House of Delegates - Indiana State Medical Association

Transcription

Indiana State Medical
Association
160th Annual Meeting
2009 House of Delegates
First Session
Friday, September 25
6:30 p.m.
Second Session
Sunday, September 27
9:00 a.m.
Hyatt Regency Hotel, Downtown
Indianapolis, IN
First Session
ISMA
House of Delegates
September 25, 2009
6:30 p.m.
Thomas Vidic, M.D., Speaker of the House
John Wernert, M.D., Vice Speaker
John Knote, M.D., Parliamentarian
John Records, M.D., Credentials Coordinator
Gordon Hughes, M.D., Chief Teller
Alan Sidel, M.D., Assistant Teller
1.
CALL TO ORDER – Thomas Vidic, M.D., Speaker
2.
INVOCATION – Pastor John Myrland, McCordsville United
Methodist Church
3.
4.
PLEDGE OF ALLEGIANCE – Thomas Vidic, M.D., Speaker
a. The national anthem – Noel Outland, soloist
INTRODUCTION OF GUESTS
5.
KEYNOTE SPEAKER – Dr. Will Miller, humorist and Purdue University
professor
6.
PARLIAMENTARY PROCEDURES
7.
CREDENTIALING PROCEDURES
8.
DISPOSITION OF MINUTES
9.
PRESIDENT'S ADDRESS – David Welsh, M.D.
10.
ALLIANCE PRESIDENT'S ADDRESS – Hallie Gorup
11.
MEMBERSHIP RECRUITMENT CAMPAIGN – David Welsh, M.D.,
ISMA President
12.
REMARKS FROM AMPAC - John W. Poole, M.D.
AMPAC Board of Trustees
13.
APPOINTMENT OF REFERENCE COMMITTEES
14.
NEW BUSINESS -- LATE RESOLUTIONS
15.
CALL FOR NOMINATIONS OF ISMA OFFICERS
16.
CALL FOR NOMINATIONS - INDIANA DELEGATION TO THE
AMA
17.
REPORT OF ELECTIONS OF TRUSTEES AND ALTERNATE
TRUSTEES
18.
ANNOUNCEMENTS
19.
CALL FOR MOTION TO RECESS
2009 ISMA House of Delegates Official Call
Indianapolis
Allen County
Lake County
Vanderburgh County
St. Joseph County
Monroe/Owen Co
44 delegates
17 delegates
14 delegates
10 delegates
9 delegates
7 delegates
Delaware/Blackford, Tippecanoe and Vigo/Parke/Vermillion
counties
5 delegates each
Elkhart County
4 delegates
Bartholomew/Brown, Clark, Hamilton, Howard, LaPorte,
Madison, Porter and Wayne/Union counties
3 delegates each
Daviess/Martin, Dearborn/Ohio,
Fayette/Franklin, Floyd, Fountain/Warren, Grant,
Harrison/Crawford, Hendricks, Jasper/Newton,
Jefferson/Switzerland and Knox counties
2 delegates each
The remaining 50 county medical societies
1 delegate each
Trustees
Speaker and Vice Speaker
Past Presidents
18
2
30
Resident Medical Society
4
Medical Student Society
4
Young Physician Society
4
Total voting members of the house
278
Second Session
ISMA
House of Delegates
September 27, 2009
9 a.m.
Tom Vidic, M.D., Speaker of the House
John Wernert, M.D., Vice Speaker
John Knote, M.D., Parliamentarian
John Records, M.D., Credentials Coordinator
Gordon Hughes, M.D., Chief Teller
Alan Sidel, M.D., Assistant Teller
1.
CALL TO ORDER – Tom Vidic, M.D., Speaker
2.
IN MEMORIAM
3.
DETERMINATION OF QUORUM - John Records, M.D., Credentials Coordinator
4.
NOMINATION/ELECTION -
5.
INTRODUCTION OF GUESTS
6.
AMERICAN MEDICAL ASSOCIATION – J. James Rohack, M.D, President
7.
ANNOUNCEMENTS
8.
PHYSICIAN COMMUNITY SERVICE AWARD
9.
PATIENT HEALTH ADVOCATE AWARD
ISMA Officers
ISMA Delegation to the AMA
10. KATHLEEN GALBRAITH LEGACY LEADERSHIP AWARD
11.
ELECTION RESULTS
President-elect_____________________________________________
Speaker of the House_________________________________________________
Vice Speaker of the House__________________________________________
Treasurer________________________________________
Assistant Treasurer____________________________________
Delegates to the AMA
1)__________________________________________________
2)__________________________________________________
3)__________________________________________________
Alternate Delegates to the AMA
1)__________________________________________________
2)__________________________________________________
3)__________________________________________________
12. MEMBERSHIP RECRUITMENT CAMPAIGN – David Welsh, M.D., Immediate Past
President
13. SWEARING IN OF NEW OFFICERS
David Welsh, M.D., Immediate Past President
14. PRESIDENT'S ADDRESS
Fred Ridge, M.D., President
15. REPORTS OF REFERENCE COMMITTEES
Reference Committee I Chair: William Mohr, M.D.
Reference Committee II Chair: Agnes Bacala, M.D.
Reference Committee III Chair: Tom Felger, M.D.
Reference Committee IV Chair: Steven Rupert, D.O.
16. RESOLUTIONS OF APPRECIATION
Please make a copy available to the secretary
17. SITE FOR FUTURE ANNUAL MEETING
Hyatt Hotel, Downtown Indianapolis, Sept. 24-26, 2010
18. FINAL ANNOUNCEMENTS & ADJOURNMENT
INDIANA STATE MEDICAL ASSOCIATION
HOD PROTOCOL
Guidelines for Addressing House of Delegates
1.
2.
3.
Step to available microphone; wait for recognition from the Speaker of the
House.
Identify yourself by name and county; if necessary identify whom you
represent.
Speak to the issue on the floor; avoid unnecessary or repetitious
background information.
Guidelines for Amending a Resolution
To help facilitate the presentation of amendments during the second session of the
HOD:
1.
2.
3.
Please have your amendment typed for presentation. The ISMA Staff will be
happy to assist you.
Please provide one copy to the HOD Secretary, Rhonda Bennett, by 8 AM
Sunday.
Please also provide one copy to the Speaker of the House.
Both the Speaker and the Vice-Speaker of the HOD will be available throughout the
annual meeting if you wish to discuss possible resolution amendments with them.
Formal Resolutions of Appreciation
Please give a copy to the HOD Secretary before leaving the Session.
Consent Calendar Procedures
The Speaker and Vice Speaker of the House of Delegates have requested
reference committees to use a consent calendar as part of the reference committee
report. The following is an example of the format and wording to be used:
(Reports and resolutions will be listed in the categories below on the front page
of each reference committee report.)
Recommended for Filing
(List of Reports)
Recommended for Adoption
(List of Resolutions)
1
Recommended for Adoption as Amended or Substituted
Recommended for Referral to Board of Trustees
Recommended for Not Adoption
After providing a few moments for the delegates to review the list, the Speaker
will call for extractions from the consent calendar for debate. Delegates should
rise, approach the microphone and indicate which resolutions they wish
extracted from the list. Once the extractions are removed, the remainder of the
consent calendar will be adopted. Then the extracted items will be debated one
by one in the order in which they appear in the reference committee report.
Guidelines for Voting Response to Items Presented by Reference Committees:
1.
ADOPT
If Reference Committee recommends adoption of a resolution, a YES vote is to
accept the recommendation of the Reference Committee and will be for the
resolution as it was submitted.
2.
NOT ADOPT
If the Reference Committee recommends a NO vote, to not adopt the resolution,
the committee chair is instructed to state: "Mr. Speaker, your Reference
Committee recommends a NO vote."
The House will then vote on the original resolution.
3.
AMENDMENT BY REFERENCE COMMITTEE
If the Reference Committee recommends an amendment to the resolution, a YES
vote is to accept the resolution as amended by the Reference Committee. The
resolution, as amended by the Reference Committee, also may be amended from
the floor
2
4.
AMENDMENT DEFEATED
If the Reference Committee's amended resolution is defeated, the item before
the House is the original resolution, which will be discussed and voted on.
5.
AMENDMENT FROM THE FLOOR
A NEW amendment from the floor takes precedence for disposition; then the
House returns to original item for completion of disposition.
6.
SUBSTITUTE RESOLUTION
If the Reference Committee recommends a substitute resolution, a YES vote is
for adoption of the substitute resolution.
A substitute resolution may be needed when the changes to be made are so
substantial that an amendment is not practical. It takes the place of an entire,
original resolution. You are voting on the entire substitute resolution. If more
than one substitute resolution is being considered, they should be lettered in
sequences; i.e. Resolution (#) A, B, etc.
7.
COMBINING RESOLUTIONS
In cases where there is more than one resolution on the same subject, the
Reference Committee may decide to consolidate them into one resolution.
The Reference Committee would then recommend that the HOD "adopt this
resolution in lieu of Resolutions # and #."
8.
SUBSTITUTE RESOLUTION NOT ADOPTED
If the substitute resolution is not adopted, the item then before the House will be
the original resolution, which will be discussed and voted on.
9.
SUBSTITUTE RESOLVE
There is a distinct difference in the use of the words "substitute resolve" and
"substitute resolution." A substitute resolve takes the place of the original
resolve.
If the resolution has two or more resolves, it should be specified whether the
substitute resolve is replacing one, two or all of the resolves in the resolution.
3
10.
REPORT BE FILED
If the Reference Committee recommends that a report be filed, it is filed by order
of the Speaker without vote.
11.
CONSENT AGENDA
Routine matters may be placed on a consent agenda, also called a consent
calendar. This is a listing of matters that are expected to be non-controversial and
on which there are likely to be no questions. Before taking the vote, the Speaker
will allow time for the members to read the list to determine if there are matters
for which they have a question, or would like to discuss or oppose. Any delegate
may remove any item from the consent agenda to be considered and voted
separately. Remaining consent agenda items will be approved without
discussion.
12. VOTE TO REFER TO THE BOARD OF TRUSTEES
The 1988 House of Delegates established policy that all referrals from the House
of Delegates, or from Reference Committees to the House, are to be made
directly to the ISMA Board of Trustees (not an ISMA commission, committee or
sub-body) for appropriate action.
"Referred to the Board of Trustees for Study" means:
The Board will study the referred item of business and will report with its
findings and recommendations.
"Referred to the Board of Trustees for Action" means:
The Board will have the power of the House to act on the item of business
as it finds appropriate. It may amend, adopt, defeat, or refer the item of
business. Any action adopted by the Board may be implemented, and the
Board’s decision will be reported to the House.
The Speaker and Vice Speaker will monitor other protocols for conduct of the
House of Delegates with the assistance of the parliamentarian under the guidance
of the Bylaws of the Indiana State Medical Association.
4
2009 ISMA REFERENCE COMMITTEES
Saturday, September 26, 2009
REFERENCE COMMITTEE I
ISMA and AMA Matters and Constitution and Bylaws
8:00 a.m., Hyatt Regency Hotel, Cosmopolitan A
CHAIR: William Mohr, M.D..
Richard Miethke, M.D.
Vipul Brahmbhatt, M.D.
Robert Stone, M.D.
Bridget Sanders, M.D.
Brian Doggett, M.D., Alternate
District 11
District 4
District 3
District 2
District 7
District 11
________________________________________________________________________
REFERENCE COMMITTEE II
Legislative Issues
10:00 a.m., Hyatt Regency Hotel, Cosmopolitan CD
CHAIR: Agnes Bacala, M.D.
District 3
Shawn Swan, M.D.
District 11
Patrick Anderson, M.D.
District 6
Eric Kleeman, M.D.
District 1
Mercy Obeime, M.D.
District 7
Arun Gowdamarajan, M.D., Alternate
District 7
______________________________________________________________________________
REFERENCE COMMITTEE III
Socio-Economic and Regulatory Issues
11:00 a.m., Hyatt Regency Hotel, Regency EF
CHAIR: Tom Felger, M.D.
Teresa Lovins, M.D.
Theresa Rohr-Kirchgraber, M.D.
Bhanu Thaker, M.D.
Douglas Morrell, M.D.
Patrick Lottie, M.D., Alternate
District 13
District 4
District 7
District 3
District 6
District 7
REFERENCE COMMITTEE IV
Public Health Issues
9:00 a.m., Hyatt Regency Hotel, Cosmopolitan B
CHAIR: Steven Rupert, D.O.
Richard Rhodes, M.D.
Michael Tachman, M.D.
Pardeep Kumar, M.D.
Cindy Basinski, M.D.
Paul Wolfe, M.D., Alternate
District 1
District 7
District 13
District 5
District 1
District 11
Members of the 2009 ISMA House of Delegates
ADAMS COUNTY (1)
Hyung S. Lee, M.D.
Alternate:
Vacancy
DECATUR COUNTY (1)
Michael L. Whitworth, M.D.
Alternate:
Vacancy
BARTHOLOMEW/BROWN
COUNTY (3)
Teresa L. Lovins, M.D.
Richard P. Miethke, M.D.
David C. Rau, M.D.
Alternates:
Max A. Henry, M.D.
Eduardo G. Rivera, Jr., M.D.
Vacancy
DEKALB COUNTY (1)
Thomas P. Mason, M.D.
Alternate:
Mark S. Souder, M.D.
BENTON COUNTY (1)
Vacancy
Alternate:
Vacancy
BOONE COUNTY (1)
Paul R. Honan, M.D.
Alternate:
Vacancy
CARROLL COUNTY (1)
Brian L. Doggett, M.D.
Alternate:
Don J. Wagoner, M.D.
CASS COUNTY (1)
John L. Yarling, M.D.
Alternate:
Vacancy
CLARK COUNTY (3)
Agnes C. Bacala, M.D.
Giavonne D. Rondo-Hillman, M.D.
Richard M. Spalding, M.D.
Alternates:
Kevin R. Burke, M.D.
Vacancy
CLAY COUNTY (1)
Vacancy
Alternate:
S. Rahim Farid, M.D.
CLINTON COUNTY (1)
Tamera Vandegriff, M.D.
Alternate:
Stephen D. Tharp, M.D.
DAVIESS-MARTIN COUNTY (2)
Merlin K. Coulter, M.D.
Prasoon K. Samaddar, M.D.
Alternates:
Horace Norton, M.D.
Vacancy
DEARBORN-OHIO COUNTY (2)
Frank L. Frable, M.D.
Usman A. Siddiqui, M.D.
Alternates:
Arthur C. Jay, M.D.
Vacancy
DELAWARE/BLACKFORD
COUNTY (5)
Helen A. Borgenheimer, M.D.
Jan R. Kornilow, M.D.
Luke P. Philippsen, M.D.
Lori J. Skidmore, M.D.
Thomas S. Whiteman, M.D.
Alternates:
Roberto J. Darroca, M.D.
Gordon M. Hughes, M.D.
John V. Osborne, M.D.
Vacancy
DUBOIS COUNTY (1)
Dean E. Beckman, M.D.
Alternate:
Thomas H. Gootee, M.D.
ELKHART COUNTY (4)
Sam J. Borrelli, M.D.
William P. Buckley, M.D.
Fernando S. Escovar, M.D.
G. Beach Gattman, M.D.
Alternates:
James R. Van Curen II, M.D.
Vacancy
FAYETTE/FRANKLIN COUNTY (2)
Joanne K. Guttman, M.D.
Abou Mazdai, M.D.
Alternates:
Vacancy
FLOYD COUNTY (2)
Stephen M. Baldwin, M.D.
Stephen W. Nale, M.D.
Alternates:
Naveed M. Chowhan, M.D.
William H. Garner, III, M.D.
FORT WAYNE (ALLEN CO) (17)
Isa S. Canavati, M.D.
Fen Lei Chang, M.D.
William R. Clark, Jr., M.D.
Donald J. Giant, M.D.
Thomas E. Gutwein, M.D.
Thomas W. Herendeen, M.D.
Joseph S. Ladowski, M.D.
Deborah A. McMahan, M.D.
W. David Pepple, M.D.
William W. Pond, M.D.
Marvin E. Priddy, M.D.
Barbara M. Schroeder, M.D.
Todd A. Sidel, M.D.
David A. Sorg, M.D.
Phillip C. Wright, M.D.
William F. Young, M.D.
Alternates:
Sanjiv G. Aggarwal, M.D.
Terrell M. Bond, Jr., M.D.
Yalamanchali C. Chowdary, M.D.
John F. Csicsko, M.D.
Natalka Fedoriw, M.D.
B. Matthew Hicks, M.D.
Angela R. Karl, M.D.
Kevin L. Murphy, M.D.
Jeffrey R. Nickel, M.D.
Brenda S. O’Hara, M.D.
Mark A. Renshaw, M.D.
Alan W. Sidel, M.D.
Joel J. Valcarcel, M.D.
Robert E. Wilkins, M.D.
FOUNTAIN/WARREN COUNTY (2)
Max N. Hoffman, M.D.
Vacancy
Alternate:
William A. Ringer, M.D.
Vacancy
FULTON COUNTY (1)
Vacancy
Alternate:
Vacancy
GIBSON COUNTY (1)
William R. Wells, M.D.
Alternate:
M.S. Krishna, M.D.
GRANT COUNTY (2)
Shawn T. Swan, M.D.
Paul D. Wolfe, M.D.
Alternates:
William J. Granger, IV, M.D.
GREENE COUNTY (1)
Krista Lynn Sexton Cox, D.O.
Alternate:
Frederick R. Ridge, Jr., M.D.
HAMILTON COUNTY (3)
Lee M. Sredzinski, M.D.
Vacancy
Alternates:
Samuel R. Heiser, M.D.
William E. Wunder, Jr., M.D.
HANCOCK COUNTY (1)
Vacancy
Alternate:
Patsy D. Needham, M.D.
HARRISON/CRAWFORD CO (2)
William V. Johnson, M.D.
Reggie D. Lyell, M.D.
Alternates:
Michael G. Bonacum, D.O.
Bruce E. Burton, M.D.
HENDRICKS COUNTY (2)
Bruce C. Inman, M.D.
David W. Zauel, M.D.
Alternates:
Robert D. Glassman, M.D.
Vacancy
HENRY COUNTY (1)
John F. Miller, M.D.
Alternate:
Robert W. Stevenson, M.D.
HOWARD COUNTY (3)
Robert B. Dinn, M.D.
Keith E. Ennis, M.D.
Bruce W. Hughes, M.D.
Alternates:
Timothy L. Davis, M.D.
Vacancy
HUNTINGTON COUNTY (1)
Julie A. Utendorf, M.D.
Alternate:
Vacancy
INDIANAPOLIS (MARION CO) (44)
Linda F. Abels, M.D.
Valeria A. Ball, M.D.
Chris D. Bojrab, M.D.
Thomas A. Broadie, M.D.
Mary D. Bush, M.D.
G. Gregory Clark, M.D.
Carolyn A. Cunningham, M.D.
David R. Diaz, M.D.
Marc E. Duerden, M.D.
John C. Ellis, M.D.
Jonathan A. Fisch, M.D.
Robert S. Flint, II, M.D.
Richard K. Freeman, M.D.
Kristi K. George, M.D.
Bruce M. Goens, M.D.
Ted W. Grisell, M.D.
Douglass S. Hale, M.D.
David C. Hall, M.D.
Ronda A Hamaker, M.D.
C. William Hanke, M.D.
Hudner L. Hobbs, M.D.
Robert M. Hurwitz, M.D.
Paul D. Isenberg, M.D.
Marc R. Kappelman, M.D.
Gerald T. Keener, Jr., M.D.
Alan P. Ladd, M.D.
Daniel E. Lehman, M.D.
James F. Leland, M.D.
Frank P. Lloyd, Jr., M.D.
Keith W. Logie, M.D.
Susan K. Maisel, M.D.
Mary Ian McAteer, M.D.
Clement J. McDonald, III, M.D.
John P. McGoff, M.D.
Thomas E. McSoley, M.D.
James D. Miner, M.D.
David H. Moore, M.D.
Maria C. Poor, M.D.
Richard H. Rhodes, M.D.
John F. Schaefer, M.D.
Kenny E Stall, M.D.
Donald C. Stogsdill, M.D.
Tim E. Taber, M.D.
John J. Wernert, M.D.
Alternates:
F. Keith Bean, M.D.
Keenan R. Berghoff, M.D.
Benjamin J. Copeland, M.D.
Woodrow A. Corey, M.D.
John H. Ditslear, M.D.
Christopher B. Doehring, M.D.
Stephen R. Dunlop, M.D.
Thomas G. Ferry, M.D.
Leanne M. Fortner, M.D.
Sheila M. Gamache, M.D.
Robert J. Goulet, Jr., M.D.
Charlene E. Graves, M.D.
Ann Marie Hake, M.D.
Andrea L. Haller, M.D.
Mark M. Hamilton, M.D.
Paul K. Haynes, M.D.
Robert E. Holt, M.D.
Douglas J. Horton, M.D.
Andrew A. Johnstone, M.D.
RoseMarie Jones, M.D.
Martin Kaefer, M.D.
E. Michael Keating, M.D.
Jeffrey J. Kellams, M.D.
David J. Kenley, M.D.
Terry L. Layman, M.D.
Anthony W. Mimms, M.D.
Ramana S. Moorthy, M.D.
Michelle W. Murphy, M.D.
Mercy O. Obeime, M.D.
Robert M. Pearce, M.D.
David M. Ratzman, M.D.
Jeffrey M. Rothenberg, M.D.
Rudolph Y. Rouhana, M.D.
Bridget M. Sanders, M.D.
David J. Scruby, M.D.
Kimberly K. Short, M.D.
Lynda R. Smirz, M.D.
Steven R. Smith, M.D.
H. Jeffery Whitaker, M.D.
Allison E. Williams, M.D.
Louis J. Winternheimer, M.D.
Ronald L. Young, II, M.D.
JACKSON COUNTY (1)
Daniel A. Walters, M.D.
Alternate:
Vacancy
JASPER-NEWTON COUNTY (2)
Ramesh S. Gaud, M.D.
James G. Wakefield, III, M.D.
Alternates:
Kenneth J. Ahler, M.D.
Malik V. Chaganti, M.D.
JAY COUNTY (1)
Vacancy
Alternate:
Herman Burgermeister, M.D.
JEFFERSON-SWITZERLAND
COUNTY (2)
Marc B. Willage, M.D.
Vacancy
Alternates:
Howard C. Jackson, M.D.
Vacancy
JENNINGS COUNTY (1)
Thomas Barley, M.D.
Alternate:
Gregory K. Heumann, M.D.
JOHNSON COUNTY (1)
John M. Records, M.D.
Alternate:
Vacancy
KNOX COUNTY (2)
James A. Koontz, M.D.
Alternate:
Ralph W. Stewart, M.D.
KOSCIUSKO COUNTY (1)
Paul T. Haney, M.D.
Alternate:
Vacancy
LAGRANGE COUNTY (1)
Rhonda L. Sharp, M.D.
Alternate:
Shashank Kashyap, M.D.
LAKE COUNTY (14)
Clarence W. Boone, M.D.
Ilwoong Chang, M.D.
Vijay B. Dave, M.D.
Heratch O. Doumanian, M.D.
Sandra L. Gadson, M.D.
John A. Griep, M.D.
Henry A. Hadidian, M.D.
Panayotis G. Iatridis, M.D.
Ramesh P. Kanuru, M.D.
Promila Mehta-Paul, M.D.
Krishnakant S. Raiker, M.D.
M. Nabil Shabeeb, M.D.
Steve Simpson, M.D.
Mary F. Vanko, M.D.
Alternates:
Charles O. Davison, M.D.
Don M. Henry, M.D.
Muhammad M. Kudaimi, M.D.
William J. Pierce, M.D.
Vacancy
LAPORTE COUNTY (3)
Joseph Arulandu, M.D.
Charles W. Tattersall, M.D.
Eric P. Wohlrab, M.D.
Alternates:
James T. Cornwell, M.D.
Algimantas J. Galinis, M.D.
Richard J. Gnaedinger, M.D.
LAWRENCE COUNTY (1)
Alan F. Smith, Jr., M.D.
Alternate:
James M. Jacobi, M.D.
MADISON COUNTY (3)
Margo J. Carrancejie, M.D.
Mark E. Seib, M.D.
Vacancy
Alternates:
Timothy L. Hobbs, M.D.
Donald W. Reed, M.D.
Vacancy
MARSHALL COUNTY (1)
Michael F. Deery, M.D.
Alternate:
Rod S. Kubley, M.D.
MIAMI COUNTY (1)
Vacancy
Alternate:
Gregory A. Quin, M.D.
PUTNAM COUNTY (1)
Vacancy
Alternate:
Vacancy
MONROE/OWEN COUNTY (7)
Diana Ebling, M.D.
James V. Faris, M.D.
Lisa J. Jerrells, M.D.
Caitilin Kelly, M.D.
Todd R. Rowland, M.D.
Robert C. Stone, M.D.
B. Diane Wells, M.D.
Alternates:
Kent A. Beams, M.D.
Brian W. Cook, M.D.
Robert D. Lodge-Rigal, M.D.
Karen Reid-Renner, M.D.
Thomas W. Sharp, M.D.
James N. Topolgus, Jr., M.D.
Andrew K. Watters, M.D.
RANDOLPH COUNTY (1)
Daniel L. Wegg, M.D.
Alternate:
Vacancy
MONTGOMERY COUNTY (1)
Timothy N. Brown, M.D.
Alternate:
Vacancy
MORGAN COUNTY (1)
Olaf B. Johansen, M.D.
Alternate:
Vacancy
NOBLE COUNTY (1)
Joseph A. Greenlee, Jr., M.D.
Alternate:
Vacancy
ORANGE COUNTY (1)
Vacancy
Alternate:
Vacancy
PERRY COUNTY (1)
Robert A. Ward, M.D.
Alternate:
Vacancy
PIKE COUNTY (1)
Gary J. Keepes, M.D.
Alternate:
Vacancy
PORTER COUNTY (3)
Patrick D. Fleming, M.D.
Michael J. Keenan, M.D.
Kannan Manickam, M.D.
Alternates:
Stephen H. Paul, M.D.
Vacancy
POSEY COUNTY (1)
Gordon Vogel, M.D.
Alternate:
Vacancy
PULASKI COUNTY (1)
Vacancy
Alternate:
Vacancy
RIPLEY COUNTY (1)
David J. Welsh, M.D.
Alternate:
Vacancy
RUSH COUNTY (1)
Alternate:
Vacancy
ST JOSEPH COUNTY (9)
Kathryn M. Cox Cohoon, M.D.
Kathleen M. Delnay, M.D.
Thomas A. Felger, M.D.
Harriet A. Hamer, M.D.
Debra R. McClain, M.D.
Donald W. Smith, M.D.
Robert M. Sweeney, M.D.
Michael L. Tachman, M.D.
Barbara L. Williams, M.D.
Alternates:
Natali M. Balog, M.D.
A. Philip DePauw, M.D.
Frances D. Dwyer, M.D.
George A. Horvath, M.D.
Michael L. Tachman, M.D.
Vacancy
SCOTT COUNTY (1)
Deepak G. Azad, M.D.
Alternate:
Shane A. Avery, M.D.
TIPPECANOE COUNTY (5)
Keven W. Dodt, M.D.
Andrew K. Edwards, M.D.
John M. Gorup, M.D.
Peter J. Hillsamer, M.D.
Gordon D. Welk, M.D.
Alternates:
Irene M. Gordon, M.D.
Edward L. Langston, M.D.
Vacancy
TIPTON COUNTY (1)
Vacant
Alternate:
Vincent Delumpa, M.D.
VANDERBURGH COUNTY (10)
Daniel S. Brown, M.D.
Maria G. Del Rio, M.D.
Michael R. Hodges, M.D.
John D. Pulcini, M.D.
Todd D. Renschler, M.D.
Steven A. Rupert, D.O.
Daniel R. Shirey, M.D.
Richard A. Tibbals, M.D.
Kim A. Volz, M.D.
Stacie Wenk, D.O.
Alternates:
Steven C. Basinski, M.D.
Steven C. Basinski, MD.
John W. Beman, M.D.
Doron H. Finn, M.D.
William R. Penland, M.D.
Paul E. Perry, M.D.
Herman F. Rusche, M.D.
James D. Spiller, M.D.
Santi Vibul, M.D.
Mona F. Wooten, M.D.
SPENCER COUNTY (1)
Stanley J. Tretter, M.D.
Alternate:
Vacancy
VIGO-PARKE-VERMILLION
COUNTY (5)
Susan S. Amos, M.D.
Robert Burkle, M.D.
Fred Drake, M.D.
Roland A. Grieg, M.D.
Victoria Potoczak, M.D.
Alternates:
Betty J. Campbell, M.D.
Robert J. Chloupek, M.D.
Robert S. Hojnicki, D.O.
J. Frank Swaim, M.D.
Robert R. Taube, M.D.
STARKE COUNTY (1)
Walter Fritz, M.D.
Alternate:
Theresa M. Alexander, M.D.
WABASH COUNTY (1)
James Haughn, M.D.
Alternate:
Vacancy
STEUBEN COUNTY (1)
Vacancy
Alternate:
Berry L. Miller, M.D.
WARRICK COUNTY (1)
Vacancy
Alternate:
Syed Ali, M.D.
SULLIVAN COUNTY (1)
E. Steve DuPre, M.D.
Alternate:
Gene A. Bourgasser, M.D.
WASHINGTON COUNTY (1)
Vacancy
Alternate:
Vacancy
SHELBY COUNTY (1)
Scott R. Miller, M.D.
Alternate:
James L. Peters, M.D.
WAYNE-UNION COUNTY (3)
Patrick R. Anderson, M.D.
David L. Jetmore, M.D.
Windel A. Stracener, M.D.
Alternates:
Vacancy
WELLS COUNTY (1)
Eric P. Purdy, M.D.
Alternate:
Vacancy
WHITE COUNTY (1)
Rene S. Gutierrez, M.D.
Alternate:
Vacancy
WHITLEY COUNTY (1)
Lisa A. Hatcher, M.D.
Alternate:
Richard S. Dickmeyer, M.D.
RESIDENT/FELLOW MEDICAL
SOCIETY (4)
Vacancy
Alternates:
Vacancy
YOUNG PHYSICIAN SOCIETY (4)
Michael C. Sha, M.D.
Dung Nguyen, M.D.
Vacancy
Alternates:
Vacancy
MEDICAL STUDENT SOCIETY (4)
Mark Baker
Adam Haste
Jennifer N. Stall
Sara R. Till
Vacancy
Alternates:
Geoff Aaron
TRUSTEES (18)
FIRST DISTRICT
William R. Penland, M.D.
Alternate:
Syed A. Ali, M.D.
SECOND DISTRICT
James A. Koontz, M.D.
Alternate:
Robert Charles Stone, M.D.
THIRD DISTRICT
Eli Hallal, M.D.
Alternate:
Agnes C. Bacala, M.D.
FOURTH DISTRICT
Thomas A. Barley, M.D.
Alternate:
FIFTH DISTRICT
Chandra G. Reddy, M.D.
Alternate:
Pardeep Kumar, M.D.
SIXTH DISTRICT
James R. Lewis, M.D.
Alternate:
SEVENTH DISTRICT
Heidi M. Dunniway, M.D.
Richard Feldman, M.D.
A. Michael Sadove, M.D.
Alternates:
G. Joseph Herr, M.D.
Bruce C. Inman, M.D.
Vicki M. Roe, M.D.
EIGHTH DISTRICT
Gordon Hughes, M.D.
Alternate:
Thomas S. Whiteman, M.D.
NINTH DISTRICT
Melany S. Rookstool, M.D.
Alternate:
Vincent B. Delumpa, M.D.
TENTH DISTRICT
Vijay B. Dave, M.D.
Alternate:
Michael J. Keenan, M.D.
ELEVENTH DISTRICT
Shawn Swan, M.D.
Alternate:
Paul D. Wolfe, M.D.
TWELFTH DISTRICT
Rhonda L. Sharp, M.D.
Alternate:
Alan W. Sidel, M.D.
THIRTEENTH DISTRICT
Brent W. Mohr, M.D.
Alternate:
Kathleen M. Delnay, M.D.
RESIDENT/FELLOW MEDICAL
SOCIETY
Mary S. Baker, M.D.
Alternate:
Vacancy
MEDICAL STUDENT SOCIETY
Adam Haste
Alternate:
Paul Haste
YOUNG PHYSICIAN SOCIETY
Michael C. Sha, M.D.
Alternate:
Andrew T. Trobridge, M.D.
ISMA PAST PRESIDENTS (30)
Lowell H. Steen, M.D.
Peter R. Petrich, M.D.
Joseph E. Dukes, M.D.
Vincent J. Santare, M.D.
Alvin J. Haley, M.D.
John A. Knote, M.D.
George T. Lukemeyer M.D.
Lawrence E. Allen, M.D.
Shirley T. Khalouf, M.D.
John D. MacDougall, M.D.
Fred W. Dahling, M.D.
George H. Rawls, M.D.
Michael O. Mellinger, M.D.
C. Dyke Egnatz, M.D.
William H. Beeson, M.D.
William C. VanNess II, M.D.
William E. Cooper, M.D.
Jerome E. Melchior, M.D.
Alfred C. Cox, M.D.
Peter L. Winters, M.D.
Barney R. Maynard, M.D.
Bernard J. Emkes, M.D.
Stephen D. Tharp, M.D.
Edward L. Probst, M.D.
Michael B. Hoover, M.D.
Ronald K. Downs, M.D.
William H. Mohr, M.D.
Kevin R. Burke M.D.
Vidya Kora, M.D.
Jon D. Marhenke, M.D.
SPEAKER (1)
Thomas R. Vidic, M.D.
VICE SPEAKER (1)
John J. Wernert, M.D.
IN MEMORIAM
Titu Aron, M.D., East Chicago
William F. Boeckmann, M.D., Fort Wayne
Ralph O. Bosch, M.D., Indianapolis
C. Richard Bowers, M.D., Sarasota, FL
Richard J. Brown, M.D., Kokomo
E. Jane Brownley, M.D., Greenwood
David L. Buckles, M.D., Gaston
Edward R. Bush, M.D., Anderson
Joseph C. Butterworth, M.D., Carmel
William D. Carter, M.D., Auburn
Johnson C. Chu, M.D., Monticello
Dean L. Cook, M.D., Elkhart
H. Joseph Cronin, M.D., Indianapolis
Margaret M. Davis, M.D., Indianapolis
Phillip R. Dawkins, M.D., Jasper
Luiz P. De Melo, M.D., Crown Point
Gerald M. DeWester, M.D., Indianapolis
John P. Donohue, M.D., Melbourne Beach, FL
Paul A. Eiler, M.D., North Manchester
Burnell Fischer, M.D., Bloomington
Juan C. Garcia, M.D., South Bend
Norman D. Gardner, M.D., Indianapolis
Bradford R. Hale, M.D., Indianapolis
Jay W. Hammer, M.D., Bloomington
Jack W. Hannah, M.D., Elkhart
Joseph H. Haseman, III, M.D., Evansville
A. Lyle Havens, M.D., Jeffersonville
James K. Hwang, M.D., Greenfield
Rashidul Islam, M.D., New Salisbury
Eugene T. Karnafel, M.D., South Bend
Robert S. Kepner, M.D., Oxford, OH
Robert C. Keyes, M.D., Fort Wayne
Ronald G. Kleopfer, M.D., Cody, WY
Willard S. Krabill, M.D., Goshen
Robert H. Leak, M.D., Ambia
Edward C. Lidikay, M.D., Indianapolis
James R. Mackenzie, M.D., Indianapolis
Robert L. Marske, M.D., Carmel
Noel J. Martin, M.D., Boonville
Charles R. Mather, M.D., West Lafayette
Glenn B. Mather,M.D., Bloomington
A. D. McKinley, M.D., Indianapolis
Alfred M. Mintz, M.D., Bradenton, FL
Fred G. Osborn, M.D., Cicero
Harry B. Parmenter, M.D., Vincennes
Peter R. Petrich, M.D., Indianapolis
Warren C. Polhemus, M.D., Lake City, FL
Frederic A. Rice, M.D., Indianapolis
Robert E. Rose, M.D., Wayne, PA
Wallace A. Scea, M.D., Muncie
William C Schafer, M.D., Washington
Francis M. Sellers, M.D., South Bend
William H. Shriber, M.D., South Bend
Paul Siebenmorgen, M.D., Terre Haute
Joseph L. Steinem, M.D., Connersville
Don A. Strehler, M.D., Pullman, WA
William J. Tierney, M.D., Anderson
Thomas E. Topper, M.D., Evansville
Joseph J. Tyrrell, M.D., Schererville
Edwin M. Walker, M.D., Bloomington
John H. Warvel, M.D., Indianapolis
Gilbert M. Wilhelmus, M.D., Newburgh
Fred Madison Wilson, M.D., Winter Haven, FL
Robert B. Yuhn, M.D., Elkhart
2008-2009 TRUSTEES
District
1
2
3
4
5
6
7
7
7
8
9
10
11
12
13
YPS
RFS
MSS
1
2
3
4
5
6
7
7
7
8
9
10
11
12
13
YPS
RFS
MSS
Trustees
William Penland, M.D., Evansville
James Koontz, M.D., Vincennes
Eli Hallal, M.D., New Albany
Tom Barley, M.D., North Vernon
Chandra Reddy, M.D., Terre Haute
James Lewis, M.D., Richmond
Richard Feldman, M.D., Indianapolis
Heidi Dunniway, M.D., Indianapolis
A. Michael Sadove, M.D., Indianapolis
Gordon Hughes, M.D., Muncie
Melany Rookstool, M.D., Noblesville
Vijay Davé, M.D., Munster
Shawn Swan, M.D., Marion
Rhonda Sharp, M.D., Lagrange
Brent Mohr, M.D., South Bend
Michael Sha, M.D., Indianapolis
Vacant
Jennifer Stall, Indianapolis
Alternate Trustees
Syed Ali, M.D., Boonville
Robert Stone, M.D., Vincennes
Partial
Term
04-07
04-05
05-06
02-04
05-06
02-04
05-06
05-07
00-03
08-09
06-07
06-09
08-11
06-09
05-08
06-09
04-07
08-11
06-09
04-07
08-09
08-09
08-09
06-09
07-10
07-10
03-06
08-11
07-10
07-10
06-09
07-10
08-09
Bruce Inman, M.D., Indianapolis
Vicki Roe, M.D., Indianapolis
Thomas Whiteman, M.D., Muncie
Vincent Delumpa, M.D., Tipton
Michael Keenan, M.D., Valparaiso
Paul Wolfe, M.D., Marion
Alan Sidel, M.D., Ft. Wayne
Kathleen Delnay, M.D., South Bend
Vacant
Vacant
Adam Haste, Argos
2nd
Term
07-10
Agnes Bacala, M.D., Jeffersonville
Marc Willage, M.D., Vevay
Pardeep Kumar, M.D., Terre Haute
Douglas Morrell, M.D., Rushville
*G. Joseph Herr, M.D., Danville
1st
Term
07-10
08-11
03-06
07-10
08-11
06-09
07-10
08-11
06-09
08-11
06-09
08-10
05-07
07-09
07-10
08-09
08-09
08-09
9/22/08
*Due to the vice speaker election of John Wernert, M.D. (then 7th district alternate
trustee), Dr. Herr (then 7th district president) filled the vacancy until an election is held at the 2009
district meeting.
