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180 YEARS WORKING ON BEHALF OF PHYSICIANS AND THE PATIENTS THEY SERVE
A LEGACY EQUALED BY NO OTHER PHYSICIAN ORGANIZATION IN OHIO
The Academy of Medicine of Cleveland/Northern Ohio Medical Association (AMC/NOMA) is the only medical organization that represents the interests of physicians in the Northern Ohio community. We are the VOICE of physicians in Northeastern Ohio.
RESOLVED - That the AMC/NOMA make judicial reform and the passage of meaningful tort reform its number one initiative for 2002/2003.
AMC/NOMA achieved both of these goals in 2002 and into 2003. Physicians in Northeastern Ohio mobilized and took the lead to achieve both judicial reform and the passage of meaningful tort reform in Ohio. Our victory at both of these initiatives clearly illustrates how important a role AMC/NOMA fills as a physician/patient advocate. AMC/NOMA responded to physicians in the region in 2002 - we mobilized a strong grassroots effort that resulted in the passage of tort reform legislation in Ohio. Several key pieces of legislation passed in 2002 due to the efforts of your AMC/NOMA. These legislative initiatives included:
* Limits on Non-Economic Damages in Medical Liability Suits - Not to exceed $350,000 in most cases
* Joint and Several Liability Reform - Holds defendants liable for only their percentage of fault
* Periodic Payments - Requests can be made to pay out future damages to the plaintiff in some cases
* Evidence of Collateral Source Payments - Allows juries to consider other sources of compensation already received by plaintiff
* Prohibition of Insurance Company - Prohibits an insurer to take any notice of intent into consideration when setting new rates for an insured physician.
* Strengthened Ohio Arbitration Law - Arbitration Agreements - The recently enacted medical liability reform legislation (SB 281) included arbitration language that authorizes health care providers to enter into an agreement to resolve future medical malpractice claims through binding arbitration. Under current Ohio law, a physician may ask patients to consider signing an arbitration agreement at the time of treatment. This agreement enables the patient to agree to arbitration up front. If the patient agrees to sign, this agreement would allow future disputes to be resolved through binding arbitration rather than the court system, though patients retain the right to revoke the agreement within 30 days of its signing. Arbitration is utilized in other states and it has worked to bring down medical liability costs. There are certain parameters that must be met under the law. AMC/NOMA has a model arbitration form available for physicians to utilize in their offices.
Many physician members from AMC/NOMA took the time out of their practice to testify before both the House and Senate committee hearings on SB 281. AMC/NOMA believed it very important that physicians take the lead on this issue and provide their input and testimony. In addition to our lobbying efforts, AMC/NOMA was the first association in the state to contact the media regarding the medical liability crisis and the only association to prepare a broad-based media campaign. The AMC/NOMA produced and distributed thousands of brochures to patients and physician offices; met with the media; produced two television ads; radio programs; wrote letters to the editor; planned and participated in a press conference with the governor in Cleveland and presented at three physician rallies in Cleveland, Lorain and Columbus.
OHIO SUPREME COURT RACE - 2002
AMC/NOMA LEADS THE WAY TO MAKE CHANGES TO THE OHIO SUPREME COURT
No other physician organization was more visible in Northern Ohio than AMC/NOMA on working to elect justices that were sure to make the law versus interpret the law. Changes to the Supreme Court were imperative in order to assure that legislatively enacted tort reforms remained in place and were not overturned. The AMC/NOMA took the lead in Northern Ohio to achieve wins for Justice Evelyn Stratton and Maureen O'Connor. The efforts of the AMC/NOMA were acknowledged by one of the candidates as the organization that had "awakened a sleeping giant in Northern Ohio."
Other legislative and physician advocacy initiatives supported by the AMC/NOMA during 2002 - 2004:
* HB 282 - Medical Liability Underwriting Association (MLUA) - The MLUA would provide a state-operated insurance coverage option in the event Ohio's medical liability market collapses. $12 million has been secured for the initial capitalization of the MLUA - so that it will be available if needed.
* SB 120 - Joint and Several Liability Reform - eliminated a defendant's joint and several liability for a plaintiff's economic damages in tort actions and provides for a recovery system based on proportionate liability. Holds defendants liable only for their percentage of fault (non-economic) in civil tort actions. Adopts a "fair share" rule where defendants only pay damages commensurate with their percentage of fault.
* House Bill 212 - Prejudgment Interest Reform - Reduces the amount of interest a plaintiff would receive or a defendant would pay in civil jury trials. Provides that judgment interest does not apply to the portion of the award that is future damages - damages that have not yet accrued.
