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1974 INDEX

AAPS NEWS LETTERS and BULLETINS


JANUARY

THROUGH

DECEMBER
NL - News Letter

EB - Emergency Bulletin
18

- Information Bulletin

LB - Legislative Bulletin
Index No.

Name or Item

AAPS Amendment

-A-

AAPS Annual Meeting

AAPS By-Lows

Type

Dote

Name or Item

Index No.

Type

Dote

NL

August

AMA and PSRO (Being hurt by lawmakers)

11

NL

October

NL

June

American Medical Association

NL

July

NL

August

American Medical News

NL

January

NL

September

NL

February-Morch

11

NL

October

NL

June
October

12

NL

November

11

NL

13

NL

December

13

NL

December

NL

February-Morch

AMPAC

11

NL

October

12

NL

November

NL

February-Morch
November

AAPS Copy for Newspaper Ads

NL

February-Morch

Anthony, E.E., M.D.

AAPS Dues Raise

NL

Moy

Anthony, Mrs. Jackie

AAPS House of Delegofes

NL

Moy

12

NL

NL

September

13

NL

December

11

Nl

October

NL

April

NL

June

Arlington Heights Herold

NL

September

NL

July

Ashbrook, John, Representative

11

NL

October

11

NL

October

NL

July

AAPS Index
AAPS Lawsuit

Anderson, Jomes L., M.D.

12

NL

November

Association of American Medical Colleges

AAPS News Letters

NL

January

Auerbach, Stuart

AAPS Ohio Chapter

11

NL

October

NL

August

13

NL

December

Babb, Forrest, J., M.D.

NL

Moy

NL

February-Morch

Ball, F.M., M.D.

NL

July

NL

April

Ballantine, H. Thomas, Jr., M.D.

NL

January

13

NL

December

Bennett, Wallace, Senator

NL

January

AAPS Pamphlets
AAPS Political Action Organization
AAPS Private Doctors Institute

-8-

AAPS PSRO Pledge Cord

EB

1-4-7 4

NL

Moy

AAPS Resolutions

NL

February-Morch

NL

June

NL

August

NL

July

NL

September

NL

September

13

NL

December

Blackburn, Benjamin 8., Representative

NL

July

Bloke, Jomes M., M.D.

13

NL

December

NL

February-Morch

AAPS Speakers Bureau

AAPS Woman's Auxiliary

Bonner, Poul, M.D.

NL

January

NL

June

NL

July

NL

Moy
January

12

NL

November

Boyd, Elmo, M.D.

NL

American Association of Medical Society Executives

NL

July

Boyle, Joseph F., M.D.

NL

January

American Bar Association Meeting

NL

August

NL

Moy

American College of Radiology

NL

June

Bradley, Wayne

NL

July

AMA Advisory Committee on PSRO

NL

April

Brazoria County (Texas Medical Society)

NL

February-March

AMA Anaheim Meeting Report

NL

January

Breo, Dennis

13

NL

December

AMA Annual Convention - June

NL

June

Broyhill, Joel, Representative

NL

January

EB

1-4-7 4

Budd, John H.

13

NL

December

NL

January

Buerger, Wolter, M.D.

NL

January
September

AMA Boord of Trustees

NL

June

NL

NL

July

12

NL

November

13

NL

December

NL

September

AMA Chicago Convention

NL

July

12

NL

November

AMA-HEW PSRO Contracts

NL

July

AMA House of Delegates

EB

l-4-74

13

NL

December

Bullington, Robert, M.D.

-C-

NL

January

Calcasieu Parish Medical Society

NL

June

(Lake Charles, Louisiana)

NL

July

California Medical Association

NL

Moy

11

NL

October

Comalier, C. Willard, M.D.

NL

January

AMA Newsletter

NL

April

Campbell, Garland, M.D.

12

NL

November

AMA Policy on PSRO

NL

July

Campbell, Mrs. Juanita

12

NL

November

AMA Medicredit Bi II

Index No.

Type

Dote

Type

Dote

NL

September

Ford, Gerald, President

NL

September

12

NL

November

Ford, Gerald, Vice-President

NL

July

NL

May

Franklin County (Ohio) Academy Council

11

NL

October

NL

June

Fulton, Richard, Representative

11

NL

October

Corter, Tim Lee, M.D., Representative

12

NL

November

Castro, Fidel

11

NL

October

Charleston (South Carolina) County Medical Society 5

NL

May

Chenault, John M., M.D.

Index No.

Name or Item

Campbell, R.L., M.D.

Carter, E.K., M.D.

NL

January

NL

April

Nome or Item

-GGabler, Mrs. Mel

Gardner, Hoyt D., M.D.

NL

September

13

NL

December

NL

June

NL

July

12

NL

November

NL

September

NL

June

Grady, John L., M.D.

NL

July

Green, Edith, Represenfative

Citizens for Quality Medicine

NL

May

Grevos. Theodore, M.D.

NL

January

Clinton County (Iowa) Medical Society

NL

February-March

Griffith, J. Keller, M.D.

NL

September

NL

June

NL

July

Cloud, Daniel, M.D.

Griffiths, Martha, Representative

Colomb, James

NL

February-March

Comprehensive Health Insurance Plan (CHIP)

NL

February-March

Constantine, Jay

NL

June

NL

September

NL

February-Morch

NL

Moy

NL

June

NL

January

12

NL

November

Crone, David, M.D.

NL

July

Hampton, H. Phillip, M.D.

Crane, Philip, Representative

NL

January

Harvey, Daryl P., M.D.

Council of Medical Staffs

Coury, John J., M.D.


Coy, Mrs. Betty

Crosthwait, Joe M., M.D.

NL

November

NL

September

-HHMO's

NL

February-March

13

NL

December

EB

l-4-74

NL

May
September

HR-9375 (Rarick Bill)

HR-16204 (The National Health Policy)

Holl County Medical Society

NL

10

EB

9-20-74

13

NL

December

(Grand Island, Nebraska)


2

NL

January

NL

January

NL

July

Hawk, John, M.D.

NL

June

NL

August

Hayes, Donald R., M.D.

NL

January
January

NL

September

Hayes. Thomas B., M.D.

NL

13

NL

December

Health. Education & Welfare. Department of

NL

February-March

NL

January

NL

May

13

NL

December

NL

January

NL

June

Cullum, Albert, M.D.

12

NL

November

Cullum, Mrs. Mary Beth

12

NL

November

Curtis, Corl T., Senator

NL

May

-D-

Heard, John P., M.D.

Henry. Patrick

NL

June

11

NL

October
January

Decker. Barry, M.D.

NL

Moy

Hicks, Nancy

Delaurentis, Joseph, M.D.

NL

January

Hildebrand, William B., M.D.

Delegates Nomination; Notice of

12

Derwinski, Edward J., Representative

NL

May

NL

January

Hill-Burton Funds

NL

NL

July

ll

NL

October

NL

February-March

Himler, George. M.D.

NL

January

Doering, Elsie L.

12

NL

November

Hines, Harry K., M.D.

NL

July

Dole, Robert, Senator

12

NL

November

Holden, Raymond T .. M.D.

NL

January

NL

June

NL

July

NL

February-Morch

12

NL

November

NL

September

Dorrity, Thomas G., M.D.

NL

May

12

NL

November

Holland, John, M.D.

-EEdwards, Charles C., M.D.

2
3

(HEW's Assistant Secretory of Health)

Emergency Medical Core Review Organization

NL
NL

January

February-March

NL

July

NL

June

(EMC RO)

Hospital-Physician Relationship
House Committee on Interstate and Foreign
Commerce

10

EB

9-20-74

House Ways and Means Committee

NL

May

Howard, Ernest, B., M.D.

Emerson, Ralph S., M.D.

NL

January

NL

January

Engelke, Otto K.. M.D.

NL

January

NL

April

England, Robert G., M.D.

13

NL

December

NL

June

Eversole, Urban H., M.D.

NL

January

NL

July

11

NL

October

Hu man Events

NL

January

Hunter, Robert B., M.D.

NL

January

NL

May

NL

July

NL

February-Morch

Howard, Bert, M.D.

-FNL

MAY

Federal Drug Administration (FDA)

Federal Register

NL

Federal Register (November 29, 197 4)

13

NL

December

Fenick, John, M.D.

12

NL

November

Florida Legislature on PSRO

NL

June

Florida Medical Association

NL

Moy

February-Morch

-1Illinois Academy of Family Physicians

r..,

Name or ltem

Dote

Name or Item

Index No.

NL

February-Morch

Mode, Arthur S., M.D.

NL

June

NL

October

Montgomery County (Ohio) Medical Society

NL

Moy

Illinois State Medical Society House of Delegates

NL

February-March

Indiana Chapter of AAPS

NL

Moy

13

NL

December

11

NL

October

-NNotional Health Insurance

National Professional Standards Review Council

-JNL

Joggord, Robert S., M.D.

NL

12

Javits, Jacob, Senator


Jirka, Frank J., M.D.

Johnson, Charles W., M.D.

September

Nelson, Gaylord, Senator

November

Nelson, Joe T., M.D.

11

NL

October

NL

June

NL

July

12

NL

November

Nesbitt, Tom E., M.D.

New York Times, The

NL

April

NL

December

NL

June

NL

July

11

NL

October

NL

June

NL

July

NL

January

NL

July

NL

January

11

NL

October

NL

February-March

May

Johnson & Johnson

NL

NL

January

11

NL

October

NL

August

Oath of Hipprocrates

NL

Julian, Mrs. Lil

12

NL

November

Ochota, Leszek, M.D.

13

NL

December

Juliana, Sister

NL

August

Orlondella, A.W., M.D.

NL

April

OSHA (Occupational Safety and Health

NL

September

Joint Commission on Accreditation of Hospitals

May

4
13

Jofinson, J.W., M.D.


Johnson, Lee L., M.D.

-K-

Nixon, Richard M., President

-0-

Adminisrrotion)

Kefauver Law

NL

May

Kennedy, Edward, Senator

NL

January

NL

April

P.L. 92-603

13

NL

December

11

NL

October

Pockwood, Robert, Senator

NL

February-March

Kennedy-Mills Bill (not Health Insurance)

NL

May

Palmer, Richard E., M.D.

NL

January

Kernodle, John R., M.D.

NL

January

NL

April

NL

June

13

NL

December

NL

January

12

NL

November

NL

January

NL

July

NL

January

NL

June

Killeen, Raymond, M.D.

-P-

Pamlico Albermorle Medical Society


(Washington, N.C.)

Kondracke, Morton

NL

September

Pamphlet Rack Order Form

Kramer, Maurice

NL

September

Parker, Thomas, M.D.

13

NL

December

'

Dote

11

Involuntary Servitude

f;

Type

Illinois Professional Standards Review Organization 3


Illinois State Medical Society

r,

Type

Index No.

Parrott, Max, M.D.

-LLeithort, Poul W., M.D.

Little, Arthur., Inc.

NL

September

11

NL

October

12

NL

November

NL

April

Louisiana State Medical Society

NL

12

Lynch, William J., Judge

May

NL

November

-M-

July

NL

October

Pell, Wilbur F., Jr., Judge

12

NL

November

Perk, Ralph, Mayor of Cleveland

11

NL

October

Pinellas County Medical Society

13

NL

December

(St. Petersburg, Florida)

NL

August

13

NL

December

NL

August

NL

September

April

12

NL

November

October

13

NL

December

12

NL

November

McGovern, George, Senator

11

NL

October

McMahon, R.R.

12

NL

November

McMillen, Thomas R., Judge

12

NL

November

NL

11

NL

Macoupin County (Illinois) Medical Society

NL

11

Porterfield, John D., M.D.

McDonald, Lawrence, M.D.

Maccarter, Paul, M.D.

7
Pell, Claiborne, Senator

Pottawatomie County Medical Society


(Shawnee, Oklahoma)
Powell, J. Enoch

NL

January

EB

1-4-74

Mortin, George B., Jr., M.D.

NL

July

NL

January

Medicaid

NL

April

NL

February-Morch

NL

Moy

NL

April

Medical Society of Georgia

NL

Moy

NL

May

Medical World News

NL

January

NL

June

Medicare

NL

April

NL

July

NL

Moy

NL

August

Marshall, Matthew, Jr., M.D.

PSRO

Meiling, Richard L., M.D.

NL

January

12

NL

November

Meyer, Morgan, M.D.

NL

January

13

NL

December

Miller, Joe D.

NL

April

PSRO Contract Awards

NL

August

NL

January

PSRO* The Great .'olitical 2ickness .!3ip

NL

July

Miller, W. Charles, M.D.


Mills, Wilbur, Representative

Qff

NL

February-March

NL

Moy

"PSRO: Organization for Regional Peer Review

NL

September

PSRO - Phyllis Schlafly on Spectrum

11

NL

October

"PSRO and Public Relations"

and Order Form


,,

NL

April

NL

June

10

EB

9-20-74

~,!crne or Item

Index No.

Type

Dote

Smoot, Don

-QQuinlan, Donald, M.D.

Quinlan, Mrs. Mary

August

NL

September

12

NL

November

13

NL

December

NL

June

Social Security Bulletin

NL

February-Morch

NL

August

South Coast Community Hospital (South Laguna,

NL

April

NL

September

California)

11

NL

October

South Carolina Medical Association

NL

May

12

NL

November

Spence, Mrs. Betty

NL

September

12

NL

November

St. Joseph Hospital (Illinois)

NL

August

Stock, Paul F.

12

NL

November

Stanbery, Morie, M.D.

12

NL

November

Stewart, Jomes H., M.D.

NL

June

Stone, Joseph

NL

August

Sweeney, Donald N., Jr., M.D.

NL

January

NL

Moy

NL

June

Texes Medical Association

NL

Moy

"To the Roots of Inflation"

NL

July

NL

July

NL

July

NL

August

NL

September

13

NL

December

NL

July

Richmond (Virginia) Academy of Family Physicians 5

NL

Moy

Rogers, Fronk, M.D.

NL

September

12

NL

November

13

NL

December

NL

September

10
Roth, Russell, B., M.D.

EB

9-20-7 4

NL

January

NL

Februo ry-Morch

NL

Moy

12

NL

November

NL

June

-TTennessee Medico! Association

Today's Woman

EB

1-4-7 4

Todd, Malcolm C., M.D.

NL

January

NL

July

11

NL

October

13

NL

December

NL

July

Tschantz, Robert E., M.D.

-U-

Ullman, Al Representative

-SS-2994 Another Kennedy Bili to Control Medicine

NL

January

Russian Request for AAPS News Letters

8
9

Moy

Rorick, John R., Representative

Roy, William, M.D., Representative

Dote

NL

Rorick Comments on AMA Capitulation

Rogers, Poul, Representative

T(Pe

NL

-R-

Rial, William Y., M.D.

Index No.

Name or Item

NL

January

11

NL

October

NL

April

IJ .S. Supreme Court

12

NL

November

11

NL

October

Utilization Review Regulations

13

NL

December

Sa'!ey, W. Col:ier, M.D.

NL

January

Sammons, Jame:'. M., M.O.

NL

January

Wall Street Journal, The

NL

January

NL

Februo ry-Morcr

Washington Post

NL

July

NL

April

Washington Reeort on Medicine & Health

NL

April

NL

June

We,nberger, Caspar, Secretory of HEW

NL

January

NL

July

NL

February-Morch

11

NL

October

NL

April

NL

January

NL

May

NL

July

Weston, C. Tucker, M.D.

11

NL

October

NL

September

Wiater, Edward, M.D

NL

January

NL

January

NL

February-Morch

S-3585 (students to practice 2 years after


graduation where HEW Secretary orders)

Samuelson, D.R., M.D.

Schenken, John R , M.D.

Schneebeli, Herman, Representative

Schreiber, Jack, M.D.

-W-

NL

June

"Will National Health Plan Cut Standards?"

12

NL

November

11

NL

October

NL

January

NL

January

NL

January

Winter, F.D., M.D.

NL

January

Witten, Carroll, M.D.

NL

Moy

Wood, Donald E., M.D.

NL

June

NL

September

Shields, Jack E., M.D.

NL

January

Wood, John M , M.D

NL

January

Simmons, Henry P., M.D.

NL

January

Woolley, Fronk K.

NL

May

NL

May

NL

August

NL

June

NL

September

NL

September

12

NL

November

13

NL

December

13

NL

December

NL

Moy

NL

January

NL

August

NL

September

13

NL

December

11

NL

October

Scrivner, Willard C., M.D.


Senate Finance Committee

Smith F. Michael, Jr., M.D.

Wunderlich, Edwin R., M.D.

NL

June

NL

July

-ZZimmerman, G.R., M.D.

er

THE VOICE FOR PRIVATE DOCTORS

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

Spe~ial AMA Meeting Report


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

which makes such a report as this possible. Please


urge at least one other doctor to 1om AAPS now
and strengthen the effort to save U.S. medicine Donald Quinlan, M.D., President.

AMA H,ouse of Delegates Yotes


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

AAPS Lawsuit Supported


Much interest was evident at the AMA Clinical Meeting in the AAPS lawsuit to declare the PSRO law unconstitutional. One resolution (No. 29 introduced by Virginia)
specifically called for AMA to support the suit. Several
delegates also urged AMA to suppo-rt the suit.
The Virginia resolution resolved "that the American
Medical Association publicly announce its approval of

The House on Dec. 5, 1973, made it clear


the best course of action was to abolish the
PSRO law. Delegates amended a report of the
Board of Trustees and Council on Medical Service (Report EE) to make it clear that: "The
considered opinion of this House of Delegates
is that the best interests of the American people, our patients, would be served by repeal of
the present PSRO legislation."
The amendment to Report EE also directed the Board
of Trustees to "work to inform the public and legislators
as to the potential deleterious effects of this law on the
quality, confidentiality and cost of medical care." This
was a renewal of a previous House directive which AMA
Executive Vice President Ernest B. Howard, M.D., said
was wrong and admitted he had declined to carry out.

the lawsuit initiated by the Association of American Phy-

INSIDE

sicians and Surgeons, and that the membership be encouraged to use every practical means to bring about a
successful termination of this lawsuit ... "
The Reference Committee only indirectly acknowledged the subject by disposing of Resolution No. 36 (urging
a study of PSRO constitutionality) in these words,
"Your committee is also well aware that the matter of
Resolution 36 is already the subject of court action instituted by members of the profession, so that adoption
of this resolution ... would be a costly duplication ot
judicial review of the law which is already under way."

Text of AMA PSRO Amendment


AMA Executive Backs Down
~eference Committee PSRO Debate
House of Delegates Debate
Rep. Crane's Speech - "PSRO Repeal
is Possible"
At Large AMA Trustee Elections
AMA Headquarters Stay
Dr. Heard Is Board Candidate
Dr. Retires in PSRO Protest

A month after the Anaheim meeting, members of the


Board of Trustees were claiming they were so confused
over action of the House of Delegates they could reach
no specific agreement on abolition of PSRO or on implementation of the House order to tell the public about the
bad provisions of the PSRO law.
They professed to be confused because parts of Report
EE as amended appeared to co_nf:ict with other parts
as oriAinally drafted. Specifically, they indicated belief that the statement of the amendment that PSRO should
be abolished was incompatible with the concluding statement of Report EE which recommended the AMA "continue
to exert its (PSROl leadership by supporting constructive amendments to the PSRO law, coupled with continuation of the effort to develop appropriate rules and
regulations."

Meet in Puerto Rico


The Board and selected members of the executive
staff early in January journeyed to Puerto Rico to meditate
on what had happened at Anaheim and, as one source
put it, "to ponder what position the AMA could take
without losing credibility."
The Board could arrive at no conclusions at Puerto
Rico. The entire subject of PSRO and Report EE - "left
up in the air" at Puerto Rico - will be discussed again
by the Board and staff at a meeting in Chicago late
this January.
Many members of the AMA House of Delegates will be
surprised to find out that trustees have adopted confusion
as a reason for failure to map out a campaign aimed at
abolishing PSRO by persuading Congress to repeal the
law.

If anything was made clear at Anaheim,


it was this: The O'Verwhelming majority of delegates, alternates and other physicians at the
meeting want the PSRO law abolished, and in
that desire, they reflect the wishes of an overwhelming majority of "the doctors back home."
AMA officers, trustees and executive staff went to
Anaheim evidently expecting to convince the House of
Delegates that the best thing to do was to let the Board
continue the policy of collaboration and support amendments to the law.

The House of Delegates said no, that was


not the best thing to do. The House without
dissent said the best thing to do is repeal the
law.
When the amendment to Report EE was adopted, Carroll Witten, M.D., Louisville, Ky., Delegate from the Section on Family and General Practice, observed that the
amendment "makes it quite clear that it is our intent to
work for repeal." No one disagreed.
Theodore Grevas, M.D., Delegate from Rock Island,
Ill., warned the House that "failure to repeal the law
at this time is never to repeal it."
It was a'so clear at Anaheim that practically every
physician, including all AMA officers and trustees, asserts
that PSRO is a bad law. That fact prompted John P.
Heard, M.D., President of the DeKalb County (Georgia)
Medical Society, to observe: "I think it would be immoral
to support a law we believe to be a bod law."
(Note: Although the trustees claim confusion now, there
was little if any immediately following the Anaheim meet-

ing, even in the AMA headquarters. The Wall Street


Journa1, The New York Times, Medical World Hews,
Human Events, and even the American Medical News
agreed that the House had voted to seek repeal of PSRO.
In the Dec. l 0, 1973, issue of American Medical News,
a headline on a story about events at Anaheim proclaimed: "AMA Expands PSRO Policy to Seek Repeal."
An editorial in the same issue contains this paragraph:
"Are the AMA's twin goals of PSRO repeal and exerting
leadership in implementing the law incompatible? No.
Not incompatible, but admittedly difficult." Dr. Howard,
AMA Executive Vice President, reportedly approves all
stories and editorials that appear in American Medical
News.

Asks Board Ignore Repeal


After the clinical meeting in Anaheim and before the
Board and staff session in Puerto Rico, a memorandum
was distributed to members of the Council on Medical
Service by the Council Chairman William B. Hildebrand,
M.D. The memorandum said that Dr. Hildebrand and
Council members C. Willard Camalier, M.D., and Donald
R. Hayes, M.D., had met in Washington, D.C., with H.
Phillip Hampton, M.D., Chairman of the Council on Legislation, and the Executive Committee of the AMA Board
of Trustees "to discuss the interpretation to the amended
Report EE as passed by the House of Delegates at Anaheim."
The memorandum said those who met couldn't come up
with an interpretation because of "diametrically opposed
points of view" in the amended Board report. Dr. Hildebrand's memorandum said that as a consequence it would
be recommended to the Board that no action seekin PSRO
repeal be taken. The memorandum said it woul
rec
ommended that only the last paragraph of amended
Report EE be implemented. That paragraph would have
left AMA committed to continuing collaboration with
government, to supporting "constructive" amendments
to PSRO and to attempting to influence HEW In drafting
rules and regulations to put PSRO into effect, but not
to workinQ for repeal.

The recommendation to ignore the House


decision that the best course of action is to
abolish PSRO was not accepted by the Board
at Puerto Rico, according to AMA sources.
The Board also ruled out suggestions that a speciaf
session of the House of Delegates be called to "clarify
Report EE"; that the Board solicit opinions on the question
of abolition of PSRO from other organizations, such as
AAPS; that AMA members be polled to find out how they
feel about repea!ing PSRO; that delegates from the six
states that drafted the repeal amendment to Report EE
be called in to explain what they expected to result from
the amendment.
The Board agreed, however, that AMA's Washington
lobbyists should be instructed to inform members of Congress about the deleterious provisions of the PSRO law.
The Board also directed the staff to draft a "white paper''
on PSRO for discussion at the next Board meeting. Tom
E. Nesbitt, M.D., Speaker of the House, Malcolm C.
Todd, M.D., AMA President Elect, and Richard E. Palmer, M.D., Board Vice Chairman, were assigned to
oversee preparation of the paper.

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

almost always has gone along with the desires of trustees and the Association's administration on major issues,
even though it sometimes has had reservations about doing so. Resolutions and reports were usually considered
according to patterns laid out in advance. Often, satellite
meetings were set up and artfully guided by the AMA
administration. Rarely, if ever did the results turn out differently than planned. At Anaheim, a sate'.lite meeting was organized for Saturday, December 1, 1973, to promote collaboration with PSRO (every originally scheduled speaker
was a PSRO booster, and some were full or part-time employees of HEW). Report EE of the Board of Trustees and
Council on Medical Service was drafted to reaffirm the
policy of collaboration, but the report was not made
available to delegates until the opening day of the
House meeting. It was expected that the numerous antiPSRO resolutions would be shunted to the Board and that
Report EE would be adopted with minimum debate and
without substantive change.
However, there was pervasive grumbling during the
meeting about PSRO collaboration and many calls for
support of AAPS efforts to abolish PSRO by challenging
its constitutionality in federal court. There was widespread support for repeal. The grumbling was not taken
seriously at first by the trustees because in the past at
Cincinnati and New York meetings, the AMA management
had succeeded in getting its way on the PSRO issue
and it was expected to do so again this time.

But that strategy began coming unglued at


the special Dec. 1 satellite meeting designed
to promote PSRO and reinforce collaboration.
A wave of protest at the unrepresentative
nature of that satellite meeting force the
last-minute inclusion of one - but only one _
opponent of PSRO. That was J. W. Johnson,
M.D., who was elected President of the San
Diego County Medical Society on a platform
vigorously opposing PSRO. His Association of
over 2,000 physicians is on record for repeal.
He called PSRO the "seed of destruction of
civilized humane medical care." And he said
he had heard that if PSRO .is abolished something worse wcnild follow, "but I've tried and
tried and I just can't think of anything worse."
Dr. Johnson's direct and unevasive criticism
of PSRO was obviously - from the amcnint
of applause he received - the point of view
shared by most of the physician audience.
It also presaged things to come.
That Saturday PSRO satellite meeting disc'osed to
physicians the degree of authoritarianism they could expect from HEW officials responsible for enforcing PSRO.
The unmistakable attitude of Henry P. Simmons, M.D.,
Deputy Assistant Secretary for HEW and director of
HEW's PSRO office, was that "things will be done our
Y!!!f'' whether doctors like it or not. And this is "your
last opportunity" to do as the bureaucrats say to avoid
something worse.
Prior to the meeting all delegates and alternate delegates had been sent a Jetter by Donald Quinlan, M.D.,
President of the AAPS, which refuted a charge by Sen.
Wallace Bennett (R., Utah) that the AAPS had pushed
the panic button on PSRO. To prove the accuracy of the
AAPS criticism of PSRO, a copy of the !aw was enclosed
with Dr. Quinlan's Jetter.

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

signed by 34 U.S. Representatives urging the AMA House


of Delegates to adopt a PSRO repeal resolution to help
those in Congress who are working toward that goal.
That open letter was so unsettling to trustees and officers
that there is evidence they spent the next two days !_lying to get signers to withdraw their signatures and attempting to discredit its urgent message.
Dr. Heard later told AAPS he hod been informed that
"several congressmen were threatened with loss of
AMPAC support if they did not remove their names from
the petition (letter) to the AMA House asking for AMA to
go on record for repeal of PSRO."
The letter from the congressmen said: "That section
(PSRO section of Public Law 92-603) will require you to
practice according to computerized standards, rather than
using your best medical judgment in treating your patients. It will deprive your patients of their right to
privacy, it will impose severe fines for medical innovation.
"Some of you have urged AMA participation in implementation of PSRO so you can control the administration of the law. But PSRO is the law of the land; it is
the working of Congress and its implementation is the
responsibilty of the Department of Health, Education and
Welfare. Even if you help implement the law, you will
not control it. The only way to avoid the law's bad
effects is to repeal it.
"The PSRO section is bad Jaw; it will be bad for
the doctor and bad for the patient. It should be repealed. UnfortiJnately, although many of us in Congress want
to work for the repeal of PSRO, we have been handicapped by the AMA's failure to continue its active opposition
to the law. Some of us have already introduced bills
to repeal PSRO, but if we are to be successful we need
your help. We strongly urge the House of Delegates
to pass a resolution specifically calling for the repeal
of PSRO and committing the all-out efforts of the
American Medical Association to that end." (Emphasis
added.)
The AMA member most responsible for the Jetter was
Dr. Heard, who is a member of the AAPS. The idea for
the Jetter developed during a conversation between Dr.
Heard and his Congressman, Rep. Benjamin B. B'ackburn. When the letter arrived at Anaheim on Sunday,
Jack E. Shields, M.D., delegate from Brownstown, Indiana, obtained permission for Dr. Heard, who is not
a delegate, to read the open letter to the House.

Strong Support Unwelcome


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

Their reaction to the letter astonished


many delegates and prompted one, Stanley S.
Peterson, M.D., Springfield, Mo., to observe
that was a classic example of why doctors
are concerned about the AMA. He said AMA
leaders aught to do what is right.
Robert B. Hunter, M.D., a trustee and AMA's chief
PSRO spokesman, who is also paid for serving on HEW
Secretary Caspar Weinberger's National PSRO Council, was tapped by trustees to dispose of the letter on
Monday, Dec. 3, at the Reference Committee hearing

on PSRO reports and resolutions. It was noted that two


congressmen, Rep. Joel Broyhill of Virginia and Rep.
Edward Derwinski of Illinois, had been persuaded to
withdraw their names.

Consequently, when the Reference Committee met, the Q!!Jy documents not in oppositian to PSRO were Report A and Report EE of
the Board of Trustees and Council on Medical
Service.

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

Witnesses opposed to PSRO and favoring abolition of


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

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

Committee Echoes Board


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

Text of PSRO Repeal Amendment


1

It is clear the AMA House of Delegates at the meeting


in Anaheim voted for abolition of the PSRO law. This action
came on a vote, without dissent, adopting an amendment
to Report EE. This report as authored by the Board of
Trustees and Council on Medical Service, was intended
to continue the Board policy of collaboration. The text of
the amendment for repeal follows.
"The AMA affirms the following principles:
"1. That the medical profession remains firmly committed to the principle of peer review, under professional
direction, and
"2. That medical society programs of proven effectiveness should not be dismantled by PSRO implementation, and
"3. That the association suggests that each hospital
medical staff, working with the local medical society,
continue to develop its own peer review based upon principles of sound medical practice and documentable object-

AMA lobbyists then went to Sen. Bennett, the chief


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

The Dec. 3 Reference Committee session


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

tive criteria, so as to certify that objective review of quality


and utilization does take place; to make these review
procedures sufficiently strong as to be unassailable by
any outside party or parties; and that the local and state
medical societ!es take all legal steps to resist the intrusion
of any third party into the practice of medicine, and
"4. That this House of Delegates, as individual physicians and through the Board of Trustees and its Council on Legislation, work to inform the public and legislators as to the potential deleterious effects of this law on
the quality, confidentiality, and cost of medical care; and
the hope that the Congress in their wisdom will respond
by either repeal, modification, or interpretation of ru!es
which will protect the public.
"The considered opinion of the House of Delegates is
that the best interests of the American people, our patients,
would be served by the repeal of the present PSRO legislation. It is also believed that this is consistent with our
long-standing policy and opposition to this legis'ation
prior to passage."

Attempts to repeal PSRO "would be fruitless."

A policy of repeal or one of nonparticipation


would hinder efforts to amend the PSRO law or
to modify regulations.

Such a position would weaken AMA efforts to


influence pending and future health legislation.

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

Adoption of Report EE would not deny possibility


of eventual action for repeal ... "should such
action become more viable and appropriate."
(Emphasis added.)

The committee report was an unmistakable signal


that abolition of PSRO was not acceptable to trustees,

officers and the Executive Vice President. Being committed


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

Another Surprise
The morning of Wednesday, Dec. 5, brought another
unnerving surprise to the Board and AMA management.
A substantial number of AMA delegates who are t1lso
AAPS members arranged for Rep. Philip Crane (R., 111.) primary circulator of the letter appealing to AMA to
support repeal - - to come to Anaheim. He was given
permission to speak to the House of Delegates at the
morning session on Wednesday. He said it is "gbsolutely
not true" that a campaign to repeal PSRO would be fruitless. He stronqly disputed arquments that the AMA
would weaken its influence on other legislative matters
it it pursued repeal.

Rep. Crane's speech ..turned the H(;:,ise


around." Delegates from six states - California, Illinois, Michigan, Kentucky, Louisiana
and New York - joined in drafting the amendment to Report EE that put the House of Delegates clearly on the side of abolition of PSRO
by repeal.
Otto K. l::nqelke, M.D., De'.eqate from Ann Arbor, Mich.,
arose to "especially thank Congressman Crane for appearing betore us at this session and getting us back
on the track." Dr. Engelke urged the House to adopt
the Michigan State Medical Society position to wmp"'CJn
tor repeal "through all methods available," including
support of the Rarick Bill (H.R. 9375).
Note: Rep. Crane's speech - the most important of the
entire Clinical Meeting -- was briefly mentioned near
the end of the American Medical News story on the
meeting. Dr. Edwards, however, was given a separate,
full-blown story in the AMA newspaper.)
The amendment to Report EE, subsequently adopted
without a dissenting vote, put the AMA unequivocally in
opposition to PSRO for the first time. But it did more than
that. It stated the belief that medical society peer review programs of "proven effectiveness" should not
"be dismantled by PSRO implementation." And it urged
state and local medical societies to "take all legal
steps to resist the intrusion of any third party into the
practice of medicine.''