2008-2009 ALTERNATE TRUSTEES
1 Syed Ali, M.D.
FAX (812) 897-5977
[email protected]
2 Robert C. Stone, M.D.
FAX (812) 886-6809
[email protected]
OFFICE ADDRESS
1301 Millis Avenue
Boonville 47601
(812) 897-4458
HOME ADDRESS
5699 Sherwood Court
Newburgh 47630
(812) 853-5699
1157 West Third Street
Bloomington, IN 47404
(812) 333-2731
3001 East Bethel Lane
Bloomington, IN 47408
(812) 333-8085
(Send mail to home)
3 Agnes Bacala, M.D.
FAX (812) 280-6627
2051 Clevidence Blvd.
Clarksville 47129
(812) 280-9145
[email protected]
2200 Utica Pike, Unit 2
Jeffersonville 47130
(812) 284-5421
4 Marc Willage, M.D.
FAX (812) 427-9056
[email protected]
213 Main Street
P.O. Box 82
Vevay 47043
(812) 427-2911
305 Quail Ridge Lane
Madison 47250
(812) 273-2633
5 Pardeep Kumar, M.D.
FAX (812) 238-0960
420 East Hospital Lane
Terre Haute 47802
(812) 238-0958
225 Southridge Road
Terre Haute 47802
(812) 299-5171
[email protected]
6 Douglas Morrell, M.D. 606 East 11th Street
FAX (765) 932-4859
Rushville 46173
(765) 932-2965
[email protected]
1432 North Ft. Wayne Road
Rushville 46173
(765) 932-4511
7 G. Joseph Herr, M.D.
FAX (317) 718-4733
[email protected]
100 Hospital Lane, #225
Medical Office Building 3
Danville 46122
(317) 718-4730
708 Masten Street
Plainfield 46168
(317) 839-9309
7 Vicki Roe, M.D.
FAX (317) 621-9190
[email protected]
(Send mail to home)
8101 Clearvista Pkway, #185
Indianapolis 46256
(317) 621-9000
8524 Scenic View Dr., #201
Fishers 46038
(317) 576-0960
7 Bruce Inman, M.D.
FAX (317) 272-7507
[email protected]
8244 E US Hwy 36, Ste. 1210
Avon 46123
(317) 272-8272
5566 Bay Landing Circle
Indianapolis, IN 46254
(317) 290-1038
8 Thomas Whiteman, M.D. 2525 W. University Ave., #501
FAX (765) 288-1292
Muncie 47303
[email protected]
(765) 284-2172
4300 Freeman Lane
9 Vincent Delumpa, M.D. 401 Fairgrounds Road
FAX (765) 675-8472
Tipton 46072
[email protected] (765) 675-3872
(Send mail to home)
14705 Victory Court
Carmel 46032
(765) 675-6380
10 Michael Keenan, M.D. 2802 Leonard Drive
FAX (219) 548-2519
Valparaiso 46383
[email protected] (219) 531-2855
2206 Shadowood Court
Valparaiso 46383
(219) 531-2967
11 Paul Wolfe, M.D.
FAX (765) 651-6639
706 North River Drive
Marion 46952
(765) 651-6637
2545 North Huntingon Road
Marion 46952
(765) 662-0952
12 Alan Sidel, M.D.
FAX (260) 482-9012
5110 N. Clinton, Suite 7
Fort Wayne 46825
(260) 484-8545
63099 Popp Road
Fort Wayne 46845
(260) 482-7051
[email protected]
13 Kathleen Delnay, M.D. 707 East Cedar Street, Ste. 450
FAX (574) 282-1739
South Bend 46617
(574) 234-4100
Andrew Trobridge, M.D. 2401 West Unversity Avenue
FAX
Muncie 47303
[email protected]
(765) 747-3111
(Send mail to home)
Muncie 47304
(765) 282-4672
4143 Spring Hill Court
South Bend 46628
13909 Waterway Blvd.
Fortville 46040
(317) 876-7973
RESIDENT AND FELLOW SOCIETY
Vacancy
Adam Haste
[email protected]
Updated 9/08
359 North West Street, #480
Indianapolis, IN 46202
2008 RESOLUTION STATUS
RESOLUTION 08-01
ISMA SUPPORT OF DEAN’S SCHOLARSHIP PROGRAM
Introduced by: Frank Frable, M.D.
Action: Adopted as amended
First Resolved Referred to ISMA Administration Department
Second Resolved implemented by inclusion in future ISMA Reports
RESOLVED, that the ISMA include on its yearly dues form an appropriate space for ISMA
members to make donations to be applied to the IU Dean’s Scholarship Fund; and be it
further
RESOLVED, that the ISMA take a proactive stance and provide positive support for the IU
School of Medicine Dean’s Scholarship Fund.
STATUS:
An article encouraging support of the Dean’s Scholarship Fund appeared in the
Dec. 15, 2008 ISMA Reports. The Communications staff prepared a fund-raising appeal letter
which was to be sent to ISMA members in February requesting them to commit funds to the
program. Unfortunately, due to state budget cuts, the Dean’s Scholarship Fund matching
program was discontinued on January 9.
RESOLUTION 08-03
REQUIRING VITAMIN D FOR NURSING HOME PATIENTS
Introduced by: Stacie Wenk, D.O.
Referred to ISMA Communications Department
RESOLVED, that the ISMA encourage nursing home patients to receive a minimum of 1000
units of vitamin D every day and educate physicians and nursing home personnel
appropriately.
STATUS:
ISMA sent a letter and an informational insert on vitamin D to every nursing
home in Indiana. An article will appear in the Jan. 19 issue of ISMA Reports. The information
has been placed in the ISMA Resource section under ―Patient Handouts‖ on the Web site and
may be downloaded by physicians or patients.
RESOLUTION 08-06A
METHADONE REPORTING
Introduced by: Michael L. Whitworth, M.D.
First Resolved Referred to Commission on Legislation
Second Resolved Referred to AMA Delegation
RESOLVED, that the ISMA support legislation that requires methadone clinics to check their
databases against INSPECT to ensure no simultaneous treatment of their patients by other
physicians; and be it further
RESOLVED, that the ISMA work with our AMA delegation to change the federal statute to
allow states the flexibility to require methadone clinics to report to programs like INSPECT.
STATUS:
First resolve: No bills have been filed regarding this resolved.
Second resolve: The AMA delegation introduced Resolution 510 at the AMA Annual
Meeting in June. The resolution was referred to the AMA Board of Trustees, and the
discussion at the reference committee on this issue follows:
Several relevant points were raised during testimony including the fact that most
prescription monitoring programs (PMPs) developed to date retain the capacity for law
enforcement queries about the behaviors of both physicians and patients. This overriding
concern was addressed by many speakers. In addition, the following points were raised: (1)
State-based PMPs are a potentially valuable decision support tool for physicians who are
considering prescribing controlled substances for their patients; (2) Methadone-based opioid
treatment programs are not required to report to existing PMPs, and it would be helpful to
verify that such patients are not also obtaining opioid prescriptions from other sources; (3)
Privacy and confidentiality issues remain a concern with the operation of PMPs, in general,
and methadone maintenance programs in particular; 4) Virtually no PMPs have the capacity
for real time queries from physicians about specific patients, or are interoperable among
states; and (5) PMPs should be designed and based on a public health, not law enforcement,
approach. Accordingly, several speakers supported referral of this resolution.
RESOLUTION 08-07
OVERDOSE REPORTING
Introduced by: Michael L. Whitworth, M.D.
Action: Referred to the Board of Trustees for study
Referred from the Board to the ISMA Government Relations Department
RESOLVED, that the ISMA support legislatively mandated reporting by the admitting or
attending physician or the hospital or emergency/urgent care center to the physician thought
to be prescribing drugs that may have been a factor in a patient overdose.
STATUS:
The Board discussed this issue at its November 2 meeting and felt the education
of our members, through ISMA Reports, would be more beneficial than legislatively
mandating the reporting. INSPECT (Indiana’s Prescription Drug Monitoring Program) was
also mentioned as a tool available to physicians to assist when researching patient overdoses.
It was also suggested that ISMA convey to the Indiana Hospital Association and the Indiana
Pharmacists Alliance the intent of the resolution.
This resolution was discussed during a meeting between the Indiana Hospital Association
and the ISMA leadership. Both parties felt that it was reasonable to not vary from current
practices regarding this issue.
RESOLUTION 08-08A
ESTABLISHING GUN CRIME AS A PUBLIC HEALTH PROBLEM
Introduced by: Stephen Dunlop, M.D., and the ISMA Family Violence Committee
Action: Action was taken on each RESOLVED statement.
First Resolved implemented by inclusion in the Public Policy Manual
Second Resolved (First Bullet) Referred from the Board to the ISMA Legal Department
Second Resolved (Second Bullet) implemented by inclusion in the Public Policy Manual
Second Resolved (Third Bullet) Referred from the Board to the ISMA Legal Department
Third Resolved implemented by inclusion in the Public Policy Manual
RESOLVED, that the ISMA establish policy recognizing that criminal firearm violence is a major
public health problem. Adopted.
And be it further
RESOLVED, that the ISMA support legislation that would:
Require that all firearm sales pass federally mandated screens for firearm sales.
Referred to the Board of Trustees for study.
Improve the reporting of felony convictions and mental health commitments to the
federal database Adopted.
Allow cities to impose different rules for carrying concealed weapons in vehicles and on
persons. Referred to the Board for study.
And be it further,
RESOLVED, that the ISMA oppose legislation that prevents schools, hospitals and businesses from
restricting the presence of firearms on their property. Adopted.
STATUS:
First Bullet – The Board discussed this at its November and May meetings. This
addresses a perceived "gap" created by private gun sales, including at gun shows. ISMA already
has policy 04-40 stating ―Resolved, that the ISMA support legislation to curtail the flow of weapons
for use in criminal activity by requiring the sale of guns at gun shows to meet the same background
check requirements as sales by licensed gun dealers.‖ Thus, no further action is necessary. At least
17 states have various versions of laws requiring background checks for gun shows. In speaking to
a few of those states, there is no apparent data available evidencing the impact of these laws. No
legislation has been introduced at the state level. Legislation is introduced nearly every year at the
federal level on this issue, without success. On April 21, 2009, S.843 was introduced by Sen.
Lautenberg (D-NJ) and is pending.
Third Bullet – The Board received information that State law greatly restricts city
governments from enacting local gun laws. However, cities do have the authority to regulate
guns on city property and local laws enacted prior to 1994 remain in force. SB0012 was
introduced in the 2009 Indiana legislative session to prohibit a state college or university
from regulating in any manner the ownership, possession, carrying, or transportation of
firearms or ammunition. The bill did not make it out of committee. After discussion, the
Board expressed concerns that this is an individual issue and that there is not enough
information available to take a position at this time. They recommended ISMA staff continue
to monitor the issue.
RESOLUTION 08-08B
ESTABLISHING GUN CRIME AS A PUBLIC HEALTH PROBLEM
First and Second Resolves implemented by inclusion in the Public Policy Manual
RESOLVED, that the ISMA support legislation to require the Indiana State Department of Health to
provide an annual report on criminal firearm violence in Indiana, including the number, age, race,
gender and zip code of victims, circumstances of the incident, type of weapon, and whether the
weapon was legally owned by the user and, if not, how it was obtained; and be it further
RESOLVED, that the ISMA support legislation to change the reporting of deaths by coroners and
police to include data on the type and source of firearms involved in injuries and deaths.
STATUS:
There were no bills regarding this resolution.
RESOLUTION 08-09
REDUCING GUN SUICIDE
First, Second, and Third Resolves implemented by inclusion in the Public Policy Manual
RESOLVED, that the ISMA support legislation to require that a statement be provided with the sale
of each firearm about the increased risk of suicide associated with bringing a firearm into a home
and how that risk can be reduced with safe storage; and be it further
RESOLVED, that the ISMA support efforts with non-profit organizations for a public awareness
campaign on the risk of suicide associated with firearm ownership; and be it further
RESOLVED, that the ISMA support legislation requiring the Indiana State Department of Health to
prepare and publish an annual report on suicide in Indiana based on available data collected by
coroners that would include:
The means used
Gender, age, race and county of residence of the victim
Any use of firearms in a suicide
Whether or not the victim owned the firearm
How the firearm was stored and obtained.
STATUS:
RESOLUTION 08-10
ROUTINE HIV TESTING DURING PREGNANCY
Introduced by: David Welsh, M.D.
Action: Adopted
Reaffirmation of existing policy -implemented by inclusion in the Public Policy Manual
RESOLVED, that the ISMA endorse and support HIV testing as a part of routine testing
during the first trimester of pregnancy; and be it further
RESOLVED, that the ISMA support the concept that all pregnant mothers be given material
about and counseling for HIV disease. (2nd Resolve passed 2003, HB 1630)
RESOLUTION 08-11
HMO LIABILITY FOR MALPRACTICE
Action: Adopted
RESOLVED, that the ISMA seek legislation to place liability for medical malpractice on an
HMO that makes a determination of medical necessity contrary to a recommendation of a
patient’s physician that falls within normal standards of medical practice and includes
contractually covered medical services.
STATUS: This policy was considered by the COL and did not receive enough support to
have it considered as part of the legislative agenda for 2009.
RESOLUTION 08-12
MEDICAL DIRECTOR LIABILITY
Action: Adopted
RESOLVED, that the ISMA undertake legislative and regulatory measures necessary to
require that medical directors of insurance entities be held accountable and liable for medical
decisions regarding contractually covered medical services; and be it further,
RESOLVED, that the ISMA ask that insurance entities be required to explain to the covered
members what is and what is not a contractually covered medical service.
STATUS:
This policy was considered by the COL and did not receive enough support to
have it considered as part of the legislative agenda for 2009.
RESOLUTION 08-13
REAFFIRMING PEER REVIEW CONFIDENTIALITY
Action: Adopted
Reaffirmation of existing policy-implemented by inclusion in the Public Policy Manual
RESOLVED, that the ISMA continue to support the confidentiality of peer review
information.
RESOLUTION 08-14
REAFFIRMING BICYCLE HELMET USE BY MINORS AND ADULTS
Action: Adopted
RESOLVED, that the ISMA support legislation calling for mandatory use of bicycle helmets
by minors and adults.
STATUS:
RESOLUTION 08-15
HEALTH INSURANCE COVERAGE FOR TUBERCULOSIS PATIENTS
Action: Adopted
RESOLVED, that the ISMA support legislation to provide Medicaid coverage for a period of
nine months for all uninsured and poor patients with active tuberculosis.
STATUS:
RESOLUTION 08-16
PROVIDING PARITY HEALTH CARE COVERAGE FOR EATING DISORDERS
Introduced by: Stacie Wenk, D.O.
Referred from the Board to the ISMA Government Relations Department
RESOLVED, that the ISMA seek legislation to require insurers to provide equivalent mental
health coverage for a diagnoses of eating disorder as with medical/surgical illness.
STATUS:
The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction
Equity Act of 2008 was included in the $700 billion Emergency Economic Stabilization Act of
2008. The new law requires large group health insurance plans that include coverage for
mental health or substance use disorders to provide these benefits at parity with the plans’
medical benefits.
This new law builds on the Mental Health Parity Act of 1996 which will now remain in effect
as the sunset date in that law has been eliminated. Plans are given discretion to determine
which mental health and substance disorders to cover and they retain the ability to make
determinations about coverage based on medical necessity in a particular case. This new
parity law does apply to ERISA plans.
At its November 2 Board meeting, staff indicated that Federal Law will include this issue
beginning in 2010. The Board determined that it was not necessary to seek state legislation as
the federal law will preempt the state law. However, based on new information, this issue
will continued to be studied as to the impact of the Federal Law will have on the State of
Indiana.
RESOLUTION 08-17A
COMPREHENSIVE INTEGRATION AND CONTINUITY OF CARE BEFORE, DURING
AND SUBSEQUENT TO HOSPITALIZATION
Introduced by: Charles Rau, M.D., and David Rau, M.D.
Resolution Submitted for Introduction by the AMA Delegation at the November AMA
Interim Meeting
RESOLVED, that the ISMA direct the AMA Delegation from Indiana to present a resolution
at the AMA requesting a new CPT code be created to describe the time and resources needed
by physicians for concurrent care and coordination of care of patients in the hospital and seek
reimbursement for the same.
STATUS:
The AMA delegation introduced Resolution 824 which was considered a
reaffirmation resolution which means that current AMA policy be reaffirmed in lieu of the
resolutions. Existing policies pertaining to the resolution are as follows:
H-385.951 Remuneration for Physician Services
H-390.888 Payment for Concurrent Care
H-390.917 Consultation Follow-Up and Concurrent Care of Referral for Principal Care
H-70.919 Use of CPT Editorial Panel Process
RESOLUTION 08-18
ELECTRONIC MEDICAL RECORDS
Introduced by: ISMA Information Technology Committee
Action: Adopted
Implemented by communication with the Indiana Health Informatics Corporation
RESOLVED, that ISMA ask the Indiana Health Informatics Corporation to encourage the
development of bi-directional interfaces for order entry and for receiving finished data by
both hospitals and physician offices, in order to standardize and allow systems from many
different electronic medical record vendors to communicate with each other.
RESOLUTION 08-19
INCENTIVES FOR E-PRESCRIBING
Introduced by: ISMA Information Technology Committee
Action: Adopted
Referred to Commission on Legislation
RESOLVED, that the ISMA seek legislation to require the Medicaid program and private
insurance companies to use electronic drug formularies and to provide financial incentives to
encourage the use of e-prescribing by physicians.
STATUS: Based upon COL rankings this did not result in a high enough response to be
considered for the 2009 legislative initiative, however, discussions with the Medicaid Director
did uncover that the Medicaid office will be monitoring closely the CMS program that offers
a bonus for E-prescribing for all participating Medicare providers beginning in 2009.
RESOLUTION 08-20
MEDICAID ELIGIBILITY
Introduced by: Vidya Kora, M.D.
Implemented by inclusion in the Public Policy Manual
RESOLVED, that the ISMA support legislation or administrative procedures to provide that
Medicaid recipients enrolled in a Medicaid plan be required to remain in the same plan for one year,
or the duration of their coverage if less than one year, so that patients have continuity of care
through a medical home.
STATUS: This has been addressed by the Administration and became policy of the
Administration in the fall of 2008. The applicant has 90 days during open enrollment to
select a MCO and after the 90 days they are not permitted to switch to a different MCO. They
may switch physicians within the MCO but not to a different MCO.
RESOLUTION 08-22
VISITING MEDICAL PERSONNEL
Introduced by: Gregory Rowdon, M.D.
First Resolved Referred to Commission on Legislation
Second Resolved (Does Not Stand Alone) Referred to Commission on Legislation
RESOLVED, that the ISMA seek legislation or rules creating an exemption from licensing
requirements for visiting medical personnel of sports teams similar to the statute in the state
of California for physicians with the addition of any other out-of-state licensed medical
providers, such as physical therapists, athletic trainers, chiropractors, massage therapists,
that accompany the visiting team, and be it further
RESOLVED, that the medical provider who is licensed to practice in another state or country
shall be exempt from licensure requirements in this state while providing medical services to
a sports team if all the following requirements are met:
1. The provider has a written or oral agreement with a sports team to provide care to
the team members, coaching staff, and families traveling with the team for a
specific sporting event to take place in this state.
2. The provider may not provide care or consultation to any person residing in this
state other than as listed in number 1 or under the Good Samaritan Act.
3. The exemption shall remain in force while the provider is traveling with the team,
but shall be no longer than 10 days in duration per sporting event.
4. A maximum of 20 additional days per sporting event may be granted upon prior
request by the provider to their respective licensing board but may not exceed 30
day total per sporting event.
5. A provider who is exempt from licensure requirements under this provision is not
authorized to practice at a health care clinic/facility including an acute care facility.
6. If the provider has been invited by the National Sport Governing Body to provide
services at the national sporting training center or to provide services at an
event/competition in this state sanctioned by the Body, then the provider meets
the following requirements:
a. The provider has been certified by the National Sport Governing Body in
regards to state or country of origin licensure and the dates within which
the provider has been invited to provide services.
b. The provider’s practice is limited to that required by the National Sport
Governing Body. Those services shall be within the area of the provider’s
competence and shall only be provided to athletes or teams’ personnel
registered to train/coach at the center or registered to compete in an event
sanctioned by the Body.
c. The exemption shall remain in force while the holder is providing services
at the invitation of the National Sport Governing Body and only during the
time certified by the Body, but may not exceed 30 days total.
STATUS:
Language to be included in a 2009 House bill authored by Rep. Welch for the
Professional Licensing Agency. As of 4/23/09 HB 1573 has passed both houses and is
waiting for the concurrence or dissent to be filed. It appears that this resolution will become
law given that there was no opposition to this language during any testimony.
The HB 1573 was signed into law by the Governor and took effect July 1, 2009. The law now
exempts certain sports team healthcare practitioners who provide treatment for their team
members from state license requirements if licensed by another state and are performing
their duties in connection with a visiting sports team.
RESOLUTION 08-23
REVERSAL OF CMS GUIDELINES
Introduced by: Caitlin Kelly, M.D.; Jerome Melchior, M.D.; Fred Ridge, M.D.; Vidya Kora,
M.D.; James Koontz, M.D.; Robert Lubitz, M.D.; Michael Sha, M.D.; Jim Poulos, M.D.; Lois
Lambrecht, M.D.; and James Faris, M.D.
Referred to AMA Delegation
RESOLVED, that the ISMA encourage the AMA to lobby for reversal of the CMS guidelines
on pay for performance and encourage their replacement with more appropriate, positive
programs to improve the quality of hospital care.
STATUS:
Due to existing AMA policy (below) related to this issue, the AMA Delegation
sent a letter (dated December 15) to the AMA Board chair asking that the AMA to continue to
work toward reversal of the CMS guidelines on pay for performance. The AMA responded
on January 21, 2009, reiterating that existing policy on pay for performance assists the AMA
in effectively participating in discussions regarding health care system reform on behalf of
the medical professional, and they will continue to communicate these views to the Centers
for Medicare and Medicaid Services (CMS).
H-450.947 Pay-For-Performance Principles and Guidelines
H-450.941 Pay-For-Performance, Physician Economic Profiling, and Tiered and Narrow
Networks
RESOLUTION 08–24
UNDERAGE DRINKING
Introduced by: Dick Huber, M.D.
First and Second Resolves implemented by inclusion in the Public Policy Manual
RESOLVED, that the ISMA support legislation requiring mandatory ID checks for alcohol purchases
for anyone who appears under age 30 (similar to ID checks for tobacco); and be it further
RESOLVED, that the ISMA support legislation that would provide education for prevention of
underage drinking, and treatment of alcohol-related problems.
STATUS: HB 1298 would require identification to buy alcoholic beverages. Requires a seller
of alcoholic beverages to require a consumer to present proof that the consumer is at least 21
years of age, regardless of the apparent age of the consumer. Provides that a permittee who
fails to require a consumer to provide identification commits a Class A infraction. This bill,
however, failed to receive a hearing before the Public Policy Committee.
RESOLUTION 08-25
PRESCRIPTION MEDICINE ABUSE
Action: Adopted
First and Second Resolves to ISMA Communications Department
Third Resolve Referred to the ISMA Government Relations Department
Fourth Resolve Referred to the ISMA Legal Department
RESOLVED, that the ISMA collaborate with other agencies and organizations to educate
Hoosiers about prescription medicine abuse; and be it further
RESOLVED, that the ISMA inform Hoosier physicians of the magnitude of prescription
medicine abuse with helpful hints to reduce abuse, such as talking to patients about the
handling and safe-keeping of drugs, using INSPECT, etc.; and be it further
RESOLVED, that the ISMA collaborate with pharmacists, pharmacies and pharmaceutical
companies and organizations to reduce prescription medicine abuse; and be it further
RESOLVED, that the ISMA study the role of prescription medicine abuse from Internet sales
and report to the 2009 ISMA House of Delegates via resolution/report if appropriate.
STATUS: First Resolve - There was no funding appropriated for undertaking an educational
program in the 2009 budget, since the budget process was completed before adoption of
Resolution 08-25. Strategically and staffing wise, it makes sense to do one campaign instead
of separate campaigns—one with certain agencies and one with pharmacists, pharmacies and
pharmaceutical companies. The ISMA staff is working to gain pharmaceutical company
support to assist in a program to educate Hoosiers about prescription medicine abuse.
Second Resolve - The ISMA sent a news release on prescription drug abuse in September
2008. The April 27, 2009 ISMA Reports published information about a pain management
resource from the Federation of State Medical Boards. The publication suggests how doctors
can help prevent abuse of prescription drugs.
Third Resolve - This resolution was discussed with the Indiana Pharmacist Alliance and an
agreement was made to continue discussions as to how both the ISMA and IPA could work
together to reduce prescription medicine abuse.
Fourth Resolve – The U.S. Drug Enforcement Administration (DEA) is actively engaged in
this issue and regularly testifies on it before Congress, including on June 24, 2008. ISMA staff
will provide the DEA’s most recent testimony to the 2009 ISMA House of Delegates.
Additionally, Congress passed the Ryan Haight Online Pharmacy Consumer Protection Act
of 2008 to address this issue. The law prohibits the delivery, distribution or dispensing of a
controlled substance over the Internet without a valid prescription. It imposes registration
and reporting requirements on online pharmacies that dispense 100 or more prescriptions or
5,000 or more dosage units of controlled substances in one month. It also requires the online
pharmacies to display certain information on their webpage, comply with state licensure
laws, and notify the Attorney General and state pharmacy board of sales activities in
advance. It increases criminal penalties involving controlled substances, gives states more
legal power over these entities, and requires the DEA to report to Congress for two years
after its enactment (10/15/08).
RESOLUTION 08-26
IMMUNITY FOR VOLUNTEER PHYSICIANS
Introduced by: Second District Medical Society; Second District Trustee Caitlin
Kelly, M.D.; Indiana Chapter ACP Health and Public Policy Committee; Michael
Sha, M.D.; Robert Lubitz, M.D., Lois Lambrecht, M.D.; and James Poulos, M.D.
Action: Adopted
Referred to the Commission on Legislation
RESOLVED, that the ISMA seek to amend state law to extend physicians voluntarily
donating care and time by providing services to patients referred to them by free clinics the
same liability protection offered physicians who donate their time on-site at the clinic.
STATUS: Based upon COL rankings this did not result in a high enough response to be
considered for the 2009 legislative initiative, however, this topic will be discussed with
legislators during the summer to generate support for consideration of this initiative in 2010
at the legislative level.
The Federal Health Care Safety Net Act of 2008 required the Government Accountability
Office (GAO) to study the implications of extending Federal Tort Claims Act (FTCA)
coverage to health care professionals who volunteer to furnish care to patients at health
centers. ISMA received notice in April 2009 that the GAO is conducting such study.
RESOLUTION 08-27
ISMA SUPPORT FOR MEMBER PHYSICIANS TREATINGPATIENTS WHO
REQUIRE HEARING IMPAIRED INTERPRETATION SERVICES
Introduced by: Kenneth N. Wiesert, M.D.
First, Second, Third Resolves Referred from the Board to the ISMA Legal Department
RESOLVED, that the ISMA create a pilot program to help ISMA member physicians pay the
costs for necessary hearing impaired interpretation services in which the ISMA makes
available to its members a maximum of $2,000 per month, on a first-come, first-served basis,
to reimburse physician members for their costs in providing necessary hearing impaired
interpretation services under the Americans with Disabilities Act, to the extent that the
services are not paid or payable by a hospital or practice entity, or reimbursed by the IRS;
and be it also
RESOLVED, that ISMA poll its membership as to current use of the mandated deaf services
to develop data for future use of and funding for this service; and be it also
RESOLVED, that based on the data compiled, the ISMA subsequently investigate the
expansion of this program.
Fiscal Note: $24,000 per year (plus ISMA staff time to create and administer program and conduct membership poll)
STATUS:
November 2008 Update - The Board consensus was that ISMA should not pay
members to provide hearing impaired interpretation services as required under the ADA, but
determined that a member survey should be conducted. The survey should include the
frequency our members provide various interpretation services and the amount spent. The
board will discuss the results at the February 4, 2009 meeting and decide on further action on
this resolution.
February 4, 2009 Update - The survey was distributed to members electronically via ISMA eReports (2,600 emails) on January 15, 2009 and February 2, 2009 and was publicized in the
corresponding January 20 and February 4 issues of ISMA Reports (8,400 hard copy). Only 24
people completed the survey, which asked questions about both foreign language and sign
language interpreters. The responses were not statistically significant. However, foreign
language seemed to be a bigger problem than sign language. Fees for interpreters generally
exceed reimbursement for the associated health care services. Very few practices were aware
that the managed care organizations pay for these services, or that a tax credit is available
through the IRS. No practices had taken advantage of them.
The issue of video relay deaf interpretation was discussed as a possible method for providing
services for deaf patients. The board determined that an article related to this subject should
be included in ISMA Reports.
May 17, 2009 Update – No additional responses were received to the interpreter survey. As
requested, ISMA provided information on this topic in the May 11, 2009 issue of ISMA
Reports. At its May 17 meeting, the board decided to take no additional action on this
resolution. Staff will continue to monitor this issue.
RESOLUTION 08-28
MALPRACTICE INSURANCE FOR PHYSICIAN ASSISTANTS
Introduced by: Richard Miethke, M.D., and the Bartholomew/Brown County Medical Society
RESOLVED, that the ISMA support legislation requiring physician assistants to carry their own
malpractice insurance policies.
STATUS:
There were no bills regarding this resolution. The Indiana Department of
Insurance has notified ISMA of its intent to adopt rules requiring PAs to carry their own
malpractice insurance policies. However, those rules have not been published yet.
RESOLUTION 08-29
OPEN ACCESS CLAUSES IN COMMERCIAL INSURANCE CONTRACTS
Introduced by: William Mohr, M.D.
Action: Adopted
Referred to the Commission on Legislation
RESOLVED, that the ISMA shall pursue enactment of legislation supporting the right of
physicians to operate their practices using sound business principles and banning ―Open
Access‖ language in commercial insurance contracts.
STATUS: Representative Welch filed HB 1300 which was modified from its original
language to include a study by the Health Finance Commission during its Summer Interim
meetings. A provider workgroup has been formed and has been meeting regularly to
prepare for the summer study meetings. It is anticipated that this resolution will be part of a
bill proposed in 2010.
RESOLUTION 08-30
SUPPORTING AWARENESS OF STRESS DISORDERS IN MILITARY MEMBERS AND
THEIR FAMILIES
Introduced by: William W. Pond, M.D.
Action: Adopted
Referred to the ISMA Communications Department
RESOLVED, that the ISMA support efforts to raise awareness of post traumatic stress
disorder (PTSD) and other associated psychiatric disorders related to the stresses involved
with military personnel and their families; and be it further
RESOLVED, that the ISMA encourage physicians throughout the state to query patients and
their families regarding stresses related to military deployments; and be it further
RESOLVED, that the ISMA publish in ISMA Reports information regarding resources that are
available for the assistance of military members and their families.
STATUS:
The ISMA sent letters to all member-psychiatrists informing of the ―Give an
Hour,‖ program and encouraged them to participate to raise awareness of PTSD. An article
on PTSD is being researched and will be included in a future ISMA Reports. An article on
PTSD was published in the March 2, 2009, issue of ISMA Reports and included links to Web
sites with additional information regarding symptoms and how to diagnose the disorder.
The ISMA staff is assisting the Alliance in their convention event, the ―Treat the Troops‖
Walk to be held in Indianapolis.
RESOLUTION 08-31A
DISPENSING OF CONTROVERSIAL PRESCRIPTIONS
Introduced by: Don M. Henry, M.D., and Kathryn Carboneau, M.D.
Referred to the ISMA Government Relations Department
RESOLVED, that the ISMA support the Indiana Pharmacists Alliance’s development of a
system that will accommodate the needs of patients who present with a legally written
prescription or request of a non-prescription drug that is required to be stored behind the
pharmacy counter.
STATUS: Senator Errington has filed SB0020 regarding this issue. This bill did not receive a
hearing and is dead. This issue was discussed with the Indiana Pharmacists Alliance and
was placed on their Board’s agenda for consideration.
RESOLUTION 08-32
“TRAP” LEGISLATION
Introduced by: Don M. Henry, M.D., and Kathryn B. Carboneau, M.D.
RESOLVED, that the ISMA review and support when appropriate health care regulation to advance
legitimate patient care, patient safety or quality issues and oppose regulation that does not.
STATUS: The Government Relations Team tracked close to 100 bills during the 2009 session.
Appropriate action was taken on several different bills as advised by the Commission on
Legislation.
RESOLUTION 08-33A
COMPREHENSIVE SEXUALITY EDUCATION
Introduced by: Don Henry, M.D., and Kathryn B. Carboneau, M.D.
Action: Referred to the Board of Trustees for action
First Resolve Referred from the Board to the ISMA Government Relations Department
Second Resolve Referred from the Board to the School Health Committee
Third Resolved Referred from the Board to the ISMA Practice Advisory Group and
Membership Development Department
RESOLVED, that the ISMA urge legislation providing for comprehensive sexuality education for all
high school and middle school students. Approved programs should:
Be based on rigorous, peer-reviewed science
Show benefit for delaying the onset of sexual activity and reduction of sexual behaviors
that put adolescents at risk for contracting sexually transmitted diseases
Teach responsible sexual behavior
Show benefit for reducing rates of unintended pregnancy
Teach that abstinence is the only sure way to have no risk of pregnancy and
sexually transmitted diseases;
and be it further
RESOLVED, that the ISMA advocate with state and local school boards for comprehensive sexuality
education in public and private schools that meets these standards:
Be based on rigorous, peer-reviewed science
Show benefit for delaying the onset of sexual activity and reduction of sexual behaviors
that put adolescents at risk for contracting sexually transmitted diseases
Teach responsible sexual behavior
Show benefit for reducing rates of unintended pregnancy
Teach that abstinence is the only sure way to have no risk of pregnancy and
sexually transmitted diseases;
and be it further
RESOLVED, that the ISMA promote physician education opportunities and offer continuing
medical education credits for courses including:
Reproductive medical care of teens
Logistics and medico-legal issues of teen medicine
Sexual behavior and public health
Physicians’ role in life-span comprehensive sexuality education
STATUS:
At the November 2 meeting, staff reported to the Board that the current baseline
law for Indiana schools requires that any sexuality education to contain abstinence based sexuality
education. The Department of Education currently provides the option to local authorities to include
comprehensive sexual education as indicated in the Department’s Health and Wellness Standards.
The Board determined that ISMA should not seek legislation in this area given that current law allows
the local school districts, under local rule, to adopt each item of the first Resolved, however felt that it
would be appropriate to promote education of the membership in this area. The authors and other
interested physicians have been contacted regarding the format that would be most appropriate for
physician education. Initial comments indicate a teleseminar or the availability of enduring materials
available for Continuing Medical Education (CME) may be most appropriate. Based on research
conducted by staff, existing on-line CME was located regarding this topic. Staff contacted the
Resolution authors and asked them to review the website and related materials. One author has
approved and staff is waiting for a reply from the second author. The website is:
http://www.contraceptiononline.org/cme/.
Second resolve – The School Health Committee met March 25. Committee chairman John Ellis, M.D.,
will contact Dr. Tony Bennett, the state school superintendent of public instruction, to discuss
sexuality education in Indiana schools in preparation for the committee to determine how to
approach this issue.
RESOLUTION 08-34A
NEGOTIATING WITH INSURANCE CARRIERS
Introduced by: Don Wagoner, M.D., and Mark Meyer, M.D.
Resolution Submitted for Introduction by the AMA Delegation at the November AMA
Interim Meeting
RESOLVED, that the ISMA direct the AMA Delegation from Indiana to request that the AMA
support any change in the anti-trust legislation laws to allow groups of physicians the ability
to negotiate with insurance payers when the carrier has a private market penetration of 60
percent or greater in a given community.
STATUS:
The AMA delegation introduced Resolution 209 which was considered a
reaffirmation resolution which means that current AMA policy be reaffirmed in lieu of the
resolutions. Existing policies pertaining to the resolution are as follows:
H-285.995 Managed Care – Policy and Initiatives
H-383.995 Negotiations Issue
RESOLUTION 08-35
ESTABLISHING THE NUMBER OF NURSE PRACTITIONERS COLLABORATING
WITH A PHYSICIAN
Introduced by: Don Wagoner, M.D., and Mark Meyer, M.D.
First Resolve Referred to the Commission on Legislation
Second Resolve - Resolution Submitted for Introduction by the AMA Delegation at the
November AMA Interim Meeting
RESOLVED, that the ISMA work with a legislator in the Indiana General Assembly to author a bill
that would enact a state statute that would limit the number of full-time equivalent nurse
practitioners that any one physician could legally collaborate with at any one time to four, the
purpose of which is to maintain good quality medical care in Indiana; and be it further
RESOLVED, that the ISMA refer this resolution to the AMA to develop national policy.
STATUS:
First Resolve – At its November 2 meeting, the Board approved advising the
Commission on Legislation (COL) of the Board’s concern with Resolution 08-35, and that the
COL is not bound to the ratios contained in the Resolved.
SB 214 was introduced by Sen. Patricia Miller that called for the ratio of four nurse
practitioners per physician. The bill did not receive a hearing.
Second Resolve – The AMA delegation introduced Resolution 211 which asked that the
number of full-time equivalent nurse practitioners supervised by a single physician should
not exceed the level above which objective evidence based data indicates maintenance of
good quality medical care would be endangered.
The reference committee heard strong testimony in favor of referral of Resolution 211. While
the testimony received was strongly supportive of the necessity to further examine and
address the issue of appropriate physician oversight of the nurse practitioners, as well as all
other nonphysician health care providers, there was strong acknowledgement of the need for
closer examination of this very important issue. Due to the complexity of the issue, and in
recognition of the value of further analysis of available data, the House of Delegates referred
the resolution to the AMA Board of Trustees with report back at the AMA 2009 June meeting.
Senator Miller has filed SB214 in response to this resolution. Will report on its status at a
later time.
RESOLUTION 08-36
PEER REVIEW FAIRNESS AND DUE PROCESS
Introduced by: ISMA Task Force on Peer Review, James Lewis, M.D., Chair
Action: Adopted
RESOLVED, that the ISMA adopt the following AMA policies on peer review:
E-9.05 Due Process
The basic principles of a fair and objective hearing should always be accorded
to the physician or medical student whose professional conduct is being
reviewed. The fundamental aspects of a fair hearing are a listing of specific
charges, adequate notice of the right of a hearing, the opportunity to be present
and to rebut the evidence, and the opportunity to present a defense. These
principles apply when the hearing body is a medical society tribunal, medical
staff committee, or other similar body composed of peers. The composition of
committees sitting in judgment of medical students, residents, or fellows should
include a significant number of persons at a similar level of training. These
principles of fair play apply in all disciplinary hearings and in any other type of
hearing in which the reputation, professional status, or livelihood of the
physician or medical student may be negatively impacted. All physicians and
medical students are urged to observe diligently these fundamental safeguards
of due process whenever they are called upon to serve on a committee which
will pass judgment on a peer. All medical societies and institutions are urged to
review their constitutions and bylaws and/or policies to make sure that these
instruments provide for such procedural safeguards. (II, III, VII) Issued prior to
April 1977; Updated June 1994.
H-375.984 Peer Review
Our AMA affirms that it is the ethical duty of a physician to share truthfully
quality care information regarding a colleague when requested by an
authorized credentialing body, so long as the information that is shared with
the credentialing body is protected by statute or regulation as confidential peer
review information. Quality of care and patient safety are the goals of peer
review. Peer review should address the prevention of medical errors and
appropriate system changes. (Sub. Res. 93, A-88; Reaffirmed: Sunset Report, I98; Amended: BOT Action in response to referred for decision BOT Rep. 23, A05)
H-225.992 Right to Relevant Information
(1) The AMA advocates "timely notice" and "opportunity to rebut" any adverse
entry in the medical staff member’s credential file, believes that any health care
organization file on a physician should be opened to him or her for inspection,
and supports inclusion of these provisions in hospital medical staff bylaws.
(2) Triggers that initiate a peer review within a health care facility should be
valid, transparent and available to all member physicians and should be
uniformly applied to all cases and physicians.
(3) A physician accused of an infraction of medical staff bylaws, rules,
regulations, policies or procedures and faced with potential peer review action
shall be promptly notified that an investigation is being conducted and shall be
given an opportunity to respond.
(4) All relevant information pertaining to a potential peer review action should
be obtained promptly from the subject physician and other relevant sources.
Relevant information includes, but is not limited to, pre-event factors, names of
other health professionals involved in the care of the patient, and the
contributing environmental factors of the health care facility/system.
(5) All material information obtained by the peer review committee regarding
the subject of the peer review should be made available to the physician under
review in a timely manner prior to the hearing.
(6) The investigating individual or body shall interview the practitioner, unless
the practitioner waives his/her right to be heard, to evaluate the potential
charges and explore alternative courses of action before proceeding to the
formal peer review process. (Res. 121, I-83; Reaffirmed: CLRPD Rep. 1, I-93;
Modified by Sub. Res. 801, A-94; Reaffirmed: CLRPD 1, A-04; Amended with
change in title: BOT Action in response to referred for decision BOT Rep. 23, A05)
H-375.965 Principles for Incident-Based Peer Review and Disciplining at
Health Care Organizations
AMA policy is that:
(1) Summary suspension of clinical privileges is an extraordinary remedy which
should be used only when the physician’s continued practice presents an
"imminent danger to the health of any individual." The decision to summarily
suspend a member’s medical staff membership or clinical privileges should be
made by the chief of staff, chair or vice-chair of the member’s clinical
department, or medical executive committee. The medical executive committee
(MEC) must meet as soon as possible, but in no event more than 14 days after
the summary suspension is imposed, or before the time in which a report
would be required to the state licensing agency if applicable, whichever is
shorter, to review and consider the summary suspension. The MEC shall then
promptly modify, continue or terminate the summary suspension. The
suspended physician must be invited to attend and make a statement
concerning the issues under investigation, but the meeting with the MEC shall
not constitute the physician’s fair hearing. If the MEC sustains the suspension,
said action will trigger the fair hearing procedures contained in these policies.
