Attorney General imposing "norms of interrogation, investigation, a no lysis, comprom ise, research, presentation and all other legal procedures to be followed by practicing attorneys on a case-by-case basis."

2. Local legal standardization committees, following rules and regulations of the Attorney General, would enforce preset rules to determine whether a case was legally necessary or was handled in the most economical manner.

If an attorney repeatedly incurred expenses deemed unnecessary, the Attorney General could fine him or bar him from handling a large category of cases.

COULD BE BLACKLISTED

In addition, the attorney could be blacklisted (with public notice of that action) and, to force him to conform to the ru les, he could be subjected to pressure by the courts, law schools, bar associations and other organizations and individuals. It would be the duty of each local and state standardization committee "to use such authority or influence it may possess as a professional organization, and to enlist the support of any other professionol or governmental organization having influence or authority over attorneys and any other person providing legal services in the area served by such review organization in assuring that each attorney providing legal services in such area shall comply with all obligations imposed on him by regulations of the Attorney General." (With the exception of substitution of attorney for physician and Attorney General for Secretary of HEW, that is the language of the PSRO law.)

Mr. Woolley also pointed out that if a PSRO law was enacted for attorneys akin to the PSRO law for doctors, "all records of attorneys, including private communications, with all clients (both publicly paid and privately paid) would be examined by government agents to assure that the services were necessary, appropriate and the most economical."

Huge Pamphlet Demand

Physician response to AAPS pamphlets which spell out the evils of the PSRO law prove there is widespread need for informational material to acquaint the people with the truth about this vicious program for government control of physicians and patients.

I n a period of six weeks, physicians ordered more than 90,000 copies of two pamphlets, "PSRO: The Great Political Sickness Rip Off," AAPS' definitive evaluation of the significance of PSRO to patients, and a reproduction in pamphlet form of a commentary by Phyllis Schlafly on the Spectrum radio program.

These pamphlets are still available at cost from AAPS and physicians are urged to distribute them to their patients and make them available to civic groups and other organizations to pass out to their members.

Amendment to By-Laws

AAPS House of Delegates at the meeting in April adopted an amendment to the Association By-Laws which must be approved by the Assembly before it can become an official part of the bylaws. Therefore, at the Annual Meeting in New Orleans this proposed amendment to the By-Laws will be submitted to the Assembly for vote.

"Add the following to Article Thirteen, Paragraph B, Page 15:

'Moreover, the members of this Association subscribe to the ethics expressed in the Hippocratic Oath, to which physicians of our western civilization have bound themselves by the tradition of centuries, believing that the principles expressed therein have contributed to the strength and dignity of the doctor-patient relationship, to the preservation of the free enterprise system so essential to a free society, and to the physical and spiritual well-being of those who honor its stipulations.' ..

Interest High in Delegate Vote

An unusually large number of AAPS members have engaged in the process of electing members to the Association's House of Delegates. In a tremendous and

extremely encouraging response, more than 40 per cent of the membership took the time to mark the mail bollots for delegates from their states.

The response indicates a high degree of interest among members in the affairs of the Association, and it is evident at a time when the determination of the medical profession to preserve medical freedom in the U.S. is being subjected to its sternest test in history.

It is a Iso indicative of the rising stature of the AAPS among the nation's doctors, who are increasingly aware that it is the only nation-wide organization of physicians that will not compromise principles and that devotes 100 per cent of its resources to programs aimed at preserving the practice of private medicine.

New AAPS delegates will meet for the first time at the Association's Annual Meeting in N~w Orleans in October and November.

Yours for Individual Liberty and Responsibility,

~~~

Donald Quinlan, M.D. President

Enclosures: Annual Meeting brochure with reservation card Represenrotive Crane's Anaheim address

ANNUAL MEETING, New Orleans, Louisiana, October 31-November 2, 1974

ASSOCIATION OF AMERICAN PHYSICIANS AND SURGEONS

2111 Enco Drive. Suite N-515. Oak Brook. Illinois 60521 312/325· 7911 Frank K. Woolley. Executive Director

EMERGENCY BULLETIR

ASSOCIATION OF AMERICAN PHYSICIANS AND SURGEONS. INC.

2111 Enco Drive, Suite N-515, Oak Brook, Illinois 60521

312/325-7911

Donald Quinlan. M_D_. President Frank K. Woolley. Executive Director

BULLETIN NO. 2-74

Index No. 10 September 20, 1974

CONTROL THROUGH 'PLANNING'

AAPS members were warned in the September AAPS News Letter about the serious threat to medicine contained in H.R. 16204, a bill designed to use health "planning" as a device to set up the Secretary of Health, Education and Welfare as medicine's czar with dictatorial control over a sovietized medical system.

THIS DANGEROUS LEGISLATION IS PERILOUSLY CLOSE TO PASSAGE IN THE CONGRESS. IT IS IMPERATIVE THAT PHYSICIANS ACT NOW TO PROTEST ENACTMENT OF H.R. 16204. WRITE, WIRE OR TELEPHONE YOUR CONGRESSMAN AND SENATORS IMMEDIATELY. LET THEM KNOW YOUR OPPOSITION AND ASK THEM TO VOTE AGAINST H.R. 16204 OR ANY COMPROMISE THAT MIGHT COME OUT OF A CONFERENCE. THIS BILL IS SO BAD IN CONCEPT AND PURPOSE THAT IT MUST BE DEFEATED. IT CANNOT BE MADE GOOD BY COMPROMISE OR AMENDMENT.

H.R. 16204 is the brainchild of the federal bureaucracy hungry for the power to control the practice of private medicine in all the aspects. It is another in the proliferation of anti-medicine bills that have flooded Congress this session, anyone of which would destroy medical freedom and wipe out constitutional rights of patients and physicians.

For more detail on this deadly legislation, see the first page of the September, 1974, AAPS News Letter, where it is disclosed that the real purpose of H.R. 16204 is bound up in these words of the bill's preamble: '7he achievement of equal access to quality health care at a reasonable cost is a priority of the Federal Goverrunent."

H.R. 16204 was written in a subcommittee of the House Committee on Interstate and Foreign Commerce. The bill was introduced in the House by Rep. Paul Rogers (D-Fla.), who is no friend of private medicine. The bill was referred to the full committee, which gave it cursory reading and reported it to the House with a recommendation for passage.

Reports from Washington indicate that the Senate Labor Committee is prepared to report a similar bill for passage. If both House and Senate pass similar legislation, the bills will be sent to a conference committee to compromise differences.

- 2 -

It is possible for legislation to be killed in a conference committee if conferees from each body, House and Senate, cannot agree on one or more provisions of the legislation.

This is not likely to happen with this legislation, however. Consequently, if this dangerous legislation is to be defeated, it must be defeated on the floor of the House or the Senate.

THEREFORE. YOU MUST ACT PROMPTLY. DON'T DELAY! HELP KILL H.R. l6204!

~/.J. ~ f- ....... ~.

Thomas G. Dorrity, M.D., J.D. AAPS Legislative Chairman

Frank K. Woolley, LL.B. Executive Director

Enc losure : PSRO AND PUBLIC RELATIONS by M. Stanton Evans

THE VOICE FOR PRIVATE DOCTORS

Index No.9 September, 1974, Volume 28, No.8

Sets Up Washington Czar

'Plarminq' Bill Threatens Medicine

Within the environs of the nation's capital are men and women who have dedicated their considerable talents to devising legislation and bureaucratic regulations designed to wipe out constitutional rights and to widen and strengthen the federal government's authoritarian control over the private lives of the American people.

Bu rea ucratic ru Ie has replaced the Golden Ru Ie.

Businessmen know about OSHA and other insidious kinds of governmental controls. And doctors know about Medicare and PSRO and the .threat of even worse. They also know that medici ne has been si ng led out by the govern ment interventionists for special treatment. One way or another, the medical profession is to be subjugated. One way or another. medicine is to be run by a czar in Washington.

Latest scheme to enslave the medical profession is wrapped up in a piece of legislation carrying the number H.R. 16204 and bearing the title: "The National Health Policy, Planning, and Resources Development Act of 1974."

The clear obiective of this lengthy and confusing bill is to establish the Secretary of Health, Education and Welfare as medicine's czar, with dictatorial power over a sovietized medical system.

H .R. 16204 ostensibly is the handiwork of the Health Subcommittee of the House Interstate and Foreign Commerce Committee, chaired by Rep. Paul Roger (D-Fla.). It is a so-called "clean" bill. This means that a blatant attempt in other drafts of the legislation to reduce medicine to the status of a public utility has been eliminated from H.R. 16204. However, eliminating that feature does not make H.R. 16204 CJ_r1y less dangerous.

This bill, which was referred back to the Interstate and Foreign Commerce Committee, proposes to hand out billions of dollars of the taxpayers' money for the purpose of buying control of medical institutions and medical personnel, including doctors. It would authorize the Secretary to dole out morethan $1 billion in grants and an unspecified amount for loan guarantees in the first three years of the program to set up a vast, nationwide bureaucracy run by HEW to plan and develop health services and health resources in every state.

H.R. 16204 is based on a false premise and a typical (and weird) bureaucratic contradiction.

The preamble to the bill declares that Congress finds that "the achievement of equal access to quality health care at a reasonable cost is a priority of the Federal Government." The premise is false. It is not a constitutional responsibility of the federal government to assure that there is instantly available to everyone in this nation a well-educated, well-trained physician of whatever specialty required, enough qualified nurses and other personnel to meet each person's needs, and whatever other facilities are necessary at a cost meeting a bureaucratic definition of reasonable.

MORE OF SAME

The bill's preamble also contains a confession that programs which have resulted in "massive infusion of federal funds into the existing health care system" have been <2!?ysmal failures, contributing to inflationary cost increases while solving nothing. The contrcdition arises because Mr. Rogers and his colleagues propose MORE OF THE SAME as corrections for these admitted failures.

Whenever government becomes involved in planning, watch out. Contrary to lay understanding, in the socializers' parlance, plannind is actually control. That's its purpose, and the planning contemplated in this bill is no exception. It means control. It means arbitrary bureaucratic meddling, and it means abandonment of the rule of law, which is the distinguishing mark of a free society.

HR 16204 pmposes to set up one of the biggest boondoggles of all time, pouring billions of dollars into literally hundreds of HEW-controlled agencies spread

Inside I

• Acts of President Make Some Uneasy

• OSHA Breaks Rules

I

• Still Can Register For AAPS Meeting

• Don't Forget Resolutions

• Lacki ng 'Consensus', Health Bills Stalled

• No Locally Set Norms

• Extraordinary Delegates Vote

• Woman's Auxiliary Will Meet

across the U.S. that would, in the guise of planning, determine whether the nation needs more or fewer health services, institutions and facilities. The HEW czar of medicine could regulate production of doctors and other health personnel, order existing institutions closed, veto new hospitals and other facilities, and fix fees and charges on the pretext of "containing inflation" in "the cost of health services."

It would close the trap on private medicine so that doctors could not escape the tyranny of government, even by establishing proprietary hospitals.

All this authoritarian manipulation of goods and services and people would be accomplished by fabricating a "national health policy" and implementing it through a bureaucratic nightmare, a conglomeration of national, state and local agencies all vying for power. This wasteful . governmental monstrosity would include a National Council for Health Policy, hundreds of Health Systems Agencies in all the states, a Health Planning and Development Agency in

every state, a Statewide Health Co-ordinating Council in each state, and a vast network of Centers of Health Planning throughout the nation.

Governors would be given a role, but only if they did the bidding of the· Secretary of HEW. If they did not, he could carve up the state into planning areas and proceed with the program anyway. As the legislation is written, it is obvious, too, that the authority of state health departments would be ci rcu mvented a nd these agencies u nderm i ned.

This legislation is the product of the same elitist mentality that has given the nation the iniquitous PSRO law -the mentality that perceives government as the master of the people and the people as lackeys whose function is to feed the government bureaucrats' ever-growing appetite for power .

HR 16204 deserves to die in committee. Write your congressman and senators to work for its defeat.

Acts of President Make Some Uneasy

True believers in individual responsibility, local self-government, the willing exchange of goods and services without government interference and control, and similar principles underlying this country's freedom and successes are feeling uneasy about President Ford.

Throughout his tenure in Congress, Ford's image remained untarnished as a believer in limiting the tyrannical power of the bureaucracy in accordance with the beliefs of the Founders of our Constitution to avoid the agony of totalitarian regimentation. But since he has assumed the presidency, he has shaken those who recognize the danger of expanding government power resulting in complete collectivism.

First, he called on Congress to hurry and enact legislation to nationalize medicine. Then he began flirting with the discredited economic notion of wage and price controls, which, in the recent past, meant g_particularly offensive and unjustified discrimination against doctors.

Next, Mr. Ford nominated Nelson Rockefeller as Vice President. Mr. Rockefeller not only is a proven government interventionist, he is an avowed champion of socialized medicine, a practiced devotee of the political doctrine of tax-and-tax, spend-and-spend, elect-and-elect, and can be counted on to urge greater and greater concentration of power in the central government. Shortly after he was nominated for Vice President, he publicly advocated that the federal government fix local transit fares.

Then Mr. Ford apparently sent up a trial balloon.

According to Morton Kondracke of The Chicago Sun-Times, the President is giving serious consideration to appointing one of two women Democrats as Secretary of Health, Education and Welfare. Mr. Kondracke said the President is contemplating dumping Caspar Weinberger and naming either Rep. Edith Green of Oregon or, worse, Rep. Martha Griffiths of Michigan. Both are government interventionists with voting records in Congress against individual liberty and responsibility.

Mrs. Green has never won a reputation for championing the cause of private medicine, and Rep. Griffiths, as many know, has a long record of supporting labor union leaders' drive for bureaucratic power and sponsoring anti-doctor legislation, including bills for complete socialization of medicine.

Both these 20-year veterans of Congress are retiring this year. They were described by Mr. Kondracke as "close friends of the President."

In these cases, Mr. Ford is acting contrary to what has appeared in the past as his fundamental beliefs. We hope he will not repeat Winston Churchill's fatal mistake after World War II of believing his political future lies in accepting "the :radle to grave welfcse state."

OSHA Breaks Rules

The Occupational Safety and Health Administration has been hounding and harassing and forcing businesses at great expense to correct conditions which, in the opinion of OSHA, constitute hazards to workers.

The Wall Street Journal recently noted that the Labor Department inspected an 11 - story building in Washington, D.C., housing the offices of OSHA and found more tha n 300 .. haza rdous conditions" menaci ng the health and safety of OSHA employees.

A red - faced OSHA official offered this lame excuse:

"Even offices normally thought to be free of hazards often do involve hazards that can readily be detected and corrected."

The record of OSHA in browbeating business suggests a more honest and accurate reason was that the typical arrogant bureaucratic opinion that there is a double standard in America -- one for government officials and another for the rest of us.

Still Can Register For AAPS Meeting

There is still time to register for one of 1974's most important medical meetings -- the Annual Meeting of the Association of American Physicians and Surgeons Oct. 31 - Nov. 2 in New Orleans, La.

Theme of the meeting is: "Are You Tired of Being Pushed Around?" Most doctors are weary of being pushed around by agents of insurance companies, hospital administrators, government bureaucrats and other politicians in and out of government, and they are tired of the constant threat that their professional freedom will be destroyed.

The New Orleans meeting has been designed to clue physicians on how they can protect themselves and keep from being pushed around. Speakers and panelists will disclose either how they have succeeded in winning against those whose goal is subjugation of doctors, or why doctors and thei r patients lost thei r freedom.

Headline speakers will include the Hon. J. Enoch Powell, former British Minister of Health; Dan Smoot, lecturer and writer on current events; Hon. John Rarick, Congressman from Louisiana and author of a bill to repeal PSRO; Donald Quinlan, M.D., AAPS President, and F. Michael Smith, M.D., President-Elect of the Louisiana State Medical Society.

The program will include the following panel discussions.

Hospital-Physician Relationship: Robert Bullington, M.D., Phoenix; Dr. Quinlan, Chicago, and J. Keller Griffith, M.D., Lake Charles, La., will disclose how they won or are winning conflicts with hospital administrations.

PSROs, HMOs & Compulsory Nationalized Medicine:

Moderated by John R. Schenken, M.D., Omaha, Neb., panelists Frank Rogers, M.D., AAPS President-Elect, Maurice Kramer of the AAPS Washington Office and Frank K. Woolley, Executive Director, will bring members up to date on national health legislation and government's tooling up activities for PSROs and HMOs.

Membership Recruitment: This panel -- Robert S.

Jaggard, M.D.: AAPS National Membership Chairman, and R.L. Campbell, M.D., Speaker of the House of Delegates -will discuss membership recruitment, a topic of vital importance to AAPS.

How to Organize an AAPS Chapter & Speakers Bureau:

Panelists for this important discussion will be Paul W. Leithart, M.D., Columbus, Ohio, Walter Buerger, M.D., Covina, Cali!., and Frank K. Woolley.

Don't Forget Resolutions

If you have resolutions you wish considered at the Annual AAPS Meefing in New Orleans, you are urged to send them to Association headquarters in Oak Brook, 111., as soon as possible. The deadline for receipt of resolutions is October 11. They must reach headquarters on or before that date.

Lacking 'Consensus', Health Bills Stalled

Apparently labor bosses are having their way with Congress in the matter of nationalizing medicine. Rep. Wilbur Mills (D-Ark.l, Chairman of the House Ways and Means Committee, disclosed that members of the committee could not "bring about a consensus" on health legislation.

For the record, Mr. Mills said "it is not a deed issue" for the current session of Congress. Nevertheless, no one stepped up to agree that it wasn't a dead issue.

Labor leaders have made it clear they prefer to wait until next year to push health legislation when, they believe, they will have a "veto proof" Congress full of liberals so indebted to them that passage of full-scale socialized medicine will be routine and a Presidential veto easily overridden, if that came to pass.

What labor bosses are advocating is a Congress beholden to them and so powerful the Constitutional balance of power will be destroyed. The consequence to the nation will be disastrous if they get their wish -- a wish that is based on a blind, insatiable lust for power.

Physicians should recognize, therefore, that this year's congressional elections are as critical for medicine as any in history. They should devote time and money to the support of conservative candidates and to the defeat of those backed by labor.

And if physicians contribute to the American Medical Political Action Committee (AM PAC) , they should make certain none of their money is used to support candidates who can be counted on to oppose the interest of ethical medicine.

You would suppose that it would be unnecessary to question whether money physicians contributed to AMPAC is being spent in support of the enemies of medicine -congressional candidates who will be against repeal of PSRO and who will vote for socialized medicine.

But it's a question that needs to be asked. Some will recall, for example, that AM PAC assigned one of its employees to work full time in the campaign of Eugene McCarthy for President.

Lately, a special fund-raising dinner was organized by labor unions to help Mrs. Betty Spence, a Buffalo Grove, 111., Democrat who is trying to unseat Rep. Phil Crane, one of ethical medicine's most loyal friends.

The Arlington Heights Herald covered the event, which was held in Washington, D.C.

Said the Herald: "But Mrs. Spence said she was encouraged by the enthusiasm of the approximately 65 persons who did attend -- a group which included various labor representatives, congressional staffers, a Montgomery Ward executive, and an American Medical Association lobbyist. "

No Locally Set Norms

.Bureaucrat Unlikely to Yield Power

Sen. Wallace Bennett (R-Utah). chief congressional sponsor of PSRO; Jay Constantine of the Senate Finance Committee Staff, who was the power behind Sen. Bennett in getting PSROpassed; Henry Simmons, M.D., chief of HEW's PSRO office, and other PSRO advocates constantly peddle the deceit that local doctors will set PSRO standards.

AAPS has consistently pointed out that the law does not authorize local doctors to set standards and that government bureaucrats are not lik~ly togive up that kind of power over doctors and their patients.

A recent decision of the National Professional Standards Review Council should dispel that falsehood and, equally important, stand as a warning to physicians, hospital administrators and everyone else what kind of PSRO standards they can expect to be forced on them.

The Council endorsed H-ICDA (an international classification of diseases) as the preferred system of diagnostic coding. The American Hospital Association protested because the Council simply ignored the fact that the majority of hospitals use ICDA-8, not H-ICDA.

This sort of bureaucratic flight from reality is significant because the Council not only is advisor to the Secretary of HEW, who is the federal PSRO administrator, but is charged by law with telling PSROs what kind of standards they are to

Extraordinary Delegate Vote

Final tabulation of balloting for membership in the AAPS House of Delegates shows that 54% of AAPS members voted in the election, an extraordinarily high degree of participation.

There was also an unusually large number of candidates for election to the House of Delegates this year compared with past elections.

As noted in the August News Letter, when a preliminary tabulation indicated more than 40% were participating, the response to the election indicates a high degree of interest among members in thA affoirs of the Association at a time when the determination of ethical doctors to preserve medical feedom is being subjected to its sternest test in history.

New AAPS delegates will be seated when the House convenes at the AAPS Annual Meeting in New Orleans Oct. 31. New delegates are being notified of their election and are expected to attend the meeting.

impose on doctors and hospitals.

Physicians will also find it worthy of note that the AMA follows the government's PSRO party line since it has become a paid agent of HEW for the purpose of forcing PSRO on doctors and patients. In an "Editor's Note" responding to a physician's critical letter published in the Sept. 2, 1974, American Medical News, the AMA makes the fJat assertion that the law "requires that each PSRO develop 'norms' of core, diagnosis, and treatment.

The statement is untrue. The PSRO law imposes no such requirement on PSROs.

It's the kind of statement that honestly should not be made.

The fact is that the AMA itself is involved in setting national, not local, PSRO standards for doctors and hospitals. It signed a $995,000 contract with HEW to develop "model sets of criteria for screening the appropriateness, necessity and quality of medical services in hospitals," according to the AMA newspaper. Furthermore, said AMN, the AMA "has held the position that medical criteria development must be a function of the individual specialty societies and must be coordinated nationally, with the completed criteria made available to all p_i:lysician groups for adaptation and used at the local level."

Woman's Auxiliary Will Meet

The AAPS Woman's Auxiliary will meet Oct. 31 and Nov. 1 in conjunction with the AAPS in New Orleans. The first session at 9:00 A.M. Thursday, Oct. 31 -- a get-aquainted coffee for all AAPS ladies. At Friday noon, Nov. ·1, the Woman's .Auxiliary is having a Luncheon at which Mrs. Mel Gabler of Longview, Texas, Educational Research Analyst, will be the guest speaker.

Fun Evening for Thursday: Members will go as a group for one evening of fun. Details will be available at the New Orleans meeting. There will also be a House and Garden Tour of historical homes of New Orleans available for Saturday morning for those who wish to participate.

Yours for Individual Liberty and Responsibility,

