THE VOICE FOR PRIVATE DOCTORS
NEWS LETTER,
Special 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 ded-
ication to principle and the capacity for action
AMA Hlouseof Delegates Votes
For Abolishing The PSRO law
Members of the American Medical Association House of Delegates climaxed a tumultuous clinical meeting at Ana-
heim, 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 Meet-
ing in the AAPS lawsuit to declare the PSRO law uncon-
stitutional. One resolution (No.29 introduced by Virginia)
specifically called for AMA to support the suit. Several
delegates also urged AMA to support the suit.
The Virginia resolution resolved ”that the American
Medical Association publicly announce its approval of
the lawsuit initiated by the Association of American Phy-
sicians and Surgeons, and that the membership be en-
couraged to use every practicol means to bring about a
successful termination of this lawsuit.. .“
The Reference Committee only indirectly acknowledg-
ed 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 in-
stituted by members of the profession, so that adoption
of this resolution . . . would be a costly duplication of
judicial review of the law which is already under way.”
Index No. 2
January, 1974, Volume 28, No. 1
which makes such a report as this possible. Please
I
urge at least one other doctor to join AAPS now
and strengthen the effort to save U.S. medicine -
Donald Quinlan, M.D., President.
The House on Dec. 5, 1973, made it ckar
the best course of action was to abolish the
PSRO law. Delegates amended a report of the
Board of Trustees and Council on Medical Ser-
vice (Report E E ) to make it clear that: “The
considered opinion of this House of Delegates
is that the best interests of the American peo-
ple, our patients, would be served b y 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.
INSIDE
0 Text of AMA PSRO Amendment
0 AMA Executive Backs Down
0 Reference Committee PSRO Debate
e House of Delegates Debate
0 Rep. Crane’s Speech - “PSRO Repeal
is Possible”
0 At Large AMA Trustee Elections
e AMA Headquarters Stay
0 Dr. Heard Is Board Candidate
0 Dr. Retires in PSRO Protest
1
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 imple-
I mentation 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 conf:ict with other parts
as originally drafted. Specifically, they indicated be-
lief that the statement of the amendment that PSRO should
be abolished was incompatible with the concluding state-
ment of Report EE which recommended the AMA "continue
to exert its (PSRO) leadership by supporting construc-
tive amendments to the PSRO law, coupled with con-
tinuation 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 subiect of PSRO and ReDort EE - "left
u p n the air" at PGerto 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
low.
l f anything was made clear at Anaheim,
it was this: The overwhelming majority of dele-
gates, alternates and other physicians at the
meeting want the PSRO law abolished, and in
that desire, they reflect the wishes of an over-
whelming 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 w a s to let h e Board
continue the policy of collaboration and support amend-
ments to the law.
The House of Delegates said no, tfiat was
not the best thing t o do. The House without
dissent said the best thing to do is repeal the
law.
When the amendment t o Repcwt E€ w a s adopted, Car-
roll Witten, M.D., Louisville, Ky., Delegate from the Sec-
tion on Family and General Practice, observed that the
amendment "makes it quite clear that it is wr 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's0 clear at Anaheim that practically every
physician, including all A M 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 bad 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
Journal, The New York Times, Medical World News,
Human Events, and even the American Medical News
agreed that the House had voted to seek repeal of PSRO.
In the Dec. 10, 1973, issue of American Medical News,
a headline on a story about events at Anaheim pro-
claimed: "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 Leg-
islation, 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 Ana-
heim."
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. Hilde-
brand's memorandum said that as a consequence it would
be recommended to the Board that no action seeking PSRO
repeal be taken. The memorandum said it would be 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 working 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 special
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 repealing 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 Con-
gress 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. Pal-
mer, 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 trus-
tees and the Association's administration on maior issues,
even though it sometimes has had reservations about do-
ing 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 differ-
ently than planned. At Anaheim, a satellite meeting was or-
ganized for Saturday, December 1,1973, to promote col-
laboration with PSRO (every originally scheduled speaker
was a PSRO booster, and some were full or part-time em-
ployees 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 anti-
PSRO resolutions would be shunted to the Board and that
Report EE would be adopted with minimum debate and
without substantive change.
Hawever, 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 wide-
spread 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
ond it was expected to do so again this time.
But that strategy began coming unglued at
the special Dec. 1 satellite meeting designed
to p r m o t e 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 o f 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 udestruction o f
civilized humane medical care. And he said
he had heard that i f PSRO is abolished some-
thing worse would follow, "but I've tried and
tried and I just can't think of anything worse."
Dr. Johnson's direct and unevasiue criticism
o f PSRO was obviously - from the amount
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 ex-
pect from HEW officials responsible for enforcing PSRO.
The unmistakable attitude of Henry P. Simmons, M.D.,
Deputy Assistant Secretary for HEW and director of
HEWS PSRO office, was that "things will be done our
way" whether doctors like it or not. And this i s ''your
lost opportunity" to do as the bureaucrats say to avoid
something worse.
Prior to the meeting all delegates and alternate dele-
gates had been sent a letter 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 !ow was enclosed
with Dr. Quinlan's letter.
Unexpected Development
Sunday, December 2, brought a new, unexpected de-
velopment --
an open letter to the House of Delegates
signed by 34 US. 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 tr~-
ing to get signers to withdraw their signatures and at-
tempting to discredit its urgent message.
Dr. Heard later told AAPS he had been informed that
"several congressmen were threatened with bss 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 l a w 92-603)will require you to
practice according to computerized standards, rather than
using your best medical judgment in treating your pa-
tients. It will deprive your patients of their right to
privacy, it will impose severe fines for medical innova-
tion.
"Some of you have urged AMA participation in im-
plementation of PSRO so you can control the administra-
tion 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 Deportment 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 law; it will be bad for
the doctor and bad for the patient. It should be repeal-
ed. Unfortynately, although many of us in Congress want
to work for the repeal of PSRO, we have been handicap-
ped 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. W e strongly urge the House of Deiegates
to pass a resolution specifically calling for the repeal
of PSRO and committing the aH-out efforts of the
American Medical Association to that end.'' (Emphasis
added.)
The AMA member most responsible for the letter was
Dr. Heard, who is a member of the AAPS. The idea for
the letter developed during a conversation between Dr.
Heard and his Congressman, Rep. Benjamin 8. B'ack-
burn. When the letter arrived at Anaheim on Sunday,
Jack E. Shields, M.D., delegate from Brownstown, En-
diana, 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 ought 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 Coun-
cil, 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.
1
i Dr. Hunter, in an obvious attempt to convince dele-
gates pursuit of repeal would be unwise and fruitless,
said AMA Washington lobbyists sought out Rep. AI UII-
man, 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. Ullman was "obviously
disturbed'' that the open letter had been submitted to
the House of Delegates. He was quoted in effect as say-
ing that he and all Democrats on Ways and Means would
oppose repeaI.
Rep. Herman Schneebeli of Pennsylvania, ranking Re-
publican on the Committee, was quoted as saying repeal
Senate sentiment for repeal.
-
"is unlikelv to succeed" and addina he knew of no
Text of PSRO Repeal Amendlment
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 commit-
ted to the principle of peer review, under professional
direction, and
"2. That medical society programs of proven effect-
iveness should not be dismantled by PSRO implement-
ation, 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 prin-
ciples of sound medical practice and documentable obiect-
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 leg-
islation."
The Dec. 3 Reference Committee session
heard testimony on 10 resolutions opposing
PSRO, half o f them demanding abolition of
this dangerous law. Only one resolution sym-
pathetic t o the collaborationist policy of the
Board of Trustees was introduced ( N o . 15 from
the Michigan delegation) and it was withdrawn
at the Reference Committee hearing. That res-
olution, incidentally, was in conflict with the
position o f the Michigan State Medical Society
House o f Delegates, which favors repeal of
PSRO.
Consequently, when the Reference Com-
mittee met, the r n h documents not in opposi-
tion to PSRO were Report A and Report E E of
the Board of Trustees and Council on Medical
Service.
Witnesses opposed to PSRO and favoring abolition of
the law either by repeal or by means of the AAPS law-
suit 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.
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:
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 societies 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 phy-
sicians and through the Board of Trustees and its Coun-
cil on Legislation, work to inform the public and legisla-
tors 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 Delegdes is
that the best interests of the American people, our patients,
would be served by the repeal of the present PSRO leg-
islation. It is also believed that this i s consistent with our
long-standing policy and opposition to this legis'ation
prior to passage."
0 Attempts to repeal PSRO "would be fruitless."
0 A policy of repeal or one of nonparticipation
would hinder efforts to amend the PSRO law or
to modify regulations.
0 Such a position would weaken AMA efforts to
influence pending and future health legislation.
0 PSRO repeal would still leave the medical pro-
fession subject to other legislative controls.
0 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., HEWS 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
would 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
progra m.
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 also
AAPS members arranged for Rep. Philip Crane (R., 111.) -
primary circulator of the letter appealing to AMA to
support r e p e a l - - t o come to Anaheim. He was given
permission to speak to the House of Delegates at the
morning session on Wednesday. He said it is "qbsolutely
not true" that a campaign to repeal PSRO would be fruit-
less. He stronqly disputed orquments that the AMA
would weaken its influence on other legislative matters
if it pursued repeal.
AMA Executive Forced To Back Down
Contained in Report EE of the AMA Board of Trustees
and Council on Medical Service, submitted to the House
of Delegates at Anaheim, Calif., is the statement that
"at all times the House of Delegates determines As-
sociation policy" and that "it is the role of the Coun-
cils, committees, and the Board of Trustees to implement
this policy."
During the PSRO hearing before the Reference Com-
mittee 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 (Go.) 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 de-
terioration 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 car-
ry out that directive. He said he received equivocal and
Rep. Crane's speech "turned the iibjse
around." Delegates from six states -. Cali-
fornia, Illinois, Michigan, Kentucky, Louisiana
and New York - joined i n drafting the amend-
ment to Report E E that put the House of Dele-
gates ckarly on the side o f abolition o f PSRO
by repeal.
Otto K. tnqelke, M.D., De'eqate from Ann Arbor, Mich.,
orose to "especially thank Congressman Crane for ap-
pearing before us at this session and getting us back
on the track." Dr. Engelke urged the House to adopt
the Michigan State Medical Society position +o comp-'gn
for 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 re-
view programs of "proven effectiveness" should not
"be dismantled by PSRO implementation." And it urged
state and local medico1 societies to "take all legal
s= 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 i n its lawsuit to outlaw PSRO by
filling amicus curiae briefs in support of the
suzt.
unresponsive answers from Executive Vice President Ernest
B. Howard, M.D.
Stated House W a s 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 hod decided it was impos-
sible 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 let-
ter from Dr. Howard in which he stated that he had, in-
deed, made such statements in Atlanta.
When Dr. Heard finished his remarks at
the Reference Committee, an angry Dr. Howard
accused him of a personal attack o n him and
challenged DT. 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 resolu-
tion with me. If I had had the wording, I would have in-
dicated my agreement with it. The discussion at the Atlanta
meeting concerned the wisdom of attempting to per-
suade the public to support our concern about PSRO. I
 indicated that such an effort would fail because the
public would not understand the technical implications
ot this comp’ex act and because there was no implementa-
tion at this time t o 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 cam-
paign and my comment in Atlanta, therefore, was incor-
rect.”
When Dr. Heard had finished, Dr. Howard
acknowledged he was forced “to eat crow grace-
fully,” to admit he had indeed accused the
House o f being wrong and had said staff could
iiot cany 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 prob-
able deleterious facets of the PSRO legislation in our
Congressman Crane Declares
That PSRO Repeal Is Possible
“1 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 cost a vote on it.”
That pungent observation opened the address of Rep.
Philip Crane (R., 111.) 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 out-
set,” he said. “And in my judgment that’s what
the Administration has done, that’s what the
medical profession has done, the health insur-
ance 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’.”
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 to any
implementation of the law. The examples that you sug-
gest which would be deleterious (invasion of confidenti-
ality ... 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 will ’dehumanize‘ medical care. In
other words, we do not have the documentable data to
support our misgivings (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 will 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 obvi-
ously 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.”
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 psy-
chiatrist‘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 leader-
ship that attempts to repeal PSRO would be fruitless, a
position AMA management said was buttressed by rank-
ing 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 o f what’s happened - and that
even includes members of the Ways and Means
Committee who don’t understand what PSRO
is all about.
 "This i s not a lost battle. There is no r e a
son why you cannot explore a variety o f 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
u p a bad law. You can do both simultaneously."
In an apparent reference to the lawsuit filed by AAPS
in federal court to outlaw PSRO, Rep. Crane said that
another option open to the AMA was to "contemplate
working through the courts."
Rep. Crane also attacked the position of the Board
of Trustees that a policy of nonparticipation 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 are re-
sponsive to their local constituencies. Furthermore, he said,
"you can go on record as a national 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. Crane urged physicians to alert their patients to
the dangers of the PSRO law. "Patients are voters," he
pointed out. "And if you alert them to the danger, then
you can 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 of PSRO would leave
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 wanted the A M A to work to abolish the law by repeal or court action or
they wanted it retained, with AMA continuing collaboration on implementation. Here are excerpts from pro and con
arguments during the Dec. 5 session of the House of Delegates.
-0-
James M. Sammons, M.D., Chairman, Board of Trus-
tees (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, W h a t in your opinion is the political
viability, the chance of success of Mr. Rarick's bill or
similar bills asking for repeal of PSRO?' The uniformity
of their answers I think is important. Uniformly it was
that it has absolutely no political viability whatsoever.
We asked why. The answers given us were - ( 1 ) the law
has not even been put into effect . . . and is not going
to be repealed until it has been tried; (2) with massive
expenditures (for Medicare and Medicaid) we must have
some assurance that quality is being delivered, and (31
we must have some control over the ever expanding
utilization." Dr. Sammans added they were assured PSRO
amendments would be given "adequate hearings."
W. Charles Miller, M.D., New Orleans, La.: "1 would
like to thank those who selected Disneyland - the land
the medical profession still subject to other legislative
controls, present and future.
"Well, to be sure that's a possibility," said Rep. Crane.
"But let me just tell you one other thing, and that is, - 3
we are going to draw the battle lines on principles -
and in my judgment that's how they should be drawn -
the best way calculated to permit the government intrusion
that could ultimately destroy your profession is to get
compliance. You draw those battle 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 battle drawn on
those lines, I can assure you they will be on your side.
"And I can assure you beyond that, that once they
are on your side, the politicians will back off in a hurry."
Rep. Crane cautioned against the despair
of "inevitability". "I think the most pernicious
doctrine i n Washington today is a certain feel-
ing of despair over the inevitability of legisla-
tion. That doctrine of inevitability is the most
pernicious dogma that Karl Marx ever advanc-
ed."
"I'm telling you," he said, "there are good ideas and
right principles, and if you people who are most immedi-
ately affected will not be in the vanguard of fighting
that battle, then to be sure, we may be down the tube;
it may be simply a matter of time and they'll take us
salami style - a slice today and a slice tomorrow and
a slice the next day."
Rep. Crane made 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 battle b e c a E
patients are going to be concerned about this."
of fantasy - as the appropriate setting to discuss the
matter we have today. Louisiana deeply feels that for
those who feel that they can control federal law once
it is started and can amend it to their satisfaction and
can indeed exist with it, we suggest you are indeed in
fantasyland. We further feel ... this organization should
be responsive to the people back home. The position the
AMA has taken on PSRO has encouraged people to look
for other sources to defend their positions and their
rights." Dr. Miller then submitted an amendment t o Re-
port EE to add a repeal section. The substance of his
proposal was later adopted.
Morgan Meyer, M.D., Lombard, Ill.: Offered two amend-
ments 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 law." Dr. Meyer said
his amendments "would encompass the somewhat splinter-
ed atmosphere we've had in the House and the splintered
atmosphere we've had back at home . . ."
Otto K. Engelke, M.D., Ann Arbor, Mich.: "I want
especially to thank Congressman Crane 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.
Matthew Marshall, Jr., M.D., Pittsburgh, Pa.: He noted
' that the Pennsylvania delegation overwhelmingly rejected
1 the proposition to repeal PSRO and added that physicians
would be able to control PSROs.
Joseph F. Boyle, M.D., Los Angeles: Agreed that repeal
would be in the best interests of the people "but 1 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, among 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 major energy in attempting to effect re-
Deal 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. 1. "That just isn't true. Senator Curtis (Sen. Carl T.
Curtis, Nebraska Repub'ican and member of the com-
mittee) told me that it wasn't true. The majority of the
Finance Commitee didn't know what was in PSRO any
more than members of the House Ways and Means Com-
mittee 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 re-
peal 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-
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 physicians at the meeting. Here are excerpts of testimony at that
Dec. 3 meeting.
-0-
H. Thomas Ballantine, Jr., M.D., Boston, Mass.: He
brought gams 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 'ow
had been tested many times.
John Heard, M.D., Atlanta, Go.: 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 AMCI
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
men will be mightily encouraged if our p r i m r y thrust is
toward repeal.'' (His statement was greeted with loud
applause from the delegates.)
Richard L. Meiling, AD., Columbus, Ohio: Noting that
Ohio State Medical Association has developed a success'
ful computerized peer review system "for protedion of
the public," he said the Ohio Association does not sup-
port PSRO and "hopes that it might be repealed."
Donald N. Sweeney, Jr., M.D., Detroit, Mich.: ' W e in
Michigan 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
working for repeal." He added the primary goal of AMA
should be repeai, with freedom to work for amendments
to PSRO and to influence rules and regulations until re-
peal can be accomplished.
Thomas Porker, 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 s y the
striking message I got from hearing Congressman Crane
this morning is of long-range importance rather than
short-range application to this problem. The message I
got from him was that I shou!d, if there were any con-
ceivable way possible for me to d o it, go home to my
district and send someme 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.
right to know what kind of propaganda is going t o be
sent out from the AMA itself."
Robert B. Hunter, M.D., Sedro Woolley, Wash., a trus-
tee and chairman of a Bwrd 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 AngeleJ: "The main reason
PSRO is of such interest is because we are questioning
the policy we took under a crisis type of situation o year
ago when we decided to take a leadership ro!e in im-
plementing 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 example,
challenging the constitutionality of this law. W e have an
obligation to challenge its constitutionality on behalf of
our patients." He noted that the Los Angeles County Medi-
cal 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, including 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
is to begin an energetic campaign seeking repeal of the
law." He urged A M t o 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 institu-
tion. 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.
Elmo Boyd, M.D., Shreveport, La.: "Why should we en-
dorse something again just because we blindly endorsed
it the first time." Dr. Boyd noted news story that Sen.
Bennett had verbally flogged AAPS for criticizing PSRO
and had made certain assertions about the law. Dr. Boyd
read what he described as '%ln English translation'' of the
law t o 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 Ifand present to you the wisdom of our
M u s e of Delegates," which favors abolition of PSRO.
Urban H. Eversole, M.D., Boston, Mass.: He said he was
"speaking for the entire New England delegation'' 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 bod."
Ralph S. Emerson, M.D., 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 oractical, sensible approach we can take."
George Himler, M.D., New York, N.Y.: The author of
the notorious Himler Report that advocated downgrading
private 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 are going to oppose it."
Willard C. Scrivner M.D., East St. Louis, Ill., a member
of the National 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 re-
peal 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 be-
cause 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 re-
pealed. He relaxed tensions by punctuating pertinent
points with repeated witticisms.
Theodore Grevus, M.D., Rock Island, 111.: "Failure to
repeal the law at this time is never to repeal the law."
He said he hoped the Reference Committee in its sum-
mation "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 imple-
menting 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."
Walter Buergerf M.D., Covina, Calif.: He urged dele-
gates to "stand on principle" and seek abolition of PSRO.
"if we do fight for repeal, we will not stand alone." For ex-
ample, 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 California
of effective control of expenditures and violate the con-
stitution. He pointed out PSRO was enacted "almost with-
out 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
Physician Retires In Protest Over PSRO
In 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 !etters 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 H05-
pital. The news reports on Dr. Hayes' decision said
other physicians at the hospital share Dr. Hayes' feel-
ings 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 recommen-
dation and voted to elect members of the Board of Trus-
tees 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 will affect election
of trustees next June. The resolution adopted to provide
at-large elections was referred to the Council on Con-
stitution 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., Portland, Ore., is named President-
Elect. 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. Chenoult, M.D., Decatur, A'a.; Ray-
mond 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 headquar-
ters from Chicago to washington, D.C. A special com-
mittee has been studying the matter. The Board at its
meeting in Anaheim, Calif., in December approved a
recommendation of the committee that Association head-
quarters remain in Chicago.
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
21 1 1 Enco Drive Suite N-515 Oak Brook llllnols 60521
Frank K Woolley Executive Director
were "far less visible but far more threatening" to -the
medical profession than "national health 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."
follow the surgeon's lead.
The local medical society, however, has dedined 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
m y office, take m 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 i n a certain number of days,
and i f 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 hos-
pital."
However, the feeling apparently is that AMA needs
to beef up its Washington operation. The Board approv-
ed a committee recommendation that trustees "expedi-
tiously consider the possibility of increased support for
the AMA Washington office."
The questionable effectiveness of the AMA's Wash-
ington 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, Go., are trying to prevail in the Board to ap-
point 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
information that cannot be found elywhere.
President
312/325 791 1
I