(2) At the request of a medical staff department or of a member under review,
or at its own initiative if needed for adequate and unbiased review, the medical
executive committee may arrange, through the state or local medical society,
the relevant specialty society or other appropriate source, for an external
hearing panel to hear the case in order to assure professional and impartial
clinical assessment.
(3) Prior to any disciplinary hearing, the physician should be provided with a
clear, and if applicable, clinically supported basis for the proposed professional
review action. A hearing panel of a health care organization should be guided
by generally accepted clinical guidelines and established standards in its review
actions.
(4) Physician health and impairment issues should be identified and managed
by a medical staff committee, which should operate separately from the
disciplinary process. (BOT Action in response to referred for decision BOT Rep.
23, A-05)
E-9.10 Peer Review
Medical society ethics committees, hospital credentials and utilization
committees, and other forms of peer review have been long established by
organized medicine to scrutinize physicians’ professional conduct. At least to
some extent, each of these types of peer review can be said to impinge upon the
absolute professional freedom of physicians. They are, nonetheless, recognized
and accepted. They are necessary, and committees performing such work act
ethically as long as principles of due process (Opinion 9.05, "Due Process") are
observed. They balance the physician’s right to exercise medical judgment
freely with the obligation to do so wisely and temperately. (II, III, VII) Issued
prior to April 1977; Updated June 1994.
H-375.990 Peer Review of the Performance of Hospital Medical Staff
Physicians
Our AMA encourages peer review of the performance of hospital medical staff
physicians, which is objective and supervised by physicians. Membership on
peer review committees and hearing panels should be open to all physicians on
the medical staff and should not be restricted to those physicians who have an
exclusive contract with the hospital, salaried physicians, or those on the faculty.
(Res. 57, I-85; Reaffirmed CLRPD Rep. 2, I-95; Reaffirmed: BOT Rep. 8, I-01;
Amended: BOT Action in response to referred for decision BOT Rep. 23, A-05)
H-375.970 Professional Review Organization Peer Review
The AMA strongly recommends that public and private sector review entities
conduct their reviews using evidence-based guidelines or practice parameters
developed by national medical specialty societies. (Sub. Res. 719, I-97;
Reaffirmation I-98)
RESOLUTION 08-37
COMPREHENSIVE TREATMENT OF SEXUAL ASSAULT PATIENTS IN INDIANA
Introduced by: Don Henry, M.D., and Kathryn B. Carboneau, M.D.
RESOLVED, that the ISMA support state legislation as well as federal requiring all facilities in
Indiana rendering emergency care to provide on-site, comprehensive services to sexual assault
patients in accordance with widely accepted standards of care, without exemption for sectarian
reason. Such services must include all the following:
Treatment of trauma
Testing and prophylaxis for sexually transmitted disease
Collection of forensic evidence
On-site availability of emergency contraception for patients capable of pregnancy
Information and written materials about a patient’s right to emergency contraception.
Information shall be scientifically accurate, factual and objective. It shall be clearly
written and readily comprehensible in a culturally competent manner. It shall explain
the nature of emergency contraception, including its use, safety, efficacy and
availability, and shall state that this form of contraception does not cause abortion of an
established pregnancy.
STATUS: There was no bill introduced during the 2009 General Assembly that included the
points of this resolution.
RESOLUTION 08-38
INVESTIGATING GROWING INDEBTEDNESS OF INDIANA MEDICAL STUDENTS
Introduced by: The ISMA-Young Physician Society, Resident and Fellow Society and
Medical Student Society
Action: Adopted
First Resolve Referred to the Commission on Legislation
Second and Third Resolves Referred to ISMA Communications Department
RESOLVED, that the ISMA work with the Indiana General Assembly to increase the amount
of financial support directed to the IU School of Medicine with the new monies directed to
reducing medical school tuition; and be it further
RESOLVED, that the ISMA request a report from the IU School of Medicine regarding the
long-term steps being undertaken to address the problem of increasing medical student debt
and examine the sources and utilization of current funding; and be it further
RESOLVED, that the ISMA request that the Indiana University Board of Trustees implement
policies to increase the transparency of the tuition-setting process and consider a tuition
freeze upon matriculation to Indiana University School of Medicine.
STATUS:
IU School of Medicine Dean Craig Brater, M.D., spoke at the Feb. 4 Board
meeting regarding the school’s long-term steps to address medical student debt and to
explain the sources and utilization of current funding. He said there are four sources for
funding the medical school: clinical, research, philanthropy and tuition. Dr. Brater reported
that Indiana ranks in the 10th percentile for medical school state funding, but IU is the second
largest U.S. medical school in the country. He said tuition setting is data driven and the
medical school has sought out additional state funding over the years, but has been
unsuccessful. He explained that 4-5% of the school’s annual budget is derived from
philanthropic giving and expressed thanks to the ISMA and its individual members who
support the school.
In conference committee, HB 1208, dealing with health, mental health and addiction
matters, and SB 393, establishing a primary care physician loan forgiveness program,
were amended into HB 1210. The new version passed the House 90-0 and passed the
Senate 48-2. The bill was signed by the Governor in May, P.L. 170, and went into effect
July 1, 2009.
As the bill has no funding mechanism for the programs to encourage the recruitment of
primary care physicians and psychiatrists, there will be little direct effect on the efforts to
encourage more medical students to enter these fields of practice. The bill does create the
administrative structures to oversee these programs once the funding becomes available.
RESOLUTION 08-41
USE OF SOCIAL SECURITY NUMBERS ON INSURANCE CONTRACTS
Introduced by: Robert J. Burkle, M.D.
Action: Referred to the Board of Trustees for action
Referred from the Board to the ISMA Legal Department
RESOLVED, that the ISMA pursue enactment of legislation to only require the tax identification
number or NPI number or physician license number on insurance contracts and not list the social
security number.
STATUS:
This was discussed at the November, February and May Board meetings.
ISMA spoke with an Anthem representative who stated that the only reason the number is
required is because it is required on the CAQH universal provider credentialing application
form. The Board determined that in lieu of pursuing enactment of legislation, ISMA Legal
Counsel will contact CAQH and formally request that the Social Security Number be
removed from the form. ISMA sent the letter to CAQH on November 13, 2008. After
receiving no response, ISMA contacted CAQH about the letter on April 28, 2009. According
to the Director of CAQH, Indiana is not the first to raise this issue. However, because the
NPI number has not been an ideal solution to the one-identifier issue, they are reluctant to
remove the number without first determining what impact it will have on the health care
delivery and payment system. They are planning to conduct a survey of various impacted
entities in 2009. ISMA is monitoring these efforts.
The Board also suggested the resolution should be forwarded to the AMA Delegation for
advice and direction. The AMA has existing policy relating to this resolution as follows:
H-190.963 Identity Fraud
Our AMA policy is to discourage the use of Social Security numbers to identify insureds,
patients, and physicians, except in those situations where the use of these numbers is
required by law and/or regulation. (Res. 805, A-01; Reaffirmed: Res. 804, A-02)
RESOLUTION 08-42A
INSURANCE COMPANY CREDENTIALING
Introduced by: Robert J. Burkle, M.D.
Referred to ISMA Communications Department
RESOLVED, that the ISMA educate the membership in regard to CAQH credentialing
opportunities, the law requiring insurance carriers to use the CAQH credentialing services
and option of reporting of non-complying insurance carriers to the Indiana Department of
Insurance.
STATUS:
The Jan. 5 issue of the ISMA Reports included an article on CAQH and referred
members to www.ismanet.org where the CAQH form can be found.
RESOLUTION 08-44
ACCELERATING THE BUILT COMMUNITY TO REDUCE OBESITYAND ENHANCE
PUBLIC HEALTH
Introduced by: Todd Rowland, M.D., and Monroe/Owen County Medical Society
Action: Adopted
Implemented by inclusion in Public Policy Manual
RESOLVED, that the ISMA create a position statement to encourage accelerated
improvements in the built community throughout Indiana to reduce obesity as a matter of
public health. The Monon Trail (Indianapolis) and the B-line (being built in Bloomington)
serve as positive examples.
RESOLUTION 08-45
BILLING HEALTH PLANS AND PHARMACY BENEFIT MANAGERS FOR CARE
COORDINATION
Introduced by: Windel Stracener, M.D.
First, Second, Third, and Fourth Resolves Referred to Commission on Legislation
Fifth Resolve - Resolution Submitted for Introduction by the AMA Delegation at the
November AMA Interim Meeting
RESOLVED, that the ISMA seek regulation or statute that defines pre-certification of medical
services and prior authorization of pharmacy services as mandated services; and be it further
RESOLVED, that ISMA invoke by regulation or statute that insurance plans recognize and pay for
claims documenting, with appropriate codes, and pre-certification of medical services and prior
authorization of pharmacy services; and be it further
RESOLVED, that ISMA seek regulation or statute indicating that all plans providing administrative
services or insurance products in Indiana are mandated by regulation or statute to pay for billed
codes relating to mandated care coordination services at the level defined by the Resource Based
Relative Value Scale (RBRVS); and be it further
RESOLVED, that ISMA seek regulation or legislation that would force insurance plans acting as
administrative services only (ASO) or fully insured plans to honor and pay for, on a Resource Based
Relative Value Scale (RBRVS) basis, the CPT codes as promulgated by the AMA, and be it further
RESOLVED, that this resolution be forwarded onto the AMA.
STATUS:
Fifth Resolve - The AMA delegation introduced Resolution 809 which was
considered a reaffirmation resolution which means that current AMA policy be reaffirmed in
lieu of the resolutions. Existing policies pertaining to the resolution are as follows:
H-385.984 Fee for Services When Fulfilling Third Party Payer Requirements
H-285.943 Payment for Managed Care Administrative Services
H-385.951 Remuneration for Physician Services
Based upon COL rankings this did not result in a high enough response to be considered for
the 2009 legislative initiative.
RESOLUTION 08- 46
ENERGY DRINKS
Action: Adopted
Referred to AMA Delegation
RESOLVED, that the ISMA ask the AMA to seek FDA regulation of energy drinks, to include
a maximum caffeine content per ounce as well as caffeine content and health warnings to be
listed on the label.
STATUS:
Due to existing AMA policy (below) related to this issue, the AMA Delegation
sent a letter (dated December 10) to the AMA Board chair asking that the AMA contact the
FDA regarding regulation of energy drinks with particular attention toward labeling of
caffeine content on products. The AMA responded on January 26 that a letter will be drafted
asking the FDA to examine these issues and develop regulations to address them.
H-150.988 Caffeine Labeling
The AMA (1) supports a continued review of the safety of dietary caffeine intake; (2)
supports continued efforts to disseminate information to the public and physicians on the
caffeine content of food and beverages; and (3) will work with the FDA to ensure that, when
caffeine is added to a product, the label reflects this in prominent letters and the amount of
caffeine in the product be written on the label. (CSA Rep. E, I-83; CLRPD Rep. 1, I-93;
Modified by Res. 523, A-97; Reaffirmed: CSAPH Rep. 3, A-07)
D-60.973 Prevention of Underage Drinking: A Call to Stop Alcoholic Beverages with Special
Appeal to Youths
Our AMA will advocate for a ban on the marketing of products such as alcopops, gelatinbased alcohol products, food-based alcohol products, alcohol mists, and beverages that
contain alcohol and caffeine and other additives to produce alcohol energy drinks that have
special appeal to youths under the age of 21 years of age. (Res. 435, A-07)
RESOLUTION 08-4 7
ASSESSMENT AND TRACKING OF NON-HOSPITAL CREDENTIALED PHYSICIANS
Introduced by: Deborah McMahon, M.D.; William Pond, M.D.; Allen County Medical Society
Action: Referred to the Board of Trustees for Action
Referred from the Board to the ISMA Government Relations and Legal Departments
RESOLVED, that the ISMA begin a dialogue with the Indiana State Department of Health to
address by rule, the issue of hospital quality assurance committees reporting non-privileged
physicians that are believed to have demonstrated a sub-standard level of care to the Medical
Licensing Board of Indiana when the physician’s patient has presented to that hospital for
treatment of associated complications. This is to assure that the conduct and complications
are addressed either at the local hospital Quality Assurance Committee level, or reported to
the Medical Licensing Board of Indiana.
STATUS:
At its November 2 meeting, the Board referred this resolution to the Task Force
on Peer Review.
On December 4, Allen County Commissioner Peters presented before the Medical Licensing
Board and was accompanied by Deborah McMahan. Mike Rinebold and Julie Reed were in
attendance. The Board took the information under advisement and was interested in
learning of the actions taken by the ISMA Task Force on Peer Review. At this time, Allen
County has not adopted an ordinance regarding this issue. Will continue to monitor and
report to the Task Force any new developments.
At its February meeting, the Task Force on Peer Review recommended at that the Board of
Trustees readopt its 7-31-94 policy on post-operative care and recommend that the Medical
Licensing Board adopt a similar rule on post-operative care responsibilities. The Board
expressed concerns about how the policy was written and asked the Task Force to revisit it.
The Task Force met by conference call on April 30, 2009 and developed the following
recommendations which were presented to and adopted by the Board at its May 17, 2009
meeting:
1. Amend the Board’s July 31, 1994 policy on pre- and post-operative care of patients.
2. Recommend that the Indiana Medical Licensing Board promulgate a rule specifying
physician post-surgical care responsibilities.
3.
Submit a resolution to the ISMA 2009 House of Delegates which seeks support in
recommending that the Medical Licensing Board adopt the above post-surgical care
rules.
This resolution has been introduced as Resolution 09-07.
NUMBER
RESOLUTION REFERRAL
REFERENCE COMMITTEE
Resolution 09-01
Statewide Guidelines for the Establishment of Brain
Death
Emil L. Weber, M.D.
#1
Resolution 09-02
Dietary Referrals for Medicare Patients
Caitilin Kelly, M.D.; Monroe/Owen County Medical Society;
2nd District Medical Society; ACP Indiana Chapter Health and
Public Policy Committee
#4
Resolution 09-03
Background Checks for Elder Care Applicants
#4
Resolution 09-04
Need for Alternative Covered Medications to be Provided,
Request, for a Prior Authorization
#2
Resolution 09-05
Medical Marijuana
Clark Brittain, D.O.
#2
Resolution 09-06
Dietary Supplements
#2
Resolution 09-07
Post-Surgical Care Responsibilities
ISMA Board of Trustees, Brent Mohr, M.D., chair
#3
Resolution 09-08
Malpractice Insurance Assistance
#3
Resolution 09-09
Dues Waivers
#1
Resolution 09-10
Indiana Department of Insurance Provider Complaints
David Welsh, M.D.
#2
Resolution 09-11
Smoke-Free ISMA
Dick Huber, M.D.
#4
Resolution 09-12
Cell Phones and Driving
Dick Huber, M.D.
#2
6
NUMBER
RESOLUTION REFERRAL
REFERENCE COMMITTEE
Resolution 09-13
Tobacco Settlement
Dick Huber, M.D.
Resolution 09-14
Rescission
#2
Caitilin Kelly, M.D.; the Indiana ACP Health and Public Policy
Committee; Monroe/Owen County Medical Society; ACP Governor’s
Council; Michael Sha, M.D.; Deepak Azad, M.D.; Lois Lambrecht, M.D.;
Robert Lubitz, M.D.; and Linda Abels, M.D.
Resolution 09-15
Labeling of Genetically Modified Foods
#4
Caitilin Kelly, M.D.; the Indiana ACP Health and Public Policy
Committee; Monroe/Owen County Medical Society; ACP Governor’s
Council; Michael Sha, M.D.; Deepak
Azad, M.D.; Lois Lambrecht, M.D.; Robert Lubitz, M.D.; and
Linda Abels, M.D.
Resolution 09-16
Choice Regarding Health Care Insurance/Provider Practices
Steven Rupert, D.O., and Stacie Wenk, D.O.
Resolution 09-17
The Physician’s Obligation to Identify and Treat Prenatal
and Perinatal Addiction
Randall Stevens, M.D., and James Norton, M.D.
#2
#1
#4
Resolution 09-18
Support of Gay Marriage
William Buffie, M.D.
#3
Resolution 09-19
Supporting Awareness of Stress Disorders in Military
Members and Their Families
William Pond, M.D.
#4
Resolution 09-20
Opposition to Intelligender
Caitilin Kelly, M.D., chair of the Ind. ACP Health and Public
Policy Committee; Monroe/Owen County Medical Society;
Deepak Azad, M.D.; Robert Lubitz, M.D.; Michael Sha., M.D.,
and Lois Lambrecht, M.D.
#4
Resolution 09-21
Suspension of Medicaid Privileges for Positive Drug Test
P.K. Samaddar, M.D.
#3
Resolution 09-22
Civil Legal System
P.K. Samaddar, M.D.
#2
Resolution 09-23
Attorney General Defense of Physicians Named in Civil
Rights Suits by Prisoners
Vidya Kora, M.D.
#2
7
NUMBER
RESOLUTION REFERRAL
REFERENCE COMMITTEE
Resolution 09-24
Body Modification
Debra Mc Mahan, M.D., and the Fort Wayne Medical Society
#4
Resolution 09-25
Newborn Auto Assignment and Retro-Active Assignment to
Medicaid Managed Care Organizations
Teresa Lovins, M.D., Indiana Academy of Family Physicians
and the Indiana Chapter of the American Academy of Pediatrics
#3
Resolution 09-26
Simple and Uniform Prior Authorization Forms
#3
Resolution 09-27
Laboratory Testing
David Welsh, M.D., and Fred Ridge, M.D.
#4
Resolution 09-28
Hospital Deliveries
#4
Resolution 09-29
Opposition to Third-Party Payment
#3
Resolution 09-30
Limiting Physician Free Choice
#3
Resolution 09-31
Motorcycle Helmets
#4
Resolution 09-32
Financial Incentives
#3
Resolution 09-33
Prohibiting Unlicensed Mid-Wifery
#3
Resolution 09-34
Notification of Professional Licensing Agency Actions
#3
Resolution 09-35
Insurance Reimbursement
#3
Resolution 09-36
Appropriate Statements of Care
#1
Resolution 09-37
Requiring Insurers to Clearly Disclose Limitations
#3
8
NUMBER
RESOLUTION REFERRAL
REFERENCE COMMITTEE
Resolution 09-38
GME Funding
#1
Resolution 09-39
Medical Careers
#1
Resolution 09-40
Penalties for Coding Errors
#3
Resolution 09-41
Compact of Conduct
#1
Resolution 09-42
Oppose Medicare Cuts
#2
Resolution 09-43
Providing Information for School Health Policies and Criteria
#4
Resolution 09-44
Unreasonable and Unnecessary Services
#3
Resolution 09-45
Testing for HIV
#4
Resolution 09-46
Generic Substitution by Pharmacist
#2
Resolution 09-47
Postoperative Care
#3
Resolution 09-48
Physician Health Officers
#1
Resolution 09-49
Limit Resident Work Hours
#1
Resolution 09-50
Non-Physician Diagnosis
#2
Resolution 09-51
Drug-Free Indiana Endorsement
#4
Resolution 09-52
Dispensing Medications
#2
9
NUMBER
RESOLUTION REFERRAL
REFERENCE COMMITTEE
Resolution 09-53
Anabolic Steroids
#4
Resolution 09-54
State Funds for Local Health Departments
#1
Resolution 09-55
Doctors’ Union
#1
Resolution 09-56
Organ Donation
#4
Resolution 09-57
Collective Bargaining
#1
Resolution 09-58
Restrictive Covenants
#1
Resolution 09-59
Use of Term “Provider”
#1
Resolution 09-60
Prescription Medication for Indigent Care
#2
Resolution 09-61
Malpractice Costs for Clinic Workers
#1
Resolution 09-62
Adjustment of Medicaid Reimbursement Rates
#3
Resolution 09-63
Uniform Rates for Liability Insurance
#1
Resolution 09-64
Study the Costs of ISMA Administrative Services for
Societies
Michael Sha, M.D., Indiana Chapter of ACP and Indiana
Radiology Society
#1
Resolution 09-65
Patient Health Information
Lee Smith Jr., M.D.
#1
10
Reference Committee I
ISMA and AMA Matters and
Constitution and Bylaws
Chair: William Mohr, M.D.
Richard Miethke, M.D.
Vipul Brahmbhatt, M.D.
Robert Stone, M.D.
Bridget Sanders, M.D.
Brian Doggett, M.D., Alternate
ISMA - AMA Matters and Constitution/Bylaws
(meets in Cosmopolitan A on the third floor of the Hyatt Regency Hotel on Saturday,
Sept. 26, at 8 a.m.)
Reports referred to Reference Committee I:
Executive Committee Annual Report
Board of Trustees Annual Report
Grievance Committee Annual Report
Commission on Constitution and Bylaws Annual Report
Young Physician Society Annual Report
Medical Student Society Annual Report
AMA Delegation Annual Report
RESOLUTIONS THAT WILL SUNSET IF NOT READOPTED*
Resolution #
Resolution Title & Author
Resolution 09-36
Appropriate Statements of Care
Resolution 09-38
GME Funding
Resolution 09-39
Medical Careers
Resolution 09-41
Compact of Conduct
David Welsh, M.D., and Fred Ridge, M.D
Resolution 09-48
Physician Health Officers
Resolution 09-49
Limit Resident Work Hours
Resolution 09-54
State Funds for Local Health Departments
Resolution 09-55
Doctors’ Union
Resolution 09-57
Collective Bargaining
Resolution 09-58
Restrictive Covenants
Resolution 09-59
Use of Term “Provider”
Resolution 09-61
Malpractice Costs for Clinic Workers
David Welsh, M.D., And Fred Ridge, M.D.
Resolution 09-63
Uniform Rates for Liability Insurance
*These resolutions are re-introducing existing ISMA policy and should not require much
discussion.
NEW RESOLUTIONS
Resolution #
Resolution 09-01
Statewide Guidelines for the Establishment
of Brain Death
Emil L. Weber, M.D
Resolution 09-09
Dues Waivers
Resolution 09-16
Choice Regarding Health Care Insurance/Provider
Practices
Steven Rupert, D.O. and Stacie Wenk, D.O.
Resolution 09-64
Study the Cost of ISMA Administrative
Services for Specialty Societies
Michael Sha, M.D., Indiana Chapter of ACP and
Indiana Radiology Society
Resolution 09-65
Patient Health Information
Lee Smith Jr., M.D.
Executive Committee
2009 Annual Report
The Executive Committee has been busy this year. The committee has performed its usual
functions such as reviewing the budget before presenting it to the Board, as well as overseeing
the insurance ad hoc committee’s report and recommendations. The association’s finances were
followed closely, especially in this difficult year. Along these lines, the AMA stipends were left
unchanged. The association policies were reviewed and recommendations were given to the
Board.
In addition to the usual functions the Executive Committee has been dealing with
Anthem/Wellpoint issues. As a result of the ongoing activities of the insurance giant, the
Executive Committee directed the association to file a compliance dispute against
Anthem/Wellpoint under the national settlement agreement after becoming a signatory society
with regards to the dispute. This matter is set for arbitration in October.
Respectfully submitted by David Welsh, M.D., chair.
Board of Trustees
Annual Report
The ISMA Board of Trustees met regularly to discuss resolutions, review reports and hear
presentations. The minutes of the meeting are available. Highlights follow.
Perhaps the biggest issue to come before the board was the report from ISMA staff that
numerous members were experiencing Anthem claims processing problems stemming from a
computer change over in the Blue Card plan. Some ISMA members began having problems in
late 2007 when Anthem first conducted the computer migration. The staff continued to respond
to ISMA member complaints throughout 2008, keeping the board informed. They met with
Anthem in December 2008, and again in January 2009.
Staff participated in a May 2009 meeting with the Indiana Department of Insurance, presenting
volumes of examples from members and requesting resolution of the matter. However, by late
June, ISMA leaders determined to file a compliance dispute against Wellpoint/Anthem under
the National Settlement Agreement before the agreement expired July 15, 2009. The Settlement
Agreement resulted from a class action lawsuit filed in 2000 and set up a process to resolve
violations like those experienced by ISMA members.
The main points of the dispute are claims processing and payment delays, customer service and
responsiveness, a lack of communication and failure to improve systems for claims adjudication
and accuracy.
At this writing, the compliance dispute is awaiting a date in October for mediation with
Wellpoint/Anthem. In the mediation, the ISMA seeks retroactive relief for medical practices
with unresolved claims payment and processing and improved processing and payment in the
future.
Other items
The board reviewed 11 resolutions referred from the House of Delegates for study or for action.
Board actions are recorded in the Status of the 2008 Resolutions contained in your House of
Delegates’ Handbook and were published in the Aug. 3 ISMA Reports.
Elisabeth Kline, M.D., received the ISMA sponsored Medical Mission stipend for her
January/February 2009 mission to Honduras.
The Board heard the results of a communication audit of ISMA publications and Web site and
approved moving forward with recommendations to improve association branding an
communications.
I would like to thank members of the Board of Trustees and staff for their commitment and
service.
Respectfully submitted by Brent Mohr, M.D., FACR, chair
Grievance Committee
2009 Annual Report
The Grievance Committee members are John Seward, M.D.; John Pless, M.D., (chair);
Bernard Emkes, M.D.; Susan Pyle, M.D.; and Steve Tharp, M.D.
The committee received no formal complaints during the 2008-2009 year.
Several patients contacted the ISMA to discuss potential complaints on issues such as
fees and charges, patient termination issues, differences of opinion concerning
diagnosis and treatment, and general ethical issues. As in past years, most
misunderstandings resulted from inadequate communication or explanation. Nearly all
misunderstandings are able to be resolved informally by the ISMA staff.
One grievance that was reported in the 2006-2007 report is still pending. The committee
met once by conference call after the 2007 convention to discuss this grievance and
reached some conclusions. However, ISMA legal counsel developed concerns that the
committee was not properly set up to receive protections under state and federal peer
review laws. ISMA legal counsel discussed this with external counsel and both parties
agree that the committee’s procedures need to be altered. The procedures are being
revised and will be submitted to the ISMA Board of Trustees for approval, as required
by ISMA Bylaws.
Under its operating rules, the Grievance Committee does not investigate complaints
against non-members of the ISMA (these are referred to the Indiana Attorney General’s
Office), nor does it investigate complaints that have also been submitted to the Indiana
Attorney General or to a private attorney.
The Grievance Committee strongly recommends better communication between
physicians and patients as the best method to avoid the majority of grievance
complaints.
As chair, I would like to thank committee members for their participation.
Respectfully submitted by John Pless, M.D., chair
Commission on Constitution & Bylaws
2009 Annual Report
Members of this commission include: Bruce Romick, M.D.; James Koontz, M.D.; James
Jacobi, M.D.; Michael Whitworth, M.D.; Chandra Reddy, M.D.; James Lewis, M.D.;
Heidi Dunniway, M.D. (Chair); Mark Hamilton, M.D.; Marc Kappelman, M.D.; Thomas
Whiteman, M.D.; Sandra Gadson, M.D.; John Yarling, M.D.; William Clark Jr. M.D.;
Brent Mohr, M.D.; Fred Dahling, M.D.; Shirley Khalouf, M.D.; Kristin Mahan, M.D.;
James Faris, M.D.; Michael Sha, M.D.; and Sanjeev Singh, Medical Student Society.
No constitution or bylaws changes were adopted during the 2008 convention. Also, no
constitution or bylaws issues have arisen since the 2008 convention. Finally, no
resolutions have been introduced for the 2009 session of the House of Delegates that
require the attention of this commission. Therefore, the commission has not met since
July 16, 2008, and no meetings are necessary at this time.
I have appreciated the opportunity to chair this commission given to me by Dr. David
Welsh. I would also like to thank the commission members for their work and our
ISMA staff for their assistance.
Respectfully submitted by Heidi M. Dunniway, M.D., chair
Young Physician Society
2009 Annual Report
The ISMA Young Physician Society (YPS) is pleased to report its objectives and activities to the
ISMA, the Board of Trustees and the House of Delegates.
Young physicians constitute a unique membership class because of the common experiences of
this group. Membership is technically defined as physicians within either their first five years of
practice or less than 40 years of age. This group of physicians face, in both their professional and
personal lives, a demanding set of circumstances – entering into professional practice, balancing
the needs of starting or raising a family, and addressing the regulatory and administrative
burdens of the profession.
The YPS continues its efforts to fulfill its missions. From identifying individuals who are
interested in taking a leadership role in the association to providing a monthly advocacy update
from the AMA-YPS, the YPS is taking an active stance. The YPS sent a delegation to the AMAYPS meetings at I-08 and A-09. We also look forward to participating in the ISMA House of
Delegates meeting in the fall.
There are several active young physicians, but I would like to recognize in particular Jerome
Adams, M.D., who serves as the head of the AMA-YPS delegations, and Drew Trobridge, M.D.,
the alternate YPS trustee to the ISMA Board of Trustees. Lastly, I would like to thank Dan
Kelsey for his very helpful support of the YPS.
The ISMA-YPS extends its appreciation to the association, the Board of Trustees and the House
of Delegates for its continued support of these and other activities that seek to address the needs
of young physicians. The Young Physician Society will carry on its efforts to guarantee a strong
future for the ISMA.
Respectfully submitted by Michael Sha, M.D., chair
MEDICAL STUDENT SECTION
ANNUAL REPORT
As a medical student section, we have again been hard at work throughout the past year. We
have participated in various community outreach projects, planned talks and educational sessions
for our fellow students, and attended our national and regional meetings. In the following, I will
attempt to outline some of the highlights as well as touch on our plans for the upcoming year.
Both of our national meetings have been very productive, and through the support of the ISMA,
we have been able to send a large delegation to the meetings. Due to the size of our school, we
are fortunate to have quite an influential role in the student house of delegates, and our students’
voices are well represented with the majority of our satellite campuses present. While many
important topics have been up for debate, none other stands out front and center more than the
continued debate on the provision of healthcare coverage in our country. As a student section, we
are particularly proud of our stance on the current issue of healthcare coverage in the United
States, and as this debate progresses, we will continue to actively participate.
This spring we were able to send a large number of individuals to the national lobby day in
Washington, D.C. In fact, Indiana was the only state to have every congressional district
represented! Accordingly, we were able to meet with every district representative and with each
of our state senators to discuss issues that affect medical students, physicians, and our patients.
In particular, this year we focused on the issues of relieving medical student debt and lifting the
cap on Medicare-funded residency slots in order to strengthen the physician workforce and
reduce the shortage of physicians.
On a national level, we continue to encourage students to become involved in any capacity. At
each of the national meetings, our students continue to be actively involved not only within
discussions but also within meeting procedures. At the most recent interim and annual meetings
we had four students serving on convention committees, including Mark Baker, Adam Haste,
Randy Jeffrey, and Sara Till. Additionally, during this upcoming year, I, Jennifer Stall, will
continue to serve on the MSS Committee on Legislation and Advocacy and Rajeev Singh will be
serving on the Committee on Economics in Medicine.
Sara Till and I will be serving as Region V delegate and alternate delegate to the AMA House of
Delegates. We both greatly enjoyed fulfilling our rolls during the exciting 2009 annual meeting
in Chicago where we were had the privilege to be part of HOD’s policy debates. We anticipate
an even more invigorating experience in Houston with the upcoming interim meeting and hope
that our enthusiasm will motivate even more students to become involved on the national and
regional levels.
From a community service standpoint, our section has participated in many events throughout
the last year - both IUSM sponsored events and our own AMA-MSS developed events. For the
national Cover the Uninsured Week, we organized a week long lunch lecture series broadcasted
state-wide to our satellite campuses and at our main campus regarding issues affecting the
uninsured and the health care system within the United States. Additionally, we held two
fundraisers during CTUW to raise money for the new IUSM student run outreach clinic in
downtown Indianapolis. We continued our date-a-doc auction in late spring, where we were able
to raise money for The Little Red Door Cancer Agency by auctioning medical students as
mentors to pre-medical students from IUPUI. Besides our fundraising activities, our student
chapter is also very involved in community service. We held a voter registration drive and
participated in health fairs at the Blackburn, Forest Manor, and Westside health clinics as well as
at the state fair. We plan to continue our involvement at these clinics and at the Indiana state
fair, where we distribute information and applications for SCHIP in hopes to provide families
with resources on the importance of securing healthcare coverage for their children. These are
just a few of the community activities with which our chapter has been and plan to continue to be
an active part of during the upcoming year.
Over the course of the coming year, we look forward to motivating students to become active
participants within the health care reform debate. We hope to provide the student body with up
to date information regarding legislation and to encourage grassroots efforts throughout the year.
During this monumental year, we hope to continue to increase our membership and help students
realize the importance of organized medicine. In all other regards, we will continue to work
diligently to represent and promote the best interests of our colleagues and patients. As always,
we would again like to thank the ISMA and all members for their continued support and
encouragement. We look forward to working with you during the upcoming year and hope to
build a stronger future for both patients and physicians.
Respectfully submitted by Jennifer N Stall, chair, Medical Student Section
AMA DELEGATION
2009 ANNUAL REPORT
The campaign of Evansville urologist Barney Marynard, M.D., for the AMA Board of
Trustees fell just 26 votes short of success in a House of 543 voting delegates. Every
member of the ISMA delegation spent many hours working on the election effort,
particularly Bill Mohr, M.D., who managed Barney’s campaign. Barney ran a clean race
we all can be proud of, upholding the tradition of strong leadership from Indiana.
In recent years, your Indiana delegation has produced a board chairman (Lowell Steen,
M.D.), a House speaker (John Knote, M.D.), a Council on Medical Education chairman
(George Lukemeyer, M.D.), a Council on Constitution and Bylaws chairman (Shirley
Khalouf, M.D.), a Council on Legislation chairman (Barney Maynard, M.D.), and two
Council on Medical Service chairmen (John Knote, M.D., and Bill Beeson, M.D.).
It is difficult to win an election when 543 votes are available and your delegation has
five. There are no losers, unless it is the AMA which will not be in a position to avail
itself of Barney’s expertise at the board level. I want to take this opportunity to
recognize and thank each member of the Indiana delegation, the ISMA leadership and
the specialty society delegates from Indiana for a job well done.
The annual meeting of the AMA was held in Chicago the third week of June. As might
be expected, the substantive matters tended to be overshadowed by the looming issue
of health care reform. At that time our leadership had been at the table since the
November election, trying to craft and modify efforts by executive and legislative
leaders to alter the delivery and payment system for our nation’s health care.
It can hardly come as a surprise that the issue of health care reform generated heated
debate. At that time a draft of proposed legislation was circulating. It included a public
plan alternative that threatened private contracting by physicians, mandated payment
negotiations be based on Medicare rates, and essentially made it nearly impossible for a
physician to avoid participation.
Conspicuously absent from this early draft was mention of the sustainable growth rate
(SGR) that ties physician payment to the Gross Domestic Product – rather than the cost
of providing care. There was no plan to erase the accrued SGR debt that would result in
a 21 percent across-the-board cut in physician payment rates for Medicare. In addition,
antitrust relief for physicians and medical liability reform were nowhere to be found.
The debate in Chicago boiled down to whether we would continue to work with
lawmakers to effect change in the legislation to advantage both our patients and our
constituency, or categorically oppose health care reform (HCR). To call the debate
heated falls short of accurate description. Many passionate pleas were made on both
sides of the issue of our involvement with HCR.
When the smoke and emotion cleared, the AMA House of Delegates voted to support
HCR “if consistent with the principles of pluralism, freedom of choice, freedom of
practice, and universal access for patients.” The AMA House of Delegates voted to
reaffirm policy for reform that includes the following goals:
Expansion of affordable coverage
Permanent repeal of SGR quality improvement, rather than profiling
Adequate physician payment
Administration simplification
Medical liability reform
Empowering physicians with antitrust relief
There is no point in detailing HR 3200 because by next week or the week after, it will be
old news. When the Senate bill finally clears the committee process and reaches the
floor, it will be significantly different than the House bill. Numerous amendments will
be added and deletions made before each chamber votes on the final bills. The results
are almost certain to end up in a joint House and Senate Conference Committee where
the final details will be determined.
It appears something will pass. Too much political capital has been invested for nothing
to happen. The White House is now calling the effort “health Insurance reform,” while
running into opposition during the August recess. The only thing certain is that much
debate will follow during the coming months.
The AMA House of Delegates along with numerous specialty societies decided the best
interests of physicians would be served by the involvement of physician leadership
throughout this lengthy process. Was this the right decision? Only history will tell, and
even with hindsight, we won’t know what would have happened had we stayed on the
sidelines and supported the status quo.
Respectfully submitted by Michael Mellinger, M.D., chair
RESOLUTION 09-01
STATEWIDE GUIDELINES FOR THE
ESTABLISHMENT OF BRAIN DEATH
Introduced by:
Emil L. Weber, M.D.
Referred to:
Whereas, reliable and consistent guidelines are essential for the establishment of brain
death and facilitate the best possible end-of-life decisions for treating physicians, nextof-kin, and/or legal representatives; and
Whereas, the Indiana Organ Procurement Organization (IOPO) has found
inconsistencies within the state for establishing brain death including: hospitals with no
policy for the establishment of death, confusion regarding recognized definitions of
brain death, inconsistencies in diagnostic protocols among physicians charged with
determining death by neurological criteria and inappropriate use of radiologic agents
for determining brain death; and
Whereas, new therapeutic interventions, i.e. hypothermia, barbiturate coma and
hemicraniectomy complicate the present day brain death determination process; and
Whereas, most practicing physicians do not confront brain death determination issues
in their day-to-day care of patients, reference guidelines serve as a valuable tool to help
direct the process to obtain accurate diagnostic information for patient care decisionmaking; therefore, be it
RESOLVED, that the ISMA adopt brain death guidelines for adults and children, and a
checklist for adults for use in Indiana medical facilities. (Proposed guidelines are
attached.)
Proposed Guidelines for Brain Death Determination
in the State of Indiana
ADULT DIAGNOSTIC CRITERIA –
PATIENTS ABOVE 18 YEARS OF AGE
I. Diagnostic criteria for clinical diagnosis of brain death
A
.
B.
Prerequisites. Brain death is the absence of clinical brain function when the
proximate cause is known and demonstrably irreversible.
1.
Clinical or neuroimaging evidence of an acute CNS catastrophe that is
compatible with the clinical diagnosis of brain death
2.
Exclusion of complicating medical conditions that may confound clinical
assessment (no severe electrolyte, acid-base, or endocrine disturbance)
3.
No drug intoxication or poisoning
4.
Core temperature > 32o C (90o F)
The three cardinal findings in brain death are coma or
unresponsiveness, absence of brainstem reflexes, and apnea.
1.
Coma or unresponsiveness—no cerebral motor response to pain in all
extremities (nail-bed pressure and supraorbital pressure)
2.
Absence of brainstem reflexes
a
)
Pupils
i.
No response to bright light
ii. Size: midposition (4 mm) to dilated (9 mm)
b
)
Ocular movement
i.
No oculocephalic reflex (testing only when no fracture or
instability of the cervical spine is apparent)
ii.
No deviation of the eyes to irrigation in each ear with 50 ml of
cold water (allow 1 minute after injection and at least 5 minutes
between testing on each side)
c) Facial sensation and facial motor response
d
)
i.
No corneal reflex to touch with a throat swab
ii.
No jaw reflex
iii
.
No grimacing to deep pressure on nail bed, supraorbital ridge, or
temporomandibular joint
Pharyngeal and tracheal reflexes
i.
No response after stimulation of the posterior pharynx with
tongue blade
ii.
No cough response to bronchial suctioning
3.
Apnea—testing performed as follows:
a)
Prerequisites
i.
Core temperature > 36.5o C or 97o F
ii.
Systolic blood pressure > 90 mm Hg
iii
.
Euvolemia. Option: positive fluid balance in the previous 6
hours
iv
.
Normal PCO2. Option: arterial PCO2 > 40 mm Hg
v.