~~~ /Y,)l

Donald Quinlan, M.D. President

Enclosures: Delegates List Reservation Form

April, 1974, Resolutions_

ANNUAL MEETING, New Orleans, louisiana, October 31-November 2, 1974

ASSOCIATION OF AMERICAN PHYSICIANS AND SURGEONS

2111 Enco Drive. SUite N-51 5. Oak Brook. uunois 6D521 312/325-7911 Frank K Woolley. Executive Director

THE VOICE FOR PRIVATE DOCTORS

Also Known As Slavery

Index No. 11 October, 1974, Volume 28, No.9

Kennedy Advocates Involuntary Servitude

The American people more than a century ago fought a bloody war between the states which outlawed involuntary servitude, also known as slavery.

Today, Sen. Edward M. Kennedy, the Massachusetts Democrat who does chores for labor bosses and who can't be ruled out as a future candidate for President of this nation which has outlawed involuntary servitude, wants to restore this inhuman practice.

Medical Society Votes To Aid AAPS Lawsuit

Another county medical society has [oined the list of those contributing to the support of the AAPS lawsuit to overturn the PSRO law.

Lee L. Johnson, M.D., Staunton, III., Secretary-Treasurer of the Macoupin County (111.) Medical Society, sent AAPS a check for $200. The decision to make the contribution was approved unanimously.

Meanwhile, oral arguments on the government's motion for dismissal of the suit were postponed for a month. Originally called for September 17, the arguments were re-scheduled for October 17. The delay resulted from the death of one of the three judges trying the case.

Members of the Macoupin County Medical Society acted in direct response to a letter sent to the presidents of all county medical societies by Donald Quinlan, M.D., AAPS President, soliciting financial support for the lawsuit.

But the action was also an expression of dissatisfaction with the AMA and the Illinois State Medical Society, particularly for failure to oppose the PSRO law, according to Dr. Johnson.

"We applaud your organization (AAPS) for the action taken in behalf of physicians who are usually too busy practicing medicine to fight the battle against federal control which we know will only lead to deterioration of patient care," said Dr. Johnson.

Inside

• MDs Grab Opportunity

• Dr. Weston Is PresidenH:lect

• AMPAC Helps Some of Medicine's Enemies

• AAPS Chapters Important

• Astounding Confession by Mills

• Lawmakers Hurt PSRO

• AMPAC Board Appointments

• Court Holds Control Doesn't Follow Subsidy

Sen. Kennedy was principal sponsor of S. 3585 which, among other horrendous things, would have forced into voluntary servitude all future graduates of all medical schools that received money from the federal government. Specifically, this bill would have compelled such medical schools to force students as a prior condition of admission to agree to practice for two years after graduation wherever the Secretary of HEW ordered.

But Senator Kennedy and his far-left collaborators on the bill found there wasn't much stomach in the Senate for this kind of extremism and they were forced to give it all up. They went down swinging, however. Senator Kennedy tried to win support for a compromise concocted by a couple of liberal friends, Sens. Gaylord Nelson (D-Wis.) and George McGovern (D-S.D.). that would have postponed this assault on the U.S. Constitution until 1980. But the Senate wouldn't buy that either.

The Senate voted for an extension of federal aid to medical schools with a provision which amounts to resurrection of indentured service, a practice rife in Colonial times which, if not legal, is at least repugnant to the spirit of the Constitution.

In the version finally adopted by the Senate, medical and dental schools, in return for federal aid, would have to agree to allocate 25% of their classroom space to students who volunteered to serve in areas designated by the government as "Medically underserved." These "volunteer" students would get tax-paid "scholarships" requiring a year of HEW-dictated service for each year of "scholarship" aid.