ASSOCIATION OF AMERICAN PHYSICIANS AND SURGEONS, INC.

2 1 1 1 Enco Drive, Suite N - 5 1 5 , Oak Brook, Illinois 6 0 5 2 1 312f325-791 1

Donald Quinlan, M.D., President

Frank K. Woolley, Executive Director

Index No. 1
BULLETIN NO. 1-74 January 4 , 1974

Re: PSRO

Members have expressed f e a r t h a t t h e PSRO Law i s now i n e f f e c t and t h a t t h e y

may g e t i n t o t r o u b l e by t a k i n g c a r e of Medicare, Medicaid and o t h e r p a t i e n t s f o r
which payment may be made ( i n whole o r i n p a r t ) under t h i s Act [ S o c i a l S e c u r i t y
Act as amended] ( S e c t i o n 1151).

THE L A W I S NOT NOW I N OPERATION

Simply Stated t h e Situation i s :

-.

1. The S e c r e t a r y i s faced w i t h t h e AAPS l a w s u i t .

2. The S e c r e t a r y has n o t implemented t h e PSRO Law as f a r as imposing r u l e s and

r e g u l a t i o n s with which p h y s i c i a n s must comply o r s u f f e r some p e n a l t y , and

3. A p h y s i c i a n may c o n t i n u e t o c a r e f o r p a t i e n t s w i t h o u t adverse a f f e c t s u n t i l
such time a s t h e Law i s implemented by a r u l e p u b l i s h e d i n t h e F e d e r a l R e g i s t e r .
The AAPS e t a1 s u i t v e r s u s Weinberger, a s d e f e n d a n t , i s now being c o n s i d e r e d
by a t h r e e - j u d g e f e d e r a l c o u r t t o determine whether t h e l e g i s l a t i o n i s c o n s t i t u t i o n a l .
While t h e l a w s u i t i s pending i n c a s e t h e defendant t r i e s t o t a k e a c t i o n which
a d v e r s e l y a f f e c t s p h y s i c i a n s , w e w i l l seek i n t e r i m i n j u n c t i v e r e l i e f . The govern-
ment f i l e d a b r i e f on December 11 i n support of i t s r e q u e s t t o d i s m i s s t h e case and
t h e Association's a t t o r n e y s are c u r r e n t l y preparing a l e g a l b r i e f i n opposition
t h e r e t o . A f t e r t h e c o u r t has r e c e i v e d our r e p l y , t h e government must respond t o
our b r i e f . We b e l i e v e t h e d e f e n d a n t ' s a t t o r n e y s have f a i l e d t o s a t i s f a c t o r i l y
answer our complaint.

Even i f AAPS e t a1 had not f i l e d s u i t , t h e Law i s n o t now i n o p e r a t i o n and

cannot be put i n t o o p e r a t i o n u n t i l proper n o t i c e i s p u b l i s h e d i n t h e F e d e r a l R e g i s t e r .

There i s o n l y one p l a c e where t h e Law r e f e r s t o January 1, 1974, and t h a t i s

i n S e c t i o n 1152(a) which s a y s :

"The S e c r e t a r y s h a l l (1) n o t l a t e r t h a n January 1, 1974, e s t a b l i s h

throughout t h e United S t a t e s a p p r o p r i a t e a r e a s w i t h r e s p e c t t o
which P r o f e s s i o n a l Standards Review O r g a n i z a t i o n s may be d e s i g n a t e d
and (2) a t t h e e a r l i e s t p r a c t i c a b l e d a t e a f t e r d e s i g n a t i o n of a n
a r e a e n t e r i n t o an agreement w i t h a q u a l i f i e d o r g a n i z a t i o n , e t c . "

He h a s e s t a b l i s h e d t h e a r e a s , BUT r u l e s and r e g u l a t i o n s t o o t h e r w i s e implement

t h e Law have n o t been i s s u e d by t h e S e c r e t a r y of HEW. Also, PSRO a r e a d e s i g n a t i o n s
a r e n o t f i n a l . Proposed a r e a d e s i g n a t i o n s were published i n t h e Federal R e g i s t e r
December 2 0 , 1973 and d e a d l i n e f o r comments i s January 2 1 , 1974. Furthermore, t h e
S e c r e t a r y has n o t e n t e r e d i n t o any agreements w i t h PSROs.
 - 2 -

I n accordance w i t h t h e Law governing a d m i n i s t r a t i v e procedure (Chapter 5 551 8

e t seq. U. S. Code a n n o t a t e d ) t h e S e c r e t a r y of HEW i s r e q u i r e d t o p u b l i s h i n t h e
Federal Register a s u b s t a n t i v e r u l e n o t less t h a n 30 days b e f o r e i t s e f f e c t i v e
d a t e , except -- as o t h e r w i s e provided by t h e agency f o r good cause found and
p u b l i s h e d with t h e rule.

-
I n a d d i t i o n , under S e c t i o n 1 1 5 2 ( f ) ( l ) , t h e S e c r e t a r y of HEW must n o t i f y a l l
p r a c t i c i n g p h y s i c i a n s i n a PSRO area b e f o r e h e e n t e r s i n t o an agreement w i t h a PSRO.

Even so, f e a r h a s been expressed t h a t t h e S e c r e t a r y may make t h e r u l e

RETROACTIVE t o January 1, 1974 o r f o r t h a t m a t t e r t o October 30, 1972. When and
i f t h e l a w i s implemented should h e a t t e m p t t o make i t r e t r o a c t i v e , he would be
v u l n e r a b l e t o s t r o n g l e g a l c h a l l e n g e . The r e a s o n being t h a t t h i s would c o n s t i t u t e
an i m p o s i t i o n of s t a n d a r d s t h a t d i d n o t e x i s t a t t h e t i m e t h e medical service w a s
rendered.
G e n e r a l l y speaking, s t a t u t e s d e a l i n g w i t h m a t t e r s of a d m i n i s t r a t i v e l a w and
a f f e c t i n g r i g h t s w i l l be c o n s t r u e d a s p r o s p e c t i v e only i n t h e i r a p p l i c a t i o n . A
c l e a r l e g i s l a t i v e e x p r e s s i o n is n e c e s s a r y t o j u s t i f y a r e t r o a c t i v e a p p l i c a t i o n .

Our a t t o r n e y s a d v i s e us t h e r e i s no c l e a r l e g i s l a t i v e e x p r e s s i o n j u s t i f y i n g
t h i s Law b e i n g made r e t r o a c t i v e .

TO DO

1. S i t tight.

2. Direct B i l l .

3. C o n t r i b u t e t o t h e AAPS Legal Defense Fund (card i s e n c l o s e d ) .

4. Write your U. S. R e p r e s e n t a t i v e and S e n a t o r s t o r e p e a l t h e Law:

-
Note: Most do n o t even know what i t does. Rarick (D., L a . ) has introduced
HR-9375 f o r r e p e a l . More t h a n 10 o t h e r s have f i l e d s i m i l a r b i l l s .

5. Urge p a t i e n t s , l o c a l a s s o c i a t i o n s , e t c . , t o w r i t e U. S. R e p r e s e n t a t i v e s
and S e n a t o r s r e q u e s t i n g r e p e a l .

6. Write AMA u r g i n g Board o f T r u s t e e s and Executive S t a f f t o c a r r y o u t t h e

c u r r e n t mandate of t h e AMA House o f Delegates t o work f o r r e p e a l of PSRO.

Note: Over t h e o b j e c t i o n s of t h e Board of T r u s t e e s and t h e Executive S t a f f

t h e AMA House of D e l e g a t e s , December 5 , 1973, amended a Board
p r o p o s a l by i n s e r t i n g t h e f o l l o w i n g c l e a r , unequivocal langauge:

"The c o n s i d e r e d o p i n i o n of t h e House o f Delegates i s

t h a t t h e b e s t i n t e r e s t s of t h e American people, o u r
p a t i e n t s , would b e s e r v e d by t h e r e p e a l of t h e p r e s e n t
PSRO l e g i s l a t i o n . ' I

Thomas G. D o r r i t y , M.D., J . D . Frank K. Woolley, LL.B. 9

AAPS L e g i s l a t i v e Chairman Executive D i r e c t o r
I
THE VOICE FOR PRIVATE DOCTORS
Medical Staff Council
Joins AAPS in Lawsuit
The Council of Medical Staffs, a New Orleans-based
mtional organization representing medical staff phy-
sicians, has announced it will join in the lawsuit filed by
AAPS et al in federal court to outlaw the Professional
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.
Like AAPS, CMS has consistently opposed the in-
iquitous PSRO law.
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 contribu-
tions, CMS is the first that has decided to join AAPS in
attacking the law in federal court.
INSIDE
0 Nixon Wants Doctors Permanently
Control led
0 AMA Trustees Turn Down Repeal
0 Resolution Deadline
0 Amendment to By-Laws
0 Illinois Family Physicians Contribute
to AAPS Lawsuit
0 Fiscal Irresponsibility Prevails in
Washington
0 Gouging by Government
0 Ma iIing Reminder
0 Bring Your Wife
Index No. 9
February - March 1974, Volume 28, No. 2
ISMS Votes To Work For
Repeal Of 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.
0 To mount a massive statewide public informa-
tion campaign to acquaint Illinois residents and
Illinois congressmen and senators of the del-
eterious effects that can be expected from PSRO.
0 To dismantle the Illinois Professional Standards
Review Organization which ISMS created last
year to help the federal government implement
PSRO in Illinois.
0 To establish a voluntary, physician-directed peer
review system in Illinois that will function better
than anything d e v i s e d 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 t o direct the Board of Trustees to
encourage other medical groups that have applied for
recognition as PSROs to withdraw their applications.
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 warnings 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 inter-
ference, government or otherwise.
It is apparent that the AMA collaborationist position
is becoming more and more unpopular.
Another noteworthy aspect of the ISMS House meet-

ing was the absence of AMA officers, trustees and high-
level staff. On several occasions in the past they have
attended medical society meetings for the explicit pur-
pose 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 J. Derwinski (R-Ill.) at-
tended the meeting and advised the ISMS
trustees and delegates to work hard for
repeal of PSRO.
I t will be remembered that Mr. Der-
winshi was one o f the original signers o f
a letter f r o m some 40 members o f Con-
gress that was sent to the A M A House o f
Delegates in Anaheim last December urg-
ing the House to go o n record unequivocal-
ly i n fauor o f PSRO repeal.
Mr. Derwinski was one of two signers
who yielded to pressure f r o m A M A lobby-
ists and withdrew his n a m e f r o m the
letter. Now he is saying what he really
thinks, not what AMA officials want him
to say. I t is clear that w h e n anyone under-
stands what PSRO is all about they are
opposed to it.
Meanwhile, local societies continue to join the list of
PSRO opponents. Latest to add their names to the list are
Clinton County (Iowa) Medical Society and Brazoria
County (Texas) Medical Society.
Nixon Wants Doctors
Permanently Controlled
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 gov-
ernment 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:
0 Announced that his Administration intends to
keep wage-price controls locked on physicians
and hospitals but w i ’ l lift them on everything
else except petroleum when the present wage-
price control law expires April 30.
0 Sent to Congress his new scheme to nationalize
medicine (”an idea whose time has come in A-
merica,” he called it). The scheme would allow
states t o set physicians’ fees, drug prices and
hospital charges and would extend those vicious,
punitive PSRO controls beyond the elderly and
indigent to encompass everyone - practicing
physicians and a 1 their patients.
Within two weeks after those anti-medicine actions,
the President let the medical profession know again just
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 nation-
alized and permanently bound in government controls.
“Our health insurance proposal would
call for states to ouersee the operation o f
insurance carriers and establish sound
procedures for cost control,” said the mess-
age. “Until these and other controls are
in place, I recommend that our present
authority to control health care could be
continued. I a m 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-2970
by Sen. Robert Packwood (R-Ore.) and as HR-12684 by
Rep. Wilbur Mills (D-Ark.) and Herman Schneebeli (R-
Pa.). Mills said his name is on the bi’l because the
President asked him to introduce it.
Three-Part Scheme
It is a three-part scheme. The first part would require
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,
but they could not offer a nonapproved plan. Employees
could refuse coverage.
The second part of the program would cover low-
income 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 com-
piling materials for the Association’s PSRO lawsuit
and assisting attorneys in meeting a March 1 1 dead-
line for replying to a government motion to dismiss
the suit, we are combining the February and March
issues of the News Letter into a single issue. The
time devoted to, preparation of materials for the
reply was important because the thoroughness of
our response could be a critical factor in the out-
come 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 abandoRed.
Employees covered under the first part of the pro-
gram would pay a fixed set of deductibles, while those
in the low-income groups would pay a range of deducti-
bles tied to income levels.
Medicare beneficiaries would also pay fixed de-
ductibles, 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, nation-
wide system of paying for health care by credit card.
Participating physicians and hospita’s 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
- FuI I Participating Providers, Associate Pa rticipating
Providers or Non-Participating Providers.
Physicians w h o elected to become
full participating providers would agree
to accept a patient’s “healthcard as the
sole means of reimbursement and to ac-
cept the level o f payment established by
government as f u l l reimbursement for
patients under all three parts o f the plan.
An associate participating provider
would agree t o the same conditions, with
one exception - he could collect a n ad-
ditional f e e f r o m patients covered under
the employer-employee insurance program
i f he gave prior notice to the patient. He
would hase t o accept fixed fees as full
payment for services to the indigent and
elderly.
A non-participating provider, accord-
ing to a W h i t e House information sheet,
“would not be reimbursed front any ap-
proved plan f o r serifices provided.”
It should be noted that physicans will not beable
to ovoid government controls by electing to become o
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 ap-
plicable 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 administrative functions by direction of
the HEW Secretary, including certification of providers
and ”establishment of the reimbursement rates and stand-
ards 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.
“ I t is also important to understand,”
said the document, “that the CHIP plan
preserves basic freedoms f o r both the pa-
tient and doctor. The patient would con-
tinue to have a freedom o f choice between
doctors. T h e doctors would continue t o
work f o r their patients, not the federal
government.”
EVERY PHYSICIAN WHO VALUES HIS PROFESSION-
AL 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 By-
Laws by adding the following to Article 13, Paragraph 6,
Page 15, after the paragraph ending “. . . and to any sub-
sequent lawful order.”:
”Moreover, the members of this Association sub-
scribe 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.”
 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 con-
tinue 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 dele-
gates and alternate delegates and others who attended
the House meeting in December believe that is exactly
what the House meant.
I t has also been reported to AAPS
that officials of A M A went to Washington
early in February and told several m e m -
bers o f Congress to ignore as “a lot o f hot
air” the action o f the House o f Delegates
in Anaheim in adopting the position that
the best interests o f physicians and their
patients would be served b.y repeal o f
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 inter-
pretation of the House of Delegates action at the 1973 Clin-
ical Conventiosn that does not include a n overt, i m m e -
diate campaign for repeal of PSRO. Instead, the trus-
tees will propose amendments to the law in an attempt
to mitigate objectionable features.” And if you doubt
the trustees are still deluding themselves they can still
get consideration from HEW officials by collaborating,
they said this: ”And they will coordinate AMA efforts to
bring about an orderly implemention of the PSRO pro-
g ra m.”
A Number of Contradictions
Many physicians undoubtedly will detect several
contradictions in the positions of the AMA on various
rslated issues. For example, trustees and officers at Ana-
heim (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.
Summons, 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
if HEW went ahead with the proposed regulation.
A M A President Russell Roth, M.D.,
attacked the proposal as legally, ethically
and medically wrong, and a “direct threat
to the medical care o f the 35 million or
so people who are covered by Medicare
and Medicaid.” He pointed out hospital
admissions for these patients would no
longer be certified by a patient’s physician
but b y a committee. And that would con-
stitute illegal interference in the practice
of medicine, he said. Dr. Summons was
described as fuming. He said the issue i s
“who’s going to m a k e the medical j u d g -
m e n t that Aunt Susie is sick enou,qh to be
treeted in the hospital.” He said he would
have “grave doubts” about serving o n such
a review committee to decide whether to
admit n patient he hadn’t even seen.
ihe contradiction arises, glaringly, because every-
thing Dr. Roth and Dr. Summons said about the pre-
admission certification proposal can be said with equal
accuracy about the PSRO law.
PSRO Eaen Worse
PSRO requires a committee to determine in advance
whether hospitalization is medically necessary. The com-
mittee can overrule the judgment of the attending phy-
sician. Even worse, PSRO authorizes a committee to deny
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-
forming services for the attending physician‘s patient was
not doing anything that was not medically necessary. All
this obviously constitutes illegal, unethical and morally
wrong interference in the practice of medicine.
But not only have AMA officers and trustees refused
to ioin AAPS in its lawsuit to outlaw PSRO, shunned the
very thought of filing suit on their own and steadfastly
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 wage-
price controls on physicians. These controls were described
by Dr. Summons 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.
Summons 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?”
W h a t right indeed? W h a t right do
 th.ey have to do these things in the name
of either price c o n t r o 1 or professional
standards review?
Added Dr. Sammons, ”These are not economic con-
trols . . . they are political controls . . . we intend to
fight them down the line.”
Just short of PSRO?
Did H E W Back O f f ?
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.
I t developed, however, that H E W 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 pro-
cedures which meet the requirements of
the law and can still be effectively im-
plemented.” But a February 12 announce-
m e n t in the Federal Register, complained
the AMA, “‘merely extends the time for
comments on the original proposal.”
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
the PSRO law, although, as Dr. Roth admitted at a news
conference January 25, “we (AMA officials) decided to
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 delib-
erate effort to cooperate with H E W over the last four
or five years, but “of late, we‘ve had nothing but rebuff
after rebuff.”
MAILING REMINDER
Mail for AAPS continues to be sent to the Assoc-
iation’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 AAPS that forwarding orders are
cancelled after one year, and then mail is returned
to the sender.
Please check your records to be sure they reflect
the AAPS Oak Brook address as shown at the bottom of
the last page of this News Letter.
IIIinois FamiIy Physicians
Contribute to AAPS Lawsuit
The Illinois Academy of Family Physicians has con-
tributed $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
Academy were convinced of AAPS‘s sincere and con-
tinuing effort.
In a letter to Illinois State Medical Society, John
Holland, M.D., Chairman of the Academy Board of Direct-
ors, said “it has now become apparent that this is, in-
deed, the fact, and it also appears that there is consider-
able and ever growing popular support within the pro-
fession for the repeal of this legislation.. .”
Dr. Holland added: ”This action has been taken be-
cause of the recognition that excessive and perhaps in-
appropriate control and regulation interferes with the
delivery of health care and may very well have the end
result of diminishing the quality of health care being
F k i d e d the public.”
GOUGING BY GOVERNMENT
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
to an HEW publication, the Social Security Bulletin.
This year, the price skyrocketed to $10.45, an increase
of 250%.
RESOLUTION DEADLlN E
Resolutions for consideration by the House of Dele-
gates at the Private Dcctors 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
18-20 at the Drake Hotel in downtown Chicago. Resolu-
tions should be in regular reso,lution form and, if possible,
typewritten double spaced.
BRING YOUR WIFE
Mrs. Jackie Anthony, President of the Auxiliary to
the AAPS which meets with us, urges you to please bring
your wife to the April meeting. The advice and experience
of our wives will be of great importance in plans of the
Auxiliary to supplement our home town efforts to alert
and arouse the public to the dangers to it inherent in
the present Federal medical policies.
1
Fiscal IrresponsibiIity and spends more than 40% of everything
everyone earns in America.
Prevails in Washington
The President proposes to spend $28.6 billion Qn