* Senate Bill 86 - Update Ohio Good Samaritan Law - Reduces the pool of indigent people eligible to sue volunteer health care workers and expands immunity for volunteer health care workers. Extends the liability protections provided to physicians working in free clinics to physicians who care for indigent people in their office setting.
* SB 179 - Expanded Peer Review Protections - Grants immunity from civil liability to a health care entity, or a member of or an individual who works for or on behalf of a peer review committee of a health care entity for any acts, omissions, decisions, or other conduct within the scope of the functions of a peer review committee of the health care entity. Expands physician peer review protections to include physician offices, ambulatory surgery centers, and other health care settings. Protects information disclosed in a peer review process from discovery in a subsequent liability claim.
* SB 187 - Insurer Notice Requirements - Mandatory notice to ODI for changes in market presence over 5 percent increase, changed from 30 to 60 days for non-renewals and rate increases, provided for expedited appellate review of SB 281.
* HB 215 - Tort Reforms (Medical Screening Panels) - originally this legislation was supposed to address setting up medical screening panels to review cases prior to going to trial. As passed, the bill now provides for certificate of expert review, affidavit of non-involvement, an I'm sorry provision, data collection on insurance claims and qualifications for experts witnesses.
MEDICAL LIABILITY SOLUTIONS UNDER REVIEW - 2004
Ohio Medical Malpractice Commission
The AMC/NOMA lobbyists have attended every meeting of the Ohio Medical Malpractice Commission and provided information and feedback to the AMC/NOMA legislative committee. In addition, AMC/NOMA physician leadership and staff have met individually with the Director of the Ohio Department of Insurance on a quarterly basis. In March, the Commission approved an interim report that recommends that legislators in Ohio consider several measures to stabilize the medical liability climate in the state. Some of these measures include:
* Explore the need for statutory changes such as limiting attorney fees
* Explore changing the statute of limitations including the 180-day notice provision
* Explore creating separate courts to handle medical liability cases
* Recommends that the Ohio Supreme Court consider special certification of attorneys authorized to bring medical malpractice cases
* Pursue legislation creating a medical review screening process to pre-screen medical malpractice lawsuits
* The legislature should give immediate consideration to establishing a patient compensation fund to help reduce medical malpractice rates.
AMC/NOMA REFORM INITIATIVES - 2004
AMC/NOMA plans to work closely with our lobbyists and legislators to implement as many of the initiatives proposed by the Commission as possible. The AMC/NOMA will also work towards getting legislation introduced and support legislation that would further the positive steps taken by tort reform and to combat the damaging effects on physicians and their patients by the destabilization of the professional liability insurance market. These initiatives include but are not limited to: Alternative Dispute Resolution (ADR); Establishment of a Medical Review Panel, Creation of a Sliding Scale for Attorney Contingency Fees, the Development of a Patient Compensation Fund (PCF), explore changing the statute of limitations including the 180-day notice provision, special certification of attorneys, and medical courts.
* Mandatory Mediation/Arbitration - If a patient signs an arbitration form as outlined in SB 281 and it remains in force, the agreement is binding. However, if there is no arbitration agreement in place and a claim has been filed, arbitration is not mandatory under SB 281. Therefore, AMC/NOMA supports the concept to allow for mandatory mediation of claims prior to a case going to trial - and the mediation results should be admissible as evidence if the case does go to trial.
* Establishment of a Medical Review Panel - During the debate on SB 281, AMC/NOMA testified in support of the establishment of a Medical Review Panel to provide for pre-litigation screening to eliminate frivolous claims. This medical liability system reform from MICRA was not enacted in SB 281. The benefit of a medical review board is that it removes lawsuits from the system before they occur by identifying whether the claim is valid or not. Other states have instituted this type of panel and it was very successful. HB 215 originally contained medical review panels but the legislation was completely changed. The AMC/NOMA continues to support the medical review panel concept.
* Creation of a Sliding Scale for Attorney Contingency Fees - During the debate on SB 281, the AMC/NOMA provided extensive testimony on the need to adopt attorney contingency fee limits similar to those enacted in California. The AMC/NOMA provided expert testimony and data to the State of Ohio House and Senate during testimony on SB 281 that clearly showed that a cap on attorney contingency fees results in an increase in patient compensation. The recent Pinnacle/ODI study (as well as other studies) confirmed that a California-type contingency law would yield a 12 percent increase in damage awards retained by the plaintiff. The AMC/NOMA continues to strongly support a sliding scale for attorney contingency fees. We are also part of a statewide coalition working towards passage of SB 80 (a bill that includes a sliding scale for these fees) - 40 percent of the first $50,000 in damages, 33 percent of the next $50,000, 25 percent of the next $500,000 and 15 percent of any amount exceeding $600,000.
