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CHICAGO -- At the American Medical Association's House of Delegates meeting Sunday, leadership urged members to adopt a new protocol for responding to and preventing harassment at AMA meetings and other gatherings.
Delegates also spoke about how the protocol would be implemented and debated whether the AMA is ready to consider partnering with the movement.
"As the voice of organized medicine, it's incumbent on us to set an example by adopting best practices for identifying and eliminating harassment wherever it exists," said AMA Board Chair Jack Resneck Jr., MD, introducing a report listing expert recommendations and a "flexible" play-by-play manual for addressing harassment within the AMA.
"The board therefore strongly supports implementing these recommendations to raise the AMA's code of conduct, including our anti-harassment enforcement procedures to the highest standards, putting the AMA in a leadership role in this space," Resneck said.
The report covers harassment in general, beyond that related to sex and gender. It also offers simpler reporting mechanisms, more timely and independent investigation processes, and clearer enforcement procedures.
Potential consequences for an individual who violates the AMA's policy include:
- Removal from an AMA event "without warning or refund"
- Ban from attending future events
- Removal from leadership roles at the AMA
- Ban on a future AMA leadership role
- Ejection from the AMA (following a review overseen by the Council on Judicial and Ethical Affairs)
- Informing a violator's employer of the AMA's actions
- Notifying law enforcement
The proposal stemmed from a call to action by delegates at the AMA's interim meeting last November. There, delegates passed an emergency resolution urging an outside review of the association's response to harassment complaints, and calling for new processes if recommended by the review.
On Sunday, in keeping with the emergency resolution, AMA president Barbara McAneny, MD, said the AMA had engaged two independent consultants to evaluate the group's policies and procedures.
outlined their findings and recommendations for bringing the AMA's procedures in line with the best practices.
Recommendations include designating a "conduct liaison" to whom participants at larger meetings can report violations of AMA's harassment policies and who will be tasked with investigating them, and establishing a "Committee on Conduct at AMA Meetings and Events."
"I think that we are where we need to be as an organization," said Samantha Rosman, MD, an American Academy of Pediatrics delegate who co-authored the November resolution. "So that this does feel like a safer place to be, that people feel like they can address [harassment] when inevitably things happen ... I am proud that the board has come to this," she said.
Kavita Arora, MD, speaking for the Young Physicians Section, specifically thanked the board for heeding its request for transparency in its processes.
Concerning Due Process
Al Herzog, MD, a member of the Council on Long Range Planning & Development, speaking on his own behalf, said he had "no problem" with the policy, except that it lacked an appeals mechanism.
Resneck explained that the two-tiered process achieves the same end.
"The accused will be interviewed both by the conduct liaison on site and by the Committee on Conduct -- consisting of 5 to 7 members. We feel that is, in some ways, built-in," Resneck said.
Resneck also noted that the Office of the General Counsel would work with the Committee on Conduct to ensure that due process was followed "and that any recommended actions that are taking place are legally appropriate."
McKinley Glover, MD, a delegate of the Massachusetts Medical Society, speaking on his own behalf, pointed to another potential oversight in the report.
Both the person reporting the harassment and the alleged target (if these are different people) are allowed to invite witnesses to be interviewed, but "there's a clear lack of allowing the alleged violator the opportunity to provide witnesses if that could potentially exonerate the individual," said Glover.
He added that he did not want the report delayed and said, "but I think that is a gap that could potentially have consequences as it relates to due process."
Glover, who also conducts research, pointed out another enforcement action that the AMA could take: reporting a violator to the National Practitioner Data Bank.
David Rosman, MD, a delegate for the Massachusetts Medical Society (and Samantha Rosman's spouse), urged passage of the report.
"The people who are struggling here are not the violators," he said.
"We've been at this two years," he added. "We've gotten this right."
Rich Evans, MD, a delegate of the Maine Medical Association, speaking on his own behalf, said it would be a "grave mistake" not to pass the report.
"It has answered the questions that were raised within the last year to year and a half ... any concerns about due process [already occur in practice today] ... a practitioner could be summarily suspended for whatever reason in their own facility ... those things work themselves out. Go forward with what we have now and allow the board to come up with a satisfactory due process proposal if that is so needed," Evans added.
Following the discussion of the report, Sue Bailey, MD, Speaker of the House of Delegates (who was chosen, unopposed, on Saturday to serve as AMA president-elect), put forward a separate resolution requiring acknowledgement of the existing harassment policy. Bailey noted that this is often done by requiring a signature. She noted that work is already underway to ensure the process is as simple as possible, for example by allowing the requirement to be met online and not repeatedly required at each individual meeting.
"We are very open to suggestions to how to make this happen. But we felt it was important to have the House agree that this is their policy to sign acknowledgment of our code of conduct policy before participating in our meetings," she said.
Ready for #TIME'S UP?
Building on this momentum, Dionne Hart, MD of the Minority Affairs Section, put forward a third policy recommendation: to evaluate the idea of partnering with TIME'S UP Healthcare.
"We need to also publicly state to not only physician members of the AMA, but all [physicians] and leaders that the AMA is actively seeking to make healthcare settings safer for everyone," Hart said.
She explained that TIME'S UP Healthcare's mission "is consistent with our values and is timely."
David Fleeger, MD, a delegate of the Texas Medical Association, said he supported the intent of Hart's resolution, but hesitated to relinquish control of messaging to an outside group.
Fleeger, who requested referral to the board, said he would trust the board "to make sure that AMA's reputation and intent are guarded [and] ... that this relationship, if we go ahead with this, is in AMA's best interest."
Rosman disagreed, she noted that the AMA has finally developed "good internal harassment policy."
"This is saying we now need to deal with the external harassment that our trainees and our physicians are dealing with on a daily basis in the workplace." The resolution does not give "a blind sign-off that we forever support" anything that TIME'S UP Healthcare says, she argued.
A handful of other delegates, mostly but not all male, suggested referral in order to integrate the Board's current efforts and any potential collaboration as well as to consider other partnerships since TIME'S UP Healthcare is not the only organization doing this type of work.
Hart clarified that the resolution calls for the AMA to "evaluate and consider" participation in the movement and not immediately join the movement. Making the same point, Joseph Heyman, MD, a delegate for the American College of Obstetricians and Gynecologists, noted that passing the resolution amounts to referral to the board.
"Whatever leads to the outcome that we're looking for in support of the resolution would please ACOG," he said.
Voting on these and other resolutions begins in the House of Delegates Monday afternoon.
(See 鶹ý's special report on sexual harassment in medicine and a summary of the #MedPageLive #MeToo Twitter chat)