I President Nixon’s inflationary $304 billion budget,

with an estimated $9.4 billion deficit built in, demon-
strates that fiscal irresponsibility i s still the order of
the day in Washington. Additional proof is the fact that
more than a third of that budget - $1 1 1 billion - i s pro-
posed to be spent by the spendingest federal agency
of them all, the Department of Health, Education and
Welfare. That incredible $1 1 1 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 H E W budget o f $ 1 1 1 billion
is almost 10% of the total personal in-
come o f the American people. Further-
more, the $304 billion added to the total
that will be spent by state and local gov-
ernments means that government taxes
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 $1 4
billion in 1973.
Mr. Nixon also expects to spend $125 million in
1974 and 1975 promomting 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!
1 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

21 1 1 Enco Drive Suite N-515 Oak Brook llllnols 60521 312/325-7911
Frank K Woolley Executive Director
 THE VOICE FOR PRIVATE DOCTORS
NEWS LEl‘’rX3l3,
AAPS Says HEW Coerces Patients
A memorandum of law filed by AAPS et al in the PSRO lawsuit accused the federal government of telling millions of
Medicare and Medicaid patients that if they don’t submit to government regulations, they or their doctors will have to
pay for their health care, even thovgh the regulations viol ate their constitutional rights.
AMA Board Names
Dr. Sammons EVP
In what Washington Report on Medicine Er
Health called “an awesome power play,” the AMA
Board of Trustees selected Chairman James H. *Sammons,
M.D., to succeed E. B. Howard, M.D., as AMA’s Executive
Vice President. Dr. Howard is slated to retire March 1,
1975. Dr. Samrnons, 47, who ascended through AMPAC to
AMA Board Chairman, beat out Richard S. Wilbur, M.D.,
in a bruising battle spanning five days and requiring 19
bollots. Final vote was 9 to 5.
Richard E. Palmer, M.D., was elevated from Vice
Chairman to Chairman, replacing Dr. Sammons, who re-
signed from the Board to take on staff duties April 1.
John M. Chenault, M.D., was elected Vice Chairman. His
wife is on the AMPAC Board of Directors, noted Wash-
ington Report.
The Board also voted to abolish the position of
Deputy EVP held by Dr. Wilbur, who was generally re-
garded at one time as the heir apparent to Dr. Howard.
Said Washington Report: ”Wilbur forces are bit-
ter about what they claim was a leading role in the coup
by Joe D. Miller, Assistant Executive Vice President of
AMA and guiding genius of AMPAC. Miller, the highest
ranking non-physician in AMA, is now seen more firmly
entrenched as a power behind the throne. The Sammons
forces struck suddenly.. . The election had been expected
to take place next month . . .Things to watch for will be
the reaction of AMA rank-and-file to the power play and
use of such ’gut issues‘ as PSRO and National Health
Insurance by Sammons to consolidate his hold on the
steering wheel.”
Index No. 4
April, 1974, Volume 28, No. 3
The memorandum of law was filed March 1 1 in
opposition to a government motion for summary judg-
ment in favor of the defendant, HEW Secretary Caspar
Weinberger.
The memorandum pointed out that PSRO could deny
patients the treatment their physicians deemed necessary,
could deny paitents freedom of choice of physician,
would jeopardize privacy and confidentiality of the phy-
sician-patient relationship, would force “norms” of di-
agnosis, care and treatment on physicians, and would
subject physicians to coercive sanctions which would de-
ter and hinder them in advising and treating their Pa-
tients.
“In essence,” said the memorandum,
“the defendant Secretary is saynig to mil-
lions of elderly and indigent Am-ericans,
and the physicians w h o care f o r their heal-
th, that i f they do not want to take the
benefits o f federal health care reimburse-
m e n t under such regulatory conditions
as Congress deems necessary, regardless
o f their private rights and interests that
may thereby be burdened, they are free to
pay for such health care themselves.
“That, o f course, is not a realistic alter-
native for most o f them. Fortunately, the
Constitution and Courts o f the United
States forbid the defendant to present
them with such a dilemma.”
Under previous ruling cf the three-judge federal
INSIDE
0 AMA Board Names Dr. Sammons EVP
0 New Bill Attracks Medical Freedom
0 HEW Soliciting PSRO Contracts
0 CMA Votes Repeal
0 Prefer AAPS to AMPAC
 court, the government was given 10 days to file a reply.
The extended discussion of cost control in Secre-
tary Weinberger’s written arguments in support of his
motion for summary judgment, said the AAPS document,
“leaves no doubt that the legislation in question was
designed to limit the demand made upon the resources
of such programs (Medicare and Medicaid) by circumscrib-
ing the health care services provided by physicians to
patients who are eligible under them.”
A NOVEL SCHEME
To, that end, AAPS asserted, “Congress has creat-
ed an elaborate and novel scheme of prior restraints
on physicians‘ diagnosis, treatment and care of patients
who are potential Medicare-Medicaid beneficiaries.”
Furthermore, said the memorandum, ”Plaintiffs allege that
subjecting their pro,fessional judgments and conduct to
prior restraints on the basis of any system of pre-set
norms of diagnosis, treatment and care will seriously
impair their ability to render, and their patients‘ abil-
ity to receive, health care in accordance with the highest
standards of medical practice.”
HEW itself recognizes that PSRO will radically change
medical practice in America, said the memorandum, ci-
ting a study - ”PSRO: Organization for Regional Peer
Review” - conducted by Arthur D. Little, Inc., under con-
tract with HEW. The study, released last year, concluded:
“Legal constraints, public demands, and profession-
al attitudes made it impossible to justify two standards
of medical care in our contempory society. The consult-
ing panel (for the study) understood P.L. 92-603 to man-
date professional review only for the beneficiaries of
the Social Security Act. More importantly, the panel
appreciated that this restriction, except in terms of dollar
support for the activity, is literally impossible.
”The norms of care and most of the forms of pro-
fessional audit developed for federal beneficiaries under
PSRO will ultimately be applied to all private medical
services. In addition to their inherent resistance to sep-
arating ’federal care’ from ’medical care,’ as evidenced
by the common extension 0.f utilization review to private
hospital care, physicians are aware of the public and
legal pressures to extend PSRO norms and reviews to the
entire private health delivery system.“
INTERFERES WITH RIGHTS
The memorandum said, ”the Professional Standards
Review Act constitutes an arbitrary, irrational and over-
broad interference with the constitutionallv arotected
rights of physicians and patients.” It noted that if phy-
sicians do not conform their decisions to government im-
posed norms and other requirements, they will be subiect-
ed to a variety of sanctions set out in the law, including
financial penalty, stigmatization through publicity, denial
of the right to treat Medicare and Medicaid patients
and harassment from PSROs and o,ther organizations
having influence over the allegedly offending physicians.
Futhermore, the law does not recognize
that “under any system o f pre-set norms
of medical diagnosis, treatment and care
the government might create, there will
be patients w h o do not fit the mold, are
not average, and their physicians will have
to depart from the norms in treating
them--if they are courageous enough to
run the risk of economic sanctions and
professional stigmatization in the event
that those in charge of enforcing compli-
ance with the norms disagree with the
departure.”
Congressional sponsors of PSRO sought to justify its
enactment by claiming it was necessary to control costs of
Medicare and Medicaid and to curb fraud. But AAPS
argued that ”the Supreme Court has held in a variety of
contexts that the state‘s interest in cost control and pre-
vention of fraud, abuse, and overuse of public spending
programs does not justify an overbroad and undiscrimin-
ating interference with the private rights and interests of
those who are beneficiaries or recipients.”
PSRO constitutes a n assault o n the con-
fidentiality o f private patient records, the
memorandum charged, pointing out that
physicians “will be required to disclose
extensive data concerning each patient
they treat. . . and PSROs are empow-
”
ered “to examine the ‘pertinent’ records
o f a physician and inspect the facilities in
which he renders care . . . ’’
Plaintiffs allege, according to the m e m -
orandum, “that the disclosures o f confi-
dential information required by this law
will substantially hinder t h e m in their
treatment o f their patients, and that this
violation o f the privacy of the physician-
patient relationship i s not constitutionally
justifiable.”
There is a long line of federal court cases begin-
ning in 1889 clearly showing that such far-reaching in-
fringement in the physician-patient relationship as author-
ized by PSRO violates fundamental constitutional prin-
ciples.
The memorandum pointed out that a Supreme Court
justice made these pertinent comments on the prevailing
side in a recent case:
”The right of privacy has no more conspicuous place
than in the physician-patient relationship, unless it be in
the priest-penitent relation. It is one thing for a patient
to agree that her physician may consult another physician
about her case. It is quite a different matter for the
state compulsorily to impose on that physician-patient
relationship another layer, or as in this case, still a third
layer of physicians. The right of privacy - the right to
care for one’s health and person and to seek out a
physician of one’s own choice protected by the Four-
teenth Amendment - becomes only a matter of theory
not a reality when a multiple physician approval system
is mandated by the Senate."
Medicine by committee was also questioned in an-
other federal case, which said:
"With respect to the three-physician requirement,
plaintiffs further contend it infringes upon the fundamental
right of physicians to administer necessary health care
to their patients. They assert that the First, Ninth and
Fourteenth Amendments protect the right of physicians
as well as every other citizen to pursue his chosen pro-
H E W Soliciting PSRO Contracts
It's later than you think!
HEW, with the AMA standing in the wings and eager
to get in the act, is now ready to start imposing PSRO con-
trols on the nation's elderly and indigent and the phy-
sicians who take care of them.
The federal agency said that now that the 203 PSRO
oreas have been established, it is soliciting contracts:
0 With prospective PSROs to plan the way they will be
set up and run.
0 With PSROs on a "conditional designation" basis.
0 With statewide "Support Centers," such as medical
foundations organized and controlled by state
medical associations, to "stimulate and support the
development and operation" of PSROs and the PSRO
program.
Thus, the flimsily disguised lure of federal dollars
is dangled before state medical associations to trap them
into becoming, indirectly, paid agents of HEW to force
PSRO controls on physicians and patients in their states.
(A number have, like AMA, asserted a willingness to be
trapped to get federal dollars.) And being paid by HEW,
they will do HEW'S bidding. Support Centers, said HEW,
will carry out their assignments "in a manner consistent
with the legislative intent (as interpreted by HEW, natur-
ally) and the policies of the Secretary (of HEW)." (Note:
In many cases medical society and foundation executives
are the same, and medical society executives have met
nationally to figure out the best way to siphon federal
money into society coffers.)
BATTLED LOSING CAUSE
AMA battled a losing cause trying to force HEW
to recognize statewide PSROs all over the country. The
Support Center idea was seen as a sop to the AMA and
those medical society executives hungry for a share of
the millions of tax dollars that will be spent through
PSROs to control doctors and force them to practice rned-
icine under bureaucratic edict.
The AMA doesn't want to be denied o slice of the
tax pie either. The March 18, 1974, A M A Newsletter
fession free from necessary interference from the state.
"Undoubtedly, physicians should be free to practice
their profession and to exercise their professional dis-
cretion subject only to such regulations as are necessary
for the protection of legitimate public interests. It is un-
deniable in this case that the disputed provision infringes
upon this right. In fact, the provision seeks to subordinate
the attending physician's judgment to that of two other
physicians without any showing that it effectively advances
a legitimate state interest . . . "
noted the Board of Trustees had approved a proposal
to develop guidelines of care, "to be funded by HEW."
Said the newsletter, "the criteria, which will be used by
PSROs, are being developed by national medical spec-
ialty societes through the AMA Advisory Committee on
P E . " Criteria means the norms of medical practice that
will be forced on physicians and the conditions under
which they will be required to practice.
BOTH HANDS OUT
That's only one AMA hand out. The other has been
out for months for money from HEW to operate a PSRO
personnel training program. In this light, it should be re-
membered by a11 physicians that it will be lay employees
(the kind AMA wants to train) who will do most of the
PSRO dirty work - snooping through private medical
records in physicians' offices, taking steps to force doc-
tors to justify their case-by-case Medicare/Medicaid
medical decisions, turning in physicians for real or fan-
cied infractions of the law omr regulations and reporting
them to HEW for discipline, and calling on numerous
public and private organizations to help harass phy-
sicians into complying with directives and regulations.
Physicians should also be warned that
H E W plans a m u c h deeper involvement
in the practice of private medicine through
PSROs than deciding whether a particular
medical procedure was necessary. HEW
intends also to rule whether the procedure
was the right one for the ailment. I f you
doubt it, read OPSR Memo # 3 , March,
1974, from the Office of Professional
Standards Review in H E W .
That m e m o clearly states that condi-
tional designation contracts with budding
PSROs will require them to review "the
q&ty, necessity and EppLoopriateness of
medical care provided. . . ''
In addition, HEW intends to force the use of non-
physician health care practitioners in the PSRO review
system. That could mean chiropractors, since they now
are defined as physicians in the Social Security Law.