As one means of carrying out that House


policy, state medical associations are invited
to join AAPS in its lawsuit to outlaw PSRO by
filling amicus curiae briefs in support of the
suit.

AMA Executive f,orced To Back Down


Contained in Report EE of the AMA Board of Trustees
and Council on Medical Service, submitted to the House
of De'.egates at Anaheim, Calif., is the statement that
"at all times the House of Delegates determines Association policy" and that "it is the role of the Councils, committees, and the Board of Trustees to implement
this policy."
During the PSRO hearing before the Reference Committee at Anaheim, Board Chairman James Sammons,
M.D., declared emphatically: "You can't sit here today
and leave this room with the mistaken belief that the
office of the Executive Vice President or any other staff
employee of this Association is not devoting his time and
effort to carrying out the will of this House. Gentlemen,
I hope the record reflects that henceforth."

These statements were subjected to ques.tion during debate at the Reference Committee
on Monday, Dec. 3, 1973.
One who questioned them was John P. Heard, M.D.,
President of the DeKalb County (Ga.) Medical Society.
Dr. Heard pointed out that the House of Delegates at
the 1973 Annual Convention in New York had directed
the AMA to oppose facets of PSRO which "act to the deterioration of quality care" and that the Association
"publicize such deleterious facets.''
Dr. Heard said he had written AMA headquarters
more than once inquiring what was being done to carry out that directive. He said he received equivocal and

unresponsive answers from Executive Vice President Ernest


B. Howard, M.D.

Stated House Was Wrong


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

When Dr. Heard finished his remarks at


the Reference Ccnnmittee, an angry Dr. Howard
accused him of a personal attack on him and
challenged Dr. Heard to produce such a letter
so everyone present could know exactly what
he, Dr. Howard, had said - "if you have the
letter with you, which I don't suppose you
have."
Dr. Heard left the meeting, returned shortly and was
recognized to speak. He read a letter to him from Dr.
Howard dated Nov. 15, 1973, in which Dr. Howard said:
"Unfortunately, at the time of the meeting (in Atlanta)
did not have the exact wording of this substitute resolution with me. If I had had the wording, I would have indicated my agreement with it. The discussion at the Atlanta
meeting concerned the wisdom of attempting to persuade the public to support our concern about PSRO. I

indicated that such an effort would fail because the


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

When Dr. Heard had finished, Dr. Howard


acknowledged he was forced "to eat crow gracefully," to admit he had indeed accused the
House of being wrong and had said staff could
not carry out the mandate of the House.
It was not the first time that Dr. Howard had put down
on paper that the House mandate to publicize the bad
aspects of the PSRO law would not be carried out. On Oct.
5, 1973, he wrote to Dr. Heard declaring a response by
Tom Nesbitt, M.D., Speaker of the House, was "a perfect
answer" to Dr. Heard's inquiry about what was being
done to publicize the deleterious facets of the law.

Won't Pursue Effort


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

testimony and in numerous public statements at the


time it was under consideration in the Congress. We are
in no position to pursue that effort today prior toany
implementation of the law. The examples that you suggest which would be deleterious (invasion of confidentiality . . . etc. . . . etc.) cannot be proven to exist today
since there is no PSRO in the nation. There is no 'rule
book for medical care.' There is no proof to which we
can point that PSRO wil,I 'dehumanize' medical care. In
other words, we do not have the documentable data to
support our misQivinQs (I share them!).
"I think there is no question whatever that the public
would not be responsive to nor would the public listen to
our protestations about the probable adverse affects of
PSRO at this time in our history. I agree with you that we
must have the public behind us if repeal or significant
change of this law becomes possible. We wi:I not have
that public support, however, if we act in a manner that
is considered irresponsible by most public leaders."

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

Congressman Crane Declares


That PSRO Repeal Is Possible
"I can assure you probably 90 per cent of the members
of the United States Congress today haven't the fuzziest
idea what a PSRO is. They don't understand the concept.
They don't understand even that they cast a vote on it."
That pungent observation opened the address of Rep.
Philip Crane (R., Ill.) to the AMA House of Delegates
Wednesday morning, Dec. 5, 1973, an address that did
much to awaken members of the House that it is possible
Congress can be persuaded to repeal PSRO.
Rep. Crane helped nullify vigorous efforts of trustees,
officers and high-level staff to block adoption by the
House of a policy favoring PSRO repeal. And that's what
happened. Shortly after Rep. Crane's speech, the House
approved a statement that "the best interests of the
American people, our patients, would be served by the
repeal of the present PSRO legislation."
(Note: The Board of Trustees, pleading lack of money,
said it would not print Rep. Crane's speech for the benefit
of delegates and alternates. A month later, members of
the Board and selected headquarters staff flew to Puerto
Rico for a Board meeting.)
Rep. Crane chided AMA leadership for conceding the
premise of medicine's enemies.

"The very worst approach you can take is


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

Rep. Crane said that from talking to physicians he


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

Lot of Repeal Support


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

"Well," said Rep. Crane, "I can assure you


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

"This is not a lost battle. There is no reason why you cannot explore a variety of options
available to you simultaneously. You don't have
to give up on the idea of repeal only because
you think what is better, or preferable, or more
likely or viable politically is an attempt to clean
up a bad law. You can do both simultaneously."
In on apparent reference to the lawsuit filed by AAPS
in federal court to outlaw PSRO, Rep. Crone said that
another option open to fhe AMA was to "contemplate
working through the courts.''
Rep. Crone also attacked the position of the Board
of Trustees that a policy of nonporticipotion would render
fruitless efforts by the AMA to amend PSRO or modify
regulations.
"THAT IS ABSOLUTELY NOT TRUE," he said.
He pointed out that members of Congress ore responsive to their local constituencies. Furthermore, he said,
"you con go on record as a notional body condemning
on principle what you know in your hearts to be wrong
and what you know does violence to your professional
ethics."

Patients Should Be Alerted


Rep. Crone urged physicians to alert their patients to
the dangers of the PSRO low. "Patients ore voters," he
pointed out. "And if you alert them to the danger, then
you con generate a great deal of political influence and
that will magnify your impact considerably."
The Illinois Congressman also shot down the AMA
management argument that repeal oi ?SRO would leave

the medical profession still subject to other legislative


controls, present and future.
"Well, to be sure that's a possibility," said Rep. Crone.
"But let me just tell you one other thing, and that is, Jf
we ore going to draw the bottle lines on principles and in my judgment that's how they should be drown the best way calculated to permit the government intrusion
that could ultimately destroy your profession is to get
compliance. You draw those bottle lines on the basis of
the professional judgment of the physician versus the
gun that's being pointed at your head by government
. . . and if the public ever sees that bottle drown on
those lines, I con assure you they will be on your side.
"And I con assure you beyond that, that once they
are on your side, the politicians will bock off in a hurry."

Rep. Crane cautioned against the despair


of "inevitability". "I think the most pernicious
doctrine in Washington today is a certain feeling of despair over the inevitability of legislation. That doctrine of inevitability is the most
pernicious dogma that Karl Marx ever advanced."
"I'm telling you," he said, "there ore good ideas and
right principles, and if you people who ore most immediately affected will not be in the vanguard of fighting
that bottle, then to be sure, we may be down the tube;
it may be simply a matter of time and they'll toke us
salami style - a slice today and a slice tomorrow and
a slice the next day."
Rep. Crone mode it clear that even if the AMA did
not come out for repeal of PSRO, "I and a number of
my colleagues will continue to wage that bottle because
patients ore going to be concerned about this."

House Debate

There Was No Middle Ground on PSRO


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

-0James M. Sammons, M.D., Chairman, Boord of Trustees (granted special permission to address the House):
"Tuesday a week ago, your President and I were in
Washington and met with the leadership on both sides
of the aisle in the House of Representatives and we met
with the leadership of the Finance Committee of the
Senate. We asked, 'What in your opinion is the politicoi
viability, the chance of success of Mr. Rorick's bill or
similar bills asking for repeal of PSRO?' The uniformity
of their answers I think is important. Uniformly it was
that it hos absolutely no political viability whatsoever.
We asked why. The answers given us were - (l) the low
hos not even been put into effect . . . and is not going
to be repealed until it hos been tried; (2) with massive
expenditures (for Medicare and Medicaid) we must hove
some assurance that quality is being delivered, and (3)
we must hove some control over the ever expanding
utilization." Dr. Sommons added they were assured PSRO
amendments would be given "adequate hearings."
W. Charles Miller, M.D., New Orleans, Lo.: "I would
like to thank those who selected Disneyland - the land

of fantasy - as the appropriate setting to discuss the


matter we hove today. Louisiana deeply feels that for
those who feel that they con control federal low once
it is started and con amend it to their satisfaction and
con indeed exist with it, we suggest you ore indeed in
fantosylond. We further feel ... this organization should
be responsive to the people bock home. The position the
AMA hos token on PSRO hos encouraged people to look
for other sources to defend their positions and their
rights." Dr. Miller then submitted on amendment to Report EE to odd a repeal section. The substance of his
proposal was later adopted.
Morgan Meyer, M.D., Lombard, Ill.: Offered two amendments to Report EE. One, finally adopted, called for PSRO
repeal. The other said that amendments to PSRO should
be pursued "with all vigor simultaneously with the strong
efforts at total repeal of the PSRO low." Dr. Meyer said
his amendments "would encompass the somewhat splintered atmosphere we've hod in the House and the splintered
atmosphere we've hod bock at home ... "
Otto K. Engelke, M.D., Ann Arbor, Mich.: "I wont
especially to thank Congressman Crone for appearing

before us at this session and getting us back on the


track." Dr. Engelke said abolition of PSRO should be
given top priority by the AMA.

men will be mightily encouraged if our primary thrust is


toward repeal." (His statement was greeted with loud
applause from the delegates.)

Matthew Marshall, Jr., M.D., Pittsburgh, Pa.: He noted


that the Pennsylvania delegation overwhelmingly reiected
the proposition to repeal PSRO and added that physicians
would be able to control PSROs.

Richard L. Meiling, M.D., Columbus, Ohio: Noting that


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

Joseph F. Boyle, M.D., Los Angeles: Agreed that repeal


would be in the best interests of the people "but I don't
think it's feasible." Apparently referring to the Senate
Finance Committee members, he said "they did know
exactly what they were passing" when they voted for
PSRO. Dr. Boyle took charge of amending Report EE.
Also he said the report should be amended (as it later
was)' to include, am~ng other things, mention that AMA
was firmly committed to professional peer review and
that hospital staffs should develop "unassailable" peer
review programs. "AMA," he said, "should in no way
indicate or imply it is opposed to those physicians and
physicians' organizations, state medical societies, county
medical societies and others, who do believe they wish
to spend their maior energy in attempting to effect repeal of PSRO."
John R. Schenken, M.D., Omaha, Neb.: Disputed Dr.
Boyle's contention that members of the Senate Finance
Committee knew what was in the PSRO amendment to
H.R. l. "That iust isn't true. Senator Curtis (Sen. Carl T.
Curtis, Nebraska Repub'ican and member of the committee) told me that it wasn't true. The maiority of the
Finance Commitee didn't know what was in PSRO any
more than members of the House Ways and Means Committee knew. Only a few knew exactly what was in the
bill." Dr. Schenken noted that the Nebraska House of
Delegates unanimously supported the Rarick Bill for repeal of PSRO. He said the primary thrust of AMA should
be toward repeal "and all other mechanisms must be
subsidiary to this thrust." He added that "many congress-

Donald N. Sweeney, Jr., M.D., Detroit, Mich.: "We in


MichiQan are very pleased to see that the primary thrust
of the information and the conversation this morning is
toward repeal. We feel as other members of this House
do - that our doctors back home feel that we should be
workinQ for repeal." He added the primary goal of AMA
should be repeal, with freedom to work for amendments
to PSRO and to influence rules and regulations until repeal can be accomplished.
Thomas Parker, M.D., Greenville, S.C.: "Now is the time
for action. Continuing to do what we're doing is not action.
Action is support of H.R. 9375 (the Rarick Bill to abolish
PSRO). Action is support of the lawsuit of AAPS to have
the law declared unconstitutional . . . You have got to
go on the offensive. The absolutely essential action we've
got to take is to seek repeal and support our friends and
then do whatever else we can."
Russell B. Roth, M.D., AMA President: "I would say the
striking message I got from hearing Congressman Crone
this morning is of long-range importance rather than
short-range application to this problem. The message I
got from him was that I should, if there were any conceivable way possible for me to do it, go home to my
district and send someone to Congress from that district
of a like mind to Congressman Crane." Dr. Roth sang a
ditty he often sings to a Porgy and Bess tune, the import
of which is that we're stuck with PSRO and there's nothing
that can be done about it.

Reference Committee Debate

PSRO Generates long Argument


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

-OH. Thomas Ballantine, Jr., M.D., Boston, Mass.: He


brought gasos of disbelief from many at the Reference
Committee when he said he had talked to Sen. Wallace
Bennett (R., Utah), chief Senate sponsor of PSRO, and
the Senator told him the constitutionality of the PSRO 'aw
had been tested many times.

John Heard, M.D., Atlanta, Ga.: Dr. Heard chided the


AMA trustees and executive staff for refusing to carry out
a 1973 mandate of the House. of Delegates to publicize
the deleterious facets of the PSRO law. He supported
abolition of PSRO, declaring "it would be immoral to
support a law we believe to be a bad law."
Raymond Killeen, M.D., Los Angeles: He criticized AMA
administration for scheduling a pro-PSRO meeting the
day before the House of Delegates met and said he
resented action of the Board of Trustees in not making
Report EE available to delegates before the day the House
convened. "This House of Delegates," he said, "has a

right to know what kind of propaganda is going to be


sent out from the AMA itself."
Robert B. Hunter, M.D., Sedro Woolley, Wash., a trustee and chairman of a Board committee promoting PSRO
collaboration: "The Board of Trustees needs no defense.
The federal government believes it will be at least three
years before they issue rules and regulations on this PSRO
implementation. It is impossible to advance until certain
information is released (by government)."
Edward Wiater, M:D., Los Angeles: "The main reason
PSRO is of such interest is because we are questioning
the policy we took under a crisis type of situation a year
ago when we decided to take a leadership ro!e in implementing the law. And what do we say about the law
- it's a bad law. We decided on a leadership role in
implementing a bad law. That's a paradox. If the AMA
had decided to work for repeal before passage (of PSRO)
we would not be in the trouble we are in today. We're
not getting very far suggesting rules and regulations. All

options have not been stated in Report EE - for examp'e,


challenging the constitutionality of this law. We have an
obligation to challenge its constitutionality on behalf of
our patients." He noted that the Los Angeles County Medical Society, which opposes PSRO, has been studying the
law for months, "whereas this Report EE was created over
the weekend."
Joseph De laurentis, M.D., Wilmington, Del.: He noted
that virtually everyone, inc'uding the AMA has branded
PSRO a bad law. "I am convinced that if we hold this
law to be harmful rather than helpful, our proper course
i.s to begin an energetic campaign seeking repeal of the
law." He urged AMA to abandon programs aimed at
forming PSRO groups, adding that the fact that HEW
would form PSROs "should not dissuade us." He said:
"There is no reason to suspect that PSROs which we form
will in the long run be operated in a different fashion
than those the government forms. PSRO is not our institution. It never was and never will be."
Edwin R. Wunderlich, M.D., Los Angeles: Reported that
the 10,000-member LACMA had adopted a policy that
the Association would "not apply for, sponsor or endorse
any PSRO organization in the country" and that LACMA
districts and LACMA membership, including hospital staffs,
were counseled on the advisability of such action.
Etmo Boyd, M.D., Shreveport, lo.: "Why should we endorse something again just because we blindly endorsed
it the first time." Dr. Boyd noted news story that Sen.
Bennett had verbally fogged AAPS for criticizing PSRO
and had mode certain assertions about the law. Dr. Boyd
read what he described as "on English trC'nslation" of the
low to refute Sen. Bennett. He also said the House action
at Cincinnati - accepting the Board of Trustees policy of
collaboration - was not based on "informed consent."
John J. Coury, M.D., Port Huron, Mich.: He withdrew
Resolution 15 of Michigan delegation supporting position
of AMA trustees "and present to you the wisdom of our
House of Delegates,'' which favors abolition of PSRO.
Urban H. Eversole, M.O., Boston, Moss.: He said he was
"speaking for the entire New England de'egation" in
endorsing Report EE of the trustees and asserting "we
must continue to exert leadership even more vigorously."
He said of himself and his colleagues: "Neither do we
think we are violating vaunted New England conscience
by supporting a totally bad law because we do not believe
that the basic precept of it is bad."
Ralph S. Emerson, M.O., Roslyn Heights, N.Y.: He argued
that "you can't test the constitutionality of something
that hasn't even started." He said support of Report EE
''is the only oracticol, sensible approach we can take"
George Himler, M.O., New York, N.Y.: The author of
the notorious Himler Report that advocated downgrading
privafe practice, fee-for-service and free choice said
"you're smoking opium" to believe PSRO-type controls
would be wiped out by abolition of PSRO. He said he was
not sure doctors would control PSRO at the local level.
"Until the time we know it is not going to work this way,
I think we would be damned fools to say we were going
to work for repeal of this and we ore going to oppose it."
Willard C. Scrivner M.O., East St. Louis, 111., a member
of the Notional Professional Standards Review Council:
"A feeble effort at repeal would be ill advised."

Jack Schreiber, M.D., Canfield, Ohio: "I am skeptical


that the law can be changed by amendment. The doctors
back home know one thing - it's a bad law. A vote for
repeal would be an expression to our doctors, who are
in a mild state of revolt, that we are going to do our best
to repeal it.''
Joe M. Crosthwait, M.D., Midwest City, Okla.: He said
PSRO was designed to correct ill-conceived financing of
Medicare and Medicaid. "The solution of bureaucrats is
to pass more bad legislation - hence PSRO. This law was
not passed in the wisdom of Congress but was the abortion
of a handful of staff bureaucrats of the Senate Finance
Committee. We must look to repeal to protect our patients
from the imminent danger to the quality of their health
care."
Thomas Parker, M.D., Greenville, S.C.: Advocating repeal of PSRO, Dr. Parker said that Board Report Z at
the Clinical Meeting in Cincinnati in 1972 which put AMA
on the road to collaboration "caused consternation because it was an about face from opposition to support"
of PSRO. But Dr. Parker emphasized that Report Z
originated in the Board of Trustees, not the House of
Delegates.
J. W. Johnson, M.D., La Jolla, Calif.: He said members
of San Diego Medical Society were polled on PSRO and
more than 50% responded. Asked whether the state or
county societies should form PSRO groups, 530 said no
and 330 said yes. But when asked whether the society
should work for repeal of PSRO, 714 voted for repeal
and 134 said no. "The results of a poll depend on how
the questions are asked," Dr. Johnson said.
W. Collier Salley, M.D., Gloucester, Va.: He urged
adoption of the Virginia resolution calling for repeal of
PSRO and support of the AAPS lawsuit to abolish the law
by challenging its constitutionality.
Daryl P. Harvey, M.D., Glasgow, Ky.: PSRO is "another
product of a negative federation, a concubine in the
harem of socialism." He said support for PSRO amounts to
"socio-economic malpractice" and the law should be repealed. He re'axed tensions by punctuating pertinent
points with repeated witticisms.
Theodore Grevas, M.D., Rock Island, Ill.: "Failure to
repeal the law at this time is never to repeal the law."
He said he hoped the Reference Committee in its summation "does not alienate some organizations that have
been fighting for repeal, such as AAPS and CMS."
James M. Sammons, M.D., AMA Board Chairman: He
made plea for retaining policy of "leadership" in implementing PSRO. He argued that repeal "is not viable."
He brought a round of laughter with a slip of the tongue.
"A position totally and unequivocally dedicated to repeal
of this law is fraught with an exercise in fruition ... ah
.. frustration.''
Waite: Buerger, M.D., Covina, Calif.: He urged delegates to "stand on principle" and seek abolition of PSRO.
"If we do fight for repeal, we will not stand alone." For example, he said, he had a letter from Gov. Ronald Reagan
saying PSRO will destroy the existing voluntary utilization
review system and replace it with a less effective system
which will increase health care costs, deprive Ca'ifornia
of effective control of expenditures and violate the constitution. He pointed out PSRO was enacted "almost without notice."

John M. Wood, M.D., Englewood, Colo., President of


the American Association of Foundations of Medical Care,
an organization seeking money from HEW: He urged
support of Board Report EE without change.
Russell Roth, M.D., AMA President, He said other things