Two of Senator Kennedy's co-sponsors on S. 3585, which would have forced medical students to practice where HEW ordered, whether they wanted to or not, flew down to Cuba to shake hands and break bread with and fawn over Fidel Castro, whose communist dictatorship is the antithesis of individual responsibility and freedom. They are Sen. Jacob Javits, the New York liberal who proclaims himself a Republican, and Sen. Claiborne Pell of Rhode Island whose liberal credentials are authenticated. This pair wants the U. S. to recognize Castro's barbarian regime.

Others who thought enough of the objectives of the bill to put their names on it, all Democrats, were Sens. Magnuson. Randolph, Hathaway and Clark.

It would have been quite all right with all these representatives of the people, elected officials sworn to uphold the Constitution, that under S. 3585, students who didn't like being pushed around by government could have been denied the right to practice medicine. The bill would have given HEW control over licensure and relicensure of physicians and dentists, stripping the states of that authority. Federal licensure of doctors, of course, is one of the goals of leftist extremists and their stooges.

The bill caught the attention of newspapers across the country, some of them (the St. Louis Globe-Democrat, for example) publishing editorials objecting to the proposal.

But the full import of this bill, its poisonous nature, apparently was lost on them all, including the AMA's publication, American Medical News.

The real purpose of S. 3585 was to drag all of medicine (the provision of care, education, licensure, and the distribution of physicians and dentists) under control of the federal government by the crafty scheme of declaring that "the quality and availability of health care in the United States affects interstate commerce."

The treatment of a patient, the prescription of medication, the admission to a hospital, the granting of a license to a physician or dentist, the teaching of medical students -- all these would be defined as acts in interstate commerce, subject to federal control and regulation.

TORTURED LOGIC

The real author of S. 3585 undoubtedly was not Senator Kennedy. From all accounts and from previous experience, it must be assumed that this approach had to originate with a mind like a Wilbur Cohen, not Kennedy.

For example: "The lack of adequate health care for individuals in the United States," proclaims the tortured logic of the bill, "often results in illness which may result in unemployment, and reducing the ability of such individuals to engage in activities which affect interstate commerce, and has a depressant effect on general business conditions ... "

Or: "Low quality health care or unavailability of health care in an area in a state may discourage the movement of persons into that area from another area and from other states and thereby adversely affect the movement of industry and other activities between states ... "

Or: "Many persons, especially those residing in metropolitan areas which cross state, boundaries, move between states in order to receive health care ... "

Government control of medical education would not cease when the student was graduated from medical school under this bill; no indeed -- HEW would control by certification the number of intern and resident positions open each year.

Don't wait to hear a cry of outrage from the liberal press (New York Times, St. Louis Post-Dispatch, Washingtol! Post, for example) at the idea of government controlling medical school admissions, postgraduate education (even to the extent of assigning positions to various specialties on the basis of Government determination of the "need" for

doctors in the specialties), and curriculum to "assure" the "quality" of medical care. the liberal press, parroting the propaganda of the nation's socializers, has often, with phony indignation, deplored AMA control of medical education, heedless of the fact the AMA doesn't.

Perhaps, but more likely not, medical school deans and officials of the Association of American Medical Colleges will realize by studying S. 3585 (even though it was rejected in the Senate) that there can be a fearful price to pay when thev beg for and get handouts from the federal government.

But make no mistake, the insidious ideas behind S. 3585 will not be allowed to die.

MDs Grab Opportunity To Recruit For AAPS

Following are excerpts from a letter recruiting members for AAPS. It was signed by four pathologists associated in private practice in Eastern Iowa and Western Illinois.

"Surely Doctor, by this time it must be obvious to you that a lot of people want to take away your constitutional rights and place all of medicine under the control of one individual in Washington.

"The Association of American Physicians and Surgeons is trying desperately to help all of us and it could be easily successful if a large segment of the profession would become members and participate in this fight against authoritarian control over the private lives of the American people.

"If you are not already a member of AAPS, please take the next minute of your time to fill out the enclosed application. By doing that, you will have taken one sep today to further your professional freedom and the freedom of all American medicine."

The letter was signed by Drs. F. D. Winter, R. J. Rettenmaier, G. R. Zimmerman and D. R. Samuelson. It was prompted by an editorial in the St. Louis Globe-Democrat highly critical of the bill by Sen. Ted Kennedy that would have forced medical graduates into involuntary servitude, a bill the Globe-Democrat said "should frighten every American."

The letter represents (1) a quick and effective use of a "handle" (the editorial) to spur membership, and (2) the use of two or more names on a membership letter, a technique which often gets better results than a single name.

If each AAPS member solicited one or more fellow AAPS members to join him in writing to all physicians in their area urging them to become members of the Association, membership would undoubtedly be significantly increased.

The authors of the above-quoted letter are right -- AAPS is trying desperately to fight off authoritarian control of medicine. It is the only nationwide medical organization that has been on the job since 1943. The more members AAPS has, the easier the task will be.

Dr. Weston Is President-Elect

c. Tucker Weston, M.D., Columbia, S.c., has been chosen President-Elect of the South Carolina Medical Association. Dr. Weston, a member of AAPS, was formerly Speaker of the SCMA House of Delegates.

Misguided Expediency

AM PAC Helps Some of Medicine's Enemies

Those who direct the affairs of the American Medical Political Action Committee (AMPAC), as well as the AMA, have not learned that "the friend of my enemy is my enemy." Perhaps if they based political decisions more on unbendable principle and less on misguided expediency, they might not so readily give aid to the friends of the enemies of the medical profession.

Recent Associated Press news stories from Washington stated that the AMA had contributed at least $25,000 to the re-election campaigns of 10 members of the House Ways and Means Committee.

Subsequently, the AMA's American Medical News editorialized that it was AMPAC, not AMA, that contributed and that the contributions were neither wrong nor illegal.

What the editorial did not explain was why AMPAC (whase policies and practices are at least influenced if not controlled by AMA executives) has chosen TO HELP SUPPORT THE RE-ELECTION OF FRIENDS OF ENEMIES OF MEDICINE.

Three of the 10 members of the House Ways and Means Committee who were recipients of the AMPAC beneficence are strong supporters of the goals of organized labor. That means they are for wild spending programs that feed inflation and threaten to wreck the

State, Local AAPS Chapters Important

The following was extracted from the AAPS Ohio Chapter Newsletter, edited by Paul Leithart, MD.

-.-

'You Can't Fight City Hall'

"A special meeting of the Franklin County Academy Council was called in August. The purpose of the meeting was to vote on seeking a Federal Grant of $250,000 for a two-year study to determine why physicians are not motivated to take more post-grad courses in cancer therapy. Discussion was limited to a few minutes and the question called for while I was requesting permission to speak. Amtrack was never railroaded like that motion. I was not permitted to voice my opinion that the motion to seek a federaf grant was unconstitutional. Nor would the president give me the 'time of day' to so inform him after the meeting.

'What to do?

"When in trouble, contact your friends. I sent a letter to the Columbus AAPS Chapter and requested they meet on this matter. After lengthy discussion, it was decided to work with the Academy's legal counsel if possible, but if necessary, to seek an injunction to prevent this illegal action by our Academy leaders.

"The matter has not been settled. It is mentioned here to illustrate what AAPS members can do -- when organized. You should know the other members in your area and act in concert. It is probably obvious to you that most doctors are

economy, they are for government regulation of the economy, they are for destruction of the practice of private medicine and the substitution of government medicine, and they are against preserving and strengthening America's free enterprise system.

The AFL-CiO recently published a report on the proand anti-labor voting records of members of Congress. The report noted that Rep. AI Ullman of Oregon, second ranking Democrat on Ways and Means, voted "right" with labor 102 times and "wrong" only 22 times. Rep. Richard Fulton (D-Tenn.) had an 81 to 7 record in support of labor objectives, and Rep. Joseph E. Karth (D-Minn.) cast 106 votes friendly to labor and only 5 in opposition to labor-backed legislation.

Nevertheless, Rep. Ullman has been rewarded with a $1,000 campaign contribution from the money contributed to AM PAC by physicians. Rep. Fulton's "Fulton for Congress Committee" got $2,500 of doctors' money, and Rep. Karth, who votes the way labor wants him to vote 96% of the time, is using $2,500 of physicians' money to get re-elected.

No doctor needs to be told that one of the tnoior goals of labor bosses is total sub;ugation of the medical profession by government.

ill-informed about the ~ontrols that are designed to engulf them.

"In discussing the federal grant with various friends, it was obvious who was, or was not, an AAPS member. The non-members were generally 'in the dark' about the implications of 'Federal' funds. They did not have the background with which to judge this latest move by their Academy toward control by HEW.

"It is important that we organize as State and Local chapters. There is a tremendous amount we can do to influence our future."

ASTOUNDING

Rep. Wilbur Mills, the Arkansas Democrat who is one of the most knowledgeable members of Congress, has made an astounding confession.

Mr. Mills has admitted, according to the AMA's American Medical News, that he doesn't know how PSRO came into being.

The Chairman of the House Ways and Means Committee, according to AMN, was discussinq national health legislation with a delegation from AMA in an attempt to win support for his scheme for nationalizing medicine. Mr. Mills evidently figured that he could win that support if he agreed to some changes in PSRO proposed by AMA.

In reporting the meeting, AMN said -- "Rep. Mills at one point exclaimed: "I can't recall the way the Senate sold us on this (PSRO). How in the world did those Senators prevail on us in the first place?"

'Lawmakers Hurt PSRO, ' Laments AMA

When you're down on your knees begging for government handouts, all you're interested in is whether you get all the money you're begging for. It doesn't really worry you much whether your pet government project -- the source of the money you want -- contributes to the inflation that threatens the economy or, worse, undermines constitutional government and chips away individual rights and freedoms.

So it is with the AMA and PSRO.

Most physicians in the practice of private medicine would be delighted at anything that stands even a slight chance of crippling the iniquitous PSRO program, especially if

AAPS Members Support Friends Of Medicine

One of those believe-it-or-not facts of political life is that AMPAC, the political arm of the AMA, supports candidates for Congress who are, to put it charitably, unfriendly to the medical profession.

For that reason, many physicians do not contribute to AMPAC and limit their support to candidates who have demonstrated that they believe in preserving medicine as a free institution.

That's why many physicians in Ohio, for example, are actively supporting the candidacy of Ralph Perk, Mayor of Cleveland, for election to the U.S. Senate, and why they are behind Rep. John Ashbrook's bid for re-election to the House of Representatives.

Both these candidates are strongly opposed to PSRO, and that's something that cannot be said of all candidates for Congress supported by AM PAC. In fact, that can't be said of AMPAC -- or AMA.

Court Holds That Control Does Not Follow Subsidy

A decision in a lawsuit in Wisconsin indicates some courts at least don't buy the government interventionists' line that government subsidies to a private institution strips its officials of the right to make independent decisions.

The hospital was sued because it refused to permit abortions, the plaintiff arguing that by accepting Hill-Burton funds the hospital surrendered its right to make that decision. The court ruled for the hospital, holding the hospital could deny facilities to a physician for performing abortions even though the institution was regulated by the state and received state and federal funds.

it can be scaled down by a reduction in appropriations.

But NOT the AMA!

"PSRO IS BEING HURT BY LAWMAKERS," lamented a headline in the Sept. 16 issue of the AMA Newsletter, the weekly "green sheet" mailed to a select list from the office of Executive Vice President E.B. Howard, M.D. The article under that worried headline reported that the Senate had cut appropriations for PSROs by $28 million -- from $58 million to $30 million.

AMA, as everyone should know, wrangled a couple of millions out of HEW to help that bureaucracy cram PSRO down the throat of the medical profession.

AMA Is Willing To 'Compromise' Again

Malcolm C. Todd, M.D., President of AMA, has been quoted by the New York Times as saying AMA is willing to [unk its proposal to let Americans help finance health insurance by deducting part or all of the premium costs as a credit againist federal income taxes.

Dr. Todd told Times reporter Nancy Hicks that AMA is willing to "compromise" by agreeing to finance the plan by direct premium payments out of social security payroll taxes.

AMA's tax credit maneuver was a contrived way to finance a national health scheme without requiring direct government payment. AMA officials claimed in effect that the federal bureaucracy wouldn't exercise controls it it wasn't paying the bill directly.

Dr. Todd seemed to be saying that AMA, by this "compromise" is willing to accept the controls which flow from direct government subsidies.

This development should make AMA members question whether the so-called Medicredit Bill was a genuine, good-faith proposal in the first place.

Yours for Individual Liberty and Responsibility,

Donald Quinlan, M.D. President

Enclo.sures: 1973 News Letter Index Reservation Form

ANNUAL MEETING, New Orleans, louisiana, October 31·November 2, 1974

ASSOCIATION OF AMERICAN PHYSICIANS AND SURGEONS

2111 Enco Drive. SUite N·51 5, Oak Brook, lllmois 60521 312/325· 7911 Frank K. Woolley, Executive Director

THE VOICE FOR PRIVATE DOCTORS

First Round Over

Index No. 12 November, 1974, Volume 28, No. 10

Judges Take PSRO Case Under Advisement

The bell ending the first round in the AAPS lawsuit to knock out the PSRO law rang October 17, but as this issue of the News Letter went to press, the three judges had not indicated who won the round, AAPS or HEW.

The judges -- Wilbur F. Pell, Jr., of the U.S. Court of Appeals and William J. Lynch and Thomas R. McMillen of the U.S.

