The American Medical Association considered about 250 reports and resolutions at its midyear meeting last week in San Francisco, carving out nearly one full day for a wide-ranging series of seminars on bioterrorism.
But the biggest block of time-nearly 81/2 hours spread over two days-was devoted to a secret debate over an internal report covering the allegations in a June lawsuit by the AMA's former chief executive, E. Ratcliffe "Andy" Anderson Jr., M.D.
After the long and contentious discussion by the House of Delegates, an AMA committee produced a sanitized two-page report that dealt strictly with "structure and governance" issues while sidestepping any public comment or judgment on Anderson's explosive allegations.
Richard Corlin, M.D., the AMA's president, blamed the unusual secrecy on "ongoing litigation" and said there was no consideration given to settling Anderson's lawsuit in an effort to avoid a potentially embarrassing public airing of his charges.
"There is no intent or desire to settle this case," Corlin said. "I see no reason we should be motivated to settle this-and we are not. The board is of the belief that the lawsuit is totally without merit."
Among other activity at the meeting, AMA delegates spent almost an entire day in educational programs on bioterrorism, including seminars on vaccine shortages and doctors' involvement in disaster preparedness. The group also unveiled a 30-second public-service announcement it plans to televise nationally to educate physicians and patients on responses to biological attacks.
The AMA also released its projected budget for the year, announcing the organization's fourth expected deficit in the past five years.
But much of the delegates' time and attention was focused on the Anderson report, which AMA officials went to extraordinary lengths to keep secret.
The report was distributed to a large but fairly select audience-each of the 549 delegates, the same number of alternates and several dozen other high-ranking AMA officials. Each of those individuals received the report upon registration and was ordered to keep the contents confidential and to return his or her copy at the close of the secret meeting.
Anderson, the AMA's former executive vice president, was fired from his $650,000-a-year job about two weeks after filing a $5 million breach-of-contract lawsuit against the Chicago-based doctors' group. A select committee formed in August spent about $600,000 investigating Anderson's allegations, producing the 45-page report.
"I suspect we're just going to shoot ourselves in the foot again," Francis Kittredge, M.D., a delegate from Bangor, Maine, said of the secret proceedings.
Though delegates refused to discuss details of the report, several who read it said it provides strong support for the AMA's position that Anderson's lawsuit is "frivolous."
"There's nothing in the report that is a big smoking gun or anything," said Earl Washburn, M.D., a delegate from California.
Anderson's lawsuit, also the main focus of attention at the last national AMA meeting in Chicago in June, dredged up memories of the AMA's failed 1997 partnership with the Sunbeam Corp. He charged that he was prevented from firing an AMA attorney who allegedly botched a real-estate deal in Chicago because the attorney provided cover for top officials involved in the Sunbeam fiasco.
Chuck Pautsch, Anderson's attorney, denounced the AMA's report and the emphasis on secrecy, questioning whether a committee handpicked by top officials could ever conduct an impartial investigation. Anderson did not testify before the committee as a result of those concerns about fairness, Pautsch said.
"They could have conducted a truly independent investigation," Pautsch said. "They chose not to."
Pautsch said no judge is likely to consider the report confidential after it was made available to more than 1,000 individuals.
While the organization grapples with the Anderson lawsuit, it also must face the prospect of another year of deficits-an estimated operating loss of $2.9 million in 2001.
AMA officials blamed the deficit on about $2.4 million in start-up costs for a new Internet-based joint venture and the amount spent on the Anderson report. The projected operating loss is more bad news for the AMA after the unexpectedly bright fiscal results of 2000, when it enjoyed an operating profit of $2.7 million after three years of big losses that totaled about $22 million.
Membership dues revenue, a continuing source of concern for the AMA's leadership, is expected to fall lower than initial projections (See chart). The organization, which claims about 291,000 members among America's 720,000 active doctors, expects about $54.2 million in revenue from membership dues in 2001, or $2.4 million below initial projections.
"Growth in membership continues to be a priority," said William Plested, M.D., who presented the report to the AMA delegates.
The annual operating loss, Plested said, stems in large part from start-up costs for the AMA's joint venture with the Little Rock, Ark.-based Axciom Corp., which is developing a new database called Preference Solution to market information on physicians.
For 2002, the AMA has projected an operating profit of $100,000.
In other action, the AMA declined to support an effort to launch national studies to determine whether financial incentives for potential organ donors will save the lives of some of the 15,000 people who die each year waiting for transplants.
Although such financial incentives have been banned by Congress since 1984, the AMA's Council on Ethical and Judicial Affairs recommended pilot studies because, it said, a "better-informed debate" on the ethical and financial issues is necessary to stem a continuing tide of needless deaths. The House of Delegates referred the matter back to the council for additional study.
The recommendation for a study of the implications of financial incentives was backed by three of the AMA's largest state delegations-California, Illinois and New York. Pennsylvania also supports the plan.
The current federal ban has so far prevented implementation of a Pennsylvania law that would allow the state to pay $300 toward a funeral to all organ donors. In May, legislation introduced in Congress called for a donor family to receive a $10,000 tax credit.