New Bill Attacks
Medical Freedom
Sen. Edward M. (Ted) Kennedy and his ideological
fellow travelers, are determined to destroy private medical
practice one way or another. It is apparent that his col-
laboration with labor bosses, whose bidding he does with-
out question, isn't going to yield the full-scale socialized
medicine they so passionately want.
So, Ted Kennedy is going to try to de-
stroy priuate medicine another way. He
has introduced legislation ( S . 2994) de-
signed to wipe out medical freedom in the
guise of health planning.
S. 2994 is as vicious in concept as the dangerous and
deadly PSRO law. It would create health Dlannina aaen-
" V
cies within prescribed areas of each state. They would
function under direction of state health commissions, which,
in turn, would be regulated and controlled by the Secre-
tary of HEW.
These statewide commissions, serving as agents of
HEW, Would:
0 Certify all existing and proposed health services,
wielding power to decide which would and which
would not be certified.
0 Determine how existing and proposed services
would be organized, allocated and distributed.
0 License all health facilities and all "health care
delivery personnel." Apparently they would usurp
the authority of other state agencies, including
medical examining boards.
0 Set standards for health care facilities and "review"
the "performance of health services."
0 Fix rates "to be used for reimbursement for health
services" and "regulate all reimbursement of health
care providers.. . "
CMA Votes Repeal
While AMA trustees and officers keep telling every-
one they don't intend to carry out the House of Delegates
directive for repeal of PSRO because repeal isn't "viable,"
medical societies keep demanding PSRO repeal.
The House of Delegates of the 24,280-member Cal-
ifornia Medical Association - second largest in the na-
tion - thunderingly rejected the AMA collaborationist
position (an increasingly minority position) and adopted
what the leadership stated was a "clear, clarion call for
repeal" of PSRO. Obviously, they do not buy the de-
featest posture of AMA trustees and officers. They pro-
claimed that the House vote calling for repeal "could
not be ignored or misinterpreted" by the AMA.
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
21 1 1 Enco Drive Suite N 515 Oak Brook Illinois 60521
Frank K Woolley Executive Director
The House of Delegates also took recog-
nition o f the AAPS lawsuit in federal
court cltallenging constitutionality o f
PSRO. Delegates instructed C M A officers
to explore the possibility of legal action
against PSRO.
(Note: Physicians should be aware that when AMA
leaders declare that repeal of PSRO isn't "viable," all
they are saying is that they don't intend to undertake
the lobbying effort that would be necessary to turn con-
gressional sentiment against repeal into the majority
vote that could achieve repeal. Veteran lobbyists know that
thousands of bills have passed state legislatures and
Congress over the years that were opposed by a majority
of members when they were introduced. When a veteran
of the lobby wars says a particular legislative goal isn't
possible before he tries, what he is saying is either that
he doesn't intend to try or that he isn't adequate for
the task.)
Entire Society Joins AAPS
All 28 members of the Chillicothe (Ohio) County
Medical Society have become members of the AAPS.
In a move spearheaded by Paul MacCarter, M.D., the
members of the society decided to join the AAPS rather
than contribute to the Ohio Medical Political Action
Committee, a satellite of the American Medical Polit-
ical Action Committee.
In other action in support of AAPS programs to
protect the practice of private medicine, the medical staff
of the South Coast Community Hospital in South Laguna,
California, donated $500 to help in the AAPS lawsuit
seeking to overturn the PSRO law. The contribution was
sent in by A. W. Orlandella, M.D., Chief of staff.
Veteran AAPS Member Dies
James L. Anderson, M.D., Miami, Fla., specialist
in neurology and psychiatry, has died. Dr. Anderson,
who had retired from active practice, served as a mem-
ber of the AAPS House of Delegates for several years.
He was a member of the Association for 29 years, having
joined in 1945, two years after AAPS was founded.
For Individual Liberty and Responsibility,
A
/
Donald Quinlan, M.D
President
Enclosures: One page, two sides brochure on Private
Doctors Institute
Reservation Card
317/325 791 1
 THE VOICE FOR PRIVATE DOCTORS
NX3W@LETTS3R
Senator Bennett Ballyhoos PSRO :
A A P S A g a i n Calls F o r 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 t o be a forum for Sen Wallace Bennett (R-Utah) to ballyhoo PSRO, sweet talk wit-
nesses w h o support PSRO (like A M A s Robert Hunter, M. D.) and to rail at those w h o denounce it as bad l a w and
TMA Files Suit
To Outlaw PSRO
Texas Medical Association filed suit in U.S. District
Court in Austin, Tex., May 8 challenging the constitu-
tionality of the PSRO law. The suit, similar to the one
filed last June b y AAPS, also charged that HEWS PSRO
regulations are “arbitrary, capricious and discrimina-
tory,” and that enforcement of PSRO w i l l undermine
the rights of physicians and their patients.
The TMA complaint alleged that if HEW is allowed
to proceed w i t h imp!ementation of the PSRO law,
Texas physicians w i l l suffer ”irreparable harm and
injury.“
The Texas Medical Association is the first medical
association to follow the AAPS lead and attack con-
stitutionality of PSRO in federal court, although others,
including California Medical Association, have flirted
with the idea.
The Council of Medical Staffs has filed amicus CU-
riae 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.
Index No. 5
May, 1974, Voclume 28, No. 4
seek to abolish it (such as AAPS witnesses).
There was abundant evidence that the hearing w a s
set u p 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 propagan-
dizing PSRO, harangued adverse witnesses, praised
those supporting PSRO, interrupted other senators,
conducted most of the questioning by prior arrange-
ment w i t h 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 o f one
reluctant witness w h o 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 coer-
cive and punitive. Therefore, it cannot be satisfac-
torily amended. It should NOT be implemented. I t
should be abolished. W e are asking the federal
court to declare it unconstitutional and we are ask-
ing Congress to repeal it.”
INSIDE
0 Misrepresentations Mark Debate
0 AAPS Dues Raised
0 AAPS Delegates to be Nominated
More Associations Favor PSRO Repeal
Support for Lawsuit
Oath is Availab!?
 Later, he said: "I can assure you, Mr. Chairman,
most doctors in this country are not being fooled or
hoodwinked 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 t o 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 i s a bad law. We know that misrepresen-
tations about it by its promoters and propagandists
w i l l continue because it i s so bad there has to be a
cover UP."
Dr. Quinlan also said that:
0 The PSRO law will require "standardized" medi-
cal 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 con-
vince their o w n patients the government i s r'ight
and they, the doctors, are therefore wrong."
In certain cases, the patient may be denied the
doctor or hospital of his choice.
0 "Doctors licensed b y the states w h o are now free
and ethically obligated to practice medicine of
the highest quality w i l l be forced to follow cen-
tral government bureaucratic direction and,
therefore, be denied the right o f providing pa-
tients w i t h the best care of which they are ca-
pa b Ie."
0 The purpose o f PSRO is to entrap doctors in a
system of government-imposed controls, but it
w i l l be patients w h o will be trapped. "They, not
the doctors, w i l l suffer most because medicine
compressed into a standardized mold by politi-
cal pressure will not be first-class care. Who will
be deprived of first-class care? Obviously the
patient, not the doctor".
0 "The gssence, the substance, the very purpose
of this law is control. It is intended to smother
the medical profession in uniformity established
by bureaucratic fiat."
0 PSRO w i l l "condone wholesale violation of the
privacy od records o f any patient of any physi-
cian who takes care of Medicare or Medicaid
patients." Officials are n o w hiding the truth. The
plain truth about confidentiality i s "that this per-
nicious 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 fur-
ther, in his opinion, the purposes o f the law ...
the plain truth i s that the PSRO law w i l l protect
individuals w h o 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 b y HEW
before the law was enacted as HEWS PSRO "Bible,"
Senator Bennett interrupted to shout angrily: "I chal-
lenge that."
Mr. Woolley was referring to a study b y 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 w i l l result in ra-
tioning o f medical care, i s ?he precursor t o control of
4 medical care, should apply to all private practice,
and is designed to insure uniformity, modify individ-
ual 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 dis-
tributed to the Senate Finance Committee and HEW
officials had never referred to it. The senator sudden-
l y 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 con-
tract but a public contract and that HEW representa-
tives actively participated in development of conclu-
sions for the book.
When Senator Curtis was allowed to continue ques-
tioning, 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 a~ all," responded
Mr. Woolley. He said, for example, that before
PSRO physician participation in review activities
was voluntary. Presumably participation is volun-
tary under PSRO, but practically it is involuntary.
He pointed out that a physician can now avoid in-
volvement 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 re-
quirements 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 differences there would be no need f o r
PSRO, so "why don't you repeal it?"
Misrepresentation Continued
The hearing was also the occasion for PSRO propa-
gandists such as Senator Bennett, HEW Secretary Cas-
par Weinberger and Henry Simmons, M.D., HEW'S
PSRO chief, to continue misrepresentations about the
law that has been characteristic o f 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 physi-
cian-patient relationship." He called PSRO a mechan-
ism for "assuring that the quality of medical care de-
livered to people eligible under this statute is high"
and that there will not be "an unnecessary or- waste-
ful or improper payment o f 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 effect,
for trying to inform the profession and the public
how bad PSRO is.
A M A 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 atmos-
phere . . ."Dr. Hunter said part o f the kit was "need-
lessly inflammatory" and had been withdrawn b y
AMA.
Misrepresentation Marks Debate"
"One of the less admirable aspects o f the debate
over nationalizing medicine is that the arguments
are often laced w i t h fraud, deceit and misrepresen-
tations," 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 pro-
claim government programs are needed because there
is a crisis in health care," Doctor Quinlan said.
"They loudly trumpet that health care is a right.
AMA's schizoid attitude toward PSRO was glaringly
evident a t 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 o f efforts o f many, including AMA, to sell the
profession on PSROs, doctors aren't buying it. "The
fault does not lie w i t h the sincerity or intensity of the
effort to cooperate," he said, "it lies w i t h the basic in-
eptitude of the statute."
Understanding of the law, however, has not per-
suaded the A M A leadership to get on the repeal band-
wagon (at least 20 state medical associations have
called for PSRO repeal). Dr. Roth remarked that "re-
sponsible accomplishment of a successful program i s
the objective of all of us." He confessed that A M 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 go-
ing 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 sugges-
tion is that you need the troops to win this war, and
we're losing the troops."
AAPS was not entirely alone among medical organ-
izations in the belief that the law i s 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 b y CMA
"express the deep concern of our members over the
absolutely disastrous effects on patient care that they
loresee w i l l very surely and very rapidly follow upon
the heels o f the implementation o f PSRO." He added:
'I. .
. our association has concluded that Section 249F
of Public Law 92-603,PSRO, represents bad law that
cannot be amended satisfactorily except b y its outright
repeal."
"And they assert they are moved to act in response
to public clamor for a change in the health care
system."
Doctor Quinlan emphasized, however, "There is
no health care crisis in the United States. There is
6
- public outcry for change. There i s no public de-
mand for Congress to dismantle our present system
and build a European-style system on the wreckage.
"But there is widespread despair over the bureau-
cratic bungling and rising costs that characterize Medi-
care and Medicaid."
The AAPS President told the committee that As-
 sociation members "'are appalled that Congress is
n o w considering further political intereference into
the private lives of citizens in the form of socialization
of medical care for a l l patterned after the failures of
Europe. Stripped of the excess legalistic language, the
proponents o f socialized medicine in America seek
to use the power of Congress to force everyone to
pay more to government and get less due to bureau-
cratic interference, and all because o f a trumped-up
'crisis' in health care. There i s 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
w h o w i l l appear before this Committee promoting
more political direction and control of medical care
are government employees? How 'many 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 mem-
bers of Congress, can do it."
Confidence Shaken
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 unimagin-
able billions for socialized medicine would be seri-
ously advanced at this time, based on the assumption
that all Americans should be dependent on govern-
ment employees for medical care." He said that all
of these proposals for politicalized medicine are based
on an assumption which is fraudulent. The assump-
tion consists of t w o parts:
First that all citizens, not just people over 65
years of age and people with low incomes, are in-
competent 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 self-
reliant Americans who produce the goods and serv-
ices upon which government depends.
Second that only government employees are com-
petent to choose the proper and appropriate phy-
sician and hospital for any citizen and determine
what is medically necessary for him. Furthermore,
that substituting the choices of government clerks
wiU result in more and better service at less cost.
I n other words, the assumption is that political-
ized medical care, with control by government em-
ployees, is better than private care.
Doctor Quinlan challenged proponents of national-
ized medicine to point to any proof eith:z< in this
country or abroad that their assumption is valid. He
said the fact is there i s 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 w h o has piled this inflationary
problem squarely upon the American housewife-the
bureaucracy o f the federal government which these
proposals before you would empower to spend even
more money. Huge additional spending through gov-
ernment when government spending is the source of
grinding inflation which hurts low and fixed income
citizens is absurd.
"HEW is scheduled to spend $ 1 1 I billions 'in 1975
without any more authority. That is more than all
spending for defense-more than all the profits o f a l l
corporations after taxes and more than all the govern-
ment spent for everything in 1960. Such w i l d spend-
ing, not doctors, is the basis of inflation.
"1 repeat: There is no public demand for change."
Clever Demagoguery
Doctor Quinlan declared that the assertion has been
made so often that health care i s a right that it has
become a cliche. "No one endeavors to define the
term," he said. "It is just solemnly intoned as one of
the eternal truths of mankind.
"What it is is a clever bit of demagoguery. It is
clearly intended to w h i p 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 i s being denied to them and the govern-
ment w i l l guarantee that right by nationalizing medi-
cine. 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 b y
the doctor w i t h 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 gov-
ernment may wish to pay for my services on behalf o f
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 w o u l d
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 o f 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 is-
sues. "Medicare, in our opinion, is a classic example
o f Congressional decision which was not grounded
on a studied evaluation of the consequences of the
decision," Doctor Dorrity said. "Most members of Con-
gress now realize this.
"Over and over again in the years before Medicare
was enacted, Congress w a s warned by medical, insur-
ance and financial experts that the program would be
enormously more costly than its proponents claimed.
HEW'S o w n actuary told this committee that Medicare
would swiftly go bankrupt unless taxes were in-
creased 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 i s
that Congress dropped the Medicare bomb on a na-
tion 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 w i t h 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 in-
flation 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 ex-
penditure 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 deduc-
tibles and coinsurance that so displease Senator Ken-
nedy, you're not talking just about socialized medi-
cine, you're proposing national disaster.
"But suppose Congress goes ahead, unmindful
of consequences, and confiscates enough of the earn-
ings of the American people to put this kind of
reckless program-even at $126 billion-into ef-
fect. 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 some-
thing for nothing through the political process.
Also, it would further undermine individual respon-
sibility and strengthen bureaucratic control.
"The demand for health care created b y such a pro-
gram 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 t o
even begin to cope w i t h the demand that would fol-
low 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 goverment-
controlled program of health care that w i l l explosively
drive up costs by unleashing an uncontrollable artifi-
cial demand and, as its tragic result, debase the qual-
ity of medical care for all Americans. America can d o
better than follow the patterns of failure of Europe."
AAPS Jhes Are
Raised To $30
Dues for regular AAPS membership have been in-
creased 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 de-
claring that "all cost; of all things have risen dispro-
portionately in the past several years" and "it i s 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 as compared to increased member-
ship dues o f practically a l l 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:
0 Urging repeal of the so-called Kefauver law
which "confers unjustified authority on the FDA
to interfere w i t h the judgment of practicing phy-
sicians in their choice of therapeutic agents . . ."
Approving item - b y -\item reimbursement for
money spent by the Public Relations Committee
for projects approved by the Executive Com-
mittee.
Directing the Board, the Finance Committee or
a special committee to develop a membership
card that w i l l allow a member to pay a desig-
t
nated amount in addition to regular dues that
can be forwarded to a local chapter for its finan-
cial assistance.
Alaskans Ask Repeal
I Support For Lawsuit
Citizens for Quality Medicine, an Alaska-based or-
ganization dedicated to keeping open the greatest
variety of choices to users of medical services and
products, has joined w i t h 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 w i l l go through June. The campaign w i l l
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 b y sending
telegrams to their congressmen and to Rep. Wilbur
Mills (R.-Ark.), Chairman of the Ways and Means Com-
mittee.
AAPS Delegates
To Be Nom-hated
Enclosed w i t h this News Letter is a form for the
nomination o f candidates for membership i n the
AAPS House o f Delegates. The Association Bylaws
provide for nomination and election o f delegates
every t w o years. It must be accomplished before the
1974 Annual MBeting October 31 - November 2 in
New Orleans, La.
This is an important assignment. Every member is
urged to nominate several AAPS members and re-
turn The list of nominees to AAPS headquarters
promptly.
After the Nominating Committee has verified avail-
ability of the candidates, ballots will be sent out
for the election in July.
M o r e 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 t o aibolish PSRO.
ANNUAL MEETING, New Orleans, Louisiana, October 31 -November 2, 1974
ASSOCIATION OF AMERICAN PHYSICIANS AND SURGEONS
21 1 1 Enco Drive Suite N-515 Oak Brook Illinois 60521
Frank K Woolley Executive Director
The Medical Society of Georgia withdrew an ap-
plication for a PSRO contract. Among county medical
societies, the Montgomery County (Ohio) Medical So-
ciety went on record in opposition to PSRO.
The Tennessee Medical Association, The Charleston
(S.C.) Medical Society, and the Richmond (Va.) Acad-
emy of Family Physicians have made financial contri-
butions to AAPS to help in the lawsuit challenging
constitutionality of the PSRO law.
K. K. Carter, M.D., President of the TMA, wrote:
”1 believe the legal mechanism is the way to attack
the government and realize it is expensive. I think
w e 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
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.
Forrest J. Babb, M.D., West Lafayette, Indiana, a
family practitioner, has been elected President o f the
Indiana Chapter of AAPS. Dr. Babb joined AAPS in
1962.
For Individual Liberty and Responsibility,
Donald Quinlan, M.D.
President
Enclosure: Notice of Nomination of Delegates
31 2/325-791 1
I

THE VOICE FOR PRIVATE DOCTORS

i NEWS LETTER

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 i s so hard to believe that any
group of Americans-even those politicians w i t h 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-
tors can give them. It is so hard to believe anyone
AAPS Suit Hearing would want to give government bureaucrats the p o w -
er to make medical decisions and to punish doctors
Set For September who disobey their orders.
'The three-judge federal court trying the A A P S law-
suit against HEW Secretary Caspar Weinberger chal-
But That's PSRO
lenging constitutionality of the PSRO law has set oral
'arguments in the case for 2 p.m. September 17, 1974.
And if the public finds it hard to believe h o w bad
The hearing had been set for June 12, but it ap-
this law is, physicians may find it difficult to believe
parently was set over until September because of the
illness of t w o of the judges and because of the sum- the lengths to which politicians bent on destruction
mer recess. of medical freedom will g o to achieve it.