* Development of a Patient Compensation Fund (PCF) - The PCF is meant to enhance or increase market availability and affordability of professional liability coverage. The AMC/NOMA believes that the PCF concept may have merit. HB 238 (a bill in the Ohio legislature) establishes a PCF and includes an annual surcharge on all medical malpractice policies. The AMC/NOMA has sent written comments to the Ohio Department of Insurance relative to our opinion regarding establishing a PCF. We believe that in order to be successful a PCF should be established along with a hard cap on non-economic damages, a cap on attorney contingency fees as well as periodic payments. The AMC/NOMA will continue to follow how this legislation progresses through the legislature.
* Explore changing the statute of limitations including the 180-day notice provision - consider a statutory requirement that medical liability insurance companies would have to provide physicians with 60-days notice if their policy is being non-renewed, cancelled or they can expect a significant premium increase. Insurance companies would also be held accountable to the ODI if they plan to discontinue writing policies in Ohio.
* Special Certification of Attorneys - Ask that the Ohio Supreme Court consider special certification of attorneys that handle medical liability claims.
* Medical Courts - Consider establishment of special courts to handle medical liability cases. These special medical courts would be composed of judges trained in medical standards.
OTHER INITIATIVES OF IMPORTANCE
Common Good
A group of healthcare experts have come together under the leadership of Common Good - a coalition dedicated to restoring the ability to make common choices and promote legal reform. The group calls upon the United States Congress to immediately initiate hearings on the broad effects of litigation on healthcare (not just on the immediate litigation insurance crisis) and to consider recommendations on how to create new systems of medical justice that will promote better care.
A petition was prepared and signed by a large number of health care groups and medical schools (including the dean of Case Western Reserve University) and referred on to Congress. The AMC/NOMA has joined in supporting the petition on behalf of the physicians in Northeastern Ohio. To view the petition, go to the Common Good web site at www.cgood.org. AMC/NOMA continues to provide information to Common Good upon request.
Supreme Court Races Gearing Up for 2004
The Ohio Republican Party has endorsed the slate of Thomas Moyer for Chief Justice and Judith Lanzinger, Terrence O'Donnell and Paul Pfeifer for Associate Justices. Moyer and Pfeiffer are seeking re-election. Terrence O'Donnell was appointed to complete the term of former Justice Deborah Cook and Judith Lanzinger is the newcomer of the four, who will run in the open seat. The open seat resulted from Justice Francis Sweeney being constitutionally barred from running for re-election due to his age.
The AMC/NOMA's Political Action Committee (NOMPAC) will be very active in this campaign. Once again, we face the challenge to ensure that the justices on our Supreme Court interpret the law and do not legislate from the bench. NOMPAC believes that in order to make certain that this occurs, we need to keep Chief Justice Thomas Moyer and Justice Terrence O'Donnell on the court and elect Appellate Court Judge Judith Ann Lanzinger. These individuals are dedicated to further establish and preserve the principles of judicial fairness.
Advocacy Actions/debate of the board: 2003-2004
Synopsis of some advocacy activities:
AMC/NOMA board of directors set policy on boutique medicine, charging administrative fees, exclusive credentialing,
* Disseminated a model arbitration agreement for physicians
* Set physician administrative fee policy
* Worked with GE Med Pro on medical student oversight issue
* Developed a brochure on medical malpractice alternatives
* Disseminated information to physician members for their offices regarding the Medicare payment issue
* Wrote to the Office of the Inspector General in response to their request for examples of exclusive credentialing
* Testified and wrote to the Ohio State Medical Board regarding in-office surgery rules and anesthesiologist assistants
* Filed an amicus brief along with Case and UHHS in support of anesthesiologist assistants. On July 26, 2004, the Ohio Court of Common Pleas invalidated a regulation prohibiting anesthesiologist assistants ("AAs") from performing epidural and spinal anesthetic procedures and implementing medically accepted monitoring techniques.
* Wrote to Congress about impact of Medicare pay cuts
* Regular meetings with legislators and the Director of ODI and the OSMB.
* Reviewed an issue that is impacting physicians in Northeastern Ohio - namely their ability to engage in medically related activities following retirement. The key issue under review by the board relates to the eligibility of a physician for free "tail" coverage upon retirement. The AMC/NOMA has written a detailed letter to ODI and met with them regarding this issue as well as provided testimony on the free tail coverage to the Ohio Med Mal Commission
* AMC/NOMA leadership appeared on numerous television and radio programs in addition to providing physician speakers at Rotary Clubs, colleges and other venues regarding the medical liability issue.
* Presented an extremely successful program entitled "Saving Northern Ohio Medicine and Protecting Patients" in March 2004. Federal and state legislators presented at the event along with nationally known speakers on the topics of patient safety, insurance issues, medical liability, and government regulations. Another seminar is being planned for March 2005.