District Court -- took the case under advisement after hearing oral arguments on the goverment's motion for a summary judgment, or dismissal. As is customary, the judges gave no indication when they would rule on the motion.

The future course of the suit, therefore, is uncertain.

There me several possibilities.

• The judges could grant the motion to dismiss. In that event, AAPS would appeal the decision to the U.S. Supreme Court.

• The three-judge court could deny HEW'S motion and set the case for trial. HEW, as the defendant, could not appeal that ruling but would have to answer the specific allegations made in the AAPS complaint and go to trial of the case on its merits.

• If AAPS appeals and the, Supreme Court reverses the lower court's dismissal, the case would be remanded to the three-judge court for trial.

• If an appeal is taken by AAPS and the Supreme Court upholds the lower court's decision to dismiss the suit, AAPS will consider filing a new suit when it finds evidence that a PSRO is taking overt action which interferes with a physician in the performance of professional services for a patient.

The possibility also arises that while the suit is still pending documented evidence can be placed in the hands of AAPS ottorneys that PSROs are exercising some degree of control over medical decisions made by physicians. If that" happens, AAPS will amend its suit to seek a preliminary injunction to stop further action detrimental to the rights of physicians.

Pair of Californians, Frank Rogers, M.D. (left), Whittier, and

Walter Buerger. M.D .. Covina. take advantage of Assembly recess

to chat about Dr. BuerRer's presentation at New Orleans Annual Meet-

inA an arRanizing AAPS chapters. Dr. Rogers is new AAPS PreSIdent

Membership Drive

Donald Quinlan, M.D., in his Presidential address at the Annual AAPS Meeting in New Orleans in October, called for the Association to work for a five-fold increase in AAPS membership.

Dr. Quinlan urged each member to recruit at least five new mem bers for the Association. "Let's make a five-fold increase in AAPS membership o national goal of the Association. Let's make five new members for AAPS an individual, personal goal. Let's view that target as the very minimum each of us can do as our contribution to the cause of preserving our professional freedom. "

It is, therefore, imperative that members of the Association report, with documentation, any overt act committed by a PSRO, or by an individual or a committee acting as an agent or an employee of a PSRO, which interferes with or places in question any medical decision made by a physician, or which forces

News Letter on Meeting

Because of the importance of the Annual Meeting recently concluded in New Orleans, this issue of the News Letter is devoted almost exclusively to the meeting. Other news items from the meeting will be published in the December News Letter.

or attempts to force a physician to do something or refrain from doing something contrary to his professional iudgment. Any such incidents should be c~ported to AAPS headquarters as soon as possible after they occur.

R.R. McMahon of the Chicago low firm of Lord, Bissell and Brook argued the case for AAPS before the three-judge federal court October 17. Mr. McMahan told the court that "the issue ... is whether our complaint alleges facts which if true. . . establish an invasion, an invasion that is of constitutional dimension. an invasion of rights of the plaintiffs that are constitutionally protected in some respects."

He said the PSRO low is overbroad, arbitrary and irrational to such a degree that it offends the due process clouse of the Constitution. He said enforcement of the law would result in injury to plaintiff physicians.

PRIOR RESTRAINT

Judge Lynch asked: "What is the injury?"

Mr. McMahon replied: "The injury, your Honor, flows from the extensive system of prior restraint on medical practice that is created by this law." He added: "It is the first instance of federal legislation, not only in the medical field but in any profession as for as I can determine, the first instance of the imposition across the board of prior restraint on professional practice -- in on attempt to achieve cost control. "

Judge Pell, who presided at the session, wonted to know whether there is "anything improper in achieving cost control by eliminating unnecessary expenditures?"

Mr. McMahan answered that that was not "improper." He said, however: "It would seem that Congress has taken the approach in this case that the congressional intent was to

~prevent abuse, misuse and over-utilization of the program.

Implicit in a system of prior restraint on the substantive practice of medicine in the case of all physicians who deal with beneficiaries or recipients under Medicare is saying in effect that overuse, misuse and physicians' malpractice ... is so rampant in the profession that the only way to stop it is not on a case-by-case basis, not on on after-the-fact bcsis of detecting and punishing culprits and abusers, but to control the substantive conduct, professional conduct, of physicians as it deals with Medicare and Medicaid beneficiaries in advance."

Mr. McMahon pointed out that physicians are not directly compensated under the Medicare and Medicaid programs and are not agents or employees of government. He said there is no contractual relationship involved.

He also emphasized that a physician, "if. he is to deal with a hospital that is complying with this law will have to comply with what the hospital requires in the way of compliance with this law across the board, whether or not his patient is a recipient himself."

In other words, he said, "if a hospital is to undertake to comply with the requirements of this law, it will either have to have two systems of in-hospital review, two systems of administration, two systems of record keeping, two systems of norms of practice -- one for beneficiaries and one for private patients. That, as a matter of reality, could not exist."

One of the thrusts of his comments to the court was that PSRO will change the way medicine is practiced. "A physician now," Mr. McMahon said, "looks at his patient and makes his decision purely on the basis of his expertise and what he sees in the circumstances of that patient. Henceforth, when this low is implemented, the physician not only will look at the circumstances of the patient, but he must then match those circumstances to the general rules and then make the decision -- if his decision and the rules do not coincide -- whether he is going to depart and whether he can defend that departure when it comes time for-the patient to be reimbursed for his services. If he cannot defend it,.he faces a penalty in the form of having to pay the difference in the core himself, or to pay a fine. And if he does this repeatedly, he con suffer blacklisting. In fact, he will not be allowed to treat on a reimbursable basis Medicare and Medicaid patients. "

[This punitive aspect of PSRO was stated in another way by Dan Smoot, author, lecturer and political analyst, at the AAPS Annual Meeting in New Orleans. He described PSRO as "a punitive law which will force physicians to practice medicine by averages and in a climate of fear -- fear of what will happen to them if they do not adhere to bureaucratic standards, fear of what will happen to their patients if they do ad/:tere. ")

Paul F. Stack, an assistant U.S. attorney representing HEW Secretary Caspar Weinberger, the defendant in the AAPS lawsuit, told the court that the sole issue to be determined is whether the PSRO low is constitutional on its face. He sought to convince the judges that PSRO is a benign and harmless statute that will do nothing more than curtail unnecessary medical and hospital expenditures for Medicare and Medicaid patients. He said he wasn't arguing that it is a good law, only that it is constitutional.

Judge Pell, however, questioned that simplistic evaluation.

"Even though there was no over-utilization, if this is federal money that is being spent," he said, "doesn't it still boil down to whether or not during the process of puttinq restrictions and controls they violate constitutional rights of these piaintiffs -- isn't that what our ultimate issue is?"

Mr. Stock reluctantly agreed.

Halt Inflationary Spending

R.L. Campbell, M.D., Corsicana, Texas, AAPS President-Elect, issued the following election statement to Associated Press, United Press International, and the three notional television networks.

"The resu Its of Tuesday's election shou Id not be construed as a blank check from the electorate for more inflationary government spending programs. On the contrary, voter disenchantment and cynicism .with the political diseases of inflation, corruption and bureaucratic controls cannot be cured by more inflationary government spending and interference through forcing cradle-to-grave nationalized medicine upon a people whose greatest need is complete relief from political trickery by both parties."

'Unusually Informative'

Annual Meeting Praised by Participants

"This has been one of the best meetings we've ever attended," said the wife of a physician from Tennessee at the AAPS Annual Meeting in New Orleans. "The speakers have been excellent and the panel discussions have been unusually informative. It has been a well-balanced program."

"An excellent program," said a member of the House of Delegates. "I've gotten more useful information about problems of medicine at this meeting than any other I can remember."

hospital, including the practice of medicine. That misinterpretation has been fostered by the American Hospital Association and the Catholic Hospital Association.

DR· BULLINGTON said trouble in St. Joseph Hospital in Phoenix began with a push for a full time medical director to be appointed by the administration. Dr. Bullington said that as Chief of Staff he was on a committee to review the proposal, which had been cleverly sold to most of the staff.

"It became obvious to me," he said, "that this was a

Panelists Robert Bullington. M.D.. Phoenix. Arizana; J. Keller Memphis. Tennessee. told Annual Meeting how they won bottles. if ieal staffs.

Those comments reflected the success of a meeting designed to provide answers to problems troubling physicians across the country, such as how to combat third-party intervention in medicine, how to assert the rights of hospital staff physicians against overly ambitious hospital administrators, how to become more effective in the affairs of state and local medical societies, how to organize state AAPS chapters and recruit new members for AAPS.

Physicians with experience in solving such problems were on hand to tell how they did it.

HOSPITAL-PHYSICIAN RELATIONSHIP

The panel on Hospital-Physician Relationship, moderated by Donald Quinlan, M.D., now Immediate Past President of AAPS, presented the winning experiences of Robert Bullington, M.D., AAPS member from Phoenix, Arizona; J. Keller Griffith, M.D., AAPS member from Lake Charles, Louisiana, and Thomas G. Dorrity, M.D., Memphis, Tennessee, member of the AAPS Board of Directors.

These panelists emphasized, directly or indirectly, the fact that unified action, or organization, is one of the most important ingredients of a successful fight to protect the rights of physicians.

Panelists agreed that much of the nationwide drive among hospital administrations to reduce staff physicians to a status subservient to the administration stems from a false interpretation of the celebrated Darling case to mean that the administration is directly responsible for everything in a

Griffith.. M.D.. lake Charles, louisiana, and Thomas G. Dorrity, M.D., not wars, against hospital administrations determined to control med·

scheme whereby the administration would literally gain control over us. This man wou Id be appointed by the administration; the doctors on the staff wouldn't be able to get rid of him; he would be working for the administration and acting as our chief of staff but would in effect be the hatchet man for the administration."

Dr. Bullington and two other conservative physicians, with help from AAPS, set about educating the staff and were so successful the staff voted against appointment of a medical di rector.

The administration persisted, however, and it finally became necessary for physicians to quit using St. Joseph Hospital, except for emergency cases. That brought the hospital around because "in 30 days this cost them something like $500,000," said Dr. Bullington.

Dr. Bullington said the tougfTest thing he had to fight was the ignorance of his colleagues about what was going on. In fact, he said, he was ignorant until he got intothe middle of it.

"I didn't believe everything that was happening, and if I hadn't called Frank Woolley (AAPS Executive Director) iust on the spur of the moment one afternoon, we would ha~e gotten beat."

DR. GRIFFITH recounted how administration at Lake Charles Memorial Hospital tried to change staff bylaws, without knowledge or consent of the staff, to give the administration absolute control over appointment and reappointment of staff and over staff privileges. That change

was even submitted to the Joint Commission on Accreditation of Hospitals as though it had the approval of the staff. When this fraudulent document was discovered, a futile protest was sent to JCAH.

This baftle was won, as in Phoenix, when physicians simply refused to send patients to the hospital, except emergencies, and declined to form a staff. When that happened, it stopped the flow of paper, which is the life blood of government programs. When the paper flow stopped, government money stopped. The hospital administration finally capitulated.

Among the pluses from the experience, Dr. Griffith said, was this: "We feel we've played some part in the JCAH swing now to the support ofthe autonomy of the medical ~,which is in direct opposition to what JCAH used to feel. We also feel that the Darling case has diminished in importance as there has been recognition it was a local decision and now other decisions by other courts have changed its impact."

DR. DORRITY said that "in our hospital within the past year, we've had terrific problems with delineation of privileges, malpractice insurance, preadmission certification, rewriting the constitution and bylaws and a push for criteria for treatment."

Dr. Dorrity said that an organized staff whipped the administration on delineation of staff privileges. Then they beat back the administration on the question of mandatory malpractice insurance, pointinq out that that requirement would give a third party insurance company control of the staff .

But that didn't end the controversy, Dr. Dorrity indicated.

Next, the medical staff had to resist an attempt to force preadmission certification on physicians, a proposal presented on the pretext of cutting down on retroactive denials of government payments.

The smoke had barely cleared from that battle when the administration "came up with this bright idea" of imposing criteria on physicians. Dr. Dorrity said that as chief of surgery he wrote the president of the staff protesting the proposal. "I explained to him," said Dr. Dorrity, "that the practice of medicine is not an exact science and cannot be made so by onvbodv's whim, that we could not treat all people alike because each is unique and none responds to the same treatment or drugs in the same manner." He said he also sent letters to chairmen of the various staff committees and all

refused to participate in the criteria project.

The administration reaction, he said, was to attemp~ unsuccessfully to defeat him for re-election as chief of sug~y_:

Jerry Randolph, M.D., a colleague of Dr. Dorrity's, told the AAPS delegates that JCAH was seeking to force criteria as a condition of accreditation on threat of losil}g the nursing school and the training_program. He said, however, that inquiry by Memphis physicians has disclosed that:

• Internship and residency training programs do not depend on accreditation, according to H. William Ruhe, M.D., Secretary of the AMA Council on Medical Education.

• The Tennessee State Board of Nursing reported that the nursing school is not dependent on JCAH accreditation.

• JCAH accreditation is not even an essential for receipt of Medicare and Medicaid funds, since these programs can approve hospitals for payment.

DR. QUINLAN summed up: "The simple fact of the matter that should be remembered is that there is a relationship between the hospital board of trustees and the medical staff and the hospital administrator, and if you allow these things to be twisted in your mind as to what their Rroper relationship is, then you fail to understand the problem. And there has been a deliberate twisting of this relationship."