Normal PO2. Option: preoxygenation to obtain arterial PO2 > 200
mm Hg
b) Connect a pulse oximeter and disconnect the ventilator.
c)
Deliver 100% O2, 6 l/min, into the trachea. Option: place a cannula at
the level of the carina.
d) Look closely for respiratory movements (abdominal or chest
excursions that produce adequate tidal volumes).
e)
Measure arterial PO2, PCO2, and pH after approximately 8 minutes
and reconnect the ventilator.
f)
If respiratory movements are absent and arterial PCO2 is > 60 mm Hg
(option: 20 mm Hg increase in PCO2 over a baseline normal PCO2),
the apnea test result is positive (i.e., it supports the diagnosis of brain
death).
g) If respiratory movements are observed, the apnea test result is
negative (i.e., it does not support the clinical diagnosis of brain
death), and the test should be repeated.
h) Connect the ventilator if, during testing, the systolic blood pressure
becomes < 90 mm Hg or the pulse oximeter indicates significant
oxygen desaturation and cardiac arrhythmias are present;
immediately draw an arterial blood sample and analyze arterial
blood gas. If PCO2 is > 60 mm Hg or PCO2 increase is > 20 mm Hg
over baseline normal PCO2, the apnea test result is positive (it
supports the clinical diagnosis of brain death); if PCO2 is < 60 mm Hg
or PCO2 increase is <20 mm Hg over baseline normal PCO2, the result
is indeterminate, and an additional confirmatory test can be
considered.
II. Pitfalls in the diagnosis of brain death
The following conditions may interfere with the clinical diagnosis of brain
death, so that the diagnosis cannot be made with certainty on clinical grounds
alone. Confirmatory tests are recommended.
A.
Severe facial trauma
B.
Preexisting pupillary abnormalities
C.
Toxic levels of any sedative drugs, aminoglycosides, tricyclic
antidepressants, anticholinergics, antiepileptic drugs, chemotherapeutic
agents, or neuromuscular blocking agents
D.
Sleep apnea or severe pulmonary disease resulting in chronic retention of
CO2
III. Clinical observations compatible with the diagnosis of brain death
These manifestations are occasionally seen and should not be misinterpreted as
evidence for brainstem function.
A.
Spontaneous movements of limbs other than pathologic flexion or
extension response
B.
Respiratory-like movements (shoulder elevation and adduction, back
arching, intercostals expansion without significant tidal volumes)
C.
Sweating, blushing, tachycardia
D.
Normal blood pressure without pharmacologic support or sudden
increases in blood pressure
E.
Absence of diabetes insipidus
F.
Deep tendon reflexes; superficial abdominal reflexes; triple flexion
response
G.
Babinski reflex
IV. Confirmatory laboratory tests (Options)
Brain death is a clinical diagnosis. A repeat clinical evaluation 6 hours later is
recommended, but this interval is arbitrary. A confirmatory test is not
mandatory but is desirable in patients in whom specific components of clinical
testing cannot be reliably performed or evaluated. It should be emphasized that
any of the suggested confirmatory tests may produce similar results in patiens
with catastrophic brain damage who do not (yet) fulfill the clinical criteria of
brain death. The following confirmatory test findings are listed in the order of
the most definitive test first. Consensus criteria are identified by individual
tests.
A
.
Conventional angiography. No intracerebral filling at the level of the
carotid bifurcation or circle of Willis. The external carotid circulation is
patent, and filling of the superior longitudinal sinus may be delayed.
B.
Electroencephalography. No electrical activity during at least 30 minutes of
recording that adheres to the minimal technical criteria for EEG recording in
suspected brain death as adopted by the American Electroencephalographic
Society, including 16-channel EEG instruments.
C. Transcranial Doppler ultrasonography
D
.
1.
Ten percent of patients may not have temporal insonation windows.
Therefore, the initial absence of Doppler signals cannot be interpreted as
consistent with brain death.
2.
Small systolic peaks in early systole without diastolic flow or
reverberating flow, indicating very high vascular resistance associated
with greatly increased intracranial pressure.
Technetium-99m hexamethylpropyleneamineoxime (HMPAO or Ceretec) or
Technetium 99m (ethyl cysteinate dimmer (ECD, Bicisate or Neurolite) brain
perfusion scintigraphy; otherwise known as isotope flow study with brain
scan.
No flow to brain and no uptake of isotope in brain parenchyma (hollow
skull phenomenon) is consistent with brain death.
E.
Somatosensory evoked potentials. Bilateral absence of N20-P22 response
with median nerve stimulation. The recordings should adhere to the
minimal technical criteria for somatosensory evoked potential recording in
suspected brain death as adopted by the American Electroencephalographic
Society.
V
.
Medical record documentation (Standard)
A
.
Etiology and irreversibility of condition
B.
Absence of brainstem reflexes
C. Absence of motor response to pain
D
.
Absence of respiration with PCO2 > 60 mm Hg
E.
Justification for confirmatory test and result of confirmatory test
F.
Optional: Repeat neurologic examination. The interval is arbitrary, but a 6hour period is reasonable.
G
.
Document repeat neurological examination if performed.
RESOLUTION 09-09
DUES WAIVERS
Introduced by:
Referred to:
Whereas, under certain circumstances the ISMA member district or county medical
societies may want to recommend waiving membership dues for a specific member or
members for a specified term; and
Whereas, specific reasons or categories of reasons should be delineated for such
recommendations (i.e., nationally declared disaster area such as flood, tornado,
hurricane or devastating fire; personal disaster of similar nature; overwhelming medical
illness; or other personal financial disaster); therefore, be it
RESOLVED, that the ISMA should act on dues waiver requests as approved and
forwarded by the initiating county by waiving member dues for a period not to exceed
two years with the option for renewal at the end of that time. Member so identified is to
remain in active status as long as member continues to practice in the area.
RESOLUTION 09-16
CHOICE REGARDING HEALTH CARE
INSURANCE/PROVIDER PRACTICES
Introduced by:
Steven Rupert, D.O., and Stacie Wenk, D.O.
Referred to:
Whereas, the 10th amendment protects the states and its people against limiting choices
not expressly described in the constitution; and
Whereas, health care is not expressly described in the constitution, and choice and
liberty is a fundamental freedom and expectation in the U.S.; therefore, be it
RESOLVED, that the ISMA House of Delegates (HOD), from all the districts of Indiana,
vote to either accept or reject the idea of national health care as accepted by the AMA;
and be it further
RESOLVED, that the ISMA send a letter based upon the HOD vote of acceptance or
rejection of national health care legislation to the AMA and to all state and federal
senators and representatives; and be it further
RESOLVED, that the ISMA design a state-run health care program, or a publicly owned
health care service organization, independent of any federal program based on a
medical cooperative, giving low cost medical services back to those who are
members/owners; this would include diagnostic radiology, laboratory services and
pharmacy; since all medical equipment will be owned prior to installation, the only cost
would be utilities, office and technicians’ salaries, and medical supplies; the majority of
the cost would be paid for by the yearly membership fee and minimal service charges
for each service rendered, and there will be no profits designed for this not- for-profit
organization; and be it further
RESOLVED, that the ISMA seek legislation that would provide support for state or
publicly owned health care service organizations; and be it further
RESOLVED, that the ISMA seek legislation allowing doctors to accept Indiana Medicaid
residents at the present reimbursement rates and deduct the loss of income on their
state taxes with the write-off at 150 percent of the Medicare price, based on 2005
Medicare rates minus the 2009 Medicaid rate; and be it further
RESOLVED, that the ISMA seek legislation protecting the citizens of Indiana that would
allow them choice between a government-run health care system versus a private-run
health care system, without incurring a penalty or a tax.
RESOLUTION 09-36
APPROPRIATE STATEMENTS OF CARE
Introduced by:
Referred to:
Whereas, Resolution 88-6A Communication/Methods by Insurers was readopted as
Resolution 99-41 and Resolution 99-41 will expire in 2009; therefore, be it
RESOLVED, that the ISMA object to statements by insurers of appropriateness of care;
that the ISMA urge all such statements by insurers and their designees be clearly
limited to statements pertaining to whether the care or service is covered or not
covered; and be it further,
RESOLVED, that the ISMA investigate whether attempts to determine appropriateness
of care by third parties constitutes the practice of medicine without a license.
RESOLUTION 09-38
GME FUNDING
Introduced by:
Referred to:
Whereas, Resolution 89-13 Additional Funding for Graduate Medical Education was
readopted as Resolution 99-41 and Resolution 99-41 will expire in 2009; therefore, be it
RESOLVED, that the ISMA support the concept and help seek additional funding for
Graduate Medical Education from the Indiana General Assembly.
RESOLUTION 09-39
MEDICAL CAREERS
Introduced by:
Referred to:
Whereas, Resolution 89-19 Medical Career Development Programs was readopted as
RESOLVED, that the ISMA, in cooperation with the IU School of Medicine and other
organizations, develop and encourage the establishment of Medical Career
Development Programs in high schools and universities throughout the state.
RESOLUTION 09-41
COMPACT OF CONDUCT
Introduced by:
Referred to:
Whereas, Resolution 86-6 Medical-Legal Compact of Conduct of the Indiana State Bar
Association and Indiana State Medical Association was readopted as Resolution 99-41
and Resolution 99-41 will expire in 2009; therefore, be it
RESOLVED, that the ISMA approve the Medical-Legal Compact of Conduct of the
Indiana State Bar Association and the Indiana State Medical Association.
RESOLUTION 09-48
PHYSICIAN HEALTH OFFICERS
Introduced by:
Referred to:
Whereas, Resolution 86-48 Physician Health Officers was readopted as Resolution 99-41
RESOLVED, that the ISMA continue to support statutory provisions that require the
local health officer to be a physician with an unlimited license to practice medicine in
Indiana.
RESOLUTION 09-49
LIMIT RESIDENT WORK HOURS
Introduced by:
Referred to:
Whereas, Resolution 89-44 Resident Work Hours was readopted as Resolution 99-41
RESOLVED, that the ISMA support, in principle, the need to limit resident work hours
and support the guidelines of the Accreditation Council for Graduate Medical
Education for resolution of the issue.
RESOLUTION 09-54
STATE FUNDS FOR LOCAL HEALTH
DEPARTMENTS
Introduced by:
Referred to:
Whereas, Resolution 99-06 State Funds for Local Health Departments supported
adequate funding for county health departments from July 1, 2001, to June 30, 2003; and
Whereas, the ISMA continues to support the need for adequate funding for county
health departments; and
Whereas, Resolution 99-06 is set to expire in 2009; therefore, be it
RESOLVED, that the ISMA request the Indiana General Assembly, in concurrence with
the governor, to fund all mandates passed to local health departments in order to assure
the public heath workforce is adequate to protect the health of Indiana’s citizens; and be
it further,
RESOLVED, that the ISMA ask the Indiana General Assembly that adequate funds to
carry out present state health mandates be provided by state budgetary appropriation
for county health departments.
RESOLUTION 09-55
DOCTORS’ UNION
Introduced by:
Referred to:
Whereas, Resolution 99-23A Doctors’Union is set to expire in 2009; therefore, be it
RESOLVED, that the ISMA work to educate members concerning a physician
negotiating organization and solicit members’ input concerning such an organization.
RESOLUTION 09-57
COLLECTIVE BARGAINING
Introduced by:
Referred to:
Whereas, Resolution 99-29A Collective Bargaining is set to expire in 2009; therefore, be
it
RESOLVED, that the ISMA study the voluntary, patient-oriented provisions of
collective bargaining based on the AMA model legislation for collective bargaining.
RESOLUTION 09-58
RESTRICTIVE COVENANTS
Introduced by:
Referred to:
Whereas, Resolution 99-33 ISMA Policy on Restrictive Covenants encouraged the ISMA
to revise its policy on restrictive covenants to match the AMA’s policy; and
Whereas, the ISMA has revised its policy on restrictive covenants to match the AMA, as
follows:
Covenants not to compete restrict competition, disrupt continuity of care,
and potentially deprive the public of medical services. The Council on
Ethical and Judicial Affairs discourages any agreement which restricts the
right of a physician to practice medicine for a specified period of time or
in a specified area upon termination of an employment, partnership or
corporate agreement. Restrictive covenants are unethical if they are
excessive in geographic scope or duration in the circumstances presented,
or if they fail to make reasonable accommodation of patients' choice of
physician; and
Whereas, Resolution 99-33 is set to expire in 2009; therefore, be it
RESOLVED, that the ISMA continue to endorse the AMA’s policy on restrictive
covenants.
RESOLUTION 09-59
USE OF TERM “PROVIDER”
Introduced by:
Referred to:
Whereas, Resolution 99-40 Use of Term “Provider” is set to expire in 2009; therefore, be
it
RESOLVED, that the ISMA oppose use of the term “provider” or “health care provider”
to refer to a physician; and that our delegates to the AMA pursue remedies on a
national level to correct this misuse of these terms.
RESOLUTION 09-61
MALPRACTICE COSTS FOR CLINIC WORKERS
Introduced by:
Referred to:
Whereas, Resolution 99-52 Malpractice Costs for Clinic Workers is set to expire in 2009;
and
Whereas, Indiana law provides malpractice immunity for doctors providing free,
uncompensated care at health care clinics, but such law does not include compensated
employees of such clinics; therefore, be it
RESOLVED, that the ISMA request the Indiana legislature be aware of the plight of
those who work/volunteer at free clinics for indigent health care; and be it further,
RESOLVED, that the ISMA encourage the Indiana General Assembly to enact
legislation that would provide professional employees of free clinics, as well as all
volunteers, immunity from medical malpractice liability and be covered with a broad
clinic malpractice insurance policy.
RESOLUTION 09-63
UNIFORM RATES FOR LIABILITY INSURANCE
Introduced by:
Referred to:
Whereas, Resolution 86-32 Uniform Rates for Liability Insurance was readopted as
RESOLVED, that the ISMA continue its efforts to ensure that the insurance
commissioner does not allow arbitrary or capricious changes in malpractice premium or
surcharge rates.
RESOLUTION 09-64
STUDY THE COST OF ISMA ADMINISTRATIVE
SERVICES FOR SPECIALTY SOCIETIES
Introduced by:
Michael Sha, M.D., Indiana Chapter of ACP and
Indiana Radiology Society
Referred to:
Whereas, the strength of the House of Medicine in Indiana rests on the strength of the
Indiana State Medical Association and specialty societies with which the ISMA
frequently collaborates; and
Whereas, every physician in practice has both a geographic and specialty designation;
and
Whereas, several specialty societies including the Indiana Chapter of the American
College of Surgeons, the Indiana Chapter of the American Academy of Pediatrics, the
Indiana Chapter of the American College of Physicians, and the ISMA Alliance
currently contract for administrative services from the ISMA; and
Whereas, the House of Medicine in Indiana can be strengthened through fostering
increased interaction between the ISMA and specialty societies, and one strong means
of fostering the strength of specialty societies is through the administrative support that
the ISMA can offer; and
Whereas, these administrative services are quite costly and outside the price range for
many smaller societies; therefore, be it
RESOLVED, that the ISMA Board of Trustees study whether a modest subsidy of the
cost of administrative services provided to specialty societies and the ISMA Alliance
can foster: (1) these organizations’ strength; and (2) greater participation by smaller
societies for which the cost of ISMA-furnished services are currently too prohibitive.
RESOLUTION 09-65
PATIENT HEALTH INFORMATION
Introduced by:
Lee Smith Jr., M.D.
Referred to:
Whereas, the emphasis on the confidentiality of health information has placed an
impediment on patients to obtain copies of laboratory or other reports from the doctors
that ordered the same; and
Whereas, to facilitate a patient’s ability to be well-informed and to know all that has
transpired from the most recent consultation; therefore, be it
RESOLVED, that the ISMA encourage physicians to routinely provide written lab
results to patients as soon as available.
Reference Committee II
Legislative Issues
Chair: Agnes Bacala, M.D.
Shawn Swan, M.D.
Patrick Anderson, M.D.
Eric Kleeman, M.D.
Mercy Obeime, M.D.
Arun Gowdamarajan, M.D., Alternate
Legislative Issues
(meets in Cosmopolitan CD on the third floor Hyatt Regency Hotel on Saturday,
Sept. 26, at 10 a.m.)
Reports referred to Reference Committee II:
Commission on Legislation Annual Report
Resolution #
Resolution 09-13
Tobacco Settlement
Dick Huber, M.D.
Resolution 09-42
Oppose Medicare Cuts
Resolution 09-46
Generic Substitution by Pharmacist
Resolution 09-50
Non-Physician Diagnosis
Resolution 09-52
Dispensing Medications
Resolution 09-60
Prescription Medication for Indigent Care
discussion.
NEW RESOLUTIONS
Resolution #
Resolution 09-04
Need for Alternative Covered Medication to be
Provided, Upon Request, for a Prior Authorization
Marc Willage, M.D.
Resolution #
Resolution 09-05
Medical Marijuana
Resolution 09-06
Dietary Supplements
Caitilin Kelly, M.D.; Monroe/Owen County Medical
Society; 2nd District Medical Society; ACP Indiana
Chapter Health and Public Policy Committee
Resolution 09-10
Indiana Department of Insurance Provider
Complaints
David Welsh, M.D.
Resolution 09-12
Cell Phones and Driving
Dick Huber, M.D.
Resolution 09-14
Rescission
Caitilin Kelly, M.D.; the Indiana ACP Health and
Public Policy Committee; Monroe/Owen County
Medical Society; ACP Governor’s Council; Michael
Sha, M.D.; Deepak Azad, M.D., Lois Lambrecht, M.D.,
Robert Lubitz, M.D., and Linda Abels, M.D.
Resolution 09-22
Civil Legal System
P.K. Samaddar, M.D.
Resolution 09-23
Attorney General Defense of Physicians Named in
Civil Rights Suits by Prisoners
Vidya Kora, M.D.
Commission on Legislation
2009 Annual Report
The 2009 legislative session opened in early January following November elections that
saw a decisive victory by Gov. Daniels. The House Democrats increased their majority
52-48 while the Senate Republicans retained majority in the Senate 32-18. With the long
session comes the biannual exercise known as HB1001 – the budget. As with every other
state across the U.S., Indiana watched revenue forecasts closely to construct a balanced
budget.
The 2009 session of the Indiana General Assembly saw more than 2,000 bills filed for
consideration. About 180 bills passed, many of which were of particular interest to the
ISMA. This report will feature items that may have a direct effect on your practice.
Space does not allow for attention to bills that failed to pass but, as always, they are often
even more important. Please refer to the Legislative News inserted with the May 11 ISMA
Reports for details. For convenience, bills are categorized under four headings: Budget,
Insurance, Legal and Miscellaneous.
Budget and defense
With the focus on a balanced budget, efforts by the administration to balance the
Medicaid program were front and center. Medicaid is the second largest expense to the
state only behind education. Plans were announced in December by the Family and
Social Services Administration (FSSA) to begin a 5 percent holdback across all Medicaid
providers and to also carve out the pharmacy management programs of the MCOs and
have the state take over management of the program. By implementing the pharmacy
carve out the state had hoped to realize a savings of over $40 million. The state would
also then consolidate the three MCO formularies into one state standardized drug list.
Language for and against both of these topics was introduced in legislation. After a
regular session ending April 29 and a special session to complete work on the budget
ending June 30, the result was no 5 percent holdback. The state balanced the budget on
the potential savings by implementing the pharmacy carve out. This will be an area to
watch closely as the state manages the program, given so much is riding on the success of
realizing nearly$ 60 million in savings over two years.
In addition to playing defense in terms of Medicaid cuts, the ISMA also held the day
when it came to scope of practice issues as in SB 89 and SB 86. Originally, SB 89
required physicians to be credentialed by a local county hospital prior to performing an
abortion in that county. This was expanded in the House after it left the Senate to include
that any physician performing a “surgical procedure” must obtain credentialing by a local
hospital. The bill died in conference committee.
SB 86 was amended to provide for licensure of certified professional midwives in the
state of Indiana. The ISMA led the opposition to the regulation of non-medically trained
individuals from assisting in the home birth of a child. The amended bill did not pass the
House floor before the deadline and therefore failed.
Insurance
HB 1300-HEALTH PROVIDER PATIENT LIMIT STUDY - The ISMA aggressively
supported this bill which was opposed by the insurance lobby and organized labor. The
final version asks the Indiana Department of Insurance to collect information regarding
the costs of initiating and operating a system that recognizes assignment of benefits to
out-of- network providersand to report results to the Health Finance Commission. For
now, reimbursement will go to the patient for services rendered by an out-of-network
provider. Payment must be accompanied by instructions to the patient as to his obligation
to the non-contracted provider.
HB 1300 also asks the Health Finance Commission to study a health plan provider
contract provision that requires a contracted provider to accept more than a certain
number of patients (open access clauses). The Health Finance Commission is to report its
findings to the legislative council before Nov. 1, 2009. The assignment of benefits
portion of HB 1300 was initially SB 75
House Resolution 91-HEALTH INSURER CODE OF CONDUCT - A work group
consisting of the AMA, national medical specialty societies and state medical societies is
currently developing this code as a template for ethical practices by insurers. The fact that
the Indiana General Assembly recognizes the need for such a resolution that encourages
this action by the AMA speaks volumes.
HB 1382-INSURANCE COVERAGE FOR PATIENTS INVOLVED IN CLINICAL
TRIALS - This bill requires most insurers to cover routine medical care not directly
related to the disease or condition involving the clinical trial.
Legal
SB 16-LEARNER’S PERMITS AND GRADUATED LICENSES - This frequently
amended bill places limits on the driving privileges granted to those under 18 years of
age. Among those limitations are: no use of communication devices, presence of an adult
in the vehicle, and changing the entrance age for the classroom portion of driver’s
edecation to 15 and a half years. It previously was 15.
SB 342-COMPENSATION OF VICTIMS OF VIOLENT CRIMES AND WRONGFUL
DEATH OF A CHILD - This was a very popular bill that passed over our concerns about
the wrongful death. The measure addresses the unborn fetus that has attained viability.
There is no definition of viability in the statute and our fear is that it might create a
double jeopardy situation for medical liability and the Patient’s Compensation Fund. This
probably will have to be determined by case law as it is not addressed in the legislation.
SB 181-CHILD SEDUCTION AND REPEAT SEX OFFENDERS - This allows a court
to subpoena certain documents, such as HIV test results, in a case that involves a
potential disease transmitting offense.
Miscelleaneous
SB 218-BILLING AND CLAIMS FOR ANATOMIC PATHOLOGY SERVICES –
Originally, this bill involved direct billing for anatomic pathology, e.g. examination of
tissue specimens. However, all significant language was stripped from the bill and the
final result was limited to allowing IU Medical Center to ship cadavers out of state.
HB 210-PSYCHIATRY LOAN REPAYMENT PROGRAM - This is a combination of a
House bill dealing with mental health and addiction matters and a senate bill establishing
a primary care physician loan forgiveness program. The final version from the conference
committee passed overwhelmingly. Unfortunately, the intent of this bill, which is to
encourage recruitment of primary care physicians and psychiatrists, is compromised by
the lack of a funding mechanism.
HB 1593-SURGICAL TECHNOLOGISTS - This started as a bill requiring certification
of all surgical technologists assisting at a facility. The final compromise language allows
physicians to use their own assistants regardless of certification if the facility in question
does not require certification.
HB 1573-VARIOUS PROFESSIONAL MATTERS - This bill addresses a hodgepodge
of issues. It creates a licensure system for genetic counselors. It essentially waives
licensure laws for 30 days for health care professionals associated with out-of-state
athletic teams. If medical records are destroyed by a natural disaster the physician is
absolved of responsibility. Also, it empowers the Medical Licensing Board to write
regulations for the handling of medical records upon closure of a practice.
I would like to thank members of the Commission on Legislation, including the ISMA
officers, for their insight and deliberation. Mike Rinebold, director of Government
Relations, and his team; Lawrence McCormack, associate director, Ambre Marr,
legislative liaison, and Sally Pierson, administrative assistant, did an excellent job on
your behalf during the past year. If you see them at the state meeting thank them for a job
well done. And, last but certainly not least, thanks to Jim McIntire and Julie Reed for
keeping us on the right side of the law.
Respectfully submitted by Michael Mellinger, M.D.
RESOLUTION 09-04
NEED FOR ALTERNATIVE COVERED
MEDICATIONS TO BE PROVIDED, UPON
REQUEST, FOR A PRIOR AUTHORIZATION
Introduced by:
Referred to:
Whereas, there are many different forms of not only commercial insurance, but also of
Medicaid and “Part D” coverages; and
Whereas, each of the above mentioned entities have differing lists of medications that
would be allowed, upon denial of coverage for initially prescribed medication;
therefore, be it
RESOLVED, that the ISMA initiate and support legislation requiring insuring entities to
list covered medications to choose from, upon denial of coverage for initially prescribed
medication requiring prior authorization – for consideration at times when there is no
compelling reason to stick with the initially prescribed medication.
RESOLUTION 09-05
MEDICAL MARIJUANA
Introduced by:
Referred to:
Whereas, one of the primary roles of physicians is to relieve pain and suffering as much
as possible; and
Whereas, to achieve this end, physicians have always been willing to use potent,
potentially harmful, even potentially lethal drugs (such as morphine); and
Whereas, adverse reactions to drugs such as aspirin and ibuprofen account for 7,600
deaths and 76,000 hospitalizations in the United States, which has not led physicians to
call for a ban of these products because their therapeutic benefits outweigh their risks;
and
Whereas, in contrast, marijuana has not been shown to cause any deaths and, compared
to the medications we use on a daily basis with patients, has almost no adverse side
effects; and
Whereas, the medical use of marijuana should be considered entirely separate from the
discussion as to its general legalization, just as we have always done with drugs such as
morphine; that is, the debate surrounding legalization for general use should not
obscure scientific findings regarding legitimate, medically prescribed use; and
Whereas, in 1997, the White House Office of National Drug Control Policy asked the
Institute of Medicine (IOM) to review scientific evidence and assess the risks and
benefits of marijuana. (They concluded marijuana has therapeutic properties that can
treat many illnesses and conditions. They further noted that “…adverse side effects of
marijuana use are within the range of effects tolerated for other medications.” Some of
these uses include treatment for HIV wasting, glaucoma, neurological movement
disorders and analgesia, and anti-emetic effect for some cancer patients.); and
Whereas, the national American College of Physicians (ACP) Health and Public Policy
Committee has released a 2008 Position Paper, approved by the ACP Board of Regents,
supporting exemption from criminal or civil penalties for physicians prescribing and
patients using medical marijuana; and
Whereas, we should not ignore an effective and safe therapeutic option for patients
because of the social discomfort we feel with its association with illegal street drug use
(any more than we do for many other drugs that we prescribe that also can be abused,
such as morphine, codeine, hydrocodone, duragesic and oxycontin); and
Whereas, there are now 13 states in the United States that allow medical marijuana for
their residents, and Illinois is also considering a proposal; the Minnesota legislature
recently approved legislation that was vetoed by its governor; additionally, Ohio allows
for a minor fine for possession of small amounts of marijuana and no incarceration, etc.;
therefore, be it
RESOLVED, that the ISMA join the American College of Physicians (ACP) and the
Institute of Medicine (IOM) in encouraging legislation that would allow licensed
physicians to legally prescribe medical marijuana to patients suffering medical
conditions where, in their medical judgment, it is the best therapeutic option for the
patient ; and be it further
RESOLVED, that the ISMA encourage legislation that would provide a mechanism for
the production and distribution of marijuana for medical purposes, and provide the
legal means, such as medical necessity defense, to thwart the federal government from
interfering with this effort. This would in no way be supporting its legalization for
general use, outside of medical practice.
RESOLUTION 09-06
DIETARY SUPPLEMENTS
Introduced by:
Caitilin Kelly, M.D.; Monroe/Owen County
Medical Society; 2nd District Medical Society;
ACP Indiana Chapter Health and Public Policy
Committee
Referred to:
Whereas, dietary supplements are taken by millions of Americans and represent a $19
billion a year business; and
Whereas, recent independent lab testing has found that many products often do not
contain the stated amount of each ingredient – sometimes having much less, sometimes
much more; and
Whereas, having too little (some products did not contain the stated amount of folic
acid) or too much (some had dangerous levels of vitamin A) can cause significant harm
to unsuspecting consumers; and
Whereas, this testing also has revealed many products to be contaminated by
potentially toxic substances including unacceptable levels of lead in children's vitamins,
as shown by a recent study; and
Whereas, it should be considered fraud not to have what is stated on the label; and
Whereas, consumers should have the right to expect uncontaminated supplements just
as they expect it with other food products; therefore, be it
RESOLVED, that the ISMA work with legislators to encourage passage of legislation
that would lead to government supervision to ensure content and purity of over-thecounter supplements, while continuing to otherwise support the Dietary Supplement
Health and Education Act passed by Congress that does not evaluate product safety or
efficacy.
RESOLUTION 09-10
INDIANA DEPARTMENT OF INSURANCE
PROVIDER COMPLAINTS
Introduced by:
David Welsh, M.D.
Referred to:
Whereas, the Indiana Department of Insurance (IDOI) is the state agency charged with
oversight of health insurance companies; and
Whereas, the IDOI is charged with issuing an annual index totaling complaints filed
against all health insurance companies; and
Whereas, Anthem routinely tells the IDOI not to include ERISA complaints in its annual
complaint index and IDOI does not include them; and
Whereas, the IDOI has complaint forms on its Web site that consumers and health care
providers, including physicians, can use to file complaints against health insurance
companies; and
Whereas, the patient complaint form can be filed electronically, but the provider
complaint form must be filed by fax or postal mail; and
Whereas, the IDOI unilaterally revised its provider complaint form in approximately
late April 2009 to prohibit physicians from filing complaints valued at less than $250
and prohibiting hospitals from filing complaints worth less than $5,000; and
Whereas, the ISMA has approached IDOI about the complaint form change and IDOI
states that it is not statutorily required to accept provider complaints and has to-date
refused ISMA’s request to remove the dollar thresholds; and
Whereas, at least one physician’s office has already notified the ISMA that IDOI refused
its complaint because it did not meet the dollar threshold; therefore, be it
RESOLVED, that the ISMA seek legislation in the 2010 Indiana legislative session
requiring the Indiana Department of Insurance to receive all physician and other
provider complaints against health insurance companies, regardless of the dollar
amount, through electronic means; and be it further
RESOLVED, that the ISMA seek to amend current Indiana law in 2010 to require the
Indiana Department of Insurance to include all ERISA complaints in each health
insurance company’s annual complaint index.
RESOLUTION 09-12
CELL PHONES AND DRIVING (A PREDEATH EXPERIENCE)
Introduced by:
Dick Huber, M.D.
Referred to:
Whereas, recent reports and studies indicate that:
1. Drivers using cell phones are four times as likely to cause a crash
2. Drivers using cell phones are as likely to crash as if driving with a 0.08 percent
blood alcohol concentration
3. Hands-free devices do not eliminate risks and may even worsen risks by
suggesting such behavior as safe
4. Cell phone distractions cause 2,600 U.S. traffic deaths each year with 330,000 `
crashes that result in injuries
5. Drivers overestimate their own ability to safely multi-task
6. Functional MRI studies show clearly that when drivers concentrate listening
on a phone, the part of the brain that controls vision becomes less effective,
and vice versa; therefore, be it
RESOLVED, that the ISMA seek and support state and federal legislation, policy, rules
and regulations to prohibit the use of wireless communication devices while driving,
except in emergency situations.
RESOLUTION 09-13
TOBACCO SETTLEMENT
Introduced by:
Dick Huber, M.D.
Referred to:
Whereas, resolution 99-31A resulted in the ISMA adopting policy addressing monies
from the tobacco settlement; therefore, be it
RESOLVED, that the ISMA again declare as policy that all monies derived from the
tobacco settlement be used for health care and the promotion of community health, and
that the ISMA continue to take a leadership role with other health care entities to ensure
that tobacco settlement monies remain within the health care arena.
RESOLUTION 09-14
RESCISSION
Introduced by:
Caitilin Kelly, M.D.; the Indiana ACP Health and Public
Policy Committee; ACP Governor’s Council; Michael Sha,
M.D.; Deepak Azad, M.D.; Lois Lambrecht, M.D.; Robert
Lubitz, M.D.; and Linda Abels, M.D.
Referred to:
Whereas, the executives of three of the nation’s largest health insurers have told federal
lawmakers that they will continue the act of retroactively canceling insurance, called
“rescission,” despite requests from both Democrat and Republican legislators to limit
this practice to only policyholders who intentionally lie or commit fraud to obtain
coverage; and
Whereas, these same three insurers have cancelled coverage of more than 20,000 people,
allowing the insurers to avoid paying more than $300 million in medical claims over a
five-year period; and
Whereas, policy holders with breast cancer, lymphoma and more than 1,000 other
conditions were targeted for rescission and insurers’ employees were praised in
performance reviews for terminating the policies of customers with expensive illnesses;
and
Whereas, a typical example of this practice is a woman diagnosed with breast cancer
who inadvertently omitted a visit to the dermatologist for acne decades earlier, and on
that basis had her coverage dropped, just when it was most needed; and
Whereas, in some cases patients had not even been informed of specific minor
abnormalities on scans or blood tests found in their records; and
Whereas, this practice is clearly unethical; and
Whereas, this practice leads to large numbers of medical bankruptcy cases, the leading
cause of bankruptcy in the U.S.; therefore, be it
RESOLVED, that the ISMA and the ACP work at the state and national levels to pass
legislation requiring health insurers to limit the practice of rescission only to
policyholders who intentionally lie or commit fraud to obtain coverage.
RESOLUTION 09-22
CIVIL LEGAL SYSTEM
Introduced by:
P.K. Samaddar, M.D.
Referred to:
Whereas, the U.S. legal system is based in part upon that of England; and
Whereas, substantial differences have evolved over the past two centuries in the
procedural methods regarding the manner in which civil tort cases are adjudicated; and
Whereas, the current English procedural system requires the unsuccessful plaintiff to
compensate the defendant for both pain and suffering and attorney fees; and
Whereas, frivolous lawsuits against a physician can cause severe financial, emotional
and personal difficulties and can potentially have a lasting negative impact on a
physician’s private practice; and
Whereas, putting the financial burden on the losing party in a malpractice lawsuit
might decrease the likelihood of such frivolous lawsuits; therefore, be it
RESOLVED, that the ISMA support a change in the civil legal system that would force
the plaintiff patient in a malpractice lawsuit to pay the defendant physician
compensatory and punitive damages if the plaintiff patient loses at court.
RESOLUTION 09-23
ATTORNEY GENERAL DEFENSE OF PHYSICIANS
NAMED IN CIVIL RIGHTS SUITS BY PRISONERS
Introduced by:
Vidya Kora, M.D.
Referred to:
Whereas, physicians treating prisoners are subject to being named by prisoners in
medical malpractice and civil rights discrimination lawsuits; and
Whereas, medical malpractice insurance generally does not cover civil rights
discrimination lawsuits or medical malpractice lawsuits arising from jail services; and
Whereas, prisoners are considered to be more litigious, can have difficult personalities,
and often have mental health or addiction issues that are difficult to treat; and
Whereas, physicians should not be deterred from treating prisoners, regardless of the
setting; and
Whereas, physicians working in hospital emergency rooms or fulfilling emergency oncall obligations cannot refuse to treat a patient; and
Whereas, Indiana law provides immunity for employees and contractors of the state in
civil suits in certain circumstances, but not for providing medical care; and
Whereas, Indiana law provides that the Office of the Indiana Attorney General will
defend employees and contractors of the state in civil rights cases in certain
circumstances; and
Whereas, a physician who is an employee or contractor of a jail could request the
defense of the Indiana Attorney General in civil rights cases brought by prisoners, but a
physician treating a prisoner in a hospital setting cannot; therefore be it
RESOLVED, that the ISMA seek legislation that will provide physicians who are
employees or contractors of the state immunity in all civil suits brought by prisoners,
including medical malpractice; and be it further
RESOLVED, that the ISMA seek legislation requiring the Office of the Indiana Attorney
General to defend civil rights discrimination lawsuits brought against all physicians
treating prisoners of the state inside a hospital.
RESOLUTION 09-42
OPPOSE MEDICARE CUTS
Introduced by:
Referred to:
Whereas, Resolution 89-50 Medicare Appropriations was readopted as Resolution 99-41
RESOLVED, that the ISMA oppose cuts by Congress to Medicare appropriations.
RESOLUTION 09-46
GENERIC SUBSTITUTION BY PHARMACIST
Introduced by:
Referred to:
Whereas, Resolution 76-1 Generic Substitution of a Prescribed Drug was readopted as
Resolution 99-41 and Resolution 99-41 will expire in 2009; and
Whereas, current law allows a pharmacist to substitute generic prescriptions under two
circumstances:
1. If the patient is covered by a government health program (Medicaid,
Children’s Health Insurance Program and Medicare), the pharmacist must
substitute generic medication when it is less expensive unless the words
“Brand Medically Necessary” are written in the practitioner’s own writing or
included with an electronically transmitted prescription;
2. If the patient is not covered by a government health program, the pharmacist
may substitute generic medication if the physician signs the “May substitute”
line of the paper prescription or indicates “may substitute” on an
electronically transmitted prescription;
therefore, be it
RESOLVED, that the ISMA oppose generic substitution for a prescribed drug done at
the discretion of a pharmacist.
RESOLUTION 09-50
NON-PHYSICIAN DIAGNOSIS
Introduced by:
Referred to:
Whereas, the Resolution entitled Non-Physician Diagnosis from the 1973 House of
Delegates was readopted as Resolution 99-41 and Resolution 99-41 will expire in 2009;
therefore, be it
RESOLVED, that the ISMA oppose legislation that would authorize non-physicians to
engage in the diagnosis or treatment of disease or injury, and unequivocally oppose and
seek to defeat any legislation that would extend the scope of any allied health
profession into the areas of the practice of medicine.
RESOLUTION 09-52
DISPENSING MEDICATIONS
Introduced by:
Referred to:
Whereas, Resolution 87-18 Dispensing Medications from the Office was readopted as
RESOLVED, that the ISMA oppose any legislative or regulatory attempts that would
deny the physician the legal and professional right to dispense medications from the
office and that the ISMA would continue to keep its members informed about the
proper guidelines and procedures for dispensing medications from the office.
RESOLUTION 09-60
PRESCRIPTION MEDICATION FOR INDIGENT
CARE
Introduced by:
Referred to:
Whereas, Resolution 99-51 Prescription Medication for Indigent Care is set to expire in
2009; therefore, be it
RESOLVED, that the ISMA support or initiate legislation to change the present
requirements governing the providing of prescription medication (not controlled
substances) that would allow free or reduced fee health care facilities the opportunity to
provide pharmaceutical services.
Reference Committee III
Chair: Tom Felger, M.D.
Teresa Lovins, M.D.
Theresa Rohr-Kirchgraber, M.D.
Bhanu Thaker, M.D.
Patrick Lotti, M.D., Alternate
(meets in Regency EF on the second floor on the Hyatt Regency Hotel on Saturday,
Sept. 26, at 11 a.m.)
Reports referred to Reference Committee III:
Commission on Medical Education Annual Report
Medical Education Fund Annual Report
Ad Hoc Committee on Insurance Annual Report
Commission on Physician Assistance Annual Report
Information Technology Committee Annual Report
Task Force on Price Transparency and Charity Care Management Annual Report
Medicaid Task Force Annual Report
Task Force on Peer Review Annual Report
Resolution #
Resolution 09-29
Opposition to Third-Party Payment
Resolution 09-30
Limiting Physician Free Choice
Resolution 09-32
Financial Incentives
Resolution 09-33
Prohibiting Unlicensed Mid-Wifery
Resolution 09-34
Notification of Professional Licensing
Agency Actions
Resolution 09-35
Insurance Reimbursement
Resolution 09-37
Requiring Insurers to Clearly Disclose Limitations
Resolution #
Resolution 09-40
Penalties for Coding Errors
Resolution 09-44
Unreasonable and Unnecessary Services
Resolution 09-47
Postoperative Care
Resolution 09-62
Adjustment of Medicaid Reimbursement
Rates
discussion.
NEW RESOLUTIONS
Resolution #
Resolution 09-07
Resolution 09-08
Malpractice Insurance Assistance
Resolution 09-18
Support of Gay Marriage
Resolution 09-21
Suspension of Medicaid Privileges for
Positive Drug Test
P.K. Samaddar, M.D.
Resolution 09-25
Newborn Auto Assignment and Retro-Active
Assignment to Medicaid Managed Care
Organizations
Teresa Lovins, M.D., Indiana Academy of Family
Physicians and the Indiana Chapter of the American
Academy of Pediatrics
Resolution 09-26
Simple and Uniform Prior Authorization Forms
Teresa Lovins, M.D., and the Indiana Academy of
Family Physicians
Commission on Medical Education
2009 Annual Report
The Indiana State Medical Association (ISMA) Commission on Medical
Education encourages quality continuing medical education activities within the
state, enables physicians to maintain their competency and incorporate new
knowledge, and improves health outcomes for patients and communities.