were "far less visible but far more threatening" to the


medical profession than "national hea:th insurance in
its draft, PSRO in its draft and HMOs in their draft." He
did not elaborate, but he added he hoped "when we
leave here we have a clear position where we stand in
respect to the totality of professional review."

~~~~~~~~.....:....~~~-

Physician Retires In Protest Over PSRO


. I~ what must be classified as the most devastating
indictment of the "police state" concept of the PSRO
law, Thomas B. Hayes, M.D., a North Andover, Mass.,
surgeon, has announced he will quit practice March 1
in protest against the PSRO law. Dr. Hayes has practiced
tor 20 years in North Andover.
He wrote personal letters to more than 1,000 of his
patients informing them of his decision, explaining that
he refused to submit to the "police state" controls over
the practice of private medicine embodied in the PSRO
law.
Dr. Hayes is senior surgeon at Lawrence . General Hospital. The news reports on Dr. Hayes' decision said.
other physicians at the hospital share Dr. Hayes' feelings about the law, but none has so far decided to

Votes At-Large
The AMA House of Delegates at the Clinical Meeting
in Anaheim reversed a reference committee recommendation and voted to elect members of the Board of Trustees at large in the future. Currently, candidates run""
for positions on the Board.
There is some question whether this Bylaw change
in the method of electing trustees wi:I affect election
of trustees next June. The resolution adopted to provide
at-large elections was referred to the Council on Constitution and Bylaws for appropriate language to be
submitted at the Annual Convention. The House can
then vote on the question again. If it approves of the
change before balloting for trustees at the convention,
delegates would be elected at large.
Terms of four members of the Board expire in June
this year. A fifth spot will become vacant if Trustee
Max Parrott, M.D., Port'and, Ore., is named PresidentElect. He has announced his candidacy.
John Robert Kernodle, M.D., whose terms expires this
year, has resigned. Others whose terms expire this
year are John M. Chenault, M.D., Decatur, A'a.; Raymond T. Holden, M.D., Washington, D.C., and Donald
E. Wood, M.D., Indianapolis, Ind.

AMA Headquarters Stay


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

follow the surgeon's lead.


The local medical society, however, has dec:ined to
have anything to do with implementation of the PSRO
law.
In describing his fundamental objections to the PSRO
law, Dr. Hayes said:

"It's like a police state. They can come to


my office, take 111,y records, decide that I'm not
practicing medicine according to the rules set
down by the government. The government
tells you what to do. They say you have to cure
a certain disease in a certain number of days,
and if you don't you can get fined. A clerk in
Boston, not a doctor, will decide whether a
patient 30 miles away should stay in a hospital."
However, the feeling apparently is that AMA needs
to beef up its Washington operation. The Board approved a committee recommendation that trustees "expeditiously consider the possibility of increased support for
the AMA Washington office."
The questionable effectiveness of the AMA's Washington lobbying activity has been subject to criticism
recent:y.

Dr. Heard Is Board Candidate


Although the AMA Board of Trustees reportedly does
not intend to fill the vacancy caused by the resignation
of John R. Kernodle, M.D., friends of J. P. Heard, M.D.,
Decatur, Ga., are trying to prevail in the Board to appoint him to fill out the unexpired term which ends in
June.
Whether the Board names someone to fill out the
unexpired term or not, Dr. Heard - whose arguments for
abolition of PSRO inspired many delegates at Anaheim has announced he is a candidate for a full term on the
Board at the election next June.

Bound News Letters Available


Spiral bound copies of 1973 AAPS News Letters and
Bulletins are available from Association headquarters
in Oak Brook. The price is $2.00 apiece. AAPS News
Letters are valuable historical documents, containing
intormation that cannot be found els
ere.

IC,

For lndlv. idu


, tj,'Jl,

......__!

CL

R po_l}Sibility'~nd Liberty

,,

PRIVATE DOCTORS INSTITUTE, Chicago, Illinois, April 18-20, 197.4


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

ASSOCIATION OF AMERICAN 1PHYSICIANS AND SURGEONS


2111 Enco Drive. Suite N-515. Oak Brook . lll1nois 60521

Frank K. Woolley. Executive Director

312/325-7911

,, ,(..~~'""'-'

Donald Quinlan; M.D.


President

l'-r .

THE VOICE FOR PRIVATE DOCTORS

Index No. 9
February - March 1974, Volume 28, No. 2

Medical Staff Council


Joins AAPS in Lawsuit
The Council of Medical Staffs, a New Orleans-based
riational organization representing medical staff physicians, has announced it will join in the lawsuit filed by
AAPS et al in federal court to outlaw the Professional

ISMS Votes To Work For


Repeal 01 PSRO Law
The Illinois State Medical Society House of Delegates,
in a dramatic reversal of previous policy, has voted:

To work diligently for repeal of the Professional


Standards Review Oragnization law.

To mount a massive statewide public informa-

Standards Review Organization law.


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

tion campaign to acquaint Illinois residents and


lllino,is congressmen and senators of the deleterious effects that can be expected from PSRO.

James Colomb, partner in the New Orleans law


firm of Guste, Barnett, and Colomb, has been engaged
by CMS to handle the amicus curiae proceedings.
Although a number of local and national medical
organizations are supporting the AAPS' legal challenge
of the constitutionality of PSRO with financial contributions, CMS is the first that has decided to join AAPS in
attacking the law in federal court.

INSIDE

Nixon Wants Doctors Permanently


Controlled

To dismantle the Illinois Professional Standards


Review Organization which ISMS created last
year to help the federal government implement
PSRO in Illinois.

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

To establish a voluntary, physician-directed peer


review system in Illinois that will function better
than anything devised by government and
forced on the profession and the public.

The ISMS House of Delegates acted at a special


meeting February 24 called for the explicit purpose of
reexamining the society's policy on the controversial PSRO
law in light of the increasing opposition of physicians
in Illinois and across the nation to the viciously punitive
nature and purpose of PSRO.
Not only did the House instruct the dismantling of
the IPSRO, it voted to direct the Board of Trustees to
encourage other medical groups that have applied for
recognition as PSROs to withdraw their applications.

AMA Trustees Turn Down Repeal


Resolution Deadline
Amendment to By-Laws
Illinois Family Physicians Contribute
to AAPS Lawsuit
Fiscal Irresponsibility Prevails in
Washington

By its action, the Illinois State Medical Society, one


of the four largest in the nation, became another in a
growing list of medical associations that have heeded the
repeated w~rnings of AAPS and awakened to the deadly
peril that PSRO poses for the practice of private medicine
and the freedom of physicians to make medical decisions
for their patients without any kind of third party interference, government or otherwise.

Gouging by Government
Mailing Reminder

It is apparent that the AMA collaborationist position


is becoming more and more unpopular.

Bring Your Wife


Another noteworthy aspect of the ISMS House meet-

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

Rep. Edward ]. Derwinski (R-lll.) attended the meeting and advised the ISMS
trustees and delegates to work hard for
repeal of PSRO.
It will be remembered that Mr. Derwinski was one of the original signers of
a letter from some 40 members of Congress that was sent to the AMA House of
Delegates in Anaheim last December urging the House to go on record unequivocally in favor of PSRO repeal.
Mr. Derwinski was one of two signers
who yielded to pressure from AMA lobbyists and withdrew his name from the
letter. Now he is saying what he really
thinks, not what AMA officials want him
to say. It is clear that when anyone understands what PSRO is all about they are
opposed to it.

indigent to encompass everyone physicians and

ciJl

qi! practicing

their patients.

Within two weeks after those anti-medicine actions,


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

"Our health insurance proposal would


call for states to oversee the operation of
insurance carriers and establish sound
procedures for cost control," said the message. "Until these and other controls are
in place, I recommend that our present
authority to control health care could be
continued. I am asking the Congress for
such authority."
The President's program for nationalizing medicine,
titled the Comprehensive Health Insurance Plan (shortened
to CHIP) -

and everyone from buffalo county knows what

this means - was introduced in the Senate as S-2_970


by Sen. Robert Packwood (R-Ore.) and as HR-12684 by
Rep. Wilbur Mills (D-Ark.) and Herman Schneebeli (RPa.). Mills said his name is on the bill because the

Meanwhile, local societies continue to join the list of


PSRO opponents. Latest to add their names to the list are
Clinton County (Iowa) Medical
County (Texas) Medical Society,

Society

and

Brazoria

President asked him to introduce it.

Three-Part Scheme
It is a three-part scheme. The first part would require

Nixon Wants Doctors


Permanently Controlled

employers to offer their full-time employees a health


insurance program approved by HEW and containing
specified benefits, including hospitalization, physicians'
services, drugs, and limited mental health care and other
services. Employers could supplement the basic program,

Three times in three weeks, President Nixon told the


nation's physicians in effect that they deserve no better
than to be permanently burdened with oppressive government controls over their fees and the way they practice
medicine.
Early in February, in a week when AMA officers and
trustees met with the President in the White House, Mr.
Nixon:

Announced that his Administration intends to


keep wage-price controls locked on physicians
and hospitals but wi"I lift them on everything
else except petroleum when the present wageprice control law expires April 30.

but they could not offer a nonapproved plan. Employees


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

Combined News Letter


Due to an enormous amount of time being
devoted by the AAPS staff to researching and compiling materials for the Association's PSRO lawsuit
and assisting attorneys in meeting a March 11 deadline for replying to a government motion to dismiss
the suit, we are combining the February and March

Sent to Congress his new scheme to nationalize

issues of the News Letter into a single issue. The

medicine ("an idea whose time has come in A-

time devoted to preparation of materials for the

merica," he. called it). The scheme would allow


states to set physicians' fees, drug prices and

reply was important because the thoroughness of

hospital charges and would extend those vicious,


punitive PSRO controls beyond the e'derly and

our response could be a critical factor in the outcome of the suit.

risks. This part of the program would be handled by the


states under contract with carriers.
The third part of the Nixon program would alter
Medicare by mandating the same benefits as the other
parts of the program.
Medicaid would be abandoFted.
Employees covered under the first part of the program would pay a fixed set of deductibles, while those
in the low-income groups would pay a range of deductibles tied to income levels.
Medicare beneficiaries would also pay fixed deductibles, which would increase costs to the elderly.
HMOs would qualify as insurance plans provided
they met government decreed standards.
The President said his plan would add about $6
billion to current health care costs, an estimate considered
highly speculative.
The Administration's so-called CHIP plan would, for
the first time in America, establish a universal, nationwide system of paying for health care by credit card.
Participating physicians and hospitals would be required
to accept the credit card as full or part payment for
services. All participating physicians, therefore, would be
required to accept assignments for all or a portion of
their fees.

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

Physicians who elected to become


full participating providers would agree
to accept a patient's "healthcard" as the
sole means of reimbursement and to accept the level of payment established by
government as full reimbursement for
patients under all three parts of the plan.
An associate participating provider
would agree to the same conditions, with
one exception - he could collect an additional fee from patients covered under
the employer-employee insurance program
if he gave prior notice to the patient. He
would have to accept fixed fees as full
payment for services to the indigent and
elderly.
A non-participating provider, according to a White House information sheet,
"would not be reimbursed from any approved plan for services provided."
It should be noted that physicans will not be able
to avoid government controls by electing to become a

non-participant in this scheme, although their fees would


not be set by government. The Administration has been
careful to include PSRO and to make it immediately applicable to services provided in physicians' offices. Further,
the legislation proposes to amend PSRO so that it will
apply to any patient eligible for reimbursement under any
phase of the program.
The legislation proposes to grant state governments
(through state laws and regulations) authority to exercise
a wide range of odministrative functions by direction of
the HEW Secretary, including certification of providers
and "establishment of the reimbursement rates and standards applicable to payments ... by insurance plans ...
for items and services provided within the state
"

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

"It is also important to understand,"


said the document, "that the CHIP plan
preserves basic freedoms for both the patient and doctor. The patient would continue to have a freedom of choice between
doctors. The doctors would continue to
work for their patients, not the federal
government."
EVERY PHYSICIAN WHO VALUES HIS PROFESSIONAL FREEDOM MUST OPPOSE THIS LATEST ASSAULT ON
THAT FREEDOM!
Contact your senators and congressman now. Demand
that they oppose S-2970 and HR-12684 and all other
legislative schemes to shackle physicians with oppressive
government controls in the guise of helping the American
people or any portion of them pay for health care.

AMENDMENTS TO BY-LAWS
A proposed amendment to the AAPS By-Laws will
be before the House of Delegates for adoption at the
Private Doctors Institute in April. It will amend the Bylaws by adding the following to Article 13, Paragraph B,
Page 15, after the paragraph ending " ... and to any subsequent lawful order.'':
"Moreover, the members of this Association subscribe to the ethics expressed in the Hippocratic
Oath, to which physicians of our western civilization
have bound themselves by the tradition of centuries,
believing that the principles expressed therein have
contributed to the strength and dignity of the doctorpatient relationship, to the preservation of the
free enterprise system so essential to a free society,
and to the physical and spiritual well-being of those
who honor its stipulations."

AMA Trustees Turn Down Repeal


Officers and trustees of the AMA, apparently still
suffering the dangerous hallucination that government
bureaucrats won't harm you if you help them control
you, have made it unmistakably clear that they will continue co'.laborating to impose PSRO on the nation and
have no intention of carrying out the directive of the
AMA House of Delegates that PSRO should be repealed.
AMA officers and trustees have gone to extraordinary
lengths to strengthen their collaborationist posture and to
try to prove the House did not direct the Board of Trustees
to pursue repeal, despite the fact that many AMA delegates and alternate delegates and others who attended
the House meeting in December believe that is exactly
what the House meant.

It has also been reported to AAPS


that officials of AMA went to Washington
early in February and told several members of Congress to ignore as "a lot of hot
air" the action of the House of Delegates
in Anaheim in adopting the position that
the best interests of physicians and their
patients would be served by repeal of
PSRO.
In a report from the Board of Trustees published in
the February 4, 1974, issue of

American Medical News

the Board had this to say to the AMA membership: "As


it is, the Board has charted a course based on its interpretation of the House of Delegates action at the 1973 Clin-

if HEW went ahead with the proposed regu'.ation.

AMA President Russell Roth, M.D.,


attacked the proposal as legally, ethically
and medically wrong, and a "dire~t _threat
to the medical care of the 35 million or
so people who are covered by Medic~re
and Medicaid." He pointed out hospital
admissions for these patients would no
longer be certified by a patient's physician
but bu a committee. And that would constitute illegal interference in the practice
of medicine, he said. Dr. Sammons was
described as fuming. He said the issue is
"who's going to make the medical judgment that Aunt Susie is sick enough to be
treated in the hospital." He said he would
have "_qrave doubts" about serving on such
a review committee to decide whether to
admit a patient he hadn't even seen.
The contradiction arises, glaringly, because everything Dr. Roth and Dr. Sammons said about the preadmission certification proposal can be said with equal
accuracy about the PSRO law.

PSRO Even Worse


PSRO requires a committee to determine in advance
whether hospitalization is medically necessary. The committee can overrule the judgment of the attending physician. Even worse, PSRO authorizes a committee to deny

ical Convention that

does not include an overt, immediate campaign for repeal of PSRO. Instead, the trus-

a patient the services of a particular specialist in certain


circumstances and, further, would require a physician to
assure a PSRO committee that another physician per-

tees will propose amendments to the law in an attempt


to mitigate objectionable features." And if you doubt

forming services for the attending physician's patient was


not doing anything that was not medically necessary. All

the trustees are still deluding themselves they can still

this obviously cons1itutes illegal, unethical and morally

get consideration from HEW officials by collaborating,


they said this: "And they will coordinate AMA efforts to

wrong interference in the practice of medicine.

bring about an orderly implemention of the PSRO program."

But not only have AMA officers and trustees refused


to join AAPS in its lawsuit to outlaw PSRO, shunned the
very thought of filing suit on their own and steadfastly

A Number of Contradictions
Many physicians undoubtedly will detect several
contradictions in the positions of the AMA on various
related issues. For example, trustees and officers at Anaheim (and since) insisted that repeal was not "viable"
and therefore shouldn't be tried. In the February 4 issue of

Amercian Medical News,

Board Chairman James H.

Sammons, M.D., admitted trustees don't know whether


amendment of PSRO is "viable" either, but he said it's
worth trying.
But a more significant contradiction in the trustees'
position on important issues shows up in their reaction to
HEW's attempt to force pre-admission certification for
hospitalization of Medicare and Medicaid patients. AMA
trustees and officers were outraged and threatened suit

spurned House policy for repeal, they have pursued with


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

What ri,qht indeed? What right do

they have to do these things in the name


of either price c o n tr o l or professional
standards review?
Added Dr. Sammons, "These are not economic controls . . . they are political controls . . . we intend to
fight them down the line."
Just short of PSRO?

Did HEW Back Off?

Illinois Family Physicians


Contribute to AAPS Lawsuit
The Illinois Academy of Family Physicians has contributed $1,000.00 to help finance the Association's
lawsuit in federal court challenging the constitutionality
of the PSRO law. The contribution had been authorized
by the IAFP Congress of Delegates if officials of the

Dr. Sammons told a meeting in Washington that


President Nixon at the insistence of AMA officials had
told HEW Secretary Caspar Weinberger to back away
from the pre-admission certification proposal. Later, AMA
reported that HEW had said it would drop its proposal.

It developed, however, that HEW's


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

Academy were convinced of AAPS's sincere and continuing effort.


In a letter to Illinois State Medical Society, John
Holland, M.D., Chairman of the Academy Board of Directors, said "it has now become apparent that this is, indeed, the fact, and it also appears that there is considerable and ever growing popular support within the profession for the repeal of this legislation ... "
Dr. Holland added: "This action has been taken because of the recognition that excessive and perhaps inappropriate control and regulation interferes with the
delivery of health care and may very well have the end
rP.sult of diminishing the quality of health care being
provided the public."

GOUGING BY GOVERNMENT
What with all this, together with failure to persuade
HEW to set up statewide PSRO areas, AMA officials lately
have been complaining that Administration officials just
don't pay attention to them.
Still, they keep insisting that by collaborating they
have a chance to "mitigate objectionable features" of

You can

be sure that none of the

members of

Congress nor any of the government bureaucrats who


accuse doctors of overcharging will have a word to say
about this kind of evidence of government gouging.
Last year, AAPS paid $4.00 for a year's subscription

Social Security Bulletin.

the PSRO law, although, as Dr. Roth admitted at a news

to an HEW publication, the

conference January 25, "we (AMA officials) decided to

This year, the price skyrocketed to $10.45, an increase

cooperate with HEW in the implementation of the law,


but I can tell you we've had very little cooperation in
return." He also lamented that AMA has made "a deliberate effort to cooperate with HEW" over the last four

of 250%.

or five years, but "of late, we've had nothing but rebuff
after rebuff."

RESOLUTION DEADLINE
Resolutions for consideration by the House of Delegates at the Private Doctors Institute in April must be
received at the AAPS office in Oak Brook, Illinois, not
later than March 29. The Institute is scheduled for April

MAILING REMINDER

18-20 at the Drake Hotel in downtown Chicago. Resolu-

Mail for AAPS continues to be sent to the Association's old address in Chicago -

but it is no longer

being forwarded to the Oak Brook, Illinois, address.


As noted in the August, 1973, News Letter, the Chicago
postmaster notified

tions should be in regular resolution form and, if possible,


typewritten double spaced.

AAPS that forwarding

BRING YOUR WIFE

orders are

Mrs. Jackie Anthony, President of the Auxiliary to

is returned

the AAPS which meets with us, urges you to please bring
your wife to the April meeting. The advice and experience

Please check your records to be sure they reflect

Auxiliary to supplement our home town efforts to alert


and arouse the public to the dangers to it inherent in

cancelled after one year, and then


to the sender.

mail

of our wives will be of great importance in plans of the


the AAPS Oak Brook address as shown at the bottom of
the last page of this News Letter.

the present Federal medical policies.

and spends more than 40% of everything


everyone earns in America.

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

More disheartenin_q than that is the


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

The President proposes to spend $28.6 billion qn


health programs in 1975, and that's more than $10
billion above the actual expenditures in 1973. The budget
requests include $16.7 billion for Medicare and $6.6
billion for Medicaid, a total of $23.3 billion for the two
programs, compared with actual expenditures of $14
billion in 1973.
Mr. Nixon also expects to spend $125 million in
1974 and 1975 promoting and developing numerous
organizations incorrectly known as health maintenance
organizations. And the budget for programs of Charles
C. Edwards, M.D., Assistant HEW Secretary for Health,
includes more than $58 million to get the PSRO program
under way. The budget message gratuitously offers the
opinion that "the quality and appropriateness of medical
services will be improved through Professional Standards
Review Organizations."

For Individual Liberty and Responsibility,


Donald Quinlan, M.D.

President

Enclosures:

Politicians Are Not Doctors!


l Page Flyer on Private Doctors Institute
Reservation Card

PRIVATE DOCTORS INSTITUTE, Chicago, Illinois, April 18-20, 1974


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

ASSOCIATION OF AMERICAN PHYSICIANS AND SURGEONS


2111 Enco Drive. Suite N-515. Oak Brook . Illinois 60521
Frank K. Woolley. Executive Director

312/325-7911

THE VOICE FOR PRIVATE DOCTORS

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

Senator Bennett Ballyhoos PSRO;


AAPS Again Calls For Repeal
What was billed as a hearing on implementation of PSRO by the Senate Finance Committee's Subcommittee
on Health May 8-9 turned out to be a forum for Sen Wal lace Bennett (R-Utah) to ballyhoo PSRO, sweet talk witnesses who support PSRO (like AMA's Robert Hunter, M. D.) and to rail at th6se who denounce it as bad law and
seek to abolish it (such as AAPS witnesses).

TMA Files Suit


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

The TMA complaint alleged that if HEW is allowed


to proceed with implementation of the PSRO law,
Texas physicians will suffer "irreparable harm and
injury."

The Texas Medical Association is the first medical


association to follow the AAPS lead and attack constitutionality of PSRO in federal court, although others,
including California Medical Association, have flirted

There was abundant evidence that the hearing was


set up as a sounding board for Senator Bennett to let
him get into the record a lot of favorable things about
PSRO (even things that were not true) and to attempt
to counter the lengthy and growing list of criticisms
of the law.
Senator Bennett, for example, is not a member of
the subcommittee, but he made speeches propagandizing PSRO, harangued adverse witnesses, praised
those supporting PSRO, interrupted other senators,
conducted most of the questioning by prior arrangement with several senators to yield to him the time
they had been allotted for questioning witnesses, and
even went so far as to put words in the mouth of one
reluctant witness who repeatedly refused to say what
Senator Bennett wanted him to say.

When it came time for AAPS to testify, President


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

INSIDE

with the idea.

The Council of Medical Staffs has filed amicus curiae proceedings in support of the AAPS suit.
T.M.A. also has raised dues by $50.00 a year and
is assessing members $100.00 each for pursuing the
PSRO lawsuit.

Misrepresentations Mark Debate


AAPS Dues Raised
AAPS Delegates to be Nominated
More Associations Favor PSRO Repeal
Support for Lawsuit
Oath is Available

Later, he said: "I can assure you, Mr. Chairman,


most doctors in this country are not being fooled or
hoodwi~ked into accepting a bad law just because
someone says it's a god law. I can also promise you
that the physician members of our organization are
not going to turn tail and run just because someone
in HEW or in Congress snarls at them.
"We are going to continue to tell the truth about
this law. It is a bad law. We know that misrepresentations about it by its promoters and propagandists
will continue because it is so bad there has to be a
cover up."
Dr. Quinlan also said that:
The PSRO law will require "standardized" medical care for Medicare and Medicaid patients.
Physicians will be forced to "subordinate their
best medical judgment of what is 'medically
necessary' for their patients" and when doctors
are overruled by government functionaries they
"will be obligated to use their influence to ~onvince their own patients the government is right
and they, the doctors, are therefore wrong."
In certain cases, the patient may be denied the
doctor or hospital of his choice.
"Doctors licensed by the states who are now free
and ethically obligated to practice medicine of
the highest quality will be forced to follow central government bureaucratic direction and,
therefore, be denied the right of providing patients with the best care of which they are capable."
The purpose of PSRO is to entrap doctors in a
system of government-imposed controls, but it
will be patients who will be trapped. "They, not
the doctors, will suffer most because medicine
compressed into a standardized mold by political pressure will not be first-class care. Who will
be deprived of first-class care? Obviously the
patient, not the doctor".
"The ~ssence, the substance, the very purpose
of this law is control. It is intended to smother
the medical profession in. uniformity established
by bureaucratic fiat."
PSRO will "condone wholesale violation of the
privacy of records of any patient of any p~ysician who takes care of Medicare or Medicaid
patients." Officials are now hiding the truth. The
plain truth about confidentiality is "that this pernicious law is a vast and unholy grant of power
to the Secretary of HEW to acquire confidential
information from records of any patient and to

use it in whatever manner he decides will further, 1n his opinlon, the purposes of the law ...
the plain truth is that the PSRO law will protect
individuals who rifle patient records for use by
PSROs and HEW, not punish them."
WOOLLEY. BENNETT CLASH

When AAPS Executive Director Frank Woolley, in


response to a question by Sen. Carl Curtis (R-Neb.),
referred to a study of PSRO commissioned by HEW
before the law was enacted as HEW's PSRO "Bible,"
Senator Bennett interrupted to shout angrily: "I challenge that."
Mr. Woolley was referring to a study by Barry
Decker, M.D., and Paul Bonner which was published
in book form under the title: "PSRO-Organization for
Regional Peer Review." In his testimony, Dr. Quinlan
had noted that Dr. Becker and Mr. Bonner, as HEW
contractors, clearly stated that PSRO will result in rationing of medical care, is the precursor to control of
all medical care, should apply to all private practice,
and is designed to insure uniformity, modify individual behavior, and systematically impose constraints on
physicians.
Mr. Woolley quoted directly from the book to prove
these assertions and said the "HEW Bible" is that being
used as reference in drafting rules and regulations.
Senator Bennett heatedly argued that the study was
nothing more than "a private contract" to which HEW
was not bound. He said copies had never been distributed to the Senate Finance Committee and HEW
officials had never referred to it. The senator suddenly acquired considerable knowledge about a book of
which he had feigned ignorance' when questioning
an earlier witness.
Mr. Woolley pointed out it was not a private contract but a public contract and that HEW representatives actively participated in development of conclusions for the book.
When Senator Curtis was allowed to continue questioning, he asked Mr. Woolley whether he concurred
in the statement that "there are no new requirements
for review in the PSRO law."

"That, of course is not true at all," responded


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

to become government agents, requiring them to


police other physicians performing services for
their patients, There are now no preadmission requirements but PSRO sets up such requirements.
And PSRO introduces a new and odious obligation
on physicians to conform to norms of diagnosis and
treatment.
Mr. Woolley pointed out logically that if there
were no di/ ferences there would be no need for
PSRO, so "why don't you repeal it?"
Misrepresentation Continued
The hearing was also the occasion for PSRO propagandists such as Senator Bennett, HEW Secretary Caspar Weinberger and Henry Simmons, M.D., HEW'~
PSRO chief, to continue misrepresentations about the
law that has been characteristic of its supporters since
its inception. Mr. Weinberger, for example, told the
subcommittee that "there is nothing in the statute that
requires, nor will it be administered in any way, that
will change the existing confidentiality of the physician-patient relationship." He called PSRO a mechanism for "assuring that the quality of medical care delivered to people eligible under this statute is high"
and that there will not be "an unnecessary or wasteful or improper payment of taxpayers dollars ~ .. "

The hearing was also the occasion for official


representatives of the AMA to submit meekly to a
senatorial tongue lashing and to apologize, in ef feet,
for trying to inform the profession and the public
how bad PSRO is.
AMA President Russell Roth said: "I think all of us
are distressed in that it (the AMA informational kit on
PSRO) has perhaps intensified an adversary atmosphere ... " Dr. Hunter said part of the kit was "needlessly inflamma,tory" and had been withdrawn by
AMA.

AMA's schizoid attitude toward PSRO was glaringly


evident at the hearing. Dr. Roth observed, as AAPS
has said repeatedly, that "as understanding of the
PSRO law spreads, resistance to it grows." He said
in spite of efforts of many, including AMA, to sell the
profession on PSROs, doctors aren't buying it. "The
fault does not lie with the sincerity or intensity of the
effort to cooperate," he said, "it lies with the basic ineptitude of the statute."
Understanding of the law, however, has not persuaded the AMA leadership to get on the repeal bandwagon (at least 20 state medical associations have
called for PSRO repeal). Dr. Roth remarked that "responsible accomplishment of a successful program is
the objective of all of us." He confessed that AMA's
effort to "line up enthusiasm and cooperation and
willingness of organizations to apply for "an active
role in PSRO" had failed.

"It hasn't happened," he lamented. "And it's going the other way at an alarming rate." Dr. Roth
said he found it "distressing to us" that so many
state societies were going for repeal. "My suggestion is that you need the troops to win this war, and
we're losing the troops."
AAPS was not entirely alone among medical organizations in the belief 1hat the law is so bad in its basic
concept that the only cure is repeal. Joseph F. Boyle,
M.D., Speaker of the California Medical Association
House of Delegates, said resolutions adopted by CMA
"express the deep concern of our members over the
absolutely disastrous effects on patient care that they
foresee will very surely and very rapidly follow upon
the heels of the implementation of PSRO." He added:
" ... our association has concluded that Section 249F
of Public Law 92-603, PSRO, represents bad law that
cannot be amended satisfactorily except by its outright
repeal."

Misrepresentation Marks Debate


"One of the less admirable aspects of the debate
over nationalizing medicine is that the arguments
are often laced with fraud, deceit and misrepresentations," AAPS President Donald Quinlan, M.D., told
the House Ways and Means Committee April 26, as
the committee opened hearings on various proposals
to nationalize U.S. medicine.
"The protagonists of government interference in
the private doctor-patient-hospital relationship proclaim government programs are needed because there
is a crisis in health care," Doctor Quinlan said.
"They loudly trumpet that health care is a right.

"And they assert they are moved to act in response


to public clamor for a change in the health care
system."
Doctor
no health
no public
mand for
and build

Quinlan emphasized, however, "There is


care crisis in the United States. There is
outcry for change. There is no public deCongress to dismantle our present system
a European-style system on the wreckage.

"But there is wide~pread despair over the bureaucratic bungling and rising costs that characterize Medicare and Medicaid."
The AAPS President told the committee that As-

sociation members "are appalled that Congress is


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

ized medicine to point to any proof either in this


country or abroad that their assumption is valid. He
said the fact is there is not a medical crisis but there
is definitely a dollar crisis in the United States.
"Government is spending more than it takes in in
taxes and is creating inflation," he said. "Housewives
are being forced to pay 15% more for groceries and
other supplies this month than they were in the same
month a year ago. And who has piled this inflationary
problem squarely upon the American housewife-the
bureaucracy of the federal government which these
proposals before you would empower to spend even
more money. Huge additional spending through government when government spending is the source of
grinding inflation which hurts low and fixed income
citizens is absurd.
"HEW is scheduled to spend $111 billions "in 1975
without any more authority. That is more than all
spending for defense-more than all the profits of all
corporations after taxes and more than all the government spent for everything in 1960. Such wild spending, not doctors, is the basis of inflation.

Confidence Shaken

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


Doctor Quinlan said that at a time when the
American people are having their confidence in the
political process of self-government shaken to its
very roots, "it is unbelievable that a proposal for
embarking on a spendthrift program of unimaginable billions for socialized medicine would be seriously advanced at this time, based on the assumption
that all Americans should be dependent on government employees for medical care." He said that all
of these proposals for politicalized medicine are based
on an assumption which is fraudulent. The assumption consists of two parts:
First that all citizens, not just people over 65
years of age and people with low incomes, are incompetent to contract effectively, efficiently, and
satisfactorily with other private citizens for the
medical and hospital services they want. This is not
only a fraud but an insult to the millions of selfreliant Americans who produce the goods and services upon which government depends.
Second that only government employees are competent to choose the proper and appropriate physician and hospital for any citizen and determine
what is medically necessary for him. Furthermore,
that substituting the choices of government clerks
will result in more and better service at less cost.
In other words, the assumption is that politicalized medical care, with control by government employees, is better than private care.
Doctor Quinlan challenged proponents of national-

Clever Demagoguery

Doctor Quinlan declared that the assertion has been


made so often that health care is a right that it has
become a cl iche. "No one endeavors to define the
term," he said. "It is just solemn:y intoned as one of
the eternal truths of mankind.
"What it is is a clever bit of demagoguery. It is
clearly intended to whip up an emotional response
and, since it is used in the context of government
medicine , it is intended to evoke the feeling in people
that a right is being denied to them and the government will guarantee that right by nationalizing medicine. You know and I know that no one has a claim
against the services of a physician unless the physician
agrees to it. Under normal circumstances, a contract
between a patient and a doctor can be terminated by
the doctor with notice and by the patient at any time.
No one, not even the government, can constitutionally
interfere in that contract. If anyone has a right to my
services, it must be enforceable by law even against
my wishes. Obviously, no such right exists. The government may wish to pay for my services on behalf of
a patient, but that does not translate into a right."
The AAPS President stated that "it seems to us a
distortion of our value system that health care would
be proclaimed as a right at the same time a denial of
rights to medical care has been written into the law
(PSRO) and has become a key part of several of the
proposals before you."

Thomas G. Dorrity, M.D., Memphis, Tennessee,


Chairman of the AAPS Legislative Committee, told the
Ways and Means Committee that many Americans
have been puzzled from time to time by the manner
in which Congress has acted on important public issues. "Medicare, in our opinion, is a classic example
of Congressional deci.sion which was not grounded
on a studied evaluation of the consequences of the
decision," Doctor Dorrity said. "Most members of Congress now realize this.
"Over and over again in the years before Medicare
was enacted, Congress was warned by medical, insurance and financial experts that the program would be
enormously more costly than its proponents claimed.
HEW's own actuary told this committee that Medicare
would swiftly go bankrupt unless taxes were increased or benefits curtailed or both.
"Congress ignored these warnings - and sure
enough costs went up and taxes went up and the price
of Medicare is now nine times original estimates, and
irresponsible people are blaming doctors. The fact is
that Congress dropped the Medicare bomb on a nation that was wholly unprepared. That program
created and turned loose a huge artificial demand for
hospital and medical care, a new demand that could
not be satisfied with the manpower and facilities
available. Costs accelerated, naturally, as doctors and
others said they would. Medicare, pouring billions of
new dollars into the economy, was highly inflationary.
"Let me emphasize to this committee that Medicare
is classic in another way-it is clear and irrefutable
proof that Congress by unwise decisions can fan inflation but Congress cannot prevent costs rising in an
inflationary economy."
National Disaster

Translate Medicare into a program for everyone,


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

"But suppose Congress goes ahead, unmindful


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

health care under the guise of giving them something for nothing through the political process.
Also, it would further undermine individual responsibility and strengthen bureaucratic control.
"The demand for health care created by such a program would be so overwhelming that the system
would swiftly degenerate into mediocrity; it would
become a bureaucratically operated fiasco. There are
not enough doctors or hospitals and other facilities to
even begin to cope with the demand that would follow the enactment of such a program.
"We hope the members of Congress are wise
enough to heed the lesson of Medicare. We trust that
the members of this Committee will not want to be
responsible for imposing on everyone a govermentcontrolled program of health care that will explosively
drive up costs by unleashing an uncontrollable artificial demand and, as its tragic result, debase the quality of medical care for all Americans. America can do
better than follow the patterns of failure of Europe."

AAPS Dues Are


Raised To 550
Dues for regular AAPS membership have been increased from $35 a year to $50, effective for 1975
dues. The dues increase was approved by the House
of Delegates in April by adoption of a resolution declaring that "all costs of all things have risen disproportionately in the past several years" and "it is a
fact that more funds are needed by AAPS to carry out
progressively increasing activities more in number and
greater in cost and expense." The resolution added
that Association dues have "remained constant for
many, many years a.s compared to increased membership dues of practically all other organizations.
Sustaining membership was increased from $75 to
$100, Builder at $200 and Life at $1,000 were not
changed.
The House also adopted resolutions:
Urging repeal of the so-called Kefauver law
which "confers unjustified authority on the FDA
to interfere with the judgment of practicing physicians in their choice of therapeutic agents ... "
Approving item - by -,item reimbursement for
money spent by the Public Relations Committee
for projects approved by the Executive Committee.
Directing the Board, the Finance Committee or
a special committee to develop a membership
card that will allow a member to pay a desig-

nated amount in addition to regular dues that


can be forwarded to a local chapter for its financial assistance.

Alaskans Ask Repeal


Citizens for Quality Medicine, an Alaska-based organization dedicated to keeping open the greatest
variety of choices to users of .medical services and
products, has joined with several other groups to
launch a campaign for repeal of PSRO. Target date for
an avalanche of telegrams to Congress is June 3, but
the campaign will go through June. The campaign will
concentrate on members of the House Ways and
Means Committee in an effort to get them to report
out HR 9375 or any other bill to repeal PSRO.
AAPS members can help the campaign by sending
telegrams to their congressmen and to Rep. Wilbur
Mills (R.-Ark.), Chairman of the Ways and Means Committee.

AAPS Delegates
To Be Nominated

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

Support For Lawsuit


The Tennessee Medical Association, The Charleston
(S.C.) Medical Society, and the Richmond (Va.) Academy of Family Physicians have made financial contributions to AAPS to help in the lawsuit challenging