Dr. Quinlan has filed suit against St. Joseph Hospital in Chicago for restoration of privileges cancelled because he would not agree to permit the administration to alter staff bylaws at will without consent of the staff.

MEMBERSHIP RECRUITMENT

R. L. CAMPBELL, M.D., Corsicana, Tex., Speaker of the House of Delegates until his election in New Orleans as President-Elect of the Association, was the lead-off speaker of the panel on membership recruitment.

Or. Campbell said that one of the biggest hurdles in recruiting new members for AAPS is overcoming the idea that federal takeover of medicine is inevitable. Many physicians, he said, have "sort of lost hope," and "we've got to keep cheering them up."

Dr. Campbell urged members of AAPS to work hard at securing new members. He pointed out that "if every member got a new member just once a year, we'd double our

Panelists on Membership Recruitment (left to right) R. L. Campbell, M.D., Corsicene, Tex.; Garland Campbell, M.D., Arkansa~ City, .Ka~sas; Robert S. Jaggard, M.D., Oelwein, Iowa, AAPS National Membership Chairman, and Moderator Donald Quinlan, M.D., Northf,eld, IIl1no's.

AAPS Executive Director Fronk Woolley addressing Assembly during panel on organizing AAPS chapters. Seated are Paul W. leithart, M.D. (left), Ohio Chapter Chairman, and Walter R. Buetger, M.D., California Chepter Chairman.

membership next year and double it again in the next year." It's not an impossible goal, he said. "Those of you who are more enthusiastic than others have to keep nudging your friends who are members to get their share." He suggested members in the various states may want to organize recruiting contest with appropriate prizes.

He also suggested that non-members should know that AAPS offers most of the membership benefits available from AMA, with exception of JAMA and the specialty journals.

Most important, however, is the fact that it is AAPS that is carrying on the battle virtually single-handed to abolish PSRO and, unlike AMA, is fighting to prevent any kind of nationalized health program being forced on doctors and their patients.

Dr. Campbell also recommended that in recruiting new members, it should be pointed out that AAPS was the first to publish a pamphlet on PSRO to enable physicians to understand the vicious controls in the law, was the first to publish a PSRO pamphlet for patients, and was the first to publish a pamphlet delineating the rights of hospital staff physicians and how they can protect those rights.

ANOTHER DR. CAMPBELL -- Garland Campbell, M.D., Arkansas City, Kansas -- pointed out that AAPS has "a great cause to sell." Dr. Campbell is responsible for 34 new AAPS members in Kansas.

He said that success was a result of selling a cause rather than a method of recruiting because "the only effort that was made was one single letter ... and it wasn't that great a letter and it didn't cost aff that much money."

He added: "You don't have to be smart, you just have to take three things -- a little of your own time (not much). some of your own money (that's deductible as an office expense) and some effort on the part of your office employees."

He advised recruiters to concentrate particularly on general practitioners and the specialists to whom general practitioners refer patients.

Dr. Campbell of Kansas also suggested, as another technique, that members can call just one non-member colleague a day and explain AAPS, its philosophy and its

activities, particularly the lawsuit to abolish PSRO. "If you'll do that three or four days a week, we can increase this membership up to something you wouldn't believe."

(Membership chairmen in the various states were presented AAPS coffee mugs by Robert S. Jaggard, M.D., Oelwein, Iowa, National Membership Chairman.)

ORGANIZING AAPS CHAPTERS

When the panel convened on organizing AAPS chapters -described by AAPS Executive Director Frank Woolley as "a mechanism to multiply your effectiveness" -- members of the Assembly were seated by states, and chapters were organized and officers elected on the floor of the Assembly.

Walter R. Buerger, M.D., Covina, Calif., Chairman of the AAPS California Chapter and a member of AAPS Board of Directors, pointed out that just two AAPS member in a state can start a state chapter.

Both Dr. Buerger and Dr. Paul Leithart, M.D., Columbus, Ohio, Chapter Chairman of Ohio and also an AAPS Director, agreed that one of the first projects a newly organized chapter should undertake is publication of a newsletter. Dr. Buerger advised mailing the newsletter not only to AAPS members but regularly to members of the House of Delegates of the state medical society ("let them know there is an organization that cares about PSRO and other issues"). Dr. Leithart said the Ohio Chapter newsletter is mailed to state and county medical journals and bulletins.

Dr. Leithart also said that the "first purpose of a newsletter is to educate." He said it is su rprising to find out when talking to AAPS members that "there is a lot of things they don't know."

Panelists pointed out that the format and the content of newsletters vary from state to state. But whatever the format, they agree, a newsletter should promote AAPS.

Mr. Woolley told members of the Assembly that AAPS has available a detailed manual of organization which contains explicit information on such subjects as how to organize, what makes a chapter succeed, action projects, how to recruit new members, how to get good publicity, how to enlist allies, and how to set up a speakers bureau.

It was a joyful moment for Elsie Doering shawn here receiving a bar of pure silver from President Donald Quinlan, M.D., honoring Miss Doering for her 25 years of service to the AAPS. Miss Doering, Assistant to the Executive Director, also received on engraved watch from the AAPS membershb.

Medical Costs & Inflation

fUp to Doctors to Tell People Truth'

Rising medical care cost are caused by inflation. Nevertheless, government bureaucrats, like HEW Secretary Caspar Weinberger and others, are attempting to mislead the people into believing that rising medical care costs are a chief cause of inflation.

It is up to the nation's physicians to tell the American. people the truth about medical costs and inflation. It is up to them because no one else will.

These cogent and timely observations were made by Donald Quinlan, M.D., in his Presidential Address at the AAPS Annual Meeting in New Orleans October 31.

Dr. Quinlan said the American people should understand that government interventionists are deceitfully trying to use inflation to pave the way for political medicine. He stressed

Donald Quinlan, M.D., delivering Presidential Address at AAPS Annual Meetin".

that if physicians can get their patients to understand that fact then physicians can use inflation, "which concerns everyone and frightens most of us," to convince citizens they should repudiate political medicine.

He said physicians determined to preserve professional freedom are in "a rough, tough, brutal fight" made all the more difficult "because doctors are loath to drop down to the level of medicine's enemies."

"Those labor bosses, politicians and bureaucrats who are determined to destroy medicine as a free institution and substitute debilitating government controls are devious, crafty, unprincipled, tireless political animals. Deceit is a way of life with them."

"Doctors must become activists in day-to-day civic affairs.

They cannot remain locked in a sheltered world of medical practice, isolated from the grim realities of political life. If they do, they will, by that kind of negativism, contribute to the doom of medical freedom."

"A license to practice medicine is no shield against servitude. "

Dr. Quinlan said that politics looks like pretty grubby business to the doctor concerned with taking care of patients and practicing the art and science of medicine.

"And so it is, but doctors who want to continue to practice the art and science of medicine without interference from government bureaucrats had better take the grubby business of politics seriously and make it their personal business. They must understand that one way or another they have to enlist the support of their patients in the cause of medical freedom or the cause will surely be lost."

He warned that it won't be easy to teach patients the truth about the cost of medical care because "the enemies of medicine have been ruthlessly lying to the people about the

cost of medical care for forty years or more.

"They have tried by this vicious deceit to turn the people against doctors so that an angry public would thoughtlessly and vengefully accept socialized medicine," Dr. Quinlan said. "It's easy to deceive the people, if you're so disposed."

Dr. Quinlan pointed out that HEW Secretary Weinberger had not been candid with the people in trying to make them believe physicians' fees rose 19 per cent after wage-price controls were lifted when the rise was only 4.4 per cent and in attempting to deceive the people into believing that rising physicians' fees are a cause of inflation.

MORAL DECADENCE

"What do we do about that ki nd of moral decadence among our adversaries?" he asked. "Do we just let that kind 'of willful deceit lie there in the minds of the people, germinating into bitterness and resentment against the medical profession?"

"NO! I think every_p_b_ysician in the nation owes it to himself, to his colleagues and to his patients to brand the lies for what they are. I think each of us should become a committee of one to tell the American people the truth.

"Most important of all, we must get it across to our patients that inflation is the terrible price we are payinq for 40 years of profligate and irresponsible government spending -- deficit spending. The simple economic truth is that inflation is caused by government living beyond its means, spending more than it collects in taxes and paying for the deficits with printing-press money."

Dr. Quinlan pointed out that Medicare and Medicaid are inflationary. "Taxes collected aren't enough to pay the bill. So, the government has printed up money to pay for Medicare and Medicaid. Those billions of dollars of printing-press money dumped into the economy have driven iJp prices and eroded the value of the dollar. Those billions initially pay bureaucratic agencies, hospitals, doctors and

druqqists and other health care items. But from there they flow into the economy, exerting inflationary pressure on all goods and services.

"That's what we have to explain to our patients so they will understand clearly that nationalized medicine will result in more and more billions of printing-press dollars being poured into the economy. The result will be economic disaster, literally destroy.0g our economy."

Dr. Quinlan criticized Secretary Weinberger for being glib about accusing doctors of inflating fees but failing to be honest with the people by admitting that his department -HEW -- "is the greatest engine of inflation in the United States government today."

"If Mr. Weinberger were candid with the people he would tell them that while doctors' fees have risen 1 00 percent since 1960, the cost of his deportment has increased a staggering 600 per cent."

"Tragically, rather than recognizing and attacking the cause of inflation -- reckless government spending -- President Ford, members of Congress and other officials in Washington are trying to duck responsibility and pin the rap on the American People."

RAllY TO AAPS

Dr. Quinlan called upon all ethical physicians in the fight for freedom to "rally around the one organization with d broad enough national base and strong enough principles to make it effective -- the Association of American Physicians and Surgeons."

"Every phvsicicn in the nation," he said, "should know that the AAPS is an organization that derives its strength from an unbreakable, unbendable set of principles firmly based on a foundation of truth. Every physician in the nation should know that AAPS will never sellout to the enemy for money or any other inducement. AAPS will not abandon the struggle against government tyranny. AAPS will not compromise with the enemy. AAPS does not believe that subservience to government is the proper fate for such a noble profession."

Donald Quinlan. M.D" outgoing AAPS President (left) and Executive Director Fronk Woolley (right) greet J. Enoch Powell, member of British Parliament and former Minister of Health, on arrival at AAPS Annual Meeting where Mr. Powell was guest speaker.

AAPS OFFICERS FOR 1974 -75

FRANK ROGERS, M.D.

President

R. L. CAMPBELL, M.D.

President-Elect

E. E. ANTHONY, M.D.

Treasurer

Frank A. Rogers, M.D., a general surgeon from Whittier, Calif. (Los Angeles County). was installed as 1974-75 President of AAPS at the Association's Annual Meeting in New Orleans. He succeeded Donald Quinlan, M.D., a Northfield, Illinois, internist who practices in Chicago.

R. L. Campbell, M.D., Corsicana, Texas, a family physician who has served with distinction as Speaker of the AAPS House of Delegates, was chosen President-Elect.

Georgia AAPS Member Elected to Congress

A member of AAPS, Lawrence McDonald, MD., Atlanta, Georgia, was elected to the U.S. House of Representatives from Georgia's 7th Congressional District. Dr. McDonald, a Democrat, defeated Republican Quincy Collins, a retired Air Force colonel.

Another AAPS member, John L. Grady, MD., Belle Glade, Florida, made an impressive showing as an American Independent Party candidate in a three-way race for the U.S. Senate. Dr. Grady, Chairman of the AAPS Florida Chapter, chalked up 272,000 votes against his Republican and Democratic opponents.

In local elections, John Fenick, M.D., an AAPS member, running on the Republican ticket, won election as mayor of traditionally Democratic Carteret, New Jersey.

Albert Cullum, MD., an AAPS member from Middlesboro, Kentucky, lost his bid to unseat Rep. Tim Lee Carter, M.D.

In Kansas, liberal U.S. Rep. William Roy, MD., a physician who consistently supported and sponsored legislation considered by doctors all over the country as detrimental to American medicine, was defeated in his attempt to unseat Republican Sen. Robert Dole. The majority of physicians in Kansas opposed Dr. Roy, a Democrat, and supported Mr. Dole.

C. W. JOHNSON, M.D.

Speaker of Hause

MARIE STANBERY, M.D.

Secretary

To succeed Dr. Campbell as Speaker, the delegates chose Charles W. Johnson, MD., San Antonio, Texas.

Marie Stanbery, M.D., New Orleans, Louisiana, was re-elected Secretary, and Ernest E. Anthony, M.D., Fort Worth, Texas, was re-elected Treasurer.

Tapes Available

All presentations at the AAPS Annual Meeting in New Orleans were captured on tape. Arty Association member who is interested in a particular presentation or speech and would like a tape of it, please let the headquarters office know and it will be put on a cassette. Cassettes will be furnished at cost, with the cost governed by the volume of request received.

AAPS Woman's Auxiliary Elects 1974-75 Officers

New President of the AAPS Woman's Auxiliary is Mrs. Lil Julian, Ypsilanti, Mich. She took office at the Auxiliary meeting in New Orleans, succeeding Mrs. Jackie Anthony, Fort Worth, Texas.

