2. Minutes:

The Minutes of the 5. December, 2001 meeting were reviewed. It was moved and seconded that these minutes be approved. This motion received unanimous approval.

3. Correspondence:

Doctor Scholten called attention to the 6. March, 2002 letter from Tom M. George, MD, 61 District Representative, Michigan House of Representatives pertaining to clarification of House Bill 4591. This bill proposes the requirement of supervision by either a surgeon or a physician with anesthesia privileges at the facility. Further, the bill as proposed , would require the supervising physician to be physically available during the provision of general anesthesia or surgical anesthesia. The bill is intended to insure the safety of surgical patients and codify what should already be the current standard of practice.

Discussion ensued regarding this bill. It was noted that 18 — 20 states do not require physician supervision for CRNAs. Several scenarios of supervision or absence of supervision were discussed as well as the concurrent exposure to malpractice Liability. There was also discussion pertaining to the Michigan geographical /professional provision of anesthesia and the wide dimension of "scope of practice" pertaining to this issue. The vicarious liability in the absence of an anesthesiologist, may revert to the surgeon…It was pointed out that the term supervision is defined or determined by the employer of CRNAs, this being the local hospital in most situations. The "rules of performance" then are determined with the safety for the patient in mind, however, as was noted, there are no "guidelines by law".

In a postscript to his letter, Representative George noted, " I am aware of cases where podiatrists are performing surgery using general anesthesia administered by nurse anesthetists. In these instances, the nurses claim the "supervising " physician is a family physician across town in their office. In other words,: surgery is proceeding under general anesthesia with no physician physically present! This bill would prohibit this practice and is therefore opposed by the nurse anesthetists and the podiatrists" T.G.

It was determined that the Committee include this topic on the Agenda for the 10. May, 2002 New Fellows and Young Surgeons Issues Forum during the MCACS Annual Meeting. It was also determined that the Committee continue to follow this issue and especially this House Bill.

4. Discussion: Draft Survey to New Fellows and Young Surgeons:

Doctor Scholten initiated discussion pertaining to the draft survey document included in the meeting packet. There was comment that the survey could enable the Committee to learn the Young Surgeons’ and New Fellows’ issues, interests and acknowledge these as part of the Forum agenda. Discussion ensued pertaining to the opportunity for the Committee to learn what it is the Young surgeon wants to address and what issues and activities the young surgeon wants the Chapter to implement It was determined that each member of the Committee review and edit the draft survey and return it on or before 27. March, 2002 to "Tom" Plasman for final preparation and mailing. A listing of the young surgeons 45 years old and younger will be obtained to whom surveys will be mailed.

There was then discussion regarding arrangement for the Forum. It was determined that the starting time would be immediately following the adjournment of the Chapter Annual Business Meeting and schedule adjournment to occur in time for the Friday, 10. May, 2002 Chapter Vintner Tour.

The Forum Program was next discussed. The initial program was determined to be as follows:

Intrduction/Welcome: Overview of the Chapter and its Activities
Presenters: Verne L. Hoshal, Jr, MD, FACS, President
Donald J. Scholten, MD, FACS, Chair, YSI

Young Surgeons Issues Committee 2002 Summary;
Moderator: James E. Reif, MD, FACS

Title: Immunity from Liability for Uncompensated Care
Presenters: Donn Schroder, MD, FACS
Christopher P. Steffes, MD, FACS

Title: CRNA Issue
Presenters: Hugh J. Lindsey, MD, FACS
Brian L. Piazza, MD, FACS

Title: State Trauma System: Michigan Trauma Care Comm.
Presenters: Donald J. Scholten, MD, FACS
Farouck N. Obeid, MD FACS
Jon C. Walsh, MD, MPH. FACS

Title: "Adopt a Hospital": ACS Hospital Trauma
Verification Program
Presenters: Jon C Walsh, MD, FACS

New Fellows & Young Surgeons Survey Results
Presenters: Donald J. Scholten, MD, FACS,
James E. Reif, MD, FACS

Discussion / Questions

• 2002-2003 / Calendar of Meetings and Events
  
• Web Site Address and Services
  John C. Eggenberger, MD, FACS,
  Chapter Web Master
  

There was then discussion pertaining to the State Trauma System. The next meeting of the Michigan Trauma Care Commission is to be 8. March, 2002. A spring and early summer of state-wide meetings are scheduled whereby testimony will be gathered to advise the State Commission. It is anticipated that legislative action could begin as early as July, 2002, however with the impact of a major number of legislative House and Senate seats changing and the election of a new Governor, there may be a delay in activity on the Commissions report. Discussion ensued pertaining to the levels of care, transfer agreements obvious Michigan difference in that the water boundaries produce an apathy toward the development of a trauma care system.

It was determined that the reports of the Michigan Trauma Care Commission be obtained for distribution during the Forum. Mr. Plasman was requested to make the necessary arrangements to secure these reports.

5. Discussion (continued from 17. Oct. 2001 Meeting)

There was discussion regarding the "Adopt a Hospital" program that has been developed with the American College of Surgeons Hospital Trauma Verification Program. Doctor Walsh stated he would obtain the necessary information is sufficient quantity for distribution during the Forum. Discussion ensued pertaining to the procedure for organizing and implementing the program.

6. Discussion: Legislation Action Committee

Doctor Scholten referred to the "Legislative Briefing" prepared for the MCACS YSIC by the MSMS Department of Government Relations. The Briefing presented information regarding Senate Bills 451-452: Timely Payment; Senate Bill 517: Physician Self-Referral; Discussion pertaining to Scope of Practice and the Medicaid $1 billion shortfall in the fiscalyear 2003 budget. Discussion ensued. It was determined to pass this information on to The Council and to request Legislative Briefing reports be presented during future meetings of the YSIC.

The 2002 Capitol Check-Up, to be Thursday, May 23, 2002 from 11:00 AM to 4:00 PM, will be sponsored by the Michigan State Medical Society, the MSMS Alliance, The Michigan Medical Group Management Association and the Michigan Doctors’ Political Action Committee. Appointment reservations will be scheduled with various legislators with whom doctors will meet to present a variety of issues of importance to doctors and their patients.

7. Day In Surgery Program:

Discussion and planning for this program were delayed because of the absence of Doctor Holden. It was recommended that a program of this nature would be most successful in conducted during the Fall 2002 Michigan House of Representatives and Senate Elections. It was also recommended that this be an ancillary topic for discussion during the Forum.