constitutionality of the PSRO law.
K. K. Carter, M.D., President of the TMA, wrote:
"I believe the legal mechanism is the way to attack
the government and realize it is expensive. I think
we agree that something must be done to halt the
regulation and direction of medicine by nonmedical
people in government, and I agree that the legal
process is the process of choice."

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

AAPS Members Elected

Enclosed with this News Letter is a form for the


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

F. Michael Smith, Jr., M.D., Thibodaux, La. has been


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

This is an important assignment. Every member is


urged to nominate several AAPS members and return the list of nominees to AAPS headquarters
promptly.

Forrest J. Babb, M.D., West Lafayette, Indiana, a


family practitioner, has been elected President of the
Indiana Chapter of AAPS. Dr. Babb joined AAPS in
1962.

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

For Individual Liberty and Responsibility,

More Associations
Favor PSRO Repeal
Two more state medical associations - Florida and
South Carolina - have joined the growing throng
of associations taking formal action favoring repeal
of PSRO.
The South Carolina association also voted against
participation in PSRO and for support of the AAPS
lawsuit to abolish PSRO.

Donald Quinlan, M.D.


President

Enclosure: Notice of Nomination of Delegates

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

ASSOCIATION OF AMERICAN PHYSICIANS AND SURGEONS


2111 Enco Drive. Suite N-51 5. Oak Brook . Illinois 60521
Frank K. Woolley. Executive Director

31 2/325-7911

THE VOICE FOR PRIVATE DOCTORS

Index No. 6
June, 1974, Volume 28, No. 5

But That's PSRO

Friendly Witness "Bought"


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

AAPS Suit Hearing


Set For September

tors can give them. It is so hard to believe anyone


would want to give government bureaucrats the power to make medical decisions and to punish doctors
who disobey their orders.

The three-judge federal court trying the AAPS lawsuit against HEW Secretary Caspar Weinberger challenging constitutionality of the PSRO law has set oral
'arguments in the case for 2 p.m. September 17, 1974.
The hearing had been set for June 12, but it apparently was set over until September because of the
illness of two of the judges and because of the summer recess.
Meanwhile, AAPS will, if necessary, seek to obtain
preliminary relief to bar HEW from any action to interfere with patients or physicians before the courts
finally decide the case. AAPS will not tolerate interference with patients' right to receive or physicians'
right to give their best medical judgment and care on
a confidential basis.
The hearing in September will be on the question
of whether the court should grant the government's
motion to dismiss the suit. Written briefs have been
filed by AAPS in opposition to the motion and by the
government in support of the motion.

But That's PSRO


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

were too many voluntary witnesses signed up


to denounce PSRO at a subcommittee hearing.

AAPS Suit Hearing


House May Alter AMA PSRO Policy
Eleven in Race for AMA Board
Worth Remembering
Scions Ask Repeal
Reds Interested in AAPS
Truth Makes Him Angry

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

INSIDE

Witnesses have been "bought" with tax money


by members of the Senate Finance Committee
staff to testify in support of PSRO because there

thing work."

Threats appear to be a substantial part of the


repertoire of bureaucrats and politicians to try
to compel doctors to drop their opposition to
PSRO and make it work the way the bureaucrats want it to work.

Not long ago, a member of the National Professional Standards Review Council-the organization of
physicians intended to create the appearance that the
medical profession will have a lot to say about PSRO
rules and regulations-addressed a medical meeting
in St. Louis about NPSRC activities. He said the first
time he met Jay Constantine, he asked why success-

should be so deeply and personally involved in the


enforcement of this one law. Could it be because,
as the member of the National Council observed, "I
think he has the most rigid type of obsession against
organized medicine."
Threats & Intimidation

ful voluntary peer review programs had to be pushed


aside to bring in PSRO. He said Constantine looked
him in the eye and said: "/ don't care what I have to

do to organized medicine to make this thing (PSRO)


work."
Throw You To Wolves

Threats, intimidation and misrepresentation have


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

Later, the Council member related, Constantine told


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

AAPS has also been reliably informed that


Constantine telephoned the Executive Director
of a state medical society to invite him or someone representing the society to testify favorably
for PSRO at a subcommittee hearing because
there were so many more opposition witnesses
than supporters. The society executive told Constantine, AAPS was informed, that the society
could not afford the expense, and Constantine
responded by offering to pick up the tab from
Finance Committee funds. A representative of
the society did testify, primarily on the operations of a medical foundation in his state, and
expenses to the hearing were paid from tax funds.
This small society is one that already had accepted Federal subsidization to operate an HEW
Emergency Medical Care Review Organization
(EMCRO) program. It received $210,000 for the
current study.
None of the members of the Finance Committee,
nor any other member of Congress, House or Senate,
for that matter, seems remotely concerned over Constantine's obsessive interest in forcing PSRO on the
medical profession and the American people. But a
few doctors, at least, find it a bit odd, and ominous,
that a paid employee of a congressional committee

AAPS President Donald Quinlan, M.D., noted


that at an American College of Radiology meeting last January attended by Senator Bennett,
Constantine and Henry Simmons, M.D., chief of
HEW's PSRO offioe, threat after threat was
tossed at physicians that if they duln't knuckle
under and accept PSRO, the wrath of Congress
and the bureaucracy will descend on them and
they will get something a lot worse.
Senator Bennett, for example, threatened that unless PSROs work {presumably to the satisfaction of
politicians and bureaucrats), Congress probably will
consider national health programs as instruments for
changing the entire health care delivery system rather
than primarily funding mechanisms.
Asked Dr. Quinlan: "If PSRO had all the virtues
claimed for it, why would such tactics {threats and
intimidation) be necessary?"
He added that AAPS isn't going to turn tail and run
(or withdraw and rewrite anti-PSRO pamphlets and
speeches) just because someone in _Congress or the
bureaucracy snarls or threatens.
These threats are made as if there were no constitutional limit or restraint on governmental intrusion
into the private affairs of citizens. Those who indulge
in such threats tried to leave the impression they
believe there is no way to put a stop to tyrannical
government and that it is undesirable even to try.
AAPS, however, is determined to find out through
legal means whether politicians have become so powerful that they can with impunity suspend or ignore
the limitations of the Constitution.

House May Alter


AMA PSRO Policy

As a "progress report on PSRO, the document fails


to note that AAPS had filed suit attacking constitutionality of PSRO, that the Council of Medical Staffs had
filed an amicus curiae brief in support of AAPS and
that the Texas Medical Association has also filed suit

As the time approached for the opening of the annual meeting of the AMA House of Delegates at the
Palmer House in Chicago, it became less and less certain that the Delegates would permit the AMA leadership to continue collaborating with HEW to force PSRO
on the unwilling profession and unknowing public.
By June l 0, a total of 13 resolutions calling on
AMA to work for outright repeal of PSRO had been
sent to AMA for introduction in the House by nine
states and one individual. There is no equivocating or
hedging in these resolutions. In effect, they want officers, trustees and staff to quit using the weak excuse that repeal is "not viable" because that is no
more than an excuse to keep on collaborating with
the enemy.

The position that repeal is not viable also


becomes increasingly hard to defend in light of
the fact that 44 bills for repeal of PSRO have
been introduced by 100 members of the House
and Senate. Obviously these members of Congress believe repeal is possible. What they would
like is some help from the AMA.
Further, it has long been apparent that the position
of the AMA trustees and staff represents a viewpoint
that is far in the minority among AMA members. And
there are some physicians who believe that the contin.uing policy of collaboration and refusal to work for
repeal is pursued in defiance of the wishes of the
House of Delegates.
By June l 0, these states had introduced repeal
resolutions - Idaho, Oklahoma, Indiana, Nebraska,
California, Louisiana, Florida, South Carolina and
Georgia. Another was submitted by Edward J. Wiater,
M.D., California delegate.
Of special interest was a Board of Trustees report
on PSRO activities of the AMA, a report that contains
a glaringly false statement, namely that the AMA had
carried on "three years of concerted opposition" to
PSRO before it was enacted.

in federal court challenging constitutionality of the


law. AMA specifically adpoted the basis for relief asserted by AAPS in its complaint filed in Illinois in
June a year ago. S1gnificantly, the TMA complaint
certified that 76.5% of all practicing physicians re
sponding to a TMA poll stated they supported "the
policy of seeking repeal" of PSRO. Only 8.6% were
recorded as not supporting repeal.
The AMA progress report noted that AMA has offered legal assistance to any state society seeking
to overturn PSRO area designations. Significantly,
however, AMA has not offered to help any society,
like Texas, that wants to file suit to outlaw PSRO on
grounds it is an unconstitutional invasion of the rights
of patients and doctors.

Eleven In Race

For AMA Board


Eleven AMA members were announced candidates
for six seats on the Board of Trustees, and a 12th
was being urged by associates to get into the race.
The terms of three incumbents expire this year
and there are three vacancies to be filled.
Incumbents seeking new three-year terms are John
M. Chenault, M.D., Decatur, Ala.; Raymond T. Holden, M.D., Washington, D.C., and Donald E. Wood,
M.D., Indianapolis, Ind. John R. Kernodle, M.D., resigned in January, and James H. Sammons, M.D.,
resigned recently when the Board chose him to succeed E. B. Howard, M.D., as Executive Vice President.
The other vacancy resulted from the decision of Max
Parrott, M.D., Portland, Ore., to run for President-Elect.
Besides the three incumbents seeking re-election,
candidates for the Board are: Daniel Cloud, M.D.,
Phoenix, Ariz.; John Heard, M.D., Decatur, Ga.; James
H. Stewart, M.D., New Orleans, La.; Hoyt D. Gardner,
M.D., Louisville, Ky.; John Hawk, M.D., Charleston,
S.C.; Frank J. Jirka, M.D., Berwyn, Ill.; Joe T. Nelson
M.D., Weatherford, Tex., and James M. Blake, M.D.,
Schenectady, N.Y.

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

Truth Makes Him Angry


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

That was the opening sentence of a letter to the


American Medical News June l O by Arthur S. Mode,

An APPS member in New York spoke to a colleague

M.D., Greenwich, Conn. Dr. Mode urged physicians

who had not sent in his AAPS dues and received an

to stand firm against PSRO and tell the world "we

unusual response.

won't cooperate with

something

bad" so doctors
The colleague said he would mail in his dues okay,

can "preserve our integrity."

but he didn't want to read AAPS publications anyDr. Mode's closing observation is worth remem-

more because they make him very angry. The reason

bering. "One thing Patrick Henry never said was:

they make him angry, he said, is that what they say

'Give me some money today and I'll fight for liberty

is all true.

tomorrow'."
CORRECTION

SOLONS ASK REPEAL


The May 1974 AAPS News Letter erroneously reThe Florida Legislature has adopted a resolution

ported that a contribution was made by the Tennes-

memorializing Congress to repeal the PSRO law. It

see Medical Association to the AAPS lawsuit chal-

is the third time a legislature has called for PSRO

lenging the constitutionality of PSRO. The contribution

repeal. Similar resolutions have been adopted by

was made personally by TMA president E. K. Carter,

legislatures in Tennessee and Kentucky.

M.D. He, in no way committed TMA to support the


AAPS lawsuit.

Reds Interested In AAPS


For Individual Liberty and Responsibility,
The following letter was received at AAPS headquarters recently from the director of a government
library in Moscow, Russia:
"Our I ibrary makes efforts to purchase periodical
publications of your country on medicine and related subjects. Would you be so kind as to send us
Donald Quinlan, M.D.
President

sample copies of two current issues of your publication, AAPS Newsletter, in order we could examine
and decide whether or not we should purchase your
publication. Thank you in advance for your kind attention to this matter."

Enclosure:

Annual Meeting Brochure

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

ASSOCIATION OF AMERICAN PHYSICIANS AND SURGEONS


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

Frank K. Woolley. Executive Director

312/325-7911

THE VOICE FOR PRIVATE DOCTORS

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

Fact of Life

AAPS Suit Best Way To Stop PSRO


The AAPS lawsuit challenging constitutionality of PSRO has emerged as the most feasible means of abolishing this
authoritarian law.
That became a fact of life for the medical profession when the American Medical Association House of Delegates on June 26
ignominiously voted to surrender the nation's physicians to government tyranny. As the House acted, AMA leaders were quietly
negotiating multimillion dollar contracts with HEW to develop
PSRO standards that will be forced on the nation's
physicians and to train PSRO personnel who will order
physicians around. The House action, summarily rejecting the
hope and desire of a vast majority of U.S. physicians that the
AMA would work for repeal of the iniquitous PSRO law, was
a thundering proclamation to the American people, to all
Enclosed with this News Letter is a new AAPS pamphlet -AMA members and to every other doctor in the country tha1
they must look elsewhere for protection from oppressive
PSRO: The Great .olitical ~ickness B_ip Qff - designed as
government intervention in the practice of private medicine.
another weapon in the continuing fight to abolish the

New PSRO Pamphlet From


AAPS Aimed at Patients

malignant PSRO law. This new pamphlet is specifically


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

AAPS members are urged to obtain this pamphlet in


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

This carefully prepared pamphlet disclosing the truth about


this vicious law is availabe from AAPS at cost: $12 for l 00,

$22 for 200, $50 for 500 and $90 for 1,000.
For further information, see story elswhere in this News

When they do look elsewhere they will see that there is a


nationwide organization of doctors left that will not abondon
principle nor trade it for any amount of government money.
That organization is the Association of American Physicians
and Surgeons. AAPS, unlike the AMA, will not surrender
abjectly to the government interventionists whose overriding
ambition is to destroy medical freedom. AAPS, unlike the
AMA, will never collaborate with the enemies of medical
freedom and will never help fasten upon physicians the yoke
of government control.
AAPS will continue to press its lawsuit to abolish PSRO;
AAPS will continue to work for congressional repeal of this
evil low; AAPS will continue to expose misrepresentations
about PSRO spread by HEW officials and others; AAPS will
continue to disseminate the truth about this vicious and
punitive law by distribution of the AAPS News Letter,
pamphlets and other materials.

Letter.

INSIDE
New AMA Policy on PSRO
Patients Respond To PSRO Pamphlet
Board Is Warned That MDs Are Discontented
Rep. Rarick Comments On AMA's Capitulation
AAPS Speakers Bureau

All AMA component medical societies and all


individual physician members of the AMA who embark
on active programs aimed at repeal of PSRO should
note and note we// that they can count on a/I-out.
<2Pposition from the leadership of the AMA - - members of the Board of Trustees and high-level staff. Even

before the final capitulation of the House of Delegates


at the Annual Convention in Chicago, AMA lobbyists
on orders from AMA headquarters were charging
through the Senate and House office buildings
buttonholing members of Congress in a frenzied effort
to keep them from introducing or sponsoring legislation
to repeal PSRO.

Incredible as it was, AMA lobbyists were engaged in


this frenzied business of preserving th is horrendous law when
it was the official position of the AMA that repeal would
serve the best interests of the American people and when no
less than 20 component state medical society and scores of
county societies were on record unequivocally favoring
outright repeal. Si nee it is now official policy of AMA not to
work for repeal, there is every reason to assume AMA
lobbyists, spending AMA members-' dues money, will be even
bolder in trying to pressure Senators and Representatives to
oppose PSRO repeal.
MILLIONS AT STAKE

It is now obvious why trustees and staff were so


desperate to manipulate the House of Delegates into rejecting
repeal and adopting a quisling policy of collaboration with
government to force PSRO controls on the nation.

could not succeed. Dr. Crane invited Bradley to step forward


and deny the report if it was not true. Brodie'>' did not denyJ!..
nor did anyone try to pretend that he had acted on his own
without instructions from AMA officials. But conservative,
anti-PSRO delegates, even before Dr. Crane spoke, heard
about Bradley's ploy, took steps, and it failed. Mr. Ford
mentioned PSRO only to say that to him the initials meant
"Politicians Should Remain Out."

The vote committing AMA to forsake the nation's


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

Millions of dollars of contracts with HEW were at stake!


Under one million-dollar contract, AMA will develop
standards of diagnosis and treatment to be forced on
physicians and their patients by enforcement of the iniquitous
PSRO law. AMA will also split $2.8 million with other
organzations to train PSRO personnel whose orders will have
to be obeyed by physicians.
Most delegates did not know that such contracts were
pending when the AMA leaders concocted a parliamentary
scheme by which the House was bamboozled into adopting
an unequivocal collaborationist policy which, one physician
observed, made the AMA a department of HEW.
But the contracts between AMA and HEW were signed
June 29 - - just three working ~ys after the House of
Delegates vote.
It is likely that HEW and AMA officials will try to deny
that the fate of these contracts so far as AMA is concerned
rode on the outcome of the balloting at the House meeting.
But it would be absurd to claim that HEW would give more
than a million dollars to help implement PSRO to an
organization that was trying to get the law repealed.
While the HEW-AMA contracts were kept quiet, it was
well known that HEW was negotiating with 128
organizations for PSRO planning contracts, statewide support
center contracts or conditional PSRO contracts. At the same
time the AMA-HEW contracts were disclosed, HEW
announced it had ~igned contracts with 119 medical
organizations for a total of about $25 million.
FAILS WITH FORD

Even Vice President Gerald Ford, who addressed the


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

The victory for the pro-PSRO forces was also achieved by


the defection of a significant number of delegates who defied
the express pol icy of their state associations to vote for repeal
of PSRO.
The carefully planned strategy to surrender the AMA without reservation to government dominion caught anti-PSRO
delegates by surprise. When the report of Reference
Committee A, whose chairman, according to House Speaker
Tom E. Nesbitt, M.D., was carefully chosen, came up for floor
consideration, a number of delegates were prepared to offer
amendments to instruct the Board of Trustees to work for
repeal of PSRO. But Speaker Nesbitt recognized William B.
Hildebrand, M.D., Chairman of the Council on Medical
Service, although numerous delegates had been waiting
patiently at microphones for recognition.
Dr. Hildebrand, speaking for the Council on Medical Service, soi d that since it was the fourth time in two years the
pros and cons of PSRO had been debated and, as someone
else had said, "the clock is ticking," he therefore moved the
question, a parliamentary maneuver to choke off discussion
before it started and bring the reference committee report to
an immediate vote. Dr. Hildebrand's motion carried by a
surprising 202 to 24 vote.
NO CHANCE TO AMEND

There was evidence that many delegates did not


comprehend what was happening. Even more failed to
understand that voting to prohibit debate also barred
amendments to the committee report. Nevertheless, after
requests for a secret ballot or a recorded roll call vote were
rejected, the report was adopted by a standing vote of 185 to
57.

Thomas Parker, M.D., delegate from Greenville,


S.C., and on AAPS member, described the event as
"the most outrageous abuse of parliamentary
procedure and collusion I hove seen so for." And John
R. Schenken, M.0., delegate from Omaha, Neb., and
also on AAPS member, requested that he be recorded
as voting against the report of Reference Committee A
because "I don't wont to be recorded as voting for

tyranny." Later, Dr. Schenken expressed his belief that


AMA delegates "have voted themselves into economic,
political and professional bondage."
Dr. Nesbitt's role in this episode is open to serious
question. He is an avowed protagonist of PSRO, a declared
opponent of repeal and noncompliance. In a letter dated April

29, 1974, to Sen. Wallace F. Bennett (R-Utah), Dr. Nesbitt


told Senator Bennett he had just engaged in three days of debate on PSRO, "at which time," he emphasized, "I strongly
supported efforts to implement Section 249-F of P .L. 92-603
(as opposed to the concepts of 'repeal' and 'noncompliance')." He said further that he had represented the
AMA at two annual meetings of state medical associations
and "my stance at these two meetings was also in support of
the implementation of PSRO."

"support center" contract to help HEW force PSRO on


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

New AMA Policy on PSRO


The AMA's latest policy on PSRO established by action of
the House of Delegates at the Annual Convention in June
was interpreted by numerous observers and delegates as a
straddling policy -- an attempt to strike a compromise
between pro- and anti-PSRO forces, a "something-for-everybody" position. In fact, some delegates justified their vote for
the Reference Committee report by saying that "it had
something for everyone."
However, anyone who studies the document carefully must
conclude that it is a crafty, cleverly deceptive statement which
offers absolutely nothing to the foes of PSRO who want that
heinous law abolished. The fact is that report was designed
as an affirmation of the role of PSRO quisling being played by
the AMA leadership. Its adoption had the effect of expunging
the previous House statement that repeal of PSRO would
serve the best interests of the American people.

effort directed at amending those sections of the law which


present potential dangers in the areas of confidentiality,
malpractice, development of norms, quality of care, and the
authority of the Secretary of HEW; and be it further
"RESOLVED, That the Association should continue its
efforts to achieve legislation which allows the profession to
perform peer review in accordance with the profession's
philosophy and the best interest of the patient; and be it
further
._

"RESOLVED, That individual state associations which elect


non-participation shall 1not be precluded from such a
position by this Association's policy statement, but should be
urged to develop effective non-PSRO review programs which
embody the principles endorsed by the profession as
constructive alternatives to PSRO; and be it further

Here is the text of the i:iew policy of PSRO collaboration:


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

Dr. Nesbitt, openly prejudiced for implementation of PSRO


and against its repeal, to have acted ethically should have
disqualified himself from presiding over House consideration
of any matter involving this controversial law. Instead, he
was an active participant in the political manipulations that
flimflammed delegates into adopting .9_policy inimical to the
best interests of patients and doctors and favorable to the
purposes of HEW.
Had Dr. Nesbitt disqualified himself, would Vice Speaker
William Y. Rial, M.D., Swarthmore, Pa., disqualified himself,
too? A foundation set up by the Pennsylvania Medical Society
got the first PSRO contract out of HEW -- a fat $250,000

"RESOLVED, That if ongoing evaluation of the PSRO


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

is now to seek "constructive" amendments to the PSRO law


and "to ensure appropriate regulations and directives." But
the basic, evil concept of PSRO now has the AMA's full
support, and the House majority has announced to the
American people that the AMA no longer believes PSRO
repeal would serve the best interests of the public.
One way to test who will be served by the pro-PSRO policy
adopted by the House is to ask yourself who was happy with
the outcome. It certainly wasn't the growing legion of
physicians who want this evil law abolished. But one who
was gladdened was Charles C. Edwards, M.D., Assistant
HEW Secretary for Health. And that should be a thundering

message to al I physicians who cherish freedom for


themselves and their patients. Dr. Edwards, whose office has
jurisdiction over implementation of PSRO, is so deeply and
ardently committed to locking PSRO controls on the medical
profession that he has approved pamphlets prepared by
subordinates and distributed to every doctor in the country
that contain f_!ggrant misrepresentations about the PRSO law.
Dr. Edwards, whose staff members were conspicuously
present during the House meeting in Chicago, must have
been apprehensive at the prospect of a vote directing AMA
trustees and staff to work for repeal. But when it was over,
Dr. Edwards, known as a liberal in the arena of medical
politics, gave audible expression to his heartfelt pleasure.
HEW DOUBLESPEAK

"Because of this action by the House of Delegates," he


said in a prepared statement, "the AMA will now be able to
work closely with the Department of HEW on shaping a
quality assurance program based on the concept of peer
review that truly represents the best interests of both the
physician and his patients."

This is typical standard HEW doublespeak.


Government-ordered surveillance is not peer review.
Government control cannot assure quality. On the
contrary, it will guarantee a deterioration in quality.
The only peer review that will serve the best interests of
the physician and his patients is true peer review
voluntarily undertaken by physicians. The best way for
HEW to serve the interests of physicians and patients is
to abandon PSRO and stop governmental interference
in the practice of private medicine altogether. As Mr.
Ford said, ''.Politicians ~hould Eemain Qut." This
includes Dr. Edwards, who is obviously a politician.
Although the AMA has formally rejected abolition of PSRO
in favor of a clear-cut policy of collaboration with
government in shackling patients and doctors with
freedom-shattering, quality-crippling PSRO controls, let no
one suppose that the AMA policy is no longer schizoidal and
ambivalent. Perplexed members can only wonder why
trustees, staff and a majority of the House were so eager to
preserve PSRO within the Medicare and Medicaid programs
but at the same time voted to do everything possible to
eliminate PSRO provisions from any national health programs
before Congress.
There is an additional puzzling contradiction in the new
AMA PSRO policy. While embracing PSRO, the new policy
declares the AMA "should continue its efforts to achieve
legislation which allows the profession to perform peer
review in accordance with the profession's philosophy and
the best interest of the patient." Obviously PSRO, so ardently
championed by trustees and staff and endorsed by the House
majority, will not allow doctors to perform peer review in
accordance with the best interest of patients and, obviously,
it is in conflict with AMA leadership's interpretation of the
profession's peer review philosophy.
WHAT HAPPENED?

Bewildered doctors all over the country are asking what


happened in the House of Delegates last month. Stuart

Auerbach, reporter for the Washington Post, tapped his


knowledge of the modus operandi of the Washington
bureaucracy and medical politicians and came up with an
answer. Surprised by the success of the motion to shut off
debate and by the lopsided 185 to 57 vote to cast the AMA
lot on the side of governmental tyranny over the practice of
medicine, Mr. Auerbach decided that "Weinberger must have
offered them a lot of money."
As it turned out, the AMA hierarchy, which had
already sacrificed the Association's independence by
accepting money from the federal government, had its
hand out for another mi/lion dollars of HEW money to
help HEW in forcing PSRO on doctors and patients.
And at the time of the meeting, 128 physician groups in
46 states had applied for PSRO money. Incredibly, in
some states in which the state medical association
strongly supported PSRO repeal, organizations
sponsored by the state associations had applied for
PSRO grants and contracts.
SERVE TWO MASTERS

In many cases, the decision to accept PSRO money and


thus to surrender to government control has originated with
state and local medical society executives who have
convinced themselves that if enough federal money is
ova ii able there is no impropriety in serving two masters -- the
medical society and a government-controlled PSRO agency.
The o_bvious conflict of interest is no more of a handicap to
them than it is to Robert B. Hunter, M.D., who is accepting
.federal money to serve on an HEW PSRO agency, the
National Professional Standards Review Council, and
simultaneously representing the AMA membership as a
trustee. Dr. Hunter has become one of the nation's most
dedicated PSRO hucksters, which is great comfort to all who
advocate subjugation of medicine to government.
But some medical society executives, who foug~
government intervention for years, have admitted pangs~
conscience at their role in establishing and running foundations that get federal money and as a consequence take
orders from government clerks. But the obvious conflict of
interest leaves most of them unmoved. They are willing to
throw away their society's independence so long as they get
a cut of the PSRO millions.
While AMA's national-state political machine becomes
well oiled with government money, the nation's practicing
physicians, busy taking care of patients, are unaware that the
collaborationist policies of the AMA leadership is
undermining the very system of medicine that gives the
practicing physician the opportunity to devote his time and
skills to caring for patients without becoming engulfed in
bureaucratic paperwork and without the necessity for carrying out orders of government clerks.
The magic word in this Political Sickness Rip Off known as
PSRO is money -- millions of dollars of federal tax money. It is
becoming increasingly apparent that if the independence and
freedom of medicine is obliterated it will be through the
connivance of medical politicians who will sell them out for
government money.

Some physicians will recall a meeting of the AMA House of


Delegates in Boston in 1970 when a delegate, noting that Joy
Constantine of the Senate Finance Committee staff hod
estimated $240 million would be available for PSRO
administration, exclaimed: "We can't let this kind of money
get away from the medical associations to be handled by
someone else."
And a few months later at Hershey, Po. the American
Association of Medical Society Executives conducted a
program on "grantmonship" -- how to get government
money and how to manipulate medical society members who
object to that kind of sellout.
Is the federal treasury one of the "new sources of
revenue" that AMA Executive Vice President Bert Howard,
M.D. told a reference committee lost month that the Association must find in lieu of raising dues again?
One is also prompted to ask: Is a quarter of a
billion dollars sufficient to induce medical politicians
and medical organization executives to abandon
principle and sell out the freedom and independence of
physicians and the best interests of their patients?
INSTRUCTIONS IGNORED

No doubt physicians whose state associations hod token a


firm stand for PSRO repeal will be astounded to know that
some AMA delegates ignored or foiled to carry out
instructions to stand fast for on AMA policy to work for
repeal. At least 20 state associations were committed to
seeking repeal. More than 100 delegates from those ossociotio ns were seated in the House. Nearly 50 of them, nevertheless, voted against repeal and for a policy of helping destroy

medico I freedom by forcing PSRO controls on


unsuspecting public and on unwilling profession.

an

The nine-member Ohio delegation, for example, was


instructed to vote for a clear-cut policy of repeal. AAPS was
reliably informed, however, that only two Ohio delegates did
not vote for the collaborationist recommendations of the Reference Committee. They were Horry K. Hines, M.D., Cincinnati, and Robert E. Tschontz, M.D., Canton.
Col ifornions reported to AAPS that many delegates from
that state, led by six lame duck delegates, repudiated the
strong a nti-PSRO policy of the California Madical Association
and voted to support the AMA leadership's policy of helping
HEW force PSRO' s vicious controls on patients and doctors.
Delegates from Texas, that cradle of medical conservatism,
also broke ranks to turn against their own colleagues who
are so strongly opposed to PSRO that TMA is the only state
association in the notion to file a lawsuit to overturn PSRO on
constitutional grounds, following the lead of AAPS which
filed suit to outlaw PSRO a year ago. Reportedly only one
delegate from Texas stood up to vote against the reference
committee report, and at least half voted for the gag motion
to shut off discussion of PSRO. A source close to the TMA
delegation said there was confusion in the ranks -- and subsequent anger that delegates "did not get to vote the way
they wonted to vote." He added: "We were snookered by
some people who railroaded the whole thing."
He could hove added that the American people also were
snookered by the medical politicians who ore running the
AMA.

Patients Respond To PSRO Pamphlet


A South Carolina member of AAPS hos been making
effective use of the Association's new p9tient pamphlet "PSRO: The Great folitical _.Sickness B_ip Qff."

F. M. Boll, f'v\.D., Charleston, picked up some copies of the


pamphlet while attending the AMA Convention in Chicago
last month. In a subsequent letter he said: "I om writing to
get more copies of the new brochure -- PSRO: The Great
!:oliticol ~ickness B_ip Qff. This little folder ... hos been well
received by my patients in the lost 24 hours in my office and I
need more of them."

Dr. Boll added that while seeing patients he wears a lapel


button with the words "Repeal PSRO." The button almost
always catches the attention and arouses the curiostiy of the
patient. When he asks for information, Dr. Ball said, "I give
him the 'Rip Off' folder."
This new brochure, a copy of which is enclosed herein, is
available from AAPS headquarters in quantity at cost (see
item on Page l of this News Letter).

"PSRO: The Great E_oliticol ~ickness B_ip Qff" was


painstakingly prepared over a considerable period of time.
The truth and accuracy of every statement in the pamphlet
was meticulously verified and documented before the copy
was sent to the printer.
The pamphlet delineates "The Frightening Consequences
of PSRO" for Americans, pointing out that this law gives
government agents the power to:
Deny you the right to choose your own
doctor,
Deny you and your doctor the right to decide
what is "medically necessary" and "medically appropriate" for you,
Deny you the right to have the kind of medical care your doctor thinks is best for you,
Deny you the right to talk to your doctor in confidence about your illness.

Board is Warned that


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

Item: Two members o( the Board or Trustees were


defeated for reelection -- a rare occurrence.
Only one incumbent, Raymond T. Holden,
M.D., of Washington, D.C., was returned to
the Board. John M. Chenault, M.D., Decatur,
Ala., and Donald E. Wood, M.D., Indianapolis, Ind., were voted off the Board. New
members elected were James M. Blake, M.D.,
Schenectady, N.Y.; Daniel Cloud, M.D.,
Phoenix, Ariz.; Hoyt Gardner, M.D., Louisville, Ky. Frank Jirka, M.D., Berwyn, 111., was
elected for a two-year term to succeed James
M. Sammons, M.D.,who is Executive Vice
President designate, and Joe T. Nelson, M.D.,
Weatherford, Tex., was elected for one year
to succeed Max Parrott, M.D., who resigned
to run for President Elect.
Item: Dr. Parrott, a member of the Board of Trustees, won election as President Elect by a mere
two votes, 121 to 119, against Richard S.
Wilbur, M.D., who got into the race only
about 48 hours before the vote. Dr. Wilbur,
former Deputy Executive Vice President, was
once considered the heir apparent to
Executive EVP E.B. Howard, M.D. But after
one of the most devisive conflicts in Board
history, Dr. Wilbur was dumped in favor of
Dr. Sammons. Fifteen ballots were required
during two days of a Board meeting to choose
Dr. Sammons.
Item: A "gag rule" proposed by AMA leadership was resoundingly defeated by the House.
The proposal would have required 30 days
notice before a nonmember could speak to a
meeting of the House of Delegates. Trustees
and staff proposed the "gag rule," as it was
quickly labeled, because of the unscheduled
appearance of Rep. Phil Crane before the
House in Anaheim, Calif. Rep. Crane was
credited with turning the House around and
influencing members to vote for repeal of
PSRO. During deliberation of the "gag rule,"
Speaker Tom Nesbitt was overruled overwhelmingly when he tried to proceed with
consideration of the proposal against the
wishes of a majority of members.
Item: The House of Delegates refused to act on a
proposal designed to increase designated representation of specialty societies in the House.
The proposal was referred for further study.
Item: The House directed simultaneous election of
Board members, a change strongly opposed
by incumbent trustees and staff who wanted retention of the traditional "slot" method.

Rep. Rarick Comments


On AMA's Capitulation
. The fol lowing commentary on the AMA House of
Delegates vote favoring more government interference with
physicians in the practice of private medicine and their
patients was inserted into the Congressional Record for June
27, 197 4.
Hon. John R. Rarick
Of Louisiana
In the House of Representatives
Thursday, June 27, 1974
Mr. Speaker, the American people in their struggle to
preserve individual liberty, were handed a major setback by
the American Medical Association's action in opposing repeal
of the Professional Standards Review Organizations -PSRO 's.
It is truly unfortunate that the once prestigious American
Medico I Association has now gone on record as
compromising the personal privacy of patients' medical
records and endorsing political medicine.
Under the PSRO scheme, patients' medical records must be
computerized in order that HEW can _lay down norms to
prescribe "equal health care guidelines." This is tantamount
to inviting a political overseer into every doctor's examining
room thus making the physician but a delivery tool,
prescribing not according to his training, experience, and
ethics, but rather adhering to bureaucratic fiat.
Ironically, the majQr reason suggested for surrender on this
critical issue of patients' privacy was that the medical lobby
feared that defense of patients' privacy would cost the AMA
money. Nothing was mentioned about the concern for
patients' rights.
Even more ironic, by the American Medical Association's
compromise to accept Government oversight, the AMA has
destroyed its own purpose and effectiveness with both its
member doctors and the American people. AMA has now
reduced its stature to being but a department of HEW rather than representing the wishes of its _members to the
Washington bureaucrats, it has now assumed the role of
representing the Washington bureaucrats to its members and
the American people.

Thus, another major bridge has been. established to


destroy historic private medicine as we Americans have
known it and usher in socialized medicine. Time will tell
whether the medical patients of America and their physicians
will bow to the AMA's cop out or continue the fight to repeal
PSRO.
The delegates swiftly voted, 185 to 57, their approval of a
resolution pushing for some amendments to the PSRO law,
but not calling for its repeal.
Perhaps AMA will favor placing doctors offices in post
offices -- another Federal service supposedly in the public's
interest, that is provided HEW wants it and it saves AMA
money. I include a related newsclipping: From the
Washington Post, June 27, 1974, By Stuart Auerbach.

CHICAGO, June -- Despite threats of a membership


revolt, the ruling body of the American Medical Association
today heeded its leadership and voted not to wage an a/I-out
war against a government-run doctors review program.

In Washington, Dr. Charles C. Edwards, Assistant


Secretory for Health of the Deportment. of Health, Education
and Welfare, commended the AMA delegates for their
"responsive and constructive position."

The vote supporting Professional Standards Review


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

PSRO legislation was passed in 1972 to allow the


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

AMA trustees and officers had spent most of the


organization's annual meeting warning members that
fighting PSROs would waste the AMA's money and was.
doomed to failure.

Earlier, the AMA delegates voted to "exert all efforts" to


amend or repeal the Kefauver-Harris amendment to the pure
food and drug laws which requires new drugs to be proved
safe and effective before they are allowed on the market.

Some officials even predicted that a war against PSROs


could mean the end of the AMA as the voice of medicine to
the public and Congress.
"/ was not willing to see funds committed on behalf of
repeal," said Dr. Malcolm C. Todd of Long Beach, Calif., the
AMA 's president-elect. "It would taken quite a bit of our
resources and I doubt that it would have been successful."
Todd's view was echoed in state caucuses today by such
other influential AMA officers as Dr. Robert B. Hunter of
Sedro Woolley, Wash., a trustee and head of the AMA's
PSRO committee; and Dr. W. B. Hildebrand, of Manasho,
Wis .. chairman of the House of DelegtJtes' committee on
medical services.
Nevertheless, it appeared un ti/ this afternoon that
substantial number of AMA delegates would insist that the
organization push for repeal of the PSRO legislotio.n and
would refuse to comply with its implementation.
The delegates swiftly voted, 185 to 57, their approval of a
resolution pushing for some amendments to the PSRO low,
but not colling for its repeal.
"The delegates finally hod enough time to talk it out," said
Dr. George B. Mortin, Jr. of Thief River Foils, Minn., chairman
of the committee that held a 4 1/2-hour hearing, listening to 64
speakers, on the PSRO issue Monday.
While most delegates appeared satisfied with the decision,
at least one -- Dr. John R. Schenken of Omaha -- demanded
that his name be specifically recorded in opposition to PSROs.
"/ don't wont my name recorded as being in favor of
tyranny," he said.

Delegates argued that the amendment is keeping new


drugs off the market. The AMA gets about one-third of its
revenue from drug company advertising in its journals.

AAPS SPEAKERS BUREAU


The need for dissemination of the truth about public
issues that vitally affect the practice of private medicine
has never been more urgent than it is now. For that
reason, AAPS maintains a Speakers Bureau, with
knowledgeable, top-notch speakers available for
appearances before meetings of medical societies or
other physicians groups or before non-phy?ician
audiences to bring out the truth about such issues as
PSRO, national health legislation.hospital-physician
relationship and health maintenance organizations.
AAPS members are urged to develop speaking
engagements for AAPS representatives before physician and non-physician organizations. When the
opportunity arises for the use of an AAPS speaker to
make the truth about these issues known, contact
Association headquarters in Oak Brook, Illinois.
It is imperative, however, that you allow a
reasonable time for the selection of an appropriate
speaker and for that speaker to make the necessary arrangements for the assignment.

For Individual Liberty and Responsibility,

