AMA Discusses Emergency Cardiac Care, Abortion as Delegates Wrap Up Interim Meeting

Emergency cardiac care (ECC), abortion, and treatment of transgender athletes were among the topics discussed as the American Medical Association (AMA) House of Delegates finished up its interim meeting on Tuesday.

Delegates passed a resolution from the Society for Cardiovascular Angiography & Interventions calling on the AMA to encourage states to standardize out-of-hospital cardiac care for patients presenting with ST elevation myocardial infarction or cardiac arrest, as some states have already done.

The resolution noted that such standardized systems “have produced significant improvements in survival for these catastrophic cardiovascular disorders.” For example, “survival for patients with OHCA [out-of-hospital cardiac arrest] and refractory ventricular fibrillation is markedly improved, from less than 10% to over 40%, when systems of ECC include uniquely applied invasive procedures like emergent Extracorporeal Membrane Oxygenation.”

“In Mississippi, we’ve had [such a] system of care since 2010,” said Clay Hays, MD, speaking on behalf of that state’s delegation. “It’s a wonderful system of care — so much so that we’re also doing it for trauma, stroke, and sepsis. The time to act is now.”

Hays was speaking in opposition to a recommendation from an AMA reference committee that the resolution be referred to the AMA Board of Trustees for a decision. In its written report, the committee said that while some of the testimony it heard at Sunday’s committee meeting was favorable to the idea, it also “heard concerns from multiple speakers that the proposed model may negatively impact emergency care in rural settings, given that funding and investment may be driven towards urban areas … As such, your Reference Committee recommends that this resolution be referred for decision to assess impact on rural settings.”

But several delegates representing rural states disagreed. “Such a network will help rural communities like we have in Oklahoma,” said Woody Jenkins, MD, speaking for the Oklahoma delegation. “I request you vote against referral for decision.”

Will Freeman, MD, speaking for the Louisiana delegation, expressed similar sentiments. “Even Louisiana can get this right,” he said, noting that his state ranks last in a lot of healthcare categories. “If we can do this, anybody can do this.”

Most delegates agreed, and the resolution passed without being referred to the board.

Delegates also reaffirmed association policy stating that abortion is a “human right” and that it “should be performed in conformance with standards of good medical practice.” Delegates also agreed with a reference committee suggestion that the AMA remove from existing policy a statement that the procedure should be performed “only by a duly licensed physician,” a decision that Maya Babu, MD, alternate delegate for the Congress of Neurological Surgeons, who spoke for the neurosurgery delegation, disagreed with.

“We are concerned that by removing language that specifies the leadership and involvement of the physician in providing medical care, we are placing patients at risk and taking a step backwards in terms of our scope-of-practice efforts,” she said. “This policy needs to be consistent with our other policies on scope of practice.”

The neurosurgery delegation tried unsuccessfully to have the language put back in, a move that Kavita Arora, MD, an alternate delegate for the American College of Obstetricians and Gynecologists, who spoke for the delegation, strongly objected to. “We already have comprehensive scope policy for the AMA that reinforces the importance of the physician-led team,” she said. “Including that language specifically in this policy is redundant and harmful. It continues to exceptionalize and stigmatize abortion.”

Furthermore, Arora added, “Abortion covers a gamut of medical practice, including spontaneous loss, medication treatment, or surgical treatment. Supervised APPs [advanced practice providers] can safely practice in this area.”

The delegates also approved a new AMA policy in opposition to having physicians “certify or confirm” an athlete’s gender in order to satisfy requirements from a third party. “We don’t need any more research; we have plenty of evidence,” said Sophia Yang, MD, who spoke on behalf of the American Association of Public Health Physicians. “Penalizing and policing transgender and intersex athletes for their gender identity is transphobic, sexist, and discriminatory.”

“If we’re going to equate testosterone levels with athletic ability, should we be testing all cisgender males for their testosterone levels, to make sure no one has too much testosterone?” she added. “Arguments like this would penalize cisgender female athletes and are also missing the point,” because everyone has natural variation in their athletic abilities, Yang said. “In every measurable way, transgender and intersex athletes face discrimination that cisgender athletes do not. We need to protect and support them.”

On a related note, the delegates approved a resolution from the Washington state delegation to collaborate with the CDC to urge the World Health Organization to adopt destigmatizing terminology in ICD-10 and future ICD codes. “Requiring a diagnosis with stigmatizing language may further restrict and harm LGBTQI+ patients attempting to access inclusive healthcare, such as gender-affirming hormonal therapy and preexposure prophylaxis, to lower the risk of acquiring HIV, and there are few if any diagnosis codes without stigmatizing language in ICD-10,” the resolution noted.

In addition, delegates approved an amendment to that resolution, offered by the Psychiatry Section Council, that would also “eliminate existing stigmatizing diagnostic synonyms” from ICD-10. “The diagnostic synonyms are a significant problem as well and must be eliminated,” said Alena Balasanova, MD, speaking for the council. “For example, when you enter the ICD code F70, which is intellectual developmental disorder, the diagnostic synonyms that come up are ‘feeblemindedness,’ ‘mental subnormality,’ ‘mental retardation,’ and ‘moron.’ These synonyms are pejorative, not clinically accurate, and clearly detrimental to our patients.”