Other Auxiliary officers for 1974-75 are: Mrs. Mary Quinlan, Northfield, Illinois, Recording Secretary; Mrs. Juanita Campbell, Corsicana, Texas, Treasurer; Mrs. Mary Beth Cullum, Middlesboro, Kentucky, Membership Chairman, and Mrs. Betty Coy, Orlando, Florida, Program Chairman.

Your for lndividuol )lib'~",ibilitY'

~~''''~

President

Enclosures: Pamphlet rack order form

Reprint from Chicago Daily News

PRIVATE DOCTORS INSTITUTE, Washington, D.C., April 24-26,1975 ANNUAL MEETING, Walt Disney World, Lake Buena Vista, Florida, October 16-18, 1975

ASSOCIATION OF AMERICAN PHYSICIANS AND SURGEONS

2111 Enco Drive. Suite N·515. Oak Brook, tllmois 60521 312/325· 7911 Frank K. Woolley. Executive Director

THE VOICE FOR PRIVATE DOCTORS

Active Speakers Bureau

Index No. 13 December, 1974, Volume 28, No. 11

New AAPS President's No.1 Target

An active AAPS Speakers Bureau will have number one priority with Frank A. Rogers, M.D., during his tenure as President of the Association.

Dr. Rogers, Whittier, California, a qenercl surgeon, was inaugrated as the 32nd President of AAPS in November at the Association's Annual Meeting in New Orleans. He will serve as President until the Annual Meeting next year.

In his inaugural address, Dr. Rogers had these suggestions for the futu re of AAPS:

Frank A. Ragers. M.D.

Speakers Available

As noted in the July, 1974, AAPS News Letter, the Association maintains a Speakers Bureau, with a list of knowledgeable, top-notch speakers available for meetings of medical societies, other physician organizations or nonphysician groups.

However, as Frank A. Rogers, M.D., AAPS President, has pointed out, it is imperative that the Speakers Bureau be expanded so that AAPS speakers will be available in every state. Even more important, AAPS members should be doing .all they can to place AAPS speakers before medical and civic organizations as often as possible all over the nation.

All AAPS members who are willing to accept speaking engagements should notify AAPS headquarters, with a list of subjects they feel competent to talk about.

The need is urgent to get the truth disseminated about PSRO, HMOs, nationalized medicine and other threats to medical freedom.

"Ours is a crusade that cannot fail. Our cause is right.

"And recognizing this, we must begin to more effectively tell our story. 'Doctors and people throughout this nation are being purposely deluded and beguiled into submissive acceptance of socialist doctrines. They need to hear the truth, and AAPS can deliver it.

"Number one priority is an active Speakers Bureau. It ~ work and it will pay its way. Communications is the very key to education and hence to effective action. AAPS spokesmen must provide this for what I know is an eager, waiting audience in every pa rt of America.

"This activity is fundamental if the deadening yoke of government is to be lifted."

Dr. Rogers said also that AAPS should explore the possibility of developing "a coalition of freedom organizations."

"Why could not AAPS lead in a nationwide combining of innumerable groups struggling for freedom? There is strength in numbers, and truly freedom is indivisible."

Dr. Rogers said he assumed the office of AAPS President "with a very clear understanding that it is not the leader protem of this Association who is of real significance" and "it is not the President who will spell success or failure."

"The Association of American Physicians and Su rgeons is soundly grounded on the bedrock of religious principle, dedicated to truth and to the eternal vigilance necessary to regain and to preserve true freedom for all. It has not faltered, nor will it, because of that dedication shared by you

people seated here tonight. For you have continuity of concern for what is right and good and valid, and that concern flows as a mighty river through the lifegiving arteries of this fine organization.

"It is that continuity of purpose and dedication to principle and that concern we all have for the future of this unique nation that can and will preserve AAPS. But ultimately, it IS the deep-rooted faith in God -- woven :nextricably into the warp and woof of AAPS that does proVide the real strength of this Association.

"Although we are a minority, we know -- each of us -- that the historic moments of the centuries were mode by minorities, that the great events of recorded time -- good and bod -- were culminated by small groups of people who were unwavering in their direction, unceasing In their desire to achieve. But In

MDs Deemed Incompetent

adddion, ladies and gentlemen of AAPS, you have on odded strength, you know your enemy and know him well -- monolithic bureoucracy mosqueradlng as benevolen t govern.'TI en t; un relen ling, uncon trolled, monstrous cuvaciit ornstn to humon dignity and progress.

Dr. Rogers called on members of AAPS to multiply the organizotion's power and Influence because "it is not medicine alone that is undel attack, but clvjlizotion itself."

"In closing, recall with me this picture. In a far-flung, near forgotten part of the world stands the tiny guardhouse of a British sentry, remote yet somehow firm and defiant -resolute. And written inside on the drab bare wall can be seen the following sentence: 'I believe that one mar, can make a difference -- and that every man should try.'

"As I accept this office tonight, I do not ask your help, but rather do humbly pledge you mine."

HEW Review Rules Threaten Licenses

Do you take core of Medicare and Medicaid patients? If you do, you should know that arrogant bureaucrats in the Deportment of Health, Education and Welfare have taken steps to nullify your license to practice medicine.

These bureaucrats hove adopted regulations which say In effect that you are not competent to decide whether a patient of yours needs hospitalization, despite the fact that your state has certified to your competence by granting you a license to practice medicine.

Not only that, these regulations, which will have the force of low, will authorize non physicians to pass on the competence of ltcensed MDs by making the decisions whether patients will be allowed to stay in the hospital.

The regulations covering utilization review of the hospitalization of Medicare and Medicaid patients were published in the Federal Register November 29, 1974, and are scheduled to become effective February 1, 1975.

It is clear that HEW officials, with their authoritarian approach to the use of power, have decided they cannot wait for the implementation of PSRO to begin exercising control over physicians' professional decisons. The new UR regulations are obviously intended to give HEW a head start on PSRO.

Said HEW: "Care has been token to assure that these regulations are supportive of the implementation of the PSRO program and consistent with approaches to be employed for PSRO review of hospital and skilled nursing facility care. Effective operation of the hospital review system required ... should ... enable PSROs to concentrate their efforts on relatively smaller areas of questionable professional activity."

The regulations require hospitals to check on the "medical necessity" for admission of Medicare and Medicaid patients within one day of admission, using pre-set criteria designed to fit every case under all conditions. The initial decision rs to be mode by a nonphysician employee of the

hospital. That decision is to be reviewed the second day by the UR committee, which is encouraged by HEW to include nonphysrcians as members and to let nonphysicians do the actual reviewing. The UR committee will be compelled in its deliberations to use "regional" norms for length of stay.

HEW bureaucrats are telling the public that all this is necessary to save money and assure quality of treatment by eliminating unnecessary hospitalization, a gratuitous statement which may be believed by the naive and gullible who might be persuaded that government programs save taxpayers' money.

The fact that control of medicine, not economy, is the real purpose of these regulations is easily demonstrated using HEW's own propaganda. In the 1975-76 fiscal year, the Medicare and Medicaid programs are expected to cost the taxpayers about $25 billion. According to the Social Security Administration, $60 million of that is supposed to be saved by enforcement of the new UR regulations, a saving, if realized, of 2411 OOths of 1 %.

So ostensibly to save 2411 OOths of 1 % of the cost of these programs, physicians' iudgments are going to be overruled and elderly and poor patients are going to be denied the hospital care their physicians think they should have.

This is all right with .AMA. .Malcolm Todd, M.D., President of AMA, told the Chicago Tribune he thi nks doctors will cooperate as long as the policing is done by physicians. "We don't think clerks or administrative people should be making these decisions."

HEW obviously has other ideas. The review setup is going to be rigged so that nonphysicians will be "doing much of the paperwork and performing other functions, such as screening, using physician-developed criteria," said HEW.

Here's the clincher. Nonphysicians should be used, said HEW, because the regulations "impose too great a burden on physicians' time to the detriment of patient care."

YOU CAN'T AFFORD TO MISS INSTITUTE

Physicians who abhor the thought of government control of medicine should not give up hope that government interventionists can be defeated, even though the AMA is now one of the interventionists.

DO YOU WANT TO KEEP ON FIGHTING TO PRESERVE YOUR FREEDOM TO MAKE YOUR OWN PROFESSIONAL DECISIONS?

If you do, the AAPS Private Doctors Institute may be the most important meeting you will have the opportunity to attend

in 1975.

The Institute is scheduled for April 24-26 at the Shoreham Hotel in Washington, D.C.

YOU CANNOT AFFORD TO MISS THIS IMPORTANT MEETING. PLAN NOW TO ATTEND. You will find out:

• That those of us who cherish freedom and the dignity of the individual still have many friends in Congress.

• How AAPS as an organization and you as an individual can most effectively combat the socializers.

• How a coordinated campaign joining AAPS and congressional friends can be developed and carried out.

• How you as an individual can do the best job in attempting to persuade your senators and congressman to your point of view, even if they are liberals.

Plans are in the works to give you the chance to meet and talk with members of Congress who can be counted on to support AAPS in the struggle to block legislation to nationalize medicine. They can evaluate for you the political climate in Congress and you, in turn, can give them the benefit of your insight into the consequences of politicalized medicine.

Circle the dates now and make plans to attend the AAPS Private Doctors Institute April 24-26 in Washington, D.C.

Additional information will be published in subsequent issues of the News Letter.

HMO Law Meant to Encircle Medicine

Health maintenance organizations, "the socialist dream for a medical utopia," will never work "because they promise unlimited services for limited fees."

With that observation, Frank A. Rogers, MD., Whittier, California, opened a panel discussion on PSROs, HMOs and Compulsory Nationalized Medicine at the October-November AAPS Annual Meeting in New Orleans -,

Dr. Rogers, who was inaugurated as AAPS President at the meeting, said that the new law providing for federal subsidies to develop HMOs was designed to bring about "total encirclement of the private practice of medicine."

Panelists for the discussion of programs for government control of medicine included Dr. Rogers, Frank K. Woolley, AAPS Executive Director, and Maurice Kramer, head of the AAPS Washington office. Robert G. England, M.D., Carlinville, Illinois, was panel moderator.

Dr. Rogers said that "even with millions of dollars (in subsidies) already poured into the HMOs which have been formulated, they are failing at a significant rate." He added that "a review of the current experience of HMO type practice reveals a high failure rate, with the majority of HMOs funded over the past two years already out of business or going broke."

He noted that HMOs under the new law are required to provide every sort of medical care possible and provide it on a round-the-clock basis.

Even such established HMOs (a new term for an old idea) as Kaiser and Ross Loos don't "even approach the requirements of the law," Or. Rogers said. He added that many of these prepaid group practice plans that have accepted government money have

protested to HEW that they could not possibly deliver the quantity of care mandated for the amount of money they were being paid.

Dr. Rogers said that about 800,000 Californians are covered under prepaid health programs and "the results of these programs have been outrageous." Care has been extremely poor and "there has been nothing but chaos from the time they were begun."

"A recent analysis by the Legislature of a sampling of 15 of these groups indicated that in California on the average 52% of the millions of dollars poured into them went for administrative expenses," Dr. Rogers reported. "In one instance, 93% of the administrative money simply disappeared."

Or. Rogers said it is apparent that the strongest proponents of prepaid health care simply advocate the abolition of fee-for-service medicine.

"The American medical profession cannot condone HMOs," Dr. Rogers concluded. "We need to study them; we need to know their characteristics because if allowed to mushroom and to become nationwide, as they have in other countries, it is going to change ethical medical practice into" unethical practice, produce impersonal assembly-line medical care.

"Our profession, in my belief, must recognize and understand that HMOs and every other government program will ultimately hasten the destruction of private qua~ty medical care. If we fail now to understand what hangs in the balance, we will have lost our professional freedom, and that loss to the American people will be even greater b.ecause the strongest bulwark against socialism in our society will have

crumbled. All society then will rapidly fall to socialism.

"It is my feeling that we should fight it now. All physicians should stand together for the protection of the profession and the American people, and I hope that we in AAPS can lead the way by enlightenment in this area."

MR. KRAMER: The AAPS representative in Washington discussed the prospects for health legislation in the next Congress. "I expect that we will hear more and more in Woshington that Democratic victories in the election mean a mandate for nationalized medicine.

MEDICAL 'REFORM'

"Involved in any national health bill are the elements thot make up the 'reform' of the medical care system. The HMOs that Dr. Rogers has described is one element, one 'ecture particularly of the Kennedy bill on the Senate side. Practically all bills incorporate the so-called PSRO quality control provisions.

"Another element that I would like to identify is the so-called planning controls. The setting up of planning areas corresponding for the most part with PSRO areas would be a significant feature of any health proposal that is developed and debated and acted on in the coming session of Congress. But HMO, PSRO and the planning bill are all integral elements of national health proposals and really need not be discussed separately from a legislative standpoint because national health legislation encompasses them all.

"You can expect very serious consideration of national health legislation early in the next session of Congress."

MR. WOOLLEY: The AAPS Executive Director traced the genesis of PSRO, pointing out that the concept sprang from the development of socialized medicine in Europe. "PSRQ IS merely policing of medical care by government." He said that when the AMA leadership decided to stop opposing nationalization of medicine and to introduce its own legislation to nationalize medicine, bureaucrats in Washington planted the idea of including provision for professional review organizations, which later become PSROs in the Bennett Amendment to H.R. 1 (P.L. 92-603).