~~~
Donald Quinlan, M.D.
President

Hunter said he thought two state medical societies -Nebraska and Louisiana - were still "adamant" against
PSROs and might refuse to cooperate with the federal effort.
"But a majority of physicians across the country will work
with the government," Todd said.

Enclosures: Political Sickness Rip Off Pamphlet


Pamphlet Order Form

H-~

THE NEW YORK TIMES

SATURDAY, JUNE 22, 1974

Letters to the Editor


To the Roots of Inflation
To the Editor:
Your report by Michael C. Jensen
on June 7 of the warning by the
panel of prominent economists that
world inflation is approaching the
"crisis stage" cited the various factors
contributing. to it and pointed out that
"government borrowing- and govern
, mentguaranteed borrowing to pay for
social programs were dominating the
long.term capital markets which pro
vide the benchmark for other credit
markets."
But the remarks of Albert SommeriJ,
chief economist of the Conferenr~
Board, also quoted by the report;
tended to raise the level of thinking.
,o embrace deeper and wider impliQfttions: The real roots of inflation, Mr.
Sommers said, Me in "a profound
historical shift in the social cond:tions
and value systems of democratic cap~italism." And because of the "explo
sion of expectations that carry demand
for output far beyond their finite
resources," he concludes that "a real
l!()lution can only be found in a change
of attitudes."
This is easier said than done. The
groundwork for runaway inflation was;
laid some forty years ago when clas
sical economics was ditched for the
Marx Keynes syndrome. From that
time, the dubious "full employment"
concept, implemented by budget defi;;
cits and high taxation, was assiduously
promoted by the entire liberal fratera
nity.

