The American Medical Association's House of Delegates succeeded at its December meeting in defusing much of the passion generated by the association's Sunbeam Corp. endorsement fiasco. But the controversy opened the door to a wholesale examination of the organization's structure.
Motivating the action was a sense among delegates that something needed to be done to assure the AMA's declining membership and other physicians that the organization can learn from its mistakes.
"We didn't want our meeting to be like the 'Seinfeld' show--about nothing," Carl Restivo Jr., president of the New Jersey Medical Association, said at the meeting.
On Dec. 7, Pearl Harbor Day, the 475 delegates began dealing with their organization's own day of infamy--Aug. 12, when the AMA signed an exclusive marketing deal with Sunbeam. As the meeting began, it seemed the imbroglio threatened to forever tarnish the AMA's moral standing and fiscal health. With membership renewals and applications in doctors' hands as delegates met, many members believed it was time to take a stand that could reverse declining membership.
As things turned out, the meeting amounted to more than planners could have hoped for. Among the accomplishments:
The Sunbeam deal convinced House of Delegates members to be more involved in shaping the future of the AMA rather than leaving it to staff and the board of trustees.
The delegates voted to launch a governance committee to examine the division of powers between itself and the board of trustees. They also recommended structural and procedural changes to ensure "propriety, efficiency and accountability." The committee is authorized to bring in an outside consultant to help answer such questions as whether board members must disclose their voting record. The committee's budget is estimated at $300,000, although the amount is not set in stone.
Meanwhile, board members also approved creating a House of Delegates task force to identify ways to increase membership. AMA membership stands at 293,000, or less than 50% of the nation's 650,000 licensed physicians. Some delegates said Sunbeam and other issues were keeping some doctors from joining and others from renewing their memberships. The AMA said the organization wouldn't know until March about any changes in its membership numbers.
Reports from the membership task force and the governance committee are scheduled to be presented at the AMA's annual meeting in June.
"For some time there has been concern about inter-relationships between the board, the staff and the membership," said Joseph Bailey Jr., M.D., an Augusta, Ga., rheumatologist whose state medical society proposed the independent consultant for the governance committee. "Certainly, we wouldn't have (addressed) much of that if there wasn't the impetus derived by the Sunbeam issue."
The issue was that "our AMA," as delegates put it, was willing to let its image be used on products it would never test. The critical reaction to that plan has claimed a number of casualties. Four executives who had a role in the Sunbeam deal resigned soon afterward.
On the eve of the Dallas meeting, at which the New Jersey delegation was planning to call for his head, AMA Executive Vice President P. John Seward, M.D., resigned, ostensibly for reasons unrelated to Sunbeam.
"This is the most dramatic change I've seen in the 20 years I've been coming (to delegates meetings)," said Perry Lambird, an Oklahoma City pathologist.
AMA Chairman Thomas Reardon, M.D., a general practitioner from Boring, Ore., said the board was surprised by Seward's resignation. AMA sources said Seward never was blamed internally for the deal, and appeared at an Aug. 12 news conference with Sunbeam Chairman Albert Dunlap only because he believed the board had approved the deal. But sources also said the stress of grappling with Sunbeam, which slapped the AMA with a $20 million lawsuit when the association said it would withdraw from the deal, was a major factor in his decision to resign.
On Dec. 9, Lynn Jensen, a 23-year AMA veteran who became chief operating officer after former COO Kenneth Monroe resigned over Sunbeam, stepped into Seward's role on an interim basis. Jensen is a rarity among AMA top executives--he's a doctor of economics, not medicine--but Reardon said the board thought it was important to replace Seward quickly with someone who knew the internal workings of the association. The board "will turn the reins over absolutely" to Jensen, Reardon said.
It may be that Seward's permanent replacement isn't an M.D. Reardon said the AMA will hire an executive search firm to find candidates over the next six months.
He wouldn't say whether the candidate had to be a physician, but he did say the person must be a strong administrator.
Two days before announcing Jensen's appointment, Reardon said no current board member or officer would be considered for the job, although later he said Jensen would not be ruled out.
"I think the board has a sensitivity that in choosing a person to replace Dr. Seward, we should look without instead of within," Reardon said.
Reardon's sensitivity was prodded in large part by the New Jersey delegation, which had proposed before the meeting that he step down because of Sunbeam. The state's position was that either Reardon knew or should have known about the deal before it was announced.
By the end of the meeting, however, delegates had passed a North Carolina-sponsored resolution that praised Reardon and the board for its "decisive action taken to investigate and correct" problems associated with the Sunbeam deal. (North Carolina was among the few delegations that wanted to reject all House investigations related to Sunbeam.) Even the delegates from New Jersey voted for the resolution.
Two moves by the board helped cure some of the ill feelings.
First, the reference committee hearing Sunbeam-related resolutions let delegates vent their feelings about the deal, rather than having them discuss specific measures, as happened with every other issue. Fifty-seven delegate and nondelegate AMA members spent 21/2 hours expressing whatever they had been thinking over the previous four months.
The board also made its Sept. 18 report on who signed the Sunbeam deal available to delegates. Because of the pending litigation with Sunbeam, delegates had to walk up to a third-floor meeting room at the Wyndham Anatole Hotel and read the report under the hawklike eye of outside legal firm Sidley & Austin. About 250 delegates read the report, which had resulted in three of the executives' departure. (Chief counsel Kirk Johnson, who prepared the report, became the fourth victim of the fiasco in November.)
Delegates who saw the report said it showed that the board's only knowledge of the Sunbeam deal before Aug. 12 was one line in the final page of a report issued to the board in June. The line mentioned the possibility of a "cobranding" deal but did not mention Sunbeam. The report put blame on the fired staff members for shepherding the deal.
However, having seen the Sept. 18 report and the board's moves to try to extricate the AMA from the Sunbeam contract, most delegates were satisfied that the organization won't let this happen again.
"I think we're at a watershed here," said Michael Pekas, M.D., a Sioux Falls, S.D., ophthalmologist who, without success, called for the resolution praising Reardon and the board to be pulled. "It's time the membership and the House of Delegates make sure they're heard by the board."