Resolution 601-03: Voluntary Hospital Emergency Call

RESOLVED: That hospitals implementing voluntary emergency back-up call panels be encouraged to include any and all willing specialists in good standing on the medical staff in such panels.

Resolution 603-03: Unfair Contracting With Small District Hospitals

RESOLVED: That public hospitals be afforded reimbursement rates from managed care entities that are fair and comparable to those paid by the managed care entities to private hospitals in the same or similar areas.

Resolution 604a-03: Action On The Nursing Shortage

RESOLVED: That CMA support increased nursing school enrollment in California; and be it further

RESOLVED: That CMA work with interested stakeholders to investigate ways to expand nursing education programs in this state; and be it further

RESOLVED: That CMA support nursing school tuition-loan and tuition loan-forgiveness programs that encourage nurses to provide services in under-served areas of California.

Resolution 606-03: Non-Physician Surgical First Assistants

RESOLVED: That it shall be the policy of CMA to encourage the relevant legislative and regulatory bodies to eliminate the restriction of non-physician first assisting in surgery to registered nurses and to permit appropriately trained and credentialed surgical technologists to function in this capacity.

Resolution 607a-03: Hospital Charges For Uninsured Patients

RESOLVED: That CMA endorse legislation requiring California hospitals to publish both usual and customary charges as well as discounted charges for patients who pay cash for hospital services.

Resolution 608-03: Gaming By Hospitals

RESOLVED: That it shall be the policy of CMA to recommend to legislators and regulators that all hospitals that base billing on admission status shall be required to use that legitimate status that optimizes costs to the benefit of their patients consistent with any regulations and contracts that may apply; and be it further

RESOLVED: That CMA shall endeavor to have this policy adopted at the national level as well as at the state level.

Resolution 609-03: JCHAO Standards On The Internet

RESOLVED: That the officers and administrative staff of CMA will work to convince the JCAHO of the utility of publishing their standards on their website for convenient and efficient access and use by medical staff leaders; and be it further

RESOLVED: That the House of Delegates of the CMA hereby directs the California Delegation to the American Medical Association to carry this policy to the AMA for national policy action.

Resolution 610-03: Drug Substitutions

RESOLVED: That CMA take any and all steps necessary to disseminate and enforce the legal restrictions against drug substitutions in hospitals without the order or authorization of the prescribing physician; and be it further

RESOLVED: That CMA assist physicians in opposing automatic drug substitutions in hospitals.

Resolution 611-03: Epi-Pen Administration And CPR Training

RESOLVED: That CMA work with legislators to modify AB 559 (Emergency Medical services) to allow non-CPR-certified school personnel to administer Epi-Pen in the event of anaphylactic reactions if a CPR-certified person is not present.

Resolution 612-03: Funding For Autopsies

RESOLVED: That autopsies be funded as part of the quality assurance of the hospital when requested by the attending physician, and therefore, paid by the hospital; and be it further

RESOLVED: That CMA work with the California Society of Pathologists to make autopsies available to patient's families and to physicians where medically indicated.

Resolution 613-03: Elimination Of Disparities In Health Care

RESOLVED: That CMA make the elimination of racial and ethnic disparities in health care an issue of highest priority; and be it further

RESOLVED: That CMA renew its commitment to supporting the importance of culturally effective health care in eliminating disparities and explore ways to provide physicians with tools for improving the cultural effectiveness of their practices; and be it further

RESOLVED: That CMA develop and incorporate strategies specific to the elimination of minority health care disparities in its ongoing legislative, political, economic and legal advocacy and public health efforts as appropriate.

Resolution 614-03: Research And Mentor Program For Students And Residents

RESOLVED: That CMA support the creation of a national research program for medical students and residents that focuses on social, economic, professional, ethical, and political issues that impact the practice of medicine, including a mentorship component; and be it further

Resolution 615-03: Appropriations For Increasing Number Of Primary Care

RESOLVED: The CMA support continued funding of Title VII, Section 747 of the Public Health Service Act; and be it further

RESOLVED: The CMA encourage members to communicate with their Senators and U.S. Representatives to support Title VII; and be it further

RESOLVED: That this matter be referred for national action.

Resolution 617-03: Medical Staff Self-Governance And Fairness In Peer Review

RESOLVED: That CMA support JCAHO standards which assure and protect the integrity of the medical staff including, but not limited to, medical staff self-governance, physician responsibility for managing and directing patient care, a fair process for physicians that includes an appeals process, a prohibition of unilateral amendment of medical staff bylaws, and maintenance of direct communication from the medical staff executive committee to the governing body without an intermediary; and be it further

RESOLVED: That this matter be referred immediately for national action.

