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8:45

Texas Medical Association - Good morning. AMA House of Delegates preliminary business has gone longer than usual. Reference Committee on Legislation won't begin for at least 15-20 more minutes.

Just been told that health system reform resolutions will be near the end of the reference committee's agenda. Will keep you up to date as we get closer.

Finally, the full House did accept for CONSIDERATION the resolution that would overturn the AMA's support of HR 3962, which passed the U.S. House last night. That resolution will be part of the health system reform debate in the Reference Committee on Legislation this morning.

Be back soon.

9:07

Texas Medical Association - Reference Committee still milling about. Will give you some background while we wait.

Texas physicians on the work group for this reference committee include Drs. Sheldon Gross (captain), Bob Gunby, Tom Garcia, Asa Lockhart, Bob Morrow, John Gill, Dan McCoy, Gary Floyd, and Travis Bias. We also have two medical students - Matt Brooker and Jessica Ngyuen.

Other Texas physicians with us today include Drs. Paul Handel and Howard Marcus as well as former AMA President Nancy Dickey, MD.

9:09	Texas Medical Association - As mentioned earlier, we have several non-health-system-reform resolutions to cover first. As we wait, I'll give you the text of the resolutions that will come up.

9:11

Texas Medical Association -

Starting with Resolution 206 - Liability Reform in Health Care Reform. It asks AMA to

Promote liability reform that mirrors the reforms of such states as Texas and California as the optimum reform plans
Strongly support that any federal liability reform does not pre-empt effective state reforms, and thereby possibly weaken proven state reforms;
Support that any alternative reforms such as specialized health courts and early offer programs not be mandated for all states, but rather be tested in states only as demonstration projects, to be incentivized only if they prove to be effective;
Support that best clinical practice guidelines represent a medical guideline not a legal one and recognize and encourage that such guidelines do not supplant clinical judgment and that failure to follow each and every clinical guideline when clinical judgment otherwise dictates should not be admissible in court as evidence or create a presumption of negligence; and
Strongly clarify the ambiguous language of several provisions (HR3200: Sections 2401, 2301, 1751, 1237, 1151,224 and 1783) in existing bills which deal with risk management, utilization review, and cost containment that might inadvertently create new legal causes of action against physicians to be sure that such provisions not lead to new theories of liability, such as presumption of negligence in cases of hospital acquired conditions.

9:12	Texas Medical Association - Russ Kridel, MD, of Texas says HR 3962 as passed last night puts physicians at risk for new causes of action. He also says it could erase the $250,000 Texas cap on noneconomic damages in liability cases.

9:14	Texas Medical Association - Dr. Kridel: "We don't want a physician who doesn't adhere strictly to a new standard of care to be subject to new liability."

9:14	Texas Medical Association - Bob Fields, CEO of Texas Medical Liability Trust, given special permission to address the reference committee.

9:16	[Comment From Adam Bloom] I wonder if they've addressed proposal 9 yet?

9:17	Texas Medical Association - Bob Fields: AMA says if there is a risk of us losing what we have, they will oppose the health care bill. There is a danger. Worried about two things: Federal preemption of state caps in Medicare Lack of global language in the bill, impact of never events

9:17	Texas Medical Association - Adam: Broader discussion of health system reform not up yet. Just talking about liability and health reform.

9:18	Texas Medical Association - Bob Fields: The noneconomic cap in Texas has resulted in a decreased probability of doctors being sued for nonmeritorious cases. Physicians liability premiums have dropped by 50 percent since caps passed in 2003.

9:19

Texas Medical Association - Fields: Sec. 261 gives us protection for enhanced liability in five sections of the bill -- 50 pages. The bill is 1,990 pages. Outside of those five sections, there are no protections. We've already identified more than 20 sections that could expose physicians to additional liabilities. Also Sec. 261 offers no protection from federal preemption.

9:22

Texas Medical Association - Fields is asking AMA to support amendment that says no preemption of state liability reforms and no new causes of action. If we don't get the AMA's full commitment and support, premiums are going to triple, claim frequencies are going to triple, "it's going to be worse than ever."

9:23	Texas Medical Association - Dr. Howard Marcus of Austin - chair of the Texas Alliance for Patient Access: We're here not to promote tort reform, we're hear to protect tort reform where it exists. This is a conservative request.

9:24	Texas Medical Association - Dr. Marcus asks physicians from Deleware, Nebraska, and Connecticut to help with negotiations with senators.

9:26	Texas Medical Association - Dr. Rich Geline from Illinois strongly supports this resolution. This resolution would protect against the surreptitious attempts of the trial lawyers to weaken liability reform through federal legislation.

9:27	Texas Medical Association - Medical Student Section supports this resolution to protect young physicians who want to practice in high-risk specialities. Also encourages AMA to look beyond caps, such as health courts, limits on attorney fees, and best-practice guidelines.

9:29

Texas Medical Association - Connecticut physician says New England Caucus supports this resolution, except the language that says Texas and California law "as the optimum reform plan."

Suggests instead "models that have been proven effective in the state level." There are other forms of liability reform that have been equally effective as caps.

9:30	Texas Medical Association - Sheldon Gross, MD, - Texas is strongly in support of this resolution.

9:31	Texas Medical Association - Joe Annis, MD, on behalf of the AMA Board of Trustees - AMA has been working with the states to make sure that no state laws are overturned by federal health reform law. Dr. Annis mentions the provision that Bob Fields discussed earlier.

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