Last week's resignation of American Medical Association Executive Vice President P. John Seward, M.D., put to rest one of the issues that was likely to dominate this week's meeting of the AMA's House of Delegates.
But still in question were whether the AMA's board of trustees would emerge unscathed from the controversial Sunbeam Corp. deal and how the AMA will handle future relationships with corporate America.
Seward's departure came three days before the 475-member House of Delegates was to consider a resolution demanding his resignation at its interim meeting in Dallas.
The AMA's board canceled a scheduled press conference Dec. 5 at which a successor to Seward was supposed to be announced. An AMA spokesman said the board still was trying to reach agreement. Possible candidates for the job include board members Nancy Dickey, M.D., president-elect; D. Ted Lewers, M.D., secretary-treasurer; William Jacott, M.D.; and board Chairman Thomas Reardon, M.D.
In a written statement, Seward called the Sunbeam contract, signed in August and rescinded a month later, "a serious mistake. This happened on my watch, and I have always accepted that responsibility. For the last three months every fiber of my being has been committed to repairing the damage and moving ahead with the work of this outstanding institution."
Seward's departure may be too little, too late to help the trustees. Some delegates fault the trustees for failing to raise questions about the Sunbeam contract before it was signed.
Four top AMA employees resigned in the wake of the controversy, but trustees kept Seward on, saying he wasn't fully informed about the deal. Nevertheless, the board quietly put Seward on probation and commenced oversight of his activities.
Late last week, the New Jersey delegation intended to forge ahead with a resolution calling for Reardon's departure.
Delegates also were to consider proposals to increase board accountability by examining ways to revamp the governance structure and calling for disclosure of now-secret trustee votes.
Delegations from five states called for the House of Delegates to conduct its own investigation of the Sunbeam deal.
Even a set of interim standards to govern corporate relationships could prove controversial. Trustees planned to ask the House of Delegates to approve interim guidelines that "extend" existing policy to cover areas of possible conflict, said board member Timothy Flaherty, M.D.
Flaherty is co-chair of a task force that expects to develop definitive standards before the annual House of Delegates meeting in June 1998. The Illinois delegation proposed that the AMA adopt a policy of not endorsing any product or service other than member services.
Questions also have been raised about a consumer mail-order catalog launched in January called Tools for Healthy Living. South Dakota delegates called for the AMA to cease its publication, but the board recommended postponing the catalog until changes are made, including the creation of a physician panel to review products.
Yet another consumer group fanned the flames last week, asking the AMA's ethics task force to investigate whether the association endorsed Procter & Gamble's Olestra fake-fat product as part of a deal that would have yielded $800,000 to the AMA. The Center for Science in the Public Interest said it wants the AMA to rescind its 1996 statement on Olestra, issued while the AMA was negotiating a sponsorship deal with the manufacturer.
Seward, 58, a family physician from Rockford, Ill., and a former board chairman, took the top executive post in July 1996, replacing the late James Todd, M.D.
Seward's departure and the four earlier resignations leave the AMA's top ranks decimated.
"I don't think there's any doubt that the AMA staff has been preoccupied with (Sunbeam)," said Thomas Adams, president and chief executive officer of the Medical Group Management Association, which has a close working relationship with the AMA. "This may be the mother of transitions."
The House of Delegates also may consider calls for:
The board of trustees to work with the U.S. Justice Department and HHS to define what constitutes Medicare and Medicaid fraud and abuse and to help circulate the definition to all physicians.
A review of the impact that hospital takeovers and mergers may have on medical student education and residency training programs in response to concern about for-profit corporations acquiring academic training institutions.
Pursuing changes to the Employee Retirement Income Security Act and other reforms that would hold managed-care plans liable when their treatment guidelines and utilization-review procedures interfere with physician-patient healthcare decisions to the patient's detriment.