Resolution 618-03: Medical Staff Self-Governance

RESOLVED: That CMA communicate its support for the self-governance of the Medical Staff of the Community Hospital of San Buenaventura; and be it further

RESOLVED: That all CMA members be encouraged to contribute to CMA’s Legal Defense Fund; and be it further

RESOLVED: That CMA’s Legal Defense Fund be used to support the efforts to encourage enforcement of the laws requiring Medical Staff self-governance at the Community Hospital of San Buenaventura; and be it further

RESOLVED: That CMA urgently call upon AMA’s Litigation Center to provide funds and resources to assist the Medical Staff at Community Hospital of San Buenaventura in legal actions supporting Medical Staff self-governance and maintaining the autonomy and protection of the physicians and their leadership; and be it further

RESOLVED: That CMA should consider at an appropriate time, the filing of an amicus curiae brief in support of the autonomy of the Medical Staff at the Community Hospital of San Buenaventura; and be it further

RESOLVED: That CMA develop a more effective and aggressive educational program on Medical Staff self-governance for hospital and medical staff leaders; and be it further

RESOLVED: That CMA utilize the policies and actions discussed above when other Medical Staffs are faced with infringements of their right to self-governance.

Resolution 619-03: Renewal Of CALS Contract With The IMQ

RESOLVED: That the CMA strongly support the IMQ in the CALS process; and be it further

RESOLVED: That the CMA encourage the AMA OMSS to urge other state medical societies to adopt similar surveying of medical staffs by practicing physicians in their state.

Report F-1-03: Regulation Of Self-Compounded Medications

RECOMMENDATION 1: That Resolution 614-02 not be adopted.

Report F-2-03: CMA Model Medical Staff Bylaws Amendments

RECOMMENDATION 1: That CMA’s Model Medical Staff Bylaws Section 14.10 be amended as follows (additions underlined):

14.10 Retaliation Prohibited: Neither the medical staff, its members, committees or department heads, the governing body, its chief administrative officer, or any other employee or agent of the hospital or medical staff, may engage in any punitive or retaliatory action against any member of the medical staff because that member claims a right or privilege afforded by, or seeks implementation of any provision of, these medical staff bylaws.

RECOMMENDATION 2: That CMA’s Model Medical Staff Bylaws Section 5.6 be amended as follows:

5.6 (a) In the case of an emergency involving a particular patient, any member of the medical staff, to the degree permitted by the scope of the applicant’s license and regardless of department, staff status, or clinical privileges, shall be permitted to do everything reasonably possible to save the life of the patient or to save the patient from serious harm provided that the care provided is within the scope of the individual’s license. The member shall make every reasonable effort to communicate promptly with the department chair concerning the need for emergency care and assistance by members of the medical staff with appropriate clinical privileges, and once the emergency has passed or assistance has been made available, shall defer to the department chair with respect to further care of the patient at the hospital.

5.6 (b) In the event of an emergency under subsection (a), any person shall be permitted to do whatever is reasonably possible to save the life of a patient or to save a patient from serious harm. Such persons shall promptly yield such care to qualified members of the medical staff when it becomes reasonably available.

5.6 (c) Emergency privileges under subsection (a) shall not be used to force members to serve on emergency department call panels providing services for which they do not hold delineated clinical privileges.

5.6 (d) In the case of a disaster in which the emergency management plan has been activated and the hospital is unable to handle the immediate patient needs, the Chief of Staff, or in the absence of the Chief of Staff, the Vice-Chief of Staff, may grant emergency privileges. In the absence of the Chief of Staff and Vice-Chief of Staff and Department Chair(s), the Chief Executive Officer or the CEO’s designee of the Hospital may grant the privileges of this subsection. The grant of privileges under this subsection shall be on a case-by-case basis at the sole discretion of the individual authorized to grant such privileges.

5.6 (e) The verification process of the credentials and privileges of individuals who receive emergency privileges under this subsection shall be developed in advance of a disaster situation. This process shall begin as soon as the immediate disaster situation is under control, and shall meet the following requirements in order to fulfill important patient care needs:

(1) The medical staff identifies in writing the individual(s) responsible for granting emergency privileges.

(2) The medical staff describes in writing the responsibilities of the individual(s) responsible for granting emergency privileges.

(3) The medical staff describes in writing a mechanism to manage the activities of individuals who receive emergency privileges. There is a mechanism to allow staff to readily identify these individuals.

(4) The medical staff addresses the verification process as a high priority. The medical staff has a mechanism to ensure that the verification process of the credentials and privileges of individuals who receive emergency privileges begins as soon as the immediate situation is under control. This privileging process is identical to the process established under the medical staff bylaws for granting temporary privileges to fulfill an important patient care need.

(5) The chief executive officer or president of the medical staff or his or her designee(s) may grant emergency privileges upon presentation of any of the following:

(i) A current picture hospital ID card.

(ii) A current license to practice and a valid picture ID issued by a state, federal, or regulatory agency.

(iii) Identification indicating that the individual is a member of a Disaster Medical Assistance Team (DMAT).

(iv) Identification indicating that the individual has been granted authority to render patient care in emergency circumstances, such authority having been granted by a federal, state, or municipal entity.

(v) Presentation by current hospital or medical staff member(s) with personal knowledge regarding practitioner's identity.

Report F-3-03: Policy Review

RECOMMENDATION: THAT THE FOLLOWING POLICIES BE ALLOWED TO EXPIRE: Resolutions 720-85, 1036-85, 509-86 and 1022-89.

ACTION: Recommendation adopted