President's Page February 2003
By Frank Randolph, M.D.

CMA HOUSE OF DELEGATES-DEMOCRACY IN ACTION

The annual meeting of the CMA House of Delegates will occur at the Hilton in San Francisco on March 22-25, 2003. Our delegation (District II-Riverside, San Bernardino, Inyo and Mono Counties) has met and begun to deliberate upon its' strategies and resolutions to be introduced at the session. The time we spend each year is intended in part to address the problems we encounter as practicing physicians in California.

Dr. Ron Bangasser will be installed President of the CMA on March 24, 2003 at the House of Delegates. The CMA President's Reception will be held that evening. This is a significant occasion. It is the second time in the history of our society that a SBCMS leader has been elected to CMA's highest leadership position; the first honor belongs to Dr. Nicholas Krikes in 1978/79.

The House of Delegates, CMA's legislative body, establishes the policies that govern the Association and elects CMA's president. The House convenes annually to debate and act on resolutions and reports dealing with medical practice, public health and self-governance issues. Policies adopted are implemented by the Board of Trustees, which deals with the many interim policy issues that arise between the Annual Sessions of the House. The House consists of more than 400 delegates elected by members of component medical societies, CMA sections (Organized Medical Staff Section, Young Physicians Section, Ethnic Medical Organization Section, Medical Student Section), the Resident Physicians Section and CMA mode of practice forums. Members of the Board of Trustees, past presidents of the association and members of the California Delegation to the American Medical Association also participate as ex officio members of the House.
The business of the House consists primarily of resolutions and recommendations submitted by the delegations that comprise the House or by individual members thereof. Each item of business is assigned to a "reference committee," consisting of six members of the House, which conducts a hearing to receive testimony for or against the proposal from other CMA members and delegates. The committee then formulates recommendations for action by the full House, which votes to adopt, reject, amend or refer (for further study or for decision by the Board of Trustees) each recommendation.
I believe that the House exemplifies democracy in action. Members can participate in the House of Delegates policy-making process in three ways: by authoring resolutions, by participating as an elected delegate or alternate delegate and/or by testifying at reference committee hearings. Any CMA member can author a resolution for introduction to the House by a delegation or individual delegate or alternate delegate. A resolution can address virtually any health-related topic or any aspect of the policies and activities of CMA. A resolution can direct CMA to take a policy position on a particular issue or to take a specific action - for example, to support, oppose or even introduce legislation.
Any member may present testimony (i.e., speak for or against a resolution or recommendation) at reference committee hearings and may attend the meetings of the full House of Delegates as an observer. Writing and submitting resolutions to the House is one of the most effective ways an individual member can influence the policies and activities of CMA. Depending on the action called for, a resolution can even result in a major public policy initiative or change. Any member may author a resolution, but a delegate, alternate delegate, component medical society or delegation must submit the resolution. Resolutions can address virtually any medical practice or health-related topic, or any aspect of the policies and activities of organized medicine.

Under House rules, resolutions should be no more than one page in length. After resolutions are received at the CMA, fiscal notes and a summary of existing CMA policy on the subject are added for the House's information.

Examples of resolutions passed last year are as follows:

601a-02-VOLUNTARY PARTICIPATION ON EMERGENCY DEPARTMENT CALL
PANELS-It shall be CMA policy that a physician's participation on a hospital's emergency department backup call panel shall be voluntary and shall not be required as a condition of staff membership; CMA will amend its Medical Staff Model Bylaws to state that: (1) participation on the emergency department backup call panel shall be voluntary; and (2) neither the appointment nor reappointment to the medical staff shall in any way be contingent on an applicant's willingness to participate on the emergency department's backup call panel; CMA will encourage hospitals to contract with, and compensate, physicians to provide on-call emergency service.

As I recall this was controversial because many delegates seemed to feel that it would undermine our hospitals. Many of our delegates expressed frustration that hospitals take advantage of our professional duty to serve in a pinch and this resolution was a reminder that such participation was ultimately a voluntary deed.

607a-02 PHYSICIAN EDUCATION ON AGENTS OF BIOTERRORISM
CMA will recommend that all physicians educate themselves regarding the
clinical presentation, diagnosis, and reporting requirements for the likely
agents of a bioterrorist attack; and recommends that county medical societies work closely with local health officers and hospital medical staffs to provide training and
educational programs for responding to likely agents of a bioterrorist attack;
and encourage medical schools to incorporate bioterrorism preparedness into the medical education curriculum.

This resolution reflected a unanimous commitment toward bioterrorism preparedness

610-02 GERIATRIC CONTINUING MEDICAL EDUCATION
CMA will promote geriatric continuing medical education for physicians
caring for the elderly in long-term care facilities and home-based settings.

613-02 ROLE OF PHYSICIANS IN CALIFORNIA LONG TERM CARE
CMA, in association with the California Association of Long Term
Care Medicine, will develop a position statement or policy related to the current
role of medical directors and attending physicians in California nursing homes.

These two resolutions reflected the concern of delegates that the care of the elderly was a priority item.
I shall continue to devote time yearly in this democratic process, which demonstrates the power of organized medicine at the same time verifying the right of the individual physician to representation. I urge SBCMS members who are interested in participating in CMA's democratic process to volunteer to serve as delegates or alternate delegates. For information, contact SBCMS Executive Director Linda Stratton at (909) 825-6526 or lstratton@sbcms.org.