The latest issues facing the ASA

  • Hertzberg, Linda, MD, FASA
| Sep 11, 2017

Linda_HertzbergThe August meeting of the ASA Board of Directors (BOD) offers a preview of issues that will be subject to discussion, and potentially controversial, at the ASA House of Delegates (HOD). The ASA Board meeting held on August 19-20 in Chicago proved no different. The California delegation will determine its position on several issues of interest during our upcoming CSA BOD meeting and the caucus meetings at the ASA.

Administrative Affairs

A recommendation was put forward to raise resident and fellow dues from $25 to $50 effective 2019.  This was opposed by the resident section and several BOD members. A few directors (including me) voted against the proposal, in consideration of the impact it could have on recruiting our next generation of members. However, the recommendation did pass and will go to the HOD for final disposition. I suspect that there will be greater opposition at the HOD.

Funding for the ASA delegation to the AMA was another source of controversy, as this has been a large expense item in the past and the expense compensation for these meetings has not conformed to the usual ASA standard. Ultimately a compromise was reached, and the matter will be referred to a committee of the President’s choice for further deliberation.

A sunset of the Committee on Future Models of Anesthesia Practice after October 2017 was recommended; this was referred to the Committee on Governance Effectiveness and Efficiencies (CGEE) for consideration of the committee’s future function within the ASA.

The Ad-hoc Committee on Women in Anesthesia (AHCWIA), in conjunction with the Committee on Professional Diversity and several members of the ASA BOD, crafted a memo proposing changes to the appointment process for committees within the ASA BOD. According to the Administrative Procedures (APs), board members traditionally have been appointed to board committees based on seniority. Consequently, there has been little to no opportunity for directors to participate in the board committee process until they have served for many years. This created a system with minimal turnover, and many talented, interested. and able members of the BOD were kept from participating.

The memo stated, “This situation could be improved through intentional consideration of other attributes including experience, interest, and diversity.” Modifications to the APs were proposed for the composition of the review committees of the BOD that would mirror how the reference committees of the HOD are constituted: “The composition of each Reference Committee should reflect the diversity of the membership in terms of gender, age, practice and geographical location.” Clearly, California and other states that encourage term limits in the director position are currently at a disadvantage in the board committee appointment process, as our directors never attain a high level of seniority.

The memo was considered by CGEE, which made a series of recommendations for change to the BOD committee appointment process, including making committee positions open to alternate directors. These changes would open the appointment process to a greater diversity of membership. Members of the AHCWIA and others present at the August BOD meeting spoke in support of the CGEE recommendations, and they were subsequently approved by the BOD.

Professional Affairs

A long-anticipated update to the Practice Guidelines for Moderate Procedural Sedation and Analgesia was considered and approved by the BOD.  The prior version of this document is one of the most frequently viewed and downloaded on the ASA website. It was produced by the ASA Committee on Standards and Practice Parameters, working in collaboration with the American Association of Oral and Maxillofacial Surgeons, American College of Cardiology, American College of Emergency Physicians, American College of Radiology, American Dental Association, American Society for Gastrointestinal Endoscopy and American Society of Dentist Anesthesiologists, and is subject to approval by these organizations as well. This document may not be amended on the floor of the HOD; it will require an up or down vote as written. I recommend that California support these updated Practice Guidelines.

The ASA Statement on Sedation & Anesthesia in Dental Office-Based Settings was developed by a subcommittee of the Committee on Quality Management and Departmental Administration (QMDA), co-chaired by Scott Kercheville, MD, Director from Texas, and myself. The request to create this statement was the result of increased public awareness of adverse outcomes in dental offices, and the risks associated with dental sedation and anesthesia. Several states in addition to California have confronted this issue on a regulatory and/or legislative level. ASA leadership believed that a national position statement should be drafted.  We inserted language into the statement which reflected our position in California that children under the age of seven should have a dedicated qualified anesthesia provider for moderate or deep sedation, and for general anesthesia. Mark Singleton, MD, also served on the QMDA subcommittee which drafted the Statement.  The Statement passed the BOD and will go to the HOD for consideration.

An ASA Statement on Developing Policy for Infection Prevention and Surgical Attire generated vigorous debate in both the Western Caucus and the Review Committee. Debate reflected the opinion that the statement as written was too generic. Revisions were drafted to the Statement and approved by the BOD. This too will go to the HOD for consideration.

Financial Affairs

A recommendation that the Certificate in Business Administration (CBA) program take a hiatus for reevaluation and comparison to other options in the market was changed to a recommendation that the program’s content and format be evaluated and modified as appropriate.

Of note, the 2018 operating budget contains a large line item of $249,000 to initiate redesign and realignment of the ASA’s Finance Department. In addition, the budget contains funds for the Strategic Dialogue Summit (discussed below) scheduled for January 2018.

Educational Session

The afternoon educational session included an interactive discussion of the proposal for a Strategic Dialogue Summit in January, put forward by ASA President Jeff Plagenhoef, MD. As envisioned, this would involve experts and healthcare stakeholders both outside and inside the anesthesia community to share ideas about the current state and future of our specialty. BOD members were asked to consider who should be invited and what issues should be addressed at the summit. It remains to be seen how the summit will develop and what recommendations may emerge from it.

CSA members present included Karen Sibert, MD, FASA, Johnathan Pregler, MD, Samuel Wald, MD, MBA, Jeffrey Poage, MD, Christine Doyle, MD, James Moore, MD, Paul Yost, MD, and CSA Executive Director David Butler. I attended as Director and a voting member of the ASA BOD. Dr. Yost was invited to join the ASAPAC Board. Congratulations to Dr. Yost for all his hard work on behalf of California and the ASAPAC!

Other Californians in attendance in their roles as ASA officers included Michael Champeau, MD, FASA, Dan Cole, MD, FASA, Linda Mason, MD, FASA, and Stanley Stead, MD, MBA, FASA.









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