Thus, undue emphasis was placed on


consumption to the disadvantage of
savi-ngs and production, and of a
sound currency. Instead of producing
in order to consume, the mood of
society thereafter became one of con,
suming in order to produce. To re,erse
the process, therefore, requires a new
kind of thinking, a new psychology.
Inflation may be construed as demand
far outstripping supply, but it is also
supply prevented from matching demand.
. Certainly cut nondefense spending
to the bone if necessary (as urged by
President Nixon, not for the first time;
on May 28 in his interim economic
report), but at the same time increase
the supply factor of the monetary
equation by freeing industry of all
bureaucratic meddling and persecutio&.
This would include repeal of the costly
and ineffectual antitrust taws amJ
those taxes (such as the progressive
income and inheritance taxes) that
raise the level of industrial costs and
hinder capital accumulation, and are
levied not primarily for revenue but
for redistributing weaith.
Admittedly this is an ambitious program, but if a re(.1 solution requires
"a change of attitudes," the hackneyed
notion that . only government action
can cure inflation must be abandoned
and liberal, unconditional reliance
placed for the very first time on free
markets.
RAYMOND v. MCNALLY
London, June 8, 1974

Copyrighted, 1974
New York Times Company
Reprinted with permission

ANNUAL MEETING, New Orleans, Louisiana, October 31-November 2, 197.4

ASSOCIATION OF AMERICAN PHYSICIANS AND SURGEONS


2111 Enco Drive. Suite N-515. Oak Brook . Illinois 60521
Frank K Woolley. Executive Director

312/325-7911

THE VOICE FOR PRIVATE DOCTORS

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

May Lose Accreditation

JCAH Rules Against Enforced Bylaws


The Accreditation Committee of the Joint Commission
on Accreditation of Hospitals has issued a ruling which has
the potential for enormously strengthening the position of
hospital staff physicians who resist attempts by hospital
administrators and boards to grab control over medical staffs
and the practice of medicine in their hospitals.
Thrust of the ruling is that a hospital governing body
risks loss of accreditation if it adopts and seeks to enforce
bylaw.s or amendments to staff bylaws that have not been
approved by the medical staff.
The Accreditation Committee acted on a complaint filed
by members of the staff of St. Joseph Hospital in Chicago.
They charged the governing body acted contrary to
accreditation standards when it unilaterally rewrote staff
bylaws and attempted to force staff physicians to agree to
them.

Members of the AAPS spearheaded resistance to


this blatant bid for power over staff physicians and
their medical decisions. One of them, AAPS President
Donald Quinlan, M.D., filed suit against the hospital
after the administration refused to renew his privileges.
Dr. Quinlan would not agree to be bound by terms of
bylaws the staff had not approved and, specifically, he
would not agree to give the hospital administration a
blank check authorization to amend the bylaws at will
without consent of the staff. Dr. Quinlan's suit is
pending.
AAPS has encouraged Dr. Quinlan and his colleagues in
their resistance to the arbitrary, dictatorial decision of the St.
Joseph Hospital administration (inspired by the ambitions of

INSIDE
Strong New Orleans Meeting
Most PSROs Tied to Medical Societies
M.D.s Approve PSROs

an administrator who precipitated the conflict and then left


the institution). In addition, AAPS has drafted and distributed
a pamphlet delineating the rights of medicdl staffs and how
thes~ rights can be defended. The pamphlet also contains a
model ~et of bylaws--designed to define the responsibilities of
staff physicians as well as their rights, based on the fact that
staff physicians are independent contractors responsible for
their own medical decisions.
TEXT OF RULING

This important ruling stands as proof of the validity of


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

Reference is made to my letter of January 24,


1974, to you advising of a complaint lodged with the

Joint Commission on Accreditation of Hospitals by


certain members of the Medical Staff of St. Joseph
Hospital concerning actions taken by the Governing
Body of that institution allegedly in conflict with
hospital accreditation standards.
Mr. Joseph Stone, Associate Director of the Joint
Commission, and I met with you, members of the
Governing Board, and the current Executive Committee
of the Medical Staff on January 31, 1974. Subsequently
we met, on February 8, 1974, with a number of the
members of the Medical Staff who had filed the
complaint.
Following a review of our notes of these two
meetings and other pertinent documents, the matter
was placed before the Accreditation Committee of the
Board of Commissioners for consideration. I have now
to advise you of the decision of that body.
The Accreditation Committee Voted:

Resolution Deadline Set


I~ PSRO For Lawyers Coming?
Amendments to By-Laws
Interest High in Delegate Vote

1)

that St. Joseph Hospital authorities be informed


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

conformance with hospital accreditation standards


(emphasis added);
2) that the Joint Commission urge that the St. Joseph
Hospital Medical Staff, in consultation with the
Governing Body, develop medical staff bylaws
which, when duly adopted by the Medical Staff, are
ratified by the Governing Body without unilateral
amendment (emphasis added);
that there be concurrence between St. Joseph Hospital Governing Body and Medical Staff that actions
taken on Medical Staff matters during the period
when the inapP._ropriately enacted medical staff bylaws (emphasis added) have been followed be accepted and not reconsidered;

3)

that the accredited status of St. Joseph Hospital


presently enjoyed be continued on condition that
the above steps are taken (emphasis added);
5) that the resurvey for continued accreditation now
scheduled for the last quarter of 1974 be deferred
until the second quarter of 1975;
6) that the proper adoption (emphasis added) of medical staff bylaws by the Medical Staff and their ratification by the Governing Body be effected by
March 1, 1975.
It was the sense of the Committee action and my
own recommendation that the Medical Staff of St.
Joseph Hospital with primary affiliation to that
institution work actively, openly, and in good faith to
devise effective bylaws in the interest of the quality of
patient care and to do this in continuing concert with
4)

the Governing Body. The goal is to achieve a collegial


self-government which recognizes the responsibility of
the Medical Staff for the quality of medical care and
equally its accountability to the Governing Body, which
has responsibility for the proper operation of the
hospital. If the Medical Staff fails to exercise this
function properly and in timely fashion, the Governing
Body then has no recourse but to effect medical staff
bylaws on its own initiative.
If the Joint Commission staff can in any way be
helpful in this exercise, please f"!el free to call on us.
NATIONWIDE MOVEMENT

The move to reduce staff physicians to a status


subservient to hospital administrations has become
nationwide, sparked by a misinterpretation of the celebrated
Darling case in Illinois. Some of the misinterpretation has
been deliberate. As a consequence, numerous hospital
officials have been inspired to seek dictatorial control over
hospital staffs on the erroneous proposition that the administration is wholly responsible for medical decisions in the
hospital and, therefore, must exercise such control.
Wliile the JCAH ruling applied to the situation at St.
Joseph Hospital and was not generalized, it is, nevertheless,
clearly a repudiation of the stand taken by many hospital
officials that the medical staff is subservient to the
administration,.
But more than that, it is further proof that when
physicians understand their rights and are determined to
defend them, they can find a way to do it -- and win. Every
ethical doctor should stand up for his rights and refuse to
permit third par_ties to substitute their judgment for his.

AAPS Planning Strong Meeting at New Orleans


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

Are you tired of being pushed around?


Most doctors are. They are tired of being pushed around
by government, by insurance companies, by hospital
administrations. And the prospect of being pushed around by
PSROs looms larger in physicians' practice.
By attending the AAPS Annual Meeting in New Orleans
October 31 - November 2, doctors will receive information
relative to self protection in addition to valuable knowledge
about other problems,

The Hon. John Rarick, Congressman from Louisiana


and chief sponsor of one of the first bills introduced in
Congress to repeal PSRO. He will talk about the
prospects for avoiding tyranny by abolishing PSRO.

Donald Quinlan, M.D., AAPS President, who will


discuss the necessity for ethical physicians to organize
to avoid being pushed around.

F. Michael Smith, M.D., President-Elect of the Louisiana


State Medical Society. Dr. Smith will speak on how
state medical societies can be a positive force for
ethical medicine.

The roster of speakers will include:

The Hon. J. Enoch Powell, former British Minister of


Health, who will bring into sharp focus the similarity of
events which led to socialized medicine in England and
the events that point in that direction in America. Mr.
Powell is considered one of the world a_uthorities on
government control of medicine. He served as British
Minister of Health 1960 to 1963, trying to make the
National Health Service work. He concluded that ''.by
its very nature" it could not work.
Dan Smoot, writer, lecturer, radio and television
commentator and publisher of the incisive The Dan
Smoot Report. Mr. Smoot will discuss the ideological
similarity between the infamous OSHA law and the

Panels will probe problems and how to solve them


involving such subjects as hospital-physician relationship,
PSROs, HMOs, compulsory nationalized medicine, membership recruitment and organizing an AAPS chapter and a
speakers bureau.
If you're tired of being pushed around, plan to

attend the AAPS Annual Meeting in New Orleans and


find out how to avoid it.
Fill out the reservation form on the enclosed
Annual Meeting .!Jyer today.

Paid Agents of HEW

Most PSROs Tied to Medical Societies


At least 77% of the medical orqanizations that so far
. have accepted contracts which make them paid agents of
HEW in forcing PSROs on the nation's physicians and their
patients have direct and obvious ties to state or county
medical societies. Undoubtedly others also are satellites of
medical societies.
Announcement of PSRO contracts between HEW, AMA
and 115 other medical organizations was deferred until the
AMA House of Delegates voted in June for all-out
collaboration with HEW in imposing the iniquitous PSRO law
on the country. Many doctors are convinc~d that the millions
of dollars of PSRO money available to the AMA. and county
medical societies, directly and indirectly, was the bribe that
got HEW the favorable PSRO vote it wanted from the AMA
AMA House of Delegates.

For past, present and future collaboration, the


AMA was awarded substantially more than a million
dollars to help develop standards of medical practice
that will be forced on doctors and to train PSRO
personnel who will push doctors around.
HEW also announced the awarding of PSRO
contracts totaling $20,850,000 to 115 medical organizations, the overwhelming majority of whom have
direct ties to state and county medical societies.
In some instances, the executive c director of a
medical society also serves as the executive of the
Qiganization that has accepted tax money to become
~gent of HEW and subject to the orders of HEW
officials.
HOW'S THAT FOR A
CONFLICT OF INTEREST!

MONUMENTAL CASE OF

STRICTLY LEGAL

In awarding certain contracts, HEW may be stretching


the provisions of the PSRO law. The law (Section 1152 (f) ( 1))
requires the Secretary of HEW to notify area physicians "in
the case of agreements ... under which any organization is
designated as the Professional Standards Review Organization for any area ... " Section 1151 (f) (2) gives area
physicians a chance by ballot to veto such an agreement.
The law also makes it mandatory that the Secretary
designate each PSRO as a conditional PSRO before he can
enter into an agreement with an organization to become a
fully functioning PSRO. The conditional PSROs must serve a
trial period up to 24 months to give the Secretary opportunity
to determine whether they are capable of performing as
PSROs.
Nothing in the law requires the Secretary to notify
physicians he intends to enter into an agreement with an
organization designating it as a conditional PSRO. Further,
nothing in the law permits physicians to block a conditional
agreement by referendum.

However, in the rnse of 11 organizations -- which will


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

MDs Approve PSROs


A majority of physicians in New Mexico and in the
Sacramento, Calif.. area approved HEW agreements
with PSRO organizations in balloting conducted in July,
according to HEW's Professional Standards Review
Office.
When HEW notified physicians in these areas that
the agency intended to enter into agreements with the
Greater Sacramento Professional Standards Review
Organization and the Professional Standards Review
Organization, State of New Mexico, more than 10 per
cent of the physicians in New Mexico and in the
Sacramento area objected in writing to HEW.
HEW then conducted a poll to determine whether
more than 50 per cent of the physicians believed that
the organizations were not representative of the area
physicians.
HEW's PSRO office reported these votes to AAPS:
New Mexico -- Yes (organization is reprsentative) 726.
No (is not representative) 264.
Sacramento -- Yes 581.
No 450.
The PSRO office at HEW said the votes clear the
way for HEW to enter into PSRO agreements with these
organizations.
According to the PR department of HEW's PSRO office,
the agency's legal staff claims it doesn't matter what the
notice in the Federal Register says because the law clearly
requires PSROs first to serve trial periods as conditional
PSROs. Therefore, say the lawyers, the 11 organizations must
be designated and serve as conditional PSROs.

That does not, however, answer the question why


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

Among the 115 HEW PSRO agreements were 13 for a


total of $2,085,492 that went to organizations designated as
PSRO "support centers" that will be paid by HEW "for the
purpose of accelerating the development of the PSRO
program. All but one of these 13 organizations that are
being paid by HEW to force PSRO controls on patients and
doctors either are state medical societies or were organized
by the state society or have other medical society
connections.
Planning agreements -- preliminary to the designation of
an organization as a conditional PSRO -- were awarded to 91
medical groups throughout the country. A cursory check
indicated that no fewer than 69 were linked to a medical
society, most having the same address as the society.
Following are announced PSRO con~ract awards,
asterisks denoting a link with a state or county medical
society.

STATEWIDE SUPPORT CENTERS

$147,810
$289,410
$193,000
$208,590
$97,350

*Connecticut Medical Institute, New Haven


"'Massachusetts Statewide Support, Boston
*New Jersey Foundation for Health, Trenton

*Medical Society of the State of New York. Lake Success


*Maryland Foundation for Health Core, Baltimore
*Virginia Professional Standards, Charlottesville

*Pennsylvania Medical Care Foundation, Lemoyne


*North Carolina Medical Peer Review, Raleigh
Indiana Physicians Support Agency, Indianapolis

*Michigan State Medical Society, East Lansing


*Medical Ad:vances Institute, Columbus
*Health Care Foundation of Missouri, Jefferson City
*United Foundations for MediCal Care, San Francisco, Calif.

CONDITIONALLY

DESIGNATED

$75,720
$243,290
$97,760
$196,650
$100,470
$134,320
$106,680
$194,330

PSROs

Bav State PSRO, Inc., Boston, Mass.


Charles River Health I Care. Foundation, Newton Lower Falls, Mass.
Prince Georges Foundation for Medical Care, Inc., Hyattsville, Md.
Mississippi Foundation for Medical Care, Inc., Jackson
Tennessee Foundation for Medical Care, Inc., Nashville
Foundation for Health Care Evaluation, Minneapolis, Minn.
Colorado Foundation for Mec:iicOJ Care, Denver

*Utah PSRO, Salt Lake City


wyoming Healfh Services Co., Inc. Cheyenne

San Joaquin Area PSRO, Stockton, Calif.


Multnomah Foundation for Medical Care, Portland, Oregon

$3,205,680
$503,420
$212,458
$1,227,954
$1,626,305
$886,000
$2,700,000
$951,495
$604,502
$662,470
$662,848

*F,ve-County Organization for Medical Care & PSR, New Hartford, N .Y.
*Genesee Region PSRO, Inc., Rochester, New York
*Kings County Health Care, Brooklyn, New York
Nassau Physicians Review, Garden City, New York

$96,000

New York County Health Services, New. Yark City


*Richmond County, New York Professional Stds. Review, Staten Island
*PSRO of Central New York, Inc.; Syracuse

$86,300
$55,500
$54,400

professional Standards Review Organization of Rockland, Nonuet, N.Y.


The Bronx Medical Services FoJndotion, Inc., Bronx, N.Y.
Foundation for Medical Core of Puerto Rico, Santurce
oeloware Foundation for Medical Care, Wilmington

$62,800
$79,600
$45,200
$45, 150

*National Capital Medical Foundation, Inc., Washington, D.C.

$55,000

Baltimore City Prof. Review Organization, Inc., Baltimore, MD.

$52,555

*Central Maryland PSRO, Inc., Baltimore


Delmarva Foundation for Medical Care, Inc., Salisbury, Maryland
Montgomery County, Md. Medical Care Foundation, Inc., Silver Spring
Southern Maryland Prof. Stds. Review Organization, Inc., Glen Burnie
*Allegheny PSRO, Pittsburgh, Penn.
*Central Pennsylvania Area 11 PSRO, Williamsport

$41,000
$55,720
$64,800
$36,555
$88,217
$47, 175

Eastern Pennsylvania Health Care Foundation, Inc., Allentown


$65,000
Montgomery/Bucks Prof. Stds. Review Organization, lnc.,Norr.istown,Penn. $54,000

*PSRO Area XII Executive Committee, Philadelphia, Penn.


*Highlands PSRO Corporation, Johnstown, Penn.
*Southcentral Pennsylvania PSRO, Lemoyne
*Sout,western Pennsylvania PSRO, Greensburg

$57,870
$48,000

*Alabama Medical Review, l_nc., Montgon,ery

$65.000

0acte Monroe PSRO Inc., Miami, Florido


Kentucky Peer Review Organization, Inc. Louisville

$73,000
$36,000

Piedmont Medical Foundation. Inc., Winston-Salem, N.C.


*South Carolina Medical Care Foundation, Columbia
Shelby County Foundation for Medical Care, Inc., Memphis, Tenn.
*Chicago Foundation for Medical Care, Chicago
*Quad River Foundation for Medical Care, Joliet, Ill.
Calumet Professional Review Organization, Highland, hid.
*Indiana Area V PSRO, Indianapolis
Genesee Medical Corporation, Flint, Michigan
Upper Peninsula Quality Assurance Association, Escanaba. Mich.

*Hartford County PSRO, Inc. Hartford, Conn.


*PSRO of Fairfield County, Inc., Bridgeport, Conn.
central Massachusetts Health Core Foundation, Worcester

*Western Massachusetts PSRO, Inc., Springfield


Southeastern Massachusetts Prof. Standards Review, Inc., Middleboro
New Hampshire Foundation for Medical Care, Concord
Pine Tree Orgonlzotion for PSRO, Inc. Waterville, Moine

*Rhode Island PSRO, Inc., Providence


*Vermont PSRO, Rutland
Area I - PSRO Region II, Morristown, New Jersey
Essex Physicians' Review, East Orange, New Jersey
Passaic Valley Professional Standards Review, Clifton, New Jersey

Adirondack Prof. Standards Review Organization,Gle~s Falls, N.Y.


*Area 9 PSRO of N.Y. State, Inc., Purchase
*Erie Region PSRO, Inc., Boffalo, New York

$45,300

$59,000

Region X Professional Review Systems, Columbus, Ohio

$55,300

Medco Peer Review, Inc., Cincinnati, Ohio


*Physicians' Peer. Review, Cleveland, Ohio
*Region Six Peer Review Corp., Akron, Ohio
*Western Ohio Foundation fr,, Medical Care, Dayton
*The Foundation for Medical Care, Milwaukee, Wis.

$52,850
$63,000
$46,000
$44,330
$36,345

-Wisconsin. Professioncl Review, Madison

$90,600

Professional Services Quality Council of Minnesota, Rochester


*Arkansas Foundation for Medical Care, Fort Smith

$66,000
$65,000

Central Eastern Missouri Professional Review Organization, St. Louis

$61,0CX)

Mid-Missouri Foundation, Jefferson City


*Northwest Missouri PSRO Foundation, Kansas City, Missouri
Southeast Missouri Foundation, Cape Girardeau
*The Iowa Foundation for Medical Care. West Des Moines
*Kansas Foundation for Medical Care, Inc., Topeka
*South Dakota Foundation for Medical Care, Sioux Falls
East Central Los Angeles, Calif., PSRO
*Foundation for Medical Care of Santa Clara County, San Jose, Calif.
*Kern County Medical Society, Bakersfield, Calif.
*North Bay PSRO, San Rofael, Calif.
*Monterey County Medical Society, Salinas, Calif.

$64,000
$49,500
$54,440
$45,500
$47,560
$51,000
$78,750
$74,000
$61.800
$61,200
$45,485

organization for PSR of Santo Barbaro/San Luis Obispo Counties,


Santo Barbara, Calif.

*Redwood Coast Region PSRO, Santa Rosa, Calif.


*Riverside County PSRO, Riverside, Calif.
*San Francisco PSRO, Inc., San Francisco, Calif.
*PSRO of Sein Mateo County, Son Mateo, Calif.
*Stanislaus Foundation for Medical Care, Modesto, Calif.
*Venturo Area PSRO, Inc., Ventura, Calif.
Nevada PSRO, Reno
*Alaska Professional Review Organization, Anchorage

$66,000
$63,BOO
$50,000
$58,650
$64,000
$46, 150
$-61,000
$56,000
$71,000
$62,000
$52,400
$46, 100
$54,000
$37,000
$52,000
$57,000
$67,000

$46,380
$60,000
$54,000
$225,760
$46, 135
$39,200
$51,620
$36,000

*4th Area Professional Standards Review Council, Toledo, Ohio

1daho Foundation for Medical Care, Inc., Boise

Connecticut Area II PSRO, Inc. New Hoven


Eastern Connecticut PSRO, Inc. Willemantic

$ lOO;ooo
$46,600
$54,000
$62,500

Northern Virginia Foundation, Alexandria


west Virginia Medical Institute, 1nc., Charleston

*Pacific PSRO, Honolulu, Hawaii

PLANNING ORGANIZATIONS

$52,000
$77,000
$64,500

*Greater Oregon PSRO, Portland


*Washington State Medical Association, Seattle

$44,700
$74,500
$56,400
$57,000
$62,000
$50,242.
$68,590
$77, 120
$38,200
$72,372
$51,200
$58,500
$147,480

Resolutions Deadline Set


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

Is PSRO For Lawyers Coming?


Lawyers, like doctors, are threatened with destruction of
professionalism by action of the federal government and must
face the question whether they have the wisdom, courage,
morality and ingenuity to cope with the threat.
That was the substance of AAPS Executive Director
Frank K. Woolley's message to the American Bar Association
at the ABA's Annual Convention in Honolulu this month.
Mr. Woolley warned the nation's lawyers that a grave
threat to their professional freedom is posed by the possibility
that Congress will extend to the legal profession the kind of
controls that are now being imposed on doctors pursuant to
the recently enacted Professional Standards Review
Organization law.
"If ethical attorneys realized the extent to which federal
laws have been designed to question and interfere with the
professional judgment of physicians and surgeons," Mr.
Woolley said, "they would more fully appreciate the threat
posed by government to the traditional freedoms of the legal
profession."
He said the PSRO law created "an elaborate and novel
scheme of prior restraints on physicians' diagnosis, treatment
and care" of patients who are actual or potential
beneficiaries of the Social Security program -- a total of more
than 85 million out of the U.S. population-of 211 million.
"This law," Mr. Woolley said, "gives the Secretary of
Health, Education and Welfare complete and final authority
to regulate and control in the minutest detail the medical
judgment of all physicians who treat Medicare, Medicaid,
disabled, maternal and child care patients who may receive
from Social Security all or part of any funds for their hospital
and medical services." He pointed out that physicians will be
forced to accept standards of diagnosis and treatment set by
agents of the federal government.
COMPARABLE CONTROLS

Mr. Woolley suggested lawyers who practice under a


professional, ethical system similar to medicine could
appreciate and understand the implications of the PSRO law
if they would imagine practicing law under a comparable
system of controls.
"Assume, for example," he said, "that for some reason
the federal government decided that it was necessary to
enhance the quality and lower the cost of your practice and
the practice of lawyers generally because the government
was subsidizing legal practice indirectly in some way or
because Congress simply determined that, as it has in the
case of some other laws, it was necessary to change the
behavior of lawyers and raise the quality and lower the cost
of legal practice."
Mr. Woolley said "comparable governmental interference with the exercise of independent judgment by
attorneys" could result in:

l.

2.

The U. S. Attorney General imposing "norms of


interrogation, investigation, analysis, compromise,
research, presentation and all other legal procedures
to be followed by practicing attorneys on a
case-by-case basis."
Local legal standardization committees, following
rules and regulations of the Attorney General, would
enforce preset rules to determine whether a case was
legally necessary or was handled in the most
economical manner.

If an attorney repeatedly incurred expenses deemed


unnecessary, the Attorney General could fine him or bar him
from handling a large category of cases.

COULD BE BLACKLISTED

In addition, the attorney could be blacklisted (with


public notice of that action) and, to force him to conform to
the rules, he could be subjected to pressure by the courts, law
schools, bar associations and other organizations and
individuals. It would be the duty of each local and state
standardization committee "to use such authority or influence
it may possess as a professional organization, and to enlist
the support of any other professional or governmental
organization having influence or authority over attorneys and
any other person providing legal services in the area served
by such review organization in assuring that each attorney
providing legal services in such area shall comply with all
obligations imposed on him by regulations of the Attorney
General." (With the exception of substitution of attorney for
physician and Attorney General for Secretary of HEW, that is
the language of the PSRO law.)
Mr. Woolley also pointed out that if a PSRO law was
enacted for attorneys akin to the PSRO law for doctors, "all
records of attorneys, including private communications, with
all clients (both publicly paid and privately paid) would be
examined by government agents to assure that the services
were necessary, appropriate and the most economical."

Huge Pamphlet Demand


Physician response to AAPS pamphlets which spell out
the evils of the PSRO law prove there is widespread need for
informational material to acquaint the people with the truth
about this vicious program for government control of
physicians and patients.
In a period of six weeks, physicians ordered more than
90,000 copies of two pamphlets, "PSRO: The Great Political
Sickness Rip Off," AAPS' definitive evaluation of the
significance of PSRO to patients, and a reproduction in
pamphlet form of a commentary by Phyllis Schlafly on the
Spectrum radio program.

These pamphlets are still available at cost from AAPS


and physicians are urged to distribute them to their patients
and make them available to civic groups and other
organizations to pass out to their members.

Amendment to By-Laws
AAPS House of Delegates at the meeting in April
adopted an amendment to the Association By-Laws which
must be approved by the Assembly before it can become an
official part of the bylaws. Therefore, at the Annual Meeting
in New Orleans this proposed amendment to the By-Laws
will be submitte_d to the Assembly for vote.
"Add the following to Article Thirteen, Paragraph B,
Page 15:
'Moreover, the members of this Association subscribe
to the ethics expressed in the Hippocratic Oath, to
which physicians of our western civilization have
bound themselves by the tradition of centuries,
believing that the principles expressed therein have
contributed to the strength and dignity of the
doctor-patient relationship, to the preservation of the
free enterprise system so essential to a free society, and
to the physical and spiritual well-being of those who
honor its stipulations.' "

