Delegates urge more effective use of doctors in disaster response

Dallas -- With the inadequate local, state and federal response to Hurricane Katrina in the rearview mirror, the AMA House of Delegates reaffirmed its commitment to put physicians at the center of disaster preparedness planning and to make it easier for them to volunteer after catastrophe strikes.

The AMA will focus its disaster preparedness improvements on four key areas: coordination, training, licensure and medical liability.

In the wake of the Sept. 11, 2001, terrorist attacks, the American Medical Association formed the Center for Public Health Preparedness and Disaster Response, but the delegates' reaction to Hurricanes Katrina and Rita has added an extra push.

"This gives us clear-cut direction," said AMA Trustee William A. Hazel Jr., MD, a Herndon, Va., orthopedic surgeon. "We have been treating it as a priority, and the house has really reinforced that it's not only a priority but a barn-burner, urgent priority. ... We have significantly geared the AMA to be a center of public health preparedness and disaster response."

As delegates focused on improving the public health response in disaster zones, AMA President J. Edward Hill, MD, reminded the house, during its opening session, that times of crisis awaken "the soul of medicine."

"Every patient I saw said those in the clinic were the kindest people they had ever met," said Dr. Hill, who volunteered at a Tupelo, Miss., clinic after Hurricane Katrina. "That, more than faulty payment systems or a broken liability system or the pressures from underwriters and Washington over pay-for-performance ... is the real calling of medicine."

Physician involvement

General surgeon Kenneth L. Mattox, MD, an alternate delegate for the Texas Medical Assn. who helped coordinate Houston's response to Katrina and Rita, said doctors are often shut out of local disaster-planning efforts and federally required emergency operations centers.

"We do not understand the [emergency operations center] on the medical side," Dr. Mattox told delegates at an educational session on the hurricane response. "We don't even know it exists many times."

Col. W.S. "Chip" Riggins Jr., MD, MPH, a regional director for the Texas Dept. of State Health Services, said local authorities too often overlook what local physician groups can contribute to disaster planning and response. "The resources state medical societies have to offer are appropriate," he said. "They're right there."

Physicians hope the AMA can improve oversight by local authorities by asking each state and local public health jurisdiction to work with physicians to develop and file with appropriate federal agencies a public health disaster plan that will:

• Address the needs of children and people with disabilities.
• Anticipate the needs of people in hospitals, nursing homes and other institutions.
• Coordinate and assign volunteer physicians.

Delegates were split, however, on how to improve national disaster response. A measure calling for the AMA to support developing a federal public health disaster intervention team was referred for further study. A report on the issue is expected at the June 2006 Annual Meeting.

"I just don't think asking the government to do everything for us would be the best way to proceed," said William S. Clark III, MD, a Waycross, Ga., ophthalmologist speaking on behalf of his state delegation.

Training, licensure and medical liability

The delegates also directed the AMA to more actively advocate its core, basic and advanced disaster life support courses and comparable training programs for hospitals' medical and nursing staffs and for public health physicians and nurses.

So those skills can be put to use, the AMA will work with the Federation of State Medical Boards and state governments to establish a clearinghouse for physicians with a license in one state to volunteer in another state where a federal emergency has been declared. This includes work on a so-called "smart card" for licensed physicians to easily identify themselves to local authorities.

Delegates also said response to disasters would be better if it were easier to ensure medical liability immunity for physician volunteers. While physicians registered with the Dept. of Health and Human Services are immune from liability when volunteering in a declared disaster area, delegates said the status quo falls short.

"We tried to call the HHS 800 number to get through but it was constantly busy," said Mary Gale Armstrong, MD, a Madison, Miss., family physician and delegate for the Mississippi State Medical Assn. "If you went to their Web site, the application was several hundred pages long."

The house said the AMA should push for national legislation that gives qualified physician volunteers automatic immunity during a national disaster or federal emergency.

Not everyone agreed that the AMA should move forward with its disaster preparedness plans. Stephen K. Epstein, MD, a Boston emergency physician and an alternate delegate for the American College of Emergency Physicians, said the AMA's plans would "overlap significantly" with existing efforts and create confusion.

In a separate action, the house amended AMA bylaws so that it could continue to operate during an emergency in which a quorum of the house or the Board of Trustees could not regularly be convened. The new bylaws are based on provisions widely used by corporate entities under emergency conditions.