Mr. Woolley reminded AAPS delegates that federalized medical standards and federal financing of medical care were

recommendations contained in a Socialist Party pamphlet -"The Case for Socialized Medicine" -- that was distributed by the thousands at the Americana Hotel in 1961 du ring the Annual Convention of the AMA.

Mr. Woolley read the following "To Do" from that pamphlet:

"We can do everything possible to encourage federal intervention in the financing of medical costs on a bit-by-bit basis and we con work to direct such intervention so that if it is not socialized medicine proper, at least it paves the way for socialized medicine. To this end, we must give high priority to attempts to amend legislative proposals in ways that will involve the government in medicol standards (emphasis by the pamphlet authors) and in a way favorable to cooperative and group medicine."

REVIEWS LAWSUIT

The AAPS Executive Director also reviewed the history of the AAPS suit in federal court to overturn the PSRO law on constitutional grounds. He said the three [udqes of the special court took the case under advisement after hearing oral argu ments October 17 on a government motion for a summary judgment (dismissal).

Mr. Woolley renewed a plea for provable, documented evidence of a PSRO or other agent of government interfering with a physician in the exercise of his medical judgment. He said that when such evidence is available, AAPS will amend its suit to ask for a specific injunction against the government.

He also urged physicians to resist attempts from all sources, including hospital administrations, to interfere with the way they practice or to attempt to make physicians subservient to the hospital administration.

"Don't give up," he said. "Preserve your rights. If you are forced to sign something after you have exhausted all your remedies, and all your local colleagues have succumbed, go ahead and sign but put under your signature, "signed under protest." That is notification that you signed under duress and did not consent to the terms of the document, Mr. Woolley said.

Fronk A. Roqers. M.D. fleft). who assumed office of AAPS President at Annual Meetinq in New Orleans. confers with AAPS Executive Director Fronk Woolley and Maurice Kromer. head of Washington office, at start of panel discussion on PSROs. HMOs and nationalized medicine.

AAPS May Establish A Political Group

The AAPS Assembly and House of Delegates adopted a resolution instructing the Board of Directors "to initiate steps towards establishing a political action organization with legal authority to collect funds and to contribute directly to the election of members of legislative bodies, primarily the U.S. Congress, who prove by deed and word that they deserve the support of ethical physicians who believe in preserving constitutional govern ment."

Another resolution set forth guidelines physicians should follow in dealing with third parties. They are:

1. The fundamental goal of the practicing physician

is to directly qualify medical care to his patients to the best of his ability and in accordance with scientific advances.

2. The necessary basic conditions for quality medical care are:

(a) freedom of choice of patients. (b) freedom of choice of physicians. (c) freedom of choice of therapy. (d) freedom of choice of location.

(e) confidentiality of medical information.

3. Remuneration should be based on the "free market" economic philosophy. Third parties should not expect physicians to subsidize health care programs by inadequate remuneration and interference with the inviolable physician-patient relationship.

4. "Cost controls" should never be accepted as an excuse to interfere with the freedom of private practice.

5. Forced or coerced labor (slavery) is inhuman and immoral and was abolished by the Thirteenth Amendment to the Constitution. Physicians have the moral and legal obligation to uphold the Thirteenth Amendment and, consequently, to oppose all forms of coerced labor, even their own.

Thus, all members of the AAPS are asked to oppose all programs that disregard the above guidelines, as freedom, legality and quality of medical care are impossible under such circumstances.

A third resolution recorded AAPS as favoring a Constitutiona I Convention.

Two other resolutions were adopted.

MORAL STANDARDS

WHEREAS, this country was founded upon belief in God, and

WHEREAS, belief in God presupposes obedience to his will, and

WHEREAS, the inestimable value of each human life and the sanctity of the family are inherent in and essential to the preservation of our heritage;

THEREFORE, BE IT RESOLVED that the Assembly and House of Delegates of the Association of American Physicians and Surgeons, Inc. in regular session assembled in New Orleans, Louisiana this 2nd day of November, 1974 recognize and deplore the planned attack upon our way of

life as manifested by widespread agitation for the acceptance of homosexual practices as normal and proper variations of sexual behavior, and

BE IT FURTHER RESOLVED that the Association of American Physicians and Surgeons affirms its support of our traditional values as a matter of principle.

NATIONAL LICENSURE

WHEREAS, the Congress of the United States is now considering the Kennedy-Javits Bill, namely Title VIII of the Health Professions Education Assistance Act of 1974, and

WHEREAS, this bill directs the Health, Education and Welfare Secretary to develop and establish national standards for licensure and subsequent renewal of licensure at least every six years, and

WHEREAS, this constitutes an unwarranted and undesirable stringency and interference with the practice of private medicine as now being conducted;

THEREFORE, BE IT RESOLVED that the Assembly and House of Delegates of the Association of American Physicians and Surgeons, Inc. in regular session assembled in New Orleans, Louisiana this 2nd day of November, 1974 do emphatically protest the enactment of such legislation.

PSRO Stand Unchanged

HEW bureaucrats, notably Henry Simmons, M.D., the agency's PSRO chief, are now busily propagandizing that opposition to the vicious PSRO law is crumbling everywhere.

That's what Dr. Simmons claimed in a speech to the American College of Surgeons which was reported in the November 20 issue of Medical Tribune.

Dr. Simmons and his HEW colleagues hovebeen reading the wrong signs. AAPS evidence suggests opposition to PSRO among individual physicians continues unabated. Almost daily, AAPS receives new requests for pamphlets and other information to help physicians combat PSRO and to explain this authoritarian law to their patients.

Furthermore, support for the AAPS lawsuit to outlaw PSRO on constitutional grounds continues to pour in, not just from individual physicians but from local medical societies.

The members of five more medical societies have sent in contributions in support of the lawsuit.

• Calcasieu Parish Medical Society, Lake Charles, La., contributed $500 from its members to help finance the lawsuit.

• Pottawatomie County Medical Society members in Shawnee, Okla., sent in $250.

• One hundred dollar contributions were received from Pinellas County Medical Society, St. Petersburg, Fla.; Hall County Medical Society, Grand Island, Neb., and Pamlico Albermarle Medical Society, Washington, North Carolina.

It is noteworthy that Dr. Simmons can no longer detect what he once described as a "campaign of misrepresentation" about PSRO. It follows that what is being said is, as he sees it, the truth. This is interesting in light of the fact that AAPS has not diminished nor softened its criticism of PSRO. In the past five months alone, AAPS has distributed almost 150,000 pamphlets elucidating the evils of PSRO. And the

Association is still pushing its lawsuit in federal court to have the PSRO low declared unconstitutional.

Now that Dr. Simmons concedes that PSRO opponents

are not misrepresenting the facts about this iniquitous law, will he be equally candid and admit that federal officials have repeatedly falsified PSRO?

State Society Can Be Positive Force

F. Michael Smith, M.D., President-Elect of the Louisiana State Medical Society end a member of AAPS, told delegates to the AAPS Annual Meeting in New Orleans that "your state medical society can be a positive force for ethical medicine," and he then gave them pointers on how they could get the job done.

The key, said Dr. Smith, a pediatrician who lives and practices in Thibodaux, La., is to pull together into a working team those members of the society willing to toil for the cause of ethical medicine.

But, he cautioned, the campaign must begin at the county medical society level where "you will find the true grassroots strength."

"Such on approach will provide the best available forum for oral discussion and presentation of desirable objectives," Dr. Smith said. "The basic objective is the

F. Mlcha&1 Smith. M.D.

election of doctors who have the proper principles as delegates to your state medical society. The traditional attitude of 'let Old Joe go, because Joe has gone for years' must be cast aside if 'Old Joe' is not a good Joe."

Once physicians who believe in conservative principles win control of the local medical society, they can turn their attention toward influencing the policies of the state medical society. Dr. Smith described how a number of such societies in Louisiana have been able to take action profoundly affecting the course of resolutions in the House of Delegates of the LSMS.

"One of the most important single steps that was taken in this state was the elimination of the committee hearing system," Dr. Smith said. "There can be no greater move made to assure democracy of action than this. In our state medical society today, the House of Delegates acts as a committee of the whole to hear and act upon all resolutions and establishment of policy.

"I scarcely need point out to you that, given the

power to select hearing committees, control of policy is no trick. There is pressing need for all medical organizations to emulate Louisiana in this matter. Abolition of this device for power control is a must if democratic principle is to prevail."

CITADELS CAPTURED

That admonition is pertinent because it is the device used by leadership of the AMA to control AMA policies to suit the purposes of that leadership. Dr. Smith touched on this fact.

"Skillfully," he said, "the citadels of power of organized medicine have been captured by a minority of ultra-liberal physicians. In our so-called organized medicine, boards function without accountability to the membership. Democratic principle lies in abnegation when delegates vote contrary to the established policy of their own component organizations.

"Mockery of democracy is promulgated when hearing committees present their own views, without regard to the resolutions or testimony presented to them. Federal grants are sought and accepted along with federal control. Principles of ethical considerations are cast aside when they clash with the pragmatism of ultra-liberal or self-serving objectives of the few."

Medicine is a valued service and big business, he said, and this explains in large measure the "why" of the power struggle for control of medicine. The medical profession, he said, has been on the losing end of the struggle so far. "We have, by default," he continued, "surrendered the power centers in our own organizational structure to those who embrace and espouse concepts foreign to our own ethics and principles. Heretofore, apathy has gripped the grassroots of our profession, as most physicians reject involvement and effort in medical politics. However, if one listens now, the rumblings of dismay, dissatisfaction and disapproval of the trends and policies of organized medicine are to be heard throughout the land.

"There is at hand now a golden opportunity for the asserting of principles to better serve the public by a return to traditional, ethical medicine."

Rep. Crane On Ways and Means

Rep. Philip Crane, Illinois Republican, one of Congress' strongest champions of individual liberty and responsibility and therefore one of the medical profession's best friends in Congress, hos been nominated to the House Ways and Means Committee.

Mr. Crane's selection was made following a shakeup of the committee leadership and a decision of House Democrats to expand the committee from 25 to 37 members to more nearly reflect the increasingly liberal complexion of the House as a consequence of the November elections.

Labor Is Big Threat To Free Institutions

One of the biggest threats to 'free institutions in the United States is organized labor. One of its goals is to take Congress away from the people and put it under control of labor leaders who are interested in more power, more control, more taxes, more inflation and more centralized government.

That's the opinion of U.S. Rep. John R. Rarick (D-La.), who was defeated for re-election to Congress largely through the efforts of labor bosses. Mr. Rarick spoke November 1 at one of the sessions of the AAPS Annual Meeting in New Orleans.

He pointed out that leaders of the AFL -C/O are boasting they can reach and control through electronic computers 10 million union members. And he warned that AAPS "is going to have to be a political action organization or you are not going to be in business much longer."

Mr. Rarick, who is chief sponsor of the first bill introduced in Congress to repeal the iniquitous PSRO law, said that neither the Republican Party nor the Democratic Party can brag that they have 10 million votes in their pockets that they can reach at one touch of the button of an electronic computer system. It is the goal of labor bosses, he said, to register and vote all 10 million union members and to extract from each of them $2 a week for COPE alone to spend for political purposes (that's $20 million a week or more than $1 billion a year).

He added: "Doctors are going to have to start reaching people they haven't been talking to. You are going to have to form coalitions with other groups also opposed to more socialization, more big government, and to try to get back to representative government so that the individuals who have quit voting and quit political action get back and get involved.

"I think the real answer for all of us is that we must get involved; we must get into politics; we must talk to people we haven't been talking to. We dare not shriek, but we've got to plead and to pray if necessary. If we don't, we may end up losing our business and our freedoms. "

Dan Smoot (left), former FBI agent, author and lecturer, and Rep.

John R. Rorick (D-la.l, chief sponsor of PSRO repeal bill, were among principle speakers at AAPS Annual Meeting. Here they compare notes on evils of PSRO and OSHA lows.

Battle for Liberty

Is Total War--Smoot

Dan Smoot, former FBI agent, author, lecturer and political analysist, warned delegates to the AAPS Annual Meeting in New Orleans, that the battle for liberty cannot be divided and subdivided. It must be total war.

"Any man who thinks he can successfully fight for his own freedom in his own corner while ignoring the total war against liberty will eventually find himself chained in his own corner to the corpse of liberty."

Mr. Smoot advised doctors not to turn all efforts to saving the profession from the socialist revolution. "You should concentrate rather on saving your republic," he SOld. Businessmen must heed the same advice, he said.

"Businessmen, alarmed about OSHA, must realize that preserving ethical medicine is lust as important to them as preserving free enterprise. Otherwise there will never be enough unity of purpose and cohesiveness of strength to stop either OSHA or PSRO, and the reverse is also true. If you think PSRO is bad for doctors, but you haven't paid much attention to OSHA, you haven't yet gotten involved in the struggle."

Mr. Smoot enlightened the AAPS delegates with a clarifying review of how the radical leftists perform. It is not obvious, for example, that leftist radicals are responsible for PSRO.

"Known radical leftists," Mr. Smoot said, "have not provided public leadership for any of the major legislation that is sucking this nation into the morass of socialism. The radical leftists always propose legislation which seems worse than the bills that get passed. And thevcriticize the bills that Congress enacts."