Meanwhile, AAPS will, if necessary, seek to obtain

preliminary relief to bar HEW from any action to in-
terfere w i t h patients or physicians before the courts
finally decide the case. AAPS w i l l not tolerate inter-
ference w i t h patients' right to receive or physicians'
right to give their best medical judgment and care on
a confidential basis.
The hearing in September w i l l be on the question
of whether the court should grant the government's
motion to dismiss the suit. Written briefs have been
filed b y AAPS in opposition to the motion and by the
government in support od the motion.
INSIDE
0 AAPS Suit Hearing
House May Alter A M A PSRO Policy
Eleven in Race for A M A Board
0 Worth Remembering
0 Solons Ask Repeal
Reds interested in AAPS
0 Truth Makes Him Angry
Nevertheless, AAPS has evidence that:
0 Witnesses have been "bought" with tax money
by members of the Senate Finance Committee
staff to testify in support of PSRO because there
were too many voluntary witnesses signed up
to denounce PSRO at a subcommittee hearing.
0 One influential member of the Finance Com-
mittee staff - Jay Constantine - has made the
cold, blunt statement that "I don't care what I
have to d o to organized medicine to make this
thing work."
0 Threats appear to be a substantial part of the
repertoire o f bureaucrats and politicians t o t r y
to compel doctors to drop their opposition t o
PSRO and make it work the way the bureau-
crats want it to work.
I
Not long ago, a member of the National Profes-
sional Standards Review Council-the organization of
physicians intended to create the appearance that the
I medical profession will have a lot to say about PSRO
I
rules and regulations-addressed a medical meeting
in St. Louis about NPSRC activities. He said the first
time he met Jay Constantine, he asked w h y success-
ful voluntary peer review programs had to be pushed
aside to bring in PSRO. He said Constantine looked
him in the eye and said: " I don't care uhat I have to
do to organized medicine to make this thing fPSROI
work."
-
Throw You To Wolves
Later, the Council member related, Constantine told
him the Senate Finance Committee staff was "getting
heat from the liberals i n the Senate" and that if there
weren't "enough" PSROs going by the time of the
AMA Annual Convention in June, "I'm going t o urge
the Senator (Senator Wallace Bennett of Utah) to get
an amendment to his amendment (PSRO i s 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 some-
one 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 Con-
stantine, 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 opera-
tions 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 ac-
cepted 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 o f the Finance Committee,
nor any other member of Congress, House or Senate,
for that matter, seems remotely concerned over Con-
sta'ntine's obsessive interest in forcing PSRO on the
medical profession and the American people. But a
f e w doctors, at least, f i n d it a bit odd, and ominous,
that a paid employee of a congressional committee
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, "1
think he .has the most rigid type of obsession against
organized medicine."
Threats & Intimidation
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 t o these
threats when the Association testified against PSRO
May 9 before the Health Subcommittee of the Senate
Finance Comimttee.
AAPS President Donald Quinlan, M.D., noted
that at an American College of Radiology meet-
ing last January attended by Senator Bennett,
Constantine and Henry Simmons, M.D., chief of
H E W S PSRO office, threat after threat was
tossed at physicians that if they didn'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 un-
less 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, w h y would such tactics (threats and
intimidation) be necessary?"
He added that AAPS isn't going t o 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 constitu-
tional limit or restraint on governmental intrusion
into the private affairs of citizens. Those w h o 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 i s undesirable even to try.
AAPS, however, is determined to find out through
legal means whether politicians have become so pow-
erful that they can w i t h impunity suspend or ignore
the limitations of the Constitution.
 House M a y Alter
AMA PSRO Policy
As the time approached for the opening of the an-
nual meeting of the AMA House of Delegates at the
Palmer House in Chicago, it became less and less cer-
tain that the Delegates would permit the A M A leader-
ship to continue collaborating w i t h HEW to force PSRO
on the unwilling profession and unknowing public.
By June 10, a total of 13 resolutions calling on
A M A to work for outright repeal of PSRO had been
sent to A M A for introduction in the House by nine
states and one individual. There is no equivocating or
hedging in these resolutions. In effect, they want of-
ficers, trustees and staff to quit using the weak ex-
cuse that repeal i s "not viable" because that is no
more than an excuse to keep on collaborating w i t h
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 Con-
gress 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 A M A trustees and staff represents a viewpoint
that is far in the minority among A M A members. And
there are some physicians who believe that the contin-
u i n g policy of collaboration and refusal to work for
repeal is pursued in defiance of the wishes of the
House o f Delegates.
By June 10, these states had introduced repeal
resolutions - Idaho, Oklahoma, Indiana, Nebraska,
California, Louisiana, Florida, South Carolina and
Georgia. Another w a s submitted b y Edward J. Wiater,
M.D., California delegate.
O f 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 A M A had
carried on "three years of concerted opposition" to
PSRO before it was enacted.
As a "progress report on PSRO, the document fails
to note that AAPS had filed suit attacking constitution-
ality 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
in federal court challenging constitutionality of the
law. AMA specifically adpoted the basis for relief as-
serted by AAPS in its complaint filed in Illinois in
June a year ago. Significantly, the TMA complaint
certified that 76.5% of a l l 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 of-
fered legal assistance to any state society seeking
to overturn PSRO area designations. Significantly,
- offered to help any society,
however, AMA has not
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 A M A members were announced candidates
for six seats on the Board of Trustees, and a 12th
was being urged b y 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. Hol-
den, M.D., Washington, D.C., and Donald E. Wood,
M.D., Indianapolis, Ind. John R. Kernodle, M.D., re-
signed in January, and James H. Sammons, M.D.,
resigned recently when the Board chose him to suc-
ceed E. B. Howard, M.D., as Executive Vice President.
The other vacancy resulted from the decision o f Max
Parrott, M.D., Portland, Ore., t o 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, 111.; Joe T. Nelson
M.D., Weatherford, Tex., and James M. Blake, M.D.,
Schenectady, N.Y.
 Worth Remembering
"Collaboration w i t h PSROs in the hope of avoiding
harsher legislation is ill-fated, futile and dumb!"
i
That was the opening sentence of a letter to the
American Medical News June 10 by Arthur S. Mode,
M.D., Greenwich, Conn. Dr. Mode urged physicians
to stand firm against PSRO and tell the world "we
won't cooperate w i t h something bad" so doctors
can "preserve our integrity."
Dr. Mode's closing observation i s worth remem-
bering. "One thing Patrick Henry never said was:
'Give me some money today and I'll fight for liberty
tomorrow'.)'
SOLONS ASK REPEAL
The Florida Legislature has adopted a resolution
memorializing Congress to repeal the PSRO law. It
is the third time a legislature has called for PSRO
repeal. Similar resolutions have been adopted by
legislatures in Tennessee and Kentucky.
Reds Interested In AAPS
The following letter was received at AAPS head-
quarters recently from the director o f a government
library in Moscow, Russia:
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 w i l l make you mad."
An APPS member in New York spoke to a colleague
who had not sent in his AAPS dues and received an
unusual response.
The colleague said he would mail in his dues okay,
but he didn't want to read AAPS publications any-
more because they make him very angry. The reason
they make him angry, he said, i s that what they say
is a l l true.
CORRECTION
The May 1974 AAPS News Letter erroneously re-
ported that a contribution w a s made by the Tennes-
see Medical Association to the AAPS lawsuit chal-
lenging the constitutionality of PSRO. The contribution
was made personally by TMA president E. K. Carter,
M.D. He, in no way committed TMA to support the
AAPS lawsuit.
For Individual Liberty and Responsibility,

"Our library makes efforts to purchase periodical

publications of your country on medicine and re-
lated subiects. Would you be so kind as to send us
sample copies of t w o current issues of your publi- Donald Quinlan, M.D.
President
cation, AAPS Newsletter, in order w e could examine
and decide whether or not w e should purchase your
publication. Thank you in advance for your kind at-
tention to this matter."
Enclosure: Annual Meeting Brochure

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

ASSOCIATION OF AMERICAN PHYSICIANS AND SURGEONS

21 1 1 Enco Drive Suite N-515 Oak Brook Illinois 60521 312/325-791 I
Frank K Woolley Executive Director
 THE VOICE FOR PRIVATE DOCTORS
I Nz3W@Lm3l'l'E_tc
Facf of Life
AAPS Suit Best Way To Stop PSRO
The AAPS lawsuit challenging constitutionality of PSRO has emerged as the most feasible means of ablishing 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, A M A leaders were quietly
New PSRO Pamphlet From
AAPS Aimed at Patients
Enclosed with this News Letter is a new AAPS pamphlet --
PSRO The Great - Sickness Eip Off - designed as
Political -
another weapon in the continuing fight to abolish the
malignant PSRO law This new pamphlet is specifically
intended to be used to educate the people, your patients, 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 100,
$22 for 200, $50 for 500 and $90 for 1,000.
For further information, see story elswhere in this News
Letter.
INSIDE
0 New A M A Policy on PSRO
~
0 Patients Respond To PSRO Pamphlet
0 Board Is Warned That MDs Are Discontented
0 Rep. Rarick Comments On AMA's Capitulation
0 AAPS Speakers Bureau
Index No. 7
July, 1974, Volume 28, No. 6
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 Houseaction, summarily rejecting the
hope and desire of a vast maiorily 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
AMA members and to every other doctor in the country thaf
they must look elsewhere for protection from oppressive
government intervention in the practice of private medicine.
When they do look elsewhere they will see that there is a
nationwide organization of doctors left that will not abandon
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 law; 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.
A l l AMA component medical societies and all
individual physician members of the A M A who embark
on active programs aimed at repeal of PSRO should
note and note well that they can count on all-out.
opposition from the leadership of the A M A - - mem-
bers of the Board of Trustees and high-level staff. Even
before the final capitulation of the House of Delegates
ot the Annual Convention in Chicago, A M A 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 this 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
counb societies were on record unequivocally favoring
outright repeal Since it i s now official policy of AMA not to
work for repeal, there is every reason to assume AMA
lobbyists, s p e n g 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 relecting
repeal and adopting a quisling policy of collaboration with
government to force PSRO controls on the nation
Millions of dollars of contracts with HEW were at stake!
Under one million-dollar contract, AMA will develop
standards of diagnosis and treatment :o be forced on
physicians and their patients by enforcement of the iniquitous
PSRO law. A M A 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 A M A leaders concocted a parliamentary
scheme by which the House was bamboozled into adopting
an unequivocal collaborationist policy which, one physician
observed, made the A M A a department of HEW.
But the contracts between AMA and HEW were signed
June 29 - - just three working -
days after the H o u s e f
Delegates vote.
It is likely that HEW and A M A 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 k n o w n 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 signed 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 pressure tactics
of the A M A 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 A M A delegates that in his opinion repeal of PSRO
could not succeed. Dr. Crane invited Bradley to step forward
and deny the report if it was not true. w e y did not d e n y 3
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
Tentioned PSRO only to say that to him the initials meant
"Politicians Should Remain Out."
The vote committing AMA to forsake the notion'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 wos 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
The victory for the pro-PSRO forces was also achieved by
the defection of a significant number of delegates who defied
the express policy of their state associations to vote for repeal
of PSRO .
The carefully planned strategyto surrender the A M A with-
out 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 Ser-
vice, said 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.
N O 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 an AAPS member, described the event as
"the most outrageous abuse o f parliamentary
procedure and collusion I have seen so far." And John
R. Schenken, M.D., delegate from Omaha, Neb., and
also an AAPS member, requested that he be recorded
as voting against the report of Reference Committee A
because " I don't want 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 performed his task well. Not only did he
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 ncicompliance. 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 de-
bate on PSRO, "at which time," he emphasized, "1 strongly
supported efforts to implement Section 249-Fof P.L. 92-603
(as opposed to the concepts of 'repeal' and 'non-
compliance') ." 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."
New A M A 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-every-
body" 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 carefuily 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 A M A 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.
Here is the text of the new 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 p o l i t m l manipulations that
flimflammed delegates into adopfi_ng a policy inimical to the
best interests of patients and doctors and favorable to the
purposesiof
- 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
"support center" contract to help HEW force PSRO on
Fen nsy I v a ni a p hy sicia ns .
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 o specific time -- 12:57p.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-FSRO position of AMA
trustees, officers and staff.
By action of the House of Delegates, the policy of the AMA
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 besr interest of the patient; and be it
further
"RESOLVED, That individual state associations which elect
non-participation shall inot 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
constructivp alternatives to PSRO, and be it further
"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 t o 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 A M A 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 all 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 fbgront 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 A M A
trustees and staff to work for repeal. But when it was over,
Dr. Edwards, known os a liberal i n 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, i t will guarantee a deterioration in quality.
The only peer review that will serve the best interests of
the physicion 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, "foliticions _Should Remain Out." This
includes Dr. Edwards, who is obviously o politician.
Although the A M A has formally rejected abolition of PSRO
in favor of a clear-cut policy of collaboration with
government i n shackling patients and doctors w i t h
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 some time voted t o 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 allow doctors to perform peer review in
accordance with the best interest of patients and, obviously,
it is in conflict with A M A 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, M r . Auerboch 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 million dollars of HEW money to
help HEW in forcing PSRO on doctors and patients.
A n d at the time of the meeting, 128physician 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
available there i s no impropriety in serving two masters -- the
medical society and a government-controlled PSRO agency.
The obvious 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 A M A 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, w h o fought
- _
government intervention for years, have admitted pongs of
conscience at their role in establishing and running founda-
tions 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 A M A leadership i s
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 carry-
ing 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 Jay
Constantine of the Senate Finance Committee staff had
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, Pa. the American
Association of Medical Society Executives conducted a
program on "grantmanship" -- how to get government
money and how to manipulate medical society members who
oblect t o that kind of sellout.
Is the federal treasury one of the "new sources of
revenue" that A M A Executive Vice President Bert Howard,
M.D., told a reference committee last month that the Assoc-
iation must find in lieu of raising dues again?
One I S also prompted to ask: Is a quarter of a
billion dollars sufficient to induce medical politicians
and medical organization executives to abondon
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 had taken a
firm stand for PSRO repeal will be astounded to know that
some A M A delegates ignored or failed to carry out
instructions to stand fast for an AMA policy to work for
repeal. At least 20 state associations were committed to
seeking repeal. More than 100 delegates from those associa-
tions were seated in the House. Nearly 50 of them, neverthe-
less, voted against repeal and for a policy of helping destroy
Patients Respond To PSRO Pamphlet
A South Carolina member of AAPS has been making
effective use of the Association's new pgtient pamphlet -
"PSRO: The Great Political _Sickness Rip Qff."
F. M. Ball, M.D., Charleston, picked up some copies of the
pamphlet while attending the A M A Convention in Chicago
last month. In a subsequent letter he said: "1 am writing to
get more copies of the new brochure -- PSRO: The Great
-Political Sickness _RipQff. This little folder . . . has been well
received by my patients in the last 24 hours in my office and I
need more of them."
Dr. Ball 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, "1 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 1 of this News Letter).
medical freedom by forcing PSRO controls on an
unsuspecting public and an unwilling profession.
The nine-member Ohio delegation, for example, was
instructed to vote f o r a clear-cut policy of repeal. AAP5 was
reliably informed, however, that only two Ohio delegates did
not vote for the collaborationist recommendations of the Re-
-
ference Committee. They were Harry K. Hines, M.D., Cincin-
nati, and Robert E. Tschantz, M.D., Canton.
Californians 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 Medical 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 nation 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 sub-
sequent anger that delegates "did not get to vote the way
they wanted to vote." He added: "We were snookered by
some people who railroaded the whole thing."
He could have added that the American people alsb were
snookered by the medical politicians who are running the
AMA .
"PSRO: The Great Political Sickness Rip 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 yo_u and your doctor the right to decide
what is "medically necessary" and "medically ap-
propriate" for you,
Deny y~ the right to have the kind of med-
ical care your doctor thinks is best for you,
Deny you the right to talk to your doctor in con-
fidence about your illness.
I
Board is Warned that
MDs Are Discontented
Although the AMA House of Delegates malority, 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
obligations.
Item: Two members of the Board of 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., Indiana-
polis, 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., Louis-
ville, Ky. Frank Jirka, M.D., Berwyn, Ill., 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 Trus-
tees, 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 leader-
ship 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 over-
whelmingly 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 rep-
resentation 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 want-
ed retention of the traditional "slot" method.
Rep. Rarick Comments
On AMA's Capitulation
.The following 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, 1974.
Hon. John R . Rarick
Of Louisiana
In the House of Representatives
Thursday, June 27, 1974
M r . Speaker, the American people in their struggle to ,
preserve individual liberty, were handed a malor 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
Medical Association has n o w 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 nerms 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 maiqr 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 k e n . 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 all-out
war against a government-run doctors review program.
The vote supporting Professional Standards Review
Organizations (PSROs) - which a committee of the AMA's
House of Delegates said h a d created an "almost
schizophrenic division" among doctors - was overwhelming
and taken without debate
AMA trustees and officers had spent most of the
organization's annual meeting warning members thot
fighting PSROs would waste the AMA's money and was
doomed to failure.
Some officials even predicted thot o war against PSROs
could mean the end of the AMA as the voice of medicine to
the public and Congress.
" I was not willing to see funds committed on beholf of
repeal," said Dr. Malcolm C. Todd of Long Beach, Calif., the
AMA's president-elect. "It would token quite a bit of our
resources and I doubt that it would hove been successful."
Todd's view was echoed in stote coucuses today by such
other influential A M A officers os D r . Robert B. Hunter of
Sedro Woolley, Wash., a trustee and heod of the AMA's
PSRO committee, and Dr. W. B. Hildebrcqd, of Monosho,
Wis., choirman of the House of Deleggtes' committee on
medical services.
Nevertheless, it appeared until this ofternoon that
substantial number of A M A delegates would insist thot the
organization push for repeal of the PSRO legislotion and
would refuse to comply with its implementation.
The delegates swiftly voted, 185 to 57, their opprovol of o
resolution pushing for some amendments to the PSRO law,
but not calling for its repeol.
"The delegotes finolly had enough time to tolk i t out," said
Dr. George 6. Martin, J r . of Thief River Falls, Minn., choirman
of the committee thot held o 41h-hour heoring, listening to 64
speokers, on the PSRO issue Mondoy.
While most delegates appeared satisfied with the decision,
ot leost one -- Dr. John R. Schenken of Omoho -- demanded
thot his nome be specificolly recorded in opposition to PSROs.
"I don't wont my nome recorded os being in favor of
tyronny, he soid.
' I
Hunter soid he thought two stote medico1 societies --
Nebraska and louisiono -- were still "odomont" against
PSROs ond might refuse to cooperote with the federal effort.
"But a mojority of physicions across the country will work
with the government," Todd said.
In Washington, Dr Chorles C. Edwards, Assistant
Secretary for Health of the Department of Health, Education
and Welfare, commended the AMA delegates for their
"responsive and constructive position. "
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
notional insurance bill to include the entire population.
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.
Delegates argued that the amendment is keeping new
drugs off the market. The A M A gets about one-third of its
revenue from drug company advertising in its lournals.
A A P S 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
reoson, AAPS maintains a Speakers Bureau, with
knowledgeable, top-notch speakers available for
oppeara nces before meetings of medical societies or
other physicians groups or before non-physician
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 phy-
sician 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 on appropriate
speaker and for that speaker to make the necessary ar-
rangements for the assignment.
For Individual Liberty and Responsibility,
n
Donald Quinlan, M.D.
President
Enclosures: Political Sickness Rip Off Pamphlet
Pamphlet Order Form
 THE NEW YORK TIMES