The ISMA is a recognized provider of Continuing Medical Education (CME) and
is nationally accredited by the Accreditation Council for Continuing Medical
Education (ACCME). The ISMA recognizes 44 organizations as providers of
quality Continuing Medical Education. The Commission on Medical Education
surveyed 10 organizations between September 2008 and July 2009. One provider
received six years accreditation; nine received four year accreditations.
The ISMA is also accredited by the Accreditation Council for Continuing Medical
Education as a national provider of CME for physicians. In 2008 and 2009, the
ISMA did not offer any CME activities.
Thomas Huth, M.D., vice president of Medical Affairs at Reid Memorial
Hospital, is the chairman of the Commission on Medical Education. Dr. Huth has
served on the commission for more than 15 years. He has the honor of serving in
that position with a number of CME professional volunteers from across the state
who survey and make CME accreditation decisions. This commission meets a
minimum of twice a year.
This past year, the ACCME made several changes:
In October 2008, the ACCME mandated an increase in CME fees to be
implemented in 2011.
In January 2009, the ACCME required that the ISMA implement the
ACCME’s Updated Criteria.
Beginning 2010, the ACCME will mandate that all recognized state
medical associations implement the ACCME’s Markers of Equivalency.
In July 2009, four state medical associations submitted to the AMA Resolutions
302 and 312. Both resolutions questioned the need for ACCME’s fee increase, as
well as the impact of the Update Criteria and the concept of equivalency.
Respectfully submitted by Thomas A. Huth, M.D., chairman
Medical Education Fund
2009 Annual Report
The goal of this committee, to accumulate $1,000,000 in principal, was achieved in 1995.
As of June 30, 2009, the balance stands at $1,176,515.02.
In August 2008, the committee elected to increase from $100,000, to $125,000 its
contribution to the Indiana University School of Medicine on an annual basis. The
contribution is funded entirely from earnings on the principal of this fund.
The ISMA Alliance raised $9,843 through the American Medical Association
Foundation, which was contributed to the medical school and its Centers for Medical
Education, for use by Indiana medical students.
Respectfully submitted by Peter Winters, M.D., chair
Ad Hoc Committee on Insurance
2009 Annual Report
The ISMA renewed its group health insurance program with Anthem on July 1, 2009. As the
fiduciary for ISMA’s group health insurance program, the committee continues to work diligently
to offer our members the best benefits, network access and service available at the lowest cost.
Based on these factors, it was the opinion of the committee that Anthem is the best carrier for the
ISMA at this time. Bids are currently being solicited from insurers and third-party administrators
to determine which carrier or combination of carriers will best serve the association for the July 1,
2010 renewal.
For subscribers renewing July 1, 2009, base rates for medical plans were increased by 11.58
percent. Rates for the dental plan were held. Further adjustments were made based on changes in
age groups. Finally, rates were also adjusted for some subscribers based on claims experience; 24
percent of individuals received a reduction and 19 percent an increase; 37 percent of groups
received a reduction and 28 percent an increase.
The two plans with the smallest deductibles were discontinued due to a low level of participation,
as was one Health Savings Account (HSA) plan that was very similar to another. A high
deductible PPO plan and a high deductible HSA plan were added. HSA plans continue to be
popular, with nearly 17 percent of subscribers participating in them.
The ISMA offers its members, their families and employees a choice of 10 PPO plan options,
including four Health Savings Account plans. It also offers one traditional plan, and a Medicare
carve-out. Ninety-eight percent of subscribers participate in PPO plans. The most popular plans
are those with $1,000 and $2,500 individual deductibles.
ISMA Insurance Agency markets the health insurance – along with other products and services –
to ISMA members and their employees. The ISMA maintains eligibility and collects premiums.
Anthem processes claims and provides reinsurance for large individual claims and high aggregate
claims.
Approximately 87 percent of premium dollars collected are available to pay claims, slightly better
than the market average of 86 percent. The remainder is used to pay for reinsurance, a human
organ and tissue transplant rider, utilization review/network access, commissions, Anthem’s fee
for claims administration, and ISMA’s fee for premium administration.
As of June 30, 2009, there were 4,387 subscribers enrolled in the program, down by 82
subscribers from one year ago. A large share of the terminations resulted from mergers of medical
practices into local hospitals and downsizings. Customer satisfaction surveys indicate insured
groups are satisfied with the program overall and with coverage for office visits, urgent care,
emergency room and prescription drugs. They are very satisfied with access to network
physicians and accuracy of claims payments. Also, they are unlikely to change carriers for a
similar price.
More than 21 percent of ISMA members participate, a strong number considering some
physicians have health insurance through a spouse’s employer and many receive health insurance
as a benefit of employment with a hospital, clinic or other large employer.
I thank members of the committee: Kevin Burke, M.D.; Ilwoong Chang, M.D.; Gregory Larkin,
M.D.; Rakesh Gupta, M.D.; Francis Price Jr., M.D.; and Kenny Stall, M.D., for their help. I also
thank the ISMA staff for their assistance.
Respectfully submitted by Alfred Cox, M.D., chair
Commission on Physician Assistance
2009 ANNUAL REPORT
2008 was a busy year for the Commission on Physician Assistance. Each year we have seen
an increase in the number of physicians requesting information about our program and an
increase in the number of physicians entering our program.
Presently, we have over 130 physicians in our program. The primary diagnosis continues to
be chemical dependency; however, we continue to see an increase in the number of cases of
behaviorally disordered physicians. We also work with psychiatrically impaired physicians.
This year we updated our Web page to better serve our members. We have listed many
resources for the physician struggling with behavioral and/or anger management issues. This
resource can also be helpful for medical staffs, as it lists workshops that address these issues
as well as courses on appropriate prescribing.
We continue to evaluate appropriate referral sources and assessment and treatment programs
for these physicians. We have updated our Physician Assistance brochure, and it is now
available on the Web site as well.
We continue to work on educating medical staffs, county medical societies and others
regarding program services and how to help the impaired or distressed colleague. The
continued interest and support of our dedicated group of commission members is
appreciated and enables the ISMA staff to carry out their duties effectively.
Respectfully submitted by Randall Stevens, M.D., chair, Commission on Physician
Assistance
Information Technology Committee
2009 Annual Report
The Information Technology Committee did not meet this year, but did offer input and
advice about developing policies regarding health information technology (HIT) and
electronic medical records.
Nationally, the HIT Committee on Meaningful Use and its workgroup have developed a
revised matrix on “meaningful use of electronic medical records.” The matrix contains
the goals and timeline for electronically capturing and recording health information in
coded format annually from 2011 to 2015. If the recommendations are finalized, they will
become the standard for the Centers for Medicare & Medicaid Services to follow in
determining any incentive payments to physicians and hospitals.
In analyzing the new matrix, the AMA requested feedback from medical societies.
Members of the IT Committee reviewed the matrix and offered comments and concerns
that were returned to the AMA.
At this year’s ISMA Convention, Maxwell IT will present a two-hour program on “How
Best to Select an EHR and “The New HITECH Stimulus Act.” The program will provide
further information on Medicare/Medicaid pay-for-performance initiatives for
“meaningful use” of EHR. Plan to attend to have your questions answered.
The IT Committee was asked to suggest names of physicians who would like to
participate in a work group as a component of the Indiana Health Informatics Corporation
(IHIC). The IHIC was formed via the Indiana Senate for the development and promotion
of health information processes within Indiana. Unfortunately, we were unable to identify
physicians who wished to participate. Two of ISMA’s IT Committee members already
serve the group: Todd Rowland, M.D., Bloomington, and Alan Snell, M.D., Indianapolis.
In addition to Dr. Rowland and Dr. Snell, I would like to thank Rami Saydjari, M.D.,
Crawfordsville; Dung Nuygen, M.D., Indianapolis; Eduardo Rivera, M.D., Columbus;
Andrew O’Shaughnessy, M.D., Fort Wayne; Matthew Zipes, Medical Student Society;
and ex officio members David Welsh, M.D., Batesville; Fred Ridge, M.D., Linton; Brent
Mohr, M.D., South Bend; Tom Vidic, M.D., Elkhart; and John Wernert, M.D.,
Indianapolis.
Respectfully submitted by Gordon Hughes, M.D., chairman
Physician Medicaid Task Force
2009 Annual Report
The Physician Medicaid Task Force (PMTF) members are: Deepak Azad, M.D.; Kevin Burke,
M.D.; Jeb Teichman, M.D.; David Black, M.D.; Chris Magee, M.D.; J. Scott Pittman, M.D.
(chair); Michael Sha, M.D.; Bernard Emkes, M.D.; Margo Carranceijie, M.D.; William Cassel,
M.D.; John Eliades, M.D.; Thomas Whiteman, M.D.; Matthew Bruns, M.D.; John Poncher,
M.D.; Don Wagoner, M.D.; C. Joe Ottinger, M.D; Arden Barnett, M.D.; Vidya Kora, M.D.; Brent
Mohr, M.D.; Fredrick Ridge Jr, M.D.; Thomas Vidic, M.D.; David Welsh, M.D.; and John
Wernert, M.D.
The Physician Medicaid Task Force (PMTF) worked closely with Jeffery Wells, M.D., and others
from the Office of Medicaid Policy and Planning (OMPP) on several Medicaid issues. In January
2009, the task force met with Dr. Wells who advised the members about the proposed 5 percent
take-back that would be implemented across the board from Medicaid. He announced that it
would take effect July 1st if the projections were accurate.
Dr. Wells stated an option to avoid the take-back was a drug carve-out that would mean one drug
benefit across the Medicaid program. Indiana should get a 34-35 percent rebate from the drug
supplier, which would represent $40 million a year in state dollars. He asked the task force to
actively support the pharmacy carve-out. There was a formal resolution from the task force to
support it.
Other issues on which the PMTF continues to work with OMPP include: Smart prior
authorizations (PAs),which should be up and running in 2009. Dr Wells said this should be
completely a non-issue for physicians. This software should offer the practice benefits by
avoiding as many PAs as possible for prescription drugs.
Prior authorization issues continue to be on the task force agenda for 2009. Our members
consider it unreasonable to require PA for procedures that are approved the majority of the time a
request is made. Elimination of the PA requirement for these procedures would decrease some of
the administrative issues currently in place for the care of the Medicaid population. Additionally,
as is the case with drug formularies, each managed care organization has its own PA
requirements. Standardization of these requirements would ease the administrative burden.
In February of 2009, Dr. Wells resigned his position to return to school to complete his residency.
The new Interim Director of Medicaid is Pat Casanova. The task force is looking forward to
meeting with Pat Casanova soon to continue our relationship with Medicaid directors.
Current issues the PMTF finds problematic include the elimination of the quality incentive
payments. Effective Aug. 20, 2009, through Dec. 31, 2009, primary medical providers will
receive a $1.50 per member per month (PMPM) reduction. Effective Jan. 1, 2010, the PMPM will
be eliminated for Anthem Medicaid. For MDwise Hoosier Alliance, the PMPM agreement was
eliminated for most providers effective immediately.
I would like to thank the task force members for their participation.
Respectfully submitted by J. Scott Pittman, M.D., chair
ISMA Task Force on Peer Review
Annual Report 2008-2009
The members of this task force are Deepak Azad, M.D., Vijay Dave, M.D., James Lewis,
M.D (Chair), Brent Mohr, M.D., William Penland, M.D., and David Welsh, M.D.
The Board of Trustees created the Task Force on Peer Review on Jan. 23, 2008 to address
two resolutions introduced during the 2007 Convention (07-17 Hospital Peer Review and
07-33 Sham Peer Review). Its stated mission is to “clarify where the issue of peer review
stands in Indiana and what it would take to change legislation to effect due process and
education.”
The task force received extensive summary materials on peer review laws and
proceedings and issued its first report for the board’s May 18, 2008 meeting. As part of
its work, the task force recommended the adoption of peer review fairness policies, which
were approved by the 2008 House of Delegates in Resolution 08-36.
The task force is also developing various educational and informational peer review
materials. These materials may include hospital peer review and due process principles,
guidelines, checklists, and/or model bylaws provisions. Some materials have been posted
on ISMA’s Website. The task force is also considering disseminating some materials
directly to hospitals and medical staffs.
As a result of the 2008 Convention, the board asked the task force to consider Resolution
08-47, which addressed cases of sub-standard care performed by physicians who do not
have hospital privileges. The task force received extensive information about this issue
and discussed it over two conference calls. The task force ultimately recommended that
the board revise its existing policy on post-operative care and that the board recommend
that the Medical Licensing Board promulgate a rule on post-surgical care responsibilities.
These recommendations were approved by the board at its May 17, 2009 meeting. The
Medical Licensing Board recommendation has been introduced as Resolution 09-07.
The task force’s efforts are ongoing.
I would like to thank the members of the task force for their ongoing participation.
RESOLUTION 09-07
POST-SURGICAL CARE RESPONSIBILITIES
Introduced by:
Referred to:
Whereas, Resolution 08-47 “ASSESSMENT AND TRACKING OF NON-HOSPITAL
CREDENTIALED PHYSICIANS” stated as follows:
RESOLVED, that the ISMA begin a dialogue with the Indiana State
Department of Health to address by rule, the issue of hospital quality
assurance committees reporting non-privileged physicians that are
believed to have demonstrated a sub-standard level of care to the Medical
Licensing Board of Indiana when the physician’s patient has presented to
that hospital for treatment of associated complications. This is to assure
that the conduct and complications are addressed either at the local
hospital Quality Assurance Committee level, or reported to the Medical
Licensing Board of Indiana; and
Whereas, Resolution 08-47 was Referred to the Board of Trustees for Action; and
Whereas, the Board of Trustees referred Resolution 08-47 to the ISMA Task Force on
Peer Review; and
Whereas, the Task Force on Peer Review considered extensive amounts of information,
including the following:
Current Indiana law requires a physician who becomes aware of illegal,
unlawful, incompetent or fraudulent conduct in the practice of medicine to
report the conduct to a peer review body. The law also permits a physician to
make a report to the Medical Licensing Board. Physicians are generally reluctant
to make such reports.
Hospitals do not appear to be reporting such illegal, unlawful or incompetent
conduct.
This issue was presented to the Medical Licensing Board in February 2009, and it
was learned that a complaint has reportedly been filed with the Office of the
Attorney General against a physician for alleged failure to provide sufficient
follow-up care, but the Office of Attorney General has not filed charges and the
physician has not been called before the Medical Licensing Board.
The Medical Licensing Board is aware that the ISMA is studying this issue and
has asked to be notified of ISMA’s actions.
The Medical Licensing Board adopted Office-Based Surgery rules in 2008 that
require physicians who perform in-office anesthesia to have privileges at a local
hospital or ambulatory surgery center, or for the office-based setting to have peer
review privileging processes in place. The rule also addresses post-operative care
and requires a physician to have admitting privileges at a nearby hospital or to
make transfer arrangements with another privileged physician or hospital; and
Whereas, the Task Force on Peer Review reached the following conclusions:
There are many concerns with requiring hospital credentialing, including
hospital obligations, conflicts of interest, and hospitals exercising oversight of
unaffiliated surgery centers.
These issues should be regulated by the Medical Licensing Board and not the
Indiana State Department of Health or county health departments; and
Whereas, the Task Force on Peer Review recommended that the Board of Trustees
recommend that the Medical Licensing Board promulgate a rule on post-surgical care
responsibility; and
Whereas, the Board of Trustees accepted the Task Force on Peer Review’s
recommendations; therefore, be it
RESOLVED, that the ISMA recommend that the Medical Licensing Board of Indiana
promulgate a rule that states the following:
After performing surgery, a physician shall continue care of a surgical
patient of the physician through the post-surgical recovery and healing
period either by providing the care directly, delegating the care to a
person of equivalent licensure and appropriate training, or coordinating
with another person of equivalent licensure and appropriate training who
agrees to assume responsibility for managing the patient’s post-surgical
care. For purposes of this rule, “post-surgical recovery and healing
period” shall be equivalent to the applicable Medicare postoperative
global period for that surgical procedure.
RESOLUTION 09-08
MALPRACTICE INSURANCE ASSISTANCE
Introduced by:
Referred to:
Whereas, there are times when significant natural, inflicted or medical disasters occur
involving members of the medical profession; and
Whereas, there are times when some disasters have a significant impact upon the
financial ability of the physician to maintain an office setting or practice; and
Whereas, a significant portion of the financial overhead of medical practice includes
malpractice insurance; therefore, be it
RESOLVED, that ISMA seek to encourage malpractice insurance companies to develop
a plan of assistance for those physicians involved in a natural or personal disaster, such
plan to apply for a period of one (1) to three (3) years from such event; such plan to
include partial or complete remittance of premiums and continuation of policy coverage
barring other unforeseen events.
RESOLUTION 09-18
SUPPORT OF GAY MARRIAGE
Introduced by:
Referred to:
Whereas, we live in a multicultural society wherein all people are created equal in the
eyes of God and our constitution; and
Whereas, the principle of separation of church and state is essential to uphold in our
diverse society; and
Whereas, to be consistent with the above, it is necessary that personal interpretation of
one’s own individual scripture should not be a basis for deciding whether
homosexuality is determined by orientation or choice; and
Whereas, the medical literature overwhelmingly supports the opinion that
homosexuality is a function of biological orientation rather than choice; and
Whereas, the ISMA is a body that is to be guided in its decision-making by science,
reason and public policy standards that promote the health and well being of all Indiana
citizens;
Whereas, the health benefits of a legally sanctioned marital relationship, regardless of the
sexual orientation of the partners, are acknowledged by numerous medical associations
and research forums; therefore, be it
RESOLVED, that the ISMA publically acknowledge the health benefits conferred upon
our LGBTQ (Lesbian, Gay, Bisexual, Transgendered, Questioning) community that
might be offered through the legal sanctioning of gay marriage.
RESOLUTION 09-21
SUSPENSION OF MEDICAID PRIVILEGES FOR
POSITIVE DRUG TEST
Introduced by:
P.K. Samaddar, M.D.
Referred to:
Whereas, patients receive Medicaid benefits due to their financial inability to afford
health insurance and/or pay medical bills; and
Whereas, the Medicaid system is funded by Indiana tax payer dollars; and
Whereas, at times, Medicaid patients abuse prescription and/or illegal drugs and
devote their financial resources to this abuse; therefore be it
RESOLVED, that ISMA support the suspension of Medicaid privileges of patients who
test positive for illegal and/or prescription drugs not prescribed for them.
RESOLUTION 09-25
NEWBORN AUTO ASSIGNMENT AND RETRO-ACTIVE
ASSIGNMENT TO MEDICAID MANAGED CARE
ORGANIZATIONS
Introduced by:
and the Indiana Chapter of the American Academy of
Pediatrics
Referred to:
Whereas, the state of Indiana, through the Division of Family Services, has divided the
Medicaid services provided to state residents into several managed care organizations
(MCO) programs; and
Whereas, patients can designate their preference for a particular MCO plan coverage for
their family based upon the physician or services they desire; and
Whereas, there is a precedent that newborn patients are automatically enrolled in the
mothers’ Medicaid MCO swhen their mother have been covered under the Medicaid
MCO plans during pregnancy; and
Whereas, it takes some time for patients’ parents to actually enroll infants with their
Medicaid MCOs of choice; and
Whereas, the MCO assignment is retroactive for services provided to newborns from
birth; and
Whereas, newborns have already received services from Medicaid providers prior to
those retroactive assignments; and
Whereas, the retroactive auto-assignment does not always attach the infants to the same
MCOs as the physician of record or parental choice; and
Whereas, the auto-assignment to an Medicaid managed care organization (MCO) can
prevent continuity of care for newborns; and
Whereas, auto-assignment policies/procedures can disrupt the establishment of the
medical home and potentially jeopardize the early identification of preventable
problems in the newborn period; and
Whereas, the auto-assignment can prevent the provider of services from receiving
payment at their MCO contracted rates; therefore be it
RESOLVED, that the ISMA through legislation, regulation or agreements work to stop
the automatic assigning of managed care organization coverage for newborn infants in
Indiana; and be it further
RESOLVED, that the ISMA through legislation, regulation or agreements work to
ensure that managed care organization coverage for newborn infants is retroactive to
birth; and be it further
RESOLVED, that the ISMA through legislation, regulation or agreements work to
ensure managed care organization assignment is based upon the parent/family choice
and/or the physician of record for services provided from birth allowing appropriate
contracted payment for services provided.
RESOLUTION 09-26
SIMPLE AND UNIFORM PRIOR AUTHORIZATION
FORMS
Introduced by:
Teresa Lovins, M.D, and the Indiana Academy of
Family Physicians
Referred to:
Whereas, recent studies have found that time spent on paperwork costs physicians
several hours each week that distract from patient care; and
Whereas, other studies have shown that as much as 20 percent of health care dollars are
spent managing insurance company-driven paperwork; and
Whereas, the same data show that primary care physicians are disproportionately
burdened with this work; and
Whereas, most insurers – both public and private – demand similar information; and
Whereas, non-standardized forms add to the delay in collecting and submitting
information to payers; therefore be it
RESOLVED, that the ISMA work with the State Insurance Commissioner and/or the
state legislature to encourage both private and public insurers to rebuild the prior
authorization process with unified and simplified forms and processes, as well as an
efficient process for physicians to pursue appropriate exceptions for individual patients.
RESOLUTION 09-29
OPPOSITION TO THIRD-PARTY PAYMENT
Introduced by:
Referred to:
Whereas, Resolution 82-6 Rescinding Resolution 62-26 was readopted as Resolution 9941 and Resolution 99-41 will expire in 2009; therefore, be it
RESOLVED, that the ISMA continue to oppose any third-party payment program that
delineates physicians by lists or assignment or payments, or treats policyholders
without uniformity.
RESOLUTION 09-30
LIMITING PHYSICIAN FREE CHOICE
Introduced by:
Referred to:
Whereas, Resolution 84-24 Closing of Staffs and Services was readopted as Resolution
99-41 and Resolution 99-41 will expire in 2009; therefore, be it
RESOLVED, that the ISMA oppose efforts by any hospital that serves to limit
physicians’ free choice and competitive alternatives through the closing of medical
staffs, sections of medical staffs, or which limit physician access to services based on
arbitrary objectives that do not clearly enhance patient care.
RESOLUTION 09-32
FINANCIAL INCENTIVES
Introduced by:
Referred to:
Whereas, Resolution 86-7 Quality Medical Care was readopted as Resolution 99-41 and
Resolution 99-41 will expire in 2009; therefore, be it
RESOLVED, that physicians of Indiana will not compromise the quality of medical care
because of financial incentives.
RESOLUTION 09-33
PROHIBITING UNLICENSED MID-WIFERY
Introduced by:
Referred to:
Whereas, Resolution 86-36 Lay Midwives was readopted as Resolution 99-41 and
RESOLVED, that the ISMA recommend enforcement of existing laws that prohibit
midwifery by unlicensed individuals.
RESOLUTION 09-34
NOTIFICATION OF PROFESSIONAL LICENSING
AGENCY ACTIONS
Introduced by:
Referred to:
Whereas, Resolution 87-16 Notification of Medical Societies and Hospitals by the
Medical Licensing Board of Indiana (Health Professions Service Bureau) was readopted
as Resolution 99-41 and Resolution 99-41 will expire in 2009; and
Whereas, the Health Professions Bureau was renamed the Professional Licensing
Agency; and
Whereas, the Professional Licensing Agency appears to be doing a better job of
promptly notifying the appropriate entities of license restrictions; therefore, be it
RESOLVED, that the ISMA monitor the Professional Licensing Agency to ensure that
effective methods are being used to promptly notify the appropriate entities of
physician licensure restrictions.
RESOLUTION 09-35
INSURANCE REIMBURSEMENT
Introduced by:
Referred to:
Whereas, Resolution 87-20 Penalties for Fiscal Intermediaries Who Do Not Reimburse
Patients Promptly was readopted as Resolution 99-41 and Resolution 99-41 will expire
in 2009; therefore, be it
RESOLVED, that ISMA seek imposition of federal and/or state sanctions on the
insurance carriers that do not reimburse patients promptly or correctly.
RESOLUTION 09-37
REQUIRING INSURERS TO CLEARLY DISCLOSE
LIMITATIONS
Introduced by:
Referred to:
Whereas, Resolution 88-28 Truth in Insurance Bill was readopted as Resolution 99-41
RESOLVED, that it is the duty of any provider of medical insurance in the state of
Indiana to fully inform in clear language prospective purchasers of insurance
limitations, which may affect the quality or quantity of medical services provided under
the plan. Examples of such features are:
1. Contracts or agreements between the insurers and physicians, hospitals,
pharmacies or other providers of services which limit or affect care provided
to the patient either directly or indirectly by limiting reimbursement in any
fashion
2. Financial incentives, withholds, “gatekeeper” arrangements or other
arrangements that may affect the medical decision-making process
3. Agreements that limit free referral of patients by the patient’s physician to
any other physician or hospital.
RESOLUTION 09-40
PENALTIES FOR CODING ERRORS
Introduced by:
Referred to:
Whereas, Resolution 89-4 Opposition to Mandatory Coding was readopted as
RESOLVED, that the ISMA and the AMA combat severe sanctions and harsh and
unreasonable penalties that are leveled against physicians because of errors in the
coding process.
RESOLUTION 09-44
UNREASONABLE AND UNNECESSARY SERVICES
Introduced by:
Referred to:
Whereas, Resolution 89-53 “Unreasonable and Unnecessary” Terminology for Services
was readopted as Resolution 99-41 and Resolution 99-41 will expire in 2009; therefore,
be it
RESOLVED, that all remedies be taken by the ISMA to force the Centers for Medicare &
Medicaid Services (CMS) and others to use “unreasonable and unnecessary” only for
services and treatments that are considered unreasonable and unnecessary by the
medical community; and be it further,
RESOLVED, that all remedies be taken by the ISMA to force CMS and others to not use
“unreasonable and unnecessary” for services that they have simply decided not to
accept as covered services.
RESOLUTION 09-47
POSTOPERATIVE CARE
Introduced by:
Referred to:
Whereas, Resolution 86-47 Postoperative Care of Surgical Patients was readopted as
RESOLVED, that the ISMA encourage the membership to provide postoperative care in
accordance with the ethics of the medical profession and to report to the Medical
Licensing Board any violations of the standards of practice of medicine.
RESOLUTION 09-62
ADJUSTMENT OF MEDICAID REIMBURSEMENT
RATES
Introduced by:
Referred to:
Whereas, Resolution 99-56 Adjustment of Medicaid Reimbursement Rates is set to
expire in 2009; therefore, be it
RESOLVED, that the ISMA advocate for an adjustment of all Medicaid reimbursement
rates in Indiana in order to bring Indiana’s rates in line with the rates of neighboring
states, the national average and Medicare rates in order to improve access to care for the
growing number of Medicaid patients in our state.
Reference Committee IV
Chair: Steven Rupert, D.O.
Richard Rhodes, M.D.
Michael Tachman, M.D.
Pardeep Kumar, M.D.
Cindy Basinski, M.D.
Paul Wolfe, M.D., alternate
(meets in Cosmopolitan B on the third floor of the Hyatt Regency Hotel on
Saturday, Sept. 26, at 9 a.m.)
Reports referred to Reference Committee IV:
Committee on Family Violence Annual Report
Commission on Sports Medicine Annual Report
Quality and Patient Safety Task Force
Resolution #
Resolution 09-11
Smoke-Free ISMA
Dick Huber, M.D.
Resolution 09-27
Laboratory Testing
Resolution 09-28
Hospital Deliveries
Resolution 09-31
Motorcycle Helmets
Resolution 09-43
Providing Information for School Health Policies and
Criteria
Resolution 09-45
Testing for HIV
Resolution 09-51
Drug-Free Indiana Endorsement
Resolution 09-53
Anabolic Steroids
Resolution 09-56
Organ Donation
discussion.
NEW RESOLUTIONS
Resolution #
Resolution 09-02
Dietary Referrals for Medicare Patients
Society; 2nd District Medical Society; ACP Indiana Chapter
Health and Public Policy Committee
Resolution 09-03
Background Checks for Elder Care Applicants
Society; 2nd District Medical Society; ACP Indiana Chapter
Health and Public Policy Committee
Resolution 09-15
Labeling of Genetically Modified Foods
Policy Committee; Monroe/Owen County Medical
Society; ACP Governor’s Council; Michael Sha, M.D.;
Deepak Azad, M.D.; Lois Lambrecht, M.D.; Robert
Resolution 09-17
The Physician’s Obligation to Identify and Treat
Prenatal and Perinatal Addiction
Resolution 09-19
Supporting Awareness of Stress Disorders in
Military Members and Their Families
Resolution 09-20
Opposition to Intelligender
Policy Committee; Monroe/Owen County Medical
Society; ACP Governor’s Council; Michael Sha, M.D.;
Deepak Azad, M.D.; Lois Lambrecht, M.D.; Robert
Resolution 09-24
Body Modification
Debra Mc Mahan, M.D., and the Fort Wayne Medical
Society
Committee on Family Violence
2009 Annual Report
The ISMA Committee on Family Violence has the responsibility to educate and promote the
identification and prevention of violence and to advocate for victims of family violence. The
committee is proud to represent and work within the association on these important issues.
The committee continues its efforts to address issues that affect the dignity, safety, and health
and well-being of our community and families. I am pleased to report on our efforts and
successes over the past year.
The Committee on Family Violence continues to recognize individuals in the state who
have devoted themselves to address family violence in our communities. We were pleased
to nominate two individuals this year: one for the Kathleen Galbraith Award and the one
for the Patient Health Advocate Award. Family violence is a difficult multifaceted
problem, and we need individuals to advocate on behalf of those who are disadvantaged
and lack a voice to speak for themselves.
The committee has engaged in a discussion regarding how to best further its educational
endeavor. In the past, we have hosted a train-the-trainer seminar, but the Internet offers a
medium though which a wider audience can be reached at a time and location more
convenient to the intended audience.
The committee continues its outreach and collaborative effort with the Indiana Coalition
Against Domestic Violence (ICADV). We are pleased that Rhonda Bennett, the
committee’s ISMA staff liaison, also serves on the Public Relations Committee for
ICADV. We look forward to working on shared advocacy goals in the forthcoming
General Assembly. Through networking and collaborating, we can better address
important issues such as domestic violence.
Lastly, the committee continues to encourage association and Alliance members to donate
their no-longer-used cell phones for the ISMA’s 911 Phone program. These phones are
refurbished or recycled with a portion of the proceeds directed to domestic violence needs.
I wish to extend my personal appreciation to the members of the Committee on Family Violence
for their commitment in furthering the committee’s mission to make our families and
communities safer. Appreciation is extended to Marilyn Bull, M.D.; Steve Dunlop, M.D.; Rose
Fife, M.D.; Helen Borgenheimer, M.D.; Rhonda Sharp, M.D.; Jeb Teichman, M.D.; Jeffrey
Kellams, M.D.; Brent Mohr, M.D.; John Pless, M.D.; Ronald Smith, M.D.; Dave Welsh, M.D.;
and Rhonda Bennett. We welcome all members of our association who are interested in finding
solutions to the family violence issues affecting our communities.
Respectfully submitted by Michael Sha, M.D., chair
Commission on Sports Medicine
2009 Annual Report
The Commission on Sports Medicine (COSM) gratefully acknowledges the ISMA Board
of Directors for continuing support.
The COSM has hosted guests and entertained requests from a number of entities during
this year.
1. Randy Dick, formerly an injury surveillance expert from the NCAA, approached
COSM and the Indiana High School Athletic Association (IHSAA) regarding
implementation of a statewide sports injury surveillance program. Randy
apprised the commission of the technical requirements to undertake such an
endeavor. Randy also provided estimated costs to initiate and then sustain an
injury surveillance program modeled after the NCAA. Although there was
uniform agreement that such a program could be beneficial to the state, there
was no immediate funding source to cover the estimated $100,000 startup and
$40-50,000 maintenance costs. This suggestion is tabled indefinitely.
2. IHSAA partnered with Methodist Sports Medicine to provide funding and
technical provision for a statewide computer concussion management program.
The 2008-2009 school year will be the first year of this new program. The Indiana
Sports Concussion Network is providing training and access to this program. It
is expected the program will grow as more schools and health providers become
educated regarding this service. Although this is one program available to assist
assessment of the concussed athlete’s status regarding return to play, it is not the
only tool. The ISMA may be helpful in providing information to member
physicians regarding this program.
3. Coaches Education Clinic – The IHSAA reports that coaches who do NOT hold
an Indiana teachers license and coach at an IHSAA member school must
complete and IHSAA-approved coaching education course to continue as coach
beyond the initial year of service.
4. COSM believes EMS and hospital emergency departments should be better
educated regarding suspected c-spine injury management in athletes wearing
sports helmets and pads. COSM members anticipate communication with
emergency department physicians and Indiana Hospital Association.
5. The Indiana legislature adopted HB 1573. This bill became law on July 1. It
provides for temporary Indiana medical licensure for a variety of health
professionals travelling with their respective out-of-state athletic teams. This
policy was introduced by Dr. Gregory Rowden, through support by COSM and
the ISMA.
6. COSM was asked by an Indiana citizen to examine the current pre-participation
procedures for cardiovascular screening of athletes. This citizen cited recent
changes to European cardiovascular screening procedures, specifically, the
addition of performing EKGs for all prospective athletes. COSM provided
documentation to support compliance with current athlete screening
recommendations as recently published by the American Heart Association.
7. COSM enlisted IHSAA assistance to complete a statewide survey of medical
services provided IHSAA member schools. A near 75 percent response rate to
this survey was achieved. The survey attempted to identify physician and
athletic trainer services to Indiana high schools. The data will be reviewed and
summarized in the 2009-2010 year.
Respectfully submitted by Stephen M. Simons, M.D.
Quality and Patient Safety Task Force
Annual Report
The task force has met twice since the last ISMA annual meeting. The first meeting involved
discussion of the committee’s purpose and goals. The committee began producing a PowerPoint
presentation that described patient safety initiatives and their benefits. It was hoped that the
PowerPoint would be used by ISMA leadership to educate Indiana physicians about this
important part of patient care.
The committee also discussed producing a purse or billfold-sized card that would contain
medication, prescription and allergy information on patients. This would then be distributed by
the ISMA membership. We also discussed the ideas of a Patient Safety Tip of the Month in
ISMA Reports.
In each of its meetings, the committee received updates related to patient safety activities by the
Indiana Hospital Association and the Regenstrief Institute. We discussed the value of generating
a “root cause” analysis protocol physicians can use in their offices after a medical error.
In the next year, the committee hopes to finalize the PowerPoint presentation for distribution to
ISMA leadership and other interested parties, finalize the patient information cards, institute the
Patient Safety Tip of the Month program, and continue to work with all parties within Indiana
with the goal of promoting patient safety.
Respectfully submitted by Kevin R. Burke, M.D., chairman
RESOLUTION 09-02
DIETARY REFERRALS FOR MEDICARE PATIENTS
Introduced by:
Society; 2nd District Medical Society; ACP Indiana
Chapter Health and Public Policy Committee
Referred to:
Whereas, globally there are more than one billion overweight adults and at least 300
million of them are obese; and
Whereas, obesity is a major risk for chronic disease, including type 2 diabetes, arthritis,
gastroesophageal reflux disease, hypertension, stroke, cardiovascular disease,
depression and certain forms of cancer; and
Whereas, education is one of the first steps to take in reversing this epidemic; and
Whereas, currently Medicare does not pay for referral to a dietitian for the diagnosis of
obesity; therefore, be it
RESOLVED, that the ISMA encourage Medicare to make dietary referrals for the
diagnosis of obesity a covered expense.
RESOLUTION 09-03
BACKGROUND CHECKS FOR ELDER CARE
APPLICANTS
Introduced by:
2nd District Medical Society; ACP Indiana Chapter Health
and Public Policy Committee
Referred to:
Whereas, the elderly represent a very vulnerable population in the United States who
often, as individuals and unlike children, lack advocates or family members who can
supervise their care and ensure their safety; and
Whereas, recent studies have shown a disturbing number of eldercare applicants
(people applying to work with the elderly in nursing home assisted care and home
settings) have a history of violent felony conviction (7,000 in seven states in one threeyear study); and
Whereas, many of these applicants‟ criminal records are not picked up on the statewide
background checks usually done, but would be picked up on a nationwide background
check; therefore, be it
RESOLVED, that the ISMA encourage legislation in Indiana requiring all eldercare
applicants have a nationwide background check performed before hiring; and be it
further
RESOLVED, that the ISMA encourage the AMA to support federal legislation requiring
a nationwide background check on all eldercare applicants before hiring.
RESOLUTION 09-11
SMOKE-FREE ISMA
Introduced by:
Dick Huber, M.D.
Referred to:
Whereas, the ISMA has banned smoking from ISMA events since 1979 and resolution
99-41 maintained such policy; therefore, be it
RESOLVED, that the ISMA continue its policy of banning smoking during any of the
association‟s business and educational activities; and be it further
RESOLVED, that the ISMA prohibit the use of any tobacco products in the association‟s
facilities; and be it further
RESOLVED, that the ISMA attempt to hold all business and educational events in
totally non-smoking surroundings.
RESOLUTION 09-15
LABELING OF GENETICALLY MODIFIED FOODS
Introduced by:
Policy Committee; ACP Governor‟s Council; Michael Sha,
M.D.; Deepak Azad, M.D.; Lois Lambrecht, M.D.; Robert
Referred to:
Whereas, an estimated 70-75 percent of processed foods on supermarket shelves contain
genetically engineered ingredients; and
Whereas, up to 45 percent of U.S. corn and up to 86 percent of U.S soybeans are
genetically modified; and
Whereas, genetically engineered foods may pose potential serious risks to humans,
including higher risks of toxicity, allergenicity, antibiotic resistance, immunesuppression and cancer; and
Whereas, eight federal agencies attempt to regulate biotechnology using 12 different
statutes or laws written long before the advent of genetically engineered food, animals
and insects; and
Whereas, the current argument opposing the labeling of genetically modified food is
that much of the public would be unnecessarily frightened and reluctant to buy foods
thus identified; and
Whereas, this argument should nevertheless not override the public‟s right to be
informed of the nature and source of their food, and should instead motivate the
companies and industries producing and utilizing genetically modified food to fund
and perform the needed studies to prove its safety and subsequently inform and
educate the public; therefore, be it
RESOLVED, that the ISMA seek legislation requiring that any foods containing
genetically engineered ingredients be clearly labeled.
RESOLUTION 09-17
THE PHYSICIAN‟S OBLIGATION TO IDENTIFY AND
TREAT PRENATAL AND PERINATAL ADDICTION
Introduced By:
Referred to:
Whereas, prenatal alcohol exposure is associated with significant maternal and fetal health
risks including spontaneous abortion, prenatal and postnatal growth restriction birth defects,
and neurodevelopment deficits, including fetal alcohol syndrome - the most common cause of
mental retardation;1 and
Whereas, smoking during pregnancy increases the likelihood of placenta previa, abruption,
premature rupture of membranes, preterm delivery, fetal growth restriction, low birth weight,
as well as increasing incidence of orofacial cleft defects and sudden infant death syndrome
after birth;2 and
Whereas, illicit drug use during pregnancy, especially cocaine use, has been linked to increased
risk of low birth weight, prematurity, perinatal death, abruptio placenta and small or
gestational age births;3 and
Whereas, the 2006 National Survey on Drug Use and Health found that 11.8 percent of pregnant
women reported current alcohol use and 2.9 percent reported binge drinking (greater than 5
drinks on the same occasion), 16.5 percent of pregnant woman reported tobacco use during
pregnancy, and 4 percent of women reported using illicit drugs during pregnancy;4 and
Whereas, a variety of screening tools have been introduced to properly screen and identify
pregnant women using alcohol, tobacco and illicit drugs, including the 5 A's of tobacco,
TACE for alcohol, and FRAMES for other drug use;5 and
Whereas, the American College of Obstetricians and Gynecologists endorses universal
screening as an ethical obligation;6 and
Whereas, one study showed that by merely identifying the pregnant substance user and the
particular substance(s) used, 54% of women cleaned up after brief physician advice and a urine
drug screen at each prenatal visit;7 and
Whereas, in one treatment facility from 2002-2008, detection and simple intervention resulted
in 274/323 (84.8%) substance-free births, with a pre-term rate of 22.2% (pre-term delivery rate
for all patients in this hospital is 19.6%);8 and
Whereas, in that same facility, of the patients who were identified as positive with a urine
drug screen who did not return for prenatal care but who did show up for delivery, 26/49
(53%) were substance-free births, indicating that the process of detection is, in fact, an
intervention in and of itself;9 and
Whereas, the ISMA historically has expressed concern for a healthy intrauterine environment
for the prenatal period; and
Whereas, the ISMA supports initiatives to help those who are addicted to drugs and ask for
help, and supports government initiatives to implement substance abuse programs that are
appropriately designed and monitored for quality, cost effectiveness and reduced recidivism;
therefore, be it
RESOLVED, that the ISMA, through its communication vehicles, encourage all physicians to
increase their knowledge regarding the effects of drug and alcohol abuse during pregnancy
and communicate that information to women of reproductive age pre-conception; and
RESOLVED, that the ISMA encourage Indiana physicians to routinely inquire about
alcohol, tobacco and drug use in the course of providing prenatal care; and
RESOLVED, that the ISMA encourage Indiana physicians to identify alcohol, tobacco and
drug use in their pregnant patients and provide these women with treatment options best
suited to their needs; and
RESOLVED, that the ISMA implore Indiana hospitals to study the prevalence and effects of
implementing a simple alcohol, tobacco and drug screening process during patient pregnancy.
