Proposed ethical guidelines for telemedicine services were tabled Monday during the annual meeting of the American Medical Association House of Delegates.
That decision comes a day after a delegate urged the committee to consider rules established by the Texas Medical Board that require patients have an initial face to face consultation.
The recommendations were based on a report by the AMA's Council on Ethical and Judicial Affairs. The guidelines focused on issues such as ensuring patient privacy and educating them on the limitations of telehealth.
During a reference committee meeting Sunday, doctors lined up to speak in support of the measures.
AMA delegates from Texas had one outspoken critic who urged the committee to revise certain aspects of its recommendations that conflicted with rules established in April by the Texas Medical Board.
AMA guidelines regarding initial doctor-patient telemedicine visits require face-to-face interaction, but say that could be accomplished with videoconferencing. The Texas rule requires physician interaction to be established, either through a face-to face visit with a physician or with the use of telecommunications if the patient is in a healthcare setting with another provider physically present.
“There is no requirement here of any form of inpatient, face-to-face interaction,” said AMA Alternate Delegate Dr. Arlo Weltge. “For physical diagnosis, there needs to be a physical exam that can be done either with an initial face-to-face, or it can be done with a presenter who is seeing the patient in consultation.”
The Texas Medical Board is being sued over its ruling by telemedicine provider Teladoc. Weltge said the AMA guidelines, “as currently written, potentially would create a major conflict in Texas and with litigation ongoing active” in his state.
Last month, the U.S. District Court in Austin issued Teladoc a preliminary injunction against the Texas Medical Board's rule from going into effect on June 3 as scheduled. The AMA guidance has been sent back to committee for review. The soonest it could be reintroduced for a vote is at the House of Delegates Interim meeting in November.
The physician organization did adopt a policy on Monday that calls for the elimination of all state non-medical exemptions from immunization requirements citing public health concerns brought by a re-emergence of vaccine-preventable diseases.
The governing body voted in favor of a resolution that recommends states leave decisions on which vaccines will be mandatory for admission into schools to public health physicians, and that any exemptions from immunization be based on medical reasons.
"When people are immunized they also help prevent the spread of disease to others," said AMA board member Dr. Patrice Harris. “As evident from the recent measles outbreak at Disneyland, protecting community health in today's mobile society requires that policymakers not permit individuals from opting out of immunization solely as a matter of personal preference or convenience.”
The decision comes one day after physicians at a reference committee meeting urged the AMA not to adopt a report authored by the group's Council on Ethical and Judicial Affairs and its Council on Science and Public Health that they said weakened the AMA's stance against all non-medical exemptions.
One of the recommendations in that report called for the AMA to lobby state medical associations for laws that offer “clear definitions of accepted grounds for non-medical exemptions that prudently limit such exemptions,” and implement “...fair, reasonable procedures for granting non-medical exemptions.”
Some were up in arms over language they felt blurred the AMA's position on exemption based on personal and philosophical beliefs.
Nineteen states allow parents to opt their children out of requirements to get vaccinated before they can attend school based on personal beliefs, while 48 states allow for exemptions based on religious beliefs. Only Mississippi and West Virginia do not allow exemptions for any non-medical reason, a stance a number of other states have begun to explore in light of a recent multistate outbreak of measles.
Among other measures adopted Monday was a resolution stating there was no medical basis for the U.S. military to exclude transgender individuals from service, and that they should be provided the same level of medical care as non-transgender service members. Also adopted was a policy to ensure that physicians are trained to report suspected cases of human trafficking while ensuring victims have the medical, legal and social resources they need.