SATURDAX T U N E 22, 1974

Letters to the Editor

T o the Roots of Inflation
To the Editor:
Your report by Michael C. Jensen
on June 7 of the walning by the
panel of prominent economists that
world inflation is approachin2 the
“crists stage” cited the various factors
contributing to it and pointed out that
“government borrourlng and govern-
* ment-guaranteed 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 Sommers,
chief economist of the Conference
Board, also quoted by the repoak
tended to raise the level of thinking
to embrace deeper and wider i m p l i w
tions: The real roots of inflation, Mr.
Sommers said, lie m “a profound
historical shift in the social conditions
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 rea1
solution 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 “fuuil employment”
concept, implemented by budget defi-
cits and high taxation, was assiduously
promoted by the entire liberal frater-
nity.
Thus, undue emphasis was placed on
consumption to the disadxiantage of
savings and production, and of a
sound currency. Instedd of producing
in order to consume, the mood of
society thereafter became one of con:
suming in order to pr0dilc.e. To w‘erse
the process, therefore, rcquires a new
kind of thinking, a new psychology.
Inflation may be coiistrued as demand
far outstripping supply, but it is a:so
supply prevented from matching de-
mand.
Certainly cut non-defense 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 a t the same time increase
the supply factor. of the monetary
,equation by freeing industry of all
bureaucratic meddling and persecutioik
This would include repeal of the costly
and ineffectual antitrust taws and
those taxes (such as the progressive
income and inheritance taxes) that
raise the level of industrial costs and
hinder capital accumu!ation, and are
levied not primarily for revenue but
for redistributing weaith.
Admittedly this is an ambitious pro-
gram, but if a red 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. RAYMONDV. MCNALLY
London, June 8, 1974
0

Copyrighted, 1974
New York Times Company

Reprinted with permission

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

ASSOCIATION OF AMERICAN PHYSICIANS AND SURGEONS

21 1 1 Enco Drive. Suite N-515 Oak Brook, Illinois 60521 312/325-7911
Frank K Woolley Executive Director
 THE VOICE FOR PRIVATE DOCTORS
I NEWUS LX3TTECR
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
bylaws 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 administrotion 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
0 Strong New Orleans Meeting
0 Most PSROs Tied to Medical Societies
0 M.D.s Approve PSROs
0 Resolution Deadline Set
0 IS PSRO For Lawyers Coming?
0 Amendments to By-Laws
0 Interest High in Delegate Vote
Index No. 8
August, 1974, Volume 28, No.7
an administrator who precipitated the conflict and then left
the institution). In addition, AAPS has drafted and distributed
a pamphlet delineating the rights of medical staffs and how
these rights can be defended. The pamphlet also contains a
model get 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-reach-
ing 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 mode to my letter of January 24,
1974, to you advising of a complaint lodged with the
Joint Commission on Accreditation of Hospitals by
cerrain members of the Medical Staff of St. Joseph
Hospitul 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 o f the
Governing Board, and the current Executive Committee
of the Medical Staff on January 3 I , 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 pluced before the Accreditution Committee o f the
Board of Commissioners for consideration. I have now
to advise you of the decision of that body.
The Accreditation Committee Voted:
I 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 by-
laws did occur at St. Joseph Hospital and is
 conformance with hospitol occreditotion stondords
(emphosis odded);
that the Joint Commission urge that the St. Joseph
Hospitol Medicol Staff, in consultation with the
Governing Body, develop medico1 staff bylaws
which, when
__ duly adopted by the Medical Stoff, ore
rotified by the Governing Body without uniloterol
omendment (emphasis odded);
that there be concurrence between Si. Joseph Hos-
pitol Governing Body and Medical Stoff that actions
token on Medical Staff motters during the period
when the happropriotely enocted medical staff by-
laws (emphasis added) have been followed be oc-
~
cepted and not reconsidered;
that the occredited stotus of St. Joseph Hospital
presently enjoyed be continued on condition that
the above steps are taken (emphasis added);
that the resurvey for continued accreditation now
scheduled for the last quartet of 1974 be deferred
until the second quarter of 1975;
_ _adoption
that the proper _ _ (emphosis
~ added) of med-
icol staff bylaws by the Medical Staff and their rati-
fication by the Governing Body be effected by
March I , 1975.
It was the sense of the Committee oction and my
own recommendation that the Medical Staff of St.
Joseph Hospital with primary offiliation to that
institution work actively, openly, and in good foith to
devise effective bylaws in the interest of the quolity of
patient core ond to do this in continuing concert with
AAPS Planning Strong Meeting at New Orleans
Are you tired of being pushed around3
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 voluable knowledge
about other problems,
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 quthorities 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
the Governing Body. The goal is to achieve o collegiol
self-government which recognizes the responsibility of
the Medicol Staff for the quality of medical core ond
equally its occountobility 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 foshion, the Governing
Body then has no recourse but to effect medico1 staff
bylaws on its own initiative.
I f the Joint Commission staff con in any woy be
helpful in this exercise, please feel free to call on us.
NATIONWIDE MOVEMENT
The move to reduce staff physicians to a status
subservient t o hospitol administrations hos become
nationwide, sparked by o misinterpretation of the celebrated
Darling cose in Illinois. Some of the misinterpretation has
been deliberate. As o consequence, numerous hospital
officials have been inspired to seek dictatorial control over
hospital staffs on the erroneous proposition that the odminis-
trotion is wholly responsible for medical decisions in the
hospital and, therefore, must exercise such control.
While the JCAH ruling applied to the situation at St.
Joseph Hospital and wos not generalized, it is, nevertheless,
clearly a repudiation of the stond token by many hospital
officials that the medical stoff is subservient to the
ad mi nist rotion.
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 stond up for his rights and refuse to
permit third porties to substitute their judgment for his.
iniquitous PSRO law and explain how relating the two
can enlist businessmen on the side of ethical medicine.
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
et hica I medici ne.
Panels will probe problems and how to solve them
involving such subjects as hospital-physician relationship,
PSROs, HMOs, compulsory nationalized medicine, rnember-
ship recruitment and organizing an AAPS chapter and a
speakers bureau.
If you're tired of being pushed oround, plon to
ottend the AAPS Annuol Meeting in New Orleans and
find out how to ovoid it.
Fill out the reservation form on the enclosed
Annuol Meeting _flyer
- todoy.
 Paid Agents of HEW
Most PSROs Tied to Medical Societies
A t 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
A M A House of Delegates voted in June for all-out
collaboration with HEW in imposing the iniquitous PSRO law
on the country. Many doctors are convinced 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 A M A
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 I15 medical or-
ganizations, the overwhelming majority of whom have
direct ties to state and county medical societies.
In some instances, the executive( director of a
medical society also serves as the executive of the
o_rganization that has accepted tax money to become
a n a g e n t of HEW and subject to the orders of HEW
officials.
HOW’S THAT FOR A MONUMENTAL CASE OF
CONFLICT OF INTEREST!
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 Organiza-
tion for any area ...” Section 1151 (f) (2) gives area
physicians a chance by $allot 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 case of 1 1 organizations -- which WIII
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 1 1 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
Off ice.
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.
N o (is not representative) 264.
Sacramento -- Yes 581.
N o 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 1 1 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. Ifhe does not, a case could be
made that he i s violating the law and depriving
physicians of a statutory right.
 *Five-County Organization for Medical Care 8. PSR. New Hartford, N.Y. $52.000
Among the 115 HEW PSRO agreements were 13 for a
'Genesee Region PSRO. Inc , Rochester, New York $77,000
total of $2,085,492 that went to organizations designated as 'Klngs County Hwlth Care, Brooklyn. New York $64.500
*Nassau Physicians Review. Garden City. New York $96,000
PSRO "support centers" that will be paid by HEW "for the New York County Health Services. New.York City $86.300
purpose of accelerating the development of the PSRO 'Richmond County, New York Professional Stds. Review, Staten Island $55,500
'PSRO of Central New York. Inc.: Syracuse $54.400
program." All but one of these 13 organizations that are 'Professional Standards Review Organizotion of Rockland. Nanuet, N.Y. $62.800
being paid by HEW to force PSRO controls on patients and 'The Bronx Medical Services Fotindotion. Inc.. Bronx. N.Y. $79.600
'Foundation for Medical Core of Puerto Rico. Sonturce $45,200
doctors either are state medical societies or were organized 'Delaware Foundation for Medical Care, Wilmington $45.150
by the state society or have other medical society 'Nat$onal Capital Medical Foundation, Inc.. Washington. D.C. $55.000
'Baltimore City Prof. Review Organization, Inc , Baltimore. MD $52.555
connections. 'Central Maryland PSRO. Inc , Baltimore $41.000
Delmorvo Foundation for Medlcal Care, Inc.. Salisbury. Maryland $55.720
Montgomery County. Md. Medical Care Foundation. Inc., Silver Spring $64.800
Planning agreements -- preliminary to the designation of Southern Maryland Prof. Stds. Review Orgonmt,on, Inc.. Glen Burnie $36.555
an o r g a n i z a t i o n as a conditional PSRO -- wereawarded to 91 'Allegheny PSRO. Pittsburgh. Penn. $88,217
'Central Pennsylvania Area II PSRO. Willlamsport $47,175
medical groups throughout the country. A cursory check 'Eastern Pennsylvanla Health Core Foundation, Inc.. Allentown $65,000
indicated that no fewer than 69 were linked to a medical Montoomerv/Bucks
- . Prof Stds Review Oraonization.. Inc..Norrictown
. Penn. $54.000
'PSRO Area XI1 Executive Committee, Philadelphla. Penn. $ 1 00:000
society, most having the same address as the society. 'Highlands PSRO Corporation. Johnstown. Penn. $46,600
'Southcentrol Pennsylvania PSRO. Lemoyne $54.000
'SoutJwestern Pennsylvania PSRO. Greensburg $62,500
Following are announced PSRO contract awards, 'Northern Virginia Foundation, Alexandria $57.870
asterisks denoting a link with a state or county medical *West Virginia Medical Institute, Inc., Charleston $48,000
'Alabama Medical Review. l.nc.. Montgomery $65.000
society. 'Dode Monroe PSRO. Inc , Miami, Florida $73.000
'Kentucky Peer Review Organization. Inc. Louisville $36,000
Piedmont Medical Foundation, Inc., Winston-Salem. N.C. $46,380
*South Carolina Medical Care Foundation. Columbia $60.000
STATEWIDE SUPPORT CENTERS Shelby County Foundation for Medical Care, Inc.. Memphis. Tenn. $54.000
'Chicago Foundation for Medical Core, Chicago $225.760
'Quod River Foundation for Medical Care, Joliet. Ill. $46.135
'Connecticut Medical Institute, New Haven $147,810 Calumet Professional Review Organization. Highland, Ihd. $39.200
'Massachusetts Statewide Support. Boston $289.410 *Indiana Area V PSRO. Indianapolis $51.620
'New Jersey Foundation for Health. Trenton $193.000 Genesee Medical Corporation, Flint. Michigan 136.000
'Medical Society of the State of New York. Lake Success $208,590 Upper Peninsula Quality Assurance Association, Exanoba. Mich. $45.300
'Maryland Foundation for Hwlth Care, Baltimore $97,350 '4th Area Professional Standards Review Council. Toledo. Ohio $59,000
'Region X Professlonal Review Systems. Columbus. Ohio $55,300
*Virginia Professional Standards, Charlottesvtlle 575.720 Medco Peer Review. Inc.. Cincinnati, Ohio $52.850
'Pennsylvania Medical Care Foundation. Lemoyne $243,290
'Physicians' Peer Revlew. Cleveland. Ohio $63.000
'North Carolina Medical Peer Review. Raleigh $97,760 'Region Six Peer Review Carp.. Akron, Ohio 146,000
Indiana Physicians Support Agency, lndionoplis $ 196.650 *Western Ohio Foundation fcr Medical Care, Doyton $44.330
'Michigan State Medical Society, East Lansing $100,470 'The Foundation for Medical Care, Milwaukee. WK $36.345
*Medical Advances Institute. Columbus $134,320 Wisconsin Professioncl Review. Madison $90,600
*Health Care Foundation of Missouri. Jefferson City $ 106,680 Professional Services Quality Council of Minnesota. Rochester $66,000
'Uniteb Foundations for Medical Care. Son Francisco, Calif $194.330 *Arkansas Foundation for Medical Core. Fort Smith $65.000
Central Eastern Missouri Professional Review Organization. St. Louis 161.000
Mid-Missouri Foundation. Jefferson City $64,000
CONDITIONALLY DESIGNATED PSROs *Northwest Missouri PSRO Foundation. Kansas City, Missouri $49,500
Southeast Missouri Foundation, Cape Girardeou $54.440
*The Iowa Foundation for Medical Care, West Des Moines $45.500
'Kansas Foundation for Medical Care, Inc., Topeka $47.560
*South Dakota Foundation for Medical Core, Sioux Falls $51.000
Bav State PSRO. Inc , Boston. Mass 53,205,680 East Central Los Angeles. Calif.. PSRO $78.750
*Charles River Health ,Care Foundation. Newton Lower Falls, Mass $503.420 'Foundation for Medical Care of Santa Clara County. San Jose, Calif. $74.000
'Prince Georges Foundation for Medical Care, Inc , Hyattsville. Md $212.458 *Kern County Medical Society, Bakersfield. Calif. $61.800
*MISSISSI~~I Foundation for Medical Care, Inc , Jackson $1,227,954 'North Bay PSRO, Son Rufael. Calif. $61,200
Tennessee Foundation for Medical Care, Inc , Nashville $1,626,305 'Monterey County Medical Society. Salinas. Calif. $45.485
'Foundation for Health Core Evaluation. Minneapolis. Minn $886.000 *Organization for PSR of Santa Borbara/Sun Luis Obispo Counties,
'Colorado Foundation for Medic'ol Care, Denver $2.700.000 Santa Barbara. Calif. $44.700
*Utah PSRO. Salt Lake City $951.495 'Redwood Coast Region PSRO. Santa Rosa. Calif. $74,500
*Wyoming Health Services Co , Inc Cheyenne $604.502 *Riverside County PSRO, Riverside. Calif. 656,400
Son Jooquin Area PSRO. Stockton. Calif $662.470 'Son Francisco PSRO, Inc., Son Francisco, Colif. $57,000
Multnomah Foundation for Medical Care. Portland. Oregon $662.848 'PSRO of Son M a t w County'. Son Mateo. Calif. $62.000
*Stanislaus Foundation for Medical Care, Modesto. Calif. $50.242
'Venturu Area PSRO, Inc., Ventura, Calif. $68.590
*Pacific PSRO, Honolulu, Hawaii $77.120
PLANNING ORGANIZATIONS Nevoda PSRO, Reno $38,200
'Alaska Professional Review Organization. Anchorage $72.372
*Idaho Foundation for Medical Care, Inc.. b i s e $51,200
*Greater Oregon PSRO. Portland $58,500
'Washington State Medical Association, %file $147.480
'Connecticut Area II PSRO. Inc. New Haven $66.000
Eastern Connecticut PSRO. Inc. Willemantic $63.800
*Hartford County PSRO. Inc. Hartford, Conn. $50,000
'PSRO of Fairfield County, Inc., Bridgeport. Conn. $58.650
'Central Massachusetts Health Care Foundation, Worcester $64.000
*Western Massachusetts PSRO. Inc., Springfield
Southeastern Massachusetts Prof. Standards Review, Inc., Middlebra
$46.150
S661.000
Resolutions Deadline Set
'New Hampshire Foundation for Medical Care, Concord $56.000
Pine Tree Organization for PSRO. Inc. Waterville. Maine $71.000
'Rhode Island PSRO. Inc.. Providence $62.000
'Vermont PSRO. Rutland $52.400
Deadline for sending in resolutions to be considered at
Area I - PSRO Reglon 11. Morristown. New Jersey $46,100 the AAPS Annual Meeting in New Orleans is October 11,
'Essex Physicians' Review. East Orange. New Jersey $54,000
'Possaic Volley Professional Standards Review, Clifton, New Jersey $37.000
1974. If AAPS members have resolutions they wish to be
Adirondock Prof. Standards Review 0rgonization.Gleqs Falls, N Y. $52,000 considered a t the meeting they must reach Association
'Area 9 PSRO of N.Y. State. Inc.. Purchase 157,000
'Erie Region PSRO. Inc.. Buffalo. New York $67.000
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.
M r . 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 21 1 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."
M r . Woolley said "comparable governmental interfer-
ence with the exercise of independent judgment by
attorneys" could result in:
The U. S. Attorney General imposing "norrrs of
interrogation, investigation, a no lysis, cornpromise,
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 subiected 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.)
M r . 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 submitted 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.’ “
Interest High in Delegate Vote
A n 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
ANNUAL MEETING, New Orleans, Louisiana, October 31-November 2, 1974
ASSOCIATION OF AMERICAN PHYSICIANS AND SURGEONS
21 1 1 Enco Drive. Suite N-515. Oak Brook, Illinois 60521 312/325-7911
Frank K Woalley. Executive Director
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 Nsw Orleans in October
and November.
Yours for Individual Liberty and Responsibility,
fl
Donald Quinlan, M.D.
President
Enclosures: Annuol Meeting brochure with reservation card
Representative Crane‘s Anaheim address
I

1
ASSOCIATION OF AMERICAN PHYSICIANS AND SURGEONS, INC.

2 1 1 1 Enco Drive, Suite N-515, Oak Brook, Illinois 6 0 5 2 1 312f325-7911

Donald Quinlan, M.D.. President

Frank K. Woolley, Executive Director

Index No. 10
BULLETIN NO. 2-74 September 20, 1974

CONTROL THROUGH 'PLANNING '

AAPS members were warned i n t h e September AAPS News L e t t e r about t h e s e r i o u s
t h r e a t t o medicine contained i n H.R. 16204, a b i l l designed t o use h e a l t h
11
planning" as a device t o s e t up t h e S e c r e t a r y o f Health, Education and Welfare
as medicine's c z a r w i t h d i c t a t o r i a l c o n t r o l over a s o v i e t i z e d medical system.