__________________________________________
1.R.L. Floyd, et al,. The clinical content of preconception care: alcohol, tobacco, and illicit drug
exposures American Journal of Obstetrics & Gynecology December 2008 (Vol. 199, Issue 6, Pages S333-S339)
2
Id.
3 Id.
4 2006 National Survey on Drug Use and Health, http://www.oas.samhsa.gov/nsduh/2k6nsduh/2k6results.pdf
(Last accessed 03/04/2009)
5 American Journal of Obstetrics & Gynecology, December 2008 (Vol. 199, Issue 6, Pages S333-S339)
6.American College of Obstetricians and Gynecologists, At-risk drinking and illicit drug use: ethical issues in
obstetric and gynecologic practice, ACOG Committee Opinion No. 422, Dec. 2008.
7.I.J. Chasnoff, el al. The 4P's Plus Screen for Substance Use in Pregnancy: Clinical Application and Outcomes.
Journal of Perinatology (2005)25, 368-374.
8 James. J. Nocon, M.D., J.D., Director Prenatal Substance Use Clinic, Wishard Memorial Hospital, 1001 West 10th
Street, F5102, Indianapolis, IN 46202
9.Id
RESOLUTION 09-19
SUPPORTING AWARENESS OF STRESS DISORDERS IN
MILITARY MEMBERS AND THEIR FAMILIES
Introduced by:
Referred to:
Whereas, AMA policy (D-510.996 Military Care in the Public and Private Sector) states:
“Our AMA will use its influence to expedite quality medical care, including
mental health care, for all military personnel and their families by developing a
national initiative and strategies to utilize civilian health care resources to
complement the federal health care systems. (Res. 444, A-07); and
Whereas, a 2008 ISMA resolution supporting awareness of stress disorders in military
members and their families complements and supports the AMA policy and was met
with significant success in Indiana; and
Whereas, with the backing and encouragement of the ISMA, the 2009 Indiana General
Assembly passed Concurrent Resolution 69 that :
“supports compassionate treatment and efforts to raise awareness of PTSD and
other associated psychiatric disorders related to the unique stresses of members
of the armed forces and their families,
“encourages physicians throughout Indiana to query patients and their families
regarding stresses related to military deployment, and
“encourages the Indiana State Medical Association to promote awareness and
disseminate information regarding resources that are available for the assistance
of members of the armed forces and their families;” and
Whereas, the 2009 ISMA Alliance has adopted as its annual focus project “Treat the
Troops, Mental Health Matters,” to address PTSD awareness as it impacts military
members and their families; and
Whereas, military members have been, are and will continue to be deployed overseas,
often to hostile environments; and
Whereas, the stresses of combat may cause post traumatic stress disorder (PTSD) in as
many as 1:8 deployed soldiers; and
Whereas, the stresses of deployment and PTSD also affect family members; and
Whereas, treatment of military family members is primarily accomplished by
nonmilitary physicians throughout the U.S.; and
Whereas, presenting medical complaints to the primary care physician may be a
manifestation of, or exacerbated by, stress disorders; and
Whereas, early compassionate treatment of patients and their families is more likely to
lead to successful resolution of stress disorders, thereby decreasing the likelihood of
chronic symptoms or even permanent disability; therefore, be it
RESOLVED, that the ISMA shall continue to support efforts to raise awareness of post
traumatic stress disorder and other associated psychiatric disorders related to the
stresses involved with military personnel and their families; and be it further
RESOLVED, that the ISMA continue to encourage physicians throughout the state to
query patients and their families regarding stresses related to military deployments;
and be it further
RESOLVED, that the ISMA develop a post traumatic stress disorder screening tool to be
placed on the ISMA Web site for physicians to use in their practice; and be it further
RESOLVED, that the ISMA Delegation present a resolution to the 2010 AMA House of
Delegates focusing attention, raising awareness, developing a screening tool, educating
physicians, disseminating information and expediting treatment for military members
and their families affected by stress disorders.
RESOLUTION 09-20
OPPOSITION TO INTELLIGENDER
Introduced by:
Caitilin Kelly, M.D., chair of the Ind. ACP Health and
Public Policy Committee, Deepak Azad, M.D., Robert
Lubitz, M.D., Michael Sha, M.D., and Lois Lambrecht,
M.D.
Referred to:
Whereas, sex discrimination by gender selection has been widely practiced in many
countries, including India and China; and
Whereas, the manufacturer Intelligender retails in the U.S. and Canada a $39.95 home
unit that is about 80 percent accurate in determining the sex of a fetus at 10 weeks, and
is marketed as “a fun way to discover more about your baby and share the news of pink
or blue as early as possible”; and
Whereas, Intelligender has sold 50,000 units online since placing it on the market in
November 2006; and
Whereas, medical ethicists have raised concerns that the significant risks of misuse of
this product far outweigh any benefits; and
Whereas, the co-founder of Intelligender has stated that the company refuses to sell its
product in India or China because “They have different cultural beliefs than we do”;
and
Whereas, such a statement fails to acknowledge that the U.S. is a multicultural society
made up of individuals with many diverse beliefs and it is naive to assume the same
risks of misuse for gender selection, a form of sex discrimination, do not exist here;
therefore, be it
RESOLVED, that the ISMA encourage removal from the market of the genderprediction test made by Intelligender.
RESOLUTION 09-24
BODY MODIFICATION
Introduced by:
Debra Mc Mahan, M.D., and the Fort Wayne Medical
Society
Referred to:
Whereas, body modification practice includes the following:
Suspension - The act of suspending a human body from hooks
(typically deep-sea hooks) that have been put through body piercings
on various parts of the body, including the torso or extremities. These
piercings are temporary and are performed just prior to the actual
suspension. The client is then raised off the ground with a block and
tackle-like machine via ropes attached to the hooks. Risks include
infection, bleeding, tearing of the skin, asphyxia or aspiration.
Tongue splitting - The tongue is cut centrally from its tip part of the
way towards its base with a scalpel. The round nature is achieved by
placing sutures in the upper and lower part of the cutting area.
Microdermal implants - A dermal punch is used to remove a circular
area of tissue. Implants are then anchored into the muscle.
Interchangeable jewelry is screwed into the threaded hole in the
anchor.
Subdermal implants – These are buried in the skin and referred to as
similar to the medical procedure of installing a pacemaker.
Transdermal implants – These are placed under the skin, but also
protrude out of it. This is done through a process known as „dermal
punching.‟ The implant is placed in between the layers of skin. Once
the implant is placed, the part that will protrude out is exposed using a
dermal punch.
Scalpelling – Scalpel is used to produce holes of large diameter that
provide quicker and greater control over holes than skin stretching.
Scarification - Scars are formed by cutting or branding the skin. A
scalpel is used to cut the skin and then ink may be rubbed onto the
fresh cut. Alternatively, foreign bodies (e.g., cremation ashes) may be
used to “pack” the wound to create massive keloids.
Skinning - A form of scarification in which a design is stenciled onto
the skin. The design is outlined as a single cutting scarification and
then the artist begins removing skin slices with the help of a scalpel
and a Kocher forceps or dissection clamp.
Nullification (or amputation) –This involves surgical removal of all or
part of a limb, most commonly this involves castration, amputation of
fingers or toes, removal of nipples, or removal of full limbs; and
Whereas, according to IC 25-22.5-1-1.1 (a)(1), the practice of medicine is defined as:
(a) "Practice of medicine or osteopathic medicine" means any one (1) or a combination
of the following:
(1) Holding oneself out to the public as being engaged in:
(A) The diagnosis, treatment, correction, or prevention of any disease,
ailment, defect, injury, infirmity, deformity, pain, or other condition of human
beings;
(B) The suggestion, recommendation, or prescription or administration of
any form of treatment, without limitation;
(C) The performing of any kind of surgical operation upon a human being,
including tattooing, except for tattooing (as defined in IC 35-42-2-7), in which human
tissue is cut, burned, or vaporized by the use of any mechanical means, laser, or ionizing
radiation, or the penetration of the skin or body orifice by any means, for the intended
palliation, relief, or cure; and,
Whereas, the above procedures require the use of medical equipment, including but not
limited to scalpel and forceps; and
Whereas, the above procedures require an extensive knowledge of human anatomy,
physiology and surgical practice; therefore, be it
RESOLVED, that the ISMA seek legislation that would add the term “body
modification” to the definition of the practice of medicine as defined under IC 25-22.5-11.1(a)(1).
RESOLUTION 09-27
LABORATORY TESTING
Introduced by:
Referred to:
Whereas, Resolution 81-24 Clinical Laboratory Tests Referred Out of State of Indiana
was readopted as Resolution 99-41 and Resolution 99-41 will expire in 2009; therefore,
be it
RESOLVED, that the pathologists, laboratories, and practicing physicians in this state
endeavor, wherever at all possible, to refer laboratory testing to qualified local, regional
and state laboratories, so that the functional integrity of these necessary facilities may be
maintained; and be it further,
RESOLVED, that the medical laboratories and pathologists in Indiana identify the needs
of the physician and patients in Indiana and endeavor to fulfill these needs.
RESOLUTION 09-28
HOSPITAL DELIVERIES
Introduced by:
Referred to:
Whereas, Resolution 81-27 ISMA Opposition to Concept of Home Deliveries was
RESOLVED, that the ISMA encourage the delivery of all pregnancies in a hospital or in
those settings best suited to minimize the risk to the mother and infant.
RESOLUTION 09-31
MOTORCYCLE HELMETS
Introduced by:
Referred to:
Whereas, Resolution 85-17 Motorcycle Helmets was readopted as Resolution 99-41 and
Resolution 99-41 will expire in 2009; and
Whereas, Indiana law only requires motorcycle drivers to wear protective headgear
when they have a learner‟s permit or a temporary learner‟s permit; therefore, be it
RESOLVED, that the ISMA support legislation to require protective headgear to be
worn by all drivers and passengers of motorcycles at all times.
RESOLUTION 09-43
PROVIDING INFORMATION FOR SCHOOL
HEALTH POLICIES AND CRITERIA
Introduced by:
Referred to:
Whereas, Resolution 89-28A School Health Clinics was readopted as Resolution 99-41
RESOLVED, that the ISMA, in cooperation with interested governmental offices and
organizations such as the State Department of Education, the State Department of
Health, the Indiana State Teachers Association, the Indiana School Boards Association
and others, establish a mechanism to assure sound and reasonably available medical
advice to elementary and secondary schools for development and interpretation of
health policies and curricula.
RESOLUTION 09-45
TESTING FOR HIV
Introduced by:
Referred to:
Whereas, Resolution 89-42 Testing for Human Immunodeficiency Virus (HIV) was
RESOLVED, that: (1) the ISMA support and endorse a program that requires more
broad-based testing for HIV; (2) upon reporting of a positive result (confirmatory), the
Indiana State Department of Health would be required to begin case-finding and casecontacting activities with those individuals who have been reported as testing positive,
as with many other STDs; and (3) hospital admittees should be appropriately tested for
HIV; and be it further,
RESOLVED, that the ISMA‟s position on Human Immunodeficiency Virus (HIV) is that
it should be treated as an infectious disease so that we may maintain control until a cure
is found.
RESOLUTION 09-51
DRUG-FREE INDIANA ENDORSEMENT
Introduced by:
Referred to:
Whereas, Resolution 89-18 Drug-Free Indiana was readopted as Resolution 99-41 and
RESOLVED, that the ISMA endorse the concept of a drug-free Indiana and lend its
support and expertise to attain this goal when asked to participate.
RESOLUTION 09-53
ANABOLIC STEROIDS
Introduced by:
Referred to:
Whereas, Resolution 86-27 Anabolic Steroids was readopted as Resolution 99-41 and
RESOLVED, that the ISMA completely and officially oppose the use of anabolic steroids
as a method of enhancing athletic performance at all levels in sports.
RESOLUTION 09-56
ORGAN DONATION
Introduced by:
Referred to:
Whereas, Resolution 99-24 Organ Donation is set to expire in 2009; therefore, be it
RESOLVED, that the ISMA through local medical societies increase awareness about
organ donation by encouraging their physician members, their staffs and their patients
to discuss their wishes about organ donation with their family members to ease the
family‟s decision at the time of death.
Constitution
&
Bylaws
This printing incorporates amendments
from the 2008 House of Delegates
Indiana State Medical Association
322 Canal Walk
Indianapolis, IN 46202-3268
(317) 261-2060 / (800) 257-4762
www.ismanet.org
Table of Contents
1.00
MEMBERSHIP QUALIFICATIONS, ELECTIONS AND RIGHTS .....................
8
1.01
1.0101
1.0102
1.010201
1.010202
1.010203
1.010204
1.0103
1.0104
1.0105
1.0106
1.0107
1.0108
CATEGORIES .................................................................................................
Regular Member .................................................................................................
Dues Exempt Member ........................................................................................
Senior Member ..........................................................................................
Disabled Member .......................................................................................
Inactive Member ........................................................................................
Financial Hardship .....................................................................................
Resident Member .................................................................................................
Medical Student Member ....................................................................................
Distinguished Member ........................................................................................
Honorary Member ...............................................................................................
Military Member .................................................................................................
Provisional Member …………………………………………………………..
8
8
8
8
8
8
9
9
9
9
9
9
9
1.02
QUALIFICATIONS .........................................................................................
9
1.03
1.0301
1.0302
1.0303
RIGHTS, PRIVILEGES AND RESPONSIBILITIES OF MEMBERS .........
Rights and Privileges by Membership Category ..................................................
Attendance at Annual Convention ......................................................................
(a) Suspension or Revocation of License ...................................................
(b) Exception ............................................................................................
(c) Extension of Health Insurance .............................................................
9
9
9
10
10
10
2.00
INCOME AND EXPENSES .........................................................
10
2.01
2.0101
2.010101
2.010102
2.010103
2.0102
2.0103
2.0104
2.0105
INCOME ..........................................................................................................
Dues ...................................................................................................................
Dues Refund ...............................................................................................
Reduced Dues ......................................................................................................
Change in Dues Structure ...........................................................................
Voluntary Contribution .......................................................................................
Revenues Derived from Association's Publications ..............................................
Revenue from ISMA Activities and Services .......................................................
Assessments Approved by the House of Delegates ...............................................
10
10
10
11
11
11
11
11
11
2.02
EXPENSES .......................................................................................................
11
3.00
CONVENTION AND MEETINGS ..............................................
11
3.01
3.0101
ANNUAL CONVENTION ..............................................................................
Selection of Site ................................................................................................
11
11
3.02
3.0201
3.020101
3.020102
3.020103
3.0202
3.0203
3.020301
3.020302
3.0204
3.0205
HOUSE OF DELEGATES - BUSINESS AND LEGISLATIVE MEETINGS
Composition .......................................................................................................
Voting Members ........................................................................................
Nonvoting Members ...................................................................................
Right to Vote ..............................................................................................
Parliamentarian ..................................................................................................
Meetings ............................................................................................................
Regular Meetings ......................................................................................
Special Meetings .......................................................................................
House Admission ...............................................................................................
Delegate Apportionment ....................................................................................
11
11
11
11
11
12
12
12
12
12
12
2
3.020501
3.020502
3.020503
3.020504
3.0206
3.0207
3.020701
3.0208
3.0209
3.0210
3.0211
3.021101
3.021102
3.021103
3.021104
3.021105
3.0212
3.021201
3.021202
3.021203
Method of Determination of Delegates .......................................................
Section Delegates .......................................................................................
Delegate Credentials ..................................................................................
Delegate Replacement ………………………………………………….
Quorum ..............................................................................................................
Authority and Responsibilities ............................................................................
Resolutions and Proposals ..........................................................................
(a) Fiscal Note ......................................................................................
(b) Deadlines for Resolutions ................................................................
(c) Late Resolutions ..............................................................................
(d) Resolution Expiration ……………………………………………
(e) Withdrawal of Resolution ………………………………………..
Election of Delegates to AMA ............................................................................
Organizing Districts ...........................................................................................
Authority to Appoint Special Committees ...........................................................
Reference Committees and Committee on Rules and Order .................................
Reference Committees ................................................................................
Responsibilities of Reference Committees ...................................................
Time and Place of Meetings ........................................................................
Non-member Attendance ............................................................................
Committee on Rules and Order of Business ................................................
Election of Officers .............................................................................................
Method of Election .....................................................................................
Terms .........................................................................................................
Oath ............................................................................................................
12
12
12
13
13
13
13
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13
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14
15
15
15
15
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16
3.03
3.0301
3.030101
3.030102
3.030103
3.030104
3.030105
3.030106
3.030107
3.030108
3.0302
3.030201
3.030202
SECTION MEETINGS .....................................................................................
Specialty Sections ................................................................................................
Purpose .......................................................................................................
Meetings .....................................................................................................
Official Sections ..................................................................................
Formation of Sections .........................................................................
Officers ...............................................................................................
Officer Elections .................................................................................
Restriction on Meetings .......................................................................
Failure to Comply ................................................................................
Hospital Medical Staff Section .............................................................................
Composition ………………………………………………………………
Organization ...............................................................................................
16
16
16
16
16
17
17
17
17
17
17
17
17
3.04
3.0401
3.0402
3.040201
3.040202
3.040203
3.040204
3.040205
3.0403
3.0404
GENERAL MEMBERSHIP MEETINGS ......................................................
General Meetings for the Membership ................................................................
Purposes of Meetings for the General Membership .............................................
Scientific Presentations and Discussions .....................................................
Dissemination of Information .....................................................................
Appointment of Committees .......................................................................
Issue Mandates to the House .......................................................................
Order Referendums .....................................................................................
Quorum for General Membership Meetings .........................................................
Special Meetings for the General Membership .....................................................
17
17
18
18
18
18
18
18
18
18
4.00
OFFICERS .....................................................................................
18
4.01
4.0101
4.0102
COMPOSITION ...............................................................................................
Limitation ...........................................................................................................
Delinquent Dues ..................................................................................................
18
18
18
4.02
REMOVAL, DEATH, RESIGNATION, VACANCY ......................................
18
4.03
DUTIES ...............................................................................................……….............. 19
3
4.0301
4.0302
4.0303
4.0304
4.0305
4.0306
4.0307
President ...............................................................................................…………............ 19
President-elect ............................................................................................……….......... 19
Treasurer ...................................................................................................…………....... 19
Assistant Treasurer ....................................................................................…………....... 19
Executive Vice President ............................................................................………..........20
Speaker .......................................................................................................…………...... 20
Vice Speaker ..............................................................................................………......... 20
4.04
EXPENSES ......................................................................................…………............... 20
4.05
4.0501
4.0502
4.0503
4.0504
4.0505
4.0506
4.0507
4.0508
4.0509
INDEMNIFICATION OF OFFICERS & TRUSTEES ..............………................ 20
Definitions ...........................................................................................…………............. 20
Conditional Indemnification ................................................................………............... 21
Mandatory Indemnification ..................................................................……….............. 22
Court-Ordered Indemnification ..............................................................………........... 22
Advancement of Expenses Prior to Final Disposition ............................………............ 22
Procedure ...................................................................................................………......... 22
Indemnification of Association Employees Other Than Trustees ...........……............... 23
Liability Insurance .................................................................................…………........... 23
Miscellaneous .....................................................................................………................ 23
5.00
BOARD OF TRUSTEES .....................................…………………………………... 23
5.01
COMPOSITION/VOTING POWER ...........................................………………...... 23
5.02
5.0201
AUTHORITY ....................................................................................…………............. 24
Delinquent Dues - Suspension ...................................................................……….......... 24
5.03
ELECTION - TRUSTEE AND ALTERNATE ........................................………...... 24
5.04
5.0401
5.0402
5.0403
5.0404
5.0405
5.0406
5.0407
MEETINGS AND TERMS ............................................................………................... 24
Regular Meetings ........................................................................................………........ 24
Special Meetings ...................................................................................………............... 24
Quorum .........................................................................................................………….... 24
Attendance at Meetings ...............................................................................………....... 24
Meeting Notices ........................................................................................………........ 24
Terms of Trustees ......................................................................................……….......... 25
Terms of Alternate Trustees ......................................................................……….......... 25
5.05
VACANCIES ..........................................................................................………............ 25
5.06
5.0601
5.0602
5.0603
5.0604
5.0605
5.0606
5.0607
5.0608
5.0609
5.0610
5.0611
5.0612
5.0613
ORGANIZATION AND DUTIES .............................................................……….....
Election of At-Large Members to Executive Committee ...........................…….............
Conduction of Business .......................................................................………...............
Publications ...……………………………….................................................................
Employ Executive ...........................................................................................................
Financial Reports ............................................................................................................
County Visitation, Expenses and Reports .......................................................................
Organizing County Societies ..........................................................................................
Scientific Work ...............................................................................................................
Interest of the Profession .................................................................................................
Charters ...........................................................................................................................
Board of Censors .............................................................................................................
Review of Commission/Committee Functions/Performance ..........................................
Duties of Alternate Trustees ...........................................................................................
6.00
THE EXECUTIVE COMMITTEE ..........................................……………….......... 27
6.01
COMPOSITION .........................................................................................................
4
25
25
26
26
26
26
26
26
27
27
27
27
27
27
27
6.02
6.0201
6.0202
DUTIES ........................................................................................................................ 28
Quorum ......................................................................................................................... 28
Executive Vice President’s Salary .................................................................................... 28
6.03
BUDGET RESPONSIBILITY ................................................................................... 28
6.04
INVESTMENT SURPLUS FUNDS ........................................................................... 28
6.05
STUDENT LOANS ...................................................................................................... 28
6.06
VACANCY .................................................................................................................... 28
7.00
ORGANIZATION OF ACTIVITIES/AND RESPONSIBILITIES……………… 28
7.01
7.0101
7.010101
7.010102
7.010103
7.010104
7.010105
7.010106
7.0102
7.010201
7.010202
7.010203
7.010204
7.010205
CREATION OF COMMITTEES AND COMMISSIONS ...................................... 28
Committees ..................................................................................................................... 29
Grievance ............................................................................................................... 29
Indiana Medical Education Fund .......................................................................... 29
ISMA-Sponsored Continuing Medical Education……………………………… 29
School Health ……………………………………………………..
29
Family Violence ………………………………………………………………… 29
Information Technology Committee…………………………………………….. 29
Commissions ............................................................................................................ 29
Constitution and Bylaws ........................................................................................ 29
Legislation ............................................................................................................. 29
Medical Education (Also Re: 7.03, Structure) ....................................................... 29
Physician Assistance .............................................................................................. 29
Sports Medicine ..................................................................................................... 29
7.02
COMMITTEE STRUCTURE ................................................................................... 29
7.03
COMMISSION STRUCTURE .................................................................................. 29
7.04
7.0401
EX-OFFICIO MEMBERS ......................................................................................... 30
Past Presidents ................................................................................................................ 30
7.05
REMOVAL OF MEMBERS ...................................................................................... 30
7.06
QUORUM ..................................................................................................................... 30
7.07
TERMS .......................................................................................................................... 30
7.08
INITIAL MEETING .................................................................................................... 30
7.09
COORDINATION OF ACTIVITIES ........................................................................ 30
7.10
7.1001
7.1002
7.1003
7.1004
7.1005
7.1006
7.1007
7.1008
7.1009
7.10010
7.10011
DUTIES AND RESPONSIBILITIES ........................................................................
Grievance Committee .....................................................................................................
Indiana Medical Education Fund Committee .................................................................
Commission on CME Committee……………………………………………………..
School Health Committee …………………………………………………
Family Violence Committee………………………………………………………….
Information Technology Committee………………………………………………….
Commission on Constitution and Bylaws .......................................................................
Commission on Legislation ............................................................................................
Commission on Medical Education ................................................................................
Commission on Physician Assistance ............................................................................
Commission on Sports Medicine ....................................................................................
5
30
30
31
31
31
31
31
32
32
32
32
32
7.11
TRAVEL REIMBURSEMENT ................................................................................. 33
8.00
RECIPROCITY OF MEMBERSHIP WITH OTHER
STATE SOCIETIES ............................................................………………............... 33
9.00
REFERENDUM .....................................................................………………............... 33
9.01
GENERAL AND SPECIAL MEETINGS ................................................................. 33
9.02
GENERAL REFERENDUM ..................................................................................... 33
10.00
THE SEAL ...............................................................………………............................. 33
11.00
COUNTY SOCIETIES ..............................................……………….......................... 33
11.01
11.0101
CHARTERS ................................................................................................................. 33
Conflicting Societies ....................................................................................................... 33
11.02
MEMBERSHIP QUALIFICATIONS ....................................................................... 34
11.03
RIGHT OF APPEAL ................................................................................................... 34
11.04
MEMBERSHIP TRANSFER ..................................................................................... 34
11.05
DIRECTION OF PROFESSION ................................................................................ 34
11.06
SELECTION OF DELEGATES ................................................................................ 34
11.07
SECRETARIAL DUTIES ........................................................................................... 34
11.08
FISCAL YEAR AND DUES ......................................................................................
11.09
FAILURE TO PAY DUES ......................................................................................... 35
11.10
SECRETARY DIRECTION ...................................................................................... 35
11.11
CONSTITUTION AND BYLAWS ............................................................................ 35
12.00
OTHER COMPONENT SOCIETIES ..........................………………..................... 35
12.01
CHARTERS .................................................................................................................. 35
12.02
CONSTITUTION AND BYLAWS ............................................................................. 36
12.03
12.0301
12.0302
12.0303
12.0304
RESIDENT AND FELLOW SOCIETY .............………………................................ 36
Composition .................................................................................................................... 36
Organization. ................................................................................................................... 36
Secretarial Duties ............................................................................................................. 36
Dues ................................................................................................................................. 36
12.04
12.0401
12.0402
12.0403
12.0404
12.0405
MEDICAL STUDENT SOCIETY ..............................................................................
Composition ....................................................................................................................
Organization. ..................................................................................................................
Resolutions ......................................................................................................................
Subscription to ISMA Publications ...........................................................................…..
Dues .................................................................................................................................
12.05
12.0501
YOUNG PHYSICIAN SOCIETY……………………………………………..……. 37
Composition………………………………………………………………………..…. 37
6
35
36
36
36
36
37
37
12.0502
12.0503
12.0504
Organization…………………………………………………………………………… 37
Secretarial Duties……………………………………………………………………. 37
Dues…………………………………………………………………………….…….. 37
13.00
TRUSTEE DISTRICT MEDICAL SOCIETIES .............……………….................. 37
13.01
COMPOSITION .........................................................................................................
13.02
NUMBER OF DISTRICTS ........................................................................................ 37
13.03
CONSTITUTION AND BYLAWS ............................................................................ 38
13.04
OFFICERS ................................................................................................................... 38
13.05
TRUSTEE ALLOCATION ........................................................................................ 38
13.06
DUES ............................................................................................................................. 38
13.07
MEETINGS .................................................................................................................. 38
13.08
13.0801
13.0802
14.00
NOTIFICATION TO HEADQUARTERS ................................................................
Election of Trustee or Alternate ......................................................................................
Agenda for Meeting ........................................................................................................
MEDICAL DEFENSE ADMINISTRATION, AUTHORITY & PROCEDURES .............……………….
37
38
38
38
38
14.01
ADMINISTRATION ........................................................................................…........ 38
14.02
POLICY AND PURPOSE ............................................................................................ 39
14.03
ELIGIBILITY - REQUEST FOR ISMA INVOLVEMENT ................................... 39
15.00
MISCELLANEOUS ........................................................................………………..... 39
15.01
DIVISION OF FEES ..................................................................................................... 39
15.02
FIFTY YEAR CLUB ............................................................................................…...... 39
16.00
PARLIAMENTARY PROCEDURE ..............................................………………..... 39
17.00
AMENDMENTS ..................................…................................………………............ 39
17.01
BYLAWS AMENDMENTS BY RESOLUTIONS .........................................…........ 39
17.02
OTHER ......................................................................................................................... 40
17.03
AMENDMENT IMPLEMENTATION ...........................................................…........ 40
18.00
MEDICAL ETHICS ...........................................................................……………..
18.01
PRINCIPLES: .....................................................................................………………. 40
40
AMERICAN MEDICAL ASSOCIATION PRINCIPLES OF MEDICAL ETHICS……………….… 40
ISMA CONSTITUTION TABLE OF CONTENTS………………………………………………………. 41
ISMA CONSTITUTION……………………………………………………………………………………. 42
7
Bylaws of the Indiana State Medical Association
1.0
MEMBERSHIP - QUALIFICATIONS, ELECTIONS AND RIGHTS
1.01
CATEGORIES: Categories of membership are: 1) Regular, 2) Dues Exempt, 3) Resident,
4) Medical Student, 5) Distinguished, 6) Honorary, 7) Military
1.0101
Regular Member: The term "Regular Member" as used in these Bylaws shall be
1) A person who holds the degree of Doctor of Medicine or Bachelor of Medicine or Doctor of
Osteopathy, and who holds a valid, unrestricted license to practice medicine, except as specified in
l.0303(b),
2) A member in good standing of a component county society and who has paid to this Association
annual dues, provided, however, that
3) the person is a citizen of the United States of America, or has filed the declaration of intention
of becoming a citizen and the first citizenship papers are in full force and effect.
1.0102
Dues-exempt Member: The term "Dues-exempt Member" in these Bylaws shall include the
following:
1.010201
Senior Member: Senior Members shall be eligible for Senior Membership on January 1 following
their 70th birthday and they shall be physicians of the state of Indiana who have held their
membership in the Indiana State Medical Association for 20 years or more; or who have held
membership in the Indiana State Medical Association or in some one or more other like state
organization(s) which is a component state organization of the American Medical Association, for
a combined total of 20 years or more, and who, upon their application, have been certified to the
Executive Vice President as eligible for such membership by the county societies of which they
are members. It shall be the duty of the component county medical society to verify, through the
office or offices of any other state organization or organizations, the fact of membership therein
when such membership is claimed as part compliance with the eligibility requirement of 20 years
of membership.
l.010202
Disabled Member: Disabled Members shall consist of physicians of the state of Indiana who are
certified by a member physician to be permanently disabled and no longer able to practice
medicine. Proof of permanent disability shall be by notification to the Executive Vice President
of the Association by the secretary of the component county medical society in which the
permanently disabled physician holds membership.
1.010203
Inactive Membership: Members who decide voluntary inactivity prior to the age of 70 shall be
exempt from payment of membership dues for the duration of their inactive status when
notification is received by the Executive Vice President of the Association from the secretary of
the county medical society in which such inactive member holds membership. In deciding whether
to approve a member's eligibility, the county medical society shall determine that the member has
ceased the practice of medicine in the state of Indiana.
8
1.010204
Financial Hardship: In the event the county relieves a member from the payment of dues
because of financial hardship, the secretary of the county medical society shall recommend in
writing to the Executive Vice President of ISMA the relief from State Association dues of said
member of the society, showing why such recommendation should be granted.
l.0103
Resident Member: Residents who hold membership in the Indiana State Medical Association
shall have all the rights and privileges of this Association.
1.0104
Medical Student Member: Medical students who attend an accredited medical school in Indiana
are members of this Association.
1.0105
Distinguished Member: Members who have fulfilled the American Medical Association's
Physician Recognition Award requirements of 150 hours for three years of continuing medical
education as a minimum shall be designated as Distinguished Members.
1.0106
Honorary Member: Honorary Members shall consist of physicians, teachers, scientists and others
of distinction who have rendered highly meritorious service to the profession of medicine, upon
whom the Association may, through action of the House of Delegates, desire to bestow such
membership as a special honor. Honorary members hereafter shall hold such membership as an
honor and distinction and by invitation may attend meetings of the Association. They shall not be
required to pay dues in the State Association. Such honor may only be bestowed by a vote or
acclamation of the House of Delegates.
1.0107
Military Member: Any physician-member of the active duty military service stationed in
Indiana, not to include physicians in the Reserve on temporary active duty shall be permitted to
join a component medical society of ISMA and become a member of ISMA at reduced dues that
shall be determined by the Board of Trustees.
1.0108
Provisional Member: Upon submission of a completed membership application, the county
medical society shall have 60 days in which to notify the ISMA in writing, or by e-mail or fax, of
the physician’s application status. If the county medical society does not so notify the ISMA by the
60th day after the physician submits the application, the ISMA shall, upon receipt of a completed
ISMA membership application, verification of data and receipt of dues, grant the applicant
provisional membership in the county and district medical associations and in the ISMA for a
period of one year from the date of the application. Provisional membership shall include all the
rights and privileges of a regular membership. Provisional membership shall end immediately if
the county medical society subsequently rejects the applicant for membership.
1.02
QUALIFICATIONS:
The Regular, Dues-exempt, and Distinguished Members of this
Association shall be the members of component medical societies and no component medical
society shall grant membership therein on a basis that does not include membership in the district
medical society and in the Indiana State Medical Association. Members of the Resident and
Fellow Society and the Medical Student Society have the same qualifications except for the
requirement of membership in a district medical society.
1.03
RIGHTS, PRIVILEGES AND RESPONSIBILITIES OF MEMBERS
1.0301
Rights and Privileges by Membership Category: All members of ISMA may attend the Annual
Convention. With the exception of Honorary Members, all ISMA members are eligible to vote
and hold office as specified elsewhere in these Bylaws. Medical Student Members may participate
in the democratic process as defined in l.0104.
9
1.0302
Attendance at Annual Convention: Members attending the Annual Convention and other
meetings shall register by indicating the component society of which they are members. At the
Annual Convention when membership has been verified by reference to the roster of members
(students excepted), they shall receive a badge which shall be evidence of their right to all the
privileges of membership at that convention. Members may not take part in any of the proceedings
of an Annual Convention until they have complied with the provisions of this section.
l.0303
(a) Suspension or Revocation of License: No person whose license to practice medicine has
been suspended or revoked by the Medical Licensing Board of Indiana, or who is under sentence
of suspension or expulsion from a component society, or whose name has been dropped from its
roll of members, shall be entitled to any of the rights or benefits of this Association or of a
component society, nor shall said person be permitted to take part in any of their proceedings until
the license and/or component membership has been restored.
(b) Exception: A member of the Indiana State Medical Association who is in need of assistance
because of neuropsychiatric illness, physical infirmity, alcohol or other substance dependence, and
who has submitted himself to the ISMA Commission on Physician Assistance or a comparable
county or hospital committee, may continue as a member of ISMA with full membership
privileges, even after suspension of his license by the Medical Licensing Board, if he is actively
cooperating with an appropriate committee and is making satisfactory progress in his
rehabilitation. It is incumbent upon the member in need of assistance to provide the ISMA
Commission on Physician Assistance with semi-annual reports from the committee with which he
is cooperating, documenting his cooperation and satisfactory progress in rehabilitation.
(c) Extension of Health Insurance: A member of the Indiana State Medical Association who is
enrolled in the group health insurance program sponsored by the ISMA may continue this coverage
with payment of premiums for a period of one year from the date of license suspension or
revocation.
2.00
INCOME AND EXPENSES
2.01
INCOME: Funds for carrying on the activities of the Association shall be raised by the following
means:
2.0101
Dues: Membership dues may be collected by the Indiana State Medical Association or by the
component county societies. The amount of dues of each component society shall be fixed by the
society itself, and the amount of dues for this Association shall be fixed from time to time by the
House of Delegates.
Dues are payable by January 15 and become delinquent on that date. The ISMA shall suspend any
member who has not paid dues in full by March 1 when the County Medical Society notifies the
ISMA in writing that the physician should be dropped from membership. The member shall
sacrifice all rights and privileges of membership of this Association until said annual dues are
received in full by the Indiana State Medical Association. For new members joining ISMA, dues
will be calculated on a pro-rated monthly basis.
2.010101
Dues Refund: A request for refund of dues will be acted upon by the Board of Trustees of the
Indiana State Medical Association in its wisdom. A letter of certification from the component
county society secretary to the Executive Vice President of the Indiana State Medical Association
to request an exemption of dues must state that the county is also exempting said dues. Upon
request and approval, dues will be refunded on a monthly pro-rated basis. Dues-exempt members
may receive any publication of ISMA upon payment of the applicable subscription price set by the
ISMA Board of Trustees. With the exception of Senior Members, all Dues-exempt Members will
10
be reviewed annually by their county medical societies to determine their eligibility for dues
exemption.
2.010102
Reduced Dues: The Indiana State Medical Association dues for Regular Members in their first
year of practice following formal training shall be one-half the amount as may be established by
the House of Delegates. County medical societies are encouraged to follow the same policy.
2.010103
Change in Dues Structure: The final vote on any issue calling for changes in dues or in dues
structure shall be by roll call vote of the House of Delegates. Each member's vote shall be
permanently recorded.
2.0102
Voluntary Contribution
2.0103
Revenues Derived from the Association's Publications.
2.0104
Revenue Derived from ISMA Activities or Services Approved by the Board of
Trustees.
2.0105
Assessments Approved by the House of Delegates.
2.02
EXPENSES: Funds shall be appropriated by the Board of Trustees to defray the expenses of the
Association, for publications, and for such other purposes as will promote the welfare of the
profession. All motions and resolutions recommending the appropriation of funds by the House of
Delegates must be referred to the Executive Committee and the Board for recommendation before
final action is taken by the House of Delegates.
3.00
CONVENTION AND MEETINGS
3.01
ANNUAL CONVENTION: The Association shall hold a Convention at least annually during
which the business and legislative sessions of the House of Delegates shall be held.
3.0101
Selection of Site: The Convention site shall be recommended by the Board of Trustees to the
House of Delegates for its approval. If conditions should prove difficult, the Board shall have the
power to change the location of the Convention. The Annual Convention shall be held in
Indianapolis and Marion County or in areas adjacent to or in close proximity to the Indianapolis
area. The date and time for the Convention shall be fixed by the Board.
3.02
HOUSE OF DELEGATES - BUSINESS AND LEGISLATIVE MEETINGS
(Referred to elsewhere in these Bylaws as House)
3.0201
Composition: The House of Delegates shall be the legislative and policymaking body of the
Association and shall consist of voting and non-voting members. Only members of the House of
Delegates, and Alternate Trustees, are entitled to speak on the floor of the House except as defined
in 3.0210.
3.020101
Voting Members: 1) Delegates or the designated Alternates, selected by the component societies;
2) Trustees or the designated Alternates, 3) Speaker, 4) Vice Speaker, 5) Past Presidents.
3.020102
Non-voting Members: 1) President, 2) President-elect, 3) Executive Vice President,
4) Treasurer, 5) Assistant Treasurer, 6) Delegates and Alternate Delegates to the American
Medical Association, and 7) Section Delegates or designated Alternate Delegates.
3.020103
Right to Vote: No delegate member of the House shall lose the right to vote by virtue of any
office that the delegate may hold.
11
3.0202
Parliamentarian: The Speaker may appoint a parliamentarian for the annual convention, who
need not be a member of the House and who shall advise the House about parliamentary matters,
but without voting privileges.
3.203
Meetings
3.020301
Regular Meetings: The House of Delegates may meet on the day before the date set for the
beginning of the general registration of the attendance at the annual convention. It may recess
from time to time as may be necessary to complete its business, provided that its hours shall
conflict as little as possible with the general or section meetings. It shall meet on the last day of
the annual convention for the election of officers for the ensuing year and for the completion of
any business previously introduced. The order of business shall be arranged as a separate section
of the program.
Nominations for officers of the Association may be made at any session of the House of Delegates.