extremely encouraging response, more than 40 per cent of


the membership took the time to mark the mail ballots for
delegates from their states.
The response indicates a high degree of interest among
members in the affairs of the Association, and it is evident at
a time when the determination of the medical profession to
preserve medical freedom in the U.S. is being subjected to its
sternest test in history.
It is also indicative of the rising stature of the AAPS
among the nation's doctors, who are increasingly aware that
it is the only nation-wide organization of physicians that will
not compromise principles and that devotes 100 per cent of
its resources to programs aimed at preserving the practice of
private medicine.
New AAPS delegates will meet for the first time at the
Association's Annual Meeting in N~w Orleans in October
and November.
Yours for Individual Liberty and Responsibility,

~~~
Donald Quinlan, M.D.
President

Interest High in Delegate Vote


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

Enclosures: Annual Meeting brochure with reservation card


Ref:,resentative Crane's Anaheim address

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

ASSOCIATION OF AMERICAN PHYSICIANS AND SURGEONS


2111 Enco Drive. Suite N-515. Oak Brook . Illinois 60521
Frank K. Woolley. Executive Director

312/325-7911

THE VOICE FOR PRIVATE DOCTORS

Index No. 9

Sets Up Washington Czar

September, 1974, Volume 28, No. 8

!!Planning' Bill Threatens Medicine


Within the environs of the nation's capital are men and
women who have dedicated their considerable talents to
devising legislation and bureaucratic regulations designed to
wipe out constitutional rights and to widen and strengthen
the federal government's authoritarian control over the
private lives of the American people.
Bureaucratic rule has replaced the Golden Rule.
Businessmen know about OSHA and other insidious
kinds of governmental controls. And doctors know about
Medicare and PSRO and the .threat of even worse. They also
know that medicine has been singled out by the government
interventionists for special treatment. One way or another,
the medical profession is to be subjugated. One way or
another. medicine is to be run by a czar in Washington.

Latest scheme to enslave the medical profession is


wrapped up in a piece of legislation carrying the
number H. R. 16204 and bearing the title: "The
National Health Policy, Planning, and Resources
Development Act of 1974."
The clear ob;ective of this lengthy and confusing
bill is to establish the Secretary of Health, Education
and Welfare as medicine's czar, with dictatorial power
over a sovietized medical system.
H .R. 16204 ostensibly is the handiwork of the Health
Subcommittee of the House Interstate and Foreign Commerce
Committee, chaired by Rep. Paul Roger (D-Fla.). It is a
so-called "clean" bill. This means that a blatant attempt
in other drafts of the legislation to reduce medicine to the
status of a public utility has been eliminated from H .R. 16204.
However, eliminating that feature does not make H.R. 16204
~y less dangerous.

H .R. 16204 is based on a false premise and a typical


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

The bill's preamble olso contains a confession that


programs which have resulted in. "massive infusion of federal
funds into the existing health care system" have been
abysmal failures, contributing to inflationary cost increases
;;:;hile solving nothing. The contr~diti'on arises because Mr.
Rogers and his colleagues propose MORE OF THE SAME as
corrections for these admitted failures.
Whenever government becomes involved in
planning, watch out. Contrary to lay understanding, in
the socia1izers' parlance, plannind is actually control.
That's its purpose, and the planning contemplated in
this bill is no exception. It means control. It means
arbitrary bureaucratic meddling, and it means
abandonment of the rule of law, which is the
distinguishing mark of a free society.

HR 16204 proposes to set up one of the biggest


boondoggles of all time, pouring billions of dollars into
literally hundre_ds of HEW-controlled agencies spread

Inside
Acts of President Make Some Uneasy
OSHA Breaks Rules

This bill, which was referred back to the Interstate and


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

Still Can Register For AAPS Meeting


Don't Forget Resolutions
Lacki~g 'Consensus', Health Bills Stalled
No Locally Set Norms
Extraordinary Delegates Vote
Woman's Auxiliary Will Meet

across the U.S. that would, in the guise of planning,


determine whether the nation needs more or fewer
health services, institutions and facilities. The HEW czar
of medicine could regulate production of doctors and
other health personnel, order existing institutions
closed, veto new hospitals and other facilities, and fix
fees and charges on the pretext of "containing
inflation" in "the cost of health services."
It would close the trap on private medicine so that
doctors could not escape the tyranny of government,
even by establishing proprietary hospitals.
All this authoritarian manipulation of goods and
services and people would be accomplished by fabricating a
"national health policy" and implementing it through a
bureaucratic nightmare, a conglomeration of national, state
and local agencies all vying for power. This wasteful
_governmental monstrosity would include a National Council
for Health Policy, hundreds of Health Systems Agencies in all
the states; a Health Planning and Development Agency in

every state, a Statewide Health Co-ordinating Council in each


state, and a vast network of Centers of Health Planning
throughout the nation.
Governors would be given a role, but only if they did the
bidding of the. Secretary of HEW. If they did not, he could
carve up the state into planning areas and proceed with the
pr0gram anyway. As the legislation is written, it i'S obvious;
too, that the authority of state health departments would be
circumvented and these agencies undermined.
This legislation is the product of the same eli~st
mentality that has given the nation the iniquitous PSRO law -the mentality that perceives government as the master of the
people and the people as lackeys whose function is to feed
the government bureaucrats' ever-growing appetite for
power.
HR 16204 deserves to die in committee. Write your
congressman and senators to work for its defeat.

Acts of President Make Some Uneasy


True believers in individual responsibility, local
self-government, the willing exchange of goods and services
without government interference and control, and similar
principles underlying this country's freedom and successes
are feeling uneasy about President Ford.
Throughout his tenure in Congress, Ford's image
remained untarnished as a believer in limiting the tyrannical
power of the bureaucracy in accordance with the beliefs of
the Founders of our Constitution to avoid the agony of
totalitarian regimentation. But since he has assumed the
presidency, he has shaken those who recognize the danger of
expanding government power resulting in complete
collectivism.
First, he called on Congress to hurry and enact
legislation to nationalize medicine. Then he began flirting
With the discredited economic notion of wage and price
controls, which, in the recent past, meant ~JJarticularly
offensive and unjustified discrimination against doctors.
Next, Mr. Ford nominated Nelson Rockefeller as Vice
President. Mr. Rockefeller not only is a proven government
interventionist, he is an avowed champion of socialized
medicine, a practiced devotee of the political doctrine of
tax-and-tax, spend-and-spend, elect-and-elect, and can be
counted on to urge greater and greater concentration of
power in the central government. Shortly after he was
nominated for Vice President, he publicly advocated that the
federal government fix local transit fares.
Then Mr. Ford apparently sent up a trial balloon.
According to Morton Kondracke of The Chicago Sun-Times,
the President is giving serious consideration to appointing
one of two women Democrats as Secretary of Health,
Education and Welfare. Mr. Kondracke said the President is
contemplating dumping Caspar Weinberger and naming
either Rep. Edith Green of Oregon or, worse, Rep. Martha
Griffiths of Michigan. Both are government interventionists
with voting records in Congress against individual liberty and
responsibility.

Mrs. Green has never won a reputation for championing


the cause of private medicine, and Rep. Griffiths, as many
know, has a long record of supporting labor union leaders'
drive for bureaucratic power and sponsoring anti-doctor
legislation, including bills for complete socialization of
medicine.
Both these 20-year veterans of Congress are retiring this
year. They were described by Mr. Kondracke as "close
friends of the President."
In these cases, Mr. Ford is acting contrary to what has
appeared in the past as his fundamental beliefs. We hope he
will not repeat Winston Churchill's fatal mistake after World
War II of believing his political future lies in accepting "the
:rad le to grave welfme state."

OSHA Breaks Rules


The Occupational Safety and Health Administration
has been hounding and harassing and forcing businesses
at great expense to correct conditions which, in the
opinion of OSHA, constitute hazards to workers.
The Wall Street Journal recently noted that the Labor
Department inspected an 11 - story building in
Washington, D.C., housing the offices of OSHA and found
more than 300 "hazardous conditions" menacing the
health and safety of OSHA employees.
A red - faced OSHA official offered this lame excuse:
"Even offices normally thought to be free of hazards often
do involve hazards that can readily be detected and
corrected."
The record of OSHA in browbeating business
suggests a more honest and accurate reason was that the
typical arrogant bureaucratic opinion that there is a
double standard in America -- one for government
officials and another for the rest of us.

Still Can Register


For AAPS Meeting
There is still time to register for one of 197 4's most
important medical meetings -- the Annual Meeting of the
Association of American Physicians and Surgeons Oct. 31 Nov. 2 in New Orleans; La.
Theme of the meeting is: "Are You Tired of Being
Pushed Around?" Most doctors are weary of being pushed
around by agents of insurance companies, hospital
administrators, government. bureaucrats and other politicians in and out of government, and they are tired of the
constant threat that their professional freedom will be
destroyed.
The New Orleans meeting has been designed to clue
physicians on haw they can protect themselves and keep from
being pushed around. Speakers and panelists will disclose
either how they have succeeded in winning against those
whose goal is subjugation of doctors, or why doctors and
their patients lost their freedom.
Headline speakers will include the Hon. J. Enoch Powell,
former British Minister of Health; Dan Smoot, lecturer and
writer on current events; Hon. John Rarick, Congressman
from Louisiana and author of a bill to repeal PSRO; Donald
Quinlan, M.D., AAPS President, and F. Michael Smith, M.D.,
President-Elect of the Louisiana State Medical Society.
The program will include the following panel
discussions.
Hospital-Physician Relationship: Robert Bullington,
M.D., Phoenix; Dr. Quinlan, Chicago, and J. Keller Griffith,
M.D., Lake Charles, La., will disclose how they won or are
winning conflicts with hospital administrations.
PSROs, HMOs & Comr:iulsory Nationalized Medicine:
Moderated by John R. Schenken, M.D., Omaha, Neb.,
panelists Frank Rogers, M.D., AAPS President-Elect, Maurice
Kramer of the AAPS Washington Office and Frank K.
Woolley, Executive Director, will bring members up to date on
national health legislation and government's tooling up
activities for PSROs and HMOs.
Membership Recruitment: This panel -- Robert S.
Jaggard, M.D., AAPS National Membership Chairman, and
R.L. Campbell, M.D., Speaker of the House of Delegates -will discuss membership recruitment, a topic of vital
importance to AAPS.
How to Organize an AAPS Chapter & Speakers Bureau:
Panelists for this important discussion will be Paul W.
Leithart, M.D., Columbus, Ohio, Walter Buerger, M.D.,
Covina, Calif., and Frank K. Woolley.

Don't Forget Resolutions


If you have resolutions you wish considered at the
Annual AAPS Meefing in New Orleans,. you are urged to
send them to Association headquarters in Oak Brook, Ill., as
soon as possible. The deadline for receipt of resolutions is
October 11. They must reach headquarters on or before that
date.

Lacking 'Consensus~
Health Bills Stalled
Apparently labor bosses are having their way with
Congress in the matter of nationalizing medicine. Rep. Wilbur
Mills (D-Ark.), Chairman of the House Ways and Means
Committee, disclosed that members of the committee could
not "bring about a consensus" on health legislation.
For the record, Mr. Mills said "it is not a dea"d issue" for
the current session of Congress. Nevertheless, no one
stepped up to agree that it wasn't a dead issue.
Labor leaders have made it clear they prefer to wait until
next year to push health legislation when, they believe, they
will have a "veto proof" Congress full of liberals so indebted
to them that passage of full-scale socialized medicine will be
routine and a Presidential veto easily overridden, if that came
to pass.
What labor bosses are advocating is a Congress
beholden to them and so powerful the Constitutional balance
of power will be destroyed. The consequence to the nation
will be disastrous if they get their wish -- a wish that is based
on a blind, insatiable lust for power.
Physicians should recognize, therefore, that this year's
congressional elections are as critical for medicine as any in
history. They should devote time and money to the support of
conservative candidates and to the defeat of those backed by
labor.
And if physicians contribute to the American Medical
Political Action Committee (AMPAC), they should make
certain none of their money is used to support candidates
who can be counted on to oppose the interest of ethical
medicine.
You would suppose that it would be unnecessary to
question whether money physicians contributed to AMP AC is
being spent in support of the enemies of medicine -congressional candidates who will be against repeal of PSRO
and who will vote for socialized medicine.
But it's a question that needs to be asked. Some will
recall, for example, that AMPAC assigned one of its
employees to work full time in the campaign of Eugene
McCarthy for President.
Lately, a special fund-raising dinner was organized by
labor unions to help Mrs. Betty Spence, a Buffalo Grove, 111.,
Democrat who is trying to unseat Rep. Phil Crane, one of
ethical medicine's most loyal friends.
The Arlington Heights Herold covered the event, which
was held in Washington, D.C.
Said the Herold: "But Mrs. Spence said she was
encouraged by the enthusiasm of the approximately 65
persons who did attend -- a group which included various
labor representatives, congressional staffers, a Montgomery
Ward executive, and an American Medical Association
lobbyist."

No Locally Set Norms

.Bureaucrat Unlikely to Yield Power


Sen. Wallace Bennett (R-Utah). chief congressional
sponsor of PSRO; Jay Constantine of the Senate Finance
Committee Staff, who was the power behind Sen. Bennett in
getting PSRO passed; Henry Simmons, M.D., chief of HEW's
PSRO office, and other PSRO advocates constantly peddle the
deceit that local doctors will set PSRO standards.
AAPS has consistently pointed out that the law does not
authorize local doctors to set standards and that government
bureaucrats are not lik~ly to give up that kind of power over
doctors and their patients.
A recent decision of the National Professional Standards
Review Council should dispel that falsehood and, equally
important, stand as a warning to physicians, .hospital
administrators and" everyone else what ki_nd of PSRO
standards they can expect to be forced on them.

impose on doctors and hospitals.

Physicians will also find it worthy of note that the


AMA follows the government's PSRO party line since it
has become a paid agent of HEW for the purpose or'
forcing PSRO on doctors and patients. In on "Editor's
Note" responding to a physician's critical letter
published in the Sept. 2, 1974, American Medical
News, the AMA makes the fiat assertion that the low
"requires that each PSRO develop 'norms' of core,
diagnosis, and treatment. . . "
The statement is untrue. The PSRO low imposes
no such requirement on PSROs.
It's the kind of statement that honestly should not
be mode.

This sort of bureaucratic flight from reality is significant


because the Council not only is advisor to the Secretary of
HEW, who is the federal PSRO administrator, but is charged
by law with telling PSROs what kind of standards they are to

The fact is that the AMA itself is involved in setting


national, not local, PSRO standards for doctors and hospitals.
It signed a $995,000 contract with HEW to develop "model
sets of criteria for screening the appropriateness, necessity
and quality of medical services in hospitals," according to the
AMA newspaper. Furthermore, said AMN, the AMA "has
held the position that medical criteria development must be a
function of the individual specialty societies and must be
coordinated nationally, with the completed c;riteria made
available to all pJ:iysician groups for adaptation and used at
the local level."

Extraordinary Delegate Vote

Woman's Auxiliary Will Meet

Final tabulation of balloting for membership in the AAPS


House of Delegates shows that 54% of AAPS members voted
in the election, an extraordinarily high degree of
participation.

The AAPS Woman's Auxiliary will meet Oct. 31 and


Nov. l in conjunction with the AAPS in New Orleans. The
first session at 9:00 A.M. Thursday, Oct. 31 -- a
get-aquainted coffee for all AAPS ladies. At Friday noon,
Nov. l, the Woman's .Auxiliary is having a Luncheon at
which Mrs. Mel Gabler of Longview, Texas, Educational
Research Analyst, will be the guest speaker.

The Council endorsed H-ICDA (an international


classification of diseases) as the_ preferred system of
diagnostic coding. The American Hospital Association
protested because the Council simply ignored the fact that the
majority of hospitals use ICDA-8, not H-ICDA.

There was also an unusually large number of candidates


for election to the House of Delegates this year compared
with past elections.
As noted in the August News Letter, when a
preliminary tabulation indicated more than 40% were
participating, the response to the election indicates a high
degree of interest among members in thP. affoirs of the
Association at a time when the determination of ethical
doctors to preserve medical feedom is being subjected to its
sternest test in history.
New AAPS delegates will be seated when the House
convenes at the AAPS Annual Meeting in New Orleans Oct.
31. New delegates are being notified of their election and are
!'lXpected to attend the meeting.

Fun Evening for Thursday: Members will go as


a group for one evening of fun. Details will be available at the
New Orleans meeting. There will also be a House and
Garden Tour of historical homes of New Orleans available
for Saturday morning for those who wish to participate.
Yours for Individual Liberty and Responsibility,

c4.._~

/y,~.

Donald Quinlan, M.D.


President

Enclosures: Delegates List


Reservation Form
April, 1974, Resolutions_

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

ASSOCIATION OF AMERICAN PHYSICIANS AND SURGEONS


. 2111 Enco Drive. Suite N-515. Oak Brook. Illinois 60521
Frank K. Woolley. Executive Director

312/325- 7911

EMERGENCY BULLETIN
ASSOCIATION OF AMERICAN PHYSICIANS AND SURGEONS. INC.
312/325-7911

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

Donald Quinlan, M.D., President


Frank K. Woolley, Executive Director

Index No. 10
September 20, 1974

BULLETIN NO. 2-74

CONTROL THROUGH 'PLANNING'


AAPS members were warned in the September AAPS News Letter about the serious
threat to medicine contained in H.R. 16204, a bill designed to use health
"planning" as a device to set up the Secretary of Health, Education and Welfare
as medicine's czar with dictatorial control over a sovietized medical system.
THIS DANGEROUS LEGISLATION IS PERILOUSLY CLOSE TO
PASSAGE IN THE CONGRESS. IT IS IMPERATIVE THAT
PHYSICIANS ACT NOW TO PROTEST ENACTMENT OF H.R. 16204.
WRITE. WIRE OR TELEPHONE YOUR CONGRESSMAN AND SENATORS
IMMEDIATELY. LET THEM KNOW YOUR OPPOSITION AND ASK
THEM TO VOTE AGAINST H.R. 16204 OR ANY COMPROMISE THAT
MIGHT COME OUT OF A CONFERENCE. THIS BILL IS SO BAD IN
CONCEPT AND PURPOSE THAT IT MUST BE DEFEATED. IT
CANNOT BE MADE GOOD BY COMPROMISE OR AMENDMENT.
H.R. 16204 is the brainchild of the federal bureaucracy hungry for the power
to control the practice of private medicine in all the aspects. It is another in
the proliferation of anti-medicine bills that have flooded Congress this session,
any one of which would destroy medical freedom and wipe out constitutional rights
of patients and physicians.
For more detail on this deadly legislation, see the first page of the
September, 1974, AAPS News Letter, where it is disclosed that the real purpose of
H.R. 16204 is bound up in these words of the bill's preamble: ''The achievement of
equal access to quality health care at a reasonable cost is a priority of the
Federal Government."
H.R. 16204 was written in a subconmittee of the House Committee on Interstate
and Foreign Commerce. The bill was introduced in the House by Rep. Paul Rogers
(D-Fla.), who is no friend of private medicine. The bill was referred to the full
conmittee, which gave it cursory reading and reported it to the House with a
recommendation for passage.
Reports from Washington indicate that the Senate Labor Conmittee is prepared
to report a similar bill for passage. If both House and Senate pass similar
legislation, the bills will be sent to a conference conmittee to compromise
differences.

- 2 -

It is possible for legislation to be killed in a


conference committee if conferees from each body,
House and Senate, cannot agree on one or more
provisions of the legislation.
This is not likely to happen with this legislation,
however. Consequently, if this dangerous legislation
is to be defeated, it must be defeated on the floor
of the House or the Senate.
THEREFORE 2 YOU MUST ACT PROMPTLY.
DON'T DELAY! HE!.P KILL H.R. 16204!

_..----/1-~ /.J.

Q,

=F- . . . . . ~.

Thomas G. Dorrity, M.D., J.D.


AAPS Legislative Chairman

Enclosure:

PSRO AND PUBLIC RELATIONS


by M. Stanton Evans

Frank K. Woolley, LL.B.


Executive Director

THE VOICE FOR PRIVATE DOCTORS

Index No. 11
October, 1974, Volume 28, No. 9

Also Known As Slavery

Kennedy Advocates Involuntary Servitude


The American people more than a century ago fought a bloody war between the states which outlawed involuntary
servitude, also known as slavery.
Today, Sen. Edward M. Kennedy, the Massachusetts Democrat who does chores for labor bosses and who can't be ruled
out as a future candidate for President of this nation which has outlawed involuntary servitude, wants to restore this inhuman
practice.
Sen. Kennedy was principal sponsor of S. 3585

Medical Society Votes


To Aid AAPS Lawsuit

Another county medical society has joined the list of


those contributing to the support of the AAPS lawsuit to
overturn the PSRO law.
Lee L. Johnson, M.D., Staunton, 111., Secretary-Treasurer
of the Macoupin County (Ill.) Medical Society, sent AAPS a
check for $200. The decision to make the contribution was
approved unanimously.

Meanwhile, oral arguments on the government's


motion for dismissal of the suit were postponed for a
month. Originally called for September 17, the
arguments were re-scheduled for October 17. The
delay resulted from the death of one of the three iudges
trying the case.
Members of the Macoupin County Medical Society
acted in direct response to a letter sent to the presidents of all
county medical societies by Donald Quinlan, M.D., AAPS
President, soliciting financial support for the lawsuit.
But the action was also an expression of dissatisfaction
with the AMA and the Illinois State Medical Society,
particularly for failure to oppose the PSRO law, according to
Dr. Johnson.
"We applaud your organization (AAPS) for the action
taken in behalf of physicians who are usually too busy
practicing medicine to figh~ the battle against federal control
which we know will only lead to deterioration of patient
care," said Dr. Johnson.

Inside

MDs Grab Opportunity


Dr. Weston Is President-Elect
AMPAC Helps Some of Medicine's Enemies
AAPS Chapters Important
Astounding Confession by Mills
Lawmakers Hurt PSRO
AMPAC Board Appointments
Court Holds Control Doesn't Follow Subsidy

which, among other horrendous things. would have


forced into voluntary servitude all future graduates of
all medical schools that received money from the
federal government. Specifically, this bill would have
compelled such medical schools to force students as a
prior condition of admission to agree to practice for
two years after graduation wherever the Secretary of
HEW ordered.
But Senator Kennedy and his far-left collaborators on
the bill found there wasn't much stomach in the Senate for
this kind of extremism and they were forced to give it all up.
They went down swinging, however. Senator Kennedy tried
to win support for a compromise concocted by a couple of
liberal friends, Sens. Gaylord Nelson (D-Wis.) and George
McGovern (D-S.D.), that would have postponed this assault
on the U.S. Constitution until 1980. But the Senate wouldn't
buy that either.
The Senate voted for an extension of federal aid to
medical schools with a provision which amounts to
resurrection of indentured service, a practice rife in Colonial
times which, if not legal, is at least repugnant to the spirit of
the Constitution.
In the version finally adopted by the Senate, medical and
dental schools, in return for federal aid, would have to agree
to allocate 25% of their classroom space to students who
volunteered to serve in areas designated by the government
as "Medically underserved." These "volunteer" students
would get tax-paid "scholarships" requiring a year of
HEW-dictated service for each year of "scholarship" aid.

Two of Senator Kennedy's co-sponsors on S.


3585, which would have forced medical students to
practice where HEW ordered, whether they wanted to
or not, flew down to Cuba to shake hands and break
bread with and fawn over Fidel Castro, whose
communist dictatorship is the antithesis of individual
responsibility and freedom. They are Sen. Jacob Javits,
the New York liberal who proclaims himself a
Republican, ar.d Sen. Claiborne Pell of Rhode Island
whose liberal credentials are authenticated. This pair
wants the U. S. to recognize Castro's barbarian regime.

Others who thought enough of the obiectives of the bill


to put their names on it, all Democrats, were Sens.
Magnuson, Randolph, Hathaway and Clark.
It wou!d have been quite all right with all these
representatives of the people, elected officials sworn to
uphold the Constitution, that under S. 3585, students who
didn't like being pushed around by government could have
been denied the right to practice medicine. The bill would
have given HEW control over licensure and relicensure of
physicians and dentists, stripping the states of that authority.
Federal licensure of doctors, of course, is one of the goals of
leftist extremists and their stooges.
The bill caught the attention of newspapers across the
country, some of them (the St. Louis Globe-Democrat, for
example) publishing editorials obiecting to the proposal.
But the full import of this bill, its poisonous nature,
apparently was lost on them all, including the AMA's
publication, American Medical News.

The real purpose of S. 3585 was to drag all of


medicine (the provision of care, education, licensure,
and the distribution of physicians and dentists) under
control of the federal government by the crafty scheme
of declaring that "the quality and availability of health
care in the United States affects interstate commerce."
The treatment of a patient, the prescription of
medication, the admission to a hospital, the granting of a
license to a physician or dentist, the teaching of medical
students -- all these would be defined as acts in interstate
commerce, subiect to federal control and regulation.
TORTURED LOGIC

The real author of S. 3585 undoubtedly was not Senator


Kennedy. From all accounts and from previous experience, it
must be assumed that this approach had to originate with a
mind like a Wilbur Cohen, not Kennedy.
For example: "The lack of adequate health care for
individuals in the United States," proclaims the tortured logic
of the bill, "often results in illness which may result in
unemployment, and reducing the ability of such individuals to
engage in activities which affect interstate commerce, and
has a depressant effect on general business conditions ... "
Or: "Low quality health care or unavailability of health
care in an area in a state may discourage the movement of
persons into that area from another area and from other
states and thereby adversely affect the movement of industry
and other activities between states . . . "
Or: "Many persons, especially those residing in
metropolitan areas which cross state. boundaries, move
between states in order to receive :-:ealth care . . . "
Government control of medical education would not
cease when the student was graduated from medical school
under this bill; no indeed -- HEW would control by
certification the number of intern and resident positions open
each year.

Don't wait to hear a cry of outrage from the


liberal press (New York Times, St. Louis Post-Dispatch,
Washington Post, for example) at the idea of
government controlling medical school admissions,
postgraduate education (even to the extent of
assigning positions to various specialties on the basis
of Government determination of the "need" for

doctors in the specialties}, and curriculum to "assure"


the "quality" of medical care. the liberal press,
parroting the propaganda of the nation's socializers,
has often, with phony indignation, deplored AMA
control of medical education, heedless of the fact the
AMA doesn't.
Perhaps, but more likely not, medical school deans and
officials of the Association of American Medical Colleges will
realize by studying S. 3585 (even though it was reiected in
the Senate) that there con be a fearful price to pay when th~y
beg for and get handouts from the federal government.
But make no mistake, the insidious ideas behind S. 3585
will not be allowed to die.

MDs Grab Opportunity


To Recruit For AAPS
Following are excerpts from a letter recruiting members
for AAPS. It was signed by four pathologists associated in
private practice in Eastern Iowa and Western Illinois.

"Surely Doctor, by this time it must be obvious to


you that a lot of people want to take away your
constitutional rights and place all of medicine under the
control of one individual in Washington.
"The Association of American Physicians and
Surgeons is trying desperately to help all of us and it
could be easily successful if a large segment of the
profession would become members and participate in
this fight against authoritarian control over the private
lives of the American people.
"If you are not already a member of AAPS, please
take the next minute of your time to fill out the enclosed
application. By doing that, you will have taken one sep
today to further your professional freedom and the
freedom of all American medicine."
The letter was signed by Drs. F. D. Winter, R. J. Rettenmaier, G. R. Zimmerman and D. R. Samuelson. It was
prompted by an editorial in the St. Louis Globe-Democrat
highly critical of the bill by Sen. Ted Kennedy that would have
forced medical graduates into involuntary servitude, a bill the
Globe-Democrat said "should frighten every American."
The letter represents ( l) a quick and effective use of a
"handle" (the editorial) to spur membership, and (2) the use
of two or more names on a membership letter, a technique
which often gets better results than a single name.
If each AAPS member solicited one or more fellow AAPS
members to ioin him in writing to all physicians in their area
urging them to become members of the Association,
membership would undoubtedly be significantly increased.
The authors of the above-quoted letter are right --AAPS
is trying desperately to fight off authoritarian control of
medicine. It is the only nationwide medical organization that
has been on the iob since 1943. The more members AAPS
has, the easier the task will be.

Dr. Weston Is President-Elect


C. Tucker Weston, M.D., Columbia, S.C., has been
chosen President-Elect of the South Carolina Medical
Association. Dr. Weston, a membe~ of AAPS, was formerly
Speaker of the SCMA House of Delegates.

Misguided Expediency

AMPAC Helps Some of Medicine's Enemies


Those who direct the affairs of the American Medical
Political Action Committee (AMPAC), as well as the AMA.
have not learned that "the friend of my enemy is my enemy."
Perhaps if they based political decisions more on unbendable
principle and less on misguided expediency, they might not so
readily give aid to the friends of the enemies of the medical
profession.
Recent Associated Press news stories from Washington
stated that the AMA had contributed at least $25,000 to the
re-election campaigns of l O members of the House Ways and
Means Committee.
Subsequently, the AMA's American Medical News
editorialized that it was AMPAC, not AMA, that contributed
and that the contributions were neither wrong nor illegal.

What the editorial did not explain was why


AMPAC (whose policies and practices are at least
influenced if not controlled by AMA executives) has
chosen TO HELP SUPPORT THE RE-ELECTION OF
FRIENDS OF ENEMIES OF MEDICINE.
Three of the 10 members of the House Ways and
Means Committee who were recipients of the AMPAC
beneficence are strong supporters of the goals of
organized labor. That means they are for wild spending
programs that feed inflation and threaten to wreck the

State, Local AAPS


Chapters Important
The following was extracted from the AAPS Ohio
Chapter Newsletter, edited by Paul Leithort, M.D.

--

'You Can't Fight City Holl'


"A special meeting of the Franklin County Academy
Council was called in August. The purpose of the meeting
was to vote on seeking a Federal Grant of $250,000 for a
two-year study to determine why physicians are not
motivated to toke more post-grad courses in cancer therapy.
Discussion was limited to a few minutes and the question
called for while I was requesting permission to speak.
Amtrack was never railroaded like that motion. I was not
permitted to voice my opinion that the motion to seek a
federal grant was unconstitu;ional. Nor would the president
give me the 'time of day' to so inform him after the meeting.
'What to do?
"When in trouble, contact your friends. I sent a letter to
the Columbus AAPS Chapter and requested they meet on this
matter. After lengthy discussion, it was decided to work with
the Academy's legal counsel if possible, but if necessary, to
seek an injunction to prevent this illegal action by our
Academy leaders.
"The matter has not been settled. It ;s mentioned here to
illustrate what AAPS members can do -- when organized.
You should know the other members in your area and act in
concert. It is probably obvious to you that most doctors are

economy, they are for government regulation of the


economy, they are for destruction of the practice of
private medicine and the substitution of government
medicine, and they are against preserving and
strengthening America's free enterprise system.
The AFL-CIO recently published a report on the proand anti-labor voting records of members of Congress. The
report noted that Rep. Al Ullman of Oregon, second ranking
Democrat on Ways and Means, voted "right" with labor l 02
times and "wrong" only 22 times. Rep. Richard Fulton
(D-Tenn.) had an 81 to 7 record in support of labor
objectives, and Rep. Joseph E. Karth (D-Minn.) cast 106 votes
friendly to labor and only 5 in opposition to labor-backed
legislation.
Nevertheless, Rep. Ullman has been rewarded with a
$1,000 campaign contribution from the money contributed to
AMPAC by physicians. Rep. Fulton's "Fulton for Congress
Committee" got $2,500 of doctors' money, and Rep. Karth,
who votes the way labor wants him to vote 96% of the time,
is using $2,500 of physicians' money to get re-elected.

No doctor needs to be told that one of the maior


goals of labor bosses is total subiugation of the medical
profession by government.
ill-informed about the tontrols that are designed to engulf
them.
"In discussing the federal grant with various friends, it
was obvious who was, or was not, on AAPS member. The
non-members were generally 'in the dark' about the
implications of 'Federal' funds. They did r:iot have the
background with which to judge this latest move by their
Academy toward control by HEW.
"It is important that we organize as State and Local
chapters. There is a tremendous amount we can do to
influence our future."

ASTOUNDING
Rep. Wilbur Mills, the Arkansas Democrat who is
one of the most knowledgeable members of Congress,
has mode an astounding confession.
Mr. Mills has admitted, according to the AMA's
American Medical News, that he doesn't know how
PSRO come into being.
The Chairman of the House Ways and Means
Committee, according to AMN, was discussing
national health legislation with a delegation from AMA
in an attempt to win support for his scheme for
nationalizing medicine. Mr. Mills evidently figured that
he could win that support if he agreed to some changes
in PSRO proposed by AMA.
In reporting the meeting, AMN said -- "Rep. Mills
at one point exclaimed: "I can't recall the way the
Senate sold us on this (PSRO). How in the world did
those Senators prevail on us in the first place?"

,Lawmakers Hurt PSRO, 'Laments AMA


When you're down on your knees begging for
government handouts, all you're interested in is whether you
get all the money you're begging for. It doesn't really worry
you much whether your pet government project -- the source
of the money you want -- contributes to the inflation that
threatens the economy or, worse, undermines constitutional
government and chips away individual rights and freedoms.
So it is with the AMA and PSRO.
Most physicians in the practice of private medicine
would be delighted at anything that stands even a slight
chance of crippling the iniquitous PSRO program, especially if

it can be scaled down by a reduction in appropriations.


But NOT the AMA!
"PSRO IS BEING HURT BY LAWMAKERS," lamented a
headline in the Sept. 16 issue of the AMA Newsletter, the
weekly "green sheet" mailed to a select list from the office of
Executive Vice ~resident E.B. Howard, M.D. The article under
that worried headline reported that the Senate had cut
appropriations for PSROs by $28 million -- from $58 million
to $30 million.
AMA, as everyone should know, wrangled a couple of
millions out of HEW to help that bureaucracy cram PSRO
down the throat of the medical profession.

AAPS Members Support


Friends Of Medicine

AMA Is Willing To
'Compromise' Again

One of those believe-it-or-not facts of political life is that


AMPAC, the political arm of the AMA, supports candidates
for Congress who are, to put it charitably, unfriendly to the
medical profession.
For that reason, many physicians do not contribute to
AMPAC and limit their support to candidates who have
demonstrated that they believe in preserving medicine as a
free institution.
That's why many physicians in Ohio, for example, are
actively supporting the candidacy of Ralph Perk, Mayor of
Cleveland, for election to the U.S. Senate, and why they are
behind Rep. John Ashbrook's bid for re-election to the House
of Representatives.

Malcolm C. Todd, M.D., President of AMA, has been


quoted by the New York Times as saying AMA is willing to
junk its proposal to let Americans help finance health
insurance by deducting part or all of the premium costs as a
credit againist federal income taxes.
Dr. Todd told Times reporter Nancy Hicks that AMA is
willing to "compromise" by agreeing to finance the plan by
direct premium payments out of social security payroll taxes.
AMA's tax credit maneuver was a contrived way to
finance a national health scheme without requiring direct
government payment. AMA officials claimed in effect that the
federal bureaucracy wouldn't exercise controls it it wasn't
paying the bill directly.
Dr. Todd seemed to be saying that AMA, by this
"compromise" is willing to accept the controls which flow
from direct government subsidies.
This development should make AMA members question
whether the so-called Medicredit Bill was a genuine,
good-faith proposal in the first place.

Both these candidates are strongly opposed to PSRO,


and that's something that cannot be said of all candidates for
Congress supported by AMPAC. In fact, that can't be said of
AMPAC -- or AMA.

Court Holds That Control


Does Not Follow Subsidy

Yours for Individual Liberty and Responsibility,

A decision in a lawsuit in Wisconsin indicates some


courts at least don't buy the government interventionists' line
that government subsidies to a private institution strips its
officials of the right to make independent decisions.
The hospitul was sued because it refused to permit
abortions, the plaintiff arguing that by accepting Hill-Burton
funds the hospital surrendered its right to make that decision.
The court ruled for the hospital, holding the hospital could
deny facilities to a physician for performing abortions even
though the institution was regulated by the state and
received state and federal funds.

Donald Quinlan, M.D.


President

Enclo.sures: 1973 News Letter Index


Reservation Form

ANNUAL MEETING, New Orleans, Louisiana, October 31-November 2, 197-4

ASSOCIATION OF AMERICAN PHYSICIANS AND SURGEONS


2111 Enco Drive. Suite N-51 5. Oak Brook . Illinois 60521
Frank K. Woolley. Executive Director

312/325-7911

THE VOICE FOR PRIVATE DOCTORS

Index No. 12
November, 197 4, Volume 28, No. l O

First Round Over

Judges Take PSRO Case Under Advisement


The bell ending the first round in the AAPS lawsuit to knock out the PSRO law rang October 17, but as this issue of the News
Letter went to press, the three judges had not indicated who won the round, AAPS or HEW.
The judges -- Wilbur F. Pell, Jr., of the U.S. Court of Appeals and William J. Lynch and Thomas R. McMillen of the U.S.
District Court -- took the case under advisement after hearing oral arguments on the goverment's motion for a summary
judgment, or dismissal. As is customary, the judges gave no
indication when they would rule on the motion.
The future course of the suit, therefore, is uncertain.
There are several possibilities.
The judges could grant the motion to dismiss. In that
event, AAPS would appeal the decision to the U.S.
Supreme Court.
The three-judge court could deny HEW'S motion and
set the case for trial. HEW, as the defendant, could
not appeal that ruling but would have to answer the
specific allegations made in the AAPS complaint and
go to trial of the case on its merits.
If AAPS appeals and the, Supreme Court reverses the
lower court's dismissal, the case would be remanded
to the three-judge court for trial.
If an appeal is taken by AAPS and the Supreme Court
upholds the lower court's decision to dismiss the suit,
AAPS will consider filing a new suit when it finds
evidence that a PSRO is taking overt action which interferes with a physician in the performance of professional services for a patient.

Pair of
Walter

Californians,

Frank

Rogers,

Buerger, M.D .. Covina. take

M.D.

(left),

Whittier,

advantage of Assembly

and
recess

to chat about Dr. Bueraer's presentation at New Orleans Annual Meetina on organizing AAPS chapters. Or. Rogers is new AAPS President

Membership Drive
Donald Quinlan, M.D., in his Presidential address
at the Annual AAPS Meeting in New Orleans in
October, called for the Association to work for a
five-fold increase in AAPS membership.
Dr. Quinlan urged each member to recruit at least
five new members for the Association. "Let's make a
five-fold increase in AAPS membership a national goal
of the Association. Let's make five new members for
AAPS an individual, personal goal. Let's view that
target as the very minimum each of us can do as our
contribution to the cause of preserving our professional
freedom."

The possibility also arises that while the suit is still


pending documented evidence can be placed in the hands of
AAPS attornays that PSROs are exercising some degree of
control over medical decisions made by physicians. If thaf
happens, AAPS will amend its suit to seek a preliminary
injunction to stop further action detrimental to the rights of
physicians.

It is, therefore, imperative that members of the


Association report, with documentation, any overt act
committed by a PSRO, or by an individual or a
committee acting as an agent or an employee of a
PSRO, which interferes with or places in question any
medical decision made by a physician, or which forces

News Letter on Meeting


Because of the importance of the Annual Meeting
recently concluded in New Orleans, this issue of the
News Letter is devoted almost exclusively to the
meeting. Other news items from the meeting will be
published in the December News Letter.

or attempts to force a physician to do something or


refrain from doing something contrary to his
professional Judgment. Any such incidents should be
~ported to AAPS headquarters as soon as possible
ofter they occur.
R.R. McMahon of the Chicago law firm of Lord, Bissell
and Brook argued the case for AAPS before the three-judge
federal court October 17. Mr. McMahon told the court that
"the issue ... is whether our complaint alleges facts which if
true. . . establish an invasion, an invasion that is of
constitutional dimension, an invasion of rights of the plaintiffs
that are constitutionally protected in some respects."
He said the PSRO law is overbroad, arbitrary and
irrational to such a degree that it offends the due process
clause of the Constitution. He said enforcement of the law
would result in injury to plaintiff physicians.
PRIOR RESTRAINT

Judge Lynch asked: "What is the injury?"


Mr. McMahon replied: "The injury, your Honor, flows
from the extensive system of prior restraint on medical
practice that is created by this law." He added: "It is the first
instance of federal legislation, not only in the medical field
but in any profession as far as I can determine, the first
instance of the imposition across the board of prior restraint
on professional practice -- in an attempt to achieve cost
control."
Judge Pell, who presided at the session, wanted to know
whether there is "anything improper in achieving cost control
by eliminating unnecessary expenditures?"
Mr. McMahon answered that that was not "improper." He
said, however: "It would seem that Cong,ess has taken the
approach in this case that the congressional intent was to
~ prevent abuse, misuse and over-utilization of the program.
Implicit in a system of prior restraint on the substantive
practice of medicine in the case of all physicians who deal
with beneficiaries or recipients under Medicare is saying in
effect that overuse, misuse and physicians' malpractice ... is
so rampant in the profession that the only way to stop it is
not on a case-by-rnse basis, not on an after-the-fact basis of
detecting and punishing culprits and abusers, but to control
the substantive conduct, professional conduct, of physicians
as it deals with Medicare and Medicaid beneficiaries in
advance."
Mr. McMahon pointed out that physicians are not directly
compensated under the Medicare and Medicaid programs
and are not agents or employees of government. He said
there is no contractual relationship involved.

He also emphasized that a physician, "if. he is to


deal with a hospital that is complying with this low will
hove to comply with what the hospital requires in the
way of compliance with this low across the board,
whether or not his patient is a recipient himself."
In other words, he said, "if a hospital is to
undertake to comply with the requirements of this low,
it will either hove to hove two systems of in-hospital
review, two systems of administration, two systems of
record keeping, two systems of norms of practice -- one
for beneficiaries and one for private patients. That, as a
matter of reality, could not exist."

One of the thrusts of his comments to the court was that


PSRO will change the way medicine is practiced. "A
physician now," Mr. McMahon said, "looks at his patient
and makes his decision purely on the basis of his expertise
and what he sees in the circumstances of that patient.
Henceforth, when this law is implemented, the physician not
only will look at the circumstances of the patient, but he must
then match those circumstances to the general rules and then
make the decision -- if his decision and the rules do not
coincide -- whether he is going to depart and whether he can
defend that departure when it comes time for the patient to
be reimbursed for his services. If he cannot defend it, he faces
a penalty in the form of having to pay the difference in the
care himself, or to pay a fine. And if he does this repeatedly,
he can suffer blacklisting. In fact, he will not be allowed to
treat on a reimbursable basis Medicare and Medicaid
patients."
[This punitive aspect of PSRO was stated in
another way by Don Smoot, author, lecturer and
politico/ analyst, at the AAPS Annual Meeting in New
Or/eons. He described PSRO as "a punitive low which
will force physicians to practice medicine by overages
and in a climate of fear -- fear of what will happen to
them if they do not adhere to bureaucratic standards,
fear of what will happen to their patients if they do
od/:tere. "]
Paul F. Stack, an assistant U.S. attorney representing HEW
Secretary Caspar Weinberger, the defendant in the AAPS
lawsuit, told the court that the sole issue to be determined is
whether the PSRO law is constitutional on its face. He sought
to convince the judges that PSRO is a benign and harmless
statute that will do nothing more than curtail unnecessary
medical and hospital expenditures for Medicare and Medicaid
patients. He said he wasn't arguing that it is a good law, only
that it is constitutional.
Judge Pell, however, questioned that simplistic evaluation.
"Even though there was no over-utilization, if this is federal
money that is being spent," he said, "doesn't it still boil
down to whether or not during the process of putting
restrictions and controls they violate constitutional rights of
these plaintiffs -- isn't that what our ultimate issue is?"
Mr. Stack reluctantly agreed.

Halt Inflationary Spending


R.L. Campbell, M.D., Corsicana, Texas, AAPS
President-Elect, issued the following election statement to
Associated Press, United Press International, and the three
national television networks.
"The resu Its of Tuesday's election shou Id not be construed
as a blank check from the electorate for more inflationary
government spending programs. On the contrary, voter
disenchantment and cynicism with the political diseases of
inflation, corruption and bureaucratic controls cannot be
cured by more inflationary government spending and
interference through forcing cradle-to-grave nationalized
medicine upon a people whose greatest need is complete
relief from political trickery by both parties."

'Unusually Informative'

Annual Meeting Praised by Participants


"This has been one of the best meetings we've ever
attended," said the wife of a physician from Tennessee at the
AAPS Annual Meeting in New Orleans. "The speakers have
been excellent and the panel discussions have been unusually
informative. It has been a well-balanced program."
"An excellent program," said a member of the House of
Delegates. "I've gotten more useful information about
problems of medicine at this meeting than any other I can
remember."

Panelists

Robert

BullinQton.

M.D.,

Phoenix,

Arizona;

J.

Keller

Memphis. Tennessee, told Annual Meeting how they won battles, if

hospital, including the practice of medicine. That


misinterpretation has been fostered by the American Hospital
Association and the Catholic Hospital Association.
DR BULLINGTON said trouble in St. Joseph Hospital in
Phoenix began with a push for a full time medical director to
be appointed by the administration. Dr. Bullington said that
as Chief of Staff he was on a committee to review the
proposal, which had been cleverly sold to most of the staff.
"It became obvious to me," he said, "that this was a

Griffiths, M.D.. Lake Charles, Louisiana, and Thomas G. Dorrity, M.D.,


not wars, against hospital administrations determined to control med-

ical stoffs.

Those comments reflected the success of a meeting


designed to provide answers to problems troubling
physicians across the country, such as how to combat
third-party intervention in medicine, how to assert the rights
of hospital staff physicians against overly ambitious hospital
administrators, how to become more effective in the affairs of
state and local medical societies, how to organize state AAPS
chapters and recruit new members for AAPS.
Physicians with experience in solving such problems were
on hand to tell how they did it.

HOSPITAL-PHYSICIAN RELATIONSHIP
The panel on Hospital-Physician Relationship, moderated
by Donald Quinlan, M.D., now Immediate Past President of
AAPS, presented the winning experiences of Robert
Bullington, M.D., AAPS member from Phoenix, Arizona; J.
Keller Griffith, M.D., AAPS member from Lake Charles,
Louisiana, and Thomas G. Dorrity, M.D., Memphis,
Tennessee, member of the AAPS Board of Directors.

These panelists emphasized, directly or indirectly,


the fact that unified action, or organization, is one of
the most important ingredients .of a successful fight to
protect the rights of physicians.
Panelists agreed that much of the nationwide drive among
hospital administrations to reduce staff physicians to a status
subservient to the administration stems from a false
interpretation of the celebrated Darling case to mean that the
administration is directly responsible for everything in a

scheme whereby the administration would literally. gain


control over us. This man would be appointed by the
administration; the doctors on the staff wouldn't be able to
get rid of him; he would be working for the administration
and acting as our chief of staff but would in effect be the
hatchet man for the administration."
Dr. Bullington and two other conservative physicians, with
help from AAPS, set about educating the staff and were so
successful the staff voted against appointment of a medical
director.
The administration persisted, however, and it finally
became necessary for physicians to quit using St. Joseph
Hospital, except for emergency cases. That brought the
hospital around because "in 30 days this cost them
something like $500,000," said Dr. Bullington.
Dr. Bullington said the tougn-est thing he had to fight
was the ignorance of his colleagues about what was going
on. In fact, he said, he was ignorant until he got into!tie
middle of it.
"I didn't believe everything that was happening,

and if I hadn't called Frank Woolley (AAPS Executive


Director) ;ust on the spur of the moment one afternoon,
we would ha~e gotten beat."
OR. GRIFFITH recounted how administration at Lake
Charles Memorial Hospital tried to change staff bylaws,
without knowledge or consent of the staff, to give the
administration absolute control over appointment and
reappointment of staff and over staff privileges. That change

was even submitted to the Joint Commission on Accreditation


of Hospitals as though it had the approval of the staff. When
this fraudulent document was discovered, a futile protest was
sent to JCAH.
This battle was won, as in Phoenix, when physicians
simply refused to send patients to the hospital, except
emergencies, and declined to form a staff. When that
happened, it stopped the flow of paper, which is the life
blood of government program.s. When the paper flow
stopped, government money stopped. The hospital
administration finally capitulated.
Among the pluses from the experience, Dr. Griffith said,
was this: "We feel we've p~yed some part in the JCAH
swing now to the support of the autonomy of the medical
staff, which is in direct opposition to what JCAH used to feel.
We also feel that the Darling case has diminished in
importance as there has been recognition it_ was a local
decision and now other decisions by other courts have
changed its impact."
DR. DORRITY said that "in our hospital within the past
year, we've had terrific problems with delineation of
privileges, malpractice insurance, preadmission certification,
rewriting the constitution and bylaws and a push for criteria
for treatment."
Dr. Dorrity said that an organized staff whipped the
administration on delineation of staff Wivileges. Then they
beat back the administration on the question of mandatory
malpractice insurance, rointing out that that requirement
would give a third party insurance company control of the
staff.
But that didn't end the controversy, Dr. Dorrity indicated.
Next, the medical staff had to resist an attempt to force
preadmission certification on physicians, a proposal
presented on the pretext of cutting down on retroactive
denials of government payments.
The smoke had barely cleared from that battle when the
administration "came up with this bright idea" of imposing
criteria on physicians. Dr. Dorrity said that as chief of surgery
he wrote the president of the staff protesting the proposal.
"I explained to him," said Dr. Dorrity, "that the practice of
medicine is not an exact science and cannot be made so by
anybody's whim, that we could not treat all people alike
because each is unique and none responds to the same
treatment or drugs in the same manner." He said he also sent
letters to chairmen of the various staff committees and all

refused to participate in the criteria project.


The administration reaction, he said, was to attempt
unsuccessfully to defeat him for re-election as chief of sug~y=
Jerry Randolph, M.D., a colleague of Dr. Dorrity's, told
the AAPS delegates that JCAH was seeking to force criteria
as a condition of accreditation on threat of losing the nursing
school and the training_program. He said, however, that
inquiry by Memphis physicians has disclosed that:
Internship and residency training programs do not
depend on accreditation, according to H. William
Ruhe, M.D., Secretary of the AMA Council on Medical Education.
The Tennessee State Board of Nursing reported
that the nursing school is not dependent on JCAH
accreditation.
JCAH accreditation is not even an essential for
receipt of Medicare and Medicaid funds, since
these programs can approve hospitals for payment.

DR. QUINLAN summed up: "The simple fact of the


matter that should be remembered is that there is a
relationship between. the hospital board of trustees and the
medical staff and the hospital administrator, and if you allow
these things to be twisted in your mind as to what their
J:_>roper relationship is, then you fail to understand the
problem. And there has been a deliberate twisting of this
relationship."
Dr. Quinlan has filed suit against St. Joseph Hospital in
Chicago for restoration of privileges cancelled because he
would not agree to permit the administration to alter staff
bylaws at will without consent of the staff.
MEMBERSHIP RECRUITMENT
R. L. CAMPBELL, M.D., Corsicana, Tex., Speaker of the
House of Delegates until his election in New Orleans as
President-Elect of the Association, was the lead-off speaker
of the panel on membership recruitment.

Dr. Campbell said that one of the biggest hurdles


in recruiting new members for AAPS is overcoming the
idea that federal takeover of medicine is inevitable.
Many physicians, he said, have "sort of lost hope,"
and "we've got to keep cheering them up."
Dr. Campbell urged members of AAPS to work hard at
securing new members. He pointed out that "if every member
got a new member just once a year, we'd double our

Panelists on Membership Recruitment (left to right) R. L. Campbell, M.D., Corsicana, Tex.; Garland Campbell, M.D., Arkansas City, Kansas;
Robert S. Jaggard, M.D., Oelwein, Iowa, AAPS National Membership Chairman, and Moderator Donald Quinlan, M.D., Northfield, lllinais.

AAPS Executive Director Frank Woolley addressing Assembly during panel on organizing AAPS chapters. Seated are Paul W. leithart, M.D.
(left), Ohio Chapter Chairman, and Walter R. Buerger, M.D., California Cha!)ler Chairman.

membership next year and double it again in the next year."


It's not an impossible goal, he said. "Those of you who are
more enthusiastic than others have to keep nudging your
friends who are members to get their share." He suggested
members in the various states may want to organize
recruiting contest with appropriate prizes.
He also suggested that non-members should know that
AAPS offers most of the membership benefits available from
AMA, with exception of JAMA and the specialty journals.

Most important, however, is the fact that it is


AAPS that is carrying on the battle virtually
single-handed to abolish PSRO and, unlike AMA, is
fighting to prevent any kind of nationalized health
program being forced on doctors and their patients.
Dr. Campbell also recommended that in recruiting new
members, it should be pointed out that AAPS was the first to
publish a pamphlet on PSRO to enable physicians to
understand the vicious controls in the law, was the first to
publish a PSRO pamphlet for patients, and was the first to
publish a pamphlet delineating the rights of hospital staff
physicians and how they can protect those rights.
ANOTHER DR. CAMPBELL -- Garland Campbell, M.D.,
Arkansas City, Kansas -- pointed out that AAPS has "a great
cause to sell." Dr. Campbell is responsible for 34 new AAPS
members in Kansas.
