A “Dead” CSA President Reflects Upon Governance Within the American Society of Anesthesiologists

  • Pauker, Kenneth, MD
| Nov 04, 2013

Using metaphors that members of our House of Delegates (HOD) may appreciate, I have — after many years in the fray — “fallen off the end of the dais” and undergone metamorphosis into a “dead president.” Having been relegated to the role of Past-President (one of 62, 35 of whom are still living), my participation in day-to-day CSA governance activities is over. I cannot help but feel just a bit blue about it, as I go about recalibrating where my time and energy should be expended in the service of our profession. At times, I daydream about the odds of resurrection, perhaps in the ASA.

Many CSA past presidents have lamented the trajectory of this transition — how quickly you feel like you are losing your relevance to the society, how you become a “dead president.” During your term, you have developed important leadership skills, but now there seems to be no suitable place to deploy them. It’s not so much that folks are dismissive of your perspectives and opinions, but rather that the nature of the progression in leadership is for you to step back and encourage others to develop into the kind of leader that you once aspired to be.

Past presidents do continue to participate as members of various committees, but not as chair, and therefore have much less influence in setting and perhaps even driving the agenda. Still, it is reassuring to me, and I hope to you, that despite my internal struggle with finding my place in this afterlife, I continue to observe, to ruminate about, and sometimes even to tweak all of the usual suspects in all of the usual venues in all of the usual ways — within the CSA perhaps a bit less, but more so at the ASA.

And within the ASA, there are multiple opportunities to contribute to the life and future of our profession, including at the committee level and at the ASA HOD. At ASA’s recent Annual Meeting in San Francisco, there was spirited debate concerning the Governance of the ASA, and I was no wallflower in that venue.

For six or seven years, there has been an ongoing discussion in many committees and in the HOD about how authority and responsibility should be apportioned between the Executive Committee (President, Immediate Past-President, and President-Elect), the Administrative Council  (AC, the Officers), the Board of Directors (BOD), and the HOD. Authority for various kinds of decisions may not be explicitly stipulated; some authorities overlap; and responsibility sometimes is not concordant with authority. Having to go to the HOD for certain kinds of financial approvals impedes the dexterity of the ASA in entering into contracts, buying land, and other matters. Some members of the HOD believe that restraint and impeding momentum to get things done — especially financial actions — are good things, but principles of “good governance” promote a different view.

The optimal size of a governing body has been generally accepted by many governance experts to be much smaller than the 403 in the HOD — more like a body of 30 or less. Each level of governance naturally guards against relinquishing its authority to another. Dr. Linda Hertzberg has previously blogged about Governance at the ASA:

“Who and What do We Represent?”     August 27, 2012
“The More Things Change…”     August 19, 2013

ASA leaders at the highest level brought forward a concern that our Bylaws do not comport with how we operate, and consequently solicited a consultation with lawyers. For many decades, the HOD had been stipulated to be the governing body and final authority on all matters, even though it meets but once a year. A new Committee on Governance Effectiveness and Efficiencies (CGEE) proposed modifications to the ASA Bylaws, now revising the Bylaws to say that the HOD would function as the primary policy setting and legislative body of the ASA, but that the budget would be presented to HOD for information, realigning the authority to take action on financial matters to reside with the BOD. The only budgetary authority for the HOD would be to set the dues.

Many leaders, particularly members of the BOD, maintained that nothing about our process of governance would actually change with the revised Bylaws, except how we describe it, that all budgetary issues would still work their way through various ASA committees, and that the budget is rarely changed by the HOD. Other members of the HOD disagreed. They contended that having ultimately to present financial and other matters to the HOD for its approval tended to temper potential actions by the AC and BOD. Furthermore, they claimed that this fix was not urgent, despite a white paper by an attorney hired by the ASA, arguing that various attorneys may subscribe to different legal theories and thereby hold differing opinions. The CSA’s recent experience in the California courts teaches us that the Law is seldom absolute, but is often highly interpretable. Finally, some members of the HOD strongly believe that the Bylaws should stipulate that the HOD could direct the BOD in whatever way it felt necessary, and that the Bylaws should specify that financial affairs and the budget needed to pass through the HOD, not just for information, but for action before final authority could be exercised by the BOD.

At its August meeting, the BOD voted to accept the expert opinion of the consulting lawyer, who argued in a white paper why this had to be changed now. The HOD just last year had referred suggested bylaws changes on this issue back for revision. Our new CGEE carefully crafted changes and explanations, and its descriptions of the proposed processes were reassuring. However, changes from last year’s version were notably minimal.

There was vigorous debate in the Reference Committee of the HOD and then an unprecedented debate of more than 90 minutes on the floor of the House. Parliamentary procedures were followed in excruciating detail, and some novel maneuvers were attempted, albeit unsuccessfully. In the end, the revised Bylaws were approved in a very, very close vote.

Already, some delegates in the minority are discussing how to revisit the issue. Comments in the Reference Committee Report suggest that the CGEE continue to meet to address residual concerns. Perhaps some modifications will be considered at next year’s HOD. Such are the machinations at the HOD — many committed people trying to do what they individually feel is best for the ASA. This dead president could not help but participate in the dance.

And having danced, I do know this: we have a constant appetite for new leaders. If, as part of my own journey, I have been able to push, cajole, or even inspire just a few others, then my energies will have been multiplied many times over, and the odds for my resurrection would be enhanced considerably.

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