3.020302
Special Meetings: Special meetings of the House of Delegates shall be called by the President
upon a petition signed by thirty (30) delegates. The signed petition shall contain the names of at
least ten (10) delegates from each of at least three (3) trustee districts. The President shall issue a
call for same as described in 3.0404.
3.0204
House Admission: All sessions of the House of Delegates shall be open to all members in good
standing of this Association for observation.
3.0205
Delegate Apportionment: Each component county society shall be entitled to send to the House
of Delegates each year one delegate for every fifty (50) members and one for each major fraction
thereof; but irrespective of the number of members, each component society which has made its
annual report and paid its assessments, as provided in this Constitution and Bylaws, shall be
entitled to one Delegate. The Young Physician Society delegates, Resident and Fellow Society
delegates, and medical student delegates shall be seated with full power to vote. In the absence of
a Young Physician Society, Resident and Fellow Society, or medical student delegate, a
corresponding alternate delegate shall be seated with full power to vote.
Where a component society is made up of physicians of more than one county, each county shall
be entitled to at least one Delegate and one Alternate Delegate; however, a multiple-county society
may have all of its delegates from the same county, if it is the desire of the majority of the
members of each participating county (provided that this would not decrease the total number of
delegates from the component medical society and provided each county of the component
medical society has at least one physician member of ISMA).
3.020501
Method of Determination of the Number of Delegates: The number of Delegates to which each
component society is entitled shall be based upon the number of members in good standing with
dues fully paid as of December 31 of the preceding year.
3.020502
Section Delegates: All Specialty Sections listed in 3.030103 of these Bylaws and which are in
compliance with 3.030102 and 3.030106 of these Bylaws shall be entitled to send to the House of
Delegates each year a Delegate or Alternate Delegate with all rights and privileges except the
power to vote.
3.020503
Delegate Credentials: The names of duly elected Delegates and Alternates from each component
society shall be sent to the Executive Vice President of this Association at least 45 days prior to
the annual convention at which such Delegates are to serve. No one shall be entitled to a seat in
the House of Delegates unless a credential card as a Delegate or Alternate, properly signed by the
12
Secretary of the appropriate component medical society or the Executive Secretary or Executive
Vice President of the larger societies, is presented to the Committee on Credentials at the time of
the annual convention.
3.020504
Delegate Replacement: Other provisions (to include those in Sections 3.020101, and 3.020503) in
these bylaws notwithstanding, if no delegate or alternate is selected by the deadline date 45 days
prior to the annual meeting, then the previous year's delegate is automatically designated.
Thereafter, the county officers, or if not available, the district officers may substitute a new
delegate upon certification of eligibility. If the officer(s) is/are not available, the county executive
may perform the delegate substitution. This substitution may be done until the time of the
beginning of the closing session of the House of Delegates.
3.0206
Quorum: Fifty (50) Delegates shall constitute a quorum.
3.0207
Authority and Responsibilities:
3.020701
Resolutions and Proposals: Only members of the Indiana State Medical Association may
sponsor resolutions to the House of Delegates. The House of Delegates shall approve all
memorials and resolutions issued in the name of the Association before same shall become
effective.
(a) Fiscal Note: Proposals calling for appropriation of funds by the House of Delegates shall be
accompanied by a fiscal note and shall be submitted to the Executive Committee and the Board for
review, presentation and recommendation for final action of the House. No proposal calling for
appropriations shall be considered if not accompanied by a fiscal note.
(b) Deadlines for Resolutions: Except as noted in 3.020701(c) and in 3.021102, all resolutions to
be presented to the House of Delegates for action shall be prepared and mailed to the Executive
Vice President of the Association so that they will be received not later than 60 days prior to the
session of the House of Delegates to which the resolutions will be presented.
(c) Late Resolutions: Except for matters of extreme emergent nature, all late resolutions must be
received by the Executive Vice President seven (7) days prior to the opening session of the House
of Delegates. Those resolutions received after 60 days prior to the first session of the House of
Delegates will be referred to the Committee on Rules and Order of Business. The Committee on
Rules and Order of Business shall submit a report to the House concerning all items considered by
same with recommendation(s) limited to the appropriateness of consideration of said resolutions.
The Committee on Rules and Order of Business will meet approximately seven (7) days prior to
the Annual Convention to consider resolutions that have been first submitted to the Committee
together with a written statement setting forth the reasons why the resolution was not mailed to the
Executive Vice President more than 60 days prior to the first session of the House of Delegates
and also setting forth in the written statement the reasons why the resolution is of such an
emergency nature that it cannot wait until the next meeting of the House.
The report of the Committee on Rules and Order of Business shall be considered in the same
manner as any other reference committee report. The House may accept or reject any
recommendation of the Committee, which shall make recommendations on each resolution
considered.
Discussion on the floor will be limited to one speaker in dissension with the Committee's
recommendation. This discussion will be limited to the appropriateness of consideration and not
the merits of the resolution itself.
13
Section 3.020701(b) may be suspended only upon a two-thirds affirmative vote of the House of
Delegates when considering the report of the Committee on Rules and Order of Business. Each
member of the House shall be furnished a copy of all proposed late resolutions for consideration of
the report of the Committee on Rules and Order of Business.
(d) Resolution Expiration: Any resolution adopted by the House of Delegates shall expire on
November 1 following the tenth anniversary of its adoption or its subsequent re-adoption. Prior to
each annual meeting, delegates shall be notified of all resolutions that will expire in th at calendar
year pursuant to this section, in sufficient time to permit submission of a resolution for re adoption. Nothing in this section shall restrict the power of the House of Delegates to rescind or
amend any resolution in force at any time.
(e) Withdrawal of Resolutions: The withdrawal of ISMA resolutions may not occur later than the
publication and distribution date of all resolutions, except by majority approval of the ISMA
House of Delegates during the first meeting of that House of Delegates.
3.0208
Election of Delegates to the American Medical Association: The House of Delegates shall elect
representatives to the House of Delegates of the American Medical Association in accordance with
the Constitution and Bylaws of that body.
Upon expiration of an AMA Delegate's or Alternate Delegate's term, election of a qualified
member shall be accomplished to fill each vacancy thereby created. Nominations shall be made
for vacancies without regard to the specific vacancy, and the candidates with the most votes,
provided that a majority vote has been obtained, shall be deemed elected to the vacancies. An
AMA Delegate and Alternate Delegate may succeed himself in office or be elected to fill any other
vacancy in the delegation. The Alternate Delegate positions are not matched with the Delegate
positions; therefore at the direction of the AMA Delegation, any Alternate can represent a
Delegate.
In the event of a permanent vacancy occurring among the AMA Delegates, the remaining elected
Delegates and Alternates to the AMA shall meet and nominate one of the Alternates to assume the
vacancy until the next meeting of the Indiana State Medical Association House of Delegates, at
which time the House shall vote to fill such vacancy. The nominated member proposed by the
AMA Delegation shall be subject to confirmation by the Board of Trustees.
3.0209
Organizing Districts: The House of Delegates shall provide for the organization of such Trustee
District Societies as will promote the best interests of the profession, such societies to be
composed exclusively of members of component county societies. Trustee districts shall be
defined by the House of Delegates.
The House shall divide the state into Trustee Districts, specifying which counties each dis trict
shall include, and when the best interest of the Association and profession will be promoted
thereby, organize in each district a medical society, and all members of component county
societies, and no others, shall be members of such district societies.
3.0210
Authority to Appoint Special Committees: The House shall have the authority to appoint
committees for special purposes from among members of the Association who need not be
members of the House of Delegates. Such committees shall report to the House of Delegates, and
the members of such committees may be present and participate on the floor in the debate of their
reports.
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3.0211
Reference Committees and Committee on Rules and Order of Business:
3.021101
Reference Committees: Immediately after the organization of the House of Delegates at each
Annual Convention, the Speaker shall announce the membership of the Reference Committees to
serve during the convention for which they are appointed.
Appointments to these reference committees shall be made by the Speaker. The chairman of each
committee shall also be appointed by the Speaker. The Speaker shall also appoint such additional
House committees as the House may approve. All such committees shall serve only during the
convention at which they are appointed. The Speaker shall have the power to appoint substitutes
from among members present for absent appointees.
Each committee shall consist of at least five ISMA members, three of whom, including the
chairman, shall be delegate-members of the House. To these committees shall be referred all
reports, resolutions, measures and propositions presented to the House of Delegates, except
matters as properly come before the Board, and the recommendations of these committees shall be
submitted to the next session of the House of Delegates for acceptance in the original or modified
form or for rejection.
3.021102
Responsibilities of Reference Committees: Four or more reference committees designated by
numerals are hereby constituted to which all matters shall be referred, at least one of which shall
be organized for the purpose of studying the addresses and reports of the President, President elect; the report of the Executive Vice President, and the report of the Chairman of the Board of
Trustees. This committee shall be expected, as it deems appropriate, to translate the reports by
these officers into recommendations for presentation to the Board of Trustees.
Where a report, resolution, measure or proposition deals with more than one subject matter,
referral may, at the discretion of the Speaker of the House, be made (a) to as many reference
committees as are necessary to cover all subjects included herein; or (b) to only one reference
committee which the Speaker deems has within the scope of its reference the most important part
of the matter referred. No report of any reference committee shall be rejected on the ground that it
covers something not included in the matters which such committee was created to consider.
3.021103
Time and Place of Meetings: The time and place of meetings of all reference committees shall
be publicly posted, and all meetings of all reference committees shall be open only to membe rs of
this Association. Officers and chairmen of all commissions and committees whose reports are
referred to reference committees are expected to appear and be heard before the respective
committees to which such references are made in regard to their reports.
3.021104
Non-member Attendance: Persons who are not members of the Indiana State Medical
Association and seek to appear and present their technical or reference material to the reference
committee must receive approval to appear on that specific subject from the reference committee
Chairman. Such persons must register as guests at the committee and be at the call of the
reference committee chairman for testimony, after which they may be excused from further
attendance.
3.021105
Committee on Rules and Order of Business: The Committee on Rules and Order of Business
shall be composed of the Chairmen of the various reference committees appointed by the Speaker.
This committee shall be charged with the duties as set forth in 3.020701(c) of these Bylaws.
3.0212
Election of Officers: The officers of this Association with the exception of the Executive Vice
President and the Board of Trustees shall be elected by the House of Delegates, as the first order
of business at the final session of the House of Delegates, and no person shall be elected to any
such office who has not been an active member of the Association for the preceding two years.
15
The officers except the Executive Vice President and the Trustees shall be elected annually. All
officers shall serve until their successors are elected and installed.
3.021201
Method of Election: If there is only one candidate nominated for an office, election may be by
voice vote. All other elections shall be by ballot and a majority of the votes cast shall be necessary
to elect. In case no nominee receives a majority on the first ballot, the nominee receiving the
lowest number of votes shall be dropped and a new ballot taken. In the event of a tie vote on any
ballot, the House of Delegates may, by majority vote, order an additional ballot, or may order
resolution of the tie by drawing lots.
3.021202
Terms: The President, President-elect, Speaker, Vice Speaker, Treasurer and Assistant Treasurer
shall serve from the termination of the annual meeting of the House of Delegates in which all but
the President are elected until the termination of the succeeding annual meeting of the House of
Delegates.
3.021203
Oath: The major officeholders of the Association shall be installed by taking the following oath
of office to be administered by the outgoing President of the Association at the final session of the
House of Delegates:
I, _____, solemnly swear that I shall carry out to the best of my ability, the duties of the office of
the Indiana State Medical Association to which I have been elected.
I shall strive constantly to maintain the ethics of the medical profession and to promote the public
health and welfare. I shall dedicate myself and my office to improving the health standards of the
American people and to do the task of bringing increasingly improved medical care within the
reach of every citizen.
I shall uphold at all times the Constitution of the United States of America and of the State of
Indiana, the Constitution and Bylaws of the American Medical Association, and the Constitution
and Bylaws of the Indiana State Medical Association. I shall champion the cause of freedom in
medical practice and freedom for all my fellow Americans. To these duties and obligations, I
pledge myself, so help me, God.
3.03
SECTION MEETINGS
3.0301
Specialty Sections
3.030101
Purpose: The purpose of specialty sections of ISMA is to provide a forum in ISMA and the
House of Delegates, to have an active input into the scientific meeting, to introduce resolutions and
have a voice on the floor of the House.
3.030102
Meetings: Each section will be required to have a minimum of one meeting annually. Minutes of
the meeting will be required. A copy of the minutes and the names of the officers shall be
forwarded to the Speaker of the House and will become a permanent record of the House.
3.030103
Official Sections: During the Annual Convention the Association, in addition to the general
meetings, may hold the following section meetings:
(a) Allergy
(b) Anesthesia
(c) Cutaneous Medicine
(d) Directors of Medical Education
(e) Emergency Medicine
(f) Family Physicians
(g) Internal Medicine
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(h)
(i)
(j)
(k)
(l)
(m)
(n)
(o)
(p)
(q)
(r)
(s)
(t)
(u)
(v)
(w)
(x)
(y)
Medical Directors and Staff Physicians of Nursing Facilities
Neurological Surgery
Neurology
Nuclear Medicine
Obstetrics and Gynecology
Oncology
Ophthalmology
Orthopedic Surgery
Otolaryngology, Head and Neck Surgery
Pathology and Forensic Medicine
Pediatrics
Physical Medicine and Rehabilitation
Preventive Medicine and Public Health
Psychiatry
Radiation Oncology
Radiology
Surgery
Urology
3.030104
Formation of Sections: Any future section can only be formed by a properly constituted
resolution and shall include the signatures of a minimum of 15 members or 25 percent of the
members, whichever is greater, who are practicing that specialty in the State of Indiana. The
resolution shall be subject to the decision of the House of Delegates.
3.030105
Officers: The officers of each section shall be a chairman, a vice-chairman, and a secretary, and
they shall preside over the meetings of the section and shall be responsible for the section speakers
and papers.
3.030106
Officer Elections: The election of officers shall be held at a meeting of the section annually. The
names of the officers shall be forwarded to the Speaker and will become a permanent record of the
House.
3.030107
Restriction on Meetings: No section meeting shall be allowed to conflict with a general meeting.
3.030108
Failure to Comply: Any section not complying with the preceding shall not have a delegate in
the House.
3.0302
Hospital Medical Staff Section
3.030201
Composition: Membership in the Hospital Medical Staff Section shall be limited to ISMA
members selected by physician members of the medical staffs from each licensed hospital in the
state of Indiana.
3.030202
Organization: The organization of the Hospital Medical Staff Section shall consist of an
Executive Committee, which shall consist of the chairman, vice-chairman, secretary/treasurer, two
members at large and the delegate and alternate delegate to the ISMA House of Delegates, with
duties as may be prescribed in the Hospital Medical Staff Section Bylaws.
3.04
GENERAL MEMBERSHIP MEETINGS
3.0401
General Meetings for the Membership: General Meetings shall mean all meetings planned for
attendance by all registered members and shall include those meetings in which guests of
registered members or the general public are also invited. The address of the President may be
delivered in a General Meeting.
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3.0402
Purposes of Meetings for the General Membership and Meetings of the Association:
3.040201
Scientific Presentations and Discussions. (Quorum NOT necessary.)
3.040202
Dissemination of Information of Interest to the General Membership.
(Quorum NOT necessary.)
3.040203
Appointment of Committees: The General or Section Meetings may recommend to the House of
Delegates the appointment of committees or commissions for scientific investigation of special
interest and importance to the profession and public. (Quorum NOT necessary.)
3.040204
Issue Mandates to the House: Matters of vital concern to the general membership may be
referred to the House of Delegates who shall act as expeditiously as possible utilizing the usual
parliamentary procedures in order to serve the needs of the profession in the most equitable
fashion. (Quorum NECESSARY.)
3.040205
Order Referendums: As described in 9.01 (Quorum NECESSARY)
3.0403
Quorum for General Membership Meetings: For the purpose of transacting official business, a
quorum of 150 members must be present at a General Meeting of the Association.
3.0404
Special Meetings for the General Membership: Special Meetings for the general membership
shall be called by the President upon receipt of a petition signed by 100 members representing a
minimum of three Trustee districts, with no one district providing more than 34 of the required 100
signatures.
Upon receipt by the President of such a petition, the President shall within 30 days thereafter issue
a call for such special meeting and shall state the items of business to be considered, at a date, time
and place fixed by the President. The President, in specifying the time of such special meeting,
shall fix the same as soon thereafter as reasonable so that suitable arrangements can be made.
4.00
OFFICERS
4.01
COMPOSITION: The officers of this Association shall be a President, President-elect,
Immediate Past President, Treasurer, Assistant Treasurer, Speaker, Vice Speaker, Trustees,
Alternate Trustees, and Executive Vice President--each of whom shall be a member, except the
Executive Vice President, who need not necessarily be either a physician or a member.
4.0101
Limitation: The offices of President, President-elect, Immediate Past President, Treasurer,
Assistant Treasurer, Speaker, Vice Speaker, as well as AMA Delegates, AMA Alternate
Delegates, and ISMA Trustees and Alternate Trustees are major offices. Individuals may not hold
more than one major office during a given term and must resign from a major office if they attain a
second, with the exception of the AMA Delegates and Alternate Delegates who may hold a major
state office while serving on the Delegation.
4.0102
Delinquent Dues: A major officeholder in ISMA who is delinquent in paying dues will not be
allowed to vote in that capacity until annual dues are paid in full.
4.02
REMOVAL, DEATH, RESIGNATION, VACANCY: Any officer may be removed from office
after a hearing before the Board, on 30 days notice, based on charges in writing, upon a vote of
three-fourths of the members of the Board. A hearing shall be mandatory if an officer's license is
suspended or revoked by the Medical Licensing Board of Indiana.
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In the event of the death, resignation, removal or permanent disability of any officer of this
Association whose successor is not otherwise provided for in these Bylaws, the vacancy shall be
filled by the Board of Trustees until the next official meeting of the House. The Board shall fill a
vacancy in the office of Treasurer or Assistant Treasurer by an election by the Trustees at the next
regular meeting of the Board following the occurrence of such vacancy.
4.03
DUTIES
4.0301
President: The President or a member designated by the President shall preside at all general
meetings of the Association. The President shall appoint all committees not otherwise provided
for; shall appoint the chairman of each commission and committee; shall fill the vacancies
resulting from the expiration of terms of members of commissions, and also appoint members to
fill the unexpired term where any other vacancy occurs. The President will have the power, with
the approval of the Board, to remove any member of any committee or commission as defined in
7.05. Within 60 days after the Annual Convention, the President may call all commissions and
committees into a joint meeting as defined in 7.08.
Charters of county societies as defined in 11.01, and component societies, as defined in 12.01, and
approved by the Board, shall be signed by the President and Executive Vice President.
Special meetings of either the Association or the House of Delegates shall be called by the
President as defined in 3.020302 and 3.0404 of these Bylaws.
The President shall deliver an annual address and shall perform such other duties as custom and
parliamentary usage may require. The President shall be the real head of the profession of the
state during the term of office, and as far as practicable, shall visit by appointment the various
sections of the state and assist the trustees in building up the county societies and in making their
work more practical and useful.
Unless otherwise specified in the Bylaws, ex-officio, the President shall be a member, without
vote, of all commissions and committees.
4.0302
President-elect: The President-elect's term of office shall be for one year at the completion of
which the President-elect succeeds to the presidency. The President-elect shall assist the President
in the discharge of duties. Ex-officio, the President-elect shall be a member, without vote, of all
commissions and committees. In the event the office of President is vacant, the President-elect
will assume the office of President.
4.0303
Treasurer: The Treasurer shall give bond at the expense of the Association in such an amount as
shall be required by the Board unless included in the coverage of a blanket or position bond. The
Treasurer shall receive all bequests and donations to the Association and shall demand and receive
all funds due the Association in the conduct of its business. The funds of the Association shall be
deposited in a depository or depositories designated by the Executive Committee; and withdrawals
from such funds shall be made on checks or drafts signed by the Treasurer, and/or others so
designated by the Executive Committee. The Treasurer shall present annually to the House of
Delegates a report of the receipts and expenditures, and the state of funds on hand.
4.0304
Assistant Treasurer: The Assistant Treasurer shall give bond at the expense of the Association
in such an amount as shall be required by the Board unless included in the coverage of a blanket or
position bond. In case of death, or incapacity of the Treasurer, the Assistant Treasurer shall
succeed to all the duties and rights of the Treasurer until a new Treasurer is elected.
19
In the absence of the Treasurer, the Assistant Treasurer shall attend to the duties and rights of the
Treasurer during such absence and shall also perform such duties of the Treasurer as may be
delegated and assigned by the Treasurer.
4.0305
Executive Vice President: The Executive Vice President shall be the directing manager of the
Association's headquarters and shall supervise the work of all salaried employees of the
Association offices.
Such supervision shall be subject to directives from the House of Delegates, the Board, the
Executive Committee, and the President of the Association. The Executive Vice President shall
discharge the administrative functions of the Association not within the duties of other offices or
of committees to perform. The Executive Vice President shall assist, at their request, all offices
and committees, and shall keep informed in regard to nonprofessional matters affecting the
medical profession, for the purpose of keeping qualified to perform the services herein mentioned.
The Executive Vice President shall be responsible for the execution of the policies of the
Association and in that connection, shall perform all specific tasks required by the committees, the
Board, and the officers of this Association. The Executive Vice President will personally notify a
major officeholder whose dues are delinquent.
4.0306
Speaker: The Speaker shall be elected annually from the members of the House. The Speaker
shall preside at all meetings of the House of Delegates and shall perform such duties as custom and
parliamentary usage require. The Speaker shall have the right to vote as a delegate member of the
House. The Speaker may address the House of Delegates at the opening session of all
conventions, limiting the address to matters of conduct and procedure of the House.
The Speaker shall be further charged with the duties as defined in these Bylaws (i.e., 3.0202,
3.021101 and 3.021102). Ex-officio, the Speaker shall be a member of all commissions and
committees and the Board of Trustees of this Association without the power to vote. Training in
parliamentary procedure shall be mandatory for the Speaker and shall be provided at the expense
of the Association. In the event the offices of President and President-elect are vacant, the Speaker
of the House of Delegates will assume the office pro tem until the next called or regularly
scheduled meeting of the House when a President and a President-elect will be elected.
4.0307
Vice Speaker: The Vice Speaker shall be elected annually from the members of the House. The
Vice Speaker of the House of Delegates shall officiate at meetings in the absence of the Speaker or
at the request of the Speaker. The Vice Speaker shall have the right to vote as a delegate member
of the House. Ex-officio, the Vice Speaker shall be a member of all commissions and committees
and the Board of Trustees of this Association without the power to vote. Training in parliamentary
procedure shall be mandatory for the Vice Speaker and shall be provided at the expense of the
association.
4.04
EXPENSES: The necessary expenses of the above offices incurred in the line of duty herein
imposed shall be allowed for in the budget but, excepting the Executive Vice President, this shall
not include the expenses of attending the Annual Convention.
4.05
INDEMNIFICATION OF OFFICERS AND TRUSTEES
4.0501
Definitions:
(a) The term "trustee" means an individual who is or was a trustee of the Association or an
individual who, while a trustee of the Association, is or was serving at the Association’s request as
a trustee, officer, partner, employee, or agent of another foreign or domestic corporation,
partnership, join venture, trust, employee benefit plan, or other enterprise, whether for profit or
not.
20
A trustee is considered to be serving an employee benefit plan at the Association's request if the
trustee's duties to the Association also impose duties on, or otherwise involve services by, the
trustee to the plan or to participants in or beneficiaries of the plan. Trustee" includes unless the
context requires otherwise, the estate or personal representative of a trustee
(b) The term "expenses" includes all direct and indirect costs (including without limitation
counsel fees, retainers, court costs, transcripts, fees of experts, witness fees, travel expenses,
duplicating costs, printing and binding costs, telephone charges, postage, delivery service fees, and
all other disbursements and out-of-pocket expenses) actually incurred in connection with the
investigation, defense, settlement or appeal of a proceeding or establishing or enforcing a right to
indemnification under this section, applicable law or otherwise.
(c) The term "liability" means the obligation to pay a judgment, settlement, penalty, fine
(including excise tax assessed with respect to an employee benefit plan), or reasonable expenses
incurred with respect to a proceeding.
(d) The term "official capacity" means:
(i) When used with respect to a trustee, the office of a trustee in the Association; or
(ii) When used with respect to an individual other than a trustee, as contemplated in
Section 4.0507 herein, the office in the Association held by the officer or the employment
or agency relationship undertaken by the employee or agent on behalf of the Association.
(e) The term "party" includes an individual who was, is, or is threatened to be made a named
defendant or respondent in a proceeding.
(f) The term "proceeding" means any threatened, pending, or completed action, suit, or
proceeding, whether civil, criminal, administrative, or investigative and whether formal or
informal.
4.0502
Conditional Indemnification: The Association shall indemnify an individual made a party to a
proceeding because the individual is or was a trustee against liability incurred in the proceeding if:
(a) The individual's conduct was in good faith;
(b) The individual reasonably believed:
(i) In the case of conduct in the individual's official capacity with the Association, that the
individual's conduct was in its best interest; and
(ii) In all other cases, that the individual's conduct was at least not opposed to its best
interest; and
(c) In the case of any criminal proceeding, the individual either:
(i) Had reasonable cause to believe the individual's conduct was lawful; or
(ii) Had no reasonable cause to believe the individual's conduct was unlawful.
A trustee's conduct with respect to an employee benefit plan for a purpose the trustee reasonably
believed to be in the interest of the participants in and beneficiaries of the plan is conduct that
satisfies the requirement of subsection (b) above.
The termination of a proceeding by judgment, order, settlement, conviction, or upon a plea of nolo
contendere or its equivalent is not, of itself, determinative that the trustee did not meet the standard
of conduct described in this Section 4.0502.
21
4.0503
Mandatory Indemnification: The Association shall indemnify a trustee who was wholly
successful, on the merits or otherwise, in the defense of any proceeding to which the trustee was a
party because the trustee is or was a trustee of the Association against reasonable expenses
incurred by the trustee in connection with the proceeding.
4.0504
Court-Ordered Indemnification: A trustee of the Association who is a party to a proceeding
may apply for indemnification to the court conducting the proceeding or to another court of
competent jurisdiction. On receipt of an application, the court, after giving any notice the court
considers necessary, may order indemnification if it determines that:
(a) The trustee is entitled to mandatory indemnification under Section 4.0503, in which case the
court shall also order the Association to pay the trustee's reasonable expenses incurred to obtain
court-ordered indemnification; or
(b) The trustee is fairly and reasonably entitled to indemnification in view of all of the relevant
circumstances, whether or not the trustee met the standard of conduct set forth in Section 4.0502
4.0505
Advancement of Expenses Prior to Final Disposition: The Association shall pay for or
reimburse the reasonable expenses incurred by a trustee who is a party to a proceeding in advance
of final disposition of the proceeding if:
(a) The trustee furnishes the Association a written affirmation of the trustee's good faith belief that
the trustee has met the standard of conduct described in Section 4.0502;
(b) The trustee furnishes the Association a written undertaking, executed personally or on the
trustee's behalf, to repay the advance if it is ultimately determined that the trustee did not meet the
standard of conduct; and
(c) As determination is made that the facts then known to those making the determination would
not preclude indemnification under this Section.
The undertaking required by subsection (b) must be an unlimited general obligation of the trustee
but need not be secured and shall be accepted without reference to financial ability to make
repayment.
Determinations and authorizations of payments under this Section shall be made in the manner
specified in Section 4.0506.
4.0506
Procedure: The Association may not indemnify a trustee unless authorized in a specific case after
determination has been made that indemnification of the trustee is permissible under the
circumstances because the trustee has met the standard of conduct set forth in Section 4.0502. The
determination shall be made by any one of the following procedures:
(a) By the Board of Trustees by majority vote of a quorum consisting of trustees not at the time
parties to the proceeding;
(b) If a quorum cannot be obtained under subsection (a), by majority vote of a committee duly
designated by the Board of Trustees (in which designated trustees who are parties may participate)
consisting solely of two or more trustees not at the time parties to the proceeding:
22
(c) By special legal counsel:
(i) Selected by the Board of Trustees or its committee in the manner prescribed in
subsection (a) or (b); or
(ii) If a quorum of the Board of Trustees cannot be obtained under subsection (a) and a
committee cannot be designated under subsection (b), selected by majority vote of the full
Board of Trustees (in which selection trustees who are parties may participate),
authorization of indemnification and evaluation as to reasonableness of expenses shall be
made in the same manner as the determination that indemnification is permissible, except
that if the determination is made by special legal counsel, authorization of indemnification
and evaluation as to reasonableness of expenses shall be made by those entitled under
subsection (c) to select counsel.
4.0507
Indemnification of Association Employees Other Than Trustees: An officer of the
Association, whether or not a trustee, is entitled to mandatory indemnification under Section
4.0503 and is entitled to apply for court-ordered indemnification under Section 4.0504, in each
case to the same extent as a trustee. The Association shall indemnify in advance expenses to an
officer, employee, or agent of the Association, whether or not a trustee, to the same extent as to a
trustee.
The Association shall also indemnify in advance expenses to an officer, employee, or agent,
whether or not a trustee, to the extent, consistent with public policy, that may be provided by
general or specific action of its Board of Trustees, the Association's Bylaws or contract.
4.0508
Liability Insurance: The Association may purchase and maintain insurance on behalf of an
individual who is or was a trustee, officer, employee, or agent of the Association, or who, while a
trustee, officer, employee, or agent of the Association, is or was serving at the request of the
Association as a trustee, officer, partner, employee, or agent of another foreign or domestic
corporation, partnership, joint venture, trust, employee benefit plan, or other enterprise, against
liability asserted against or incurred by the individual in that capacity or arising from the
individual status as a trustee, officer, employee, or agent, whether or not the Association would
have power to indemnify the individual against the same liability.
4.0509
Miscellaneous: The indemnification and advance for expenses provided for does not exclude any
other rights to indemnification and advance for expenses that a person may have under a resolution
of the Board of Trustees or any other authorization, whenever adopted, after notice, by majority
vote of all the voting shares then issued and outstanding.
This Section does not limit the Association's power to pay or reimburse expenses incurred by a
trustee, officer, employee, or agent in connection with the person's appearance as a witness in a
proceeding at a time when the person has not been named a defendant or respondent to the
proceeding.
The provisions of this Section shall be in addition to and not in limitation of any other right of
indemnification and reimbursement or limitations of liability to which any trustee or officer may
be entitled to as a matter of law.
5.00
BOARD OF TRUSTEES: (Referred to elsewhere in these Bylaws as Board)
5.01
COMPOSITION/VOTING POWER: The Board of Trustees shall consist of: (1) trustees with
power to vote and duly elected alternates, including the young physician trustee and alternate
elected by the Young Physician Society, resident trustee and alternate elected by the Resident and
Fellow Society, and the student trustee and alternate elected by the Medical Student Society each
of the alternates without power to vote except when the corresponding Trustee is not in
23
attendance; (2) ex-officio, the president, president-elect, treasurer, immediate past president, all
with power to vote; assistant treasurer without power to vote except when the treasurer is not in
attendance; and (3) speaker, vice speaker and the Executive Vice President, all without power to
vote.
5.02
AUTHORITY: The Board shall be the executive body of the Association with full power to
transact any business that emergencies or the welfare of the Association may require and shall
perform and exercise all of the rights and duties as specified in this section. The Board of Trustees
is accountable to the House of Delegates.
5.0201
Suspension of Dues-delinquent Major Officeholders: The Board will declare major
officeholders who are delinquent in paying their dues as suspended from the office after February
1, at which time such officers shall sacrifice all rights and privileges of the office until said dues
are received in full by ISMA.
5.03
ELECTION - TRUSTEE AND ALTERNATE: The Trustees shall be elected by the respective
district societies. If any district fails to meet and elect its Trustee(s) or Alternate Trustee(s) by the
time of the expiration of the incumbent's term of office, the Executive Vice President of the
Association shall cause a special meeting to be called by said district society for the purpose of
such election.
5.04
MEETINGS AND TERMS
5.0401
Regular Meetings: The Board shall meet as follows: (1) At least once each quarter of the
calendar year, the time, date and location to be fixed by the Board; (2) On the day preceding the
first day of the scientific meetings of the Annual Convention of the Association; (3) On the last
day of the Annual Convention of the Association after the adjournment of the House of Delegates;
(4) At such other times as necessity may require, subject to the call of the Chairman. It shall hold
no meeting that will conflict with any meeting of the House of Delegates. Notice of each regular
meeting shall be given at least ten days before such meeting.
5.0402
Special Meetings: Special meetings may be called at any time by the Chairman or at the request
of seven members of the Board. Notice shall be given at least five days before each special
meeting. The notice shall specify the general purpose of and business to be transacted at the
meeting.
5.0403
Quorum: Twelve members of the Board shall constitute a quorum.
5.0404
Attendance at Meetings: If any elected Trustee fails, without reason acceptable to the Board, in
any calendar year to attend a majority of the meetings of the Board, said person shall thereby cease
to be a Trustee, and the Executive Vice President shall take action in accordance with 5.05.
5.0405
Meeting Notices: Notice is given if delivered in person, by telephone, mail or telegram. If
mailed, such notice shall be deemed to be delivered when deposited in the United States mail,
addressed to a Trustee (and other persons entitled to notice) at the Trustee's address then appearing
on the records of the Association, with postage prepaid, and if given by telegraph, shall be deemed
delivered when the telegram is delivered to the telegraph company.
Notice of any meeting and the object of business to be transacted at a meeting of the Board need
not be given if waived in writing, or by telegraph, mail, or telephone before, during, or after such
meeting. Attendance at any meeting shall constitute a waiver of notice of such meeting except
where attendance is for the express purpose of objecting to the transaction of any business because
the meeting is unlawfully called or convened.
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5.0406
Terms of Trustees: Terms of Trustees shall begin with the first meeting of the Board following
the final session of the House of Delegates at the Annual Convention. The term of the elected
District Trustee shall be for three years with approximately one-third of the total number of
Trustees elected annually (exception, the young physician trustee, student trustee and the resident
trustee shall have a one-year term). No Trustee shall be eligible to serve longer than two terms
consecutively. The time given to serving an unexpired term shall not be considered in determining
the period within which a Trustee may serve consecutively.
5.0407
Alternate Trustees: Each Trustee district shall elect an Alternate Trustee whose term of office
shall be for three years (exception, the young physician trustee, student alternate trustee and the
resident alternate trustee shall have a one-year term). The alternate trustee shall be elected in a
year during which the trustee is not elected. No alternate trustee shall be eligible to serve longer
than two terms consecutively. The time given to serving an unexpired term shall not be
considered in determining the period within which an alternate trustee may serve consecutively.
5.05
VACANCIES: In the event of a vacancy occurring from any cause, except expiration of the term
of office in the office of a district trustee, the duly elected alternate trustee from the same district
shall temporarily assume, on an interim basis, the office of the trustee in that district, until such
time as the vacancy is filled by election. In the event of a vacancy in the office of the alternate
trustee, the president of the district medical society shall temporarily assume, on an interim basis,
the office of alternate trustee until such time as the alternate trustee can resume the duties of that
office, or until such time as a new alternate trustee is elected.
In the event vacancies occur in any trustee district in the offices of either the trustee or alternate
trustee, the vacancies shall be filled on a permanent basis by an election by the members of the
association within the trustee district in which the vacancies occur. A call for such elections shall
be issued by the Executive Vice President of the Indiana State Medical Association following a
conference(s) with the officers of the district organization. The call shall state the date, time and
place of holding the election and shall be sent registered mail to the county secretary, as filed in
the Indiana State Medical Association Executive Vice President's office, of each component
society within the district. Such call shall be mailed within ten days after the Executive Vice
President of ISMA has learned of the vacancies. The election may be held at a regular meeting at
which business other than the election may be transacted. Such election shall be within 15 days
after the Executive Vice President of the Indiana State Medical Association shall have mailed
such call. If an alternate trustee is elected as trustee in such an election, the resultant vacancy in
the position of alternate trustee may be filled immediately by election at the same meeting, without
further notice.
5.06
ORGANIZATION AND DUTIES: Immediately following the conclusion of the Annual
Convention, the Board shall organize by electing a Chairman, who shall serve for one year, and a
Clerk who, in the absence of the Executive Vice President of the Association, shall keep a record
of its proceedings and who in the absence of the Chairman will act as Chairman pro tem.
It shall, through its Chairman, make an annual report to the House of Delegates. The Chairman of
the Board shall be elected by secret ballot. The number of terms of the Chairman shall be limited
to not more than three in succession. The Chairman of the Board of Trustees shall be an ex-officio
member, without vote, of all ISMA commissions and committees.
5.0601
Election of At-large Members to Executive Committee: The Board shall, at its meeting
following the close of the House of Delegates, elect two members of the Board as at-large
members who, with the President, the President-elect, the Immediate Past President, the Chairman
of the Board, the Treasurer, the Assistant Treasurer, with the power to vote in the absence of the
Treasurer, and ex-officio the Speaker and Vice Speaker without power to vote, shall constitute and
be known as the Executive Committee. Members of the Committee shall serve until the next
25
organizational meeting of the Board and until their successors are elected and qualified. The
authority and functions assigned by the Board to the Executive Committee shall be reviewed
annually at the first regular meeting of the Board of Trustees.
5.0602
Conduction of Business: The Board shall perform all acts and transact all business for or on
behalf of the Association and manage the property and conduct the affairs, work and activities of
the Association, except as may be otherwise provided in this Constitution and Bylaws.
All resolutions and recommendations of the House calling for the expenditure of funds, passed by
the House of Delegates, shall be referred to the Executive Committee, which shall determine
whether the expenditures are advisable and so inform the Board of Trustees. If the Board of
Trustees decides that the expenditure(s) is inadvisable, the Board shall report, at its earliest
convenience, to the House of Delegates the reasons for its action.
In no instance may the Executive Committee or the Board of Trustees fail to implement a mandate
of the House of Delegates for reasons other than fiscal impossibility, budgetary restrictions or
legal ramifications.
5.0603
Publications: The Board shall provide for the publication of and determine the editorial policies,
in accordance with the policy enunciated by the House of Delegates, of: (1) publications as it may
deem expedient, (2) a publication for public information and dissemination, and (3) all
proceedings, transactions and memoirs.
The Board shall provide for and superintend all publications of the Association and shall appoint
an editor and an editorial board, as it deems necessary, and fix the amount of their salaries. The
proceedings of the Board for the year shall be reported to the House of Delegates at the Annual
Convention and be published and distributed to all members immediately preceding the annual
convention.
5.0604
Employ Executive: The Board shall employ the Executive Vice President, and fill any vacancy
therein, who shall be the person to manage and direct the activities of the Association under the
authority granted by the Board.
5.0605
Financial Reports:
annually.
5.0606
County Visitation, Expenses and Reports: Each Trustee shall be organizer, peacemaker, and
censor for the represented district. The Trustee shall visit the counties in the represented district at
least once a year for the purpose of organizing component societies where none exist; for inquiring
into the condition of the profession, and for improving and increasing the zeal of the county
societies and their members.
The Board shall have the accounts of the Association audited at least
The Trustee shall make an annual report of official work and of the condition of the profession of
each county in the represented district. The House of Delegates may take such action, if any, as it
deems appropriate, upon such reports. The necessary expenses incurred by such Trustee in the
line of the duties herein imposed may be allowed by the Board on a properly itemized statement,
but this shall not be construed to include the Trustee's expense of attending the Annual Convention
of the Association.
5.0607
Organizing County Societies: The Board shall make careful inquiry into the condition of the
profession of each county in the state and shall have authority to adopt such methods as may be
deemed most efficient for building up and increasing the interest in such county societies as
already exist, and for organizing the profession in counties where societies do not exist. It shall
especially and systematically endeavor to promote friendly relations among physicians of the same
26
locality and shall continue these efforts until every physician in every county of the state who can
be made reputable has been brought under medical society influence. In sparsely settled sections,
it shall have authority to organize the physicians of two or more counties into societies; and these
societies, when organized and chartered, shall be entitled to all the privileges and representation
provided herein for county societies, until such counties may be organized separately.
5.0608
Scientific Work: The Board shall, through its officers and otherwise, give diligent attention to
and foster the scientific work and spirit of the Association, and shall study and strive constantly to
make each Annual Convention a stepping stone to future ones of higher interest. The Board shall
encourage postgraduate and research work, as well as home study, and shall endeavor to have the
results utilized and intelligently discussed in the component county societies.