He said that success was a result of selfing a
cause rather than a method of recruiting because "the
only effort that was mode was one single
letter ... and it wasn't that great a fetter and it didn't

cost all that much money."


He added: "You don't have to be smart, you just have to
take three things -- a little of your own time (not much), some
of your own money (that's deductible as an office expense)
and some effort on the part of your office employees."
He advised recruiters to concentrate particularly on
general practitioners and the specialists to whom general
practitioners refer patients.
Dr. Campbell of Kansas also suggested, as another
technique, that members can call just one non-member
colleague a day and explain AAPS, its philosophy and its

activities, particularly the lawsuit to abolish PSRO. "If you'll


do that three or four days a week, we can increase this
membership up to something you wouldn't believe."
(Membership chairmen in the various states were
presented AAPS coffee mugs by Robert S. Jaggard, M.D.,
Oelwein, Iowa, National Membership Chairman.)
ORGANIZING AAPS CHAPTERS

When the panel convened on organizing AAPS chapters -described by AAPS Executive Director Frank Woolley as "a
mechanism to multiply your effectiveness" -- members of the
Assembly were seated by states, and chapters were
organized and officers elected on the floor of the Assembly.
Walter R. Buerger, M.D., Covina, Calif., Chairman of the
AAPS California Chapter and a member of AAPS Board of
Directors, pointed out that just two AAPS member in a state
can start a state chapter.
Both Dr. Buerger and Dr. Paul Leithart, M.D., Columbus,
Ohio, Chapter Chairman of Ohio and also an AAPS Director,
agreed that one of the first projects a newly organized
chapter should undertake is publication of a newsletter. Dr.
Buerger advised mailing the newsletter not only to AAPS
members but regularly to members of the House of Delegates
of the state medical society ("let them know there is an
organization that cares about PSRO and other issues"). Dr.
Leithart said the Ohio Chapter newsletter is mailed to state
and county medical journals and bulletins.
Dr. Leithart also said that the "first purpose of a newsletter
is to educate." He said it is surprising to find out when
talking to AAPS members that "there is a lot of things they
don't know."
Panelists pointed out that the format and the content of
newsletters vary from state to state. But whatever the format,
they agree, a newsletter should promote AAPS.
Mr. Woolley told members of the Assembly that AAPS has
available a detailed manual of organization which contains
explicit information on such subjects as how to organize,
what makes a chapter succeed, action projects, how to recruit
new members, how to get good publicity, how to enlist allies,
and how to set up a speakers bureau.

It was a iayful mament far Elsie Doering shown here receiving a bar af pure silver from President Danald Quinlan, M.D., honoring Miss
Doering for her 25 years of service to the AAPS. Miss Doering, Assistant to the Executive Director, also received an engraved watch from the
AAPS membershi:,.

Medical Costs & Inflation

'Up to Doctors to Tell People Truth'


Rising medical care cost are caused by inflation.
Nevertheless, government bureaucrats, like HEW
Secretary Caspar Weinberger and others, are attempting to
mislead the people into believing that rising medical care
costs are a chief cause of inflation.
It is up to the nation's physicians to tell the American.
people the truth about medical costs and inflation. It is up to
them because no one else will.
These cogenr and timely observations were made by
Donald Quinlan, M.D., in his Presidential Address at the
AAPS Annual Meeting in New Orleans October 31.
Dr. Quinlan said the American people should understand
that government interventionists are deceitfully trying to use
inflation to pave the way for political medicine. He stressed

that if physicians can get their patients to understand that


fact then physicians can use inflation, "which concerns
everyone and frightens most of us," to convince citizens they
should repudiate political medicine.
He said physicians determined to preserve professional
freedom are in "a rough, tough, brutal fight" made all the
more difficult "because doctors are loath to drop down to the
level of medicine's enemies."
"Those labor bosses, politicians and bureaucrats who are
determined to destroy medicine as a free institution and
substitute debilitating government controls are devious,
crafty, unprincipled, tireless political animals. Deceit is a way
of Iife with them."
"Doctors must become activists in day-to-day civic affairs.
They cannot remain locked in a sheltered world of medical
practice, isolated from the grim realities of political life. If they
do, they will, by that kind of negativism, contribute to the
doom of medical freedom."
"A license to practice medicine is no shield against
servitude.''
Dr. Quinlan said that politics looks like pretty grubby
business to the doctor concerned with taking care of patients
and practicing the art and science of medicine.

"And so it is, but doctors who want to continue to


practice the art and science of medicine without
interference from government bureaucrats had better
take the grubby business. of politics seriously and
make it their personal business. They must understand
that one way or another they have to enlist the support
of their patients in the cause of medical freedom or the
cause will surely be lost."
Donald Quinlan, M.D., delivering Presidential Address at AAPS
Annual Meeting.

He warned that it won't be easy to teach patients the truth


about the cost of medical care because "the enemies of
medicine have been ruthlessly lying to the people about the

cost of medical care for forty years or more.


"They have tried by this vicious deceit to turn the people
against doctors so that an angry public would thoughtlessly
and vengefully accept socialized medicine," Dr. Quinlan said.
"It's easy to deceive the people, if you're so disposed."
Dr. Quinlan pointed out that HEW Secretary Weinberger
had not been candid with the people in trying to make them
believe physicians' fees rose 19 per cent after wage-price
controls were lifted when the rise was only 4.4 per cent and
in attempting to deceive the people into believing that rising
physicians' fees are a cause of inflation.
MORAL DECADENCE

drum:1ists and other health care items. But from there they
flow into the economy, exerting inflationary pressure on all
goods and services.
"That's what we have to explain to our patients so they
will understand clearly that nationalized medicine will result
in more and more billions of printing-press dollars being
poured into the economy. The result will be economic
disaster, literally destroy~g our economy."
Dr. Quinlan criticized Secretary Weinberger for being glib
about accusing doctors of inflating fees but failing to be
honest with the people by admitting that his department -HEW -- "is the greatest engine of inflation in the United
States government today."

"If Mr. Weinberger were candid with the people


he would tell them that while doctors' fees have risen
100 percent since 1960, the cost of his department .has
increased a staggering 600 per cent."
"Tragically, rather than recognizing and attacking
the cause of inflation -- reckless government spending
-- President Ford, members of Congress and other
officials in Washington are trying to duck responsibility
and pin the rap on the American People."

"What do we do about that kind of moral decadence


among our adversaries?" he asked. "Do we just let that kind
of willful deceit lie there in the minds of the people,
germinating into bitterness and resentment against the
medical profession?"
"NO! I think every_p.b_ysician in the nation owes it to
himself, to his colleagues and to his patients to brand the lies
for what they are. I think each of us should become a
committee of one to tell the American people the truth.

"Most important of all, we must get it across to


our patients that inflation is the terrible price we are
payinq for 40 years of profligate and irresponsible
government spending -- deficit spending. The simple
economic truth is that inflation is caused by
government living beyond its means, spending more
than it collects in taxes and paying for the deficits with
printing-press money."
Dr. Quinlan pointed out that Medicare and Medicaid are
inflationary. "Taxes collected aren't enough to pay the bill.
So, the government has printed up money to pay for
Medicare and Medicaid. Those billions of dollars of
printing-press money dumped into the economy have driven
up prices and eroded the value of the dollar. Those billions
initially pay bureaucratic agencies, hospitals, doctors and

RALLY TO AAPS

Dr. Quinlan called upon all ethical physicians in the fight


for freedom to "rally around the one organization with a
broad enough national base and strong enough principles to
make it effective -- the Association of American Physicians
and Surgeons."
"Every physician in the nation," he said, "should know
that the AAPS is an organization that derives its strength
from an unbreakable, unbendOble set of principles firmly
based on a foundation of truth. Every physician in the nation
should know that AAPS will never sell out to the enemy for
money or any other inducement. AAPS will not abandon the
struggle against government tyranny. AAPS will not
compromise with the enemy. AAPS does not believe that
subservience to government is the proper fate for such a
noble profession."

Donald Quinlan. M.D . outgoing AAPS President (left) and Executive

Director

Frank

Woolley

(right)

greet J.

Enoch

Powell,

of British Parliament and former Minister of Health, on arrival at AAPS Annual Meeting where Mr. Powell was guest speaker.

m"mber

AAPS OFFICERS FOR 1974 - 75

FRANK ROGERS, M.D.


President

R.

L.

CAMPBELL, M.D.
President-Elect

E. E. ANTHONY, M.D.
Treasurer

Frank A. Rogers, M.D., a general surgeon from Whittier,


Calif. (Los Angeles County), was installed as 1974-75
President of AAPS at the Association's Annual Meeting in
New Orleans. He succeeded Donald Quinlan, M.D., a
Northfield, Illinois, internist who practices in Chicago.
R. L. Campbell, M.D., Corsicana, Texas, a family physician
who has served with distinction as Speaker of the AAPS
House of Delegates, was chosen President-Elect.

Georgia AAPS Member


Elected to Congress
A member of AAPS, Lawrence McDonald, M.D., Atlanta,
Georgia, was elected to the U.S. House of Representatives
from Georgia's 7th Congressional District. Dr. McDonald, a
Democrat, defeated Republican Quincy Collins, a retired Air
Force colonel.
Another AAPS member, John L. Grady, M.D., Belle Glade,
Florida, made an impressive showing as an American
Independent Party candidate in a three-way race for the U.S.
Senate. Dr. Grady, Chairman of the AAPS Florida Chapter,
chalked up 272,000 votes against his Republican and
Democratic opponents.
In local elections, John Fenick, M.D., an AAPS member,
running on the Republican ticket, won election as mayor of
traditionally Democratic Carteret, New Jersey.
Albert Cullum, M.D., an AAPS member from Middlesboro,
Kentucky, lost his bid to unseat Rep. Tim Lee Carter, M.D.
In Kansas, liberal U.S. Rep. William Roy, M.D., a physician
who consistently supported and sponsored legislation
considered by doctors all over the country as detrimental to
American medicine, was defeated in his attempt to unseat
Republican Sen. Robert Dole. The majority of physicians in
Kansas opposed Dr. Roy, a Democrat, and supported Mr.
Dole.

C. W. JOHNSON, M.D.
Speaker of

MARIE STANBERY, M.D.

House

Secretary

To succeed Dr. Campbell as Speaker, the delegates chose


Charles W. Johnson, M.D., San Antonio, Texas.
Marie Stanbery, M.D., New Orleans, Louisiana, was
re-elected Secretary, and Ernest E. Anthony, M.D., Fort
Worth, Texas, was re-elected Treasurer.

Tapes Available
All presentations at the AAPS Annual Meeting in
New Orleans were captured on tape. Ariy Association
member who is interested in a particular presentation
or speech and would like a tape of it, please let the
headquarters office know and it will be put on a
cassette. Cassettes will be furnished at cost, with the
cost governed by the volume of request received.

AAPS Woman's Auxiliary


Elects 1974 - 75 Officers
New President of the AAPS Woman's Auxiliary is Mrs. Lil
Julian, Ypsilanti, Mich. She took office at the Auxiliary
meeting in New Orleans, succeeding Mrs. Jackie Anthony,
Fort Worth, Texas.
Other Auxiliary officers for 1974-75 are: Mrs. Mary
Quinlan, Northfield, Illinois, Recording Secretary; Mrs.
Juanita Campbell, Corsicana, Texas, Treasurer; Mrs. Mary
Beth Cullum, Middlesboro, Kentucky, Membership Chairman,
and Mrs. Betty Coy, Orlando, Florida, Program Chairman.

Yo"cs foe lodividool )L;l,e~oosibility,

~~gees~
President
Enclosures: Pamphlet rack order form
Reprint from Chicago Daily News

PRIVATE DOCTORS INSTITUTE, Washington, D.C., April 24-26, 1975


ANNUAL MEETING, Walt Disney World, Lake Buena Vista, Florida, October 16-18, 1975

ASSOCIATION OF AMERICAN PHYSICIANS AND SURGEONS


2111 Enco Drive. Suite N-51 5. Oak Brook . Illinois 60521
Frank K. Woolley. Executive Director

31 2/325- 7911

THE VOICE FOR PRIVATE DOCTORS

Index No. 13
December, 1974, Volume 28, No. 11

Active Speakers Bureau

New AAPS President's No. I Target


An active AAPS Speakers Bureau will have number one priority with Frank A. Rogers, M.D., during his tenure as President
of the Association.
Dr. Rogers, Whittier, California, a generat surgeon, was inaugrated as the 32nd President of AAPS in November at the
Association's Annual Meeting in New Orleans. He will serve
as President until the Annual Meeting next year.
In his inaugural address, Dr.
suggestions for the future of AAPS:

Rogers

had

these

"Ours is a crusade that cannot fail. Our cause is


right.
"And recognizing this, we must begin to more
effectively tell our story. Doctors and people
throughout this nation are being purposely deluded
and beguiled into submissive acceptance of socialist
doctrines. They need to hear the truth, and AAPS can
deliver it.

Frank A. Rogers. M.D.

Speakers Available
As noted in the July, 1974, AAPS News Letter, the
Association maintains a Speakers Bureau, with a list of
knowledgeable, top-notch speakers available for meetings
of medical societies, other physician organizations or
nonphysician groups.
However, as Frank A. Rogers, M.D., AAPS President,
has pointed out, it is imperative that the Speakers Bureau
be expanded so that AAPS speakers will be available in
every state. Even more important, AAPS members should
be doing .all they can to place AAPS speakers before
medical and civic organizations as often as possible all
over the nation.
All AAPS members who are willing to accept
speaking engagements should notify AAPS headquarters,
with a list of subjects they feel competent to talk about.
The need is urgent to get the truth disseminated
about PSRO, HMOs, nationalized medicine and other
threats to medical freedom.

"Number one priority is an active Speakers


Bureau. It ~ work and it will pay its way.
Communications is the very key to education and hence
to effective action. AAPS spokesmen must provide this
for what I know is an eager, waiting audience in every
part of America.
"This activity is fundamental if the deadening
yoke of government is to be lifted."
Dr. Rogers said also that AAPS should explore the
possibility of developing "a coalition of freedom organizations."
"Why could not AAPS lead in a nationwide combining
of innumerable groups struggling for freedom? There is
strength in numbers, and truly freedom is indivisible."
Dr. Rogers said he assumed the office of AAPS President
"with a very clear understanding that it is not the leader protem of this Association who is of real significance" and "it is
not the President who will spell success or failure."
"The Association of American Physicians and Surgeons
is soundly grounded on the bedrock of religious principle,
dedicated to truth and to the eternal vigilance necessary to
regain and to preserve true freedom for all. It has not
faltered, nor will it, because of that dedication shared by you

people seated here tonight. For you have continuity of


concern for what is right and good and valid, and that
concern flows as a mighty river through the lifegiving arteries of this fine organization.
"It is that continuity of purpose and dedication to
principle and that concern we all have for the future of this
unique nation that can and will preserve AAPS. But
u!timately, it is the deep-rooted faith in God -- woven
inextricably into the warp and woof of AAPS that does provide the real stren~th of this Association.

"Although we ore a minority, we know -- each of


us -- that the historic moments of the centuries were
mode by minorities, that the great events of recorded
time -- good and bod -- were culminated by small
groups of people who were unwavering in their
direction, unceasing in their desire to achieve. But in

addition, ladies and gentlemen of AAPS, you hove on


added strength; you know your enemy and know him
well -- monolithic bureaucracy masquerading as
benevolent governme,1t; unrelenting, uncontrolled,
monstrous anachronism to human dignity and
prowess.
Dr. Rogers called on members of AAPS to multiply the
organization's power arid influence because "it is not
medicine alone that is unde1 attack, but civjlization itself."
"In closing, recall with me this picture. In a for-flung.
near forgotten port of the world stands the tiny guardhouse
of a British sentry, remote yet somehow firm and defiant -resolute. And written inside on the drab bare wall con be
seen the following sentence: 'I believe that one mar, can
make a difference -- and that every man should try.'
"As I accept this office tonight, I do not ask your heir,
but rather do humbly pledge you mine."

MDs Deemed Incompetent

HEW Review Rules Threaten Licenses


Do you take care of Medicare and Medicaid patients?
If you do, you should know that arrogant bureaucrats in
the Department of Health, Education and Welfare have taken
steps to nullify your licerise to practice medicine.
These bureaucrats hove adopted regulations which say
in effect that you are not competent to decide whether a
patient of yours needs hospitalization, despite the fact that
your state has certified to your competence by granting you a
license to practice medicine.
Not only that, these regulations, which will have the
force of law, will authorize nonphysicians to pass on the
competence of ltcensed MDs by making the decisions whether
patients will be allowed to stay in the hospital.
The regulations covering utilization review of the
hospitalization of Medicare and Medicaid patients were
published in the Federal Register November 29, 1974, and
are scheduled to become effective February l, 1975.

It is clear that HEW officials, with their


authoritarian approach to the use of power, have
decided they cannot wait for the implementation of
PSRO to begin exercising control over physicians'
professional decisons. The new UR regulations are
obviously intended to give HEW a head start on PSRO.
Said HEW: "Care has been taken to assure that
these regulations are supportive of the implementation
of the PSRO program and consistent with approaches
to be employed for PSRO review of hospital and skilled
nursing facility care. Effective operation of the hospital
review system required . .. should . .. enable PSROs to
concentrate their efforts on relatively smaller areas of
questionable professional activity."
The regulations require hospitals to check on the
"medical necessity" for admission of Medicare and Medicaid
patients within one day of admission, using pre-set criteria
designed to fit every case under all conditions. The initial
decision is to be mode by a nonphysician employee of the

hospital. That decision is to be reviewed the second day by


the UR committee, which is encouraged by HEW to include
nonphysicians as members and to let nonphysicians do the
actual reviewing. The UR committee will be compelled in its
deliherations to use "regional" norms for length of stay.
HEW bureaucrats are telling the public that all this is
necessary to save money and assure quality of treatment by
eliminating unnecessary hospitalization, a gratuitous
statement which may be believed by the naive and gullible
who might be persuaded that government programs save
taxpayers' money.

The fact that control of medicine, not economy, is


the real purpose of these regulations is easily
demonstrated using HEW's own propaganda. In the
1975-76 fiscal year, the Medicare and Medicaid
programs are expected to cost the taxpayers about $25
billion. According to the Social Security Administration,
$60 million of that is supposed to be saved by
enforcement of the new UR regulations, a saving, if
realized, of 24/ 1OOths of 1%.
So ostensibly to save 24/ 1OOths of 1% of the cost
of these programs, physicians' iudgments are going to
be overruled and elderly and poor patients are going to
be denied the hospital care their physicians think they
should have.
This is all right with AMA . Malcolm Todd, M.D.,
President of AMA, told the Ch.icago Tribune he thinks doctors
will cooperate as long as the policing is done by physicians.
"We don't think clerks or administrative people should be
making these decisions."
HEW obviously has other ideas. The review setup is
going to be rigged so that nonphysicians will be "doing much
of the paperwork and performing other functions, such as
screening, using physician-developed criteria," said HEW.
Here's the clincher. Nonphysicians should be used, said
HEW, because the regulations "impose too great a burden on
physicians' time to the detriment of patient care."

YOU CAN'T AFFORD TO MISS INSTITUTE


Physicians who abhor the thought of government control of medicine should not give up hope that government
interventionists can be defeated, even though the AMA is now one of the interventionists.
DO YOU WANT TO KEEP ON FIGHTING TO PRESERVE YOUR FREEDOM TO MAKE YOUR OWN PROFESSIONAL
DECISIONS?
If you do, the AAPS Private Doctors Institute may be the most important meeting you will have the opportunity to attend
in 1975.
The Institute is scheduled for April 24-26 at the Shoreham Hotel in Washington, D.C.
YOU CANNOT AFFORD TO MISS THIS IMPORTANT MEETING. PLAN NOW TO ATTEND.
You will find out:
That those of us who cherish freedom and the dignity of the individual still have many friends in Congress.
How AAPS as an organization and you as an individual can most effectively combat the socializers.
How a coordinated campaign joining AAPS and congressional friends can be developed and carried out.
How you as an individual can do the best job in attempting to persuade your senators and congressman to your point
of view, even if they are liberals.
Plans are in the works to give you the chance to meet and talk with members of Congress who can be counted on to
support AAPS in the struggle to block legislation to nationalize medicine. They can evaluate for you the political climate in
Congress and you, in turn, can give them the benefit of your insight into the consequences of politicalized medicine.
Circle the dates now and make plans to attend the AAPS Private Doctors Institute April 24-26 in Washington, D.C.
Additional information will be published in subsequent issues of the News Letter.

HMO Law Meant to Encircle Medicine


Health maintenance organizations, "the socialist dream
for a medical utopia," will never work "because they promise
unlimited services for limited fees."
With that observation, Frank A. Rogers, M.D., Whittier,
California, opened a panel discussion on PSROs, HMOs and
Compulsory Nationalized Medicine at the October-November
AAPS Annual Meeting in New Orleans._
Dr. Rogers, who was inaugurated as AAPS President at
the meeting, said that the new law providing for federal
subsidies to develop HMOs was designed to bring about
"total encirclement of the private practice of medicine."
Panelists for the discussion of programs for government
control of medicine included Dr. Rogers, Frank K. Woolley,
AAPS Executive Director, and Maurice Kramer, head of the
AAPS Washington office. Robert G. England, M.D.,
Carlinville, Illinois, was panel moderator.
Dr. Rogers said that "even with millions of dollars (in
subsidies) already poured into the HMOs which have been
formulated, they are failing at a significant rate." He added
that "a review of the current experience of HMO type
practice reveals a high failure rate, with the majority of
HMOs funded over the past two years already out of
business or going broke."
He noted that HMOs under the new law are required to
provide every sort of medical care possible and provide it on
a round-the-clock basis.
Even such established HMOs (a new term for an

old idea) as Kaiser and Ross Loos don't "even approach the requirements of the law," Dr. Rogers said.
He added that many. of these prepaid group practice
plans that have accepted government money have

protested to HEW that they could not possibly deliver


the quantity of care mandated for the amount of money
they were being paid.
Dr. Rogers said that about _800,000 Californians are
covered under prepaid health programs and "the results of
these programs have been outrageous." Care has been
extremely poor and "there has been nothing but chaos from
the time they were begun."
"A recent analysis by the Legislature of a sampling of
15 of these groups indicated that in California on the average
52% of the millions of dollars poured into them went for
administrative expenses," Dr. Rogers reported. "In one
instance, 93% of the administrative money simply
disappeared."
Dr. Rogers said it is apparent that the strongest

proponents of prepaid health care simply advocate the


abolition of fee-for-service medicine.
"The American medical profession cannot condone
HMOs," Dr. Rogers concluded. "We need to study them; we
need to know their characteristics because if allowed to
mushroom and to become nationwide, as they have in other
countries, it is going to change ethical medical practice intounethical practice, produce impersonal assembly-line medical
care.
"Our profession, in my belief, must recognize and
understand that HMOs and every other government program
will . ultimately hasten the destruction of private qual~ty
medical care. If we fail now to understand what hangs in the
balance, we will have lost our professional freedom, and that
loss to the American people will be even greater b.ecause the
strongest bulwark against socialism in our society will have

crumbled. All society then will rapidly fall to socialism.


"It is my feeling that we should fight it now. All
physicians should stand together for the protection of the
profession and the American people, and I hope that we in
AAPS can lead the way by enlightenment in this area."
MR. KRAMER: The AAPS representative in Washington
discussed the prospects for health legislation in the next
Congress. "I expect that we will' hear more and more in
Washington that Democratic victories in the election mean a
mandate for nationalized medicine.

recommendations contained in a Socialist Party pamphlet -"The Case for Socialized Medicine" -- that was distributed by
the thousands at the Americana Hotel in 1961 during the
Annual Convention of the AMA.
Mr. Woolley read the following "To Do" from that
pamphlet:

"We can do everything possible to encourage


federal intervention in the financing of medical costs on
a bit-by-bit basis and we can work to direct such
intervention so that if it is not socialized medicine
proper, at least it paves the way for socialized
medicine. To this end, we must give high priority to
attempts to amend legislative proposals in ways that
will involve the government in medical standards
(emphasis by the pamphlet authors) and in a way
favorable to cooperative and group medicine."

MEDICAL 'REFORM'

"Involved in any national health bill are the elements


that make up the 'reform' of the medical care system. The
HMOs that Dr. Rogers has described is one element, one
1eature particularly of the Kennedy bill on the Senate side.
Practically all bills incorporate the so-called PSRO quality
control provisions.
"Another element that I would like to identify is the
so-called planning controls. The setting up of planning areas
corresponding for the most part with PSRO areas would be a
significant feature of any health proposal that is developed
and debated and acted on in the coming session of Congress.
But HMO, PSRO and the planning bill are all integral
elements of national health proposals and really need not be
discussed separately from a legislative standpoint because
national health legislation encompasses them all.
"You can expect very serious consideration of national
health legislation early in the next session of Congress."
MR. WOOLLEY: The AAPS Executive Director traced the
genesis of PSRO, pointing out that the concept sprang from
the development of socialized medi.cine in Europe. "PSRQ
is merely policing of medical care by government." He said
that when the AMA leadership decided to stop opposing
nationalization of medicine and to introduce its own
legislation to nationalize medicine, bureaucrats in Washington planted the idea of including provision for professional
review organizations, which later became PSROs in the
Bennett Amendment to H.R. l (P.L. 92-603).
Mr. Woolley reminded AAPS delegates that federalized
medical standards and federal financing of medical care were

REVIEWS LAWSUIT

The AAPS Executive Director also reviewed the history


of the AAPS suit in federal court to overturn the PSRO law on
constitutional grounds. He said the three judges of the special
court took the case under advisement after hearing oral
arguments October 17 on a government motion for a
summary judgment (dismissal).
Mr. Woolley renewed a plea for provable, documented
evidence of a PSRO or other agent of government interfering
with a physician in the exercise of his medical judgment. He
said that when such evidence is available, AAPS will amend
its suit to ask for a specific injunction against the government.
He also urged physicians to resist attempts from all
sources, including hospital administrations, to interfere with
the way they practice or to attempt to make physicians
subservient to the hospital administration.
"Don't give up," he said. "Preserve your rights. If you
are forced to sign something after you have exhausted all
your remedies, and all your local colleagues have succumbed,
go a head and sign but put under your signature, "signed
under protest." That is notification that you signed under
duress and did not consent to the terms of the document, Mr.
Woolley said.

Frank A. RoRers. M.D. fleftl, who assumed office of AAPS President at

Annual

MeetinR

in

New

Orleans.

canfers

with

AAPS

Executive

Directar Frank Waolley and Maurice Kramer, head of Washington office, at start of panel discussion on PSROs, HMOs and nationalized medicine.

AAPS May Establish


A Political Group
The AAPS Assembly and House of Delegates adopted a
resolution instructing the Boa rd of Di rectors "to initiate steps
towards establishing a political action organization with legal
authority to collect fun.els and to contribute directly to the
election of members of legislative bodies, primarily the U.S.
Congress, who prove by deed and word that they deserve the
support of ethical physicians who believe in preserving
constitutiona I government."
Another resolution set forth guidelines physicians
should follow in dealing with third parties. They are:
l. The fundamental goal of the practicing
physician
is to directly qualify medical care to his patients to
the best of his ability and in accordance with
scientific advances.
2. The necessary basic conditions for quality medical
care are:
(a) freedom of choice of patients.
(b) freedom of choice of physicians.
(c) freedom of choice of therapy.
(d) freedom of choice of location.
(e) confidentiality of medical information.
3. Remuneration should be based on the "free market"
economic philosophy. Third parties should not expect
physicians to subsidize health care programs by
inadequate remuneration and interference with the
;nvioiubie physician-patient relationship.
4. "Cost controls" should never be accepted as an
excuse to interfere with the freedom of private
practice.
5. Forced or coerced labor (slavery) is inhuman and
i11,:noral and was abolished by the Thirteenth
Amendment to the Constitution. Physicians have the
moral and legal obligation to uphold the Thirteenth
Amendment and, consequently, to oppose all forms
of coerced labor, even their own.
Thus, all members of the AAPS are asked to oppose
all programs that disregard the above guidelines, as
freedom, legality and quality of medical care are impossible under such circumstances.
A third resolution recorded AAPS as favoring a
Constitutional Convention.
Two other resolutions were adopted.
MORAL STANDARDS

WHEREAS, this country was founded upon belief in


God, and
WHEREAS, belief in God presupposes obedience to
his will, and
WHEREAS, the inestimable value of each human
life and the sanctity of the family are inherent in and essential
to the preservation of our heritage;
THEREFORE, BE IT RESOLVED that the Assembly
and House of Delegates of the Association of American
Physicians and Surgeons, Inc. in regular session assembled in
New Orleans, Louisiana this 2nd day of November, 197 4
recognize and deplore the planned attack upon our way of

life as manifested by widespread agitation for the acceptance


of homosexual practices as normal and proper variations of
sexual behavior, and
BE IT FURTHER RESOLVED that the Association of
American Physicians and Surgeons affirms its support of our
traditional values as a matter of principle.
NATIONAL LICENSURE

WHEREAS, the Congress of the United States is


now considering the Kennedy-Javits Bill, namely Title VIII of
the Health Professions Education Assistance Act of 197 4, and
WHEREAS, this bill directs the Health, Education
and Welfare Secretary to develop and establish national
standards for licensure and subsequent renewal of licensure
at least every six years, and
WHEREAS, this constitutes an unwarranted and
undesirable stringency and interference with the practice of
private medicine as now being conducted;
THEREFORE, BE IT RESOLVED that the Assembly
and House of Delegates of the Association of American
Physicians and Surgeons, Inc. in regular session assembled in
New Orleans, Louisiana this 2nd day of November, 1974 do
emphatically protest the enactment of such legislation.

PSRO Stand Unchanged


HEW bureaucrats, notably Henry Simmons, M.D., the
agency's PSRO chief, are now busily propagandizing that
opposition to the vicious PSRO law is crumbling everywhere.
That's what Dr. Simmons claimed in a speech to the
American College of Surgeons which was reported in the
November 20 issue of Medical Tribune.
Dr. Simmons and his HEW colleagues have.been reading
the wrong signs. AAPS evidence suggests opposition to PSRO
among individual physicians continues unabated. Almost
daily, AAPS receives new requests for pamphlets and other
information to help physicians combat PSRO and to explain
this authoritarian law to their patients.
Furthermore, support for the AAPS lawsuit to outlaw
PSRO on constitutional grounds continues to pour in, not just
from individual physicians but from local medical societies.
The members of five more medical societies have sent in
contributions in support of the lawsuit.
Calcasieu Parish Medical Society, Lake Charles, La.,
contributed $500 from its members to help finance the
lawsuit.
Pottawatomie County Medical Society members in
Shawnee, Okla., sent in $250.
One hundred dollar contributions were received from
Pinellas County Medical Society, St. Petersburg, Fla.;
Hall County Medical Society, Grand Island, Neb., and
Pamlico Albermarle Medical Society, Washington,
North Carolina.
It is noteworthy that Dr. Simmons can no longer detect
what he once described as a "campaign of misrepresentation" about PSRO. It follows that what is being said is, as he
sees it, the truth. This is interesting in light of the fact that
AAPS has not diminished nor softened its criticism of PSRO.
In the past five months alone, AAPS has distributed almost
150,000 pamphlets elucidating the evils of PSRO. And the

Association is still pushing its lawsuit in federal court to have


the PSRO law declared unconstitutional.
Now that Dr. Simmons concedes that PSRO opponents

are not misrepresenting the facts about this iniquitous low,


will he be equally candid and admit that federal officials hove
repeatedly falsified PSRO?

State Society Can Be Positive Force


F. Michael Smith, M.D., President-Elect of the Louisiana
State Medical Society o_nd a member of AAPS. told delegates
to the AAPS Annual Meeting in New Orleans that "your
state medical society con be a positive force for ethical
medicine," and he then gave them pointers on how they
could get the job done.
The key, said Dr. Smith, a pediatrician who lives and
practices in Thibodaux, Lo., is to pull together into a working
team those members of the society willing to toil for the cause
of ethical medicine.
But, he cautioned, the campaign must begin at the
county medical society level where "you will find the true
grassroots strength."
"Such on approach will provide the best available forum
for oral discussion and presentation of desirable
objectives," Dr. Smith said. ''The basic objective is the

F. Michael Smith. M.D.

election of doctors who hove the proper principles as


delegates to your state medical society. The traditional
attitude of 'let Old Joe go, because Joe hos gone for years'
must be cost aside if 'Old Joe' is not a good Joe."
Once physicians who believe in conservative principles
win control of the local medical society, they con turn their
attention toward influencing the policies of the state medical
society. Dr. Smith described how a number of such societies
in Louisiana hove been able to toke action profoundly
affecting the course of resolutions in the House of Delegates
of the LSMS.
"One of the most important single steps that was token
in this state was the elimination of the committee hearing
system," Dr. Smith said. "There can be no greater move
made to assure democracy of action than this. In our state
medical society today, the House of Delegates acts as a
committee of the whole to hear and act upon all resolutions
and establishment of policy.

"/ scarcely need point out to you that, given the

power to select hearing committees, control of policy is

no trick. There is pressing need for all medical


organizations to emulate Louisiana in this matter.
Abolition of this device for power control is a must if
democratic principle is to prevail."
CITADELS

CAPTURED

That admonition is pertinent because it is the device


used by leadership of the AMA to control AMA policies to
suit the purposes of that leadership. Dr. Smith touched on this
fact.
"Skillfully," he said, "the citadels of power of organized
medicine have been captured by a minority of ultra-liberal
physicians. In our so-called organized medicine, boards
function without accountability to the membership.
Democratic principle lies in abnegation when delegates vote
contrary to the established policy of their own component
organizations.
"Mockery of democracy is promulgated when hearing
committees present their own views, without regard to the
resolutions or testimony presented to them. Federal grants
are sought and accepted along with federal controL
Principles of ethical considerations .are cast aside when they
clash with the pragmatism of ultra-liberal or self-serving
objectives of the few."
Medicine is a valued service and big business, he said,
. and this explains in large measure the "why" of the power
struggle for control of medicine. The medical professio.n, he
said, has been on the losing end of the struggle so far. "We
have. by default," h~ continued, "surrendered the power
centers in our own organizational structure to those who
embrace and espouse concepts foreign to our own ethics and
principles. Heretofore, apathy has gripped the grassroots of
our profession, as most physicians reject involvement and
effort in medical politics. However, if one listens now, the
rumblings of dismay, dissatisfaction and disapproval of the
trends and policies of organized medicine are to be heard
throughout the land.
"There is at hand now a golden opportunity for the
asserting of principles to better serve the public by a return to
traditional, ethical medicine."

Rep. Crane On Ways and Means


Rep. Philip'Crane, Illinois Republican, one of Congress'
strongest champions of individual liberty and responsibility
and therefore one of the medical profession's best friends in
Congress, t,as been nominated to the House Ways and
Means Committee.
Mr. Crane's selection was made following a shakeup of
the committee leadership and a decision of House Democrats
to expand the committee from 25 to 37 members to more
nearly reflect the increasingly liberal complexion of the House
as a consequence of the November elechons.

Battle for Liberty


Is Total War--Smoot

Labor Is Big Threat


To Free Institutions
One of the biggest threats to 'free institutions in the
United States is organized labor. One of its goals is to take
Congress away from the people and put it under control of
labor leaders who are interested in more power, more
control, more taxes, more inflation and more centralized
government.
That's the opinion of U.S. Rep. John R. Rarick (D-La.),
who was defeated for re-election to Congress largely through
the efforts of labor bosses. Mr. Rarick spoke November 1 at
one of the sessions of the AAPS Annual Meeting in New
Orleans.
He pointed out that leaders of the AFL-C/0 are

boasting they can reach and control through electronic


computers 10 million union members. And he warned
tho! AAPS ,, is going to have to' be
political action

organization or you are not going to be in business


much longer."
Mr. Rarick, who is chief sponsor of the first bill
introduced in Congress to repeal the iniquitous PSRO law,
said that neither the Republican Party nor the Democratic
Party can brag that they have 10 million votes in their pockets
that they can reach at one touch of the button of an electronic
computer system. It is the goal of labor bosses, he said, to
register and vote all 10 million union members and to extract
from each of them $2 a week for COPE alone to spend for
political purposes (that's $20 million a week or more than $1
billion a year).
He added: "Doctors are going to have to start reaching
people they haven't been talking to. You are going to have to
form coalitions with other groups also opposed to more
socialization, more big government, and to try to get back to
representative government so that the individuals who have
quit voting and quit political action get back and get
involved.
"I think the real answer for all of us is that we

must get involved; we must get into politics; we must


talk to people we haven't been talking to. We dare not
shriek, but we've got to plead and to pray if necessary.
If we don't, we may end up losing our business and our
freedoms."

Dan Smoot, former FBI agent, author, lecturer and


political analysist, warned delegates to the AAPS Annual
Meeting in New Orleans, that the battle for liberty cannot be
divided and subdivided. It must be total war.
"Any man who thinks he can successfully fight for his
own freedom in his own corner while ignoring the total war
against liberty will eventually find himself chained in his own
corner to the corpse of liberty."
Mr. Smoot advised doctors not to turn all efforts to
saving the profession from the socialist revolution. "You
should concentrate rather on saving your republic," he said.
Businessmen must heed the same advice, he said.
"Businessmen, alarmed about OSHA, must
realize that preserving ethical medicine is 1ust as
important to them as preserving free enterprise. Otherwise there will never be enough unity of purpose and
cohesiveness of strength to stop either OSHA or PSRO,
and the reverse is also true. If you think PSRO is bod for
doctors, but you haven't paid much attention to OSHA,
you haven't yet gotten involved 111 the struggle."
Mr. Smoot enlightened the AAPS delegates with a
clarifying review of how the radical leftists perform. It is not
obvious, for example, that leftist radicals are responsible for
PSRO.
"Known radical leftists," Mr. Smoot said, "have not
provided public leadership. for any of the major legislation
that is sucking this nation into the morass of socialism. The
radical leftists always propose legislation which seems worse
than the bills that get passed. And theycriticize the bills that
Congress enacts."
Before long, he predicted, they will charge that PSRO is
not bringing medical cost down or stopping gouging by
doctors and they will propose total government control.
"And the conservatives in the medical association (AMA)
and Congress will counter by proposing a moderate
alternative to give the bureaucracy tighter control t~an PSRO
now gives it but not quite as much control as the radical left
demands. That will be the legislation enacted and the AMA type conservative will then congratulate themselves on
another victory over socialized medicine."
That tactic works, Mr. Smoot said, because most
conservatives have no fundamental principles about the kind
of governmental system we ought to have. "So, the
conservatives have been perpetually in retreat for 40 years -always compromising, always yiei'ding, getting into and
supporting programs that move the nation ever closer to the
liberal idea of total government."

Dan Smoot (left), former FBI agent, author and lecturer, and Rep.
John

R.

Rarick

(D-La.),

chief

sponsor

of

PSRO

repeal bill,

were

among principle speakers at AAPS Annual Meeting. Here they compare notes on evils of PSRO and OSHA laws.

But, "every active liberal generally supports any


program that increases the power of the central
government . .. whether or not he likes that particular
program or whether or not it affects his persona/
interests. So, the liberals ore never in retreat -- never.

AMA Advocates Nationalized Medicine


If the nation's physicians in the practice of private
medicine had taken the time away from their patients to
attend the recent AMA Clinical Convention in Portland,
Oregon, and if they had understood what was done, they
Nould have been profoundly disturbed.
Most of the news stories about the meeting concentrated
on the bitterness generated by the fact that as a consequence
of the actions of the members of the Board of Trustees and
the executive staff who have managed the affairs of the
Association the past six years the AMA has gone broke.
That would have been distressing enough to practicing
physicians who have paid their AMA dues without being told
how rapidly AMA's financial condition was deteriorating.
They would have been particularly unhappy with disclosure
of AMA's shaky finances had they known that a past effort
by F. Michael Smith, M.D., Thibodaux, Louisiana, to call
attention to the situation had been rebuffed by a reference
committee of the House of Delegates. Dr. Smith currently is
President-Elect of the Louisiana State Medical Society.

But what would have most deeply shocked the


practicing physicians at Portland would have been the
realization that the House of Delegates, almost with an
air of indifference, had voted to let the AMA's ruling
hierarchy lead an unsuspecting nation down the road
to the disaster of nationalized medicine.
FREEDOM OF CHOICE

One of the AMA's ancient bottle cries was "freedom of


choice." But today, the AMA proposes to deny the nation's
employers (who include physicians) the freedom to choose
whether they will offer health insurance to their employees,
the coverage to be included and the amount of money they
will pay for the insurance.
The AMA is now promoting standardization of medical
practice through PSROs, has approved national health
program "guidelines" by which it favors "appropriate"
coi:,trol by government over cost and quality of medical care
to all patients and advocates standardization of health
insurance in a package that would inevitably result in
regulation of doctors to fit their treatment of patients into the
insurance coverage prescribed by government.

AMA is now d leading advocate of compulsory


nationalized medicine for the entire population.
And by the terms of its so-called guidelines, AMA is
now committed to accepting "minimum" federal government
financing and federal government involvement in administration of its national health program, with what is minimum
and who will decide left open. AMA also gave its formal
blessing to HMOs by declaring it supports "maintenance of
pluralism in health delivery systems."
The policy in support of compulsory nationalized
medicine was adopted without much debate. It was almost
the last item (No. 19) in the last reference committee report
called up in the last minutes of the convention, when some
delegates had departed and those remaining were itching to
go home.
The vote, however, merely formalized into policy a
decision made by the Board of Trustees before the

convention. On November 8, 197 4, AMA headquarters


issued a statement which stated unequivocally that AMA "is
for National Health Insurance" -- its own brand -- and has
been since it introduced its so-called Medicredit bill in 1970.
The statement contained this denial that AMA
advocates compulsory nationalized medicine: "The AMA is
willing to consider a National Health Insurance program that
would require employees to offer voluntary health insurance
to their employees. This concept is known as mandated
National Health Insurance. It is not compulsory Notional
Health Insurance, a point on which there seems to be
considerable confusion." (Emphasis added)
PERILOUS

FINANCES

The acrimonious debate at the convention was over the


Association's perilous financial condition. The staff and
Board came to the House with several proposals to help save
the sinking AMA ship -- an 82% dues increase from $110 to
$200, a mandatory $60 special assessment on all regular
dues-paying members, elimination of all advertising from
AMA publications, reduction in the size of publications and
the frequency of publication, and the elimination of specified
councils and committees.

Members of the House, in a stinging rebuke to


management, said "NO!" to everything but the special
$60 mandatory assessment.
Delegates rejected the dues increase until next
June and agreed to 'consider it then only on
demonstration of "stronger economy measures and
improved executive management of the Association's
affairs."
A special committee of the House was named to
make sure the Board of Trustees carried out that
mandate.
When it was disclosed that AMA spending pTOgrams
had exhausted $10,300,000 in reserves in less than five years
and that officers had been forced to borrow some $2 million
to meet year-end expenses, there were cries for "heads to roll
among AMA management."
The upshot was that most recommendations of the
Board were put on hold until management comes up with
some satisfactory answers.
The decision to eliminate drug advertising from AMA
publications was reportedly based in part on the question
whether AMA was unduly, even unethically, influenced by
carrying pharmaceutical company advertising.
On the matter of undue influence, no one raised the
question whether the same criticism might apply to AMA for
accepting money from the federal government.

Indiana Chapter Pushes Contest


The Indiana AAPS Chapter continues to conduct its
Freedom Essay Contest and is pleased with the results.
Chapter officers expressed the hope that other states will
become interested and start essay contests.

Government Medicine
Foments Grievances

Children's Textbooks
May Give You A Shock

Nationalized medicine is a s.ystem "from which all


preference except that politically channeled through the state
has been eliminated," J. Enoch Powell, a world authority on
government medicine, pointed out to delegates to the AAPS
Annual Meeting in New Orleans.

Have you looked inside the textbooks your children are


required to study in school lately? You may be in for a shock
if and when you do.
Would it surprise you to know that some textbooks for
grade school children suggest that garbage collectors are
more important to health than doctors because they remove
filth that causes disease while doctors merely treat diseases
after people get sick?
Have you done anything about such textbooks? Two
people who have are Mr. and Mrs. Mel Gabler of Longview,
Texas. They have been examining school textbooks for the
past 14 years and have appeared before the Texas
Schoolbook Commission numerous times to protest adoption
of textbooks that do such things as glorify Marilyn Monroe in
American history over George Washington.
Mrs. Gabler was featured speaker at the AAPS
Woman's Auxiliary meeting in conjunction with the AAPS
Annual Meeting in New Orleans.
Mrs. Gabler said one of the books reviewed was a
commercial for homosexuality -- not presenting anything
wrong with homosexuality but explaining "when you can ply
your trade, the hours, the type of bars you can go into and
the infighting as to who will be male and female."
And, said Mrs. Gabler, how would you like Mother
Goose interpreted for your children this way in a textbook:
"Jack be nimble, Jack be quick, snap the blade and give it a
flick; grab the purse, it's easily done, and just for kicks and
just for fun, plunge the knife and cut and run."
One history book, she said devoted 6- 1/2 pages to
Marilyn Monroe and her marriage to Arthur Miller. George
Washington was barely mentioned. It was for fifth graders
and the book asked such questions as what Marilyn enjoyed
most about being married to Miller and what problems they
had.

"This is where we reach the heart of the matter," Mr.


Powell said, "since by definition a comprehensive national
health service nationalizes preference; the alternative in the
last resort, the whole debate in which you are deeply and
passionately concerned, is between a nationalized
preference and a dispersed preference ... It is a system from
which has been eliminated not only the preference of the
consumer, but that of the producer ... It is the fundamental
characteristic of a comprehensive nationalized health service
-- it excludes the prospect of a career and a lifetime within the
network of interacting choices and preferences of consumers
and producers, or, if you prefer, of patients and
professionals. In place of that network there is the situation of
how much money the state will allocate to pay for what the
state has chosen."
Mr. Powell, a member of the British Parliament and a
former British Minister of Health (1960-63), was the principal
speaker at the Friday night banquet, November 1.
One of the great dangers of any system of organized
provision of services is that eventually it destroys the belief
there can be an alternative, said Mr. Powell.
Mr. Powell is one of those rare individuals of learning
and wisdom who, when selected for a position of power in
government does not abuse it. As British Minister of Health,
the chief administrative officer for the National Health
Service, he possessed enormous authority over doctors and
hospitals -- and patients. Unlike most public officials who
become increasing.ly arrogant with that kind of power, Mr.
Powell studied the system in detail from the vantage point of
his position and concluded it was so inheren'tly flawed that it
could not work efficiently and effectively.
He concluded that "comprehensiveness" was impossible under any system. And, as he told AAPS delegates, he
found out that: "What nationalization does is to make the
unavoidable impossibility of 'comprehensive' into a
grievance, a grievance of the citizen against the state and
against his tellow citizens, a grievance (against) a series of
shortages -- staff, building, equipment and, above all,
money, as if that were something separate.
Mr. Powell also noted that nationalization of medicine
permits the state to divert resources from health care to other
projects which government officials believe are politically
more attractive.
"Certainly," he said, "there is no doubt that in the
absence of the National Health Service the hospitals in Britain
would have improved and expanded in the 1950s and 1960s
faster than they did. Nationalization, bringing them all under
state ownership and control, enabled the state deliberately to
hold back investment in hospitals in order to give preference
to investment in housing."

Mrs. Mel Gabler. LonQview. Texas <left). was main speaker at


Woman's Auxiliary luncheon. With her is Mrs. E. E. (Jackie) An,;,ony,
Fort Worth. Texas. the outQoin11 Auxiliary President.

Small-Town Doctors
"Out of Touch"--AMA
Members of the AMA who live and practice in small
towns -- including members of the Board of Trustees, past
and present, and numerous former AMA presidents -- must
have been more than mildly surprised to learn from the
November 11 American Medical News that in the affairs of
medicine they are considered in AMA headquarters as
irrelevant and "out of touch."
This attitude toward small-town doctors was disclosed
in an article in AMN on the AAPS Annual Meeting in New
Orleans. AMN writer Dennis Breo attended the meeting but
re;:iorted very little of what actually transpired. He decided
instead to try his hand at a hatchet job on AAPS. His editors
labeled his exercise in invective as "news analysis." In this
case, the term "news analysis" was a deceit, since it
suggested the reader was getting an erudite treatise on a
news event when all he was getting was a misleading
editorial against AAPS.
American Medical News, an official publication of
AMA, tried hard to portray AAPS as insignificant and
inconsequential. Apparently Mr. Breo figured the best way to
prove that thesis was to point out that most physicians who
attended the meeting came from "small-town America."
Clearly, that settled the question in Mr. Breo's mind. He said
they opposed "Big Brother Government, The Liberal Media,
the Eastern Establishment ... the Professional Standards
Review Organization law, health maintenance organizations,
national health insurance, and all other aspects of 'socialized'
medicine."
And when all this was said and done by these
small-town doctors, AMN concluded, "there was left
hanging the question of AAPS' role and relevance in
contemporary medicine."
The AMA's staff writer arbitrarily selected l O towns as
typical of the places the physicians came from to attend the
AAPS meeting. These towns singled out for special mention
by Mr. Breo are where l 03 physicians live and practice. And
among these physicians considered so out of touch with
contemporary medicine they are against Big Brother
Government, PSROs, HMOs and socialized medicine are 63
members of the AMA.

The attitude of the American Medical News


toward the small-town MD may hove relevancy to the
fact that about 40 per cent of those 103 physicians do
not belong to the AMA.

week's election, there are those who would question if AAPS


isn't out of touch."
First, the implication is false that the American
people ore increasingly anxious for nationalized

medicine.
Second, and most important, the statement seems
to be saying that AAPS, to be in touch, should
recognize that the enemies of medical freedom in
Congress outnumber its friends and AAPS should
therefore abandon principle, cower before medicine's
enemies and meekly accept Big Brother Government
control of medicine.
If being "in touch" means surrendering pri nci pie to
accomodate a shift in the political complexion of Congress,
AAPS will remain out of touch.
The undisguised editorial generated reaction. John H.
Budd, M.D., Cleveland, Ohio, a member of the AMA Board of
Trustees, wrote the AMN editors that "my anger is more
than slight." He said this attempt to "ridicule, disparage
and condemn an organization of physicians ... genuinely
concerned over the extent and type of government control
engulfing medicine" was "offensive to me."
Leszek Ochota, M.D., an AMA member wrote: "After
your typical liberally arrogant and slanted 'analysis' of
the Association of American Physicians and Surgeons, I
would like to join this association. Please kindly let me know
their address."
Dr. Ochota is now an AAPS member.

Rea/ ClzriJlmaJ

Spirit

Despite the corruption, both political and non-political,


which we see all around us this is the time of year for
rejoicing by those of us who believe in God and His son Jesus
Christ. While Christ was crucified by evil forces who used 30
pieces of silver to accomplish their purposes, His noble and
courageous love of individual freedom and responsibility has
been on unquenchable beacon of light shining brig'htly down
through the ages. True believers can take comfort in knowing
that despite distortions by power seekers who describe
heaven in collectivist terms carefully disguising the
subjugation of each individual to the dictates of government,
the unabridged word of Christ rejects corruption, bribery,
coercion and duress and espouses individual love and
charity. He admonished us through Paul to "Rejoiceth not in
iniquity, but rejoiceth in the truth." This is the real spirit of
Christmas I wish for you and yours.

The concluding paragraph in the AMN editorial on


AAPS is worth pondering by all who believe principle is more
important than political expediency.
"In a nation increasingly committed to the health care of
its citizens and in a Congress increasingly liberal after last

Your Patients Need Your Freedom,

171

a~~~
Frank Rogers, M.D.
President

PRIVATE DOCTORS INSTITUTE, Washington, D.C., April 24-26, 1975


ANNUAL MEETING, Walt Disney World, Lake Buena Vista, Florida, October 16-18, 1975

ASSOCIATION OF AMERICAN PHYSICIANS AND SURGEONS


2111 Enco Drive. Suite N-515. Oak Brook . Illinois 60521
Frank K. Woolley. Executive Director

312/325-7911