THIS DANGEROUS LEGISLATION I S PERILOUSLY CLOSE TO

PASSAGE I N THE CONGRESS. I T 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 I N
CONCEPT AND PURPOSE THAT I T MUST BE DEFEATED. IT
CANNOT BE MADE GOOD BY COMPROMISE OR AMENDMENT.

H.R. 16204 is t h e b r a i n c h i l d of t h e f e d e r a l bureaucracy hungry f o r t h e power

t o c o n t r o l t h e p r a c t i c e of p r i v a t e medicine i n a l l t h e a s p e c t s . It i s a n o t h e r i n
t h e p r o l i f e r a t i o n of anti-medicine b i l l s t h a t have flooded Congress t h i s s e s s i o n ,
any one o f which would d e s t r o y medical freedom and wipe o u t c o n s t i t u t i o n a l r i g h t s
o f p a t i e n t s and physicians.

For more d e t a i l on t h i s deadly l e g i s l a t i o n , s e e t h e f i r s t page of t h e

September, 1974, AAPS News L e t t e r , where i t i s d i s c l o s e d t h a t t h e r e a l purpose of
H.R. 16204 i s bound up i n t h e s e words o f t h e b i l l ' s preamble: "The achievement of
e q u a l a c c e s s t o q u a l i t y h e a l t h c a r e a t a reasonable c o s t is a p r i o r i t y o f t h e
Federal Government. I'

H.R. 16204 w a s w r i t t e n i n a subcommittee o f t h e House Committee on I n t e r s t a t e

and Foreign Commerce. The b i l l w a s introduced i n t h e House by Rep. Paul Rogers
(D-Fla.), who i s no f r i e n d of p r i v a t e medicine. The b i l l was r e f e r r e d t o t h e f u l l
committee, which gave it cursory reading and r e p o r t e d it t o t h e House with a
recommendation f o r passage.

Reports from Washington i n d i c a t e t h a t t h e Senate Labor Committee is prepared

t o r e p o r t a s i m i l a r b i l l f o r passage. I f both House and Senate pass s i m i l a r
l e g i s l a t i o n , t h e b i l l s w i l l be s e n t t o a conference committee t o compromise
differences .
 - 2 -

It i s p o s s i b l e f o r l e g i s l a t i o n t o be k i l l e d i n a
conference committee i f c o n f e r e e s from each body,
House and Senate, cannot a g r e e on one o r more
p r o v i s i o n s of t h e l e g i s l a t i o n .

T h i s i s n o t l i k e l y t o happen w i t h t h i s l e g i s l a t i o n ,
however. Consequently, if t h i s dangerous l e g i s l a t i o n
i s t o be d e f e a t e d , i t must b e d e f e a t e d on t h e f l o o r
o f t h e House o r t h e Senate.

THEREFORE, YOU MUST ACT PROMPTLY.

DON'T DELAY! HELP KILL H.R. 162041

Thomas G. D o r r i t y , M.D., J.'D. Frank K. Woolley, LL.B.

AAPS Legis l a t i v e Chairman Executive D i r e c t o r

Enclosure: PSRO AND PUBLIC RELATIONS

by M. S t a n t o n Evans
 THE VOICE FOR PRIVATE DOCTORS
W m 3 W S LErrTEa%
A
Sets U p Washington Czar
'Planning' Bill Threatens Medicine
Within the environs of the nation's capital are men and
women who have dedicated their considerable talents to
devising legislotion 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 governmentol 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 sublugated One way or
another medicine is to be run by a czar in Washington
Latest scheme to enslave the medical profession i s
wrapped up in a piece of legislation carrying the
number H.R. 16204 and bearing the title: "The
Notional Health Policy, Planning, and Resources
Development Act of 1974."
The clear oblective of this lengthy and confusing
bill i s 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 Commerc'e
Committee, chaired by Rep. Paul Roger (D-Fla.). It is a
so-called "clean" bill. This means that a blotant 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
any less dangerous.
This bill, which was referred back to the Interstate and
Foreign Commerce committee, proposes to hand out billions
of dollors 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 o vast, nationwide bureaucracy run by HEW to plan and
develop health services and health resources in every state.
Index No. 9
September, 1974, Volume 28, No. 8
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 also 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
while solving nothing. The contradition arises because Mr.
Rogers and his colleagues propose MORE OF THE SAME as
corrections for these admitted failures.
Whenever government becomes involved i n
planning, watch out. Contrary to lay understanding, in
the socializers' 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, a n d i t 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 hundreds of HEW-controlled aqencies spread
Inside
0 Acts of President Make Some Uneasy
0 OSHA Breaks Rules
0 Still Can Register For AAPS Meeting
0 Don't Forget Resolutions
0 Lacking 'Consensus', Health Bills Stalled
0 No Locally Set Norms
0 Extraordinary Delegates Vote
0 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
Acts of President Make Some Uneasy
True believers i n 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
col lectivism .
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 a particularly
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.
k c o r d i n g 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.
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
pcogram anyway. As the legislation is written, it is obvious,
too, that the authority of state health departments would be
circumvented and these agencies undermined.
This legislation is the product of the same elitist
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
conaressman and senators to work for its defeat.
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
Iradle to grave welfare 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 1 1 - story building in
Washington, D.C., housing the offices of OSHA and found
nore 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
:orrected."
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 1974'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 ore weary of being pushed
around by agents of insurance companies, hospital
administrators, government bureaucrats and other politi-
cians 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 how 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 w i l l 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 8, Comp+ry 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 8. 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
dote.
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 dead 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 AMPAC 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, Ill.,
Democrat who is trying to unseat Rep. Phil Crane, one of
ethical medicine's most loyal friends.
The Arlington Heights Herald covered the event, which
was held in Washington, D.C.
Said the Herald: "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
-BureaucratUnlikely 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 .toset standards and that government
bureaucrats are not likely to~giveup 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
impartant, stand as a warning to physicians, hospital
administrators and everyone else what kind of PSRO
standards they can expect to be forced on them.
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.
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
Extraordinary Delegate Vote
Final tabulation of balloting for membership in the AAPS
House of Delegates shows that 54% of AAPS members voted
i n the election, a n extraordinarily high degree of
participation.
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 the affairs of the
Association at a time when the determination of ethical
doctors to preserve medical feedom is being sublected 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
expected to attend the meeting.
ANNUAL MEETING, New Orleans, Louisiana, October 31 -November 2, 1974
ASSOCIATION OF AMERICAN PHYSICIANS AND SURGEONS
21 1 1 Enco Drive Suite N-515 Oak Brook Illinois 60521 312/325-7911
Frank K Woolley Executive Director
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 of
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 flat assertion that the law
"requires that each PSRO develop 'norms' of care,
diagnosis, and treatment "
The statement is untrue The PSRO low imp=
no such requirement on PSROs
It's the kind of statement that honestly should not
be made
The fact is that the A M A 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 criteria made
available to all physician groups for adaptation and used at
the local level "
Woman's Auxiliary Will Meet
The AAPS Woman's Auxiliary will meet Oct. 31 and
Nov. 1 in conjunction with the AAPS in New Orleans. The
first session at 9:OO A.M. Thursday, Oct. 31 -- o
get-aquainted coffee for a11 AAPS ladies. At Friday noon,
Nov. 'I, the Woman's ,Auxiliary is having a Luncheon at
which Mrs. Me1 Gabler of Longview, Texas, Educational
Research Analyst, will be the guest speaker.
Fun Evening for Thursday: Members will go OS
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 Li/berty and Responsibility,
Donald Quinlan, M.D
President
Enclosures: Delegates List
Reservation Form
April, 1974, Resolutions-
 THE VOICE FOR PRIVATE DOCTOR§

NEWS LECTTER
Index No. 1 1
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 wos principol sponsor of S. 3585
Medical Society Votes which, among other horrendous things, would have
forced into voluntory servitude all future graduates of
To Aid AAPS Lawsuit 011 medico/ schools that received money from the
federol government. Specifically, this bill would hove
Another county medical society has joined the list of
compelled such medicol schools to force students as o
those contributing to the support of the AAPS lawsuit to
prior condition of admission to agree to practice for
overturn the PSRO law.
two yeors ofter graduation wherever the Secretory of
Lee L. Johnson, M.D., Staunton, Ill., Secretary-Treasurer
HEW ordered.
of the Macoupin County (Ill.) Medical Society, sent AAPS a
check for $200. The decision to make the contribution was But Senator Kennedy and his far-left collaborators on
the bill found there wasn't much stomach in the Senate for
approved unanimously.
this kind of extremism and they were forced to give it all up.
Meonwhile, orol orguments on the government's
They went down swinging, however. Senator Kennedy tried
motion for dismissal of the suit were postponed for a
to win support for a compromise concocted by a couple of
month. Originolly colled for September 17, the
liberal friends, Sens. Gaylord Nelson (D-Wis.) and George
arguments were re-scheduled for October 17. The
McGovern (D-S.D.), that would have postponed this assault
deloy resulted from the deoth of one of the three judges
on the U.S. Constitution until 1980. But the Senate wouldn't
trying the case.
buy that either.
Members of the Macoupin County Medical Society
The Senate voted for an extension of federal aid to
acted in direct response to a letter sent to the presidents of all
medical schools with a provision which amounts to
county medical societies by Donald Quinlan, M.D., AAPS
resurrection of indentured service, a practice rife in Colonial
President, soliciting financial support for the lawsuit.
times which, if not legal, is at least repugnant to the spirit of
But the action was also an expression of dissatisfaction the Constitution.
with the A M A and the Illinois State Medical Society, In the version finally adopted by the Senate, medical and
particularly for failure to oppose the PSRO law, according to
dental schools, in return for federal aid, would have to agree
Dr. Johnson. to allocate 25% of their classroom space to students who
"We applaud your organization (AAPS) for the action volunteered to serve in areas designated by the government
taken in behalf of physicians who are usually too busy as "Medically underserved." These "volunteer" students
practicing medicine to fight the battle against federal control would get tax-paid "scholarships" requiring a year of
which we know will only lead to deterioration of patient HEW-dictated service for each year of "scholarship" cid.
care," said Dr. Johnson.
Two of Senotor Kennedy's co-sponsors on S.

Inside 3585, which would hove forced medicol students to

practice where HEW ordered, whether they wanted to
0 MDs Grab Opportunity
or not, flew down to Cubo to shake hands and break
0 Dr. Weston Is PresidentAect
bread with and fawn over fidel Costro, whose
0 AMPAC Helps Some of Medicine's Enemies
communist dictatorship is the antithesis of individuol
0 AAPS Chapters Important
responsibility and freedom. They ore Sen. Jacob Jovits,
0 Astounding Confession by Mills
0 Lawmakers Hurt PSRO
the New York liberal who procloims himself o
0 AMPAC Board Appointments
Republican, and Sen. Cloiborne Pel1 of Rhode lslond
whose liberal credentiols ore authenticated. This pair
0 Court Holds Control Doesn't Follow Subsidy
wants the U.S. to recognize Costro's borborion regime.
 Others who thought enough of the objectives of the bill
io put their names on it, all Democrats, were Sens.
Magnuson. Randolph, Hathaway and Clark.
It would 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 aver 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 objecting 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 physicions 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, subject 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 health 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 notion'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 b-y studying S 3585 (even though it was relected in
the Senate) that there can be a fearful price to pay when they
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 i t must be obvious to
you that a lot of people wont 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 i t
could be easily successful if a large segment of the
profession would become members and participate in
this fight against authoritorion control over the private
lives of the American people.
"If you are not already a member of AAPS, please
fake the next minute of your time to fill out the enclosed
application. By doing that, you will have token 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. Retten-
maier, G. R. Zimmerman and D. R. Somuelson. 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 ( 1 ) 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 loin 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 jobsince 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 member of AAPS, was formerly
Speaker of the SCMA House of Delegates.
Misauided 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 10 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 exploin wos why
AMPAC (whose policies ond practices are at leost
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 Woys and
Meons Committee who were recipients of the AMPAC
beneficence ore strong supporters of the goals of
Organized labor. Thot meons they ore for wild spending
programs that feed inflotion ond threaten to wreck the
State, Local AAPS
Chapters Important
The following was extracted from the AAPS Ohio
Chapter Newsletter, edited by Paul Leithart, M.D.
-e-
'You Can't Fight City Hall'
"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 take 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 unconstitutional. 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 is 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 regulotion of the
economy, they ore for destruction of the proctice of
private medicine and the substitution of government
medicine, ond they are against preserving and
strengthening America's free enterprise system.
The AFL-CIO recently published a report on the pro-
and anti-labor voting records of members of Congress. The
report noted that Rep. AI Ullman of Oregon, second ranking
Democrat on Ways and Means, voted "right" with labor 102
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 ConQress
Committee" got $2,500 of doctors' money, and Rep. Karth,
who votes the way labor wonts him to vote 96% of the time,
is using $2,500 of physicians' money to get re-elected.
N o doctor needs to be told that one of the mojor
gools of labor bosses is toto1subjugation of the medical
profession by government.
ill-informed about the controls that are designed to engulf
them.
"In discussing the federal grant with various friends, it
was obvious who was, or was not, an AAPS member. The
non-members were generally 'in the dark' about the
implications of 'Federal' funds. They did vot 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 made an astounding confession.
Mr. Mills has admitted, according to the AMA's
American Medical News, that he doesn't know how
PSRO came into being.
The Chairman of the House Ways and Means
Committee, according to A M N , was discussing
national health legislation with a delegation from A M A
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, A M N 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?"
'LawmakersHurt PSRO,'Laments A M A
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
AAPS Members Support
Friends Of Medicine
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 Representati ves.
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
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 hospital 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.
ANNUAL MEETING, New Orleans, Louisiana, October 31-November 2, 1974
ASSOCIATION OF AMERICAN PHYSICIANS AND SURGEONS
21 1 1 Enco Drive. Suite N-515 Oak Brook Illinois 60521 312/325-7911
Frank K Woolley Executive Director
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 President 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.
AMA Is Willing To
'Compromise' Again
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
pay i ng the bi II d i rectIy .
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 A M A members question
whether the so-called Medicredit Bill was a genuine,
good-faith proposal in the first place.
Yours for Individual Liberty and Responsibility,
Donald Quinlan, M.D.
President
Enclo,sures: 1973 News Letter Index
Reservation Form
 THE VOICE FOR PRIVATE DOCTORS