5.0609
Interest of the Profession: The Board shall, in connection with the House of Delegates, consider
and advise as to the interests of the profession and of the public in those important matters wherein
it is dependent upon the profession, and shall use its influence to secure and enforce all proper
medical and public health legislation and to diffuse popular information in relation thereto.
5.0610
Charters: The Board shall, upon application, provide and issue charters to component county
societies organized to conform to the spirit of this Constitution and Bylaws. The Board shall also
provide and issue charters to component societies. Charters are defined in 11.01 and 12.01.
5.0611
Board of Censors: The Board shall be the Board of Censors of the Association. It shall consider
all questions involving the rights and standings of members whether in relation to other members,
to the component societies, or to this Association. All questions of an ethical nature brought
before the House of Delegates or the General or Section Meetings shall be referred to the Board
without discussion.
It shall hear and decide all questions of discipline affecting the conduct of members of component
societies on which an appeal is taken from the decision of an individual Trustee, and its decision in
all such matters shall be final.
5.0612
Review of Commission/Committee Functions/Performance:
The Board shall review the functions and performance of all ISMA commissions and committees
every two years to determine if they are performing adequately, effectively, and efficiently; and
the Board may recommend to the House of Delegates changes or dissolution of those commissions
or committees which do not appropriately serve the purposes of the Indiana State Medical
Association.
5.0613
Duties of Alternate Trustee: The duties of the Alternate Trustee shall be to: 1) represent
the
Trustee District when the regularly elected Trustee is not in attendance, and 2) vote only when the
Trustee is not in attendance either in the House of Delegates or in the Board meetings.
6.00
EXECUTIVE COMMITTEE
6.01
COMPOSITION: The Executive Committee shall consist of the President, the President-elect,
the Immediate Past President, the Chairman of the Board, two (2) At Large Members elected by
the Board, the Treasurer, the Assistant Treasurer, with power to vote in the absence of the
Treasurer, and ex-officio the Speaker and Vice Speaker without power to vote. The Executive
Committee shall hold its first meeting immediately following the Board meeting held at the close
of the last session of the House of Delegates at the Annual Convention, and shall organize by
electing its Chairman, from its voting members. If the Executive Committee is unable to select a
chairman within thirty (30) days after the final session of the House of Delegates, then a meeting
of the Board of Trustees shall be called and a Chairman of the Executive Committee shall be
27
selected by the Board of Trustees. Its Secretary shall be the Executive Vice President of the
Association.
6.02
DUTIES: It shall meet with the Executive Vice President on the call of the Chairman, or of any
three (3) members to plan and execute such work as may be necessary for the welfare of the
Association and the conduct of the Executive Vice President 's office and such other duties as the
Board may specify during the intervals between the meetings of the Board, and shall report its
actions to the Board. The Executive Committee is accountable to the Board of Trustees.
6.0201
Quorum: Four (4) voting members of the Executive Committee shall constitute a quorum.
6.0202
Executive Vice President's Salary: The amount of the Executive Vice President’s salary shall
be fixed by the Executive Committee on approval of the Board, at least annually.
6.03
BUDGET RESPONSIBILITY: It shall prepare a budget for the ensuing fiscal year; and all
expenditures of the Association, except those otherwise provided for under the Constitution and
Bylaws, shall be governed by the budget. No expense not provided for in the budget or otherwise
under the Constitution and Bylaws shall be incurred by any officer, commission or committee. A
committee, commission or officer may submit a request for funds to meet unusual expenses not
included in the annual budget, and the Executive Committee shall have the power, by a two-thirds
vote, to amend the budget to provide such funding.
All recommendations and resolutions calling for expenditure of funds, passed by the House of
Delegates, shall be referred to the Executive Committee.
6.04
INVESTMENT SURPLUS FUNDS: The investment of all surplus funds of this Association
shall be under the direct control and management of the Executive Committee, subject to
instructions which may be given by the Board. The Executive Committee shall have the right and
is encouraged to obtain advice and counsel of recognized financial experts in regard to the
discharge of the duties as covered by this section of the Bylaws.
6.05
STUDENT LOANS: The Executive Committee, with the approval of the Board, shall have the
authority to make loans to medical students in accordance with the terms and conditions under
which funds are made available for that purpose. Rules and regulations adopted shall be subject to
the approval of the Board. The Executive Vice President shall have the duty and responsibility of
keeping minutes of all transactions and shall file a copy of such minutes, as well as a copy of all
papers pertaining to any applications or loans, in the Headquarters Office of the Association.
6.06
VACANCY: A vacancy on the Executive Committee shall be filled by an election by the Trustees
at the next regular meeting of the Board following the occurrence of such vacancy.
7.00
ORGANIZATION OF ACTIVITIES AND RESPONSIBILITIES
7.01
CREATION OF COMMITTEES AND COMMISSIONS: The organization of the Association,
the performance of which is not provided elsewhere in the Constitution and Bylaws and is not
carried on in the meetings of the Board or of the House of Delegates or by special committees
created by the Executive Committee, the Board, or the House of Delegates, may be performed by
the following committees and commissions:
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7.0101
The Committees:
7.010101
Grievance
7.010102
Indiana Medical Education Fund
7.010103
ISMA-Sponsored Continuing Medical Education
7.010104
School Health
7.010105
Family Violence
7.010106
Information Technology
7.0102
The Commissions:
7.010201
Commission on Constitution and Bylaws Encompasses the field of: Constitution and Bylaws.
7.010202
Commission on Legislation Encompasses the fields of: State and Federal Legislation; State and Federal
Regulations.
7.010203
Commission on Medical Education Encompasses the fields of: Accreditation; Education Programs.
7.010204
Commission on Physician Assistance –
encompasses the fields of: Alcoholism; Drug Abuse; Neuropsychiatric Illness;
Physical Infirmity.
7.010205
Commission on Sports Medicine –
encompasses the field of: Sports Medicine
7.02
COMMITTEE STRUCTURE: Except as otherwise stated in the Bylaws, a committee shall
consist of not less than five (5) members appointed from the general membership of the
Association and shall be appointed annually by the President. The President shall also appoint the
Chairman of each committee. The Committee Chairman shall appoint a Vice Chairman.
7.03
COMMISSION STRUCTURE: The President may appoint one commission member for each
600 regular members of a trustee medical district, or a major fraction thereof; but in any event,
each district shall have one member on each commission.
The original appointees in each commission shall be divided into three groups by lot. The first
group shall serve three years; the second, two years; and the third, one year. Thereafter, each
incoming President shall appoint members of each commission to fill the vacancies resulting from
the expiration of the terms of members, and such appointments shall be for three years. The
President shall also appoint members to fill the unexpired term where any vacancy occurs through
death, resignation or otherwise.
The President may appoint a maximum of four (4) At-Large members, one of whom may be a
resident physician, for a term of one year, with the right to vote, to each commission. The
President shall appoint the Chairman of each commission. The Commission Chairman shall
appoint a Vice Chairman.
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In addition to the above-mentioned appointments, the Commission on Medical Education shall
maintain in its membership a faculty member of the Indiana University School of Medicine, who is
a member of the Association of Indiana Directors of Medical Education (AIDME), appointed
annually by the President upon recommendation of the Chairman of the Commission.
7.04
EX-OFFICIO MEMBERS: The President, President-elect, Executive Vice President, Speaker,
Vice-Speaker of the House and the Chairman of the Board of Trustees shall be ex-officio members
of all committees and commissions without voting rights where their inclusion on the committee or
commission is not otherwise provided for in these Bylaws.
7.0401
Past Presidents: The three (3) most recent past presidents are ex-officio, non-voting members of
the Commission on Legislation.
7.05
REMOVAL OF MEMBERS: The President shall have the power, with the approval of the
Board, to remove any member of a committee or commission where such member, for any reason,
does not or cannot work at attempting to perform the duties pertaining to membership on such
committee or commission.
7.06
QUORUM: Unless otherwise specified, one-third of the voting membership of a committee or
commission shall constitute a quorum.
7.07
TERMS: Unless otherwise provided in the Bylaws, no member of a commission shall serve on
the same commission more than two consecutive terms, but this shall not prevent the member from
serving more than two terms if the term of another member intervenes. The time given to the
serving of an unexpired term shall not be considered in determining the period within which a
member may serve consecutively.
7.08
INITIAL MEETING: Within sixty days after the meeting of the Annual Convention, the
President may call all commissions and committees into a joint meeting in order to give a
statement of the duties and responsibilities of all committees and commissions, call special
attention to any immediate problems confronting the Association, and assign such problems of
parts thereof to appropriate committees and commission. The commissions may provide for such
sub-commissions within the separate commissions as they may deem advisable. Each committee
or commission shall have the right to call upon other committees, commissions, or members of the
profession for counsel and advice with respect to its work.
7.09
COORDINATION OF ACTIVITIES: Each committee and commission shall have the privilege
and is encouraged to have joint meetings with any existing committee or commission for the
purpose of coordinating activities to make them more effective in the medical service of the public
and the intent of the Association.
7.10
DUTIES AND RESPONSIBILITIES: Each committee and commission shall have the duty and
responsibility of keeping constantly and currently informed on the matters within the area of its
special interest and activity; of studying the conditions within that area with the purpose of finding
possibilities for improvement; of finding the best solutions it can to the specific pro blems referred
to it; of contributing in its area to the achievements of the Association as a whole in the protection
and improvement of the health of the whole human family; and of making all its efforts useful by
passing on to the Association in the most effective manner possible the results of its studies and
activities in its own area of special interest. Each commission and committee shall submit to the
House of Delegates an annual written report of its studies, findings and activities.
7.1001
Grievance Committee: The duties of this committee shall be to receive complaints, appeals, or
suggestions from physicians or lay persons concerning professional conduct. It shall attempt to
find the facts regarding any matter brought to its attention through procedures proper and
30
appropriate to that end, and shall attempt to adjust differences between patients and physicians. It
may, if it believes the facts justify, cite a member of the Indiana State Medical Association to the
Board of the Indiana State Medical Association. It shall, subject to the approval of the Board,
revise its set of rules and regulations governing its procedure and official actions.
7.1002
Indiana Medical Education Fund Committee: The purpose of this committee shall be to
promote, develop and improve medical education in the Indiana University School of Medicine for
the general benefit of the entire public by obtaining and using funds from private sources to
accomplish that result. The funds collected will be deposited in a trust and at periodic intervals,
the committee shall make a distribution from the trust to be used by the Indiana University School
of Medicine.
The Indiana Medical Education Fund Committee shall consist of eight persons, five of whom shall
be from the Indiana State Medical Association, appointed by the President thereof, and shall be
voting members. The other three members (the Dean, or the Dean's designee, of the Indiana
University School of Medicine; the President of the Indiana State Medical Association; and the
Executive Vice President of the Association, who shall also act as Secretary) shall be ex-officio
and nonvoting.
The five members shall serve staggered three-year terms to insure continuity. The actions of this
committee shall be certified to the Board of Trustees. Each year a report of the committee's
activities, including a financial accounting report of the fund itself as administered by the trustee,
shall be annually reported to the House of Delegates.
7.1003
ISMA - Sponsored Continuing Medical Education Committee: The duties of this committee
shall be as follows: Review and approve the CME mission of the ISMA on an annual basis;
provide periodic review of the overall CME program in terms of it’s correlation with the CME
mission program effectiveness, and activity quality; participate in the CME program selfassessment process; provide advice on the overall direction of the ISMA with reference to the
changes in the continuing medical education thrust; review the needs assessment data and activity
development; assist in the identification of needs of the physician target audience; recommend
activities and specific topics; review proposed agendas and learning objectives to assure their
validity in terms of predetermined needs and match with the CME mission statement, overall
compliance with adult learning theories; and in compliance with the essentials and standards of the
ACCME; recommend appropriate and qualified faculty; and budgetary review of the CME
program.
7.1004
School Health Committee: The duties of this committee shall be to develop, assist, coordinate,
expand and improve the health of school-aged children in Indiana.
7.1005
Family Violence Committee: The duties of this committee shall be as follows: Educate, as
mandated in ISMA policies, Indiana’s physicians, medical students, other health personnel, and the
public regarding the standardized universal medical screening process involving victim
identification, appropriate assessment, and referral; advocate on behalf of ISMA for all victims of
family violence through participation in public awareness and health promotion education;
coordinate the medical response with local, state, and national organizations by promoting
appropriate joint activities; and participate in appropriate activities in coordination with other
ISMA committees and commissions, in accordance with Section 7.09 of this Constitution and
Bylaws.
7.1006
Information Technology Committee: The duties of this committee shall be as follows: Educate
ISMA members on the full potential of the Internet and information technology; strive to
constantly improve and update the use of the Internet and information technology within the
ISMA; promote the effective use of the Internet and information technology as a communication
31
and educational tool for ISMA members, other health care professionals, patients, and consumers;
and promote policy related to the Internet and information technology as it pertains to medicine in
Indiana.
7.l007
Commission on Constitution and Bylaws: The Commission on Constitution and Bylaws shall
keep in contact with the developments and changes in procedures in carrying on the work of this
Association; shall suggest revisions necessary to keep the Constitution and Bylaws always in
accord with the practices and procedures best adapted to the functioning of the Association; and
shall keep the practices and procedures of the Association consistent with the provisions contained
in the Constitution and Bylaws--to the end that all members of the profession, by reference to the
Constitution and Bylaws, will be able to obtain accurate information regarding procedure and
practice within the Association, and that hampering of such procedure and practice by obsolete
provisions in the Constitution and Bylaws be avoided.
Amendments passed by the House of Delegates become effective immediately and are submitted to
the Commission on Constitution and Bylaws for implementation.
7.l008
Commission on Legislation: The Commission on Legislation shall study all legislation,
regulations and regulatory proposals, both state and national, and all local legislative and
regulatory trends and movements, as to their affect upon the practice of medicine and the
protection of the public health; shall keep the profession informed at all times concerning the
matters within its area of responsibility; shall conduct investigations of legislative and regulatory
proposals; and shall maintain liaison with members of the State Legislature and the United States
Congress, state regulatory agencies whose scope and charge may affect the practice of medicine
and the public health and welfare and with the legislative and regulatory activities of the American
Medical Association.
It shall strive to implement and make effective the legislative and regulatory proposals adopted by
the Association but shall not abrogate its responsibility within the scope of this charge for want of
a specific mandate from the House.
7.1009
Commission on Medical Education: The Commission on Medical Education shall maintain
liaison with, and be of assistance to medical schools and the Medical Licensing Board. It shall
keep in contact with, and endeavor to assist in improving and maintaining high quality
undergraduate, graduate, and continuing medical education within the state. The Commission on
Medical Education shall serve as the Indiana State Medical Association state's accrediting body to
accredit institutions and organizations for the presentation of intrastate continuing medical
education programs.
7.10010
Commission on Physician Assistance: The Commission on Physician Assistance shall develop a
program to recognize, treat and rehabilitate physicians who are in need of assistance because of
neuropsychiatric illness, physical infirmities, or alcohol and other substance dependence. The
Commission will encourage informal and formal referral of all physicians in need of assistance to
component county medical society screening committees.
The ISMA Commission on Physician Assistance is organized pursuant to Indiana’s Peer Review
Act as set forth at I.C. 34-4-12.6-1 et al, and claims all the rights, privileges, confidentiality and
immunities provided therein.
7.10011
Commission on Sports Medicine: The Commission on Sports Medicine shall provide liaison
between the Indiana State Medical Association and various athletic organizations. The
commission will research issues and make recommendations in a variety of areas relating to sports
medicine in our state, in an attempt to improve the medical care of Indiana athletes and related
personnel.
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7.11
TRAVEL REIMBURSEMENT: ISMA will reimburse commission and committee members at
the rate currently allowed by the IRS for mileage driven to attend ISMA commission and
committee meetings. This does not include any expense of attending same during the Annual
Convention.
8.00
RECIPROCITY OF MEMBERSHIP WITH OTHER STATE SOCIETIES
To broaden professional fellowship, this Association is ready to arrange with other state medical
associations for an interchange of certificates of membership so that members moving from one
state to another may avoid the formality of reelection.
9.00
REFERENDUM
9.01
GENERAL AND SPECIAL MEETINGS: Providing a quorum is present (150 members,
Section 3.0403 of these Bylaws), a general or special meeting of the Association may, by a twothirds vote of the members present, order a general referendum on any question pending before the
House of Delegates; and when so ordered, the House of Delegates shall submit such question to
the members of the Association who may vote by mail or in person, and if the members voting
shall comprise a majority of all members of the Association, a majority vote shall determine the
questions and be binding on the House of Delegates.
9.02
GENERAL REFERENDUM: The House of Delegates may, by a two-thirds vote of its members,
submit any question before it to a general referendum, as provided in the preceding paragraph, and
the result shall be binding on the House of Delegates.
10.00
THE SEAL
The Association shall have a common Seal, with the power to break, change, or renew same at
pleasure.
11.00
COUNTY SOCIETIES
11.01
CHARTERS: All county societies now in affiliation with this Association or those which may
hereafter be organized in this state, which have adopted principles of organization not in conflict
with this Constitution and Bylaws, or those of the American Medical Association, shall on
application receive a charter from and become a component part of this Association. The
acceptance or retention of this charter shall be regarded as a pledge on the part of said component
society to conduct itself in harmony with the letter and spirit of this Constitution and Bylaws and
other rules and resolutions of this Association.
Charters shall be issued only upon approval of the Board and shall be signed by the President and
Executive Vice President of this Association. The Board shall have the authority to revoke the
charter of any component society whose actions are in conflict with the letter and spirit of this
Constitution and Bylaws or those of the AMA.
11.0101
Conflicting Societies: With the exception of the component Student Medical Society and the
component Resident and Fellow Society and the component Young Physician Society, only one
component medical society shall be chartered in any county. Where more than one component
county society exists, friendly overtures and concessions shall be made, with the aid of the Trustee
for the district if necessary, and all of the members brought into one organization. In case of
failure to unite, an appeal may be made to the Board, which shall decide what action shall be
taken.
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11.02
MEMBERSHIP QUALIFICATIONS: Each component county society shall be judge of the
qualifications of its own members, but, as such societies are the only portals to regular
membership in this Association, every reputable and legally registered physician who holds a
degree of Doctor of Medicine, a degree of Bachelor of Medicine, or a degree of Doctor of
Osteopathy and who holds a valid, unrestricted license to practice medicine in Indiana shall be
eligible for membership.
Provided, however, that each component county society may deny membership in such society for
infraction or violation of any law relating to the practice of medicine or of the Constitution and
Bylaws of such society, the Constitution and Bylaws of the Indiana State Medical Association, the
Constitution and Bylaws of the American Medical Association, or for a violation of the Preamble
to the Principles of Medical Ethics of the American Medical Association; and may, after due
notice and hearing, censor, suspend or expel any member for any such infraction. Before a charter
is issued to any component county society, full and ample notice and opportunity shall be given to
every physician in the county to become a member.
11.03
RIGHT OF APPEAL: Physicians who may feel aggrieved by the action of the society of their
county in refusing them membership, or in suspending or expelling them, shall have the right to
appeal to the Board whose decision shall be final. In hearing appeals, the Board may admit oral or
written evidence as in its judgment will best and most fairly present the facts. In case of every
appeal, both as a Board and as individual Trustees in district and county work, efforts at
conciliation and compromise shall precede all such hearings.
11.04
MEMBERSHIP TRANSFER: When members in good standing in a component society move to
another county in this state, their names shall be transferred without cost to the roster of the
component county society into whose jurisdiction they move, provided the transfer is approved by
majority vote of the membership of said society to which the transfer is proposed. Physicians who
have the major part of their practice in a county other than the county in which they reside may
hold membership in the component county society of their residence or in the component county
society of the county in which they have the major part of their practice. However, a physician
shall not hold active memberships in more than one component county society at the same time.
11.05
DIRECTION OF PROFESSION: Each component society shall have general direction of the
affairs of the profession in its county, and its influence shall be constantly exerted for bettering the
scientific, moral and professional status of every physician in the county; and systematic efforts
shall be made by each member, and by the society as a whole, to increase the membership until it
embraces every qualified and honorable physician in the county.
11.06
SELECTION OF DELEGATES: In advance of the annual convention of this Association, each
component county society shall elect delegates and alternate delegates to represent it in the House
of Delegates of this association. The secretary of the society shall send a list of such delegates and
alternate delegates to the Executive Vice President of this association annually, at least 45 days
prior to the annual convention at which such delegates are to serve. In the event that a component
county society is unable to seat a full delegation from its elected delegates and alternate delegates,
the secretary of the county society may certify other qualified members of the component county
society to be seated as replacement delegates.
11.07
SECRETARIAL DUTIES: The Secretary of each component society shall keep a roster of all its
members and of the non-affiliated registered physicians of the county, in which shall be shown the
full name, address, college and date of graduation, date of license to practice in this state, and such
other information as may be deemed necessary. In keeping such a roster, the Secretary shall note
any changes in the personnel of the profession by death, or by removal to or from the county; and
in making the required annual report, the Secretary shall be certain to account for every physician
who has lived in the county during the year.
34
Formatted: Bullets and Numbering
The Secretary of each component society shall prepare and send to the Trustee of the Secretary's
district a quarterly report briefly stating the activities of the Secretary's component county society
including meetings, programs, changes in officers and personnel or membership. A copy of this
quarterly report to the Trustee shall also be sent to the Executive Vice President of the Indiana
State Medical Association. The Indiana State Medical Association shall supply each County
Secretary with a form for these reports.
11.08
FISCAL YEAR AND DUES: The fiscal year of the Association shall be from January 1 to
December 31 of the same calendar year. The dues shall be collected by the calendar year and be
payable in advance. Unless collected by the Indiana State Medical Association, the secretary of
each component society shall forward the dues for the society to the Executive Vice President of
this Association and shall furnish the Indiana State Medical Association Headquarters with a roster
of officers, members, and a listing of non-affiliated physicians of the county, on or before January
1 of each year, and shall promptly report thereafter the names of any new members elected to
membership in the society, and promptly forward to the Executive Vice President of this
Association the dues for such members.
The dues and the rights and benefits of all members shall be as provided in 1.00 et seq. of the
Bylaws.
11.09
FAILURE TO PAY DUES: Any component county society which fails to pay dues or make the
report required by January 15 of each year shall be delinquent. Any component county society
which fails to pay dues or make the report by March 1 shall be held suspended and none of its
members or delegates shall be permitted to receive any of the publications of the Association or
participate in any of the business or proceedings of the Association or of the House of Delegates
until such requirements have been met.
11.10
SECRETARY DIRECTION: Each component county society shall be held responsible for the
faithfulness in the performance of duty on the part of its Secretary in making reports and remitting
dues to the Association.
11.11
CONSTITUTION AND BYLAWS: Each component society shall have its own Constitution and
Bylaws which shall not be in conflict with the Constitution and Bylaws of this Association or of
the American Medical Association.
An up-to-date copy thereof shall be filed with the Executive Vice President of the Indiana State
Medical Association not later than May 1 of each calendar year; or where such copy is on file and
no change has been made, it shall then be sufficient to file a certificate to that effect with the
Executive Vice President.
12.00
OTHER COMPONENT SOCIETIES
12.01
CHARTERS: All component societies now in affiliation with this Association and those which
may hereafter be organized in this state, which have adopted principles of organization not in
conflict with this Constitution and Bylaws, or those of the American Medical Association, shall
receive a charter from and become a component part of this Association. The acceptance or
retention of this charter shall be regarded as a pledge on the part of said component society to
conduct itself in harmony with the letter and spirit of this Constitution and Bylaws and other rules
and resolutions of this Association. Charters shall be issued only upon approval by the Board and
shall be signed by the President and Executive Vice President of this Association. The Board
shall have the authority to revoke the charter of any component society whose actions are in
conflict with the letter and spirit of this Constitution and Bylaws or those of the AMA.
35
12.02
CONSTITUTION AND BYLAWS: Each component society shall have its own Constitution and
Bylaws, which shall not be in conflict with the Constitution and Bylaws either of this Association
or the American Medical Association. An up-to-date copy thereof shall be filed with the
Executive Vice President of the Indiana State Medical Association not later than May 1 of each
calendar year, or where such copy is on file and no change has been made, it shall then be
sufficient to file a certificate to that effect with the Executive Vice President.
12.03
RESIDENT AND FELLOW SOCIETY (RFS)
12.0301
Composition: Residents enrolled in Accreditation Council for Graduate Medical Education
(ACGME) and American Osteopathic Association (AOA)-accredited programs in the state of
Indiana shall be eligible to join the Resident and Fellow Society with all rights and privileges as a
regular member of ISMA. Any member of this society shall be eligible to hold office. There shall
be only one RFS.
All Resident physicians who hold membership in the Resident and Fellow Society or the County
and District Medical Societies, shall be required to hold membership in the Resident and Fellow
Society of the Indiana State Medical Association and the County and District Medical societies,
with the County Medical Society membership to be held in the county in which the resident lives
or works.
12.0302
Organization: The Resident and Fellow Society will hold an annual meeting with the election of
appropriate officers, four delegates and four alternate delegates to the ISMA House of Delegates,
appropriate delegates and alternate delegates to the Resident Physicians Section of the AMA, and
a resident trustee and alternate trustee to the ISMA Board of Trustees. The term of office for the
trustee and alternate trustee shall be for one year.
12.0303
Secretarial Duties: The Secretary of the RFS component society shall keep a roster of all its
members in which shall be shown the full name, address, college and date of graduation, date of
license to practice in this state, and such other information as may be deemed necessary.
12.0304
Dues: Resident and Fellow Society members shall pay one time state dues as determined by the
ISMA Executive Committee, and these dues will cover their dues obligation for the entire training
period. RFS members shall be exempt from paying county, district and state dues from July to
December of the year in which they become a member. Any subsequent dues for county and
district societies shall be determined by those societies. Dues shall be collected in accordance with
ISMA Bylaws. No relief of dues shall be possible.
12.04
12.0401
Composition: Medical students actively enrolled in an accredited medical school in Indiana are
members of this society with all rights and privileges as described in 1.0104.
12.0402
Organization: The Medical Student Society will hold an annual meeting with the annual meeting
with the election of its Governing Council, four delegates and four alternate delegates to the ISMA
House of Delegates, appropriate delegates and alternate delegates to the Medical Student Section
of the AMA, and a trustee and alternate trustee to the ISMA Board of Trustees. The term of office
for the trustee and alternate trustee shall be for one year.
12.0403
Resolutions: All resolutions shall be introduced at its annual meeting and approved by the ISMAMSS Governing Council, prior to submission to the ISMA House of Delegates.
36
12.0404
Subscription to ISMA publications: Medical Student members may subscribe to ISMA
publications at the current rate determined periodically by the Board of Trustees. Student
delegates and alternates are to receive ISMA publications free of charge.
12.405.1
Dues: Medical Student members shall be assessed no dues.
12.05
12.0501
Composition: All ISMA members under the age of 40 and/or in the first five years of practice,
shall be eligible to join the Young Physician Society with all rights and privileges of membership
in the ISMA. Any member of this Society shall be eligible to hold office.
12.0502
Organization: The Young Physician Society will hold an annual meeting with the election of
appropriate officers, to include four voting delegates and four alternate delegate to the ISMA
House of Delegates, appropriate delegates and alternate delegates to the Young Physician Section
of the AMA, and a trustee and alternate trustee to the ISMA Board of Trustees. The term of office
for the trustee and alternate trustee shall be for one year.
12.0503
Secretarial Duties: The Secretary of the Young Physician Society shall keep a roster of all its
members, in which shall be shown the full name, college date of graduation, date of license to
practice medicine in this state, and other such information as they may deem necessary.
12.0504
Dues: Members of the Young Physician Society shall pay dues to the ISMA the same as any other
regular member, which shall entitle the member to full rights and privileges of ISMA membership.
These dues shall be collected in accordance with the ISMA Bylaws. The Young Physician Society
may set its own membership fee for membership in the Young Physician Society.
13.00
TRUSTEE DISTRICT MEDICAL SOCIETIES
13.01
COMPOSITION: A Trustee District Medical Society, hereinafter called the district society, shall
be a society whose members consist of the members of the county medical societies in the counties
which constitute the trustee district.
13.02
NUMBER OF DISTRICTS: The state shall be divided into thirteen (13) trustee districts with
boundary lines by county and number of each district to be as follows:
First District - Posey, Vanderburgh, Warrick, Spencer, DuBois, Perry, Pike and Gibson.
Second District - Knox, Daviess, Martin, Monroe, Owen, Greene and Sullivan.
Third District - Crawford, Harrison, Floyd, Clark, Scott, Washington, Orange and Lawrence.
Fourth District - Jackson, Jennings, Jefferson, Switzerland, Ohio, Dearborn, Ripley, Decatur,
Bartholomew, Brown.
Fifth District - Clay, Vigo, Vermillion, Parke and Putnam.
Sixth District- Shelby, Rush, Fayette, Franklin, Union, Wayne, Henry and Hancock.
Seventh District- Morgan, Johnson, Marion and Hendricks.
Eighth District- Madison, Delaware, Randolph, Jay and Blackford.
Ninth District- Fountain, Montgomery, Boone, Hamilton, Tipton, Clinton, Tippecanoe, Warren,
Benton, White, Newton and Jasper.
Tenth District- Porter and Lake.
Eleventh District- Carroll, Howard, Grant, Wabash, Miami, and Cass.
Twelfth District- Wells, Adams, Whitley, Allen, Noble, Huntington, DeKalb, LaGrange, Steuben
and Kosciusko.
Thirteenth District- Pulaski, Fulton, Marshall, Starke, LaPorte, St. Joseph and Elkhart.
37
13.03
CONSTITUTION AND BYLAWS: Each district society shall adopt a Constitution and Bylaws,
which shall not conflict with the Constitution and Bylaws of the Indiana State Medical Association
or those of the American Medical Association, and only one district society shall exist withi n any
one trustee district. The authorized district society in each trustee district shall receive a charter
from the Indiana State Medical Association, and the Secretary of the district society shall have
custody of the charter.
13.04
OFFICERS: Each district society shall organize by electing a President, a Secretary and a
Treasurer and Trustee(s) and Alternate Trustee(s) as the current Trustee(s) term and Alternate
Trustee(s) term for the district expires, and such others as may be provided for in its Constitution
and Bylaws. The offices of Secretary and Treasurer may be held by the same physician. The
Trustee(s) shall continue to have the same duties and terms as are set forth in the Constitution and
Bylaws of this Association.
13.05
TRUSTEE ALLOCATION: Each district society shall have one Trustee and one Alternate
Trustee for each 600 regular members or major fraction thereof, but in any event each district shall
have one Trustee and one Alternate Trustee. The term of each trusteeship newly created by the
numerical growth of a district shall begin at the organizational meeting of the Board immediately
following the adjournment of the final session of the House of Delegates at the Annual
Convention, in accordance with 5.0406 and 5.06.
13.06
DUES: The dues of the district society, in an amount fixed by the district society to meet the
society needs, shall be collected by the Secretaries of the component county societies, or by the
Indiana State Medical Association, and delivered to the Treasurer of the district society. The
Secretary of each district society shall report to the office of the Indiana State Medical Association
the names and addresses of the members of the district society, together with a copy of the minutes
of each meeting of the district society.
13.07
MEETINGS: Each district society shall meet at least once each year at a time and place to be
fixed by the district society. On or before January 1 of each year, each district society shall notify
the headquarters of the Indiana State Medical Association of the time and place of the annual
district meeting for that year; but if no such notification has been received in the headquarters on
or before the January meeting of the Board, the Trustee shall fix the time and place of the district
meeting, and notice of such meeting shall be sent to the members of the county medical societies
in such district.
13.08
NOTIFICATION TO HEADQUARTERS
13.0801
Election of Trustee or Alternate: Whenever a district society is to elect a Trustee and/or
Alternate, the headquarters office of the Indiana State Medical Association shall so notify the
individual members of such district society not later than six weeks in advance of said election
date.
13.0802
Agenda for Meeting: The district society shall send to the headquarters office a copy of its
program showing the time and place of its meeting and early enough so that the headquarters
office may notify all members within the district of the meeting at least thirty (30) days prior to the
meeting date.
14.00
MEDICAL DEFENSE - MEDICAL DEFENSE ADMINISTRATION, AUTHORITY AND
PROCEDURES
14.01
ADMINISTRATION: The administration of this entire section shall be entrusted to the ISMA
Board of Trustees which shall have full authority to develop rules and procedures and make
38
reports as it may deem appropriate. Any matter not specifically addressed in this section shall be
left to the discretion of the Board of Trustees.
14.02
POLICY AND PURPOSE: It shall be the policy of ISMA that this section of the Bylaws shall
only be used as authority to involve ISMA in medical defense and/or counter-suit litigation that is
of such a nature that the issues presented are of significant concern and impact on the practice of
medicine as a whole. In no event shall this section be construed as authority or obligation for
ISMA to hire attorneys and pay expenses on behalf of an individual member. However, the
Executive Committee is empowered to expend funds for attorneys and other experts who may be
required in the pursuit of litigation that may have an impact on the practice of medicine as a whole.
14.03
ELIGIBILITY - REQUEST FOR ISMA INVOLVEMENT: Before a request for ISMA
involvement will be considered by the ISMA Board of Trustees, the following conditions should
be met:
(a) The physician making the request should be an ISMA member in good standing.
(b) A written request for ISMA involvement in medical defense and/or countersuit litigation
should be sent to the Board of Trustees detailing the facts of the case as well as why the issues
involved are of such a nature that they impact on the practice of medicine as a whole.
(c) A written statement of support from the physician's component county medical society should
accompany the request for ISMA involvement.
15.00
MISCELLANEOUS
15.01
DIVISION OF FEES: This Association does not countenance or tolerate fee-splitting, division
of fees, or commission paying directly or indirectly; and any member found guilty shall be
expelled from membership.
15.02
FIFTY YEAR CLUB: The Fifty Year Club is an honorary club and should not be confused with
the classification of Senior Member (1.010201). Fifty Year Club membership shall be officially
recognized annually. Eligibility for honorary membership in the Club includes:
(a) Shall have practiced medicine for fifty (50) years;
(b) Shall have been a member of a component county medical society for at least a portion of those
fifty years; and
(c) Shall have been approved for Fifty Year Club membership by a county medical society.
16.00
PARLIAMENTARY PROCEDURE
The deliberations of this association shall be governed by the fourth edition of The Standard Code
of Parliamentary Procedure when not in conflict with this Constitution and Bylaws and when not
in conflict with special rules of procedure that may be adopted by the various deliberative bodies
within the association.
17.00
AMENDMENTS
17.01
BYLAWS AMENDMENTS: These Bylaws may be amended by resolution as in 3.020701(b),
which shall be treated as any other proposed amendment, at any meeting of the House of Delegates
by a majority vote of all the voting members present. Amendments to the Bylaws must be
submitted to the Association 60 days in advance of the meeting. These amendments must be
39
presented to the Commission on Constitution and Bylaws prior to the meeting and are eligible for
passage after lying on the table for one day.
17.02
OTHER: Any other Bylaw amendment presented to the House of Delegates will not be eligible
for consideration by the House of Delegates unless two-thirds majority of the House of Delegates
votes to consider the amendment as presented.
17.03
AMENDMENT IMPLEMENTATION: Amendments which are passed by the majority of the
House become effective immediately and shall be submitted to the Commission on Constitution
and Bylaws for implementation.
18.00
MEDICAL ETHICS
18.01
PRINCIPLES: The Principles of Medical Ethics of the American Medical Association shall
govern the conduct of members in their relations to each other and to the public.
AMERICAN MEDICAL ASSOCIATION PRINCIPLES OF MEDICAL ETHICS
Preamble:
The medical profession has long subscribed to a body of ethical statements developed primarily for the benefit of
the patient. As a member of this profession, a physician must recognize responsibility not only to patients, but also
to society, to other health professionals, and to self. The following Principles adopted by t he American Medical
Association are not laws, but standards of conduct which define the essentials of honorable behavior for the
physician.
I.
A physician shall be dedicated to providing competent medical service
with compassion and respect for human dignity.
II.
A physician shall deal honestly with patients and colleagues, and strive
to expose those physicians deficient in character or competence, or who
engage in fraud or deception.
III.
A physician shall respect the law and also recognize a responsibility to
seek changes in those requirements which are contrary to the best
interests of the patient.
IV.
A physician shall respect the rights of patients, of colleagues, and of
other health professionals, and shall safeguard patient confidences
within the constraints of the law.
V.
A physician shall continue to study, apply and advance scientific
knowledge, make relevant information available to patients, colleagues,
and the public, obtain consultation, and use the talents of other health
professionals when indicated.
VI.
A physician shall, in the provision of appropriate patient care, except in
emergencies, be free to choose whom to serve, with whom to associate,
and the environment in which to provide medical services.
VII.
A physician shall recognize a responsibility to participate in activities
contributing to an improved community.
40
VIII.
A physician shall, while caring for a patient, regard responsibility to the
patient as paramount.
IX.
A physician shall support access to medical care for all people.
41
INDIANA STATE MEDICAL ASSOCIATION
CONSTITUTION
TABLE OF CONTENTS
ARTICLE I
-
TITLE AND DEFINITION
ARTICLE II
-
PURPOSES
ARTICLE III
-
COMPONENT SOCIETIES
ARTICLE IV
-
MEMBERS
ARTICLE V
-
HOUSE OF DELEGATES
ARTICLE VI
-
OFFICERS
ARTICLE VII
-
TRUSTEES
ARTICLE VIII
-
CONVENTION
ARTICLE IX
-
FUNDS, DUES & ASSESSMENTS
ARTICLE X
-
AMENDMENTS
42
CONSTITUTION
ARTICLE I - TITLE AND DEFINITION
The name of this organization is the Indiana State Medical Association. It is the confederacy of Indiana
component medical societies.
ARTICLE II - PURPOSES
The Indiana State Medical Association shall diligently serve its members so that they can better care for their
patients and the public and thereby add to the quality and comfort of life. The goals of the Association to
accomplish this mission are:
A.
Organize the medical profession in Indiana and to unite with other medical societies to participate in
the American Medical Association;
B.
Commit to the active support of medical education at all levels in order to advance medical
knowledge and medical science;
C.
Represent members' interest in the governmental, public, and private sectors;
D.
Inform physicians and the public about health care issues;
E.
Promote effective freedom of choice for patients, physicians, and the public; and
F.
Protect its members and their patients from imposition.
ARTICLE III - COMPONENT SOCIETIES
Component societies are those county, district, or other medical societies specified in the Bylaws, contained
within the state of Indiana which hold charters from this Association.
ARTICLE IV - MEMBERS
The Indiana State Medical Association is composed of individual members of component medical societies
and others as shall be provided in the Bylaws.
ARTICLE V - HOUSE OF DELEGATES
The legislative and policy-making body of the Association is the House of Delegates composed of elected
representatives and others as provided in the Bylaws. The House of Delegates shall transact all business of
the Association not otherwise specifically provided for in the Constitution and Bylaws and shall elect the
officers of the Association, except Trustees, Alternate Trustees, and the Executive Vice President, as
otherwise provided in the Bylaws.
(2)
43
ARTICLE VI - OFFICERS
The officers of the Association shall be a President, President-elect, Immediate Past President, Treasurer,
Assistant Treasurer, Speaker, Vice Speaker, Trustees, Alternate Trustees, and the Executive Vice President.
Their qualifications and terms of office shall be provided in the Bylaws.
ARTICLE VII - BOARD OF TRUSTEES
The Board of Trustees is composed of Trustees and Alternate Trustees, elected by the component district
medical societies, the Young Physician Society, the Resident and Fellow Society, and the Medical Student
Society, the President, President-elect, Immediate Past President, Treasurer, Assistant Treasurer, Speaker,
Vice Speaker, and the Executive Vice President. The members of the Board of Trustees shall have the
power to vote as prescribed in the Bylaws.
ARTICLE VIII - CONVENTION
The House of Delegates and the general scientific program shall be convened annually and at such other
times as deemed necessary or as provided in the Bylaws, in cities recommended by the Board of Trustees
and approved by the House of Delegates.
ARTICLE IX - FUNDS, DUES AND ASSESSMENTS
Funds may be raised by annual dues or by assessment of the active members on recommendation of the
Board of Trustees and after approval by the House of Delegates, or in any other manner approved by the
Board of Trustees as provided in the Bylaws.
ARTICLE X - AMENDMENTS
The House of Delegates may amend this Constitution at any convention provided the proposed amendment
shall have been introduced at the preceding annual convention and provided two-thirds of the voting
members of the House of Delegates vote approval and provided that it shall have been published twice
during the year and distributed to each of the members.
(3)
44

House of Delegates - Indiana State Medical Association

Transcription

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