There is more work to be done. Your leadership will continue to go to the legislature with issues and we will continue to monitor matters of importance to physicians in this region - not only related to legislation, but community issues as well. This is not the time for complacency. The medical profession in the Northeastern Ohio region must stay mobilized and focused.
The medical profession and medical practice continues to be maligned by the media, certain attorneys, government officials and others. Society has to be reminded that corporations, insurance companies and medical malpractice attorneys do not provide health care - only physicians provide health care. There is only one organization in the community that speaks for the broad constituency of physicians, AMC/NOMA. The AMC/NOMA is truly the physician advocacy organization in Northeastern Ohio. We work everyday utilizing our resources and staff on behalf of the physicians in Northern Ohio.
The effectiveness of the AMC/NOMA, like that of any professional society, is directly related to the number of members who actively participate in its programs and activities. The success of the AMC/NOMA efforts and activities is entirely dependent upon strong commitment and involvement in organized medicine. This year we are continuing our campaign to assist physicians with the medical liability crisis by providing tangible and verifiable survey information on the medical liability crisis legislators and the media. We are continuing to keep the public informed of the crisis through the media, our website, physician office brochures and meetings with both federal and state legislators. Our seminar "Saving Northern Ohio Medicine and Protecting Patients" in March 2004 was one such initiative. Another seminar is being planned for the spring of 2005.
AMC/NOMA - THE PHYSICIANS' ADVOCATE FOR 180 YEARS
AMC/NOMA knows that there has never been a more difficult time to be a physician. The judicial system, insurance companies and even some patients treat doctors as enemies, instead of caregivers and guardians of society's well being.
How AMC/NOMA Assists Physicians
* Advocacy - AMC/NOMA represents physicians before the Ohio General Assembly, State Medical Board and other state and federal regulatory boards. We formulate legislative strategies and provide testimony before the legislature. AMC/NOMA's Physician Advocacy Committee (consisting of our members) addresses issues related to the media, hospital credentials, medical liability and other matters of critical importance.
* Media Relations - AMC/NOMA acts as the spokesperson for physicians and organized medicine in Northeast Ohio. We develop aggressive media campaigns to keep the issues that matter most to our members top-of-mind with the public.
* Counsel - Rules change. AMC/NOMA provides resources regarding legal counsel, contract and practice review, insurance services, computer billing programs, practice promotional tools and investment options.
* Communications - AMC/NOMA keeps members informed of changes and developments in the medical community through our magazine, The Cleveland Physician, our website (www.amcnoma.org) and regular mailings, faxes and emails.
* Community Service - AMC/NOMA offers physician referrals, pollen line and the Tel-Med library.
* Access - Through the AMC/NOMA website, members have access to legislators and the public has access to our members.
ABOUT THE AMC/NOMA
The AMC/NOMA is Northeastern Ohio's professional medical association. We are a non-profit, 501(c) 6 professional trade organization, and we represent the Northern Ohio medical community. The professional organization was originally formed as the Nineteenth District of Ohio in 1824, becoming known as the Academy of Medicine in 1902. In 1999, the society added the Northern Ohio Medical Association name and became the AMC/NOMA changing our focus to an independent regional organization. The mission of the AMC/NOMA is to support physicians in being strong advocates for all patients while promoting the highest quality of medicine. Our dues were reduced in 1999 when we became independent and have remained constant, while other associations have raised their dues by more than 20 percent over the past few years.
The Academy of Medicine of Cleveland/Northern Ohio Medical Association (AMC/NOMA) has seen over a significant increase in our membership totals for 2004. In recent months, over 1,100 new members have joined and many of our past members have indicated an interest in returning to the AMC/NOMA as a result of our visible activities bringing recognition to the medical liability crisis. Through the efforts of the AMC/NOMA Membership Committee and the AMC/NOMA officers over 1,300 physicians have recently joined.
We need all physicians in the community to work through the AMC/NOMA and support our efforts. The AMC/NOMA has supported physicians' causes for over 180 years - a record equaled by none. Trial lawyers continue to speak out against Ohio tort reform legislation. They speak with one voice, not through myriad different organizations. With efforts to change the makeup of the Ohio Supreme Court, 2004 is a critical year. If this is achieved, the trial lawyers will almost certainly test the constitutionality of the cap on non-economic damages.
WE NEED YOUR SUPPORT AND YOUR INVOLVEMENT IN THE AMC/NOMA
The Academy of Medicine of Cleveland/Northern Ohio Medical Association
(AMC/NOMA)
6000 Rockside Woods Blvd. Ste. 150
Independence, Ohio 44131
216-520-1000