Terrorism measures lead into uncharted waters

Atlanta The American Medical Association deferred action on two terrorism-related issues during its recent Interim Meeting, referring the matters to the Board of Trustees for further review.

One resolution would have directed delegates to recommend changes to the USA Patriot Act that would safeguard patient confidentiality and keep doctors from facing legal action for failing to hand over records or for informing a patient of an investigation.

The statute, adopted largely in response to the Sept. 11, 2001, terrorist attacks, permits government agencies in some cases to demand confidential medical records and forbids the cooperating doctors from disclosing that such a demand had been made.

The American Psychiatric Assn. and the American Academy of Child and Adolescent Psychiatry offered the language. The groups cited fears that such a system could abrogate the rights of mental health patients who become suspects in terrorism-related activities, along with those of the physicians who treat them.

AMA delegates also voted that more study is needed on whether the group should support mandated federal compensation for victims of terrorist attacks.

The resolution in question was prompted by the plight of several survivors of the 2001 anthrax attacks, some of whom have been denied health insurance coverage for their injuries based on their carriers' assertion that the incidents were acts of war.

These areas are relatively unexplored terrain for the Association, and AMA Trustee Cecil B. Wilson, MD, suggested that members could easily get off track in terms of legislative priorities if they start getting deeply involved in issues of terrorism and national security.

"We are attempting to have a focused agenda," he said.

Most of the testimony on the two issues concerned the current lack of knowledge within the physician community about what such legislative initiatives would entail.

Some attendees nevertheless warned that the Association will need to weigh in sooner rather than later.

"We need the Board of Trustees to think about how we're going to deal with future attacks," said Richard Pieters, MD, an alternate delegate from Massachusetts.

When the AMA leaders take up those considerations, there may be important consequences both for doctors and for the patients that they are trying to help. Calling on the government to pay for the medical care of terrorist victims, for instance, could have the unintended consequences of sabotaging physicians' top legislative priority, said David T. Hannan, MD, a delegate from New York.

"If we as a house at some future date decide that the victims of any type of attack, whether it be domestic or foreign, deserve compensation, aren't we indeed thwarting our efforts to have a tort reform agenda which says that there should be limits on compensation?" he asked.