N1C.lWS Ll3YrTEm

Index No. 12
November, 1974, Volume 28, No. 10
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 US.
District Court -- took the case under advisement after hearing oral arguments on the goverment’s motion for a summary
Pair of Californians, Frank Rogers, M.D. (left), Whittier,
Walter Buerger, M.D., Covina, take advantage of Assembly recess
to chat about Dr. Buerger’s presentation at New Orleans Annual Meet-
ing on organizing AAPS chapters. Dr. 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.”
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.
0 The judges could grant the motion to dismiss. In that
event, AAPS would appeal the decision to the US.
Supreme Court.
0 The three-iudge 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.
0 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.
0 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 in-
terferes with a physician in the performance of pro-
fessiona’l services for a patient.
The possibility also arises that while the suit is still
pending documented evidence can be placed in the hands of
and AAPS attorneys that PSROs are exercising some degree of
control over medical decisions made by physicians. If that
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
wblished in the December News Letter.
 or attempts to force o physicion to do something or
refroin from doing something controry to his
professional judgment. Any such incidents should be
reported to AAPS heodquorters os soon os possible
ofter
_ _ _they
_ - occur.
R.R. McMohan of the Chicago law firm of Lord, Bissell
and Brook argued the case for AAPS before the three-iudge
federal court October 17. Mr. McMahan 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 on 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. McMahan answered that that was not "improper." He
said, however: "It would seem that Congless has taken the
approach in this case that the congressional intent was to
c
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-case basis, not on an after-the-fact bczis of
detecting and punishing culprits and abusers, but to control
the substantive conduct, professional conduct, of physicians
os it deals with Medicare and Medicaid beneficiaries - in
advance ."
Mr. McMahan 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 o physicion, "if. he is to
deal with o hospital that is complying with this low will
hove to comply with whot the hospitol requires in the
way of compliance with this law ocross the board,
whether or not his potient is o recipient himself."
In other words, he said, "if o hospital is to
undertoke to comply with the requirements of this low,
i t will either hove to hove two systems of in-hospitol
review, two systems of administrotion, two systems of
record keeping, two systems of norms of practice -- one
for beneficiaries ond one for private potients. Thot, os a
motter of reolity, 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. McMahan 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 i s going to depart and whether he can
defend that departure when it comes time forithe 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 woy by Don Smoot, author, lecturer ond
political onolyst, ot the AAPS Annuol Meeting in New
Orleans. He described PSRO as " 0 punitive law which
will force physicions to practice medicine by overages
and in o climote of feor -- feor of what will hoppen to
them i f they do not odhere to bureaucratic stondords,
feor of whot will hoppen to their potients if they do
adhere. "1
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., Corsicona, Texas, AAPS
President-Elect, issued the following election statement to
Associated Press, United Press International, and the three
national television networks.
"The results of Tuesday's election should 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 Bullinaton. M.D.. Phoenix, Arizona;
Memphis. Tennessee, told Annual Meeting how they won battles, if
ical staffs.
Those comments reflected the success of a meeting
designed t o 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
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
J. Kcllcr Griffithr M.D.. l a k e Charles, Louisiana, and Thomas G. Dorrity, M.D.,
not wars, against hospital administrations determined to control med-
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 toughest thing he had to fight
was the ignorance of his colleagues about what was ga &
i
E. In fact, he said, he was ignorant until he got into the
middle of it.
"I didn't believe everything that was happening,
and if I hadn't called Frank Woolley (AAPS Executive
Director) just on the spur of the moment one afternoon,
we would have gotten beat."
DR. GRlFFlTH recounted how administration at Lake
Charles Memorial Hospital tried to change staff bylaws,
without knowledge or consent of the staff, to give the
administrotion 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 baftle 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 programs. 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 played -~ 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 t reat ment .' '
Dr. Dorrity said that an organized staff whipped the
administration on delineation of staff privileges. Then they
beat back the administration on the question of mandatory
malpractice insurance, pointing out that that requirement
would give a third party insurance company control of the
staff.
But that ddn'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
den io Is of govern ment pay ments .
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
Panelists on Membership Recruitment (left to right) R. 1. Campbell, M.D., Corsicona, 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.
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 sugery.
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 threatoflosing the nursing
school and the training- pLoyrom. He said, however, that
inquiry by Memphis physicians has disclosed that:
0 Internship and residency training programs do not
depend on accreditation, according to H. William
Ruhe, M.D., Secretary of the A M A Council on Medi-
cal Education.
0 The Tennessee State Board of Nursing reported
that the nursing school is not dependent on JCAH
accreditation.
0 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
prop% relationship is, then you fail to understand the
problem. And there has been a deliberate twisting of this
relations hip. "
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. 1. 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 thot one of the biggest hurdles
in recruiting new members for AAPS i s overcoming the
idea that federal takeover of medicine is inevitable.
Many physicians, he soid, have "sort of losf 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
Illinois.
 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 Chapter Chairmon.
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 i s
AAPS that i s carrying on the battle virtually
single-handed fo 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 selling a
cause rather than a method of recruiting because "the
only effort that was made was one single
letter . . . and i t wasn't that great a letter 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."
Panelijts 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 wos o ioyful moment for Elsie Doering shown here receiving a bar of pure silver from President Donald Quinlon, M.D., honoring Miss
Doering for her 25 years of service to the AAPS. Miss Doering, Assisfont to the Executive Director, also received on 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 cogent 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
Donald Quinlan, M.O., delivering Presidentiol Address ot AAPS
Annual Meeting.
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 life 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 I t 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."
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
"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-physician 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 a//, we must get it ocross to
our patients that inflation I S the terrible price we are
poying for 40 years of profligate and irresponsible
government spending -- deficit spending. The simple
economic truth is that inflation i s caused by
government living beyond its means, spending more
than it collects in taxes and poying for the ddicits 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
?,I prices and eroded the value of the dollar. Those billions
initially pay bureaucratic agencies, hospitals, doctors and
Donald Quinlan. M.D., outgoing AAPS President (left) and Executive Director
of British Parliament and former Minister of Health, on arrival at AAPS Annual Meeting where Mr. Powell was guest speaker.
druggists 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 destroying _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 deportment has
increosed o staggering 600 per cent."
"Trogicolly, rather than recognizing and attacking
the cause of inflation -- reckless government spending
-- President ford, members of Congress ond other
officials in Washington ore trying to duck responsibility
and pin the rap on the Americon People."
RALLY TO AAPs
Dr. Quinlan called upon all ethical physicians in the fight
for freedom to "rally around the one organization with u
brood 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, unbendbble set of principles firmly
based on a foundation of truth. Every physician in the nation
should know that AAPS will n z 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."
Frank Woolley (right) greet J. Enoch Powell, member
 AAPS OFFICERS FOR 1974- 75
FRANK ROGERS, M.D. R. 1. CAMPBELL, M.D. E. E. ANTHONY, M.D.
President President-Elect
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.C., 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, N e w Jersey.
A16ert 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.
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
21 1 1 Enco Drive Suite N 515 Oak Brook Illinois 60521
Frank K Woolley Executive Director
C. W. JOHNSON, M.D. MARIE STANBERY, M.D.
Treasurer Speaker of 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 Any 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 Off‘icers
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.
Yours for Individual/Liberty an onsibility,
Frank Rogers,
President
Enclosures: Pamphlet rack order form
Reprint from Chicago Daily News
312/325 791 1
 THE VOICE FOR PRIVATE DOCTORS
WWIWV@ LETTER
L
Acfive Speakers Bureau
New AAPS President's No. 1 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 general surgeon, was inauarated
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 meeting:
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 doina all thev can to dace AAPS soeakers before
medical and civic oraanizations as often as Dossible all
wer the nation.
All AAPS members who are willing to accept
speaking engagements should notify AAPS headquarters,
Nith a list of subjects they feel competent to talk about.
The need is urgent to get the truth disseminated
ibout PSRO, HMOs, nationalized medicine and other
.hreats to medical freedom.
Index No. 13
December, 1974, Volume 28, No. 1 1
v 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. Rogers had these
suggestions for the future of AAPS:
"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.
"Number one priority is an active Speakers
Bureau. It will 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 organiza-
tions."
"Why could not AAPS lead in a nationwide combining
of innumerable groups struggling far freedom? There is
strength in numbers, and truly freedom is indivisible."
Dr. Rogers said he assumed the office of AAPS Presideht
"with a very clear understanding that it is not the leader pro-
tem 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 i s right and good and valid, and that
concern flows as o mighty river through the life-
giving arteries of this fine organization.
“It i s that continuity of purpose and dedication to
principle and that concern we a11 have for the future of this
unique notion that can and will preserve AAPS. But
dtimotely, it i s the deep-rooted faith in God -- woven
inextricably into the warp and woof of AAPS that does pro-
vide the real strength of this Association.
“Although we are c minority, we know -- each of
us -- that the historic moments of the centuries were
made by minorities, that the great events of recorded
time -- good and bad -- were culminofed by smoll
groups of people who were unwavering in their
direction, unceasing i n their desire to cchieve. But in
MDs Deemed Incompetent
HEW Review Rules Threaten Licenses
Do you take care of Medicor? and Medicaid patients?
If you do, you should know that arrogant bureaucrats in
the Department of Health, Education and Welfare have taken
steps t J nullify your Iicer7se to practice medicine
These bureaucrats huve adopted regulations which say
in effect that you are not competent to decide whether a
patient of yours needs hospitalization, despite the fact that
vour state has certified to vour comDetence bv arantina vou 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 lkensed 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 1, 1975.
I t i s clear that HEW officials, with their
outhoritorian approach to the use of power, have
decided they connot wait for the implementation of
PSRO to begin exercising control over physicions’
professionol decisons. The new UR regulotions are
obviously intended to give H€W a head start on PSRO.
Said HEW: “Core has been taken to assure that
these regulations ore supportive of the implemenfation
of the PSRO program and consistent with opprooches
to be employed for PSRO review of hospital ond skilled
nursing facility core. Effective operotion of the hospital
review system required. . . should. . . enable PSRGs 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 i s to be mode by a nonphysician employee of the
addition, lodies and gentlemen of AAPS, you hove on
oddeo’ strength, you know your enemy and know him
iwll -- monolithic bureaucracy masquerading as
benevoient g o v e r n m el?f; un relenting, uncontrolled,
monstrous anachronism to humon dignity and
p rog r e s .
Dr. Fiogers called on members of AAPS to multiply the
organization‘s power aqd influence because “it is not
medicine alone thot is under attack, but civjlizotion itself.”
“In closing, recall with me this picture. In o far-flung,
near forgotten part of the world stands the tiny guardhouse
of a British senti-y, remote yet somehow firm and defiant --
resolute. And written inside on the drab bare wall can be
seen the following sentence: ‘I believe that one man can
make a difterence -- and tl3ot every man should try.’
”As I accept this office tonight, I do not ask your help,
but rather do humbly pledge you mine.”
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
deliberations to use ”regional” norms for length of stay.
HEW bureadcrats are telling the public that all this is
necessary to save money and assure quality of treatment by
eli m i noting 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 thot control of medicine, not economy, is
the real purpose of these regulations is easily
demonstrated using HEW‘S own propagondo. In the
1975-76 fiscal year, the Medicare and Medicaid
progroms are expected to cost the taxpayers about $25
billion. According to the Social Security Administration,
$60 million of thot i s supposed to be saved by
enforcement of the new UR regulotions, o saving, if
reolized, of 24/ I OOths of I O/O.
So ostensibly to sove 2411 OOths of I O/o of the cost
of these programs, physicions’ judgments ore going to
be overruled ond elderly and poor potients are going to
be denied the hospital care their physicions think they
s houId have.
This is all right with AMA. .Malcolm Todd, M.D.,
President of AMA, told the Chicago 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 functicns, 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.”
I

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 O W N 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:
0 That those of us who cherish freedom and the dignity of the individual still have many friends in Congress.

0 How AAPS as an organization and you as an individual can most effectively combat the socializers.
0 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.
4dditional information will be published in subsequent issues of the News Lettei.

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
busirtess or going broke."
He noted that HMOs under the new law are required to
provide every sori 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 ap-
proach 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, 9 3 % 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 into
unethical 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 qua 'ty
x
medical care. If we fail now to understand what hangs in t e
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 i s my feeling that we should fight it now. All
physicions 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.
MEDICAL 'REFORM'
"Involved in any national health bill are the elements
thot make up the 'reform' of the medical care system. The
HMOs that Dr. Rogers has described is one element, one
'eature 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 medicine in Europe. "PSRO
I S 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 Washing-
ton planted the idea of including provision for professional
review organizations, which later became PSROs in the
Bennett Amendment to H.R. 1 (P.L. 92-603).
Mr. Woolley reminded AAPS delegates that federalized
medical standards and federal financing of medical care were
Frank A. Rogers, M.D. fleft), who assumed office of AAPS President at
Director Frank Woolley and Mourice Kramer, head of Washington office, at start of panel discussion on PSROs. HMOs and 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 musf give high priority to
attempts to amend legislative proposals in ways thot
will involve the government in medical standards
(emphasis by the pamphlet authors) and in a way
favorable to cooperative and group medicine. "
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 ludges 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 aqent of government interfering
with a physician in the exercise of his medical judgment. He
said that when such evidence i s 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 ahead 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.
Annual Meetinq in New Orleans. confers with AAPS Executive

AAPS May Establish
A Political Group
The AAPS Assembly and House of Delegates adopted a
resolution instructing the Board of Directors "to initiate steps
towards establishing a political action organization with legal
authority to collect funds 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
constitutional government."
Another resolution set forth guidelines physicians
should follow in dealing with third parties. They are:
1 . 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
inviolable 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
immoral 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 im-
possible 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, 1974
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 Vlll of
the Health Professions Education Assistance Act of 1974, 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 misrepresenta-
tion" 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
State Society Can Be Positive Force
F. Michael Smith, M.D., President-Elect of the Louisiana
State Medical Society a.nd a member of AAPS, told delegates
to the AAPS Annual Meeting in New Orleans that "your
state medical society can 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, La., 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 an 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 have the proper principles as
delegates to your state medical society. The traditional
attitude of 'let Old Joe go, because Joe has gone for years'
must be cast aside if 'Old Joe' is not a good Joe."
Once physicians who believe in conservative principles
win control of the local medical society, they can turn their
attention toward influencing the policies of the state medical
society. Dr. Smith described how a number of such societies
in Louisiana have been able to take action profoundly
affecting the course of resolutions in the House of Delegates
of the LSMS.
"One of the most important single steps thaf was taken
in this state was the elimination of the committee hearincl
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.
"I scarcely need point out to you that, given the
are not misrepresenting the facts about this iniquitous low,
will he be equally candid and admit that federal officials have
repeatedly falsified PSRO?
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
dernocrotic 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 t o 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 profession, he
said, has been on the losing end of the struggle so far. "We
have, by default," h.e 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, has 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 elections.
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
govern ment,
That's the opinion of US. 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 thot leaders of the AFL-CIO are
boasting they can reach and control through electronic
computers 10 million union members. And he warned
that AAPS "is going to have to be a 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 info poli~ics;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 (left), farmer FBI agent, author and lecturer, and Rep.
John R. Rarick (D-lo.), chief sponsor of PSRO repeal bill, were
among principle speakers a t AAPS Annual Meeting. Here they com-
pare notes on evils of PSRO and OSHA laws.
Buttle for Liberty
Is Total War-Smoof
Dan Smoot, former FBI agent, author, lecturer and
political onalysist, 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 "
M r Smoot advised doctors not to turn a11 efforts to
saving the profession from the socialist revoiution "You
should concentrate rather on saving your republic," he said
Businessmen must heed the same advice, he said
"Businessmen, alarmed about OSHA, must
realize thot preserving ethical medicine is just as
important to them os preserving free enterprise Other-
wise there will never be enough unity of purpose and
cohesiveness of strength to stop eifher OSHA or PSRO.
and ?hereverse is also true If you think PSRO is bad for
doctors, but you haven't paid much attention to OSHA,
you haven't yet gotten involved in 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 legislotion which seems worse
than the bills that get passed. And they'criticize 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 than PSRO
now gives it but not quite as much control as the radical left
demands. That will be the legislation enacted and the A M A -
type conserva?ive 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 yielding, getting into and
supporting programs that move the nation ever closer to the
liberal idea of total government."
But, "every active liberal generally supports any
program thot increases the power of the central
government , . . whether or not he likes that particular
program or whether or not it affects his personal
interests. So, the liberals are never in retreat -- never."
 A M A Advocates Nationalized Medicine
~
'
If the notion's physicians in the practice of private
medicine had token the time away from their patients to
attend the recent AMA Clinicol Convention in Portland,
Oregon, and i f thev hod understood what was done, they
dvould hove 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 hove been particularly unhappy with disclosure
of AMA's shaky finances had they known that a past effort
by F. Michael Smith, M.D., Thibadoux, 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 physicions a t 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 on unsuspecting nation down the road
to the disaster of nationalized medicine.
FREEDOM OF CHOICE
One of the AMA's ancient battle cries was "freedom of
choice." But today, the A M A 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"
coptrot 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 6 leadina advocate of comDulsorv
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 administra-
tion of its national health program, with what is minimum
and who will decide left open. AMA alsd 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, 1974, AMA headquarters
issued o 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 A M A
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 Heolth Insurance. It is not compulsory National
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 $ 1 10 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 mandotory assessment.
Delegates rejected the dues increase until next
June and agreed to 'consider i t 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 A M A management."
The upshot was that most recommendations of the
Board were put on hold until management comes up with
some satisfactory answers
The deckion to eliminate drug advertising from AMA
publications was reportedly based in part on the question
whether AMA was unduly, even unethically, influenced by
carryi ng pha rmaceuttcal compo ny advertist ng
On the matter of undue influence, no one raised the
question whether the same criticism might apply to A M A 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 Children's Textbooks
Foments Grievances May Give You A Shock
I Nationalized medicine is a system "from which all Have you looked inside the textbooks your children are
i preference except that politically channeled through the state required to study in school lately2 You may be in for a shock
i f and when you do
has been eliminated," J. Enocli Powell, o world authority on
government medicine, pointed out to delegates to the AAPS Would i t surprise you to know that some textbooks for
Annual Meeting in New Orleans. grade school cbildren suggest that garbage collectors are
more important to health than doctors because they remove
"This i s where we reach the heart of the matter," Mr.
filth that causes disease while doctors merely treat diseases
Powell said, "since by definition a comprehensive national
after people get sick2
health service nationalizes preference; the alternative in the
Have you done anything about such tpxtbooks2 Two
lojt resort, the whole debate in which you are deeply and
people who have are M r and Mrs Me1 Gabler of Longview,
passionately concerned, i s between a nationalized
Texas They have been examining school textbooks for the
preference and a dispersed preference . . . It is a system lrom
past 14 years and have appeared belore the Texas
which has been eliminated not only the preference of the
Schoolbook Commission numerous times to proiest adoption
consumer, but that of the producer . . . It is the fundamental
of textbooks that do such things as glorify Marilyn Monroe in
characteristic of a comprehensive nationalized health service
American history over George Washington
-- i t excludes the prospect of a career and a lifetime within the
Mrs Gabler was featured speoker at the AAPS
network of interacting choices and preferences of consumers
Woman's Auxiliary meeting in conlcinction with the AAPS
and producers, or, i f you prefer, of patients and
Annual Meeting in New Orleans
professionals. In place of that network there is the situatron of
Mrs Gabler said one of the books reviewed was a
how much money the state will allocate to pay far what the
commercial for homosexuality -- not presenting anything
state has chosen."
wrong with homosexuality but explaining "when you can ply
M r . Powell, a member of the British Parliament and a your trade, the hours, the type of bars you can go into and
former British Minister of Health (7960-63), was the principal the infighting os to who will be vale and female "
speaker at the Friday night banquet, November 1 , And, said Mrs Gabler, how would you like Mother
One of the great dangers of any system of organized Goose interpreted for your children this way in a textbook
provision of services is that eventually it destroys the belief "Jack be nimble, Jack be quick, snap the blade and give it a
fhere can be an alternative, said M r . Powell. flick, grab the purse, it's easily done, and lust for kicks and
Mr. Powell is one of those rare individuals of learning lust for fun, plunge the knife and cut and run "
and wisdom who, when selected for a position of power in One history book, she said devoted 6-'/2 pages to
government does not abuse it. As British Minister of Health, Marilyn Monroe and her marriage to Arthur Miller George
the chief administrative officer for the National Health Washington was barely mentioned It was for fifth graders
Service, he possessed enormous authority over doctors and and the book asked such questions as what Marilyn enloyed
hospitals -- and patients. Unlike most public officials who most about being married to Miller and what problems they
become increasingly arrogant with that kind of power, Mr. had
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 impossi-
ble 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 att ractive.
"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 Mrr. Me1 Gabler. longview, Texas (left). was main speaker at
hold back investment in hospitals in order to give preference Woman's Auxiliary luncheon. With her is Mrs. E. E. (Jackie) Anlitany.
to investment in housing." Fort Worth. Texas. the outgoing 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 A M A presidents -- must
have been more than mildly surprised to learn from the
November 1 1 American Medical News that in the affairs of
medicine they are considered in A M A headquarters as
irrelevant and "out of touch."
This attitude toward small-town doctors was disclosed
in on orticle in A M N on the AAPS Annual Meeting in New
Orleans. A M N writer Dennis Breo attended the meeting but
reported very little of what actually transpired. He decided
instead to try his hand at o 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, A M N concluded, "there was left
hanging the question of AAPS' role and relevance in
contemporary medicine."
The AMA's staff writer arbitrarily selected 10 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 103 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 have relevancy to the
fact that about 40 per cent of those 103 physicions -
do
not
- belong to the AMA.
The concluding paragraph in the A M N 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
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
21 1 1 Enco Drive. Suite N-515 Oak Brook. Illinois 60521 312/325-7911
Frank K Woolley. Executive Director
week's election, there ore those who would question if AAPS
isn't out of touch "
First, the implication is false that the Americon
people are increasingly anxious for nationolized
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 principle to
occomodate o 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 A M A Board of
Trustees, wrote the A M N 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 M A membar wrote: "After
your typical liberally arrogant and slanted 'anulysis' of
the Association of American Physicians and Surgeons, I
would like to ioin this association. Please kindly let me know
their address."
Dr. Ochota is now an AAPS member.
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 an unquenchable beacon of light shining brightly down
through the ages. True believers can take comfort in knowing
that despite distortions by power seekers who describe
heaven i n 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 y6urs.
Your Patients Need Your Freedom,
Frank Rogers, M.D.
President