Before long, he predicted, they will charge that PSRO is not bringing medical cost down or stopping gouging by doctors and they will propose total government control. "And the conservatives in the medical association (AMA) and Congress will counter by proposing a moderate alternative to give the bureaucracy tighter control then PSRO now gives it but not quite as much control as the radical left demands. That will be the legislation enacted and the AMA - type conservative will then congratulate themselves on another victory over socialized medicine."

That tactic works, Mr. Smoot said, because most conservatives have no fundamental principles about the kind of governmental system we ought to have. "So, the conservatives have been perpetually in retreat for 40 years -always compromising, always yielding, getting into and supporting programs that move the nation ever closer to the liberal idea of total government."

But, "every active liberal generally supports any program that increases the power of the central government ... whether or not he likes that particular program or whether or not it affects his personal interests. So, the liberals are never in retreat -- never."

AMA Advocates Nationalized Medicine

If the notion's physicians in the practice of private rned ici ne hod to ken the ti me away from thei r patients to attend the recent AMA Clinical Convention in Portland, Oregon, and if they had understood what was done, they .vould have been profoundly disturbed.

Most of the news stories about the meeting concentrated on the bitterness generated by the fact that as a consequence of the actions of the members of the Board of Trustees and the executive staff who have managed the affairs of the Association the past six years the AMA has gone broke.

That would have been distressing enough to practicing physicians who have paid their AMA dues without being told how rapidly AMA's financial condition was deteriorating. They would have been particularly unhappy with disclosure of AMA's shaky finances had they known that a past effort by F. Michael Smith, M.D., Thibodaux, Louisiana, to call attention to the situation had been rebuffed by a reference committee of the House of Delegates. Dr. Smith currently is President-Elect of the Louisiana State Medical Society.

But what would hove most deeply shocked the practicing physicians at Portland would have been the realization that the House of Delegates, almost with an air of indifference, had voted to let the AMA's ruling hierarchy lead an unsuspecting nation down the road to the disaster of nationalized medicine.

FREEDOM OF CHOICE

One of the AMA's ancient battle cries was "freedom of choice." But today, the AMA proposes to deny the nation's employers (who include physicians) the freedom to choose whether they will offer health insurance to their employees, the coverage to be included and the amount of money they will pay for the insurance.

The AMA is now promoting standardization of medical practice through PSROs, has approved national heqlth program "guidelines" by which it favors "appropriate" control by government over cost and quality of medical care to all patients and advocates standardization of health insurance in a package that would inevitably result in regulation of doctors to fit their treatment of patients into the insurance coverage prescribed by government.

AMA is now d leading advocate of compulsory nationalized medicine for the entire population.

And by the terms of its so-called guidelines, AMA is now committed to accepting "minimum" federal government financing and federal government involvement in administration of its national health program, with what is minimum and who will decide left open. AMA also gave its formal blessing to HMOs by declaring it supports "maintenance of pluralism in health delivery systems."

The policy in support of compulsory nationalized medicine was adopted without much debate. It was almost the last item (No. 19) in the last reference committee report called up in the last minutes of the convention, when some delegates had departed and those remaining were itching to go home.

The vote, however, merely formalized into policy a decision made by the Board of Trustees before the

convention. On November 8, 1974, AMA headquarters issued a statement which stated unequivocally that AMA "is for National Health Insurance" -- its own brand -- and has been since it introduced its so-called Medicredit bill in 1970.

The statement contained this denial that AMA advocates compulsory nationalized medicine: "The AMA is willing to consider a National Health Insurance program that would require employees to offer voluntary health insurance to their employees. This concept is known as mandated National Health Insurance. It is not compulsory National Health Insurance, a point on which there seems to be considerable confusion." (Emphasis added)

PERILOUS FINANCES

The acrimonious debate at the convention was over the Association's perilous financial condition. The staff and Board came to the House with several proposals to help save the sinking AMA ship -- an 82% dues increase from $110 to $200, a mandatory $60 special assessment on all regular dues-paying members, elimination of all advertising from AMA publications, reduction in the size of publications and the frequency of publication, and the elimination of specified councils and committees.

Members of the House, in a stinging rebuke to management, said "NO!" to everything but the special $60 mandatory assessment.

Delegates rejected the dues increase until next June and agreed to 'consider it then only on demonstration of "stronger economy measures and improved executive management of the Association's affairs. r r

A special committee of the House was named to make sure the Board of Trustees carried out that mandate.

When it was disclosed that AMA spending programs had exhausted $10,300,000 in reserves in less than five years and that officers had been forced to borrow some $2 million to meet year-end expenses, there were cries for "heads to roll among AMA management."

The upshot was that most recommendations of the Board were put on hold until management comes up with some satisfactory answers.

The decision to eliminate drug advertising from AMA publications was reportedly based in part on the question whether AMA was unduly, even unethically, influenced by carrying pharmaceutical company advertising.

On the matter of undue influence, no one raised the question whether the same criticism might apply to AMA for accepting money from the federal government.

Indiana Chapter Pushes Contest

The Indiana AAPS Chapter continues to conduct its Freedom Essay Contest and is pleased with the results. Chapter officers expressed the hope that other states will become interested and start essay contests.

Government Medicine Foments Grievances

Nationalized medicine is a system "from which all preference except that politically channeled through the state has been eliminated," J. Enoch Powell, a world authority on government medicine, pointed out to delegates to the AAPS Annual Meeting In New Orleans.

"This is where we reach the heart of the matter," Mr.

Powell said, "since by definition a comprehensive national health service nationalizes preference; the alternative in the last resort, the whole debate in which you are deeply and passionately concerned, IS between a nationalized preference and a dispersed preference ... It is a system from which has been eliminated not only the preference of the consumer, but that of the producer ... It is the fundamental characteristic of a comprehensive nationalized health service -- it excludes the prospect of a career and a lifetime within the network of interacting choices and preferences of consumers and producers, or, if you prefer, of patients and professionals. In place of that network there is the situation of how much money the state will allocate to pay for what the state has chosen."

Mr. Powell, a member of the British Parliament and a former British Minister of Health (1960-63), was the principal speaker at the Friday night banquet, November 1.

One of the great dangers of any system of organized provision of services is that eventually it destroys the belief there can be an alternative, said Mr. Powell.

Mr. Powell is one of those rare individuals of learning and wisdom who, when selected for a position of power in government does 110t abuse it. As British Minister of Health, the chief administrative officer for the National Health Service, he possessed enormous authority over doctors and hospitals -- and patients. Unlike most public officials who become increcsinqlv arrogant with that kind of power, Mr. Powell studied the system in detail from the vantage point of his position and concluded it was so inherently flawed that it could not work efficiently and effectively.

He concluded that "comprehensiveness" was impossible under any system. And, as he told AAPS delegates, he found out that: "What nationalization does is to make the unavoidable impossibility of 'comprehensive' into a grievance, a grievance of the citizen against the state and against his tellow citizens, a grievance (against) a series of shortages -- staff, building, equipment and, above all, money, as if that were something separate.

Mr. Powell also noted that nationalization of medicine permits the state to divert resources from health care to other projects which government officials believe are politically more attractive.

"Certainly," he said, "there is no doubt that in the absence of the National Health Service the hospitals in Britain would have improved and expanded in the 1950s and 1960s faster than they did. Nationalization, bringing them all under state ownership and control, enabled the state deliberately to hold back investment in hospitals in order to give preference to investment in housing."

Children's Textbooks May Give You A Shock

Have you looked inside the textbooks your children are required to study In school lately? You may be In for a shock If and when you do.

Would it surprise you to know that some textbooks for grade school children suggest that garbage collectors are more important to health than doctors because they remove filth that causes disease while doctors merely treat diseases after people get Sick?

Have you done anything about such textbooks? Two people who have are Mr. and Mrs. Mel Gabler of l.cnqvew, Texas. They have been examining school textbooks for the past 14 years and have appeared before the Texas Schoolbook Commission numerous times to protest adoption of textbooks that do such things as glorify Marilyn Monroe In American history over George Washington.

Mrs. Gabler was featured speaker at the AAPS Woman's Auxiliary meeting in conjunction With the AAPS Annual Meeting in New Orleans.

Mrs. Gabler said one of the books reviewed was a commercial for homosexuality -- not presenting anything wrong With homosexuality but explaining "when you can ply your trade, the hours, the type of bars you can go into and the infighting as to who will be male and female."

And, said Mrs. Gabler, how would you like Mother Goose interpreted for your children this way in a textbook:

"Jack be nimble, Jack be quick, snap the blade and give it a flick; grab the purse, it's easily done, and lust for kicks and just for fun, plunge the knife and cut and run."

One history book, she said devoted 6-1/2 pages to Marilyn Monroe and her marriage to Arthur Miller. George Washington was barely mentioned. It was for fifth graders and the book asked such questions as what Marilyn enjoyed mast about being married to Miller and what problems they had.

Mrs. Mel Gabler, l.enqview. Texas (left), was main speaker at Waman's Auxiliary luncheon, With her is Mrs, E, E, (Jackie) Anl;,ony, Fart Warth. Texas, the autllainll Auxiliary Presid .. nt,

Small- Town Doctors "Out of Touch"--AMA

Members of the AMA who live and practice in small towns -- including members of the Board of Trustees, past and present, and numerous former AMA presidents -- must have been more than mildly surprised to learn from the November 11 American Medical News that in the affairs of medicine they are considered in AMA headquarters as Irrelevant and "out of touch."

This attitude toward small-town doctors was disclosed in an article in AMN on the AAPS Annual Meeting in New Orleans. AMN writer Dennis Breo attended the meeting but reported very little of what actually transpired. He decided I nstead to try his hand at a hatchet job on AAPS. His editors labeled his exercise in invective as "news analysis." In this case, the term "news analysis" was a deceit, since it suggested the reader was getting an erudite treatise on a news event when all he was getting was a misleading editorial against AAPS.

American Medical News, an official publication of AMA, tried hard to portray AAPS as insignificant and inconsequential. Apparently Mr. Breo figured the best way to prove that thesis was to point out that most physicians who attended the meeting came from "small-town America." Clearly, that settled the question in Mr. Breo's mind. He said they opposed "Big Brother Government, The Liberal Media, the Eastern Establishment ... the Professional Standards Review Organization law, health maintenance organizations, national health insurance, and all other aspects of 'socialized' medicine."

And when all this was said and done by these small-town doctors, AMN concluded, "there was left hanging the question of AAPS' role and relevance in contemporary medicine."

The AMA's staff writer arbitrarily selected 10 towns as typical of the places the physicians came from to attend the AAPS meeting. These towns singled out for special mention by Mr. Breo are where 103 physicians live and practice. And among these physicians considered so out of touch with contemporary medicine they are against Big Brother Government, PSROs, HMOs and socialized medicine are 63 members of the AMA.

The attitude of the American Medical News toward the small-town MO may have relevancy to the fact that about 40 per cent of those 103 physicians do not belong to the AMA

The concluding paragraph in the AMN editorial on AAPS is worth pondering by all who believe principle is more important than political expediency.

"In a nation increasingly committed to the health care of its citizens and in a Congress increasingly liberal after last

week's election, there are those who would question if AAPS isn't out of touch."

First, the implication is false that the American people are increasingly anxious for nationalized medicine.

Second, and most important, the statement seems to be saying that AAPS, to be in touch, should recognize that the enemies of medical freedom in Congress outnumber its friends and AAPS should therefore abandon principle, cower before medicine's enemies and meekly accept Big Brother Government control of medicine.

If being "in touch" means surrendering principle to accomodate a shift in the political complexion of Congress, AAPS will remain out of touch.

The undisguised editorial generated reaction. John H.

Budd, M.D., Cleveland, Ohio, a member of the AMA Board of Trustees, wrote the AMN editors that "my anger is more than slight." He said this attempt to "ridicule, disparage and condemn an organization of physicians ... genuinely concerned over the extent and type of government control engulfing medicine" was "offensive to me."

Leszek Ochoto, M.D., an AMA member wrote: "After your typical liberally arrogant and slanted 'analysis' of the Association of American Physicians and Surgeons, I would like to join this association. Please kindly let me know their address."

Dr. Ochota is now an AAPS member.

Real C~riJlmaJ SpirU

Despite the corruption, both political and non-political, which we see all around us this is the time of year for rejoicing by those of us who believe in God and His son Jesus Christ. While Christ was crucified by evil forces who used 30 pieces of silver to accomplish their purposes, His noble and courageous love of individual freedom and responsibility has been an unquenchable beacon of light shining brig'htly down through the ages. True believers can take comfort in knowing that despite distortions by power seekers who describe heaven in collectivist terms carefully disguising the subjugation of each individual to the dictates of government, the unabridged word of Christ rejects corruption, bribery, coercion and duress and espouses individual love and charity. He admonished us through Paul to "Rejoiceth not in iniquity, but rejoiceth in the truth." This is the real spirit of Christmas I wish for you and yours.

Your Patients Need Your Freedom,

g~~

Frank Rogers, M.D. President

PRIVATE DOCTORS INSTITUTE, Washington, D.C., April 24-26, 1975 ANNUAL MEETING, Walt Disney World, Lake Buena Vista, Florida, October 16-18, 1975

ASSOCIATION OF AMERICAN PHYSICIANS AND SURGEONS

2111 Enco Drive. SUite N-515. Oak Brook. Illinois 60521 312/325-7911 Frank K. Woolley. Executive Director